Citation Nr: 18142247 Decision Date: 10/15/18 Archive Date: 10/15/18 DOCKET NO. 99-04 087A DATE: October 15, 2018 ORDER Entitlement to service connection for sinusitis, to include nasal polyps is denied. Entitlement to a rating in excess of 10 percent for scar, left eyebrow is denied. Entitlement to an effective date prior to February 20, 2009, for the grant of service connection of a right hip disability is denied. REMANDED Entitlement to service connection for sleep apnea is remanded. Entitlement to service connection for a lung condition, to include restrictive lung disease, to include as secondary to exposure to environmental agents is remanded. Entitlement to service connection for diabetes mellitus, to include as secondary to exposure to environmental agents is remanded. Entitlement to a rating in excess of 10 percent for a right hip disability is remanded. Entitlement to a rating in excess of 10 percent prior to June 26, 2015, for lumbosacral strain and in excess of 20 percent thereafter is remanded. Entitlement to a rating in excess of 20 percent for hypertension is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. FINDINGS OF FACT 1. The preponderance of the evidence is against a finding that the Veteran has, or has had at any time during the appeal, a diagnosis of a sinusitis, to include nasal polyps. 2. The Veteran’s left eye brow scar is painful, measures 1.65 square centimeters, and does not result in characteristic disfigurement. 3. On February 20, 2009, more than a year following the Veteran’s discharge from service, correspondence was received from Senator Feinstein’s congressional office, indicating that the Veteran wished to file an additional claim for entitlement to service connection for a right hip disability, which was considered to be an informal claim. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for sinusitis, to include nasal polyps have not been met. 38 U.S.C. §§ 1101, 1131, 1154(a), 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304. 2. The criteria for entitlement to a rating in excess of 10 percent for scar, left eyebrow have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.7, 4.21, 4.118, Diagnostic Codes (DC) 7800, 7804. 3. The criteria for entitlement to an effective date prior to February 20, 2009, for the grant of service connection of a right hip disability have not been met. 38 U.S.C. § 5110. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served in the United States Air Force from March 1976 to March 1980. The record reflects that the Veteran was afforded a Travel Board hearing in September 2014 before a Veterans Law Judge that is no longer with the Board and the Veteran subsequently elected to have an additional hearing. In July 2018, the Veteran, his spouse, and his children testified before the undersigned Veterans Law Judge at a videoconference hearing on the issues that the Veteran testified to in September 2014, and additional issues which were certified to the Board during the pendency of the appeal and have been properly merged for ease of adjudication. A transcript of that hearing has been associated with the record. When this claim was most recently before the Board in March 2015, the Board granted the Veteran’s claim for entitlement to service connection for a right hip disability and remanded the Veteran’s claims for entitlement to service connection for diabetes mellitus, entitlement to service connection for a sinus disability, entitlement to a rating in excess of 20 percent for hypertension, and entitlement to a rating in excess of 10 percent for lumbosacral strain. The claim has now returned to the Board for further appellate action. Neither the Veteran nor his representative has raised any issues with the duty to notify or duty to assist. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. If a condition noted during service is not shown to be chronic, then generally a showing of continuity of symptomatology after service is required for service connection. 38 C.F.R. § 3.303(b), Walker v. Shinseki 708 F.3d 1331. (Fed. Cir. 2013). Service connection may also be granted for any disease diagnosed after discharge from service when all of the evidence, including lay evidence, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). In order to establish service connection for a claimed disability, the following three elements must be satisfied: (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship (nexus) between the present disability and the disease or injury incurred or aggravated during service. Hickson v. West, 12 Vet. App. 246 (1999). Service connection may also be granted where disability is proximately due to or the result of already service-connected disability. 38 C.F.R. § 3.310. The requirement of a current disability is satisfied when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim. McClain v. Nicholson, 21 Vet. App. 319 (2007). In evaluating the evidence in an appeal, it is the responsibility of the Board to weigh the evidence and decide where to give credit and where to withhold same and, in doing so, accept certain medical opinions over others. Schoolman v. West, 12 Vet. App. 307 (1999). In this regard, the Board has been charged with the duty to assess the credibility and weight given to the evidence. Jandreau v. Nicholson, 492 F.3d 1372 (2007). Competent medical evidence is evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. It may also include statements conveying sound medical principles found in medical treatises and/or statements contained in authoritative writings, such as medical and scientific articles and research reports or analyses. 38 C.F.R. § 3.159(a)(1). Competent lay evidence is any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159(a)(2). This may include some medical matters, such as describing symptoms or relating a contemporaneous medical diagnosis. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Where there is an approximate balance of positive and negative evidence regarding any issue material to the determination of the matter, VA shall give the benefit of the doubt to the Veteran. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 1. Entitlement to service connection for sinusitis, to include nasal polyps The Veteran and his representative assert that he has sinusitis, to include nasal polyps, that began while he was on active duty service. A condition precedent for establishing service connection is the presence of a current disability. The question currently for the Board on this issue is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the Veteran does not have a current diagnosis of sinusitis, to include nasal polyps, and has not had one at any time during the pendency of the claim or recent to the filing of the claim. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); 38 C.F.R. § 3.303(a), (d). In this regard, the Board notes the Veteran’s most recent VA examination conducted in connection with his claim. During the July 2017 VA examination, the examiner indicated that the Veteran did have a diagnosis of allergic rhinitis, for which the Veteran’s already service-connected, but not chronic sinusitis. The examiner further noted that the Veteran’s nasal polyps were surgically removed in 1998. See, July 2017 VA examination. While the Veteran believes that he has a current diagnosis of sinusitis, to include nasal polyps, the Veteran is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. As the Board finds that the Veteran does not have a current diagnosis of sinusitis, service connection is therefore denied. Increased Rating Disability evaluations are determined by the application of a schedule of ratings, which is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. See 38 U.S.C. § 1155; 38 C.F.R. Part 4. The percentage ratings in VA’s Schedule for Rating Disabilities (Rating Schedule) represent as far as can practicably be determined the average impairment in earning capacity resulting from such disabilities and their residual conditions in civil occupations. See 38 C.F.R. § 4.1. Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability more closely approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107 (b); 38 C.F.R. §§ 3.102, 4.3. Where entitlement to compensation has already been established and increase in disability is at issue, the present level of disability is of primary concern. See Francisco v. Brown, 7 Vet. App. 55 (1994). However, “staged” ratings are appropriate where the factual findings show distinct time periods when the service-connected disability exhibits symptoms that would warrant different ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007). Separate compensable evaluations may be assigned for separate periods of time if such distinct periods are shown by the competent evidence of record during the appeal, a practice known as “staged” ratings. See Fenderson v. West, 12 Vet. App. 119, 126 (1999). The Board observes that the words “slight,” “moderate,” and “severe” are not defined in the Rating Schedule. Rather than applying a mechanical formula, the Board must evaluate all of the evidence to the end that its decisions are “equitable and just.” 38 C.F.R. § 4.6 (2016). It should also be noted that use of descriptive terminology such as “mild” by medical examiners, although an element of evidence to be considered by the Board, is not dispositive of an issue. All evidence must be evaluated in arriving at a decision regarding an increased rating. 38 U.S.C. § 7104 (a); 38 C.F.R. §§ 4.2, 4.6. Once the evidence has been assembled, it is the Board’s responsibility to evaluate the evidence. 38 U.S.C. § 7104 (a) (West 2014). 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 (2016); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 2. Entitlement to a rating in excess of 10 percent for scar, left eyebrow The Veteran and his representative assert that he is entitled to a rating in excess of 10 percent for service-connected scar, left eyebrow. The Veteran’s service-connected scar is currently rated under Diagnostic Code 7804. Pursuant to Diagnostic Code 7804, one or two scars that are unstable or painful warrant a 10 percent rating; three or four scars that are unstable or painful warrant a 20 percent rating; and five or more scars that are unstable or painful warrant a 30 percent rating. An unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. See, 38 C.F.R. § 4.118, Diagnostic Code 7804, Note (1). Scars evaluated under Diagnostic Codes 7800, 7801, 7802, or 7805 may also receive an evaluation under Diagnostic Code 7804, when applicable. See 38 C.F.R. § 4.118, Diagnostic Code 7804, (Note 3). The Board will not only consider the criteria under the currently assigned diagnostic code, but also the criteria set forth in other potentially applicable diagnostic codes, such as Diagnostic Code 7800. Under Diagnostic Code 7800, a 10 percent rating is warranted for scars that are located on the head, face, or neck when there is one characteristic of disfigurement. See, 38 C.F.R. § 4.118, Diagnostic Code 7800. A 30 percent rating is warranted when there is visible or palpable tissue loss and either gross distortion or asymmetry of one feature or paired set of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, or lips), or; with two or three characteristics of disfigurement. Id. A 50 percent rating is warranted when there is visible or palpable tissue loss and either gross distortion or asymmetry of two features or paired sets of features, or; with four or five characteristics of disfigurement. Id. An 80 percent rating is warranted when there is visible or palpable tissue loss and either gross distortion or asymmetry of three or more features or paired sets of features, or; with six or more characteristics of disfigurement. Id. For purposes of evaluation of under 38 C.F.R. § 4.118, the eight characteristics of disfigurement are: a scar that is five or more inches, or thirteen centimeters, in length; a scar that is at least one-quarter of an inch, or 0.6 centimeters, wide at the widest part; surface contour of the scar that is elevated or depressed on palpation; a scar that is adherent to underlying tissue; skin that is hypo- or hyper-pigmented in an area exceeding six square inches, or 39 square centimeters; skin texture that is abnormal (irregular, atrophic, shiny, scaly, etc.) in an area exceeding six square inches, or 39 square centimeters; underlying soft tissue that is missing in an area exceeding six square inches, or 39 square centimeters; and skin that is indurated and inflexible in an area exceeding six square inches, or 39 square centimeters. See, 38 C.F.R. § 4.118, Diagnostic Code 7800, Note 1. VA is to consider unretouched color photographs when evaluating under these criteria. Id. at Note 3. Additionally, VA is to separately evaluate disabling effects other than disfigurement that are associated with individual scars of the head, face, or neck, such as pain, instability, and residuals of associated muscle or nerve injury, under the appropriate diagnostic code(s) and apply 38 C.F.R. § 4.25 to combine the evaluation(s) with the evaluation assigned under Diagnostic Code 7800. Id. at Note 4. Finally, the characteristics of disfigurement may be caused by one scar or by multiple scars; the characteristics that are required to assign a particular evaluation need not be caused by a single scar in order to assign that evaluation. Id. at Note 5. The Veteran was most recently afforded a VA scars examination in July 2017. At this examination, the Veteran’s left eye scar was noted to be painful when intense pressure was applied to it. Additionally, it was noted that there was underlying soft tissue missing in an area totaling 1.65 square centimeters. See, July 2017 VA examination. During this examination, no other disfiguring characteristics were reported, no distortion of facial features and tissue loss were noted, and there was no indication of limitation of function due to the scar. Accordingly, based on the above, the Board finds that a compensable rating under Diagnostic Code 7800 is not warranted as the preponderance of the evidence is against a finding that the Veteran’s left eyebrow scars satisfies the criteria for characteristics of disfigurement under 38 C.F.R. § 4.118. 38 C.F.R. § 4.118, Diagnostic Code 7800, Note 1. Additionally, there is no indication that the Veteran has surface contour of the scar that is elevated or depressed on palpation; that the scar is adherent to underlying tissue; that the Veteran’s skin is hypo- or hyper-pigmented in an area exceeding six square inches, or 39 square centimeters; that the Veteran has abnormal skin texture (irregular, atrophic, shiny, scaly, etc.) in an area exceeding six square inches, or 39 square centimeters; that underlying soft tissue is missing in an area exceeding six square inches, or 39 square centimeters; or that the Veteran’s skin is indurated and inflexible in an area exceeding six square inches, or 39 square centimeters. As there is no competent evidence of characteristics of disfigurement, a compensable rating is not warranted under Diagnostic Code 7800. Turning to Diagnostic Code 7804, the Board notes, as outlined above, that in order to be entitled to a rating of 20 percent, the evidence must show that the Veteran has three or four scars that are unstable or painful; and a 30 percent rating is warranted for five or more scars that are unstable or painful. See, 38 C.F.R. § 4.118, Diagnostic Code 7804. As the Veteran’s July 2017 VA examination indicated that the Veteran has one scar that is painful, a rating in excess of 10 percent is not warranted, as the preponderance of the evidence is against a finding of three or four scars that are unstable or painful. As Diagnostic Codes 7801 and 7802 only pertain to scars that are not of the head, face, or neck, those provisions are inapplicable and do not support a rating in excess of 10 percent at any time during the course of the appeal. See 38 C.F.R. § 4.118, Diagnostic Codes 7801, 7802. Finally, as there is no indication of any other disabling effects that would warrant evaluation under an appropriate diagnostic code, an increased rating under Diagnostic Code 7805 is not warranted. See 38 C.F.R. § 4.118, Diagnostic Code 7805. Specifically, the examination reports provide that aside from the Veteran’s subjective reports of pain and discomfort, there are no other pertinent symptoms associated with his neck scar, such as instability. Moreover, the May 2011 examination report provides that his neck scar poses no significant effects on occupational activities, and that it does not affect his usual daily activities. Accordingly, based on the above, the Board finds that the preponderance of the evidence is against the Veteran’s claim and therefore, entitlement to a rating in excess of 10 percent for scar, left eyebrow, is denied. Earlier Effective Date The statutory guidelines for the determination of an effective date of an award of disability compensation are set forth in 38 U.S.C. § 5110. Except as otherwise provided, the effective date of an evaluation and award of compensation based on an original claim, a claim reopened after a final disallowance, or a claim for increase will be the date of receipt of the claim or the date entitlement arose, whichever is the later. 38 C.F.R. § 3.400. Effective March 24, 2015, a specific claim in the form prescribed by VA must be filed in order for benefits to be paid or furnished to any individual administered by VA. 38 U.S.C. § 5101 (a)(2012); 38 C.F.R. § 3.151(a). In cases involving direct service connection, the effective date will be the day following separation from active service or the date entitlement arose if the claim is received within one year after separation from service. Otherwise, the effective date will be the date of receipt of the claim or the date entitlement arose, whichever is later. 38 C.F.R. § 3.400(b)(2)(i). In cases involving new and material evidence, where evidence other than service department records is received within the relevant appeal period or prior to the issuance of the appellate decision, the effective date will be as though the former decision had not been rendered. 38 C.F.R. § 3.400(q)(1)(i). In cases where the evidence is received after the final disallowance, the effective date is the date of receipt of the new claim or the date entitlement arose, whichever is later. 38 C.F.R. § 3.400 (q)(1)(ii). 3. Entitlement to an effective date prior to February 20, 2009, for the grant of service connection of a right hip disability The Veteran and his representative assert that the Veteran is entitled to an effective date prior to February 20, 2009, for the grant of service connection of a right hip disability. Following a review of the record, the Board finds that the preponderance of the evidence is against a claim for entitlement to an effective date prior to February 20, 2009. The record reflects that on February 20, 2009, VA received congressional correspondence from the Veteran’s congresswoman indicating that intent to file a claim for entitlement to service connection for a right hip disability. The Regional Office interpreted this correspondence as an informal claim for service connection for a right hip disability. While the Veteran asserts that he suffered from a right hip disability prior to February 20, 2009, there is no indication of a claim, either formal or informal, for service connection for a right hip disability prior to the informal claim received on February 20, 2009. As there is no indication of a claim, either formal or informal, for service connection for a right hip disability within one year of the Veteran’s date of separation from active service in March 1980, or any other date prior to February 20, 2009, the Board finds that the appropriate date for the establishment of service connection is based upon the date of which the informal claim for entitlement to service connection for a right hip disability was received, which is February 20, 2009. REASONS FOR REMAND 1. Entitlement to service connection for obstructive sleep apnea is remanded, The record reflects that the Veteran has not been afforded a VA examination in connection with his claim for entitlement to service connection for obstructive sleep apnea. During the Veteran’s July 2018 videoconference hearing, the Veteran and his spouse testified that his current obstructive sleep apnea symptoms had their onset while the Veteran was in service and that the same symptoms have continued since. See, July 2018 hearing transcript. The Veteran’s claim for entitlement to service connection for obstructive sleep apnea was previously denied on the basis that the Veteran did not receive treatment for obstructive sleep apnea while he was in service. As the Board finds that the Veteran and his spouse provided competent and credible testimony regarding the onset of the Veteran’s obstructive sleep apnea symptoms but finds that the medical evidence of record does not contain sufficient competent medical evidence to determine if the Veteran’s obstructive sleep apnea is etiologically related to his active duty service and therefore, an examination is warranted. 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson 20 Vet. App. 79, 81 (2006). 2. Entitlement to service connection for a lung condition, to include restrictive lung disease, to include as secondary to exposure to environmental agents is remanded. 3. Entitlement to service connection for diabetes mellitus, to include as secondary to exposure to environmental agents is remanded. Pursuant to the Board’s March 2015 remand, the Veteran was scheduled VA examinations in connection with his claims for service connection for a lung condition and for diabetes mellitus, both to include as due to herbicides, pesticides, mustard gas, asbestos, and other environmental chemicals. The RO was also asked to address the Veteran’s contentions regarding his exposure to those chemicals by complying with certain VA procedures. Following a review of the record, the Board notes that the RO only addressed the Veteran’s contentions of exposure to Agent Orange and asbestos, and did not address his alleged exposure to pesticides, mustard gas, and other environmental chemicals. With respect to the Veteran’s claim for service connection for diabetes mellitus, the June 2015 VA examiner provided an opinion as to whether the Veteran’s diabetes mellitus was directly due to service or whether it was caused or aggravated by any jet fuel exposure, but did not provide an opinion as to whether or not the Veteran’s diabetes mellitus was possibly related to his alleged chemical and environmental agent exposures. See, June 2015 VA examination. As to the Veteran’s lung condition, the April 2017 VA examiner only addressed whether or not the Veteran’s conceded exposure to jet fuel could cause restrictive lung disease and also did not address the other toxins that the Veteran has alleged exposure to. Accordingly, a remand is warranted to ensure compliance with the March 2015 Board remand directive to assess the Veteran’s alleged exposure to pesticides, mustard gas, and other environmental chemicals during his active duty service and to obtain more complete medical opinions, also as directed by the March 2015 remand. Stegall v. West, 11. Vet. App. 268 (1998); Barr v. Nicholson, 21 Vet. App. 2007. 4. Entitlement to a rating in excess of 10 percent for a right hip disability is remanded. 5. Entitlement to a rating in excess of 10 percent prior to June 26, 2015, for lumbosacral strain and in excess of 20 percent thereafter is remanded. 6. Entitlement to a rating in excess of 20 percent for hypertension is remanded. During the Veteran’s July 2018 videoconference hearing, the Veteran testified that his service-connected right hip disability, lumbosacral strain and hypertension have gotten worse since his last VA examinations. Specifically, with respect to his hip and lumbosacral strain, the Veteran stated that his pain has significantly increased and has gotten to the point where he is unable to support himself and that his range of motion has decreased. See, July 2018 hearing transcript. With respect to the Veteran’s hypertension, the Veteran stated that he has been having more difficulty keeping his blood pressure under control and his doctor has expressed concern that his inability to control his blood pressure may result in a cardiac event. Id. Accordingly, VA is required to afford the Veteran with contemporaneous VA examinations to assess the current nature, extent, and severity of his right hip disability, lumbosacral strain, and hypertension, as the Veteran’s most recent VA examinations may no longer reflect an accurate picture of the Veteran’s disability. Snuffer v. Gober, 10 Vet. App. 400 (1997). 7. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. Finally, with respect to the Veteran’s claim for entitlement to a TDIU, the Board notes that this claim is also inextricably intertwined with his increased rating claims that remain appeal. Accordingly, the Board will therefore defer any action with respect to this claim until the completion of the development noted above. Harris v. Derwinski, 1 Vet. App. 180 (1991). The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records and associate them with the Veteran’s claims file. 2. Attempt to verify the Veteran’s contentions through appropriate agencies regarding being exposed to pesticides, mustard gas, and other environmental toxins as outlined by the Veteran. 3. Then, and following the receipt of any outstanding VA records, schedule the Veteran for VA examinations with the appropriate medical personnel in connection with his outstanding claims. The Veteran’s claims file, to include a copy of this remand, should be provided to the examiner. Following a complete review of the record, the examiner is asked to provide the following opinions: a. Whether it is at least as likely as not that the Veteran’s obstructive sleep apnea had its onset during service or is otherwise etiologically related to the Veteran’s active duty service. In providing this opinion, the examiner is specifically asked to address the testimony provided by the Veteran and his spouse regarding the onset of his obstructive sleep apnea symptoms. b. Whether it is at least as likely as not that the Veteran’s lung condition, to include restrictive lung disease, is either caused or aggravated by the Veteran’s alleged exposure to environmental agents. The examiner is asked to specifically address the specific environmental agents that the Veteran alleges exposure to, such as pesticides, mustard gas, tear gas, and others. c. Whether it is at least as likely as not that the Veteran’s diabetes mellitus is either caused or aggravated by the Veteran’s alleged exposure to environmental agents. The examiner is asked to specifically address the specific environmental agents that the Veteran alleges exposure to, such as pesticides, mustard gas, tear gas, and others. d. Determine the current severity of the Veteran’s right hip disability. The examiner is asked to address the Veteran’s lay statements provided during his sworn testimony during the July 2018 videoconference hearing. e. Determine the current severity of the Veteran’s lumbosacral strain. The examiner is asked to address the Veteran’s lay statements provided during his sworn testimony during the July 2018 videoconference hearing. f. Determine the current severity of the Veteran’s hypertension. The examiner is asked to address the Veteran’s lay statements provided during his sworn testimony during the July 2018 videoconference hearing. All opinions provided must be supported by a complete rationale. If the examiner must resort to speculation for any of the requested opinions, an explanation as to why this is so is required. Michael J. Skaltsounis Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD P. Daugherty, Associate Counsel