Citation Nr: 18143229 Decision Date: 10/18/18 Archive Date: 10/18/18 DOCKET NO. 15-25 681 DATE: October 18, 2018 ORDER The issue of whether new and material evidence has been received to reopen a previously denied claim for entitlement to service connection for left knee strain is dismissed. The issue of whether new and material evidence has been received to reopen a previously denied claim for entitlement to service connection for plantar and retrocalcaneal spurs of the left foot with degenerative joint disease (DJD) is dismissed. The issue of whether new and material evidence has been received to reopen a previously denied claim for entitlement to service connection for strained calf muscle/pulled left hamstring is dismissed. The issue of entitlement to service connection for a left shoulder disorder is dismissed. Restoration of the 10 percent rating for old healed fracture, right long finger, effective from April 1, 2017, is granted. Entitlement to service connection for a psychiatric disorder other than attention deficit disorder (ADD) and posttraumatic stress disorder (PTSD), diagnosed as depressive disorder not otherwise specified (NOS), is granted as secondary to service-connected right ankle sprain. New and material evidence not having been received, the application to reopen a previously denied claim for entitlement to service connection for a low back disorder is denied. REMANDED Entitlement to an increased disability rating in excess of 10 percent for residuals of a right ankle sprain is remanded. Entitlement to an increased disability rating in excess of 10 percent for old healed fracture, right long finger, is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. FINDINGS OF FACT 1. In a September 2018 written statement, prior to the promulgation of a decision in the appeal, the Veteran requested that his appeal of the issues of whether new and material evidence has been received to reopen a previously denied claim for entitlement to service connection for left knee strain; whether new and material evidence has been received to reopen a previously denied claim for entitlement to service connection for plantar and retrocalcaneal spurs of the left foot with DJD; whether new and material evidence has been received to reopen a previously denied claim for entitlement to service connection for strained calf muscle/pulled left hamstring; and entitlement to service connection for a left shoulder disorder be withdrawn. 2. In a January 2017 rating decision, the RO reduced the evaluation for the Veteran's service-connected old healed fracture, right long finger, from 10 percent to a noncompensable rating, effective from April 1, 2017. 3. At the time of the January 2017 rating decision, the 10 percent evaluation for old healed fracture, right long finger, had been in effect for less than five years. 4. At the time of the January 2017 rating decision, the evidence did not establish that an improvement in the Veteran's service-connected old healed fracture, right long finger, had actually occurred which resulted in an improvement in his ability to function under the ordinary conditions of life. 5. There is no verified in-service stressor for the Veteran’s claimed PTSD. 6. The Veteran's psychiatric disorder other than ADD and PTSD, diagnosed as depressive disorder NOS, is attributable to his service-connected right ankle sprain. 7. In a February 2012 rating decision, the RO denied the Veteran’s service connection claim for a low back disorder. Although the Veteran filed a notice of disagreement in June 2012, and a statement of the case was issued in December 2013, he did not file a timely substantive appeal, and no new and material evidence was received prior to the expiration of the appeal period. 8. In a June 2014 rating decision, the RO reopened and denied the Veteran's service connection claim for a low back disorder. The Veteran was informed of that decision and his appellate rights, but he did not appeal or submit new and material evidence within one year. 9. The evidence received since the June 2014 rating decision is cumulative and redundant of the evidence of record at that time, and does not raise a reasonable possibility of substantiating the claim of entitlement to service connection for a low back disorder. CONCLUSIONS OF LAW 1. The criteria for withdrawal of the appeal of the issue of whether new and material evidence has been received to reopen a previously denied claim for entitlement to service connection for left knee strain, have been met. 38 U.S.C. § 7105(b)(2), (d)(5); 38 C.F.R. § 20.204. 2. The criteria for withdrawal of the appeal of the issue of whether new and material evidence has been received to reopen a previously denied claim for entitlement to service connection for plantar and retrocalcaneal spurs of the left foot with DJD, have been met. 38 U.S.C. § 7105(b)(2), (d)(5); 38 C.F.R. § 20.204. 3. The criteria for withdrawal of the appeal of the issue of whether new and material evidence has been received to reopen a previously denied claim for entitlement to service connection for strained calf muscle/pulled left hamstring, have been met. 38 U.S.C. § 7105(b)(2), (d)(5); 38 C.F.R. § 20.204. 4. The criteria for withdrawal of the appeal of the issue of entitlement to service connection for a left shoulder disorder, have been met. 38 U.S.C. § 7105(b)(2), (d)(5); 38 C.F.R. § 20.204. 5. Restoration of the 10 percent evaluation for old healed fracture, right long finger, is warranted. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.102, 3.105, 3.344(c), 4.71a, Diagnostic Codes 5266, 5229. 6. The Veteran's psychiatric disorder other than ADD and PTSD, diagnosed as depressive disorder NOS, is proximately due to, or the result of, his service-connected right ankle sprain. 38 U.S.C. §§ 1101, 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 7. The June 2014 rating decision that reopened and denied the Veteran’s claim of entitlement to service connection for a low back disorder is final. 38 U.S.C. § 7105; 38 C.F.R. § 3.156. 8. New and material evidence has not been received to reopen the claim of entitlement to service connection for a low back disorder. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty service in the United States Army from April 1990 to July 1993. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from rating decisions dated in March 2012, October 2013, October 2016, and January 2017. The October 2013 rating decision denied the Veteran’s service connection claim for anxiety/PTSD. The record reflects that the RO previously denied the issue of entitlement to service connection for ADD in a February 2012 rating decision. However, the RO did not consider the Veteran’s currently diagnosed psychiatric disorders or adjudicate the issue of entitlement to service connection for PTSD in that decision. The Board also notes that PTSD has unique evidentiary and regulatory requirements. See 38 C.F.R. § 3.304(f). Subsequently, in April 2012, the Veteran filed a claim for service connection for anxiety and PTSD. The Federal Circuit Court has held that claims that are based on distinctly and properly diagnosed diseases or injuries must be considered separate and distinct claims for new and material evidence purposes. See Boggs v. Peake, 520 F.3d 1330 (Fed. Cir. 2008). See also Ephraim v. Brown, 82 F.3d 399, 402 (Fed. Cir. 1996) ((a newly diagnosed psychiatric disorder (e.g., PTSD), even if medically related to a previously diagnosed disorder (such as depressive neurosis), is not the same for jurisdictional purposes when it has not previously been considered). Therefore, the Board has determined that a de novo service connection analysis is proper for the psychiatric disorder issue on appeal. See also Velez v. Shinseki, 23 Vet. App. 199, 204 (2009) (when determining whether a new and material evidence analysis is required, the focus VA's analysis must be on whether the evidence presented truly amounts to a new claim "based upon distinctly diagnosed diseases or injuries," or whether it is evidence tending to substantiate an element of the previously adjudicated matter. Velez v. Shinseki, 23 Vet. App. 199, 204 (2009). Here, PTSD and anxiety disorder were not previously adjudicated in any way by the RO; thus, it constitutes a new and distinct claim. As the record reflects that the Veteran has received diagnoses for different psychiatric disorders during the appeal period, the Board has expanded the claim to encompass all currently diagnosed psychiatric disorders other than ADD. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). I. Duties to Notify and Assist 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). II. Law and Analysis 1. Whether new and material evidence has been received to reopen a previously denied claim for entitlement to service connection for left knee strain; whether new and material evidence has been received to reopen a previously denied claim for entitlement to service connection for plantar and retrocalcaneal spurs of the left foot with DJD; whether new and material evidence has been received to reopen a previously denied claim for entitlement to service connection for strained calf muscle/pulled left hamstring; and entitlement to service connection for a left shoulder disorder. The Board may dismiss any appeal which fails to allege specific error of fact or law in the determination being appealed. 38 U.S.C. § 7105. An appeal may be withdrawn as to any or all issues involved in the appeal at any time before the Board promulgates a decision. 38 C.F.R. § 20.204. Withdrawal may be made by the veteran or by his authorized representative. Except for appeals withdrawn on the record at a hearing, appeal withdrawals must be in writing. 38 C.F.R. § 20.204. In a September 2018 written statement, the Veteran requested to withdraw the issues of whether new and material evidence has been received to reopen a previously denied claim for entitlement to service connection for left knee strain; whether new and material evidence has been received to reopen a previously denied claim for entitlement to service connection for plantar and retrocalcaneal spurs of the left foot with DJD; whether new and material evidence has been received to reopen a previously denied claim for entitlement to service connection for strained calf muscle/pulled left hamstring; and entitlement to service connection for a left shoulder disorder. Given that there remain no allegations of errors of fact or law for appellate consideration, the Board does not have jurisdiction to review these appeals, and they are dismissed. 2. The propriety of the reduction in the evaluation of old healed fracture, right long finger, from 10 percent to a noncompensable rating, effective from April 1, 2017. Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4. The rating 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. § 1155; 38 C.F.R. § 4.1. In the rating schedule, separate diagnostic codes identify the various disabilities. The basis of disability evaluations is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. Evaluations are based upon lack of usefulness of the part or system affected, especially in self-support. 38 C.F.R. § 4.10. Over a period of many years, a veteran's disability claim may require ratings in accordance with changes in laws, medical knowledge, and his or her physical or mental condition. 38 C.F.R. § 4.1. Where a reduction in evaluation of a service-connected disability or employability status is contemplated and the lower evaluation would result in a reduction or discontinuance of compensation payments, a rating proposing the reduction or discontinuance will be prepared setting forth all material facts and reasons. The beneficiary will be notified at his or her last address of record of the contemplated action and furnished detailed reasons therefor, and be given 60 days for the presentation of additional evidence to show that compensation payments should be continued at the present level. If additional evidence is not received within that period, final rating action will be taken and the award will be reduced or discontinued effective the last day of the month in which a 60-day period from the date of notice to the beneficiary of the final rating action expires. 38 C.F.R. § 3.105(e). The beneficiary will be informed that he or she may request a predetermination hearing, provided that a request for such a hearing is received by VA within 30 days from the date of the notice. If a timely request is received, VA will notify the beneficiary in writing of the time and place of the hearing at least 10 days in advance of the scheduled hearing date. The hearing will be conducted by VA personnel who did not participate in the proposed adverse action and who will bear the decision-making responsibility. If a predetermination hearing is timely requested, benefit payments shall be continued at the previously established level pending a final determination concerning the proposed action. 38 C.F.R. § 3.105(i). These are such important safeguards that the United States Court of Appeals for Veterans Claims (Court) has held that where VA has reduced a veteran's rating without observance of applicable law and regulation, such a rating is void ab initio. Brown v. Brown, 5 Vet. App. 413, 422 (1993). Thus, to remedy such cases, the decision must be reversed as unlawful. Dofflemyer v. Derwinski, 2 Vet. App. 277 (1992). Under 38 C.F.R. § 3.344(c), when a rating has been in effect for less than five years, reexaminations disclosing improvement will warrant a rating reduction. Prior to reducing a veteran's disability rating, however, VA must comply with several general VA regulations applicable to all rating-reduction cases, regardless of the rating level or the length of time that the rating has been in effect. These provisions require that VA rating reductions, as with all VA rating decisions, be based on review of the entire history of the disability. Faust v. West, 13 Vet. App. 342, 349 (2000) (citing 38 C.F.R. §§ 4.1, 4.2, 4.10, Brown, 5 Vet. App. at 420, and Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991)). In any rating reduction case, VA must ascertain, based upon review of the entire recorded history of the condition, whether the evidence reflects an actual change in the disability and whether the examination reports reflecting such change are based upon thorough examinations. Not only must it be determined that an improvement in a disability has actually occurred, but also that that improvement in a disability actually reflects an improvement in the veteran's ability to function under the ordinary conditions of life and work. Brown, 5 Vet. App. at 421; see also Schafrath, 1 Vet. App. at 594 ("[T]hese requirements for evaluation of the complete medical history of the claimant's condition operate to protect claimants against adverse decisions based on a single, incomplete[,] or inaccurate report and to enable VA to make a more precise evaluation of the level of disability and of any changes in the condition.") and 38 C.F.R. § 3.344 (c). In considering the propriety of a reduction, the Board must focus on the evidence available to the RO at the time the reduction was effectuated, although post-reduction medical evidence may be considered in the context of evaluating whether the condition had demonstrated actual improvement. Dofflemyer v. Derwinski, 2 Vet. App. 277 (1992). Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits. VA shall consider all information and lay and medical evidence of record in a case and when there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, the weight of the evidence must be against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). In considering the evidence of record under the laws and regulations as set forth above, the Board concludes that restoration of the 10 percent evaluation for the Veteran's service-connected old healed fracture, right long finger, effective from April 1, 2017, is warranted. Initially, the Board finds that the RO complied with the procedural requirements of 38 C.F.R. § 3.105 in reducing the Veteran's evaluation. The RO provided the Veteran with a letter in October 2016, notifying him of the proposed reduction in the corresponding rating decision, his right to present additional evidence within 60 days, and his right to request a hearing. Thereafter, the January 2017 rating decision effectuating the reduction was not issued until the appropriate time period had elapsed, and the effective date of the reduction was in accordance with applicable criteria. Nevertheless, the evidence at the time of the January 2017 rating decision did not establish that an improvement in the Veteran's old healed fracture, right long finger, had actually occurred which resulted in an improvement in his ability to function under the ordinary conditions of life. In a June 2014 rating decision, the RO granted entitlement to service connection for old healed fracture, right long finger, and assigned a 10 percent rating effective from January 30, 2014. The disability was evaluated under 38 C.F.R. § 4.71a, Diagnostic Code 5226. When the January 2017 rating decision reduced the disability rating to a noncompensable evaluation effective from April 1, 2017, the RO changed the diagnostic code to 5229. 38 C.F.R. § 4.71a. Disability of the musculoskeletal system is primarily the inability, due to damage of inflection in the parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. It is essential that the examination on which ratings are based adequately portray the anatomical damage and the functional loss with respect to all these elements. The functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated structures, or to deformity, adhesions, defective innervation, or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part of which becomes painful on use must be regarded as seriously disabled. 38 C.F.R. §§ 4.40, 4.45. VA must analyze the evidence of pain, weakened movement, excess fatigability, or incoordination and determine the level of associated functional loss in light of 38 C.F.R. § 4.40, which requires the VA to regard as "seriously disabled" any part of the musculoskeletal system that becomes painful on use. DeLuca v. Brown, 8 Vet. App. 202 (1995). Although pain may be a cause or manifestation of functional loss, limitation of motion due to pain is not necessarily rated at the same level as functional loss where motion is impeded. See Mitchell v. Shinseki, 25 Vet. App. 32 (2011); c.f. Powell v. West, 13 Vet. App. 31, 34 (1999); Hicks v. Brown, 8 Vet. App. 417, 421 (1995); Schafrath v. Derwinski, 1 Vet. App. 589, 592 (1991). The possible manifestations of functional loss include decreased or abnormal excursion, strength, speed, coordination, or endurance (38 C.F.R. § 4.40), as well as less or more movement than is normal, weakened movement, excess fatigability, and pain on movement (as well as swelling, deformity, and atrophy) that affects stability, standing, and weight-bearing (38 C.F.R. § 4.45). Thus, functional loss caused by pain must be rated at the same level as if the functional loss were caused by any of the other factors cited above. Therefore, in rating the severity of a joint disability, VA must determine the overall functional impairment due to these factors. Mitchell, 25 Vet. App. at 32. The provisions of 38 C.F.R. § 4.14 (avoidance of pyramiding) do not forbid consideration of a higher rating based on greater limitation of motion due to pain on use, including during flare-ups. The guidance provided under DeLuca must be followed in adjudicating claims where a rating under the provisions of 38 C.F.R. § 4.40 and 38 C.F.R. § 4.45, should only be considered in conjunction with the Diagnostic Code provisions predicated on limitation of motion. Johnson v. Brown, 9 Vet. App. 7 (1996). The intent of the Rating schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. It is the intention to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59. The evidence from this period reflects that the Veteran's right hand is his dominant hand. As such, major finger disability ratings are applicable. 38 C.F.R. § 4.69. Under Diagnostic Code 5226, ankylosis of the long finger, unfavorable or favorable, warrants a 10 percent evaluation. 38 C.F.R. § 4.71a, Diagnostic Code 5226. VA also must consider whether evaluation as amputation is warranted and whether an additional evaluation is warranted for resulting limitation of motion of other digits or interference with overall function of the hand. 38 C.F.R. § 4.71a, Note following Diagnostic Code 5226. Limitation of motion in the index or long finger is rated under Diagnostic Code 5229. 38 C.F.R. § 4.71a, Diagnostic Code 5229. A noncompensable evaluation is awarded with a gap of less than one inch (2.5 cm.) between the fingertip and the proximal transverse crease of the palm, with the finger flexed to the extent possible, and; extension is limited by no more than 30 degrees. A maximum 10 percent rating is assigned when there is a gap of one inch or more between the fingertip and the proximal transverse crease of the palm, with the finger flexed to the extent possible, or; with extension limited by more than 30 degrees. Id. Ankylosis is an immobility and consolidation of a joint due to disease, injury or surgical procedures. See Shipwash v. Brown, 8 Vet. App. 218, 221 (1995). A disability is to be evaluated as unfavorable ankylosis, if both the metacarpophalangeal (MP) and the proximal interphalangeal (PIP) joints of a digit are ankylosed; or if only the MP or the PIP joint is ankylosed and there is a gap of more than two inches (5.1 centimeters) between the fingertips and the proximal transverse crease of the palm (palm crease), with fingers flexed to the extent possible. Whereas, a disability is to be evaluated as favorable ankylosis, if only the MCP or the PIP joint is ankylosed, and there is a gap of two inches (5.1 centimeters) or less between the fingertips and the palm crease. 38 C.F.R. § 4.71a, Diagnostic Codes 5216-5230, Note 3. For the index, long, ring, and little fingers (digits II, III, IV, and V), zero degrees of flexion represents the fingers fully extended, making a straight line with the rest of the hand. The position of function of the hand is with the wrist dorsiflexed 20 to 30 degrees, the MCP and PIP joints flexed to 30 degrees, and the thumb (digit I) abducted and rotated so that the thumb pad faces the finger pads. Only joints in these positions are considered to be in favorable position. For digits II through V, the MCP joint has a range of zero to 90 degrees of flexion, the PIP joint has a range of zero to 100 degrees of flexion, and the distal (terminal) interphalangeal (DIP) joint has a range of zero to 70 or 80 degrees of flexion. See 38 C.F.R. § 4.71a, Diagnostic Codes 5216-5230, Note (1). When two or more digits of the same hand are affected by any combination of amputation, ankylosis, or limitation of motion that is not otherwise specified in the rating schedule, the evaluation level assigned will be that which best represents the overall disability (i.e., amputation, unfavorable or favorable ankylosis, or limitation of motion), assigning the higher level of evaluation when the level of disability is equally balanced between one level and the next higher level. See 38 C.F.R. § 4.71a, Diagnostic Codes 5216-5230, Note (2). If there is limitation of motion of two or more digits, evaluate each digit separately and combine the evaluations. See 38 C.F.R. § 4.71, Diagnostic Codes 5216-5230, Note 5. The Veteran’s right finger disability was initially evaluated during a May 2014 VA examination. The diagnosis was old healed fracture of the right long finger. The examiner noted that the Veteran's right middle finger fracture had caused chronic limitation of the MCP joint range of motion and function. The Veteran also had pain when trying to use his right middle finger. The right long finger was the only digit that had limitation of motion. The Veteran was able to oppose his right thumb, and the gap between the thumb pad and the fingers was more than 2 inches (5.1 centimeters). Pain began at that point. There was a 1 inch (2.5 centimeter) gap between the right long finger and the proximal transverse crease of the thumb, with painful motion beginning at a gap of 1 inch or more. The examiner determined that there was no limitation of extension or associated evidence of painful motion for the index or long finger. There was also no change in these findings with repetitive use testing. The examiner additionally reported the right long finger experienced functional loss in the form of less movement than normal; weakened movement; excess fatigability; incoordination, impaired ability to execute skilled movements smoothly; pain on movement; and deformity. The examiner remarked that it was not possible without resorting to mere speculation to determine if additional limitation of motion was present due to pain during flare ups or when the joint was used repeatedly over a period of time as there was no conceptual or empirical basis for making such a determination without directly observing function under those conditions. The Veteran did not have tenderness or pain to palpation for the joint or soft tissue of either hand, including the thumb and fingers. In addition, the Veteran’s muscle strength for his right hand grip was normal (5 out of 5). The examiner marked that ankylosis was present in the thumb and/or fingers. Specifically, the examiner reported that the Veteran’s right long finger had MCP joint ankylosis in full flexion. There was a gap of more than two inches (5.1 centimeters) between the fingertips, and the proximal transverse crease of the palm, with the fingers flexed to the extent possible. Regarding the effect of the ankylosis, the examiner stated that the Veteran was unable to flex the 3rd MCP joint. However, the examiner also stated in a June 2014 addendum that the examination’s report’s question regarding whether the Veteran had ankylosis in the thumb or fingers should be answered "No." The examiner explained that the Veteran did not have ankylosis for VA rating purposes as the joint was not completely fixed. The Veteran did not have any relevant scars, and he did not use any assistive devices. There was also 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. The examiner added that diagnostic testing for arthritis did not reveal any abnormal findings. An additional VA examination for the right finger disability was conducted in August 2016. The Veteran informed the examiner that the severity of his right finger disability has worsened. In addition to his initial symptoms, he experienced stiffness and swelling. He also now had flare ups that involved symptoms of stiffness and burning that were a 10 out 10 in severity. The events occurred twice a week for 45 minutes. The Veteran also reported having functional loss that entailed an inability to bend his middle finger. The Veteran’s right hand range of motion was normal for all digits apart from the long finger. The MCP joint had 0 degrees of extension and 90 degrees of flexion; the PIP joint had 0 degrees of extension and 70 degrees of flexion; and the DIP joint had 0 degrees of extension and 50 degrees of flexion. No gap was present between the pad of the thumb and the fingers; or between the finger and proximal transverse crease of the hand on maximal finger flexion. Additional contributing factors of disability included less movement than normal. The Veteran was noted to have pain in finger flexion during range of motion testing that caused functional loss. There was no evidence of pain with the use of the hand, and the Veteran did not have objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue. The examiner noted that the abnormal range of motion contributed to functional loss in the form an impaired grip strength. The Veteran’s right hand grip strength was now a 4 of 5 (active movement against some resistance). The examiner noted that this reduction in muscle strength was due to the right finger disability. There was no muscle atrophy. In addition, there was no additional loss of function or range of motion after three repetitions. The right long finger’s range of motion improved to 100 degrees of flexion for the PIP joint and 70 degrees of flexion for the DIP joint. All the other range of motion findings were unchanged. The examiner stated that the examination was medically consistent with the Veteran’s statements describing functional loss with repetitive use over time; and symptoms of pain, fatigue, and lack of endurance significantly limited functional ability with repeated use over a period of time. However, the examiner stated that he was unable to describe this functional loss in terms of range of motion, and no change in range of motion was expected. The examiner opined that it was possible that the Veteran’s range of motion would increase with repetitive use. Although the examiner found that the examination was also consistent with the Veteran’s statements describing functional loss during a flare up, he stated that symptoms of pain, weakness, fatigability, or incoordination did not significantly limit functional ability with flare ups. Regarding the range of motion testing, the examiner remarked that there were some inconsistencies in range of motion passively and actively. The examiner was able to obtain near normal range of motion of the finger with passive range of motion, without objective signs of pain. The examiner stated that no ankylosis was present in Veteran’s right hand, including the long finger. An associated x-ray of the right hand also showed no evidence for fracture or other significant bone or soft tissue abnormality. There continued to be no use of assistive devices related to the right finger disability. The examiner found that the Veteran did have a scar on the right middle finger lateral side, but it was not painful or unstable, and it did not have a total area equal to or greater than 39 square centimeters (6 square inches). The examiner stated that the scar measured 1. 3 centimeters by 0.1 centimeters. In addition, there was still 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. The January 2017 rating decision at issue appeared to base the reduction of the Veteran’s disability rating on the fact that the August 2016 VA examination was negative for evidence of ankylosis in the right long finger. The RO indicated that a reduction was warranted as the Veteran did not meet the criteria for a 10 percent rating under Diagnostic Code 5226. However, the Board notes that this fact alone does not justify a reduction. VA may not reduce a rating simply on the basis that the Veteran does not actually meet certain schedular criteria, unless the underlying disorder has shown improvement, or clear and unmistakable error is shown in the determination to assign the disability rating (which the RO did not find here). In order to warrant a reduction, the evidence must show that the Veteran’s service-connected right finger disability materially improved overall resulting in an improvement in his ability to function under the ordinary conditions of life and work. See e.g. Peyton v. Derwinski, 1 Vet. App. 282 (1990). Despite the findings from the August 2016 VA examination regarding ankylosis, the Veteran had reported at that time that the severity of his disability had worsened with new symptoms of stiffness and swelling. In contrast to the Veteran’s previous denial of flare ups during the May 2014 VA examination, the Veteran informed the August 2016 examiner that he now had twice weekly flare ups with symptoms of stiffness and burning that was a 10 out of 10 in severity. Moreover, the examiner determined that the Veteran had developed an impaired grip strength as a result of his right finger disability. Although the examiner indicated that some range of motion findings were inconsistent, he documented that the Veteran continued to demonstrate limitation of motion as well as pain in the flexion of the right long finger. Regarding the functional loss noted in the August 2016 VA examination, the January 2017 rating decision does not reflect that the RO afforded it appropriate consideration. The RO stated that the provisions of 38 C.F.R. 4.40 and 4.45 concerning functional loss due to pain, fatigue, weakness, lack of endurance, incoordination, and flare ups as cited in DeLuca v. Brown and Mitchell v. Shinseki had been considered and were not warranted. As the RO did not include any specific discussion of the Veteran’s functional loss, it is unclear whether his impaired grip strength was considered. Although the January 2017 rating decision also noted that the Veteran's painful motion of the right long finger had been considered in terms of 38 C.F.R. § 4.59, the RO stated that it was VA's policy regarding painful motion of the fingers to require painful motion to exist in at least two of the particular digits of the same hand to warrant a compensable evaluation. As only the Veteran's right middle finger was affected by painful motion, the RO concluded that a noncompensable evaluation must be assigned. In fact, the Board notes that a 10 percent rating under 38 C.F.R. § 4.59 is only inappropriate when the diagnostic code under which the Veteran is rated does not contain a 10 percent rating. Sowers v. McDonald, 27 Vet. App. 472 (2016). As noted above, Diagnostic Code 5229 does provide for a 10 percent rating for limitation of motion of the long finger. Moreover, it does not appear that VA has any specific policy that bars the application of 38 C.F.R. § 4.59 to painful motion of an individual finger. The guidance provided by the VA Adjudication and Procedure Manual states that when considering evaluations for the fingers based on loss motion, a compensable evaluation can be assigned for “painful motion of the thumb, index, or long finger as directed at M21-1, Part III, Subpart iv, 4.a.1p.” M21-2, III.iv.4.A.4.h (emphasis added). This referenced section further states that “38 C.F.R. 4.71a, DC 5228 and 5229 allow for compensable evaluations for LOM of the thumb, index finger, and long finger. Consequently, compensable evaluations are warranted for painful motion of each of these fingers. Separate evaluations must be assigned for each SC digit evaluated under these DCs affected by painful motion.” M21-1, III.iv.4.A.1.p (emphasis added). In addition, this section specifically notes that “major joint involvement or multiple minor joint involvement is not a factor in determining whether a minimum compensable evaluation may be assigned under 38 C.F.R. 4.59.” Id. The M21-1 also states that the policy decision to assign the minimum compensable evaluation under the corresponding DC for painful motion under 38 C.F.R. 4.59 was effective from May 23, 2016; prior to both the October 2016 and January 2017 rating decisions. M21-1, III.iv.4.A.1.b. Based on the foregoing, the Board finds that the evidence before the RO at the time of the January 2017 rating decision did not show an actual improvement in the Veteran’s service-connected right finger disability and his ability to function under the ordinary conditions of life and work, warranting a reduction from 10 percent to a noncompensable rating. Moreover, at the time of the January 2017 rating decision, the RO did not give due consideration to the functional loss caused the Veteran’s disability. Under these circumstances, the Board finds that the reduction of the right long finger disability from 10 percent to a noncompensable rating effective from April 1, 2017 was improper, and restoration of the 10 percent evaluation is warranted. 3. Entitlement to service connection for a psychiatric disorder other than ADD, to include anxiety and PTSD, and as secondary to service-connected right ankle sprain. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). To establish a right to compensation for a present disability, a Veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service-the so-called "nexus" requirement. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 38 F.3d 1163, 1167 (Fed. Cir. 2004)). The absence of any one element will result in denial of service connection. Service connection may also be granted for any disease initially diagnosed after service 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). In addition, service connection may be granted where a disability is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310. Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 48 (1995) (en banc). Service connection for PTSD requires medical evidence diagnosing the condition; a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred. 38 C.F.R. § 3.304(f). A diagnosis of PTSD must be established in accordance with 38 C.F.R. § 4.125(a), which provides that all psychiatric diagnoses must conform to the fifth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-V). 38 C.F.R. § 3.304(f). Effective August 4, 2014, VA amended the portion of its Schedule for Rating Disabilities dealing with mental disorders and its adjudication regulations that define the term "psychosis" to remove outdated references to the DSM IV and replace them with references to the recently updated DSM-V. See 79 Fed. Reg. 45, 094 (August 4, 2014). VA adopted as final, without change, this interim rule and clarified that the provisions of this interim final rule do not apply to claims that have been certified for appeal to the Board or are pending before the Board on or before August 4, 2014. See Schedule for Rating Disabilities - Mental Disorders and Definition of Psychosis for VA Purposes, 80 Fed. Ref. 14,308 (March 19, 2015). In the present case, the RO certified the Veteran's appeal to the Board in April 2016, which is after August 4, 2014. Thus, the DSM-V is applicable in the present case. The pertinent regulation provides that, if the evidence establishes that the Veteran engaged in combat with the enemy and that the claimed stressor is related to that combat, in the absence of clear and convincing evidence to the contrary, and provided that the claimed stressor is consistent with the circumstances, conditions, or hardships of the Veteran's service, the Veteran's lay testimony alone may establish the occurrence of the claimed in-service stressor. See 38 U.S.C. § 1154(b); 38 C.F.R. § 3.304(f)(1). Effective July 13, 2010, if a stressor claimed by a veteran is related to the Veteran's fear of hostile military or terrorist activity and a VA psychiatrist or psychologist, or a psychiatrist or psychologist with whom VA has contracted, confirms that the claimed stressor is adequate to support a diagnosis of PTSD and that the veteran's symptoms are related to the claimed stressor, in the absence of clear and convincing evidence to the contrary, and provided that the claimed stressor is consistent with the places, types, and circumstances of the Veteran's service, the veteran's lay testimony alone may establish the occurrence of the claimed in-service stressor. For purposes of this paragraph, "fear of hostile military or terrorist activity" means that a veteran experienced, witnessed, or was confronted with an event or circumstance that involved actual or threatened death or serious injury, or a threat to the physical integrity of the veteran or others, such as from an actual or potential improvised explosive device (IED); vehicle-imbedded explosive device; incoming artillery, rocket, or mortar fire; grenade; small arms fire, including suspected sniper fire; or attack upon friendly military aircraft, and the veteran's response to the event or circumstance involved a psychological or physiological state of fear, helplessness, or horror. See 75 Fed. Reg. 39843, 39852 (July 13, 2010) (now codified at 38 C.F.R. § 3.304(f)(3). For stressors unrelated to combat that are not based on fear of hostile military or terrorist activity, credible supporting evidence is necessary in order to grant service connection. Such evidence may be obtained from service records or other sources. See Moreau v. Brown, 9 Vet. App. 389 (1996). The United States Court of Appeals for Veterans Claims (Court) has held that the regulatory requirement for "credible supporting evidence" means that "the appellant's testimony, by itself, cannot, as a matter of law, establish the occurrence of a non-combat stressor." Dizoglio v. Brown, 9 Vet. App. 163, 166 (1996). Therefore, the Veteran's lay testimony, is insufficient, standing alone, to establish service connection. Cohen v. Brown, 10 Vet. App. 128, 147 (1997). The Veteran has asserted that he has PTSD as a result of stressful events during his active duty service. He contends that two different events during his service with C Company, 3rd Battalion, 17th Infantry, at Fort Ord, California contributed to his PTSD. See June 2012 VA Form 21-0781. Regarding the first event, the Veteran stated that in November 1992, his company was in charge of a live fire night range for the Marine Corps Division. A marine was shot in the back of the head when he stepped in front of another marine. There was a cease fire as well as efforts to clean up the live fire range. The Veteran could not recall the name of the serviceperson who was shot. Regarding the second event, the Veteran stated that in June 1990, a specific serviceperson killed himself while the Veteran was on leave. The serviceperson hung himself out of the Veteran's room in the second floor of the barracks. The Veteran was informed of the event by his commanding officer. In this case, the record does not reflect that the Veteran participated in combat during service. The Veteran’s DD Form 214 and military personnel records show that he did not have any foreign service. In addition, his military decorations, medals, and badges, to include the Army Service Ribbon, National Defense Service Medal, Marksman Badge with M16 Component Bar, and Expert Badge with Hand Grenade Component Bar, are not indicative of combat. Moreover, the Veteran has not indicated that either of his identified stressors occurred during combat. As such, the combat provisions are not for application. 38 C.F.R. § 3.304(f)(2). See also 38 U.S.C. § 1154(b) and 38 C.F.R. § 3.304(d) (pertaining to combat Veterans). In addition, the Veteran's claimed stressors in the present case do not involve "fear of hostile military or terrorist activity," as contemplated by the amended regulation, 38 C.F.R. § 3.304(f)(3). The Board notes that the Veteran’s STRs and military personnel records do not include entries related to these stressors. There is also no evidence that the Veteran received a diagnosis of PTSD during service. In addition, efforts undertaken by the RO to verify the Veteran’s reported stressors have not been successful. A review of the casualty listing from 1950 to 2002 did not show any record that the serviceperson identified by the Veteran died from suicide. See October 2013 VA Memorandum. In August 2013, the Joint Services Records Research Center (JSRRC) stated that it had reviewed the 1992 United States Marine Corps Chronology, but they were unable to find documentation of the incident described by the Veteran regarding the accidental shooting at the rifle range. The JSRRC had also contacted the United States Marine Corps Mortuary in an attempt to verify the incident, but that office responded that there was information available to substantiate the event. The JSRRC noted that there might be a criminal investigation related to the event, and they suggested that the RO contact the US Army Crime Records Center. Although the RO contacted the US Army Crime Records Center as the JSRRC suggested, they responded that there were no records regarding the firing range incident. See October 2013 Response from US Army Crime Records Center. In addition, the Veteran has not submitted any information apart from his statements to verify his reported stressors. Consequently, there is no credible supporting evidence that a claimed in-service stressor actually occurred. 38 C.F.R. § 3.304(f); Cohen, 10 Vet. App. at 147; Moreau, 9 Vet. App. at 395. In the absence of a verified stressor event, service connection for PTSD must be denied. 38 C.F.R. § 3.304(f). Regarding the question of whether the Veteran is entitled to service connection for a psychiatric disorder other than ADD and PTSD, the record has also raised a theory of secondary service connection. In a February 2012 VA mental health history and physical note, the Veteran reported feeling depressed and having nightmares related to the uncorroborated stressors discussed above. He believed that his current symptoms began three years before the visit, but he was unsure what event cause the symptoms. The record reported that a review of the Veteran’s symptoms revealed low back pain, bilateral shoulder pain, and right ankle pain. The Axis I diagnosis was anxiety disorder NOS, rule out PTSD. An addendum changed the Axis I diagnosis to major depressive disorder, rule out PTSD. In January 2014, Dr. H-G, PhD, a psychologist, completed a Disability Benefits Questionnaire (DBQ) concerning the Veteran’s claimed psychiatric disorder and diagnosed the Veteran with depressive disorder not otherwise specified (NOS). She also provided a medical opinion, stating that the Veteran’s depressive disorder NOS was secondary to his right ankle disability. Dr. H-G observed that the Veteran endorsed symptoms of social isolation and emotional withdrawal. The Veteran also reported that his chronic ankle pain and limitations in mobility associated with the right ankle disability made him feel depressed to the point that did "not want to bother going out." Dr. H-G expressed her belief that the Veteran's depressive disorder NOS was functionally and socially debilitating. His current symptoms included anhedonia, a chronic sleep impairment, trouble with activities of daily living, and suicidal ideation without current intent or plan. Dr. H-G also noted that that in May 2003, the Veteran received diagnoses for anxiety disorder and panic disorder without agoraphobia; and he was prescribed selective serotonin reuptake inhibitors (SSRI's) for these disorders that manifested on the anxiety spectrum. However, she noted that SSRI's can also be prescribed for secondary depressive symptoms that were often associated with anxiety. Dr. H-G opined that the Veteran's right ankle disability had caused his depressive disorder NOS. She explained that there was a body literature detailing the connection between depressive disorders, chronic pain, and physical impairments in veterans. She also cited to specific studies that described the holistic effects of chronic pain, limited mobility, and subsequent depression. Dr. H-G found that the findings from the studies mirrored the Veteran's history of a right ankle sprain with chronic pain, limited mobility, and resultant depressive disorder NOS. The Board finds that this opinion provides significant probative value as Dr. H-G considered the pertinent evidence of record and supported her conclusions with medical literature. Moreover, the record does not contain any negative opinion on secondary service connection to weigh against Dr. H-G’s conclusion. Consequently, the weight of the evidence supports finding that the Veteran's current psychiatric disorder is due to, or the result of, his right ankle disability. Service connection for a psychiatric disorder other than ADD and PTSD, diagnosed as depressive disorder NOS, is therefore granted as secondary to service-connected right ankle sprain. 38 C.F.R. § 3.310. In light of this grant of secondary service connection, the Board need not consider whether the Veteran's psychiatric disorder is directly related to service. The Board notes that the Veteran has also received diagnoses for anxiety disorder NOS and major depressive disorder during the appeal period. However, the evidence does not differentiate the symptoms attributable to depressive disorder NOS versus those due to other diagnoses. See Mittleider v. West, 11 Vet. App. 181 (1998). Therefore, the Board considers all manifested psychiatric symptoms as being due to his depressive disorder NOS. 4. Whether new and material evidence has been received to reopen a previously denied claim for entitlement to service connection for a low back disorder. Rating actions are final and binding based on evidence on file at the time the claimant is notified of the decision and may not be revised on the same factual basis except by duly constituted appellate authority. 38 C.F.R. § 3.104(a). The claimant has one year from notification of an RO decision to initiate an appeal by filing a notice of disagreement with the decision, and the decision becomes final if an appeal is not perfected within the allowed time period. 38 U.S.C. § 7105(b), (c); 38 C.F.R. §§ 3.160(d), 20.200, 20.201, 20.202, 20.302(a). If the claimant files a timely notice of disagreement with the decision and the AOJ issues a statement of the case, a substantive appeal must be filed within 60 days from the date that the AOJ mails the statement of the case to the appellant, or within the remainder of the 1 year period from the date of mailing of the notification of the determination being appealed, whichever period ends later. 38 C.F.R. § 20.302(b). Although a decision is final, a claim will be reopened if new and material evidence is presented. 38 U.S.C. § 5108. New and material evidence can be neither cumulative, nor redundant, of the evidence of record at the time of the last prior final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. New evidence means existing evidence not previously submitted to VA. Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. 38 C.F.R. § 3.156(a). In determining whether evidence is new and material, the credibility of the evidence is presumed. Justus v. Principi, 3 Vet. App. 510, 513 (1992). The evidence need not relate specifically to the reason why the claim was last denied; rather it need only relate to any unestablished fact necessary to substantiate the claim. Shade v. Shinseki, 24 Vet. App. 110, 118 (2010). Additionally, the phrase "raises a reasonable possibility of substantiating the claim" is meant to create a low threshold that enables, rather than precludes, reopening. Shade, 24 Vet. App. at 117. Reopening is required when the newly submitted evidence, combined with VA assistance and considered with the other evidence of record, raises a reasonable possibility of substantiating the claim. Shade, 24 Vet. App. at 117. Notwithstanding the foregoing, at any time after VA issues a decision on a claim, if VA receives or associates with the claims file relevant official service department records that existed and had not been associated with the claims file when VA first decided the claim, VA will reconsider the claim. 38 C.F.R. § 3.156 (c)(1). Such official service department records include, but are not limited to, records that are related to a claimed in-service event, injury, or disease, regardless of whether such records mention the Veteran by name. Such records do not include any records that VA could not have obtained when it decided the claim because the records did not exist when VA decided the claim, or because the claimant failed to provide sufficient information for VA to identify and obtain the records from the respective service department, the Joint Services Records Research Center, or from any other official source. The Veteran’s service connection claim for a low back disorder was initially denied by a February 2012 rating decision. The Veteran was notified of this decision and his appellate rights in a February 2012 letter. After the Veteran submitted a timely notice of disagreement in June 2012, he was furnished with a statement of the case in December 2013. However, the Veteran did not submit a timely substantive appeal in response to the statement of the case, and no new and material evidence was received prior to the expiration of the appeal period. As a result, the February 2012 rating decision is final. 38 U.S.C. § 7105(c); 38 C.F.R. §§ 3.104, 3.156(b), 20.302, 20.1103. The Veteran filed a request to reopen his claim in January 2014. A June 2014 rating decision subsequently reopened and denied the issue on its merits. The Veteran was informed of this decision and his appellate rights in a July 2014 letter. However, the Veteran did not appeal or submit new and material evidence within one year of that decision. See 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. Therefore, the June 2014 rating decision is final. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.156(b), 20.200, 20.201, 20.302, 20.1103. At the time of the June 2014 rating decision, the evidence of record included the Veteran’s statements, STRs, military personnel records, VA treatment records dated from August 1992 to January 2014, private treatment records dated from February 2011 to September 2011, and a January 2012 VA examination. In the Veteran’s initial August 2011 claim, he asserted that his current low back disorder began during service in August 1991. The Veteran’s STRs show that at the time of his enlistment, the Veteran denied a history of recurrent back pain in his July 1989 Report of Medical History. The report also noted that the Veteran had fractured his right ankle while playing football in 1984. In the July 1989 enlistment examination, the spine/other musculoskeletal system was marked as normal in the clinical evaluation. However, a note was added to the enlistment examination on February 6, 1990 stating that the Veteran had a motor vehicle accident on February 1, 1990 that involved a mild low back injury. The Veteran was now asymptomatic. In a subsequent April 1990 Applicant Medical Prescreening Form, the Veteran denied having a history of back trouble. On August 17, 1990, a lumbar spine x-ray was requested in relation to the Veteran's diagnosis of low back pain with radiation to both legs. The x-ray report noted that the Veteran had an incidental finding of spina bifida occulta of S-1. The report's impression noted that the Veteran had bilateral spondylolysis with grade I spondylolisthesis. Later on August 21, 1990, a consultation report stated that the Veteran had experienced progressively worse low back pain for 2 to 3 months. The Veteran complained of numbness and tingling down the posterior right thigh since a road march one week ago. There was no bowel or bladder complaints. The record also stated that the Veteran had a motor vehicle accident on March 20, 1990, and the Veteran had been struck from the left side. He was in mild distress. The record indicated that the Veteran had normal (5 out of 5) motor functioning in the L2-S1. During the right straight leg raise test, the Veteran complained of pain during the right hip range of motion. Tenderness was present anteriorly, but he complained of palpable tenderness generally on the right side. X-rays were unavailable. The Veteran was noted to have full range of motion with complaints of right low back pain. The consultation report noted in the assessment that the Veteran had low back pain, but there was insufficient information to properly evaluate. A follow-up with x-rays was planned. On September 14, 1990, an x-ray report was requested for the lumbosacral spine as grade I spondylolisthesis had been noted on a prior x-ray. The radiologic report stated that a defect was present at the L5-S1, specifically spondylolisthesis grade I. That same day, a bone scan of the lumbosacral spine was requested. The clinical history stated that grade 1 spondylolisthesis had been noted on plain films, and an acute process needed to be ruled out. On October 9, 1990, the impression from the bone scan stated that the bone images were normal. On October 29, 1990, a consultation request sheet noted that the Veteran had a history of low back pain with radiculitis in both legs as well as bilateral spondylosis with grade I spondylolisthesis. The November 6, 1990 consultation report noted that the Veteran complained of back pain, and a motor vehicle accident had contributed to his back pain. The current complaint had manifested 2 months ago, and the pain seemed occurred while running. The Veteran found that sleeping on his stomach and taking motrin had been helpful. There were no bowel or bladder symptoms. The physical examination revealed that the Veteran's neurovascular functioning was intact with no motor or sensory deficits. His deep tendon reflexes were symmetrical, and straight leg testing was negative bilaterally. The Veteran had good range of motion of the back with minimal tenderness. The assessment was mildly symptomatic L5-S1 spondylolisthesis. The record stated that the Veteran should return for a reevaluation if his symptoms increased. In September 1992, an STR stated that the Veteran had experienced low back pain for 24 hours. The pain did not radiate into his legs. He first felt the pain when he lost his balance while diving into a pool from a diving board. The record stated that the Veteran had no history of back trauma. The assessment was lumbosacral strain. The Veteran’s July 1993 Report of Medical History indicates that he initially checked "don't know" regarding whether he had recurrent back pain, but ultimately answered “no.” In the July 1993 separation examination, no abnormalities were noted in the spine/other musculoskeletal category of the clinical evaluation After service, a September 1994 VA medical certificate stated documented a diagnosed impression of low back pain. In addition, a VA medical certificate received with other VA medical certificates dated between 1993 and 1997 noted that the entry was recorded on May 17th, but did not include a year. This record stated that the Veteran had experienced low back pain for 2 months. The assessment was low back pain. In January 1996, a VA medical certificate reported that the Veteran had non-urgent low back pain. In a subsequent April 4, 2011 private treatment record, Veteran’s reported mid to low back pain that had been present for 2 weeks. The Veteran performed a lot of heavy lifting and work, and he thought that he might have strained his back. No numbness or acute injury were reported. The impression noted it was likely he had back strain. The Veteran was advised to lift no more than 10 pounds. He was to being using Flexeril and ibuprofen for back pain. A subsequent record from May 2, 2011 stated that the Veteran hurt his back 2 weeks ago when putting up racks in his work as a truck driver. The Veteran's back had tightened up in the middle of the night. The pain initially improved, but he felt pain again 3 days ago. The Veteran reported that it was the worst back pain he ever had. The impression was still back strain. It was noted that the Veteran would be out of work for 7 days. In June 2011, the Veteran reported that his back pain seemed to be a bit worse over the past month. The impression was unchanged. In July 2011, a private treatment record noted that the Veteran was injured at work on April 11, 2011. He developed low back pain and he was out of work for approximately 10 days. He returned to light duty, but after about 5 days, his back tightened again when picked something up. The Veteran was re-injured on April 29, 2011 when exiting a trick. He continued to have low back pain. X-rays of the lumbosacral spine showed some degenerative changes at the L4 and L5 facet as well as some disc narrowing. The impression was strain of the lumbosacral spine with probable disc bulging. Subsequent records dated in July, August, and September of 2011 reflect that the Veteran continued to experience low back problems, and he sought worker's compensation. In November 2011, a VA treatment record stated that the Veteran’s worker’s compensation claim was being disputed. Regarding his low back pain, the Veteran has having a lot of discomfort in the right side of his back with numbness down his right leg. In December 2011, a VA treatment record detailed that after the April 2011 injury, the Veteran worked wore a brace at work and did not perform any lifting until June 2011 when he felt a tearing sensation in the right lower back while exiting the cab of a truck. The Veteran was provided with a VA examination concerning his service connection claim in January 2012. During the examination, the Veteran confirmed that the February 1990 motor vehicle accident referenced by the enlistment examination occurred just prior to his military entry in 1990. The Veteran also informed the examiner that his back did not give him any trouble after his military discharge until the spring of 2011 when he injured his back at his job. The Veteran informed the examiner that he had worked as a truck driver for the past 15 years, and his job involved a lot of heavy lifting during that period. The first work injury occurred in April 2011 when he was lifting and installing heavy shelving units in a warehouse. This activity resulted in the onset of severe low back pain and tightness in low back within hours of the injury. The Veteran's symptoms initially improved, but he reported injuring his back again when stepped off a truck and wrenched his back. The examiner also stated that the Veteran confirmed that his current back problem was caused by his work-related injury, and he felt confident that he would win his worker's compensation claim that was set to have a hearing the next week. The diagnoses were lumbar strain with spondylolysis and grade I spondylolisthesis, and mild degenerative disc disease with disc herniation abutting. The examiner gave a negative nexus opinion for both diagnoses. Regarding the current lumbar strain with spondylolysis and grade I spondylolisthesis, the examiner noted that the Veteran had a precipitating event prior to his military service in the form of a motor vehicle accident. In addition, the examiner highlighted the fact that the Veteran played football in high school. Although the spondylolysis and grade I spondylolisthesis were diagnosed in the military, it was more likely than not that this disorder occurred prior to military service. The examiner explained that although the exact cause of spondylolysis was unknown, the disorder, which resulted in spondylolisthesis, was believed to be the result of repeated microtrauma to the spine, such as that sustained while playing football. Playing football was a recognized risk factor for this disorder. In addition, heredity was believed to play a role, and the Veteran's 1990 x-rays showed an incidental finding of spina bifida occulta, a hereditary defect that increased the risk for spondylolysis. Moreover, the examiner highlighted the fact that the Veteran had a normal bone scan in 1990. The examiner reasoned that if the spondylolysis had occurred in the military, it would be expected that the bone scan obtained in 1990 would have shown a stress reaction or stress fracture. The normal bone scan indicated that the defect occurred at some point in the remote past, and not acutely in the late summer of 1990 when the Veteran began reporting back problems. The examiner also explained that patients with back pain as a result of spondylolysis with spondylolisthesis typically improved with conservative treatment and were able to return to normal activities. He noted that the STRs documented that the Veteran's lumbar pain resolved, recurred briefly in 1992 when he had strain with diving, and again resolved. The Veteran also had a normal exit examination and denied any back problems at his military exit. In addition, the Veteran confirmed that he did not have any further back problems and remained asymptomatic for the 18 years after military discharge until a new injury occurred on the job after his military service in 2011. The examiner noted that this post-service injury was well-documented in the Veteran's medical records. The examiner also highlighted the Veteran's report that his occupation as a truck driver for 15 years involved a lot of heavy lifting; his report that he injured his low back twice on the job in 2011, and the Veteran’s belief that he would win his worker's compensation claim for the post-service injury. The examiner concluded that it was more likely than not that this disorder was the result of the Veteran's job injury, and it was not related to military service. Regarding the diagnosis of mild degenerative disc disease with disc herniation abutting the right L5 nerve root, the examiner noted that the Veteran did not have back pain at the time of his military exit, and his exit examination was normal. The Veteran also confirmed that he had not experienced back pain problems until 2011, which was 18 years after his military service. If this disorder had manifested during the Veteran's military service, it would be expected that the Veteran would have experienced recurring back problems over the many years since his military service. The examiner also pointed to the Veteran's heavy lifting in his occupation as a truck driver for 15 years, noting that recurring heavy lifting was a recognized risk factor for degenerative disc disease and herniation. Moreover, truck driving alone was considered a risk factor for disc herniation. The examiner also stated that the Veteran gave a clear mechanism for injury by confirming that he had been injured on the job twice in April 2011, and he had pending worker's compensation claim that he expected to win. The relevant evidence that has been received since the June 2014 rating decision includes statements from the Veteran and his representative, and VA treatment records dated from July 2015 to September 2017. The Veteran has indicated that he should be service-connected his low back disorder. See June 2016 Claim. However, he has not identified any new theory of entitlement or provided any additional information regarding the etiology of his low back disorder. The Veteran’s representative has similarly provided no information that is material to the Veteran’s previously denied claim. In an October 2017 statement labeled as a brief in response to VA’s 90 day letter, the Veteran’s representative only stated that the Veteran should be granted service connection for a low back disorder without offering any further argument. In terms of the newly received VA treatment records, these records reflect that the Veteran has continued to receive treatment for symptoms of chronic low back pain. See VA treatment records dated in June 2016, January 2017. The Board finds that that these statements and treatment records are cumulative of the information and assertions that were previously of record. In addition, statements from the Veteran and his representative are not material as they are not competent to provide a probative opinion as to the etiology of the Veteran’s current low back disorder. That particular inquiry is within the province of trained medical professionals as it involves a complex medical issue. See Jandreau v. Nicholson, 492 F .3d 1372, 1377 (Fed. Cir. 2007) ("Whether lay evidence is competent and sufficient in a particular case is a fact issue to be addressed by the Board."). Neither the Veteran nor his representative have been shown to have the appropriate medical training and expertise to opine as to whether the Veteran’s current low back disorder had its onset during, or is otherwise related to military service. See Jandreau, 492 F.3d at 1376. In short, the Board finds that "the evidence supporting the claim is insufficient to trigger the duty to assist when the old and new evidence is considered together, [and, therefore,] the new-and-material evidence standard has not been met and the claim should not be reopened. Shade, 24 Vet. App. at 123 (Lance, J. concurring); see 66 Fed. Reg. 45620-01, 45629 (Aug. 29, 2001) ("We believe it is fair and reasonable to apply the same standard . . . in determining whether a claim has been reopened, triggering VA's full duty to assist by providing a VA examination or obtaining a medical opinion."). Accordingly, the Board finds that new and material evidence has not been presented to reopen the Veteran's previously denied claim of entitlement to service connection for a low back disorder. The preponderance of the evidence is against the claim, and the benefit of the doubt doctrine is not for application. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). REASONS FOR REMAND 1. Entitlement to an increased disability rating in excess of 10 percent for residuals of a right ankle sprain is remanded. The Veteran’s right ankle disability was last evaluated during an August 2016 VA examination. However, there is no indication from the report that the examiner conducted joint testing for pain in passive motion. 38 C.F.R. § 4.59 requires that VA examinations include joint testing for pain on both active and passive motion, in weight-bearing and nonweight-bearing, and, if possible, with range of motion measurements of the opposite undamaged joint. Correia v. McDonald, 23 Vet. App. 158, 168-69 (2016). Thus, the Board finds that a remand is necessary to obtain an adequate VA examination to evaluate the Veteran’s right ankle sprain disability under the relevant rating criteria. Barr v. Nicholson, 21 Vet. App. 303 (2007). 2. Entitlement to an increased disability rating in excess of 10 percent for old healed fracture, right long finger is remanded. The October 2016 rating decision that proposed a reduction of the Veteran’s right finger disability was issued in response to an increased rating claim that the Veteran submitted for the disability in July 2016. The October 2016 proposed reduction is an implicit denial of the Veteran’s claim for an increased rating. Moreover, in discussing its proposed reduction of the right finger disability from a 10 percent to a noncompensable rating, the RO included a discussion noting why a 20 percent rating was not warranted. The Veteran stated in his November 2016 notice of disagreement (NOD) that he wanted to appeal all the issues in the October 2016 rating decision. He also noted in a subsequent February 2017 NOD in response to the January 2017 rating decision effectuating the reduction that he disagreed with the evaluation of the disability. The Board finds that the November 2016 NOD submitted subsequent to the proposed reduction is an NOD to the denial of an increased rating. Although the RO issued a September 2017 statement of the case (SOC) that addressed the propriety of the rating reduction, the SOC did not address the Veteran’s increased rating claim. The Board notes that rating reduction claims are separate from increased ratings claims. Dofflemeyer v. Derwinski, 2 Vet. App. 277, 279-80 (1992). A remand is therefore required for the issuance of a statement of the case and to provide the Veteran an opportunity to perfect the appeal. Manlincon v. West, 12 Vet. App. 238 (1999). 3. Entitlement to a TDIU is remanded. In this case, the record has raised the theory that the Veteran is unemployable as a result of his right ankle disability and now service-connected psychiatric disability. See January 2014 opinion from Dr. H-G. If the claimant or the record reasonably raises the question of whether the Veteran is unemployable due to the disability for which an increased rating is sought, then part and parcel of that claim for an increased rating is whether TDIU is warranted. Rice v. Shinseki, 22 Vet. App. 447 (2009). Thus, the Board has assumed jurisdiction over the issue. As resolution of the Veteran’s increased rating claim for his right ankle disability may impact his claim for a TDIU, the Board finds that the issues are inextricably intertwined. See Harris v. Derwinski, 1 Vet. App. 180 (1991). Final appellate review of the Veteran's claim for a TDIU must be deferred until the appropriate actions concerning the intertwined increased rating claim are completed and the matter is either resolved or prepared for appellate review. The matter is REMANDED for the following action: 1. The AOJ should issue a statement of the case addressing the issue of entitlement to an increased disability rating in excess of 10 percent for old healed fracture, right long finger. 2. The AOJ should request that the Veteran provide the names and addresses of any and all health care providers who have provided treatment for his right ankle disability. The AOJ should also secure any outstanding, relevant VA medical records, to include records from the Durham VA Medical Center dated since September 2017. 3. After the preceding development in paragraph 2 is completed, provide the Veteran with a VA examination to ascertain the current severity and manifestations of his service-connected right ankle sprain. The claims file must be made available to the examiner. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran's service treatment records, post-service medical records, and assertions. A clear explanation for all opinions based on specific facts for the case as well as relevant medical principles is needed. For the Veteran's right ankle sprain, the examiner should report all signs and symptoms necessary for rating the disability under the rating criteria. In particular, the examiner should provide the range of motion in degrees and test the range of motion in (1) active motion, (2) passive motion, (3) weight-bearing, and (4) nonweight-bearing. This testing must be conducted for both the joint in question and any paired joint. If the examiner is unable to conduct the required testing or concludes that the required testing is not necessary in this case, he or she should clearly explain why this is so. The presence of objective evidence of pain, excess fatigability, incoordination, and weakness should also be noted, as should any additional disability (including limitation of motion) due to these factors. In addition, based on examination results and the Veteran's documented history and assertions, the examiner should indicate whether, and to what extent, the Veteran experiences functional loss due to pain and/or any of the other symptoms noted above during flare-ups and/or with repeated use; to the extent possible, the examiner should express any such additional functional loss in terms of additional degrees of limited motion. In this regard, even if the Veteran is not experiencing a flare-up at the time of the examination, the examiner must elicit relevant information as to the Veteran's flares or ask him to describe the additional functional loss, if any, he suffers during flares and then estimate the Veteran's functional loss due to flares based on all the evidence of record-including the Veteran's lay information-or explain why he or she could not do so. The examiner should also indicate whether the Veteran has marked or moderate ankle limitation of motion; ankylosis of the ankle; ankylosis of the subastragalar or tarsal joint; malunion of the os calcis or astragalus; or astragalectomy of the ankle. The examiner is also asked to evaluate any scars associated with the Veteran's right ankle sprain. 4. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal, including the inextricably intertwined issue of entitlement to a TDIU. If the benefit sought is not granted to the Veteran’s satisfaction, send the Veteran and his representative a Supplemental Statement of the Case and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. GAYLE STROMMEN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD K.C. Spragins