Citation Nr: 1320298 Decision Date: 06/24/13 Archive Date: 07/02/13 DOCKET NO. 05-38 370 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Atlanta, Georgia THE ISSUES 1. Whether new and material evidence has been submitted to reopen a claim of entitlement to service connection for a bilateral arm disability. 2. Whether new and material evidence has been submitted to reopen a claim of entitlement to service connection for a bilateral wrist disability. 3. Entitlement to service connection for a low back disability. 4. Entitlement to service connection for a bilateral shoulder disability. 5. Entitlement to service connection for a bilateral knee disability. 6. Entitlement to service connection for a bilateral leg disability. 7. Entitlement to service connection for a headache disability. 8. Entitlement to service connection for a psychiatric disability, to include posttraumatic stress disorder (PTSD). 9. Entitlement to a rating in excess of 30 percent for a bilateral foot disability. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Veteran ATTORNEY FOR THE BOARD David S. Ames, Counsel INTRODUCTION The Veteran served on active duty from July 1973 to July 1976, with subsequent service in the United States Army Reserve from July 1976 to July 1996. This matter comes properly before the Board of Veterans' Appeals (Board) on appeal from a rating decision by the Department of Veterans Affairs (VA) Regional Office in Atlanta, Georgia (RO). This case was remanded by the Board in July 2007 and January 2010 for additional development. The issues of entitlement to service connection for a psychiatric disability and a bilateral arm disability are remanded to the RO via the Appeals Management Center, in Washington, D.C. FINDINGS OF FACT 1. A March 1999 rating decision denied service connection for a bilateral wrist disability. 2. Evidence associated with the claims file since the March 1999 rating decision is not so significant that it must be considered in order to fairly decide the merits of the Veteran's claim of entitlement to service connection for a bilateral wrist disability. 3. A March 1999 rating decision denied a claim to reopen the previous denied issue of entitlement to service connection for a bilateral arm disability. 4. Evidence associated with the claims file since the March 1999 rating decision was not of record at the time of the March 1999 rating decision and is so significant that it must be considered in order to fairly decide the merits of the Veteran's claim of entitlement to service connection for a bilateral arm disability. 5. The preponderance of the evidence of record demonstrates that the Veteran was employed as a civilian at the time of the August 8, 1986, motor vehicle accident, and the accident was incurred while engaged in civilian duties, not in service. 6. The Veteran had a low back disability which preexisted all of his periods of active duty for training (ACDUTRA) and inactive duty for training (INACDUTRA) from August 9, 1986, and after. 7. The preponderance of the competent evidence of record is against a finding that the Veteran's currently diagnosed low back disability was incurred in or aggravated by service. 8. The preponderance of the competent evidence of record shows that the Veteran's currently diagnosed bilateral shoulder disorder was not incurred in or aggravated by service. 9. The preponderance of the competent evidence of record shows that the Veteran's currently diagnosed bilateral knee disorder was not incurred in or aggravated by service. 10. The competent evidence of record shows that the Veteran has not had a diagnosis of a leg disorder, other than a knee or foot disorder, at any point during the period relevant to this claim. 11. The medical evidence of record is consistent with a finding that the Veteran experienced moderately severe impairment of both feet secondary to pain and functional impairment throughout the entire period on appeal. CONCLUSIONS OF LAW 1. Evidence submitted to reopen the claim of entitlement to service connection for a bilateral wrist disability since the March 1999 final denial is not new and material, and therefore, the claim is not reopened. 38 U.S.C.A. §§ 5103A, 5107, 5108, 7105 (West 2002 & Supp. 2012); 38 C.F.R. § 3.156 (2001). 2. Evidence submitted to reopen the claim of entitlement to service connection for a bilateral arm disability since the March 1999 final denial is new and material, and therefore, the claim is reopened. 38 U.S.C.A. §§ 5103A, 5107, 5108, 7105 (West 2002 & Supp. 2012); 38 C.F.R. § 3.156 (2001). 3. A low back disability was not incurred in or aggravated by active service, and may not be presumed to have been so incurred. 38 U.S.C.A. §§ 1110, 1131, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2012). 4. A bilateral shoulder disability was not incurred in or aggravated by active service, and may not be presumed to have been so incurred. 38 U.S.C.A. §§ 1110, 1131, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2012). 5. A bilateral knee disability was not incurred in or aggravated by active service, and may not be presumed to have been so incurred. 38 U.S.C.A. §§ 1110, 1131, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2012). 6. A bilateral leg disability was not incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1131, 5103A, 5107 (West 2002); 38 C.F.R. § 3.303 (2012). 7. The criteria for a 20 percent rating, but not higher, for a right foot disability have been met. 38 U.S.C.A. § 1155, 5103A, 5107 (West 2002); 38 C.F.R. § 4.71a, Diagnostic Code 5284 (2012). 8. The criteria for a 20 percent rating, but not higher, for a left foot disability have been met. 38 U.S.C.A. § 1155, 5103A, 5107 (West 2002); 38 C.F.R. § 4.71a, Diagnostic Code 5284 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Upon receipt of a substantially complete application, VA must notify the claimant and any representative of any information, medical evidence, or lay evidence not previously provided to VA that is necessary to substantiate the claim. The notice must: (1) inform the claimant about the information and evidence not of record that is necessary to substantiate the claim; (2) inform the claimant about the information and evidence that VA will seek to provide; and (3) inform the claimant about the information and evidence the claimant is expected to provide. 38 U.S.C.A. §§ 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. § 3.159 (2012); Pelegrini v. Principi, 18 Vet. App. 112 (2004). If VA does not provide adequate notice of any element necessary to substantiate the claim, or there is any deficiency in the timing of the notice, the burden is on the claimant to show that prejudice resulted from a notice error, rather than on VA to rebut presumed prejudice. Shinseki v. Sanders, 129 S. Ct. 1696 (2009). The Board finds that any defect with regard to the timing or content of the notice to the Veteran is harmless because of the thorough and informative notices provided throughout the adjudication and because the Veteran had a meaningful opportunity to participate effectively in the processing of the claims with an adjudication of the claims by the RO subsequent to receipt of the required notice. The record does not show prejudice to the Veteran, and the Board finds that any defect in the timing or content of the notices has not affected the fairness of the adjudication. Mayfield v. Nicholson, 19 Vet. App. 103 (2005); Dingess v. Nicholson, 19 Vet. App. 473 (2006); Kent v. Nicholson, 20 Vet. App. 1 (2006). Specifically, the Veteran was notified in letters dated in June 2002, October 2004, July 2005, August 2007, October 2007, and May 2009. The Veteran has neither alleged nor demonstrated any prejudice with regard to the content or timing of the notice provided. Shinseki v. Sanders, 129 S. Ct. 1696 (2009) (burden of showing that an error is harmful or prejudicial falls on party attacking agency determination); Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006). The Board considers it significant that the subsequent statements made by the Veteran and his representative suggest actual knowledge of the elements necessary to substantiate the claims. Dalton v. Nicholson, 21 Vet. App. 23 (2007) (actual knowledge is established by statements or actions by the claimant or the claimant's representative that demonstrate an awareness of what is necessary to substantiate a claim). Thus, VA has satisfied its duty to notify the Veteran and had satisfied that duty prior to the adjudication in the supplemental statements of the case. Overton v. Nicholson, 20 Vet. App. 427 (2006) (Veteran afforded a meaningful opportunity to participate effectively in adjudication of claim, and therefore notice error was harmless). The Board also finds that the duty to assist requirements have been fulfilled. All relevant, identified, and available evidence has been obtained, and VA has notified the Veteran of any evidence that could not be obtained. The Veteran has not referred to any additional, unobtained, relevant, available evidence. VA has obtained examinations with respect to the service connection and increased rating claims. While an examination was not provided with respect to the bilateral wrist claims, an examination is not required as the Veteran has not submitted new and material evidence related to wrist disabilities and there is no competent evidence that the Veteran's wrist disabilities were incurred in, or are otherwise related to, service. 38 C.F.R. § 3.159(c) (2012). Thus, the Board finds that VA has satisfied the duty to assist provisions of law. No further notice or assistance to the Veteran is required to fulfill VA's duty to assist him in development. Smith v. Gober, 14 Vet. App. 227 (2000); Dela Cruz v. Principi, 15 Vet. App. 143 (2001); Quartuccio v. Principi, 16 Vet. App. 183 (2002). The Board has thoroughly reviewed all the evidence in the Veteran's claims file. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, all of the evidence submitted by the Veteran or on his behalf. Gonzales v. West, 218 F.3d 1378 (Fed. Cir. 2000). The Veteran's claims file is voluminous and a discussion of each piece of relevant evidence would be impractical. The analysis below focuses on the most salient and relevant evidence and on what the evidence shows, or fails to show. The Veteran should not assume that the Board has overlooked any evidence that is not explicitly discussed. Timberlake v. Gober, 14 Vet. App. 122 (2000). The Board is aware that it cannot reject evidence favorable to the Veteran without discussing the evidence. Daves v. Nicholson, 21 Vet. App. 46 (2007). The Board will discuss favorable evidence individually when a discussion is required to properly weigh that evidence. However, to the extent that the multiple pieces of evidence address the same argument or advance the same evidentiary point, the Board will discuss that argument or the evidentiary point itself rather than the specific documents which advance them. New and Material Evidence A rating decision in April 1994 denied the Veteran's claim of entitlement to service connection for a bilateral arm disorder on the basis that the Veteran's service medical records were negative for complaints or treatment for a bilateral arm condition. The Veteran filed a timely notice of disagreement with the April 1994 RO decision and his arms claim was again denied in a March 1995 rating decision, However, the Veteran did not perfect an appeal as to that claim. In a March 1999 rating decision, the RO declined to reopen the previously denied bilateral arm claim and also denied service connection for a bilateral wrist disability on the basis that there was no evidence that the Veteran had been treated in service for a bilateral wrist condition. The relevant evidence of record at the time of the March 1999 rating decision consisted of the Veteran's service medical records; service personnel records; lay statements from the Veteran and others; Social Security Administration (SSA) records; and VA, private, and military medical records dated from to July 1979 to July 1998. The Veteran did not file a notice of disagreement after the March 1999 rating decision. Therefore, the March 1999 rating decision is final based on the evidence then of record. 38 U.S.C.A. § 7105 (West 2002); 38 C.F.R. § 20.1103 (2012). A claimant may reopen a finally adjudicated claim by submitting new and material evidence. The regulatory changes of the new and material evidence requirement, found at 38 C.F.R. § 3.156(a), apply only to a claim to reopen a finally decided claim that was received on or after August 29, 2001. 38 C.F.R. § 3.159(c) (2012). The Veteran in this case filed his claim to reopen the issues of entitlement to service connection for bilateral arm and wrist disabilities in May 2001, before the effective date for regulatory change of the new and material evidence requirement. Therefore, the changes to the definition of new and material evidence will not be applied here. The definition of new and material evidence in effect prior to August 29, 2001 will be applied. Although the RO determined in April 2003 that new and material evidence was presented to reopen the claims of entitlement to service connection for bilateral arm and wrist disabilities, that decision is not binding on the Board. The Board must first decide whether evidence has been received that is both new and material to reopen the claim. Barnett v. Brown, 83 F.3d 1380 (Fed. Cir. 1996); McGinnis v. Brown, 4 Vet. App. 239 (1993). Consequently, the Board will adjudicate the question of whether new and material evidence has been received, furnishing a complete explanation as to its reasons and bases for such a decision. For claims to reopen filed prior to August 29, 2001, new and material evidence means evidence not previously submitted to agency decision makers which bears directly and substantially upon the specific matter under consideration, which is neither cumulative nor redundant, and which, by itself or in connection with evidence previously assembled, is so significant that it must be considered in order to fairly decide the merits of the claim. 38 C.F.R. § 3.156(a) (2001). In May 2001, a claim to reopen the issues of entitlement to service connection for bilateral arm and wrist disabilities was received. Evidence of record received since the March 1999 rating decision includes additional service personnel records; VA, private, and military medical records dated from the Veteran's separation from service to June 2011; Social Security Administration (SSA) records; lay statements from the Veteran and others; and a transcript of a June 2006 hearing before the Board. Much of the evidence received since the March 1999 rating decision is "new" in that it was not of record at the time of the March 1999 decision. With respect to the Veteran's bilateral wrist disorder claim, none of the new evidence includes competent evidence which relates any currently diagnosed wrist disability to service or to a service-connected disability. While the new evidence includes medical records which demonstrate ongoing treatment for wrist symptoms, earlier medical records showing treatment for the same problems and complaints were previously before the RO at the time of the March 1999 rating decision. Thus, the newly submitted medical records are cumulative of those considered at the time of the last final decision on these issues. In addition, none of the new evidence includes competent evidence which relates any currently diagnosed wrist disability to service or to a service-connected disability. There is no medical evidence which relates any currently diagnosed wrist disability to service or to a service-connected disability. To the extent that the Veteran himself has reported that he experienced wrist symptoms in service and continuously after separation from service, his statements are not competent to demonstrate continuity of symptomatology for that disability. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Nor are the Veteran's statements competent to demonstrate that any symptoms he experienced in service are related to any currently diagnosed wrist disability. Davidson v. Shinseki, 581 F.3d 1313 (2009); Barr v. Nicholson, 21 Vet. App. 303 (2007). Accordingly, the Board finds that the evidence received since the March 1999 rating decision is not material as it is not so significant that it must be considered in order to fairly decide the merits of the bilateral wrist claim. Since the additional evidence received since the March 1999 rating decision is not material, it does not constitute new and material evidence sufficient to reopen the Veteran's claim of entitlement to service connection for a bilateral wrist disability. As new and material evidence to reopen the finally disallowed claim has not been submitted, there is no reasonable doubt to be resolved in favor of the Veteran and the claim must remain denied. Annoni v. Brown, 5 Vet. App. 463 (1993). With respect to the Veteran's bilateral arm disorder claim, the evidence of record includes a March 2004 VA rheumatology report which stated that the Veteran had bilateral lateral epicondylitis, which was related to frequent use/movement required with a wheelchair. The Board notes that there are numerous medical reports of record which state that the Veteran uses a wheelchair, at least in part, due to his service-connected bilateral foot disability. The claim was previously denied, in part, because there was no medical evidence that the Veteran had a bilateral arm disability which was related to service. The March 2004 VA rheumatology report provides medical evidence of a possible relationship between a currently diagnosed bilateral elbow disability and the Veteran's service-connected bilateral foot disability. Therefore, the new evidence includes competent evidence which is so significant that it must be considered in order to fairly decide the merits of the claim. As the new evidence is also material, the claim for service connection for a bilateral arm disability must be reopened. Molloy v. Brown, 9 Vet. App. 513 (1996). To that extent only, the bilateral arm disability claim is allowed. Low Back Disability Generally, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R. § 3.303(a) (2012). In addition, service connection may be granted for any disease diagnosed after discharge, when all the evidence including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d) (2012). The determination as to whether these requirements are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. Baldwin v. West, 13 Vet. App. 1 (1999). Active military, naval, or air service includes: (1) active duty; (2) any period of ACDUTRA during which the individual concerned was disabled or died from a disease or injury incurred or aggravated in the line of duty; and (3) any period of INACDUTRA during which the individual concerned was disabled or died from an injury incurred or aggravated in the line of duty. 38 U.S.C.A. § 101(23), (24) (West 2002); 38 C.F.R. § 3.6(a) (2012). Presumptive periods do not apply to ACDUTRA or INACDUTRA. Biggins v. Derwinski, 1 Vet. App. 474 (1991). Therefore, consideration of 38 U.S.C.A. §§ 1111 and 1131 (presumption of soundness), 3.306 (presumption of aggravation of a chronic pre-existing disease), and 38 C.F.R. §§ 3.307 and 3.309 (presumption of service incurrence for certain disease) for the periods of ACDUTRA or INACDUTRA is not appropriate. In this case, the Veteran's service personnel records show that he had a period of active service from July 1973 to July 1976, with subsequent service in the Army Reserve from July 1976 to July 1996, during which time he had numerous periods of ACDUTRA and INACDUTRA. The Veteran claims that his low back disability was the result of an injury he sustained during service. The evidence of record includes numerous statements regarding the initial injury which started the Veteran's low back disability. While many of those statements are contradictory, the majority of the statements cite a motor vehicle accident which was alleged to have occurred in service in 1986. In August 2010, the Veteran was provided with a VA medical examination specifically to determine the etiology of his low back disability. After a review of the Veteran's claims file, a physical examination, and diagnostic testing, the examiner opined that it was at least as likely as not that the Veteran's low back disability was related to or caused by the accident that occurred in 1986. However, the examiner was unable to state whether the Veteran was on active duty, ACDUTRA, or INACDUTRA at that time. The Board finds that the August 2010 VA medical examination report is highly probative to the extent that it found that the Veteran's initial low back injury began following an August 8, 1986, motor vehicle accident. While other medical reports of record have provided different etiological statements regarding the Veteran's low back disability, none of those reports specifically attempted to pinpoint the incident which started the Veteran's low back disability following a complete review of the relevant evidence. In addition, the Board emphasizes that ascribing the Veteran's initial low back disability to the August 8, 1986, motor vehicle accident is consistent with the majority of the Veteran's own reports of his medical history. Therefore, the Board finds that the preponderance of the evidence of record demonstrates that the Veteran's low back disability began as a result of the August 8, 1986, motor vehicle accident. Having concluded that the Veteran's low back disability began as a result of the August 8, 1986 motor vehicle accident, the Board turns to the question of the nature of the Veteran's service on that date. The Veteran has repeatedly and consistently stated that he was on-duty at the time of the accident. There are multiple medical and personnel reports of record which document the circumstances surrounding that accident. Those records demonstrate that the accident occurred at approximately 12:00 p.m. on August 8, 1986. The Veteran's service personnel records state that, for the period from July 28, 1986, to July 27, 1987, the Veteran earned 47 inactive duty points, 1 extension course point, and 14 active duty points. There are no personnel records which state the precise dates during which the Veteran served on ACDUTRA or INACDUTRA during that period. However, a February 3, 1987, report stated that the Veteran had undergone a period of ACDUTRA from January 10, 1986, to January 30, 1986. That period of training was seven months prior to the Veteran's accident and the report was dated well into 1987 and did not mention any other period of ACDUTRA. There is no other evidence of record that the Veteran had a second period of ACDUTRA in 1986. Accordingly, the Board finds that the preponderance of the evidence of record demonstrates that the Veteran was not on ACDUTRA on August 8, 1986. However, there are no records associated with the Veteran's claims file which document the dates of his INACDUTRA service in 1986. The evidence of record demonstrates that the August 8, 1986, motor vehicle accident occurred on the grounds of Fort Benning, Georgia. An Official Superior's Report of Traumatic Injury stated that, at the time of the accident, the Veteran's regular work day began at 7:30 a.m. and ended at 4:30 p.m., and that he was paid for working on Monday, Tuesday, Wednesday, Thursday, and Friday. The Board takes judicial notice that August 8, 1986, was a Friday. Accordingly, the evidence of record demonstrates that the motor vehicle accident occurred during the Veteran's normal employment. The question then becomes establishing whether this normal employment qualified as active service for VA purposes. 38 U.S.C.A. § 101(23), (24) (West 2002); 38 C.F.R. § 3.6(a) (2012). The Veteran earned 47 inactive duty points from July 28, 1986, to July 27, 1987. The Board takes judicial notice that INACDUTRA points are awarded as 1 point for a four hour drill period with two drill periods per day, morning and afternoon drill. That equates to 2 points a day or 4 points for one weekend of INACDUTRA a month. Accordingly, had the Veteran's normal employment counted as INACDUTRA, he would have accumulated 10 points per week, and at least several hundred points in any one year period. The Veteran never accumulated more than 53 INACDUTRA points in any one year period during his entire period of reserve service. Instead, he consistently accumulated approximately 40 to 50 points per month, which is consistent with approximately 10 to 12 weekend drills per year. Accordingly, the Board finds that the preponderance of the evidence of record demonstrates that the Veteran's normal employment was not counted as INACDUTRA. A contemporaneous record stated that, at the time of the accident, the Veteran was employed by the Range Supervisory Branch, Range Division Department. A second record stated that the Veteran's occupation at the time of the accident was Range Assistant. Another record specifically stated that his employer was "Civil Service, Range Control Division." That constitutes evidence that the Veteran was working as a civilian at the time of the August 8, 1986, motor vehicle accident. Such a finding is also consistent with multiple Department of Labor records regarding a claim for Workers' Compensation for the motor vehicle accident. The Board finds that the filing of a Workers' Compensation claim with the Department of Labor is strong evidence that the Veteran himself believed that he was employed as a civilian at the time of the motor vehicle accident. The Board notes that an August 8, 1986 Individual Sick Slip stated that the incident occurred in the line of duty. However, this sick slip itself also stated that the Veteran's organization and station was Range Support Branch, Range Division. Therefore, the Individual Sick Slip confirms and corroborates a finding that the Veteran's injury was incurred while he was performing the duties of his civilian employment with Range Support Branch, not that the injury was incurred in active service for VA purposes. Accordingly, the Board finds that the preponderance of the evidence of record demonstrates that the Veteran was employed as a civilian at the time of the August 8, 1986, motor vehicle accident, and the accident was incurred while engaged in civilian duties. Therefore, all residuals of that accident were not incurred in service for VA purposes. 38 U.S.C.A. § 101(23), (24) (West 2002); 38 C.F.R. § 3.6(a) (2012). As a result of that finding, the Board finds that the Veteran had a low back disability which preexisted all of his periods of ACDUTRA and INACDUTRA from August 9, 1986, and after. The presumption of soundness and the presumption of aggravation of a chronic preexisting disease are not applicable to periods of ACDUTRA and INACDUTRA. Biggins v. Derwinski, 1 Vet. App. 474 (1991). Therefore, service connection for the Veteran's low back disability is only warranted if the preponderance of the evidence of record shows that the disability was aggravated by an injury incurred in the line of duty. 38 U.S.C.A. § 101(23), (24) (West 2002); 38 C.F.R. § 3.6(a) (2012) The medical evidence of record includes numerous complaints of low back injuries and symptoms after the August 1986 incident. The medical evidence of record shows that low back disabilities, including lumbosacral strain, arthritis, degenerative joint disease, and degenerative disc disease, have been consistently diagnosed since August 1986. A May 1988 Individual Sick Slip stated that the Veteran had arthritis. A December 1989 Department of Labor Workers' Compensation form stated that the Veteran had been injured while working for the Postal Service on December 22, 1989, resulting in complaints of sharp pain in the left side of his back when bending. A December 1989 private medical report stated that the Veteran had been treated from December 27, 1989, to December 29, 1989. The Veteran was referred to an orthopedic surgeon for back problems which were job-related. A December 1989 Postal Service report stated that the Veteran was partially disabled from December 26, 1989, to January 3, 1989, due to multiple conditions. The clinical findings included decreased extension of the back and lumbar tenderness. A January 1990 private medical report stated that the Veteran continued to complain of low back pain. On examination, the Veteran was very tender in the lower lumbosacral area, with marked limitation of motion of the lumbosacral spine. A second January 1990 private medical report stated that the Veteran was not showing any significant improvement, and was still complaining of a lot of pain in the neck and back. On examination, the Veteran was very tender in the lower lumbosacral spine area. A third January 1990 private medical report stated that the Veteran complained of low back pain, but felt that it was improving with treatment, including prescription opioid medication. On examination, there was a lot of tenderness in the lower lumbosacral spine and paravertebral muscles, and the Veteran had marked limitation of motion of the lumbosacral spine. A March 1990 Postal Service report stated that the Veteran was totally disabled from December 22, 1989, to March 12, 1990, and partially disabled from March 12, 1990, to April 12, 1990, due to a lumbosacral strain. A second March 1990 Postal Service report stated that the Veteran was partially disabled from March 16, 1990, to April 16, 1990. The cause of the disability was not listed, but the report stated that the Veteran needed a chair with back support. An April 1990 private medical report stated that the Veteran was being treated for a low back injury and continued to have some pain in his low back which was gradually improving. On examination, the Veteran had minimal paravertebral muscle tenderness along the lumbosacral spine, with minimal tenderness at the lumbosacral spine. The Veteran had limitation of motion of the lumbosacral spine on all motions. An April 1990 Postal Service report stated that the Veteran was totally disabled from March 28, 1990, to April 18, 1990, and partially disabled from April 19, 1990, to May 19, 1990. The cause of the disability was not listed, but the report stated that the Veteran needed a chair with back support. A June 1990 private medical report stated that the Veteran had an on-the-job injury to his low back and complained of persistent back pain. A June 1990 Postal Service report stated that the Veteran was totally disabled from June 6, 1990, to June 7, 1990, and partially disabled from June 7, 1990, to July 7, 1990, due to a lumbosacral strain. A July 1990 Postal Service report stated that the Veteran was totally disabled from July 8, 1990, the July 9, 1990, and partially disabled from July 7, 1990, to August 7, 1990, due to a lumbosacral strain. An October 1990 Postal Service report stated that the Veteran was totally disabled from October 18, 1990, to October 25, 1990, and partially disabled from October 26, 1990, to November 26, 1990, due to a lumbosacral strain. A November 1990 Postal Service report stated that the Veteran was totally disabled from November 15, 1990, to November 16, 1990, and partially disabled from November 16, 1990, to December 16, 1990, due, in part, to a lumbosacral strain. A November 1990 private medical report stated that the Veteran was under professional care for treatment of back pain. The report stated that the Veteran was totally disabled from November 28, 1990, to November 30, 1990. A December 1990 Postal Service medical report stated that the Veteran was being followed for low back pain and a lumbosacral strain. The Veteran complained of a lot of low back pain which was aggravated by bending, stooping, and lifting. On examination, there was tenderness in the lower lumbosacral spine and paravertebral muscles, and the Veteran had a limited range of motion of the lumbosacral spine, with pain. Associated reports gave a diagnosis of chronic lumbosacral spine strain. The Veteran was found to have been totally disabled from November 15, 1990, to November 16, 1990, partially disabled from November 16, 1990, to December 16, 1990, totally disabled from December 17, 1990, to December 18, 1990, and partially disabled from December 20, 1990, to January 20, 1991. An April 1991 private medical report stated that the Veteran complained of a lot of low back pain. On examination, there was tenderness in the lower lumbosacral spine and paravertebral muscles, as well as pain and limitation of motion of the spine. An April 1991 Postal Service report stated that the Veteran was totally disabled from March 4, 1991, to April 15, 1991, and partially disabled from April 16, 1991, to May 17, 1991, due to chronic lumbosacral strain. A second April 1991 private medical report stated that the Veteran continued to complain of pain in his back. On examination, the Veteran was essentially unchanged. A second April 1991 Postal Service report stated that the Veteran was partially disabled from April 29, 1991, to May 30, 1991, due to a chronic lumbosacral strain. A May 1991 service medical report stated that the Veteran complained of chronic low back pain and had been evaluated extensively by a private orthopedic surgeon. He continued to complain of pain and an inability to do Reserve Training duties. It was reported that he needed an evaluation for a permanent profile or a medical board for fitness for duty. The provisional diagnosis was back injury, low back pain. A July 1991 Postal Service report stated that the Veteran was partially disabled from July 11, 1991, to August 22, 1991, due to low back pain. A July 1991 private medical report gave a diagnosis of low back pain and opined that the Veteran could not perform his physical training examination for the next six weeks. An August 1991 private medical report stated that the Veteran was referred for six weeks of treatment. The Veteran was found to have multiple lumbar dysfunctions, including decreased mobility in all directions, diminished muscle strength, low back pain, an acute spinal curve, and decreased flexibility. A September 1991 Postal Service report stated that the Veteran was partially disabled from July 11, 1991, to November 21, 1991, due to low back pain. A March 1992 service medical report stated that the Veteran complained of low back pain since March 8, 1992, when he fell while running. After examination, the assessment included low back strain. Subsequently, an April 1992 service personnel report stated that the Veteran had injured his right thigh and lower back while doing physical training on March 8, 1992, resulting in treatment for a muscle spasm on March 10, 1992 and treatment for continued pain on March 18, 1992. The report stated that the injury included a low back strain which was incurred in the line of duty, however the examiner opined that the injury was not likely to result in a claim against the government. The Veteran's unit commander stated that the Veteran was on INACDUTRA at the time of the incident. Accordingly, the preponderance of the evidence of record demonstrates that a March 8, 1992, injury was incurred in service for VA purposes. The medical evidence of record includes numerous complaints of low back symptoms after the March 8, 1992 injury, to the present. The Veteran was repeatedly placed on a restricted physical profile due to chronic low back pain, degenerative joint disease, and arthritis. A March 1996 service personnel record stated that the Veteran did not participate in physical training for the previous four years. While the Veteran attended his required training drills for a period of time, he was reported to have spent these training periods in desk duties without physical training. A September 1995 service medical report stated that the Veteran was examined and found to have been not fit for military duties from March 1992 until an indefinite date. The diagnosis included chronic pain syndrome of the lower back. An April 1997 service memorandum stated that the Veteran then had not drilled at all since January 1994. A May 1996 service personnel report stated that the Veteran had injured his back on November 2, 1995, when he was told to put his duffel bag in an upright position. The report stated that the Veteran had a prior line of duty report for the same problem in 1992. The report stated that the injury was incurred in the line of duty, however the examiner opined that the injury was not likely to result in a claim against the government. The Veteran's unit commander stated that the injury happened while the Veteran was hospitalized at Fort Gordon. A June 1996 service line of duty report stated that the Veteran had sustained an injury in the line of duty on November 2, 1995, while placing a duffel bag in an upright position. The report stated that the Veteran was treated for that injury on November 3, 1995, and that no further treatment for the injury was necessary. The report stated that the Veteran did not experience any long-term health problems from the injury and that any claim for any form of disability benefits that the Veteran might claim as a result of the injury should be denied. Subsequent medical records include reports of other nonservice-related back injuries, including a motor vehicle accident in April 1996 and a spinal injury in 1997. In summary, the medical evidence of record shows that the Veteran's low back symptoms did not result in significant medical treatment for a few years after the Veteran recovered from the August 1986 motor vehicle accident. However, in December 1989 the Veteran experienced an on-the-job injury with the Postal Service. Following that injury, the Veteran experienced near constant low back symptomatology which resulted in severe disability. This disability was of such a severity that the Veteran was found to be either totally or partially disabled for nearly the entire period from December 1989 to March 1992. In March 1992, the Veteran injured his low back during INACDUTRA training, resulting in more complaints of back symptoms. Following the March 1992 injury, the Veteran's back symptoms continued to be reported at a very significant level, and he never again engaged in physical training as part of his service. An additional injury was also reported in November 1995, when the Veteran reported experiencing back pain after shifting a duffel bag while he was being treated at a military hospital. The evidence of record shows that the March 1992 and November 1995 injuries were incurred in the line of duty. Accordingly, the Board must determine whether those injuries aggravated the Veteran's preexisting low back disability. Presumptive periods do not apply to ACDUTRA or INACDUTRA. Biggins v. Derwinski, 1 Vet. App. 474 (1991). Therefore, there is no presumption that the Veteran's preexisting low back disability was aggravated by his ACDUTRA or INACDUTRA. Therefore, to warrant service-connect, the evidence of record must actively demonstrate that the Veteran's pre-existing low back disability was aggravated by subsequent ACDUTRA or INACDUTRA. Aggravation may not be conceded where the disability underwent no increase in severity during service on the basis of all the evidence of record pertaining to the manifestations of the disability prior to, during, and subsequent to service. 38 U.S.C.A. § 1153 (West 2002); 38 C.F.R. §§ 3.304, 3.306(b) (2012). In this case, there is no evidence that the Veteran's preexisting low back disability underwent a permanent increase in the underlying severity due to his March 1992 or November 1995 line of duty injuries. The contemporaneous medical evidence does not demonstrate any increase in symptomatology. The Veteran experienced near constant low back symptomatology which resulted in severe disability prior to the March 1992 injury, and continued to experience, at worst, the same level of disability after the injury. The same scenario also applies to the November 1995 injury. The November 1995 injury was also specifically found, at that time, to be sufficiently minor so as to not result in any long-term health problems from the injury. In summary, the Board finds that the evidence of record demonstrates that the Veteran was already seriously disabled as a result of his low back disability prior to the March 1992 and November 1995 injuries, and his level of disability did not increase following those injuries. In addition, there is no probative medical evidence of record which states that the Veteran's March 1992 and November 1995 injuries caused a permanent increase in the underlying severity of his preexisting low back disability. The only medical evidence of record which states that the Veteran's low back disability was aggravated by service is the June 2011 VA medical note, which opined that the Veteran's lumbar degenerative disc disease and spinal osteoarthritis were more likely than not directly related to service. However, that report was restricted to an examination of the Veteran's records and reported history and did not include physical or diagnostic examination. In addition, the basis given for the opinion was that the Veteran's "military health records" clearly indicated that his low back pain began "while serving in the military." The Board notes that the examiner cited to multiple documents which were dated while the Veteran was not on active service, ACDUTRA, or INACDUTRA. The Board notes that those medical records are service records in that they were conducted on a military base by military medical professionals. However, the evidence of record shows that the Veteran was employed for most of those times in a civilian capacity and thus those treatments do not qualify as having occurred "while [the Veteran was] serving in the military." Most significantly, those include the Veteran's August 1986 automobile accident, and numerous medical treatments for low back symptoms dated in 1992, 1995, and 1996, at which time the Veteran was not on active service, ACDUTRA, or INACDUTRA. In addition, the examiner completely omitted any discussion of the numerous private and Postal Service examinations dated prior to March 1992 which stated that the Veteran was partially or totally disabled on numerous occasions as a result of his low back disability. Therefore, the Board finds that the evidence shows that the June 2011 medical opinion is based on inaccurate facts, namely that the Veteran was in active service at the time of the cited medical treatments, and it completely ignored numerous medical records that bear directly and significantly on the issue of aggravation. These errors are major ones with significant implications for the opinion provided. Therefore, the Board finds that the June 2011 medical opinion warrants no probative weight because it is based on inaccurate factual bases. Coburn v. Nicholson, 19 Vet. App. 427 (2006); Kowalski v. Nicholson, 19 Vet. App. 171 (2005); Swann v. Brown, 5 Vet. App. 229 (1993); Black v. Brown, 5 Vet. App. 177 (1993). Under certain circumstance, lay evidence can be competent and sufficient to establish the etiology or diagnosis of a condition. Davidson v. Shinseki, 581 F.3d 1313 (2009). However, such etiological evidence is only competent to the extent that it relies on observable symptomatology. Barr v. Nicholson, 21 Vet. App. 303, 307 (2007). In this case, the Veteran is competent to state that he experienced low back pain, but he is not competent to demonstrate that his preexisting low back disability underwent a permanent increase in the underlying severity as a result of active service, ACDUTRA, or INACDUTRA. Barr v. Nicholson, 21 Vet. App. 303 (2007). Accordingly, the Veteran's lay statements do not provide competent evidence that his preexisting low back disability was aggravated by active service. Accordingly, the Board finds that the preponderance of the competent evidence of record is against a finding that the Veteran's currently diagnosed low back disability was incurred in or aggravated by service. Therefore, the Board finds that service connection for a low back disability is not warranted. The Board finds that the preponderance of the competent evidence weighs against the Veteran's claim for service connection for a back disability. Therefore, the claim is denied. 38 U.S.C.A. § 5107 (West 2002); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Bilateral Shoulder Disability An October 1974 service medical record stated that the Veteran complained of a sore right shoulder. On physical examination, the Veteran had a normal right shoulder range of motion. The Veteran's active service medical records, dated from July 1973 to July 1976, are otherwise negative for any complaints or diagnosis of a shoulder disorder. In a February 1986 service report of medical history, the Veteran denied having, or ever having had a painful or 'trick' shoulder. On clinical evaluation, the Veteran's upper extremities were normal. The medical evidence of record shows that the Veteran was treated for a possible left brachial plexus strain following the August 8, 1986, motor vehicle accident, though no final diagnosis of a shoulder disorder was given. In a November 1986 service medical report, the Veteran complained of left shoulder pain after he was involved in a truck accident on August 8, 1986. He reported that his left shoulder still worked. On observation of the Veteran's left shoulder, he had painful left shoulder abduction against resistance and decreased left hand grip, but no muscle atrophy. The diagnosis was old injury of left shoulder. In a second November 1986 service medical report, the Veteran reported that he had a history of an automobile accident in which his truck rolled over many times. He reported that he had not suffered any significant injuries but he stated that he still felt that he was not fully functioning as before the accident. On examination, the Veteran's left shoulder was negative for any abnormalities. The impression was residual symptoms after automobile accident. In a January 1990 private magnetic resonance imaging (MRI) report, the Veteran complained of neck and right shoulder pain after being hit by a cart on December 22, 1989. After examination, the impression did not include a shoulder disorder. In a November 1992 service report of medical history, the Veteran denied having, or ever having had a painful or 'trick' shoulder. In a May 1995 service medical record, the Veteran complained of pain in his shoulders since 1992. After examination, the assessment was multiple somatic complaints, all long-standing. In a July 1995 service medical report stated that the Veteran had a history of left shoulder arthritis. A May 1996 service personnel report stated that the Veteran had injured his left shoulder on November 2, 1995, when he was told to put his duffel bag in an upright position. The report stated that the Veteran had a prior line of duty report for the same problem in 1992. The report stated that the injury was incurred in the line of duty, however the examiner opined that the injury was not likely to result in a claim against the government. The Veteran's unit commander stated that the injury happened while the Veteran was hospitalized at Fort Gordon. A June 1996 service line of duty report stated that the Veteran had sustained an injury in the line of duty on November 2, 1995, while placing a duffel bag in an upright position. The report stated that the Veteran was treated for this injury on November 3, 1995, and that no further treatment for the injury was necessary. The report stated that the Veteran did not experience any long-term health problems from the injury and that any claim for any form of disability benefits that the Veteran might claim as a result of the injury should be denied. In a March 2004 VA outpatient medical report, the Veteran complained of pain his left shoulder for over one year. He reported that he had previously experienced a left shoulder injury in 1992 while in the Army. On physical examination, no left shoulder abnormalities were noted. The medical evidence of record shows that the Veteran has consistently complained of bilateral shoulder pain since March 2004. In a November 2004 VA orthopedic surgery consultation report, the Veteran reported that he had been thrown from a truck in 1986 while on active duty. He complained of bilateral shoulder pain and weakness. After examination, the relevant assessments were multisite pain and rule out rotator cuff tears, bilaterally. A September 2008 VA x-ray examination report stated that the Veteran had bilateral acromioclavicular degenerative joint disease, but otherwise normal shoulders. In an October 2008 VA outpatient medical report, the Veteran complained of bilateral shoulder pain which began five to six years before. After examination, the assessment was myofascial pain syndrome and osteoarthritis of the bilateral acromioclavicular joints. An August 2010 VA joints examination included a review of the Veteran's medical history and reported history. After physical and x-ray examination, the relevant diagnoses were degenerative joint disease, myofascial pain syndrome, and fibromyalgia. The examiner opined that the Veteran's bilateral shoulder condition was not caused or aggravated by active, ACDUTRA, and INACDUTRA service. The rationale was that the Veteran had minimal degenerative changes on x-ray examination which were typical for someone of his age. The examiner then stated that the Veteran's other two overlying conditions were psychological issues, for which the examiner was not competent to provide an opinion. A June 2011 VA medical note included a review of the Veteran's medical history, including notations of the Veteran's right shoulder complaint in October 1974, and treatment for shoulder pain resulting from a truck accident in August 1986 and a motor vehicle accident in May 1996. Subsequently, the examiner opined that the Veteran's service medical records clearly indicated that the onset of the Veteran's shoulder pain occurred "while serving in the military" and that, as a result the Veteran's bilateral shoulder arthritis was more likely than not directly related to service. The preponderance of the competent evidence of record shows that the Veteran's currently diagnosed bilateral shoulder disorder was not incurred in or aggravated by service. The medical evidence of record clearly demonstrates that the Veteran has a current diagnosis of a bilateral shoulder disability, namely osteoarthritis. However, the medical evidence of record does not clearly demonstrate when this disability began. While the Veteran complained of right shoulder symptoms in October 1974, no abnormalities were found at that time and the Veteran subsequently denied experiencing a painful shoulder. Subsequently, the Veteran reported experiencing shoulder symptoms following civilian injuries in August 1986 and December 1989, as well as a November 1995 in-service duffel bag injury. Following this last injury, the Veteran's records are largely silent for any shoulder complaints until March 2004, when he began consistently reporting bilateral shoulder pain. The Board finds that medical history, combined with the Veteran's numerous periods of ACDUTRA and INACDUTRA, is sufficiently vague as to prevent any significant etiological opinions from being drawn directly from the contemporary medical evidence. Accordingly, the Board places greater probative weight on subsequent medical opinions which have reviewed and interpreted that medical evidence. There are only two medical reports of record which opine on the etiology of the Veteran's currently diagnosed bilateral shoulder disability. The first is the August 2010 VA joints examination, which opined that the Veteran's bilateral shoulder osteoarthritis was not caused or aggravated by any period of service, on the basis that his osteoarthritis was consistent with age-induced osteoarthritis. The Board finds that opinion warrants high probative weight as it included an extensive review of all relevant medical and reported history, and physical and diagnostic examinations. The second etiological opinion is in the June 2011 VA medical note, which opined that the Veteran's bilateral shoulder arthritis was more likely than not directly related to service. However, that report was restricted to an examination of the Veteran's records and reported history and did not include physical or diagnostic examination. In addition, the basis given for the opinion was that the Veteran's "military health records" clearly indicated that his shoulder pain began "while serving in the military." In this regard, the Board notes that the examiner cited to multiple documents which were dated while the Veteran was not on active service, ACDUTRA, or INACDUTRA. The Board notes that these medical records are service records in that they were conducted on a military base by military medical professionals. However, the evidence of record shows that the Veteran was employed for most of those times in a civilian capacity and thus those treatments do not qualify as having occurred "while [the Veteran was] serving in the military." Most significantly, those include the Veteran's August 1986 automobile accident, which was specifically cited by the June 2011 examiner as one of the Veteran's shoulder injuries. Therefore, the Board finds that the evidence shows that the June 2011 medical opinion is based on inaccurate facts, namely that the Veteran was in active service at the time of the cited medical treatments. That error is a major one with significant implications for the opinion provided. Therefore, the Board finds that the June 2011 medical opinion warrants no probative weight because it is based on an inaccurate factual basis. Coburn v. Nicholson, 19 Vet. App. 427 (2006); Kowalski v. Nicholson, 19 Vet. App. 171 (2005); Swann v. Brown, 5 Vet. App. 229 (1993); Black v. Brown, 5 Vet. App. 177 (1993). Under certain circumstance, lay evidence can be competent and sufficient to establish the etiology or diagnosis of a condition. Davidson v. Shinseki, 581 F.3d 1313 (2009). However, such etiological evidence is only competent to the extent that it relies on observable symptomatology. Barr v. Nicholson, 21 Vet. App. 303, 307 (2007). The Veteran is competent to state that he experienced shoulder pain, but he is not competent to demonstrate that any pain he experienced during active service, ACDUTRA, or INACDUTRA, is related to his currently diagnosed bilateral shoulder disability. Barr v. Nicholson, 21 Vet. App. 303 (2007). The Board also notes that the Veteran's statements are competent to demonstrate continuity of symptomatology of arthritis. 38 C.F.R. §§ 3.307, 3.309 (2012); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). However, the Board finds that any reports of continuity of bilateral shoulder symptomatology since service are not credible as such reports are contradicted by the evidence of record. Specifically, there is no medical evidence that the Veteran sought treatment for shoulder symptoms between November 1995 and March 2004. Maxson v. Gober, 230 F.3d 1330 (Fed. Cir. 2000); Mense v. Derwinski, 1 Vet. App. 354 (1991). In addition, in October 2008, the Veteran actively reported that his bilateral shoulder pain began five to six years before. Therefore, the preponderance of the evidence of record demonstrates that any shoulder symptoms that the Veteran experienced during service ceased and did not resume until several years after his last period of INACDUTRA. Accordingly, the Veteran's lay statements do not provide competent and credible evidence that he experienced bilateral shoulder symptoms in-service and continuously to the present day. As a final matter, the Board notes that the August 2010 VA joints examination also diagnosed myofascial pain syndrome and fibromyalgia. However, the examiner stated that those disorders were psychological in nature, as opposed to musculoskeletal. Thus, any such psychological diagnoses are inextricably intertwined with the Veteran's psychiatric disability claim and will be considered as part of that claim, rather than in conjunction with the bilateral shoulder disability claim. Harris v. Derwinski, 1 Vet. App. 180 (1991). Accordingly, the Board finds that the preponderance of the competent evidence of record is against a finding that the Veteran's currently diagnosed bilateral shoulder disability is related to service. Therefore, the Board finds that service connection for a bilateral shoulder disability is not warranted. The Board finds that the preponderance of the competent evidence weighs against the Veteran's claim for service connection. Therefore, the claim is denied. 38 U.S.C.A. § 5107 (West 2002); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Bilateral Knee and Leg Disabilities The Veteran's service medical records from his period of active service from July 1973 to July 1976 include several reports of knee and leg symptoms. In an October 1973 service medical report, the Veteran reported that he had fallen on a rock with his left knee in September 1973, and reported experiencing pain around the kneecap with exercise. After examination, the impression was chondromalacia of the left knee. A November 1973 service medical report stated that x-ray examination was negative for a stress fracture. A March 1974 service medical report stated that the Veteran complained of pain in both knees and had been to the clinic many times, but x-rays were negative and the Veteran had a full range of motion. After physical and x-ray examination, the impression was chondromalacia. The Veteran complained of pain in his knees in service medical reports dated in February 1974, March 1974, May 1974, and October 1974, though no knee or leg diagnosis was given in those reports. In a November 1974 service medical report, the Veteran complained of pain in his left knee since falling in the shower the previous night. He also reported intermittent bilateral knee pain for the previous 15 months. The provisional diagnosis was contusion of the knee. No final diagnosis was given. A June 1976 letter from a military officer stated that the Veteran had been treated for a blood clot in his left leg in November 1974. In July 1979, January 1983, and February 1986 service reports of medical history, the Veteran denied having, or ever having had leg cramps, arthritis, or a 'trick' or locked knee. On clinical evaluation, the Veteran's lower extremities were normal. Two August 1981 medical reports stated that, on examination, the Veteran's knees were negative for any abnormalities. Multiple Department of Labor reports stated that the Veteran sustained a right ankle sprain in June 1983 in conjunction with civilian employment. The Veteran was found to be able to return to work on August 1, 1983. A May 1988 Individual Sick Slip stated that the Veteran had arthritis. A March 1989 Postal Service report stated that the Veteran was totally disabled from March 23, 1989, to March 29, 1989, and partially disabled from March 29, 1989, to March 31, 1989, 1989, due to a puncture wound to the right thigh. In a May 1989 service medical report, the Veteran stated that he had hurt his right knee three months before in the Post Office. He reported experiencing pain following physical training the previous day. After physical examination, the assessment was mild ligament strain of the right knee. Multiple medical and service personnel records stated that the Veteran incurred a right knee strain in the line of duty in May 1989. In a January 1990 medical report, the Veteran complained of back and lateral leg pain which had been present since he fell in a hole while running a sprint. After physical examination, no leg diagnosis was given. An April 1990 medical report stated that the Veteran was being treated for symptoms including left leg pain. Multiple medical and service personnel records stated that the Veteran incurred a right thigh contusion in the line of duty in March 1992. In a July 1992 service medical report, the Veteran complained of bilateral knee pain. After examination, no leg or knee diagnosis was given. In a November 1992 service report of medical history, the Veteran stated that he was having a lot of problems with his back and legs and had been on pain medication for years. A July 1993 Postal Service report stated that the Veteran incurred an injury in July 1993 that caused right leg and left knee pain. The Veteran was cleared to return to work two days later. In a May 1995 medical record, the Veteran complained of pain in his legs since 1992. After examination, the assessment was multiple somatic complaints, all long-standing. In a second May 1995 medical record, the Veteran complained of right knee pain. On examination in August 1995, the Veteran complained of bilateral knee pain. After physical examination, no leg or knee diagnosis was given. In a November 1995 medical record, the Veteran complained of bilateral knee pain and swelling. The provisional diagnosis was bilateral knee pain. On x-ray examination, the Veteran's bilateral knees were within normal limits and were negative for degenerative joint disease and a fracture. The assessment was bilateral patellofemoral syndrome. In a February 1999 VA outpatient medical report, the Veteran complained of right lateral thigh numbness and pain. He reported a remote history of a thigh contusion. On x-ray examination, of the right femur, there was myositis ossificans of the greater trochanter. The impression was right thigh pain. A December 1999 VA x-ray examination report stated that, after views of the Veteran's right knee, the impression was normal right knee. In a December 2000 VA MRI examination report, the Veteran complained of left knee pain with swelling for the previous two months. After examination, the left knee impression was degenerative changes in both the medial and lateral meniscus with a tear through the body of the medial meniscus. The right knee impression was degenerative changes in the posterior horn of the medial meniscus without a frank tear, and somewhat attenuated, but otherwise normal appearing, anterior cruciate ligament with no tear suspected. In a February 2001 private medical report, the Veteran complained of left knee pain that began on an intermittent basis in 1994. The Veteran reported that he had experienced a left knee injury while doing physical training during service in 1992, but he reported that it resolved without sequelae until 1994. He reported that his knee had been hurting since the previous Holiday season. After physical examination, the assessment was tender knee and patellar tendonitis. A May 2001 VA x-ray examination report stated that, after views of the Veteran's bilateral knees, the impression was negative bilateral knees. A March 2004 VA medical report stated that the Veteran had experienced a torn ligament in his left knee in 2001. A June 2004 VA medical note stated that recent x-ray showed mild arthritic changes in the bilateral knees. The medical evidence of record shows that bilateral knee arthritis has been consistently diagnosed since June 2004. A March 2005 VA x-ray examination report stated that, after views of the Veteran's bilateral knees, the impression was no evidence of acute injury or destructive process, with calcification at the tendon attachment site at the anterior superior aspect of the patella bilaterally, suggesting calcific tendinitis. An August 2010 VA joints examination included a review of the Veteran's medical history and reported history. After physical and x-ray examination, the examiner stated that it was very likely that the Veteran's back was contributing to his knee problems. The knee diagnosis was mild bilateral knee degenerative joint disease. The examiner stated that those findings are what would be expected in a 57 year old. The examiner opined that the Veteran's bilateral knee condition was not caused or aggravated by active, ACDUTRA, and INACDUTRA service, nor was it caused or aggravated by the Veteran's service-connected bilateral foot disability. The rationale was that the Veteran had minimal degenerative changes on x-ray examination which were typical for someone of his age. The examiner also opined that the Veteran did not have a general leg disability, separate from his knee and foot disabilities. A May 2011 VA x-ray examination report stated that, after views of the Veteran's bilateral knees, the diagnosis was degenerative joint disease of the bilateral knees. A June 2011 VA medical note included a review of the Veteran's medical history, including notations of the Veteran's left knee complaint in November 1974, and diagnostic findings related to the Veteran's knees in June 1992 and December 2000. Subsequently, the examiner opined that the Veteran's service medical records clearly indicated that the onset of the Veteran's knee pain occurred "while serving in the military" and that, as a result the Veteran's bilateral knee arthritis was more likely than not directly related to service. Initially, the Board notes that there are numerous medical reports of record which state that the Veteran experiences bilateral leg neurological disorders secondary to his low back disability. However, service connection for a low back disability has been specifically denied. As a result, service connection is not warranted for any bilateral leg or knee disability that the Veteran experiences which is secondary to his low back disability. The knee and leg claims will be discussed separately. Bilateral Knee Disability With respect to the Veteran's knee disability claim, the Board finds that the preponderance of the competent evidence of record shows that the Veteran's currently diagnosed bilateral knee disorder was not incurred in or aggravated by service. The medical evidence of record clearly demonstrates that the Veteran has a current diagnosis of a bilateral knee disability, namely osteoarthritis. However, the preponderance of the medical evidence of record demonstrates that disability began several years after separation from service and is not related to service. The Board notes that the Veteran complained of knee symptoms on multiple occasions during active and Reserve service. However, none of the knee diagnoses given during service have been present at any point since May 2001. McClain v. Nicholson, 21 Vet. App. 319 (2007). In addition, the preponderance of the medical evidence of record demonstrates that diagnoses given since May 2001 are not related to service. These post-May 2001 diagnoses are a knee ligament tear, calcific tendonitis, and arthritis. With respect to the knee ligament tear, the medical evidence of record clearly demonstrates that this tear was sustained in late 2000, while not in service, and is thus unrelated to the Veteran's service. With respect to the calcific tendonitis, that diagnosis was only made once, in March 2005, and did not appear previously or since. There is no medical evidence of record that relates that single finding of calcific tendonitis to service. Finally, with respect to the arthritis, there are only two medical reports of record which opine on the etiology of the Veteran's currently diagnosed bilateral knee arthritis. The first is the August 2010 VA joints examination, which opined that the Veteran's bilateral knee osteoarthritis was not caused or aggravated by any period of service, on the basis that his osteoarthritis was consistent with age-induced osteoarthritis. The Board finds that opinion warrants high probative weight as it included an extensive review of all relevant medical and reported history, and physical and diagnostic examinations. The second etiological opinion is in the June 2011 VA medical note, which opined that the Veteran's bilateral knee arthritis was more likely than not directly related to service. However, that report was restricted to an examination of the Veteran's records and reported history and did not include physical or diagnostic examination. In addition, the basis given for the opinion was that the Veteran's "military health records" clearly indicated that his shoulder pain began "while serving in the military." The Board notes that the examiner cited to multiple documents which were dated while the Veteran was not on active service, ACDUTRA, or INACDUTRA. The Board notes that those medical records are service records in that they were conducted on a military base by military medical professionals. However, the evidence of record shows that the Veteran was employed for most of those times in a civilian capacity and thus those treatments do not qualify as having occurred "while [the Veteran was] serving in the military." Most significantly, these include the Veteran's December 2000 MRI, which was conducted several years after separation from service and was specifically provided for diagnosis of the Veteran's late-2000 post-service knee ligament tear. In addition, the Board notes that the examiner failed to explain how the Veteran's bilateral knee arthritis could be related to service when x-ray examinations in November 1995, December 1999, and May 2001 found no knee abnormalities, and knee osteoarthritis was not diagnosed on x-ray examination until June 2004. Therefore, the evidence shows that the June 2011 medical opinion is based on inaccurate facts, namely that the Veteran was in active service at the time of the cited medical treatments. That error is a major one with significant implications for the opinion provided. Therefore, the Board finds that the June 2011 medical opinion warrants no probative weight because it is based upon inaccurate factual bases. Coburn v. Nicholson, 19 Vet. App. 427 (2006); Kowalski v. Nicholson, 19 Vet. App. 171 (2005); Swann v. Brown, 5 Vet. App. 229 (1993); Black v. Brown, 5 Vet. App. 177 (1993). Under certain circumstance, lay evidence can be competent and sufficient to establish the etiology or diagnosis of a condition. Davidson v. Shinseki, 581 F.3d 1313 (2009). However, such etiological evidence is only competent to the extent that it relies on observable symptomatology. Barr v. Nicholson, 21 Vet. App. 303, 307 (2007). In this case, the Veteran is competent to state that he experienced knee pain, but he is not competent to demonstrate that any pain he experienced during active service, ACDUTRA, or INACDUTRA, is related to his currently diagnosed bilateral knee disability. Barr v. Nicholson, 21 Vet. App. 303 (2007). The Board also notes that the Veteran's statements are competent to demonstrate continuity of symptomatology of arthritis. 38 C.F.R. §§ 3.307, 3.309 (2012); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). However, the Veteran's statements are of little probative value, as the medical evidence of record actively demonstrates that the Veteran did not have bilateral knee arthritis on x-ray examination in November 1995, December 1999, and May 2001. Accordingly, any knee symptoms he experienced at those time were not related to arthritis. As such, the preponderance of the evidence of record demonstrates that any knee symptoms that the Veteran did experience during service were not related to his currently diagnosed bilateral knee arthritis. Accordingly, the Board finds that the preponderance of the competent evidence of record is against a finding that the Veteran's currently diagnosed bilateral knee disability is related to service. Therefore, the Board finds that service connection for a bilateral knee disability is not warranted. The Board finds that the preponderance of the competent evidence weighs against the Veteran's claim for service connection. Therefore, the claim is denied. 38 U.S.C.A. § 5107 (West 2002); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Bilateral Leg Disability With respect to the Veteran's leg disability claim, the competent evidence of record shows that the Veteran has not had a diagnosis of a leg disorder, other than a knee or foot disorder, at any point during the period relevant to this claim. The medical evidence shows that the Veteran experienced multiple leg symptoms and injuries in service, including during his period of Reserve service. However, the medical evidence of record does not show that the Veteran has had a diagnosed leg disorder, other than a knee or foot disorder, at any point since May 2001. McClain v. Nicholson, 21 Vet. App. 319 (2007). The Board notes that the medical evidence of record also includes diagnoses of a hip disorder. However, service connection for a bilateral hip disorder has previously been denied by VA and the Veteran has not perfected an appeal of that claim. Accordingly, any hip disorder that the Veteran currently experiences is not for consideration in conjunction with the bilateral leg disability claim on appeal. 38 C.F.R. § 20.101 (2012). While the Veteran has reported experiencing multiple leg symptoms since May 2001, those symptoms have been related to a knee disability, a foot disability, or a back disability. Therefore, none of the Veteran's reported leg symptoms constitute a separate leg disability for VA purposes. In addition, the August 2010 VA joints examination specifically opined that the Veteran did not have a general leg disability, separate from his knee and foot disabilities. The Veteran's statements are competent to demonstrate that he has experienced leg symptomatology. Barr v. Nicholson, 21 Vet. App. 303 (2007); Washington v. Nicholson, 21 Vet. App. 191 (2007). However, the Veteran's statements are not competent to demonstrate that he those leg symptoms are related to a leg disability which is separate and distinct from his knee, foot, and back disabilities. Medical diagnosis and causation involve questions that are beyond the range of common experience and common knowledge and require the special knowledge and experience of a trained physician. As he is not a physician, the Veteran is not competent to make a determination that he has a diagnosis of a leg disability which is separate and distinct from his knee, foot, and back disabilities. Barr v. Nicholson, 21 Vet. App. 303 (2007). The existence of a current disability is the cornerstone of a claim for VA disability compensation. Degmetich v. Brown, 104 F. 3d 1328 (1997); Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998). Accordingly, the Board finds that the competent evidence of record shows that the Veteran has never had a diagnosis of a leg disability at any point during the period on appeal. Therefore, service connection for a leg disability is not warranted. Accordingly, the Board finds that the preponderance of the competent evidence of record is against a finding that the Veteran has a current diagnosis of a bilateral leg disability which is related to service. Therefore, the Board finds that service connection for a bilateral leg disability is not warranted. The Board finds that the preponderance of the competent evidence weighs against the Veteran's claim for service connection. Therefore, the claim is denied. 38 U.S.C.A. § 5107 (West 2002); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Headache Disability The Veteran's service medical records from his period of active service from July 1973 to July 1976 include several reports of headaches. In an April 1974 service medical report, the Veteran complained of headaches for the previous two weeks. After examination, the assessment was tension headaches. In a July 1975 service medical report, the Veteran complained of multiple symptoms including a headache. After examination, the assessment was tension headache. In July 1979, January 1983, and February 1986 service reports of medical history, the Veteran denied having, or ever having had, frequent or severe headaches. On clinical evaluation, the Veteran's head and neurologic system were normal. A September 1995 medical report stated that the Veteran had headaches. A second September 1995 medical report stated that the Veteran complained of headaches for the previous three months. After examination, the assessment was sinus headache. In September 1995, the Veteran was found to be not fit for military duty, in part due to chronic headaches and addiction to pain medication. An October 1995 medical report stated that the Veteran was admitted for rehabilitation from opioid dependence and presented with daily headaches. After examination, the impression was chronic pain syndrome secondary to motor vehicle accident and opioid withdrawal. In a June 2000 VA outpatient medical report, the Veteran complained of a headache for the previous four days. The medical evidence of record shows that the Veteran has consistently complained of headaches since 2000, with subsequent diagnoses of chronic headaches, migraine headaches, and sinusitis. In a January 2011 VA headaches examination, the Veteran reported that he experienced chronic headaches which began in 1975 after being truck in the head with a rifle, resulting in loss of consciousness and hospitalization. The Veteran reported that the headaches had continued and worsened since that time. Following physical and neurological examination, the assessment was chronic headaches. After a review of the claims file, an April 2011 addendum noted the Veteran's various documented treatments for headache symptoms, including during his period of active service. The assessment was then given as migraine headaches. The examiner opined that the Veteran's headaches were less likely as not related to his period of service. The preponderance of the competent evidence of record demonstrates that the Veteran's current diagnosed headache disability is not related to service. The Veteran's service medical records include multiple reports of headaches during service, including diagnoses of tension headaches. However, the medical evidence of record is then negative for any complaints of headaches for approximately 20 years, from July 1975 to September 1995. During that time, the Veteran actively denied experiencing frequent or severe headaches in July 1979, January 1983, and February 1986. The Veteran's headaches in 1995 were subsequently ascribed to opioid dependency. There is no medical evidence of record that relates the Veteran's currently diagnosed migraines to his isolated active service headaches or the headaches he experienced in 1995. The only medical evidence of record which opines on the etiology of the Veteran's headache disability is the April 2011 VA addendum, which found that the Veteran's headaches were less likely as not related to his period of service. Under certain circumstance, lay evidence can be competent and sufficient to establish the etiology or diagnosis of a condition. Davidson v. Shinseki, 581 F.3d 1313 (2009). However, such etiological evidence is only competent to the extent that it relies on observable symptomatology. Barr v. Nicholson, 21 Vet. App. 303, 307 (2007). In this case, the Veteran is competent to state that he experienced headaches, but he is not competent to demonstrate that any headaches he experienced during active service, ACDUTRA, or INACDUTRA, are related to his currently diagnosed headaches disability. Barr v. Nicholson, 21 Vet. App. 303 (2007). In addition, the Veteran's statements are not competent to demonstrate continuity of symptomatology of headaches. 38 C.F.R. §§ 3.307, 3.309 (2012); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Furthermore, the Board finds that any reports of continuity of headache symptomatology since service are not credible as such reports are contradicted by the evidence of record. Specifically, there is no medical evidence that the Veteran sought treatment for headaches between July 1975 and September 1995. Maxson v. Gober, 230 F.3d 1330 (Fed. Cir. 2000); Mense v. Derwinski, 1 Vet. App. 354, 356 (1991). In addition, he actively denied experiencing frequent or severe headaches in July 1979, January 1983, and February 1986. Accordingly, the Veteran's lay statements do not provide competent and credible evidence that he experienced headaches in-service and continuously to the present. Accordingly, the Board finds that the preponderance of the competent evidence of record is against a finding that the Veteran's currently diagnosed headache disability is related to service. Therefore, the Board finds that service connection for a headache disability is not warranted. The Board finds that the preponderance of the competent evidence weighs against the Veteran's claim for service connection. Therefore, the claim is denied. 38 U.S.C.A. § 5107 (West 2002); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Bilateral Foot Disability Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities. 38 C.F.R. Part 4 (2012). The Schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. § 4.1 (2012). The Board may only consider the specific factors as are enumerated in the applicable rating criteria. See Massey v. Brown, 7 Vet. App. 204 (1994); Pernorio v. Derwinski, 2 Vet. App. 625 (1992). In considering the severity of a disability, it is essential to trace the medical history of the Veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41 (2012). Consideration of the whole recorded history is necessary so that a rating may accurately reflect the elements of disability present. 38 C.F.R. § 4.2 (2012); Peyton v. Derwinski, 1 Vet. App. 282 (1991). Although the regulations do not give past medical reports precedence over current findings, the Board is to consider the Veteran's medical history in determining the applicability of a higher rating for the entire period in which the appeal has been pending. Powell v. West, 13 Vet. App. 31 (1999). Staged ratings are appropriate whenever the factual findings show distinct time periods in which a disability exhibits symptoms that warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007). Service connection for pes planus was granted by a January 1984 rating decision and a 0 percent rating was assigned under 38 C.F.R. § 4.71a, Diagnostic Code 5276, effective November 1, 1983. Subsequently, a September 1998 rating decision assigned a 10 percent rating under 38 C.F.R. § 4.71a, Diagnostic Code 5276, effective April 21, 1998. Finally, a March 2001 rating decision, implementing a February 2001 Board decision, assigned a 30 percent rating under 38 C.F.R. § 4.71a, Diagnostic Code 5276, effective July 12, 1999. As stated in the February 2001 Board decision, the Veteran's bilateral foot disability issue is complicated by the fact that the Veteran has several nonservice-connected foot conditions. At the time of the February 2001 decision, the Board concluded that the evidence of record did not contain a clear basis upon which to dissociate the symptoms of any nonservice-connected foot disorder from his service-connected pes planus. The Board must make the same conclusion in this case. The most recent VA foot examination, conducted in February 2011, stated that the Veteran did not have bilateral pes planus, despite the fact that he has been in receipt of service-connection for that disability for the approximately 30 years. Therefore, the Board finds that it is unable to separate the effects of the Veteran's service-connected and nonservice-connected foot disabilities. When it is not possible to separate the effects of service-connected and nonservice-connected disabilities, the effects should be attributed to the service-connected disability. Mittleider v. West, 11 Vet. App. 181 (1998). A Veteran is not entitled to be doubly compensated for the same disability. The rating of the same disability under various diagnoses is to be avoided, as is the rating of the same manifestation under different diagnoses. 38 C.F.R. § 4.14 (2012); Amberman v. Shinseki, 570 F.3d 1377 (Fed. Cir. 2009). The Board notes that there are only three diagnostic codes which provide for a rating in excess of 30 percent for a bilateral foot disability. The first is Diagnostic Code 5276, which provides that a 50 percent rating is warranted for acquired flatfoot when it is pronounced, with marked pronation, extreme tenderness of the plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo achillis on manipulation, not improved by orthopedic shoes or appliances. 38 C.F.R. § 4.71a, Diagnostic Code 5276 (2012). The Board finds that such a rating is not warranted as the medical evidence of record shows that the Veteran was specifically found to not have flat feet in VA examinations conducted in September 1999 and January 2011. In addition an August 2005 VA feet examination report did not note any flatfoot on physical examination, and gave an assessment of a history of pes planus. Such an assessment constitutes evidence that the Veteran was not felt to have a diagnosis of pes planus at that time. Accordingly, the evidence of record demonstrates that any flatfoot that the Veteran does experience is sufficiently mild as to be undetectable on VA examinations in September 1999, August 2005, and January 2011. Therefore, the Board finds that the preponderance of the evidence of record demonstrates that the Veteran has never had pronounced bilateral flatfoot, and his bilateral foot symptoms are not analogous to a 50 percent rating under Diagnostic Code 5276. Therefore, a rating in excess of 30 percent is not warranted under Diagnostic Code 5276. 38 C.F.R. § 4.71a, Diagnostic Code 5276 (2012). The second diagnostic code which provides for a rating in excess of 30 percent for a bilateral foot disability is Diagnostic Code 5278, which provides that a 50 percent rating is warranted for bilateral acquired claw foot (pes cavus) with marked contraction of the plantar fascia with dropped forefoot, all toes hammer toes, very painful callosities, and marked varus deformity. 38 C.F.R. § 4.71a, Diagnostic Code 5278 (2012). The Board finds that such a rating is not warranted for the Veteran's bilateral foot disability, as the medical evidence of record does not show that the Veteran has ever experienced bilateral claw foot, marked contraction of the plantar fascia, dropped forefoot, or all toes hammer toes. Accordingly, the Veteran's bilateral foot symptoms are not analogous to a 50 percent rating under Diagnostic Code 5278 The third diagnostic code which provides for a rating in excess of 30 percent for a bilateral foot disability is Diagnostic Code 5284, which provides separate individual ratings for other foot injuries, and can be applied unilaterally. Under Diagnostic Code 5284, other foot injuries warrant a 10 percent rating when they are moderate in degree, a 20 percent rating when they are moderately severe in degree, a 30 percent rating when they are severe in degree, and a 40 percent rating with actual loss of use of the foot. 38 C.F.R. § 4.71a, Diagnostic Code 5284 (2012). The Board finds that Diagnostic Code 5284 is the most appropriate for the Veteran's bilateral foot disability. As the Veteran has multiple foot disorders with a myriad of symptoms, Diagnostic Code 5284 provides the best method of rating the Veteran's disability by focusing on the overall impact of the symptomatology rather than requiring specific criteria to be met. In the January 2011 VA feet examination report, the examiner specifically opined that the Veteran experienced moderately severe impairment of both feet secondary to pain and a moderate degree of impairment associated with excessive fatigability and functional loss of motion. The Board finds that the medical evidence of record is consistent with a finding that the Veteran experienced moderately severe impairment of both feet secondary to pain and functional impairment throughout the entire period on appeal. While the August 2005 VA feet examination report stated that the Veteran had moderate impairment due to a bilateral feet crush injury, the report also found that the Veteran had surgical scars which were extremely tender to touch and he had pain with all ranges of motions. Such high levels of pain are consistent with the medical evidence of record throughout the entire period on appeal, where the Veteran consistently reported moderate to severe pain which had a significant impact on his ability to walk and stand. Accordingly, the Board finds that the medical evidence of record shows that the Veteran has experienced symptoms which are moderately severe in each foot throughout the entire period on appeal. Such a finding equates to a 20 percent rating for each foot under Diagnostic Code 5284. 38 C.F.R. § 4.71a, Diagnostic Code 5284 (2012). While a single rating of 20 percent is less than the Veteran's currently assigned rating, his current 30 percent rating contemplates all symptoms in both feet. 38 C.F.R. § 4.71a, Diagnostic Code 5276 (2012). Assigning a 20 percent rating for each foot results in a combined greater than the 30 percent current assigned for a bilateral foot disability. 38 C.F.R. §§ 4.25, 4.26 (2012). Accordingly, assigning two 20 percent ratings actively increases the Veteran's disability rating for his service-connected bilateral foot disability and is more beneficial to the Veteran. However, the Board finds that a rating in excess of 20 percent is not warranted for either foot under Diagnostic Code 5284. Specifically, the medical evidence of record does not show that the Veteran's symptoms have been best characterized as severe in either foot at any point during the period on appeal. The September 1999 VA feet examination report characterized all noted disabilities as mild. The August 2005 VA feet examination report stated that the Veteran's bilateral foot disability resulted in moderate impairment. The January 2011 VA feet examination report characterized the Veteran's bilateral foot disability as moderate to moderately severe. The Board notes that the Veteran has consistently complained of severe bilateral foot pain and claimed that it prevents him from walking or standing. However, pain alone, without evidence of decreased functional ability, does not warrant a higher rating. Mitchell v. Shinseki, 25 Vet. App. 32 (2011). In this case, the Veteran's functional impairment has been consistently reported to be moderate in severity at most. In addition, the January 2011 VA feet examination report found that the Veteran's symptoms were moderately severe specifically when pain was taken into account. Accordingly, the preponderance of the evidence of record shows that the Veteran's bilateral foot disability symptoms have never been analogous to a rating in excess of 20 percent under Diagnostic Code 5284 for either foot. 38 C.F.R. § 4.71a, Diagnostic Code 5284 (2012). This claim has also been reviewed with consideration of whether staged ratings would be warranted. While there may have been occasional fluctuations of the Veteran's bilateral foot symptoms, the evidence shows no distinct periods of time during which his symptoms have varied to such an extent that a rating in excess of 20 percent for either foot would be warranted under any diagnostic code. 38 U.S.C.A. § 5110 (West 2002); Hart v. Mansfield, 21 Vet. App. 505 (2007). Generally, evaluating a disability using either the corresponding or analogous diagnostic codes contained in the Schedule is sufficient. 38 C.F.R. §§ 4.20, 4.27 (2012). However, because the ratings are averages, it follows that an assigned rating may not completely account for each individual veteran's circumstance, but nevertheless would still be adequate to address the average impairment in earning capacity caused by disability. In exceptional cases where the rating is inadequate, it may be appropriate to assign an extraschedular rating. 38 C.F.R. § 3.321(b) (2012). The threshold factor for extraschedular consideration is a finding that the evidence before VA presents such an exceptional disability picture that the available schedular evaluations for that service-connected disability are inadequate. Thun v. Peake, 22 Vet. App. 111 (2008); Fisher v. Principi, 4 Vet. App. 57 (1993). Therefore, initially, there must be a comparison between the level of severity and symptomatology of the Veteran's service-connected disability with the established criteria found in the Schedule for that disability. Thun v. Peake, 22 Vet. App. 111 (2008). If the criteria under the Schedule reasonably describe the Veteran's disability level and symptomatology, then the Veteran's disability picture is contemplated by the Schedule, and the assigned schedular evaluation is adequate, and no referral is required. When service-connected disability affects employment in ways not contemplated by the rating schedule, § 3.321(b)(1) is applicable. VAOGCPREC 06-96 (1996), 61 Fed. Reg. 66749 (1996). The Board finds that the Veteran's disability picture is not so unusual or exceptional in nature as to render his disabilities rating for a bilateral foot disability inadequate. The Veteran's bilateral foot disability was rated under 38 C.F.R. § 4.71a, Diagnostic Code 5284, the criteria of which are found by the Board to specifically contemplate the Veteran's level of disability and symptomatology. The Veteran's bilateral foot disability is manifested by moderately severe impairment of both feet secondary to pain and functional impairment. When comparing that disability picture with the symptoms contemplated by the Schedule, the Board finds that the Veteran's symptoms are adequately contemplated by the disability ratings assigned herein for his bilateral foot disability. Ratings in excess of the ratings assigned herein are provided for certain manifestations of foot disabilities, but the medical evidence does not show that those manifestations are present. The Board finds that the criteria for 20 percent ratings for the Veteran's bilateral foot disability reasonably describe the Veteran's disability level and symptomatology and, therefore, the currently assigned schedular ratings are adequate and no referral is required. VAOGCPREC 06-96 (1996), 61 Fed. Reg. 66749 (1996); 38 C.F.R. § 4.71a, Diagnostic Code 5284 (2012). In reaching this decision, the Board finds that the preponderance of the evidence of record shows that the Veteran's bilateral foot disability does not meet the criteria for ratings in excess of those assigned herein. Therefore, the claim for increased ratings beyond those assigned herein is denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); Massey v. Brown, 7 Vet. App. 204 (1994). ORDER New and material evidence not having been submitted, the claim to reopen the issue of entitlement to service connection for a bilateral wrist disability is denied. As new and material evidence has been submitted, the claim of entitlement to service connection for a bilateral arm disability is reopened. To that extent only, the appeal is granted. Service connection for a low back disability is denied. Service connection for a bilateral shoulder disability is denied. Service connection for a bilateral knee disability is denied. Service connection for a headache disability is denied. Service connection for a bilateral leg disability is denied. A rating of 20 percent, but not higher, for a right foot disability, to replace the bilateral rating currently assigned, is granted. A rating of 20 percent, but not higher, for a left foot disability, to replace the bilateral rating currently assigned, is granted. REMAND Unfortunately, additional development is required prior to the disposition of the Veteran's claims of entitlement to service connection for a psychiatric disability and a bilateral arm disability. In January 2010, the Board remanded the psychiatric disability claim on appeal so that an attempt could be made to verify one of the Veteran's claimed stressors. Specifically, the Board stated that an attempt should be made to verify the Veteran's alleged November 1986 stressor with the United States Army and Joint Services Records Research Center (JSRRC). The evidence of record does not shows that the RO made any attempt to verify the Veteran's alleged stressor. A June 2011 supplemental statement of the case stated that the Veteran's stressor could not be verified because there were no service personnel records associated with the Veteran's claims file that showed his unit of assignment in 1973. However, the Board notes that the Veteran's unit of assignment in 1973 is entirely irrelevant to the stressor he reported, as that stressor was stated to have occurred in approximately 1985 or 1986. The Veteran's service personnel records clearly show that the Veteran's unit of assignment from May 1977 to December 1994 was the 803rd General Supply Company, stationed in Opelika, Alabama. Accordingly, there is sufficient evidence of record to make an attempt to verify the Veteran's alleged stressor. In this case, the RO did not make an attempt to verify the Veteran's alleged stressor, as requested by the January 2010 Board remand, despite the fact that there was sufficient evidence of record to make such an attempt. Compliance with a remand is not discretionary, and if a remand request is not satisfied, another remand for corrective action is required. Stegall v. West, 11 Vet. App. 268 (1998). In addition, the Board notes that the January 2011 VA psychiatric examination report gave an Axis I diagnosis of PTSD, but did not give a diagnosis of any other psychiatric disorder nor did it otherwise comment on the presence or absence of any psychiatric disorder other than PTSD. However, the medical evidence of record includes numerous diagnoses of psychiatric disorders other than PTSD, including statements indicating that the Veteran has a psychiatric disorder which is secondary to multiple physical disabilities. Therefore, even if the Veteran's PTSD stressor cannot be confirmed, service connection for a psychiatric disability is still warranted if the Veteran has a diagnosis of a psychiatric disorder other than PTSD which is related to a service-connected disability. Accordingly, the Veteran must be provided with an addition VA psychiatric examination to determine whether he has any psychiatric disabilities other than PTSD and, if so, whether they are related to any service-connected disability. 38 C.F.R. § 3.159(c)(4) (2012). With respect to the Veteran's bilateral arms disability claim, there is medical evidence of record that the Veteran has bilateral lateral epicondylitis which is related to his wheelchair use. There is also evidence of record that the Veteran uses his wheelchair, at least in part, due to his service-connected bilateral foot disability. The Veteran has never been provided with a VA medical examination to determine the etiology of any bilateral arm disability. Therefore, the Veteran must be provided with a VA medical examination to determine whether he has a current diagnosis of a bilateral arm disability and, if so, whether it is related to any service-connected disability. 38 C.F.R. § 3.159(c)(4) (2012). Accordingly, the case is REMANDED for the following actions: 1. Forward the Veteran's statements, transcribed at his June 2006 Board hearing, regarding his claimed PTSD stressor (uncovering a decomposing dead body on the Ruth Range in Fort Benning, Georgia, in November 1986), and copies of his service personnel records and any other relevant evidence, to the United States Army and Joint Services Records Research Center (JSRRC), and request that JSRRC attempt to verify the alleged stressor. 2. Thereafter, schedule the Veteran for a VA examination to ascertain the etiology of any current psychiatric disability. The examiner must review the claim file and should note that review in the report. Based upon review of the service and post-service medical records, the examiner must provide a full multiaxial diagnosis pursuant to DSM-IV. The examiner must provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that any psychiatric disability found is due to, or was aggravated by, the Veteran's service. The examiner should also provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that any psychiatric disability found is due to a service-connected disability. The examiner should further provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that any psychiatric disability found is aggravated by any service-connected disability. If any current psychiatric disability is attributable to factors unrelated to service or a service-connected disability, the examiner should specifically so state. If the Veteran is not found to have a psychiatric disability other than PTSD, the examiner must specifically explain that finding in light of the numerous other diagnoses of psychiatric disorders other than PTSD. A complete rationale for the opinion must be provided. 3. Schedule the Veteran for a VA examination to ascertain the etiology of any current bilateral arm disability. The examiner must review the claim file and should note that review in the report. Based upon review of the service and post-service medical records, the examiner must provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that any bilateral arm disability found is due to, or was aggravated by, the Veteran's service. The examiner should also provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that any bilateral arm disability found is due to a service-connected disability, to specifically include wheelchair use secondary to any service-connected disability. The examiner should further provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that any bilateral arm disability found is aggravated by any service-connected disability, to specifically include wheelchair use secondary to any service-connected disability. If any current bilateral arm disability is attributable to factors unrelated to service or a service-connected disability, the examiner should specifically so state. A complete rationale for the opinion must be provided. 4. Then, readjudicate the claims. If the decision remains adverse to the Veteran, issue a supplemental statement of the case and allow the applicable time for response. Then, return the case to the Board. The Veteran has the right to submit additional evidence and argument on the matter or matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). These claims must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board or United States Court of Appeals for Veterans Claims for development or other appropriate action must be handled in an expeditious manner. 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2012). _________________________________________________ Harvey P. Roberts Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs