Citation Nr: 18144393 Decision Date: 10/24/18 Archive Date: 10/24/18 DOCKET NO. 15-15 853 DATE: October 24, 2018 ORDER A claim for service connection for posttraumatic stress disorder (PTSD) is reopened. A claim for service connection for psychiatric disability other than PTSD, including bipolar disorder, obsessive-compulsive disorder (OCD), and attention deficit hyperactivity disorder (ADHD), is reopened. A claim for service connection for a left eye disorder is reopened. A claim for service connection for right shoulder disability is reopened. Entitlement to service connection for right shoulder disability is granted. A claim for service connection for back disability is reopened. A claim for service connection for right wrist disability is reopened. Entitlement to service connection for traumatic brain injury (TBI) is denied. Entitlement to service connection for right ankle disability is denied. Entitlement to service connection for residuals of frostbite of the left big toe is denied. Entitlement to service connection for residuals of frostbite of the right big toe is denied. Entitlement to service connection for residuals of heat stroke is denied. Entitlement to service connection for rheumatoid arthritis is denied. REMANDED Entitlement to service connection for PTSD is remanded. Entitlement to service connection for psychiatric disability other than PTSD, including bipolar disorder, OCD, and ADHD, is remanded. Entitlement to service connection for a left eye disorder is remanded. Entitlement to service connection for back disability is remanded. Entitlement to service connection for right wrist disability is remanded. Entitlement to service connection for a TMJ disorder is remanded. Entitlement to service connection for left wrist disability is remanded. Entitlement to service connection for left knee disability is remanded. Entitlement to an increased disability rating for left shoulder disability is remanded. Entitlement to an increased disability rating for right knee disability is remanded. FINDINGS OF FACT 1. Evidence received since the February 2011 rating decision denying service connection for PTSD addresses the occurrence of claimed stressors during service. 2. Evidence received since the September 2005 rating decision denying service connection for bipolar disorder addresses a connection between service and current psychiatric disorders, including bipolar disorder, OCD, and ADHD. 3. Evidence received since the August 1998 rating decision denying service connection for a left eye disorder addresses the question of aggravation during service of a preexisting left eye disorder. 4. Evidence received since the September 2005 rating decision denying service connection for right shoulder disability addresses injury in service. 5. Right shoulder injury in service produced chronic tendinitis of that shoulder. 6. Evidence received since the February 2011 rating decision denying service connection for back disability addresses injury in service and continuity after service. 7. Evidence received since the October 2007 rating decision denying service connection for right wrist disability addresses injury in service and continuity after service. 8. The Veteran does not have any current diagnosed TBI or other residuals related to claimed TBI. 9. Right ankle swelling during service resolved in service, without residual pathology. 10. Any frostbite of the left big toe during service resolved in service, without residual pathology. 11. Any frostbite of the right big toe during service resolved in service, without residual pathology. 12. Any heat stroke during service resolved in service, without residual pathology. 13. The Veteran does not have any current diagnosed rheumatoid arthritis. CONCLUSIONS OF LAW 1. Evidence received since the February 2011 rating decision denying service connection for PTSD is new and material to that claim. 38 U.S.C. §§ 1110, 5108, 7105 (2012); 38 C.F.R. §§ 3.303, 3.304, 3.156 (2017). 2. Evidence received since the September 2005 rating decision denying service connection for psychiatric disability other than PTSD is new and material to that claim. 38 U.S.C. §§ 1110, 5108, 7105; 38 C.F.R. §§ 3.303, 3.156. 3. Evidence received since the August 1998 rating decision denying service connection for a left eye disorder is new and material to that claim. 38 U.S.C. §§ 1110, 5108, 7105; 38 C.F.R. §§ 3.303, 3.156. 4. Evidence received since the September 2005 rating decision denying service connection for right shoulder disability is new and material to that claim. 38 U.S.C. §§ 1110, 5108, 7105; 38 C.F.R. §§ 3.303, 3.156. 5. Right shoulder disability was incurred in service. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. § 3.303. 6. Evidence received since the February 2011 rating decision denying service connection for back disability is new and material to that claim. 38 U.S.C. §§ 1110, 5108, 7105; 38 C.F.R. §§ 3.303, 3.156. 7. Evidence received since the October 2007 rating decision denying service connection for right wrist disability is new and material to that claim. 38 U.S.C. §§ 1110, 5108, 7105; 38 C.F.R. §§ 3.303, 3.156. 8. No TBI or TBI residuals were incurred or aggravated in service. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303. 9. No current right ankle disability was incurred or aggravated in service or is presumed to be service-connected. 38 U.S.C. §§ 1110, 1112, 5107 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2017). 10. No current residuals of frostbite of the left big toe were incurred or aggravated in service. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303. 11. No current residuals of frostbite of the right big toe were incurred or aggravated in service. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303. 12. No current residuals of heat stroke were incurred or aggravated in service. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303. 13. No rheumatoid arthritis was incurred or aggravated in service or is presumed to be service-connected. 38 U.S.C. §§ 1110, 1112, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 1995 to January 1998. 1. Request to reopen a claim for service connection for PTSD The Veteran has pending appeals to reopen a claim for service connection for PTSD and a claim for service connection for psychiatric disability other than PTSD. Much of the same evidence is relevant to both claims. The Board will summarize in this section the evidence regarding psychiatric disorders. The Veteran contends that he has PTSD as a result of events during service. Several times he has submitted claims for service connection for PTSD. In a February 2011 rating decision, a Department of Veterans Affairs (VA) Regional Office (RO) denied reopening of a previously denied claim for service connection for PTSD. A rating decision becomes final when a claimant does not file a notice of disagreement (NOD) within one year after a decision is issued. 38 U.S.C. § 7105. A rating decision also becomes final if a claimant files a timely NOD, but does not file a timely substantive appeal. 38 U.S.C. § 7105. The Veteran did not a file a timely NOD with the February 2011 rating decision, and that decision became final. A final decision on a claim that has been denied shall be reopened if new and material evidence with respect to that claim is presented or secured. 38 U.S.C. §§ 5108, 7104(b). The United States Court of Appeals for Veterans Claims (Court) has ruled that, if the Board of Veterans’ Appeals (Board) determines that new and material evidence has been submitted, the case must be reopened and evaluated in light of all of the evidence, both new and old. Manio v. Derwinski, 1 Vet. App. 140, 145 (1991). New and material evidence received within a year after the rating decision will be considered as having been filed in connection with the claim. 38 C.F.R. § 3.156(b). If service department records not previously associated with the claims file are received, VA will reconsider the claim. 38 C.F.R. § 3.156(c). In August 2012 the Veteran filed a request to reopen a claim for service connection for PTSD. In a June 2013 rating decision, the RO denied reopening of the claim. The Veteran appealed the June 2013 rating decision. In order to reopen a previously and finally disallowed claim, there must be new and material evidence presented or secured since the last time that the claim was finally disallowed on any basis (not only since the last time that the claim was disallowed on the merits). Evans v. Brown, 9 Vet. App. 273 (1996). The February 2011 rating decision is the most recent final disallowance of the PTSD service connection claim on any basis. The Board will consider whether new and material evidence has been submitted since that decision. New evidence means existing evidence not previously submitted to agency decision makers. 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. 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. 38 C.F.R. § 3.156(a). The Court has interpreted the language of 38 C.F.R. § 3.156(a) as creating a low threshold, and viewed the phrase “raises a reasonable possibility of substantiating the claim” as “enabling rather than precluding reopening.” The Court emphasized that the regulation is designed to be consistent with 38 C.F.R. § 3.159(c)(4), which “does not require new and material evidence as to each previously unproven element of a claim.” Shade v. Shinseki, 24 Vet. App. 110 (2010). See also Evans v. Brown, supra, at 284 (1996) (the newly presented evidence need not be probative of all the elements required to award the claim, but only need to be probative in regard to each element that was a specified basis for the last disallowance). For the purpose of establishing whether new and material evidence has been submitted, the credibility of evidence is presumed unless the evidence is inherently incredible or consists of statements that are beyond the competence of the person or persons making them. See Justus v. Principi, 3 Vet. App. 510, 513 (1992); Meyer v. Brown, 9 Vet. App. 425, 429 (1996); King v. Brown, 5 Vet. App. 19, 21 (1993). Service connection may be established on a direct basis for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Service connection may also be granted for any disease diagnosed after service when all the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). In general, service connection requires (1) evidence of a current disability; (2) medical evidence, or in certain circumstances lay evidence, of in-service incurrence or aggravation of a disease or injury; and (3) evidence of a nexus between the claimed in-service disease or injury and the current disability. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection for certain chronic diseases, including psychoses and arthritis, may be established based upon a legal presumption by showing that the disease manifested itself to a degree of 10 percent disabling or more within one year from the date of discharge from service. 38 U.S.C. § 1112 (2012); 38 C.F.R. §§ 3.307, 3.309 (2017). A veteran will be considered to have been in sound condition when examined and accepted for service, except as to disorders noted on entrance into service, or when clear and unmistakable (obvious or manifest) evidence demonstrates that the disability existed prior to service and was not aggravated by service. Only such conditions as are recorded in examination reports are to be considered as noted. 38 U.S.C. § 1111 (2012); 38 C.F.R. § 3.304(b) (2017). When there is a preexisting injury or disease, it will be considered to have been aggravated by service when there is an increase in disability during service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease. 38 U.S.C. § 1153 (2012); 38 C.F.R. § 3.306(a) (2017). In Horn v. Shinseki, 25 Vet. App. 231, 234 (2012), the Court explained that, when no preexisting condition is noted upon entry into service, the burden falls on VA to rebut the presumption of soundness, which requires both clear and unmistakable evidence that an injury or disease existed before service and clear and unmistakable evidence that an injury or disease was not aggravated by service. The Court went on to state that “even when there is clear and unmistakable evidence of preexistence, the claimant need not produce any evidence of aggravation in order to prevail under the aggravation prong of the presumption of soundness.” Horn at 235. In such cases, the Court explained, the burden is on VA to establish by clear and unmistakable evidence that the disability did not increase in severity during service, or to establish by clear and unmistakable evidence that any increase in severity during service was due to the natural progress of the disease. See Horn at 235. PTSD is a mental disorder that develops as a result of traumatic experience. It is possible for service connection to be established for PTSD that becomes manifest after separation from service. Service connection for PTSD requires: (1) medical evidence diagnosing the condition in accordance with VA regulations; (2) a link, established by medical evidence, between current symptoms and an in-service stressor; and (3) credible supporting evidence that the claimed in-service stressor occurred. 38 C.F.R. § 3.304(f). VA considers mental disorders based on the nomenclature in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) from the American Psychiatric Association. 38 C.F.R. § 4.130 (2017). Diagnosis of a mental disorder must conform to the DSM-V. See 38 C.F.R. § 4.125(a) (2017). The DSM V at Code 309.81 addresses the criteria for a diagnosis of PTSD. In summary, under that Code PTSD may be diagnosed when the person was exposed to a traumatic event, the traumatic event is persistently reexperienced, there is persistent avoidance of stimuli associated with the trauma, there are alterations in cognitions and moods associated with the trauma in at least two ways, there are persistent symptoms of increased arousal in at least two ways, the disturbance lasts more than one month, and the disturbance causes clinically significant distress or impairment in functioning. The evidence necessary to establish the occurrence of a recognizable stressor during service varies depending on the circumstances of the veteran’s service and of the claimed stressor. If the veteran engaged in combat with the enemy, the claimed stressor is related to that combat, and the claimed stressor is consistent with the circumstances, conditions, or hardships of the veteran’s service, then, in the absence of clear and convincing evidence to the contrary, the veteran’s lay testimony alone may establish the occurrence of the claimed in-service stressor. 38 C.F.R. § 3.304(f)(2). Similarly, if a stressor claimed by a veteran is related to the veteran’s fear of hostile military or terrorist activity, a VA or VA-contracted psychiatrist or psychologist confirms that the claimed stressor is adequate to support a diagnosis of PTSD, and the claimed stressor is consistent with the circumstances, conditions, or hardships of the veteran’s service, then, in the absence of clear and convincing evidence to the contrary, the veteran’s lay testimony alone may establish the occurrence of the claimed in-service stressor. 38 C.F.R. § 3.304(f)(3). In general, if a veteran’s service and claimed stressors were not under circumstances that provide for his or her lay testimony alone to establish the occurrence of the stressor, the record must contain service records that corroborate the veteran’s testimony as to the occurrence of the claimed stressor. See Zarycki v. Brown, 6 Vet. App. 91, 98 (1993). If a PTSD claim is based on in-service personal assault, evidence from sources other than the veteran’s service records may corroborate the veteran’s account of the stressor. 38 C.F.R. § 3.304(f)(5). The evidence that was in the Veteran’s claims file in February 2011 includes the Veteran’s service treatment records, his post-service treatment records, his records from the United States Social Security Administration (SSA), and his written statements. The Veteran’s service treatment records do not reflect any mental health complaints or treatment. In treatment in September 1997, he reported that, three months earlier, he fell into a foxhole and struck his left shoulder. He stated that he continued to have pain and problems with that shoulder. His service personnel records do not reflect any performance or disciplinary issues. On VA examination in April 1998, the Veteran reported that during service he was in a motor vehicle accident (MVA) in 1995. He stated that in that accident he sustained right knee injury and chipping of four front teeth. He also related that in late 1996 he sustained injuries of both shoulders in an MVA. In VA primary care in August 2004, the Veteran reported a history of MVAs in service, with injuries to his face, neck, and shoulders. He reported that presently he had musculoskeletal pain, and insomnia due to pain. In September 2004, he reported difficulty with focus, concentration, and reading comprehension. He related insomnia, depression, and occasional uncontrolled anger. He requested evaluation for attention deficit disorder (ADD) and bipolar disorder, noting family history of those disorders. The treating physician provided an assessment of ADD and depression. In October 2004 the Veteran reported a several-month history of difficulty sleeping. He also related problems with anger, depression, anxiety, and overstimulation. The physician prescribed medication to help with sleep. The physician noted that the Veteran had multiple complaints each visit, and that he spoke constantly and was very verbose. The physician’s assessment was insomnia, possible fibromyalgia, and possible bipolar disorder. In an October 2004 psychology consultation, the Veteran reported history of findings of possible ADD and bipolar disorder. He indicated that he had always had difficulty focusing, concentrating, maintaining attention, and comprehending reading and conversation. He reported history of several head traumas, including one that produced bleeding from his mouth, eye sockets, and ears. He indicated that he had anxiety attacks and mood changes. He reported periods of high energy accompanied by sleeplessness, distractibility, irritability, racing thoughts and ideas, spending sprees, overtalkativeness, and feelings of omnipotence. A clinician observed that he was calm, with a euthymic mood and appropriate affect. His speech was meaningful, fluent, and normally paced. Psychological testing was administered. In an October 2004 letter, a VA rehabilitation counselor informed the Veteran that his vocational rehabilitation program was to be paused, due to poor attendance and unsatisfactory progress. In December 2004 a VA psychologist reported on the Veteran’s psychological testing. The psychologist found that the results of the MMPI-II test were invalid because of excessive endorsement of highly pathological items. On other tests, there was evidence of a learning disability in the areas of written language and dictation, and of probable brain impairment due to multiple head injuries. The psychologist also found likely bipolar disorder. In December 2004 and April 2005, VA primary treatment notes reflected history of ADHD, insomnia, and bipolar affective disorder. The physician adjusted medications. In March 2005 the Veteran wrote that his diagnosed ADD and bipolar disorder caused him to have poor attendance and insufficient concentration at VA vocational rehabilitation. In May 2005 the Veteran sought service connection for PTSD, bipolar disorder, and sleep disturbances. In a May 2005 statement, he wrote that during service he participated with his unit in live fire field exercises. He stated that, during an exercise, the Bradley Fighting Vehicle (BFV) he was in drove off a cliff. He reported that he and everyone in the vehicle sustained injuries. He stated that he sustained injury of his face. He related that, later in the exercise, guns and artillery were fired at his BFV. He stated that he and the others in his vehicle were in great danger from the weapons fire, and were lucky to survive. He reported that the experience was traumatic, and left him unable to sleep and extremely angry, with a desire to kill the servicemembers who had shot at them. In VA mental health treatment in June 2005, the Veteran reported that he used drugs, including LSD, before he entered service. Also before service, he stated, he worked fighting fires and saw people burned. He reported that during service he was almost killed when another group fired on his group. He related a history of head injuries. He indicated that presently he had insomnia, anger problems, and variable moods. A clinician observed that he had atypical affect, as he displayed little emotion when discussing very traumatic events. The clinician found that he appeared to overreport or overendorse psychiatric disorder symptoms. The clinician listed diagnoses of PTSD and ADD. The Veteran had VA mental health treatment visits in July and August 2005. Records from SSA include reports of non-VA mental health consultations and treatment in 2006. It was noted that the Veteran was initially diagnosed with bipolar disorder, and that other diagnoses considered included paranoid schizophrenia, OCD, and PTSD. In a February 2006 assessment, the Veteran reported bipolar disorder since childhood. He related PTSD, which he attributed to events in firefighting before service and to events during service. In VA treatment of the Veteran in October 2007 through December 2010, lists of active problems included bipolar disorder and depression. In a December 2007 letter to a U. S. Senator, the Veteran indicated that he had PTSD, ADHD, OCD, and bipolar disorder. In VA psychiatric treatment in February 2009, the Veteran indicated that his psychotic symptoms were under control. His medications included Citalopram for depression, Quetiapine for clear thinking, and Trazodone for sleep. In primary care in February 2009, diagnoses included PTSD. In psychiatric treatment in April 2009, he reported irritability and mania. In July 2009, he reported normal sleep and appetite if he took his medications. In September 2009, he reported trouble sleeping and periods of irritability. The treating psychiatrist adjusted medications. In December 2009 the Veteran reported feeling well. The psychiatrist continued medications. After relocating, in December 2010 the Veteran established treatment at a new VA facility. He reported psychiatric treatment since 2004, with diagnoses of PTSD, bipolar disorder, and ADHD. He indicated that presently he was off medications. He related his PTSD to his tank coming under fire during service. He reported episodes of irritability, including road rage. He related that he typically did not leave home except to go to appointments. A clinician observed that his thinking was hard to follow, his insight and judgment were poor, and his mood was labile. The clinician listed diagnoses of bipolar disorder, PTSD, and ADD. The evidence that has been added to the Veteran’s claims file since February 2011 includes additional treatment records, additional SSA records, and his testimony at a Board videoconference hearing held in April 2018 before the undersigned Veterans Law Judge. After the February 2011 rating decision, the RO received records of VA treatment of the Veteran in 2002 through 2005, some of which were not in the claims file before that rating decision. In May 2002 he reported that during service he was thrown around inside a tank, and sustained neck injury. He also stated that he fell into a ditch and had onset of low back pain. In January 2005, a list of active problems included ADHD, insomnia, and bipolar affective disorder. Records of more recent treatment, in 2011 through 2015, were also added to the file. In 2011 through 2015, lists of active problems included ADHD, insomnia, bipolar affective disorder, and PTSD. Treatment with psychiatric medications continued. In August 2013 the Veteran reported sleep problems and anger issues. SSA records received after February 2011 reflect the Veteran’s reports of sleep problems, memory impairment, difficulty getting along with people, and aggressive behavior. The records reflect that SSA found that the Veteran was disabled from March 2004, and that his impairments included disorders of the left and right shoulders, tinnitus, limited vision in the left eye, PTSD, bipolar disorder, and obsessive-compulsive personality disorder. In the April 2018 Board hearing, the Veteran reported that during service he was traumatized during a training exercise, when his BFV came under live fire from other participants in the exercise. He indicated that a very large number of rounds were fired. He stated that after the incident he had nightmares and anger issues. He also reported that during service his BFV went off a cliff, and he sustained head and neck injuries. Another service incident he reported was falling into a ditch and sustaining injuries to both shoulders and his head. In the February 2011 rating decision, the RO denied service connection for PTSD in part because the in-service stressors that the Veteran reported were not verified. Treatment records added to the claims file after February 2011 and the Veteran’s 2018 hearing testimony provide additional details about the stressors in service he reported, including the incident of his BFV coming under weapons fire, the fall of his BFV off a cliff, and his fall into a ditch. Thus, there is new evidence relevant to the occurrence of an in-service stressor, which is an unestablished fact necessary to substantiate the service connection claim. The new evidence raises a reasonable possibility of substantiating the claim. As there is new evidence that is also material, the Board grants reopening of the claim. As the Board has reopened the claim, the Board must consider service connection on its merits. The Board finds it necessary, however, to remand the claim for further development, as explained in the remand section, below. 2. Request to reopen a claim for service connection for psychiatric disability other than PTSD In addition to seeking service connection for PTSD, the Veteran has sought service connection for psychiatric disorders other than PTSD. He essentially contends that those disabilities began in service, worsened in service, or were caused by injuries or other events during service. He has described those disorders as bipolar disorder, OCD, and ADHD. In a September 2005 rating decision, an RO denied service connection for bipolar disorder. The Veteran did not a file a timely NOD with that rating decision, and it became final. In August 2012, the Veteran sought service connection for bipolar disorder, OCD, and ADHD. In a June 2013 rating decision, the RO denied reopening of a previously denied claim for bipolar disorder, described as now also claimed as OCD and ADHD. The Veteran appealed that decision. The September 2005 rating decision is the only, so the most recent, final disallowance on any basis of service connection for psychiatric disability other than PTSD. The Board will consider whether new and material evidence has been submitted since that decision. The evidence that was of record in September 2005 includes medical records from during and after service and statements from the Veteran. The post-service treatment records include consideration of mental disorders including PTSD, bipolar disorder, OCD, and ADHD. The evidence added since September 2005 includes additional post-service medical records, SSA records, and the Veteran’s testimony at the 2018 Board hearing. Added treatment records provide additional history and findings regarding his psychiatric disorders, including bipolar disorder, OCD, and ADHD. In the 2018 hearing, the Veteran asserted that he developed bipolar disorder after sustaining head injuries in service. In the September 2005 rating decision, the RO denied service connection for bipolar disorder because the evidence did not show a relationship between his bipolar disorder and his service. The additional treatment records and the Veteran’s hearing testimony are relevant to the history of his psychiatric disorders other than PTSD, including the question of whether those disorders are related to events in service. Some of the added evidence enables rather than precludes reopening of the claim. Therefore, there is evidence that is both new and material. The Board grants reopening of the claim. As the Board has reopened the claim, the Board must consider service connection on its merits. The Board finds it necessary, however, to remand the claim for further development, as explained in the remand section, below. 3. Request to reopen a claim for service connection for a left eye disorder The Veteran reports that he had left eye problems before service. He contends that during his service he sustained injury of that eye and incurred increased disability of that eye. In an August 1998 rating decision, an RO denied service connection for a left eye problem. The Veteran did not a file a timely NOD with that rating decision, and it became final. In August 2012 he submitted a claim for service connection for left eye impairment. In a June 2013 rating decision, the RO denied reopening of the previously denied claim. The Veteran appealed that decision. The August 1998 rating decision is the most recent final disallowance of his claim for service connection for a left eye disorder. The Board will consider whether new and material evidence has been submitted since that decision. The evidence of record in August 1998 includes the Veteran’s claim, his service treatment records, and VA examination reports. In September 1994, the Veteran completed a medical prescreening form for entrance into service. He stated that he wore glasses, that he had lazy eye of the left eye, and that his last eye examination was in 1992. In an October 1994 medical history, he again reported that he wore glasses. On examination in October 1994, his distant vision was 20/20 in the right eye. In the left eye it was 20/200 without correction and 20/200 with correction. The examiner noted amblyopia of the left eye. In follow-up in November 1994, distant and near vision were each 20/20 in the right eye. In the left eye, distant vision was 20/200, corrected to 20/60. Near vison was 20/200, corrected to 20/60. The Veteran entered service in January 1995. In January 1995 he was examined to determine his glasses prescription, and glasses were made for him. His service medical records do not show any further reports of, or treatment for, eye or vision issues. In December 1997, while he was still in service, he submitted a claim for service connection for multiple conditions, including a left eye condition. His assembled service treatment records do not include the report of any examination at or around the time of his January 1998 separation from service. On VA examination in April 1998, the Veteran reported that in January 1998, before his separation from service, he was told that he was legally blind in his left eye. He stated that this was attributed to prolonged strain from lack of proper glasses. He reported that military clinicians would not give him more powerful glasses. He related that clinicians had advised him to use a patch over his left eye, but military authorities disallowed that. He indicated that presently he did not use the glasses that were prescribed. He reported that his left eye vision was blurred. He denied difficulty perceiving color, light, or motion with his left eye. The examiner observed that his eyes were grossly normal, with normal iris, pupil, conjunctiva, and fundi. Without glasses, his right eye vision was 20/20, with normal color vision. With his left eye, he could not read any letters on the chart. The examiner described that result as equivalent to worse than 20/150. With his left eye, the Veteran perceived with great difficulty the number of fingers held up 18 inches away. Extraocular motions were normal. The examiner diagnosed amblyopia, hyperopia, astigmatism, and strabismus of the left eye. The evidence added since August 1998 includes more recent medical records and the Veteran’s testimony in the 2018 Board hearing. In VA treatment in November 2004, the Veteran reported headaches with reading and photophobia when driving. New glasses were prescribed and fitted. In October 2009, he reported that his left eye had lazy eye and was almost blind. On examination without glasses, vision in the right eye was 20/20. Vision in the left eye was 5 feet/100 feet. The assessment included refractive amblyopia of the left eye. In a VA ophthalmology consultation in January 2012, the Veteran reported a history of three head injuries: one during childhood, when he fell out of a tree and hit the back of his head; and two during service. He stated that he could not see well with any of the several pairs of glasses he had. He related intermittent feelings of pressure in his left eye. He reported a history of lazy eye since childhood. He reported that in childhood the left eye was 20/50, and was patched. He expressed a belief that presently his left eye was legally blind. He stated that migraines had been attributed to eye strain. He reported that his right eye vision had worsened. On examination, his uncorrected vision was 20/40 in the right eye, and counting fingers at 1 foot in the left eye. The examiner’s impression was refractive amblyopia of the left eye. In May 2012 the Veteran had a consultation with a blindness rehabilitation specialist. In optometry treatment in August 2012, he reported difficulty reading and watching television. He stated that his eyes did not focus correctly, and that sometimes they jumped out of focus. The optometrist found that his vision was 20/20 in the right eye and 20/1200 in the left eye. In a blindness rehabilitation consultation, his vision was noted to be 20/20 in the right eye, and 20/500, with amblyopia, in the left eye. The optometrist tested low vision devices with him to determine which were helpful. In February 2013 it was noted that he had decreased vision. In optometry treatment, he reported a twenty-year history of intermittent blurring of his vision in each eye. At the 2018 Board hearing, the Veteran reported that from childhood forward he had lazy eye of his left eye. He stated that in childhood he had services to address the issue, including patching of the eye and fitting of glasses. He indicated that he had some visual loss in his left eye at the time of entrance to service. He related that he was accepted for service despite those conditions. He stated that in accidents in training exercises in service, shrapnel got in both of his eyes. He related that clinicians removed the shrapnel and put gauze over his eyes. He stated that his vision was blurry for several weeks, but he eventually got his vision back. He reported that shrapnel in his left eye caused irritation, scar tissue, and vision decrease. He indicated that he had been told that some shrapnel was still present in his left eye. He reported that over time his left eye vision had worsened further. He noted that he had received VA blindness rehabilitation services. Refractive error of the eye is not a disease or injury for purposes of VA disability compensation. See 38 C.F.R. §§ 3.303(c), 4.9 (2017). However, congenital or developmental conditions, if subjected to a superimposed disease or injury, may be service connected for the additional disability. See VAOPGCPREC 82-90, 55 Fed. Reg. 45711 (1990). In addition, the Court has indicated that VA must consider whether a refractive error diagnoses during service represented aggravation of a preexisting traumatic eye disability. See Browder v. Derwinski, 1 Vet. App. 204 (1991); Browder v. Brown, 5 Vet. App. 268 (1993). In the August 1998 rating decision, the RO denied service connection for a left eye condition because current left eye problems existed before service and did not permanently worsen in service. The Veteran’s 2018 testimony that he got shrapnel in his left eye during service is relevant to the question of whether the condition of his left eye worsened during service. The absence of any report of shrapnel injury on examination in April 1998, soon after service, undermines the credibility of his 2018 account of shrapnel injury. Despite that reduced credibility, the account is not inherently incredible. He is in a position to recall injuries during service. Therefore, for the purpose of determining whether new and material evidence has been submitted, the Board presumes that the report of that injury is credible. The new evidence regarding claimed injury in service enables rather than precludes reopening of the claim. Therefore, there is evidence that is both new and material; the Board grants reopening of the claim. As the Board has reopened the claim, the Board must consider service connection on its merits. The Board finds it necessary, however, to remand the claim for further development, as explained in the remand section, below. 4. Request to reopen a claim for service connection for right shoulder disability VA established service connection for disability of the Veteran’s left shoulder. The Veteran contends that he has chronic right shoulder disability due to injury in service. In the alternative, he contends that his right shoulder disability is secondary to his left shoulder disability. The Veteran is right handed. Several times over the years, he has submitted claims for service connection for right shoulder disability. In a September 2005 rating decision, an RO denied reopening of a previously denied claim for service connection for right shoulder disability. The Veteran did not a file a timely NOD with that rating decision, and it became final. The September 2005 rating decision is the most recent final disallowance on any basis of service connection for right shoulder disability. The Board will consider whether new and material evidence has been submitted since that decision. Service connection may be granted on a secondary basis for a disability that is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a) (2017). Aggravation of a non-service-connected disease or injury by a service-connected disability may also be service-connected. 38 C.F.R. § 3.310(b). The evidence of record in September 2005 includes statements from the Veteran and medical records from during and after his service. His service treatment records reflect a report of injury, in 1997, of both shoulders, with worse injury in the left shoulder. Over several months he received treatment for ongoing left shoulder pain. After service he reported pain in both shoulders, worse in the left. The evidence added since September 2005 includes additional and more recent medical records, SSA records, and statements from the Veteran, including his testimony at the 2018 Board hearing. In the hearing he reported that during service he sustained injuries to his right and left shoulders at the same time, when he fell into a ditch. He stated that he continued to have problems with both shoulders after that. He stated that he has had surgeries on both shoulders, including a right shoulder surgery in 2017. In an April 2002 rating decision, the RO denied reopening of service connection for right shoulder disability because the evidence did not link his current right shoulder disability to his service. At the 2018 hearing, the Veteran explained in greater detailed the circumstance of his right shoulder injury in service and his right shoulder symptoms thereafter. That testimony addresses his claim of injury in service, which is an unestablished fact necessary to substantiate the service connection claim. The new evidence raises a reasonable possibility of substantiating the claim. As there is new evidence that is also material, the Board grants reopening of the claim. 5. Service connection for right shoulder disability As the Board has reopened the claim, the Board must consider service connection on its merits. In consideration of claims on their merits, the Board must assess the credibility and weight of all the evidence, including the medical evidence, to determine its probative value, accounting for evidence which it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. See Masors v. Derwinski, 2 Vet. App. 181 (1992); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992); Hatlestad v. Derwinski, 1 Vet. App. 164 (1991); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Equal weight is not accorded to each piece of evidence contained in the record; every item of evidence does not have the same probative value. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a claim, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107. To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert, 1 Vet. App. at 54. The Veteran contends that his current right shoulder disability began with injury in service, and has worsened with right shoulder overuse because of his left shoulder disability. During service the Veteran was seen in September 1997 for persistent left shoulder pain following a fall that occurred three months earlier. In October 1997 he reported ongoing pain, tingling, and numbness in his left shoulder since about three months earlier, when he fell into a foxhole and struck that shoulder. A treating clinician diagnosed left shoulder impingement. In October and November 1997, a clinician recommended limited activity due to left shoulder impingement. In December 1997, a clinician indicated that both shoulders sustained injury, but the left shoulder was badly impaired. On VA examination of the Veteran in April 1998, a few months after his separation from service, he reported that during service he sustained injuries of both of his shoulders. He stated that his shoulders were yanked and pulled and the muscles were stressed. He indicated that rotator cuff damage and torn muscles were found. He reported that in service clinicians treated him with anti-inflammatory medications for pain. He stated that presently he had intermittent aching, even at rest. He reported pain with overhead activity, as required in his work as an electrician. The examiner observed that the shoulders had no sign of inflammation. Both shoulders had full ranges of active and passive motion without difficulty. In August 1999 the Veteran had a VA orthopedic consultation for chronic shoulder pain. He reported that during service he fell and had severe pain and a snapping sensation in his shoulder. He related left shoulder pain at present and occasional right shoulder pain. The physician noted snapping and popping with circumduction in both shoulders, more in the left. In the left shoulder there was apprehension on the supraspinatus test. Notes from VA physical therapy in October 1999 reflect a three-year history of problems in both shoulders, worse in the left. In April 2000, the Veteran had surgery of his left shoulder. He was instructed to restrict activities with his left upper extremity for six weeks. In primary care in July 2000, he reported right shoulder problems resulting from the same incident in service in which he injured his left shoulder. He reported right shoulder pain and popping, especially with overhead use, similar to symptoms in his left shoulder. In orthopedic treatment in September 2000, he reported ongoing left shoulder pain with overhead lifting. In primary care in January 2001, he reported pain and popping in both shoulders, especially with overhead use, worse in the left. On x rays his right shoulder appeared normal. In a March 2001 statement, the Veteran wrote that after his left shoulder surgery his shoulder disability worsened. He reported present right shoulder pain and restriction. In April 2001 a VA physician wrote that the Veteran was seen for chronic tendinitis of both shoulders. On VA examination in March 2002, the Veteran reported that problems with his shoulder prevented performing certain tasks and retaining construction jobs. The examiner found that both shoulders had crepitus with elevation, and full ranges of motion without discomfort. In February 2003 a VA clinician wrote that the Veteran was examined for right shoulder pain and right wrist pain, and that he should limit activity with his right upper extremity. In February 2004 the Veteran had private treatment for bilateral shoulder pain. On VA examination in July 2004, the Veteran reported left and right shoulder injuries in service and ongoing bilateral shoulder problems. On examination both shoulders had full ranges of motion, with pain with motion above 90 degrees. There was crepitus with motion. There was tenderness at both AC spaces, worse in the left. Bilateral shoulder x-rays did not show fracture, dislocation, or bony destruction. On VA examination in November 2004, the Veteran reported right shoulder injury in physical training in service. He related chronic bilateral shoulder pain, worse in the left. He expressed his belief that favoring his left shoulder after surgery in 2000 led to worsening of his right shoulder problems. On examination the right shoulder had full ranges of motion, with pain at the ends of the ranges. The examiner’s diagnosis was right shoulder condition, chronic since 1995. The examiner stated that he could not opine as to a relationship between the left and right shoulder disorders without resorting to mere speculation. The examiner recommended examination by an orthopedic specialist. VA treatment notes from 2005 through 2015 reflect ongoing shoulder pain. In March through August 2006, the Veteran had non-VA treatment for right shoulder problems. In March 2006 x-rays showed no evidence of degeneration. In May 2006 MRI showed tendinopathy of the rotator cuff. On VA examination in May 2006, both shoulders had full ranges of motion with pain on motion. The Veteran had surgery on his left shoulder in February 2009 and again in October 2009. In VA treatment in September 2014, he reported that he had right shoulder surgery in 2006. In the April 2018 Board hearing, the Veteran reported that during service he sustained injuries to his right and left shoulders at the same time, when he fell into a ditch. He stated that he continued to have problems with both shoulders after that. He stated that he had undergone multiple surgeries on both shoulders, including a right shoulder surgery in 2017. The Veteran’s service medical records contain a clinician’s notation, in December 1997, that the Veteran reported injury of both shoulders. In the claim the Veteran filed in December 1997, before separation from service, he reported problems with both shoulders. On examination in April 1998, only a few months after separation from service, he reported injuries of both shoulders during service, and ongoing episodes of pain, worse with activity. Thereafter, he continued to report symptoms in both shoulders, worse in the left. Clinicians have characterized the bilateral shoulder disorders as tendinitis. Evidence from service of right shoulder injury is followed by evidence from shortly after service of ongoing right shoulder symptoms. The evidence of continuity between the service injury and post-service symptoms is probative. A VA examiner indicated that an opinion could not be rendered without resort to speculation. Giving the Veteran the benefit of the doubt, service connection for his current right shoulder disability is warranted. 6. Request to reopen a claim for service connection for back disability The Veteran contends that he has disorders of the upper and lower back due to injuries in service. In a February 2011 rating decision, an RO denied service connection for back disability. He did not file a timely NOD with that decision; the decision became final. In an August 2012 claim, he sought service connection for back and neck disability. In a June 2013 rating decision, the RO denied reopening of the claim. The Veteran appealed that decision. The February 2011 rating decision is the only final decision on the claim. The Board will consider whether new and material evidence has been submitted since that decision. The evidence of record in February 2011 includes statements from the Veteran and medical records from during and after his service. During service, the Veteran received treatment in 1995 for twisting injury of the left ankle in a march. He was treated in 1996 for right ankle swelling and right knee pain and swelling, reported as occurring for more than a year after a door slammed into the knee. He received treatment in 1997 for shoulder pain following a fall into a foxhole. His service medical records do not reflect any report of injury of or pain in his lower or upper back. After service, on VA examination in April 1998, the Veteran reported sustaining injuries in two MVAs in service. He related ongoing effects from injuries to his teeth, shoulders, and right knee. He also reported recurrent sprains of his left ankle. He did not report any chronic or recurrent problems in his lower or upper back. In VA treatment in April 2001, the Veteran reported chronic low back pain with occasional flare-ups. In February 2002 he reported a two- to three-year history of intermittent low back pain. He related pain in the morning and with bending, and radiation of pain down his right lower extremity. He stated that during service he was thrown around inside a tank and sustained neck injury, possibly cervical spine fracture. He reported that during service he fell into a ditch and had low back pain. The treating clinician found that his lumbosacral spine was not tender to palpation and had a full active range of motion without pain. The lower back appeared normal on x-rays. The clinician’s impression was chronic low back pain. In February 2004, the Veteran had private treatment for pain in both of his shoulders and his neck. In VA treatment in 2004 and 2005, lists of problems included neck pain, cervical spine arthritis, degeneration of intervertebral disc, osteoarthritis, and degenerative joint disease (DJD). In August 2004, he reported multiple MVAs in service, with injuries of the face, neck, and both shoulders. The treating physician noted arthralgias, myalgias, and arthritis. The physician also noted radiculopathy of the bilateral upper extremities. In September 2004, the Veteran reported that in a 1996 MVA he sustained cervical strain and fracture. He reported current neck pain and finger numbness. On neuromuscular testing, upper extremity function was normal. In October 2004, he reported persistent back and shoulder pain. A clinician provided osteopathic manipulative treatment of the thoracic spine. In May 2005 a VA physician who treated the Veteran signed an assessment of physical disorders that was completed for SSA purposes. It was reported that the Veteran had a ten-year history of daily, moderate pain in his shoulder, knees, wrists, low back, and neck. The pain was attributed to traumatic arthritis from an MVA during military service. It was related that his legs went numb if he sat for more than a few minutes, and that prolonged sitting or standing caused numbness and tingling in both hands. It was stated that degenerative disc disease (DDD) of the cervical and lumbar spine was suspected. In May 2005 the Veteran provided an account of stressful events during his service. He reported that, in a field exercise, his BFV drove off a cliff. He stated that his face smashed into a night scope and he needed medical attention later. In private treatment in February 2006, the Veteran reported medical problems including pain in his cervical spine and lower spine, DJD, and cervical spine osteoporosis. He related a history of crushing of his cervical spine and of several concussions. In March 2006, he stated that in an accident in service he sustained injuries of his neck and both shoulders. A clinician found that his neck had a normal range of motion, with mild crepitus. In VA treatment records from 2007 through 2009, lists of problems included osteoarthritis and neck pain. In a December 2007 letter to a U. S. Senator, the Veteran listed his current disabilities, including disorders of the back and neck. In VA treatment in February 2009, it was noted that the Veteran had chronic neck pain, and that MRI showed degenerative changes and stenosis of the cervical spine. His neck pain was described as stable. In July 2009 the Veteran reported that he sustained massive trauma to his back in service when his BFV went off a cliff. In October 2010 the Veteran submitted a claim for service connection for a back condition. In VA treatment in December 2010, a list of problems included neck pain, degeneration of intervertebral disc, osteoarthritis, and DJD. The evidence added since February 2011 includes additional and more recent medical records, SSA records, and statements from the Veteran, including his testimony at the 2018 Board hearing. In VA treatment in December 2011, the Veteran reported that he had fee basis treatment for back pain, and was told that he had DDD and unequal leg length. A clinician’s assessments included degeneration of intervertebral disc, traumatic arthropathy, cervical spine arthritis, and DJD. In 2012 lists of problems included cervical spine arthritis, degeneration of intervertebral disc, traumatic arthropathy, osteoarthritis, neck pain, DJD, and chronic back pain. In August 2012 the Veteran sought service connection for multiple conditions including disorders of the upper and lower back. He stated that during service his back was broken. In a VA examination in October 2012, the Veteran reported chronic pain in his low back and his neck. In VA treatment in November 2012, the Veteran reported injuries to his back and neck in a BFV accident in service. He related present radiation of low back pain into the lower extremities. He stated that nerve studies showed severe nerve damage in his neck. A physician provided an assessment of diffuse pain, including neck pain. The physician stated that he had referred leg pain but no true radicular pattern. The physician called for further imaging and testing. In December 2012, EMG/NCV testing showed normal results, with no electrodiagnostic evidence of radiculopathy or plexopathy. X-rays showed no interval change in his sacrum since 2009. In VA treatment in February and August 2013 and September and November 2014, lists of problems included cervical spine arthritis, degeneration of intervertebral disc, traumatic arthropathy, osteoarthritis, neck pain, DJD, and chronic back pain. In February the Veteran reported that bending caused sharp low back pain. CT of the spine showed no significant abnormalities. In August 2013 he reported low back pain and mid-thoracic tenderness. There was no evidence of neurological deficits. In August 2014 he reported neck pain and low back stiffness. In November 2014 he related intermittent radiation of neck pain into the upper extremities. In the April 2018 Board hearing, the Veteran discussed injuries he sustained during service. He stated that when his BFV went off a cliff he sustained injuries of several areas, including his neck. He reported that when he fell into a ditch he had injuries of many areas, including his back. In the February 2011 rating decision, the RO denied service connection for back disability because evidence did not establish a connection between a current upper or lower back disorder and an injury, disease, or event in service. Evidence added since that decision includes additional accounts of claimed back and neck injuries in service and ongoing symptoms in those areas. That evidence addresses claimed injury in service and continuity of disorders after service. Those are unestablished facts necessary to substantiate the service connection claim. The new accounts are not inherently incredible. The Veteran is in a position to recall injuries and symptoms during and since service. Presuming credibility of the new accounts, they raise a reasonable possibility of substantiating the claim. As there is evidence that is both new and material, the Board grants reopening of the claim. As the Board has reopened the claim, the Board must consider service connection on its merits. The Board finds it necessary, however, to remand the claim for further development, as explained in the remand section, below. 7. Request to reopen a claim for service connection for right wrist disability The Veteran contends that he had right wrist injury during service and has ongoing right wrist disability. In an October 2007 rating decision, an RO denied reopening of a previously denied claim for service connection for right wrist disability. He did not file a timely NOD with that decision; the decision became final. In an August 2012 claim, he sought service connection for right and left wrist disabilities. In a June 2013 rating decision, the RO denied reopening of the right wrist disability service connection claim. The Veteran appealed that decision. The October 2007 rating decision is most recent final denial of that claim on any basis. The Board will consider whether new and material evidence has been submitted since that decision. The evidence of record in October 2007 includes statements from the Veteran and medical records from during and after his service. During service the Veteran received treatment for musculoskeletal pain attributed to injuries in service. However, his service medical records do not reflect any report of injury of or pain in his right or left wrist. After service, on VA examination in April 1998, he reported joint injuries in service, but did not report any injury of or symptoms in his right or left wrist. In VA treatment in April 2001, the Veteran reported a several-month history of bilateral wrist pain, possibly carpal tunnel syndrome (CTS). Later in April 2001, he reported a three-year history of bilateral CTS, worse since starting work in construction six months ago. He indicated that activities with hyperextension of the wrists caused pain in the wrists and numbness in the fingertips. He reported that the symptoms lasted for hours after the activity. He stated that in 1992 and 1996 he had frostbite in both hands, and all his fingers turned black and blue. He indicated that the frostbite had not bothered him since. He stated that presently he had stiffness in his right wrist, but had no hand weakness. A clinician found that both wrists had full ranges of motion. Tinel’s/Phalen’s test was positive for pain in the left wrist and index finger. The clinician’s assessment was possible bilateral CTS. In another consultation, the Veteran reported a three-year history of wrist and hand symptoms. He related wrist pain with use, and fingertip numbness that increased with use. He stated that once a week his hands were numb on awakening. He reported that his fingertips turned purple with cold exposure. He related a history of multiple hand injuries, with fractures of possibly every finger. A clinician prescribed elastic splints for both wrists. In VA treatment in June 2001, the Veteran reported striking the back of his left hand with a hammer. A clinician observed a contusion. X-rays showed no fractures or dislocations. In July 2001, the Veteran related ongoing numbness and tingling in both hands. In August 2001, he reported a burning sensation from his left wrist up his forearm. A clinician noted tenderness near the left wrist and tendinitis of both thumb extensor tendons. Tinel’s sign was positive bilaterally and Phalen’s test was negative bilaterally. In November 2001, the Veteran reported bilateral hand pain since 1995 or 1996. On electromyography (EMG) testing there was no electrodiagnostic evidence of CTS bilaterally. On VA examination in March 2002, the Veteran reported that during service he sustained left shoulder injury in a fall. He indicated that after service he worked in construction, but left that work because of left shoulder problems. He stated that he then worked as a security guard, but stopped in February 2002 because of a right wrist problem. He related that, since the 2000 shoulder surgery, with exposure to cold he had numbness and purplish discoloration in the tips of the second and third fingers of both hands. The examiner found normal vasculature and deep tendon reflexes in both upper extremities. In February 2003 a VA clinician wrote that the Veteran had been examined for right shoulder pain and right wrist pain. The clinician stated that the Veteran should limit activity with those joints. In VA treatment in May 2004, the Veteran reported multiple problems including right wrist pain. In June 2004, a clinician noted that the Veteran was seen for bilateral wrist pain. On VA examination in July 2004, the Veteran reported that during service he sustained left shoulder injury with a fall into a hole. He stated that he injured or reinjured both shoulders with fall type push-ups. In treatment in September 2004, he reported a history of neck injury in an MVA in service, and a history of left shoulder injury and surgery. He reported numbness in the third to fifth fingers in both hands. On examination reflexes in both upper extremities were 2/4. On EMG findings were normal, with no electrophysiologic evidence for bilateral ulnar or median neuropathies or cervical radiculopathy. On VA examination in November 2004, the Veteran reported that he injured his right shoulder in service in physical training. In January 2005 the Veteran’s VA treating physician wrote that he had repetitive work injury of his wrists. In February 2005, the Veteran sought service connection for right wrist disability. He stated that he had many problems with it in service, and the problems had worsened. In VA treatment in April 2005, a list of problems included sprains and strains of the wrist and hand. The Veteran reported ongoing pain in both wrists, worse in the right. He indicated that he was no longer working at a repetitive factory job. A treating physician noted evidence of pain with motion of the right wrist. The physician found no evidence of CTS. The physician’s assessment was chronic bilateral wrist sprain from previous repetitive work injury. The evidence added since October 2007 includes additional medical records and additional statements, including 2018 hearing testimony, from the Veteran. In VA treatment in December 2008 through January 2010, lists of problems included tenosynovitis of the hand and wrist. From December 2008 he was noted to have tendonitis of the left biceps. He underwent left shoulder surgery in February 2009 and again in October 2009. On VA examination in March 2010, the Veteran reported problems in multiple joints, including the right wrist. In VA treatment in December 2010, a list of problems included wrist and hand sprains and strains. In December 2010 some older VA treatment records were added to the file. Those records include notes of treatment in May 2002, which reflect the Veteran’s report of left forearm and wrist pain. In July 2003, he related chronic pain and popping of his right wrist. In August 2004, he stated that three to six hours per day he had decreased sensation in some of the fingers in both hands. In VA treatment in 2012 through 2014, lists of problems included sprains and strains of the wrist and hand, tendonitis, and CTS. In November 2014 the Veteran reported numbness in some fingers in both hands, and intermittent radiation of neck pain to those fingers. A clinician’s assessment included CTS. In December 2014 EMG had normal findings, with no evidence of CTS or peripheral neuropathy. SSA records added to the file in September 2015 include a May 2005 VA report indicating that prolonged sitting or standing resulted in numbness and tingling in both hands. In the April 2018 Board hearing, the Veteran reported that he sustained injury of his right and left wrists in service when he fell into a ditch. In the October 2007 rating decision, the RO denied reopening of a claim for service connection for right wrist disability because evidence did not show that a chronic right wrist disorder began in service or was attributable to events in service. Evidence added since that decision includes additional accounts of claimed right wrist injury in service and right wrist problems after service. That evidence addresses claimed injury in service and continuity of disorders after service. Those are unestablished facts necessary to substantiate the service connection claim. The new accounts are not inherently incredible. The Veteran is in a position to recall injuries and symptoms during and since service. Presuming credibility of the new accounts, they raise a reasonable possibility of substantiating the claim. As there is evidence that is both new and material, the Board grants reopening of the claim. As the Board has reopened the claim, the Board must consider service connection on its merits. The Board finds it necessary, however, to remand the claim for further development, as explained in the remand section, below. 8. Service connection for TBI The Veteran has reported sustaining head injuries before and during service. He essentially contends that he sustained TBI in service and that current problems were caused or aggravated by TBI in service. He contends that the current problems that are attributable to TBI are dizziness, fainting, nausea, headaches, bipolar disorder, and right eye problems. In October 1994 the Veteran completed a medical history for entrance into service. He marked no for any history of head injury. On examination at that time the examiner marked normal for the condition of the Veteran’s head. During service the Veteran was seen for injuries. In 1997 he reported that he fell into a foxhole and struck his left shoulder. However, his service treatment records do not reflect any report of head injuries. His service dental records reflect surgeries, but no report of trauma or injury to his teeth. In his VA claim filed in December 1997, before separation from service, he reported injuries but did not report head injury. On VA examination after service, in April 1998, the Veteran reported that in an MVA service in 1995 he chipped four teeth and sustained right knee injury. He related that in training in 1995 and 1996 he sustained left ankle sprains. He indicated that in 1996 he sustained shoulder injuries in an MVA. The examiner observed chipped incisors. In VA treatment in January 1999, the Veteran reported shoulder injury in a fall in service. In private dental treatment in February 1999, the dentist noted chipped teeth. On VA examination in March 2002, the Veteran reported left shoulder injury in a fall in 1996. In VA treatment in May 2002, he stated that during service he was thrown around inside a tank and sustained neck injury. In July 2003, he reported headaches triggered by problems with his left TMJ. Medical records from 1999 through 2003 do not reflect any report of injury directly to the head. In VA treatment of the Veteran in June 2004, on neurological screening he was alert and oriented, with intact memory. A clinician noted that he had been seen for facial pain. On VA examination in July 2004, the Veteran reported that in an MVA during service he sustained injury of his face and chipped several teeth. He stated that during service he fell into a hole and sustained shoulder injury. He reported present headaches. In VA treatment in August 2004, the Veteran reported a history of MVAs in service, with injuries to his face, neck, and shoulders. In September 2004 he stated that in a 1996 MVA he had trauma to multiple areas, including his neck. In October 2004 he related problems with anger, depression, anxiety, and overstimulation. The treating physician found that he was alert and oriented and had intact memory. The physician noted that on each visit he had multiple complaints and was very verbose. In an October 2004 psychological evaluation, the Veteran reported a history of several head traumas. He indicated that current problems included blackout episodes. In the Veteran’s May 2005 account of stressful events during service, he reported that when his BFV drove off a cliff his face was smashed against a night vision scope. He stated that he needed medical attention later and he had ongoing problems through the present. In VA treatment in July 2005, the Veteran reported a history of MVAs and head injuries. In August 2009, he stated that during service he had head trauma several times, including from a tank accident, a grenade explosion, and a fall with jaw injury. He reported that presently he had occasional dizzy spells. In January 2010 he stated that he had serious head trauma in 1993, which was before his service. He related that since then he had episodes of visual impairment in his right eye, followed by migraine headaches. In VA treatment in January 2012, the Veteran reported that he had a TBI as a child, when he fell out of a tree and hit the back of his head. He stated that he had two more TBIs during service. In May 2012 his account of one TBI before service and two TBIs during service was noted. In August 2012 he submitted a claim for service connection for multiple conditions including TBI. In VA treatment in November 2012 a history of brain injuries was noted but characterized as questionable. In the 2018 Board hearing, the Veteran reported that several incidents in service could have caused TBI. When his BFV drove off a cliff, he related, the back of his head struck a night vision scope. He reported that afterward he was seen by a medic but he declined hospital treatment. He reported that in a training exercise a grenade exploded within ten feet of his head. He stated that the effects were treated with an analgesic. He related that when he fell into a ditch, his head hit a rock. He indicated that the head injury was treated with an analgesic. He asserted that the current residuals of those head injuries were dizziness, fainting, nausea, headaches, bipolar disorder, and right eye problems. The Veteran claims he has had TBI and has residuals of TBI. He is in a position to remember blows to his head. Medical training is needed, however, to diagnose TBI or residuals of TBI. No physician has found that he had a TBI or has residuals of TBI. No physician has indicated that any current disorder is related to any history of TBI. VA is obliged to provide an examination or obtain a medical opinion when the record contains competent evidence that the claimant has a current disability or signs and symptoms of a current disability, the record indicates that the disability or signs and symptoms of disability may be associated with active service, and the record does not contain sufficient information to make a decision on the claim. 38 U.S.C. § 5103A(d) (2012); 38 C.F.R. § 3.159(c)(4) (2017); McLendon v. Nicholson, 20 Vet. App. 79 (2006). The types of evidence that indicate a current disability may be associated with military service include, but are not limited to, medical evidence that suggests a nexus but is too equivocal or lacking in specificity to support a decision on the merits, or credible evidence of continuity of symptomatology such as pain or other symptoms capable of lay observation. McLendon, 20 Vet. App. at 83. The threshold for finding a link between current disability and service is low. Locklear v. Nicholson, 20 Vet. App. 410 (2006); McLendon, 20 Vet. App. at 83. As there is not competent evidence that the Veteran had TBI or has residuals of TBI, VA is not obliged to obtain a medical examination or opinion addressing the claim. As the preponderance of the evidence is against current TBI residuals, occurrence of TBI in service, and a link between any head injury in service and any current disorder, the Board denies service connection for TBI. 9. Service connection for right ankle disability The Veteran reports that he sustained right ankle injury in service and has ongoing right ankle disability. He previously sought, and an RO denied, service connection for left ankle disability. The issue of service connection for left ankle disability is not presently before the Board. During service the Veteran had treatment in March 1995 for left ankle pain after twisting that ankle while marching. He did not report any problem with the right ankle at that time. The treating clinician found left ankle sprain. In August 1996 the Veteran had arthroscopic surgery on his right knee. Two days after the surgery he reported swelling in his right knee and right ankle. A clinician found tenderness, edema, and erythema in the right ankle. In the Veteran’s December 1997 VA claim he sought service connection for chronic sprains of the left ankle. On VA examination in April 1998, he reported left ankle sprains in training in 1995 and 1996, and ongoing susceptibility of that ankle to sprains with twisting. He did not report any right ankle problems. The examiner observed that he had normal gait and stance, and that his left ankle had full ranges of motion without discomfort. On VA examination in July 2004, the Veteran’s gait was upright and steady. In January 2006 he requested an increased disability rating for three conditions, including left ankle disability. He apparently mistakenly believed that service connection had been granted for left ankle disability. In May 2007 he sought reopening of a claim for service connection for left ankle injury. In a December 2007 letter to a U.S. Senator, he stated that his disabilities included disabilities of both ankles. In August 2012 the Veteran submitted a claim for service connection for multiple conditions, including right ankle disability. In the April 2018 Board hearing, he indicated that when he fell into a ditch during service he sustained injuries of multiple areas, including both ankles. The Veteran received treatment in service for shoulder injuries sustained in a fall into a ditch, but records do not reflect any right ankle complaints at that time. He received treatment in service for left ankle sprain. However, he did not report any right ankle problems at any time during service, nor earlier than several years after service. As there is no finding of right ankle arthritis within a year after service, there is no basis to presume service connection for any such arthritis. No physician has indicated that he has any current right ankle disorder that is related to any injury or other event in service. The evidence does not support continuity of right ankle problems from service through the present. Therefore, VA is not obliged to obtain a medical examination or opinion addressing the claim for service connection for right ankle disability. The preponderance of the evidence is against incurrence in service of any right ankle disability, so service connection is denied. 10. Service connection for residuals of frostbite of the left big toe The Veteran reports that during service he sustained frostbite, including to his left and right big toes. His assembled service medical records are silent for complaints of frostbite or any toe problem. His December 1997 claim and the VA examination in April 1998 also are silent for any toe problems. In VA treatment in April 2001, the Veteran reported a three-year history of bilateral wrist and hand problems. He stated that in 1992 (before his service) and 1996 (during his service) he had frostbite of both hands, with all fingers turning black and blue. He stated that the frostbite had not bothered him since. He also stated that his fingers turned purple when they got cold. He reported ongoing episodes numbness in his hands, occasionally upon awakening, and other times with use. A clinician prescribed wrist splints. In February 2002 he reported left shoulder and low back pain. He stated that when he stretched his back he had a warm sensation in both heels and both great toes. The treating clinician noted that he could flex and extend both great toes. In VA treatment in July 2009, a clinician observed that the Veteran’s extremities had no clubbing, cyanosis, or edema. In August 2012 the Veteran submitted a claim for service connection for multiple conditions, including frostbite of the left and right big toes. In VA treatment in November 2012, he reported low back pain and frequent numbness in his toes. The treating physician observed that he could toe-walk without difficulty. Sensation to light touch was intact in both lower extremities. In the April 2018 Board hearing, the Veteran reported that during service he was in training exercises outdoors in cold weather for hours. He stated that he got frostbite in his fingers and toes. He related that it was especially bad in his toes, which turned black. He reported that he had treatment in the field, over about three days. He related that the treatment restored the tissue of toes, but the bones in the toes had ongoing damage. He stated that presently both major toes did not move at all. As the Veteran does not have medical training, he is not qualified to conclude that the big toe frostbite injury during service that he reports is connected to the current stiffness or ankylosis in his big toe joints that he reports. No clinician has supported such a relationship. VA physicians have found that he could flex and extend both big toes. They have not found any other current dysfunction in his toes. Therefore, VA is not obliged to obtain a medical examination or opinion addressing the claim. Considering the absence of service documentation of toe frostbite, the lack of a report of toe frostbite history when he reported finger frostbite history in 2001, and the lack of medical support for a connection between current toe problems and claimed frostbite in service, the preponderance of the evidence is against service connection for residuals of frostbite of the left big toe 11. Service connection for residual of frostbite of the right big toe The evidence summarized in the above section regarding the left big toe also applies to the right big toe. For the reasons stated above, the preponderance of the evidence is against service connection for residuals of frostbite of the right big toe. 12. Service connection for residuals of heat stroke The Veteran reports that he had heat stroke during service and again after service. He contends that he has residual problems related to the heat stroke during service. The Veteran’s assembled service medical records are silent for complaints of heat stroke or heat-related injury or symptoms. His December 1997 claim and the VA examination in April 1998 also are silent for any heat-related problems. In VA treatment in October 2004, he reported a history of heat stroke on two occasions, one with hospitalization. In the April 2018 Board hearing, he reported that during service, while inside a track vehicle in extremely hot weather, he became overheated, dehydrated, and disoriented. He stated that he was taken for treatment and found to have an extremely elevated core temperature. He related that he was treated with intravenous fluids and an ice bath. He reported that since then he was particularly sensitive to heat, and susceptible to quick onset of new episodes of heat stroke. He stated that after separation from service he had another episode of heat stroke. There is no competent evidence that the Veteran has current heightened susceptibility to heat stroke or any other current problems related to past heat strokes. The Veteran does not have medical training, so his opinion that he has heightened susceptibility does not have the persuasive weight of a medical opinion. He is in a position to recall an incident of overheating and receiving treatment during service. His service treatment records are silent as to the incident, so there is no documentation of his condition during and after the incident. Records from the years immediately following service are silent as to ongoing or recurrent problems related to a history of heat stroke. As there is no competent evidence of signs and symptoms of a current disorder related to a history heat exposure, VA is not obliged to obtain a medical examination or opinion addressing the claim. Considering the absence of documentation of heat-related illness during service, the absence of medical finding of a current disorder related to a history of heat exposure, and the absence of medical support for a relationship between any current disorder and heat exposure in service, the preponderance of the evidence is against service connection for residuals of heat stroke. 13. Service connection for rheumatoid arthritis The Veteran contends that he has rheumatoid arthritis due to injuries and other events during service. During service he had treatment for musculoskeletal injuries, including shoulder, knee, and ankle injuries. However, his assembled service medical records are silent for complaints or findings of rheumatoid arthritis. His December 1997 claim and the VA examination in April 1998 also are silent for findings of rheumatoid arthritis. In VA treatment in July 2009, the Veteran reported that he had arthritis and DJD in all of his joints. The treating clinician observed that the Veteran was relatively healthy appearing and had many somatic concerns and issues. His extremities had no clubbing, cyanosis, or edema. In November 2012 a physician indicated that the Veteran had no history of rheumatoid arthritis. After musculoskeletal examination the physician did not find any evidence of rheumatoid arthritis. In the April 2018 Board hearing, the Veteran indicated that he has rheumatoid arthritis as a result of injuries during service. In addition, he asserted that screws and rods inserted in surgeries to address his injured joints may have caused rheumatoid arthritis. He also indicated that he had heard that the health of his bones was undermined because, during long periods of field exercises, he had to eat packaged meals (MREs) instead of freshly-prepared food. As rheumatoid arthritis was not diagnosed within a year after the Veteran’s service, there is no basis to presume service connection for rheumatoid arthritis. There is no competent evidence that the Veteran currently has, or has ever had, rheumatoid arthritis. In fact, a VA clinician noted that there was no history of rheumatoid arthritis. In the absence of competent evidence of diagnosis or signs or symptoms of current rheumatoid arthritis, VA is not obliged to obtain a medical examination or opinion addressing the claim. As the preponderance of the evidence is against a finding of current rheumatoid arthritis, service connection for claimed rheumatoid arthritis is denied. REASONS FOR REMAND 1. Service connection for PTSD The Board is remanding this reopened claim for efforts to corroborate reported stressors, and for mental health professional file review, examination, and opinion regarding the likely etiology of the Veteran’s PTSD. The Veteran contends that traumatic experiences in service caused his PTSD. He has been diagnosed with PTSD. Additional information is needed to support the occurrence of an in-service stressor to which his PTSD may be linked. The in-service stressors the Veteran has reported are: (1) coming under fire in a vehicle in a training exercise, (2) sustaining injuries while in a vehicle that fell off a cliff, and (3) sustaining injuries from personally falling into a ditch. He did not deploy to any war zone, and did not engage in combat with the enemy. He has not reported any traumatic event involving fear of hostile military or terrorist activity. Therefore, corroboration from service records therefore is necessary. The Board is remanding the claim for a search for records supporting the occurrence of the reported stressors of coming under fire and vehicle falling off a cliff. The Veteran’s service treatment records from 1997 contain notation of injuries sustained from falling into a foxhole, consistent with his reported stressor of falling into a ditch. It is not clear, however, whether that fall constituted a traumatic event capable of causing or contributing to causing his PTSD. The Veteran has not had a VA examination addressing his claim for service connection for PTSD. The record contains reflects a diagnosis of PTSD, reports of traumatic events in service, and the Veteran’s assertion that current PTSD is related to events in service. However, no mental health professional has linked current PTSD to any corroborated event in service. The Board is remanding the claim for an examination with file review and opinion addressing the likelihood that the fall or any other reported stressor is causally related to his PTSD.   2. Service connection for psychiatric disability other than PTSD The Board is remanding this reopened claim for mental health professional file review, examination, and opinion regarding the likely etiology of the Veteran’s psychiatric disorders other than PTSD. The Veteran essentially contends that his psychiatric disorders, including bipolar disorder, OCD, and ADHD, began in service, worsened in service, or were caused by injuries or other events in service. His statements and his treatment contain somewhat differing accounts as to when symptoms of those disorders began. For example, he has related having ADHD before service, and has asserted that bipolar disorder had onset after head injuries in service. The Board is remanding the claim for the VA mental health professional who performs the review and examination addressing the PTSD claim to also address the claim regarding psychiatric disorders other than PTSD. 3. Service connection for a left eye disorder The Board is remanding this reopened claim for a medical file review, examination, and opinion addressing the likely history and etiology of current left eye disability. The Veteran contends that preservice left eye problems were aggravated in service. Medical records and the Veteran’s statements provide evidence that before he entered service his left eye was affected by lazy eye, refractive error, and refractive amblyopia. The assembled service medical records do not document worsening during service. There is no record of a service separation examination to help show the condition of his left eye at separation from service. An examination in April 1998, just a few months after separation from service, shows visual loss worse than was shown at entrance to service. Medical records indicate that the condition of his left eye worsened further after service. The evidence of worse disability soon after service suggests, but is insufficient to show, worsening during service. Therefore, the Board is remanding the claim for medical file review, examination, and opinion regarding etiology, particularly claimed aggravation in service.   4. Service connection for back disability The Board is remanding this reopened claim for a medical file review, examination, and opinion addressing the likely etiology of current disorders of the lower and upper back. The Veteran contends that injuries in service produced current disorders in those areas. One of the reported events leading to musculoskeletal injuries, a fall into a foxhole, is reflected in service treatment records. As early as a few years after service, the Veteran reported a several-year history of back pain. A medical history signed by a VA physician in 2005 indicated that present neck and low back pain was due to injury in service. However, that physician did not report having reviewed records from the time of the Veteran’s service. The Veteran has not had a VA examination addressing the likely etiology of current disorders of his lower and upper back. The record contains competent evidence that he has signs and symptoms of current disability of those areas. The record indicates that those current signs and symptoms may be associated with injuries in service, but the record does not contain sufficient information to decide the claim. The Board is remanding the claim for an examination with file review and opinion addressing the likelihood that any of the current disorders of the lower and upper back are causally related to injury or other events in service. 5. Service connection for right wrist disability The Board is remanding this reopened claim for a medical file review, examination, and opinion addressing the likely etiology of current disorders of the right wrist. The Veteran contends that injury in service produced current right wrist disorders. One of the reported events leading to musculoskeletal injuries, a fall into a foxhole, is reflected in service treatment records. As early as a few years after service, the Veteran reported a several-year history of right wrist problems. The Veteran has not had a VA examination addressing the likely etiology of current disorders of his right wrist. The record contains competent evidence that he has signs and symptoms of current disability of those areas. The record indicates that those current signs and symptoms may be associated with injuries in service, but the record does not contain sufficient information to decide the claim. The Board is remanding the claim for an examination with file review and opinion addressing the likelihood that any current disorder of the right wrist is causally related to injury or other events in service. 6. Service connection for a TMJ disorder The Board is remanding this claim for a medical file review, examination, and opinion addressing the likely etiology of any current TMJ disorder. The Veteran reports that during service he sustained face and tooth injuries in an MVA. He also reports that in service he had a dental infection and dental and jaw surgeries. He contends that those events were followed by ongoing TMJ problems including pain. Medical and dental treatment records from the Veteran’s service do not reflect any report of injury in an MVA. Dental treatment records from service do not reflect any report of traumatic injury to the teeth or jaws. He had treatment for an impacted tooth number 11. Treatment included surgeries for extraction of the tooth, grafting of bone to the maxillary area, and placement of an implant. In treatment in January 1997, after one of the surgeries, he had soft tissue swelling in the left side of his face. In a VA claim he filed in December 1997, before separation from service, he reported having chipped four front teeth in a training accident. He also reported the surgeries related to tooth 11. On examination in April 1998, a few months after separation from service, the Veteran reported that during service he sustained injuries in two MVAs. He related that in the earlier MVA, in 1995, four teeth were chipped and his left knee was injured. The examiner noted a barely perceptible defect of two upper and two lower incisors. The TMJs were normal. In an August 1998 rating decision, an RO granted service connection for residuals of the treatment of the impacted maxillary canine tooth 11. The RO denied service connection for four chipped front teeth, because service medical records did not mention chipped front teeth. However, the RO referred the Veteran to a VA dental clinic for any needed treatment. In VA treatment in July 2003, the Veteran reported headaches that he stated were triggered by problems with his left TMJ. In June 2004, a VA clinician noted that the Veteran had been seen for facial pain. On VA dental examination in July 2004, the Veteran reported that, in an MVA during service, he hit the left side of his face and chipped several teeth. He also reported the surgeries to address the impacted tooth 11. He stated that presently he had headaches with pain in his left temple, left eye area, and left cheek. He indicated that he was aware of nocturnal bruxism. The examiner noted tenderness to palpation at the left temporalis and masseter muscles. He noted slight chipping of the lower anterior teeth. He observed a low angle mandible and a deep vertical overbite. He diagnosed temporomandibular dysfunction, especially on the left side. He expressed the opinion that it was doubtful that the TMJ disorder was related to the treatment for tooth 11. He opined that the TMJ disorder more likely was due to the skeletal relationship, the absence of tooth 11 due to impaction, the history of trauma to the face, and the bruxism. In the Veteran’s May 2005 account of stressful events during service, he reported that, when his BFV drove off a cliff, his face was smashed against a night vision scope. He stated that he needed medical attention later and he had ongoing problems. In VA treatment in August 2009, the Veteran stated that during service he had head trauma several times, including from a tank accident, a grenade explosion, and a fall. He indicated that he sustained jaw injury in the fall. In VA treatment in January 2012, it was noted that about ten years earlier he had jaw surgeries complicated by infection. In August 2012 the Veteran submitted a claim for service connection for multiple conditions, including a TMJ disorder. In a June 2013 rating decision, an RO denied service connection for a TMJ disorder, noting that the July 2004 examiner attributed a TMJ disorder to causes other than the impaction and treatment of tooth 11. In the April 2018 Board hearing, the Veteran reported that he underwent jaw surgeries during service. He related ongoing jaw problems. The July 2004 examiner opined that facial trauma during service that the Veteran reported was one of several factors likely combining to cause his current TMJ disorder. The Veteran’s service medical and dental records do not mention facial trauma. However, during and soon after service he reported sustaining dental trauma in an MVA in service. The Board is remanding the claim for a new VA examination with file review and opinion addressing the likelihood that any injury in service contributed substantially to causing his TMJ disorder. 7. Service connection for left wrist disability The Board is remanding this claim for a medical file review, examination, and opinion addressing the likely etiology of current disorders of the left wrist. The Veteran contends that injury in service produced current left wrist disorders. Much of the evidence relevant to his right wrist also addresses his left wrist. One of the reported events claimed to have produced musculoskeletal injuries, a fall into a foxhole, is reflected in service treatment records. As early as a few years after service, the Veteran reported a several-year history of left wrist problems. The Veteran has not had a VA examination addressing the likely etiology of current disorders of his left wrist. The record contains competent evidence that he has signs and symptoms of current disability of those areas. The record indicates that those current signs and symptoms may be associated with injuries in service, but the record does not contain sufficient information to decide the claim. The Board is remanding the claim for an examination with file review and opinion addressing the likelihood that any current disorder of the left wrist is causally related to injury or other events in service. 8. Service connection for left knee disability The Board is remanding this claim for a medical file review, examination, and opinion addressing the likely etiology of current left knee disability. Before the Veteran’s separation from service, he claimed service connection for right knee disability. An RO granted service connection, effective from separation from service, for a right knee disability described as medial meniscus tear. The Veteran reports that during service he also had injury of his left knee. He contends that left knee injury in service caused chronic, ongoing left knee disability, or that his right knee disability caused or aggravates his left knee disability. Service connection may be granted on a secondary basis for a disability that is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a) (2017). Aggravation of a non-service-connected disease or injury by a service-connected disability may also be service-connected. 38 C.F.R. § 3.310(b). During service the Veteran had treatment for right knee problems. In August 1996 he reported that a year and a half earlier a door slammed into his right knee. He related episodes of locking and giving way of that knee since then. Right knee MRI revealed a tear of medial meniscus. He underwent arthroscopic surgery in August 1996, and had physical therapy afterward. His service medical records do not reflect any report of left knee injury or problems. On VA examination in April 1998, the Veteran reported that during service, in an MVA in 1995, he sustained injury of his right knee. He indicated that he had a meniscus tear, and underwent surgery in 1997. He reported that since surgery he had several reinjuries of the right knee from running. He did not report any problems with his left knee. The examiner observed normal gait and stance. The right knee had a normal range of motion and no evidence of instability. In January 2006 the Veteran requested an increased disability rating for his right knee disability. On VA examination in May 2006, he reported that during service that knee was injured by a tank lid. He stated that presently he had chronic pain in the knee, worse with prolonged activity. He reported that his left knee had occasional mild pain. The examiner observed a normal, non-antalgic gait. Both knees had limitation of flexion. The right knee had pain with motion; the left knee did not. Right knee x-rays showed minimal degenerative changes. In October 2007 the Veteran had right knee surgery. In VA treatment in May 2009, the Veteran reported intermittent right knee pain with extension, especially when descending trails while hiking. He also reported intermittent edema in his right knee. A clinician prescribed a brace. In November 2009 the Veteran reported that his right knee had locking and increased pain. The treating clinician observed that the Veteran had a steady gait, and that his right knee had no swelling and no limitation in passive motion. In VA treatment in December 2011, the Veteran reported persistent pain and clicking in his right knee. He stated that he had been told that his legs were unequal in length. The treating clinician noted that the Veteran’s left knee had medial tenderness to palpation, without evidence of effusion. In February 2012 the Veteran reported worsening right knee disability, with popping, intermittent swelling, and increased pain with activity. The treating clinician found that the right knee had tenderness and limitation of motion. Right knee x-ray showed mild to moderate medial compartment arthrosis. In June 2012 the Veteran reported ongoing right knee pain. A clinician noted pain with motion of the left knee. In July 2012 it was noted that an unloader brace on the right knee was providing relief, especially with activity. In August 2012 the Veteran submitted a claim for service connection for multiple conditions, including left knee disability. In a June 2013 rating decision, an RO denied service connection for left knee disability because evidence did not show left knee injury or disease in service. In VA treatment in August 2013, the Veteran wore an orthosis on his right knee. His gait was smooth and symmetrical. In January 2014 he reported that his right knee was improved with the new unloader brace. He stated that his left knee had a long history of pain, and now had catching, locking, and swelling. He reported that, after a crush injury of his right knee, he put his weight on his left knee, and his left knee became symptomatic. The treating physician found that the left knee had a full range of motion. Lachman’s sign was symmetric. McMurray sign was positive. Left knee x-rays showed mild joint space narrowing. The clinician’s assessment was internal derangement of the left knee. In June 2014 a clinician issued unloader braces for the Veteran’s left and right knees. In the April 2018 Board hearing, when asked about his left knee disability, the Veteran reported that during service his right knee was crushed in the driver’s hatch of a BFV. He noted that during service he had surgery on that knee, followed by physical therapy. The hearing testimony did not include further information about the history and nature of his left knee disability. The Veteran has a current left knee disorder, described as internal derangement. He contends that his right knee disability led to overuse and degeneration of his left knee. The claims file does not contain any medical finding or opinion regarding a relationship between the right knee disability and the left knee. The Board is remanding the claim for a new VA examination with file review and opinion addressing the likely etiology of the left knee disability, including the claim that the left knee disability is secondary to right knee disability. 9. Increased disability rating for left shoulder disability The Board is remanding this claim to obtain additional medical information. The Veteran contends that his left shoulder disability warrants a disability rating higher than the existing 20 percent rating. In the April 2018 Board hearing, he reported a history of multiple surgeries on that shoulder, most recently in 2016. He stated that presently his left shoulder disability limited the weight he could lift with that arm. He reported chronic pain, pain spasms, and pain at the site of surgically-placed hardware. It was noted that his shoulder problems limited his ability to work with his arm above his head. The Veteran’s claims file contains VA treatment records as recent as from 2015. On remand any more recent records should be added to the file. The most recent VA examination of his left shoulder was in February 2012. He should receive a new VA examination to determine the current condition of that shoulder. As is generally necessary with examinations of joints, the examination should include consideration of pain on active and passive motion and with and without weightbearing, comparison to the other shoulder, and consideration of functional impairment due to pain, weakness, fatigability, repeated use, flare-ups, or incoordination. 10. Increased disability rating for right knee disability The Board is remanding this claim to obtain additional medical information. The Veteran contends that his right knee disability warrants a rating higher than the existing 10 percent rating. In the April 2018 Board hearing, he reported that the right knee cartilage is gone and that surgical replacement of the knee with a prosthetic joint is needed. He stated that he usually wore a brace on the knee. He indicated that the knee has instability, locking, giving out, and intermittent limitation of motion. As with the left shoulder rating claim, with regard to the right knee disability, more recent VA treatment records should be obtained and a new examination should be performed. The examination should address the considerations relevant to joint disorders in general, and should include findings as to any current instability, locking, and giving out. The matters are REMANDED for the following action: 1. Request from the U.S. Army and Joint Services Records Research Center (JSRRC) a search of military records to corroborate stressors reported by the Veteran. He reports that: (1) during a training exercise, a Bradley Fighting Vehicle (BFV) came under fire; and (2) during a training exercise, a BFV fell off a cliff, and the occupants sustained injuries. Associate search results with his claims file. 2. Obtain records of all VA outpatient and inpatient treatment of the Veteran from January 2015 through the present. Associate those records with his claims file. 3. Schedule the Veteran for a VA psychiatric examination to address the likely etiology of the Veteran’s diagnosed posttraumatic stress disorder (PTSD) and his other current psychiatric disorders, including but not limited to bipolar disorder, obsessive-compulsive disorder (OCD), and attention deficit hyperactivity disorder (ADHD). Provide the expanded claims file to the examiner. Ask the examiner to review the claims file and examine the Veteran. Inform the examiner that the Veteran has reported that, during service, he: (1) came under fire while in a vehicle, (2) sustained injuries while in a vehicle that fell off a cliff, and (3) sustained injuries when he personally fell into a ditch. Ask the examiner to provide an opinion, with respect to each claimed stressor, as to whether it is at least as likely as not that psychological trauma associated with the event caused or contributed to causing the Veteran’s PTSD. Ask the examiner to provide diagnoses for all current psychiatric disorders other than PTSD. Ask the examiner, for each current psychiatric disorder other than PTSD, to provide opinions responding to the following questions: (1) Is it at least as likely as not that the disorder had onset during service? (2) Is it at least as likely as not that the disorder resulted from any injury or other events in service? (3) Is there clear and unmistakable evidence that the disorder existed prior to service? (4) Is there clear and unmistakable evidence that the disorder was not aggravated during service? Ask the examiner to explain the conclusions reached. 4. Schedule the Veteran for a VA eye examination to address the likelihood that lazy eye, refractive error, and refractive amblyopia of the left eye before service were aggravated in service. Provide the expanded claims file to the examiner. Ask the examiner to review the claims file and examine the Veteran. Ask the examiner to provide opinion responding to the following questions: (1) Does any medical evidence from during or since service support a history of shrapnel injury of the left eye during service? (2) Is it at least as likely as not that impairment of the left eye before service increased during service? (3) If impairment of the left eye increased during service, was the increase limited to the natural progress of the disorders that existed before service? Ask the examiner to explain the conclusions reached. 5. Schedule the Veteran for a VA musculoskeletal examination to address the likely etiology of current disorders of his lower back, upper back, right and left wrists, and left knee, and the current manifestations and effects of disabilities of his left shoulder and right knee. Provide the expanded claims file to the examiner. Ask the examiner to review the claims file and examine the Veteran. Ask the examiner to provide diagnoses for each current disorder of the Veteran’s lower back, upper back, right and left wrists, and left knee. Ask the examiner, for each of those disorders, to provide an opinion as to whether it is at least as likely as not that he disorder is related to one or more injuries during the Veteran’s 1995 to 1998 service. Ask the examiner, for each current disorder of the left knee, to provide an opinion as to whether it is at least as likely as not that the disorder resulted from or is aggravated by his chronic right knee disability. Ask the examiner, for the left shoulder and right knee, to conduct all necessary tests of the function and functional impairment of those joints. Ask the examiner to report the ranges of motion, whether there is evidence of pain on motion, the points at which any pain on motion begins, whether there is pain on active and passive motion, whether there is pain on motion with and without weightbearing, and whether there is functional impairment due to pain, weakness, fatigability, repeated use, flare-ups, or incoordination. Ask the examiner to report the ranges of motion of the opposite joints (right shoulder and left knee) for comparison. Ask the examiner to report on evidence of right knee instability, locking, or giving out. Ask the examiner to explain the conclusions reached. 6. Schedule the Veteran for a VA examination of his jaw and teeth, to address the likely etiology of a current TMJ disorder. Provide the expanded claims file to the examiner. Ask the examiner to review the claims file and examine the Veteran. Ask the examiner to provide an opinion as to whether it is at least as likely as not that any facial and dental injury in service, including claimed injury in a motor vehicle accident, contributed significantly to causing the current TMJ disorder. Ask the examiner to explain the conclusions reached. (Continued on the next page)   7. Then review the expanded record and consider the remanded claims. If any of the remanded claims is not granted to the Veteran’s satisfaction, issue a supplemental statement of the case and afford the Veteran and his representative an opportunity to respond. Thereafter, return the case to the Board for appellate review, if otherwise in order. K. PARAKKAL Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD K. J. Kunz, Counsel