Citation Nr: 18140577 Decision Date: 10/03/18 Archive Date: 10/03/18 DOCKET NO. 15-19 653 DATE: October 3, 2018 ORDER Service connection for bilateral hearing loss is denied. Service connection for tinnitus is granted. Service connection for an acquired psychiatric disorder, claimed as posttraumatic stress disorder (PTSD) is denied. An initial compensable disability rating for right biceps strain with scar, right forearm status post laceration (dominant) right forearm condition is denied. REMANDED Service connection for a right shoulder disorder is remanded. Service connection for a low back disorder is remanded. Service connection for residuals of a traumatic brain injury (TBI) is remanded. Service connection for migraine headaches, claimed as a residual of a TBI is remanded. FINDINGS OF FACT 1. At no time during, or prior to, the pendency of the claim has the Veteran had a hearing loss disability as defined by VA regulations. 2. Resolving all doubt in his favor, the Veteran has a current diagnosis of tinnitus which has been continually present since his military service. 3. At no time during, or prior to, the pendency of the claim has the Veteran had diagnosis of an acquired psychiatric disorder. 4. Since the grant of service connection, the Veteran’s right biceps with scar, right forearm, status post laceration (dominant), right forearm condition, have been manifested by four linear scars on the right upper extremity measuring 1.5 centimeters (cm), 0.3 cm, 0.2 cm, and 0.4 cm. There is evidence that the scars are painful but no evidence that these scars are deep, unstable, loose their covering repeatedly, cover an area of 144 square inches or greater, or that they adversely affect any function. CONCLUSIONS OF LAW 1. The criteria for service connection for bilateral hearing loss are not met. 38 U.S.C. §§ 1101, 1110, 1112, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.385. 2. The criteria for service connection for tinnitus are met. 38 U.S.C. §§ 1101, 1110, 1112, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 3. The criteria for service connection for an acquired psychiatric disability are not met. 38 U.S.C. §§ 1101, 1110, 1112, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 4. The criteria for an initial 10 percent disability rating, and no higher, for right biceps strain with scar, right forearm status post laceration (dominant) right forearm condition have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.16, 4.118, Diagnostic Codes (DCs) 7805-5206. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty service from July 1991 to January 2004. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2013 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Denver, Colorado. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury. Id.; also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff’d, 78 F.3d 604 (Fed. Cir. 1996) [(table)]. Additionally, for Veterans who have served 90 days or more of active service during a war period or after December 31, 1946, certain chronic disabilities, such as organic diseases of the nervous system, are presumed to have been incurred in service if manifest to a compensable degree within one year of discharge from service. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. In an October 4, 1995, opinion, VA’s Under Secretary for Health determined that it was appropriate to consider high frequency sensorineural hearing loss an organic disease of the nervous system and therefore a presumptive disability. Alternatively, when a disease at 38 C.F.R. § 3.309(a) is not shown to be chronic during service or the one year presumptive period, service connection may also be established by showing continuity of symptomatology after service. See 38 C.F.R. § 3.303(b). However, the use of continuity of symptoms to establish service connection is limited only to those diseases listed at 38 C.F.R. § 3.309(a) and does not apply to other disabilities which might be considered chronic from a medical standpoint. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 1. Service connection for bilateral hearing loss The threshold for normal hearing is from 0 to 20 decibels, and higher threshold levels indicate some degree of hearing loss. Hensley v. Brown, 5 Vet. App. 155, 157 (1993). For the purposes of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. The Court has held that service connection can be granted for a hearing loss where the Veteran can establish a nexus between his current hearing loss and a disability or injury he suffered while he was in military service. Godfrey v. Derwinski, 2 Vet. App. 352, 356 (1992). The Court has also held that VA regulations do not preclude service connection for a hearing loss which first met VA’s definition of disability after service. Hensley, supra, at 159. As an initial matter, the Veteran’s service personnel records show that his military occupational specialty (MOS) was armament repairer. Furthermore, VA’s Duty MOS Noise Exposure Listing finds those with an MOS of armament repairer have “highly probable” noise exposure. See M21-1MR, Part III, Subpart iv, 4.B.12.c. Thus, the Board finds that the Veteran had hazardous noise exposure in service. However, the Veteran’s service treatment records are negative for hearing loss. Significantly, the Veteran’s November 2003 separation audiological examination shows the following puretone thresholds: 500 Hz 1000 Hz 2000 Hz 3000 Hz 4000 Hz Right Ear 5 5 -5 -5 5 Left Ear 5 5 0 -5 5 In May 2012, the Veteran submitted a claim for service connection for bilateral hearing loss and he was afforded a VA audiological examination in August 2013. This examination revealed the following: 500 Hz 1000 Hz 2000 Hz 3000 Hz 4000 Hz Right Ear 5 10 5 10 10 Left Ear 5 5 0 5 10 Puretone Threshold Average Right Ear 9 Left Ear 5 Speech discrimination Right Ear 98% Left Ear 100% At such time, the examiner noted review of the claims file, and wrote that, based on the Veteran’s reports as well as his service personnel records, it appeared that the Veteran was exposed to hazardous noise levels while in service. However, audiological assessment revealed that the Veteran’s hearing sensitivity was within normal limits. Furthermore, electronic hearing testing conducted at enlistment, during service, at separation, and at present does not show a significant threshold shift beyond normal variability/progression. As such, the examiner opined that the Veteran’s reported hearing loss was less likely than not caused by or a result of noise exposure in service. Based on the foregoing, the Board finds that the Veteran does not have a current hearing loss disability under 38 C.F.R. § 3.385 as audiometric testing fails to reveal that the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz is 40 decibels or greater or that the auditory threshold in at least three frequencies are 26 decibels or greater; or that the speech recognition score using the Maryland CNC Test are less than 94 percent. In this regard, in McClain v. Nicholson, 21 Vet. App. 319, 321 (2007), the Court held that the requirement of the existence of a current disability is satisfied when a Veteran has a disability at the time he files his claim for service connection or during the pendency of that claim, even if the disability resolves prior to adjudication of the claim. However, in Romanowsky v. Shinseki, 26 Vet. App. 289 (2013), the Court held that when the record contains a recent diagnosis of disability prior to a Veteran filing a claim for benefits based on that disability, the report of diagnosis is relevant evidence that the Board must address in determining whether a current disability existed at the time the claim was filed or during its pendency. In the instant case, the probative evidence of record fails to demonstrate a current diagnosis of hearing loss at any point during the pendency of the claim. While the Board has also considered the Court’s holding in Romanowsky, supra, there is also no probative evidence of a recent diagnosis of disability prior to the Veteran’s claim. In this regard, there is no evidence that such disability meets the standards of hearing loss under 38 C.F.R. § 3.385 and, in fact, all audiometric testing conducted prior to, and during, the pendency of the claim fails to reflect hearing loss as defined by VA regulations. The Board has considered the Veteran’s allegations that he suffers from hearing loss due to noise exposure in service. However, the Board must adhere to the guidelines of 38 C.F.R. § 3.385, which do not provide for a finding of a current disability for pure tone thresholds or speech recognition scores that fail to meet the required minimum pure tone thresholds and speech recognition scores listed in the regulation. Moreover, the Veteran, as a lay person, is not competent to offer a diagnosis of bilateral hearing loss as he does not possess the requisite specialized knowledge. While the Board acknowledges that the Veteran is a service representative and thus familiar with VA regulations, to include those governing the definition of hearing loss as found at 38 C.F.R. § 3.385, he is not competent to render a diagnosis of hearing loss. In this regard, such a diagnosis requires the administration and interpretation of audiological test results. Therefore, as such is a complex medical question, the Veteran is not competent to offer a diagnosis of bilateral hearing loss. See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007) (although the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions). Therefore, as the objective medical evidence is against the finding that the Veteran’s alleged hearing loss rises to the level that allows for compensation under the governing law and regulation, the Board finds that he does not have a current diagnosis of hearing loss for VA purposes prior to, or during, the pendency of the claim. As such, service connection for bilateral hearing loss is not warranted. In reaching such decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, the preponderance of the evidence is against the Veteran’s claim of entitlement to service connection for bilateral hearing loss. As such, that doctrine is not applicable in the instant appeal, and his claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, supra. 2. Service connection for tinnitus As above, the Veteran’s service personnel records show that it is “highly probable” that the Veteran was exposed to hazardous noise in service. In May 2012, he submitted a claim for service connection for tinnitus and he was afforded a VA audiological examination in August 2013. As above, audiological assessment revealed that the Veteran’s hearing sensitivity was within normal limits. At the time of the examination, the Veteran reported that he first began experiencing tinnitus while in service. Significantly, the examiner opined that the Veteran’s reported tinnitus was less likely than not caused by or a result of noise exposure in service. Unfortunately, the examiner did not provide a rationale for this opinion. Initially, the Board notes that tinnitus is a disorder that is readily observable by laypersons and does not require medical expertise to establish its existence. See Charles v. Principi, 16 Vet. App. 370 (2002). Furthermore, while the Veteran’s service treatment records are negative for specific complaints of tinnitus, the Veteran is competent to report a history of tinnitus that began in service. See 38 C.F.R. § 3.159(a)(2); Washington v. Nicholson, 19 Vet. App. 362, 368 (2005); Layno. In its capacity as a finder of fact, the Board finds the Veteran is credible as to his reports of the onset and recurrence of tinnitus symptoms. He is also competent to comment on the onset and frequency of his tinnitus. Lay evidence can be competent and sufficient evidence to establish etiology if the layperson is competent to identify the medical condition and lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Davidson; Jandreau. Here, under Charles the Veteran is competent to identify the medical condition of tinnitus and his lay statements describe tinnitus beginning in service supports the later diagnosis by the August 2013 VA examiner. While the August 2013 VA examiner opined that the Veteran’s tinnitus was not related to his in-service noise exposure, the examiner did not provide a rationale for this opinion. As such, the Board finds that the August 2013 opinion is not probative. In this case, affording the Veteran the benefit of the doubt, the Board finds that the Veteran’s competent and credible lay evidence is sufficient to establish a nexus between service and tinnitus and service connection for tinnitus is warranted. 38 C.F.R. § 3.303(a). 3. Service connection for an acquired psychiatric disorder, claimed as PTSD The Veteran contends that he has an acquired psychiatric disorder due to his military service. Service treatment records are negative for psychiatric problems. Significantly, the Veteran’s November 2003 separation examination shows a normal psychiatric system and in a November 2003 report of medical history, the Veteran specifically denied “frequent trouble sleeping,” “depression or excessive worry,” and “nervous trouble of any sort.” Post-service treatment records are also negative for psychiatric problems. Significantly, VA treatment records show negative PTSD screenings in January 2009 and August 2012. The Veteran submitted a claim for service connection for PTSD in January 2008. In connection with the Veteran’s claim, he was afforded a VA psychiatric examination in August 2013. The examiner reviewed the claims file, examined the Veteran, and opined that there was no evidence of a psychiatric disorder. Here, review of the medical evidence of record indicates that the Veteran does not have, and has not at any point pertinent to this appeal had, a diagnosed acquired psychiatric disorder. Because the Veteran has not received a diagnosis for an acquired psychiatric disorder, he has not met the first criteria of service connection, and his claim fails. The Board observes that the Veteran has complained of depression/anxiety and asserted that this is related to his military service. As a layperson, the Veteran is competent, as a layperson, to report that about which he has personal knowledge—to include his own symptoms. See, e.g., Layno, 6 Vet. App. at 470; Grottveit, 5 Vet. App. at 93. However, none of the medical evidence of record reflects a diagnosis of a current acquired psychiatric disorder —much less, an acquired psychiatric disorder to have had its onset during military service—and neither the Veteran nor his representative have presented or identified any such evidence or opinion. In addition to the medical evidence, in adjudicating this claim, the Board has considered the assertions of the Veteran and his representative; however, such evidence provides no basis for allowance of the claim. As indicated above, this claim turns on the fundamental medical matter of current disability—here, one requiring a medical diagnosis—a matter within the province of trained medical professionals. See Jones v. Brown, 7 Vet. App. 134, 137-38 (1994). As the Veteran and his representative are not shown to be other than laypersons without the appropriate medical training and expertise, neither is competent to render a probative (persuasive) opinion on such a medical matter. See, e.g., Bostain v. West, 11 Vet. App. 124, 127 (1998), citing Espiritu v. Derwinski, 2 Vet. App. 492 (1992). See also Routen v. Brown, 10 Vet. App. 183, 186 (1997) (“a layperson is generally not capable of opining on matters requiring medical knowledge”). Hence, the lay assertions in this regard have no probative value. The Board emphasizes that Congress has specifically limited entitlement to service connection for disease or injury to cases where such incidents have resulted in disability. See 38 U.S.C. § 1110; see also 38 C.F.R. § 3.303. Thus, where, as here, competent evidence does not establish the existence of the disability for which service connection is sought, there can be no valid claim for service connection. See Gilpin v. West, 155 F.3d 1353; Brammer, 3 Vet. App. at 225. In the instant case, the claim for service connection for an acquired psychiatric disorder is denied, because the first essential criterion for a grant of service connection—evidence of a current disability upon which to predicate a grant of service connection—has not been met with regard to this claim. For all the foregoing reasons, the Board finds that the claim for service connection for an acquired psychiatric disorder must be denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the doubt doctrine; however, as no competent, probative evidence supports the claim, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 53-56. 4. An initial compensable disability rating for right biceps strain with scar, right forearm status post laceration (dominant) right forearm condition The Veteran seeks an initial compensable disability rating for his service-connected right biceps strain with scar, right forearm status post laceration (dominant) right forearm condition. Disability evaluations are determined by the application of the facts presented to VA’s Schedule for Rating Disabilities (Rating Schedule) at 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and the residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(a), 4.1. In evaluating the severity of a particular disability, it is essential to consider its history. 38 C.F.R. § 4.1; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. If there is disagreement with the initial rating assigned following a grant of service connection, separate ratings can be assigned for separate periods of time, based on the facts found. Fenderson v. West, 12 Vet. App. 119, 126 (1999). See AB v. Brown, 6 Vet. App. 35 (1993) (a claim for an original or an increased rating remains in controversy when less than the maximum available benefit is awarded). Reasonable doubt as to the degree of disability will be resolved in the Veteran’s favor. 38 C.F.R. § 4.3. In its evaluation, the Board shall consider all information and lay and medical evidence of record. 38 U.S.C. § 5107(b). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Board shall give the benefit of the doubt to the claimant. Id.; 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 49. The Veteran’s right biceps strain with scar, right forearm status post laceration (dominant) right forearm condition is currently rated as noncompensably disabling under 38 C.F.R. § 4.118, DCs 7805-5206. Pursuant to 38 C.F.R. § 4.27, hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the evaluation assigned; the additional code is shown after the hyphen. Under DC 5206, a noncompensable rating is warranted for flexion limited to 110 degrees of the major or minor elbow. A 10 percent rating is warranted for flexion limited to 100 degrees of the major or minor elbow. A 20 percent rating is warranted for flexion limited to 90 degrees of the major elbow and flexion limited to 70 degrees of the minor elbow. A 30 percent rating is warranted for flexion limited to 70 degrees of the major elbow and flexion limited to 55 degrees of the minor elbow. A 40 percent rating is warranted for flexion limited to 55 degrees of the major s elbow and flexion limited to 45 degrees of the minor elbow. A maximum rating of 50 percent is warranted for flexion limited to 45 degrees of the major elbow. 38 C.F.R. § 4.71a, DC 5206. The diagnostic criteria for disorders of the skin are found at 38 C.F.R. § 4.118, DC’s 7801-7805. Under DC 7801, burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are deep and nonlinear in an area or areas of at least 6 square inches (39 sq. cm.) but less than 12 square inches (77 sq. cm.) warrant a 10 percent rating Under DC 7802, burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are superficial and nonlinear in an area or areas of 144 square inches (929 sq. cm.) or greater warrant a 10 percent evaluation. Note (2) under that code provides that if multiple qualifying scars are present, assign a separate evaluation for each affected extremity based on the total area of the qualifying scars that affect that extremity. Under DC 7804, one or two scars that are unstable or painful warrant a 10 percent evaluation. Note (2) for that code provides that if one or more scars are both unstable and painful, add 10 percent to the evaluation that is based on the total number of unstable or painful scars. Note (3) under that provides that scars evaluated under DCs 7800, 7801, 7802, or 7805 may also receive an evaluation under DC 7803, when applicable. DC 7805 provides that other scars (including linear scars) and other effects of scars evaluated under DCs 7800, 7801, 7802, and 7804 require the evaluation of any disabling effect(s) not considered in a rating provided under DCs 7800-04 under an appropriate DC. 38 C.F.R. §§ 4.118, DCs 7801-7805. Also pertinent is 38 C.F.R. § 4.73, DC 5305, which pertains to disability of muscle group V, defined as including the flexor muscles of the elbow, including the biceps, brachialis, and brachioradialis. The function of these muscle groups is listed as elbow supination (long head of biceps as stabilizer of the shoulder joint), and flexion of the elbow. For severe residuals of injuries to this muscle group, a 40 percent evaluation is warranted for the major arm, and a 30 percent evaluation is merited for the minor arm. For moderately severe residuals, a 30 percent evaluation is assigned to the major arm, and a 20 percent evaluation is warranted for the minor arm. A 10 percent evaluation is assigned for moderate residuals of either arm, and a zero percent evaluation is warranted for slight residuals of either arm. Evidence relevant to the current level of severity of the Veteran’s right biceps strain with scar, right forearm status post laceration (dominant) right forearm includes August 2013 and November 2015 VA examinations. During the August 2013 VA scars examination, the Veteran was diagnosed with scar of the right forearm, status post laceration as well as scars of the right thumb and index finger, status post injury. While it was initially noted that these scars were painful, the examiner subsequently clarified that it was more of an itching sensation than pain. The scars were not unstable (with frequent loss of covering of skin). There were four linear scars on the right upper extremity measuring 1.5 centimeters (cm), 0.3 cm, 0.2 cm, and 0.4 cm. There were no scars of the head, face, or neck. Significantly, the examiner found that the Veteran’s scars did not impact his ability to work. During the August 2013 VA hand/finger examination, the examiner diagnosed tender scar status post injuries to the right finger as well as healed fracture, 5th metacarpal, right hand. The Veteran reported that he had multiple injuries from working on military tanks. He stated that he would often have hydraulic fluid on his hands when the injuries would occur and that now his hands have scars that will re-open. The Veteran reported that, to date, the condition had not been formally diagnosed. The current symptoms were recurrent bumps on the index finger that will cause cyst formation that breaks by itself. Specifically, the Veteran reported that he will observe a hard, white bump on the scar and then the scar will open back up. It will stay open for about a week and then heal back over. On physical examination, there was no limitation of motion or evidence of painful motion for any fingers or thumb. The Veteran was able to perform repetitive-use testing with three repetitions. There was no evidence of tenderness or pain to palpation for joints or soft tissue of either hand, including the thumb and fingers. There were no contributing factors of weakness, fatigability, incoordination, or pain during flare-ups or repeated use over time that could additionally limit the functional ability of the hand. Significantly, the examiner found that the Veteran’s right hand/finger condition did not impact his ability to work. During an August 2013 VA muscles examination, the examiner diagnosed right biceps strain. The Veteran reported that this condition was incurred during his military service while working on a tank and had resulted in intermittent pain, aggravated by physical exertion as in lifting or carrying heavy objects. Significantly, it was noted that the Veteran was right hand dominant. The disability affected muscle group V: flexor muscles of the elbow, triceps, brachialis, and brachoioradialis. Significantly, the examiner found that the muscle injury did not affect muscle substance or function but did cause occasional fatigue/pain. Muscle strength testing was normal and there was no muscle atrophy. The Veteran did not use any assistive devices as a normal or occasional mode of locomotion and there was no functional impairment of an extremity such that no effective function remained other than that which would be equally well served by an amputation with prosthesis. There were no other pertinent physical findings, complications, signs, and/or symptoms. With regard to functional impact, the examiner noted that the Veteran’s muscle injury impacted his ability to work as a systems manager as he was required to carry heavy objects which aggravated his arm pain. During a November 2015 VA scars examination, the examiner continued a diagnosis of scar, right forearm and bicep, status post laceration. The scar was neither painful nor unstable (with frequent loss of covering of skin). There was one linear scar of the right upper extremity measuring 1.5 cm. There were no scars of the head, face, or neck. Significantly, the examiner found that the Veteran’s scar did not impact his ability to work. During the November 2015 VA elbow/forearm examination, the examiner diagnosed right forearm condition, status post laceration. The Veteran reported that, in October 2001, he slipped and went forward into an engine block where he was lacerated by a blunt piece of equipment. No stitches were provided. The condition had improved but there was residual itching at the scar site as well as a mass underneath the skin. On physical examination, there was no limitation of motion or evidence of painful motion the elbow. The Veteran was able to perform repetitive-use testing with three repetitions. There were no contributing factors of weakness, fatigability, incoordination, or pain during flare-ups or repeated use over time that could additionally limit the functional ability of the elbow. Muscle strength testing was normal and there was no muscle atrophy. The Veteran did not use any assistive devices as a normal or occasional mode of locomotion and there was no functional impairment of an extremity such that no effective function remained other than that which would be equally well served by an amputation with prosthesis. There were no other pertinent physical findings, complications, signs, and/or symptoms. Significantly, the examiner found that the Veteran’s right forearm condition did not impact his ability to work. During a November 2015 VA muscles examination, the examiner continued a diagnosis of right bicep strain. The Veteran reported that his condition resulted in moderate pain in the right bicep/elbow region. Specifically, he reported experiencing sharp, shooting pain which was localized in the right bicep/elbow region when attempting to pick up an object. Significantly, it was noted that the Veteran was right hand dominant. The disability affected muscle group V: flexor muscles of the elbow, triceps, brachialis, and brachoioradialis. Significantly, the examiner found that the muscle injury did not affect muscle substance or function but did cause occasional fatigue/pain. Muscle strength testing was normal and there was no muscle atrophy. The Veteran did not use any assistive devices as a normal or occasional mode of locomotion and there was no functional impairment of an extremity such that no effective function remained other than that which would be equally well served by an amputation with prosthesis. There were no other pertinent physical findings, complications, signs, and/or symptoms. With regard to functional impact, the examiner noted that the Veteran’s muscle injury did not impact his ability to work. Also of record are VA treatment records dated through March 2018 and private treatment records dated through August 2017, which, upon comparison to the VA examination reports, document similar findings. In this case, the Board further finds that the Veteran is entitled to a 10 percent rating under 38 C.F.R. § 4.118, DC 7804. Specifically, the August 2013 VA scar examiner noted that the Veteran’s scars were painful. Also, during the August 2013 VA hand/finger examination, the Veteran reported experiencing recurrent bumps on the index finger that will cause cyst formation that break by itself. As above, DC 7804 provides a 10 percent rating for one or two scars that are unstable or painful. As such, affording the Veteran the benefit of the doubt, a 10 percent disability rating is warranted for his scars of the right arm under DC 7804. As for the potential of an even higher rating, the Board further finds that a rating in excess of 10 percent is not warranted under the diagnostic codes pertaining to scars, 38 C.F.R. § 4.118, DCs 7800 to 7805, because the record does not show, and the Veteran does not contend, that the scars of the residuals, laceration, post-operative, left middle finger are deep or nonlinear. The record also does not show that the Veteran has three or more unstable or painful scars or scars with an area or areas of at least 39 square centimeters. Also, a higher rating is not warranted under DC 5206 as there is no evidence of loss of motion of the elbow or any other joint. Furthermore, a higher rating is not warranted under DC 5305 as there is no evidence of moderate muscle injury. The Board has considered the Veteran’s statements regarding the difficulty he has with his right arm causing him to miss work as well as his subjective symptoms, including fatigue and pain. However, the Board concludes that the medical findings on objective examinations are of greater probative value than the lay allegations regarding the severity of the Veteran’s right arm disability. Thus, although considered, the Veteran’s own assertions are not considered more persuasive than the motor and sensory testing results and pertinent clinical findings of record which, as indicated, do not warrant any higher schedular rating for the disability under consideration. REASONS FOR REMAND 1. Service connection for a right shoulder disorder is remanded. The Veteran contends that he injured his right shoulder during his military service and that he suffers from residuals of this injury. Service treatment records confirm that the Veteran injured his right shoulder in May 1998 at which time he was assessed as having a soft tissue injury. Also, in a November 2003 report of medical history, the Veteran reported experiencing “painful shoulder, elbow, or wrist” following a May 1998 injury. However, the Veteran’s November 2003 separation examination shows normal upper extremities. Post-service treatment records show complaints of right shoulder pain as early as November 2009 and a December 2009 magnetic resonance imaging (MRI) scan of the right shoulder shows an apparent remote injury of the anterior capsule and anterior labrum. The Veteran submitted an initial claim for a right shoulder disorder in May 2008. In connection with this claim, he was afforded a VA shoulder examination in August 2013. Significantly, the examiner diagnosed a right shoulder strain and opined that it was less likely than not that a right shoulder disorder was incurred in or caused by an accident that occurred during the Veteran’s military service. The examiner noted the Veteran’s in-service right shoulder injury but found that there were no medical records showing that the Veteran suffered from chronic right shoulder pain or a right shoulder disorder after his 1998 injury. Unfortunately, the Board finds that the August 2013 medical opinion is inadequate as it is based on factual inaccuracy. Significantly, the August 2013 VA examiner indicated that there were no complaints of right shoulder pain following the 1998 injury. However, as above, in a November 2003 report of medical history, the Veteran reported experiencing “painful shoulder, elbow, or wrist” following a May 1998 injury. Furthermore, post-service treatment records show complaints of right shoulder pain as early as November 2009 and also show MRI evidence of “apparent remote injury of the anterior capsule and anterior labrum” in December 2009. As the August 2013 medical opinion is based on factual inaccuracy, on remand, an addendum medical opinion should be obtained. 2. Service connection for a low back disorder is remanded. The Veteran contends that he injured his low back during his military service and that he suffers from residuals of this injury. Service treatment records confirm that the Veteran injured his low back in January 1996 and was treated for low back pain on several occasions during his military service including September 1997, July 1999, July 2001, August 2001, September 2001, October 2001, and January 2002. Significantly, he was assessed with a thoracolumbar sprain in September 2001. Also, in a November 2003 report of medical history, the Veteran reported experiencing “recurrent back pain or any back problem” since January 1996 with an injury in August 2001. However, the Veteran’s November 2003 separation examination shows a normal spine. Post-service treatment records show complaints of low back pain as early as August 2008. The Veteran submitted an initial claim for a low back disorder in May 2008. In connection with this claim, he was afforded a VA spine examination in August 2013. Significantly, the examiner diagnosed degenerative disc disease with retrolisthesis and degenerative arthritis of the lumbar spine and opined that it was less likely than not that a lumbar spine disorder was incurred in or caused by an accident that occurred during the Veteran’s military service. The examiner noted the Veteran’s in-service complaints of low back pain as well as his post-service August 2008 complaint of back pain but found that there were “no medical records to show that the [V]eteran had injuries to his back in the service.” Unfortunately, the Board finds that the August 2013 medical opinion is inadequate as it is based on factual inaccuracy. Significantly, the August 2013 VA examiner indicated that there were “no medical records to show that the [V]eteran had injuries to his back in the service.” However, as above, the Veteran’s service treatment records show that the Veteran fell and injured his low back during a fall in 2001. As the August 2013 medical opinion is based on factual inaccuracy, on remand, an addendum medical opinion should be obtained. 3. Service connection for residuals of a TBI, to include migraine headaches, is remanded. The Veteran contends that he experienced a TBI during his military service and that he suffers from residuals of this injury, to include migraine headaches. Specifically, he contends that, as a heavy equipment mechanic, he was exposed to muzzled blasts (standing about 20 feet from firing tanks) and that the sound knocked winds out of him. He also fell off tanks a few times with mild closed head injury (no loss of consciousness). Service treatment records are negative for a head injury in service. Significantly, in a November 2003 report of medical history, the Veteran specifically denied “a head injury, memory loss or amnesia” as well as “frequent or severe headaches.” Post-service VA treatment records show allegations of a TBI as early as August 2012. The Veteran was afforded a VA TBI examination in August 2013. Significantly, the examiner diagnosed a TBI and noted that symptoms included headaches two to three times per month, sensitivity to bright lights, and decreased short-term memory. The examiner also appeared to relate the Veteran’s TBI to his military service in Kosovo where, it was noted that, the Veteran participated in combat activity. The Veteran was also afforded a VA headaches examination in August 2013, at which time he was diagnosed with migraine headaches. While the August 2013 VA TBI examination report appears to relate the Veteran’s TBI to his military service, the examiner did not provide a rationale for this opinion. As the August 2013 VA examiner did not provide an appropriate medical opinion with supporting rationale, on remand, an addendum medical opinion should be obtained. Finally, with regard to all of the remanded issues, the Board notes that the most recent VA treatment records in the claims file are dated in March 2018. Given the necessity to remand these issues for other reasons, VA treatment records dated since March 2018 should be obtained prior to readjudication of the remanded issues. The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records dated since March 2018. 2. Request an addendum to the August 2013 VA shoulder examination. The claims file should be made available to the examiner. If the August 2013 VA examiner is not available, the claims file should be provided to an appropriate examiner to render the requested opinions. The need for an additional examination of the Veteran is left to the discretion of the clinician selected to write the addendum opinion. The examiner should then opine as to whether a right shoulder disability (to include right shoulder strain and/or “apparent remote injury of the anterior capsule and anterior labrum”) more likely, less likely, or at least as likely as not (50 percent or greater probability) began in or is otherwise related to his military service. The examiner should consider the Veteran’s lay statements regarding symptomatology since service and any other pertinent evidence in the claims file, to include a November 2003 report of medical history wherein the Veteran reported experiencing “painful shoulder, elbow, or wrist” following a May 1998 injury; post-service treatment records show complaints of right shoulder pain as early as November 2009; and also a December 2009 MRI showing “apparent remote injury of the anterior capsule and anterior labrum.” 3. Request an addendum to the August VA spine examination. The claims file should be made available to the examiner. If the August VA examiner is not available, the claims file should be provided to an appropriate examiner to render the requested opinions. The need for an additional examination of the Veteran is left to the discretion of the clinician selected to write the addendum opinion. The examiner should then opine as to whether the Veteran’s diagnosed degenerative disc disease with retrolisthesis and degenerative arthritis of the lumbar spine more likely, less likely, or at least as likely as not (50 percent or greater probability) began in or is otherwise related to his military service. The examiner should consider the Veteran’s lay statements regarding symptomatology since service and any other pertinent evidence in the claims file, to include the Veteran’s service treatment records show that the Veteran fell and injured his low back during a fall in 2001; the November 2003 report of medical history wherein the Veteran reported experiencing “recurrent back pain or any back problem” since January 1996 with an injury in August 2001; and post-service treatment records showing complaints of low back pain as early as August 2008. 4. Request an addendum to the August VA TBI examination. The claims file should be made available to the examiner. If the August VA examiner is not available, the claims file should be provided to an appropriate examiner to render the requested opinions. The need for an additional examination of the Veteran is left to the discretion of the clinician selected to write the addendum opinion. The examiner should then opine as to whether the Veteran’s diagnosed TBI and/or migraine headaches more likely, less likely, or at least as likely as not (50 percent or greater probability) began in or is otherwise related to his military service. The examiner should consider the Veteran’s lay statements regarding symptomatology since service and any other pertinent evidence in the claims file, to include the Veteran’s service treatment records which are negative for a TBI; the November 2003 report of medical history wherein the Veteran denied experiencing “a head injury, memory loss or amnesia” as well as “frequent or severe headaches;” and post-service treatment records showing complaints of a TBI as early as August 2012. 5. Readjudicate the claim. L.M. BARNARD Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD April Maddox, Counsel