Citation Nr: 18147439 Decision Date: 11/06/18 Archive Date: 11/05/18 DOCKET NO. 16-35 137 DATE: November 6, 2018 ORDER New and material evidence having been received, the claim of entitlement to service connection for a left hand injury (previously characterized as a broken left small finger) is reopened and, to that extent only, the appeal is granted. As new and material evidence has not been received, the claim of entitlement to service connection for a neck disorder is not reopened. As new and material evidence has not been received, the claim of entitlement to service connection for a right foot bunion is not reopened. New and material evidence having been received, the claim of entitlement to service connection for arthritis is reopened and, to that extent only, the appeal is granted. Entitlement to service connection for posttraumatic stress disorder (PTSD) is denied. Entitlement to service connection for an anxiety disorder is denied. REMANDED Entitlement to service connection for a left hand injury is remanded. Entitlement to service connection for arthritis is remanded. FINDINGS OF FACT 1. An unappealed July 2008 rating decision is the last final decision that denied service connection for a left hand injury. 2. The evidence received since the final July 2008 rating decision is new and material, and the service connection claim for a left hand injury is reopened. 3. An unappealed November 2013 rating decision is the last final decision that denied service connection for a neck disorder, a right foot bunion, and arthritis. 4. The evidence received since the final November 2013 rating decision is not new and material, and the service connection claim for a neck disorder and right foot bunion is not reopened. 5. The evidence received since the final November 2013 rating decision is new and material, and the service connection claim for arthritis is reopened. 6. The evidence does not show that the Veteran has a current diagnosis of PTSD that was incurred in, or resulted from, active duty service. 7. The evidence does not show that the Veteran’s anxiety disorder was incurred in or resulted from active duty service. CONCLUSIONS OF LAW 1. The July 2008 rating decision denying service connection for a left hand injury is final. 38 U.S.C. § 7105(c); 38 C.F.R. §§ 3.104, 3.160(d), 20.302, 20.1103. 2. The November 2013 rating decision denying service connection for a neck disorder, a right foot bunion, and arthritis is final. 38 U.S.C. § 7105(c); 38 C.F.R. §§ 3.104, 3.160(d), 20.302, 20.1103. 3. The criteria to reopen the service connection claim for a left hand injury are met. 38 U.S.C. §§ 5107, 5108; 38 C.F.R. § 3.156(a). 4. The evidence received since the November 2013 rating decision is not new and material, and the criteria to reopen the service connection claim for a neck disorder are not met. 38 U.S.C. §§ 5107, 5108; 38 C.F.R. § 3.156(a). 5. The evidence received since the November 2013 rating decision is not new and material, and the criteria to reopen the service connection claim for a right foot bunion are not met. 38 U.S.C. §§ 5107, 5108; 38 C.F.R. § 3.156(a). 6. The criteria to reopen the service connection claim for arthritis are met. 38 U.S.C. §§ 5107, 5108; 38 C.F.R. § 3.156(a). 7. The criteria to establish service connection for PTSD are not met. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.304(f). 8. The criteria to establish service connection for an anxiety disorder are not met. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from May 1974 to May 1977. Petition to Reopen Previously Denied Service Connection Claims Rating decisions are final and binding based on evidence on file at the time the claimant is notified of the decision and may not be revised on the same factual basis except by a duly constituted appellate authority. 38 C.F.R. § 3.104(a). The claimant has one year from notification of a Regional Office (RO) decision to initiate an appeal by filing a notice of disagreement (NOD) with the decision, and the decision becomes final if an appeal is not perfected within the allowed time period. 38 U.S.C. §7105; 38 C.F.R. §§ 3.160, 20.201, 20.302. If the Board issues a decision on appeal, confirming the RO’s decision, then the Board’s decision subsumes the RO’s decision on the same issue at hand. 38 C.F.R. § 20.1104. Moreover, if the Board’s decision is not timely appealed, then it, too, is final and binding based on the evidence then of record. 38 C.F.R. § 20.1100. It is the Board’s jurisdictional responsibility to consider whether it is proper for a claim to be reopened. Jackson v. Principi, 265 F.3d 1366 (Fed. Cir. 2001). VA may reopen a claim that has been previously denied if new and material evidence is submitted by or on behalf of the claimant. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). Regarding applications for reopening, 38 C.F.R. § 3.156(a) defines “new” evidence as evidence not previously submitted to agency decision makers and “material” evidence as 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 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). When determining whether the claim should be reopened, the credibility of the newly submitted evidence is to be presumed. Fortuck v. Principi, 17 Vet. App. 173, 179 (2003); Justus v. Principi, 3 Vet. App. 510, 513 (1992). In order to reopen a claim, it is not necessary that new and material evidence be received regarding each previously unproven element of a claim. Indeed, newly submitted evidence need not be overwhelming as a “low threshold” standard is applied. See Shade v. Shinseki, 24 Vet. App. 110, 121 (2010). 1. Whether new and material evidence has been received to reopen a claim of service connection for a left hand injury In July 2008, the RO denied service connection specifically for a left hand small finger disorder. The Veteran did not appeal the July 2008 rating decision, nor was new and material received within a year of notification of the rating decision. 38 C.F.R. § 3.156(b). Therefore, the rating decision became final. See 38 U.S.C. § 7105(c); 38 C.F.R. § 3.104(a). The Veteran most recently petitioned to reopen his claim in July 2014. In a July 2015 rating decision, the RO declined to reopen the service connection claim for a left hand injury due to lack of new and material evidence, specifically regarding an in-service incurrence or nexus. Based on the procedural history as reflected above, the July 2008 decision is the last final decision regarding the left hand injury claim. Thus, the question before the Board is whether the evidence received after the final July 2008 rating decision is new and material, as defined above. When the RO issued the July 2008 rating decision, the record included incomplete service treatment records (STRs), VA treatment records, a January 2008 claims application, and a May 2008 statement from the Veteran. The evidence of record in July 2008 did not demonstrate a current disability. The July 2008 rating decision denied service connection based on the lack of a current disability and in-service incurrence. The pertinent evidence obtained since the July 2008 rating decision consists of VA treatment records, and the Veteran’s statements. Specifically, the Veteran reported in December 2014 that his left hand fingers were broken, and in his July 2016 VA Form 9 that he caught his finger in the hood of a truck. VA treatment records also reflect assessments of bilateral carpel tunnel syndrome and trigger finger of the third digit of the left hand. As such, without addressing the merits of this evidence, the Board finds that the new evidence addresses the issues of a current disability and in-service injury. The Board thus concludes that the evidence received subsequent to the last final decision dated in July 2008 is new and material as it is not cumulative and, when considered with evidence earlier of record, does relate to the unestablished elements necessary to substantiate the claim. For this reason, the petition to reopen is granted. 2. Whether new and material evidence has been received to reopen a claim of service connection for a neck disorder The Board will summarize the relevant evidence. The Veteran filed an original service connection claim for a neck disorder in January 2008. At that time, the Veteran contended that he had a small cyst in his neck, which was treated during service. The RO denied service connection in July 2008, finding that the Veteran did not have a current disability or an in-service incurrence. The Veteran did not appeal this rating decision, nor was new and material evidence received within a year of notification of the rating decision. 38 C.F.R. § 3.156(b). Therefore, the rating decision became final. See 38 U.S.C. § 7105(c); 38 C.F.R. § 3.104(a). The Veteran filed another claim in May 2013. At that time, VA treatment records included x-ray evidence of early osteoarthropathy with small spurs seen at C4-5 and C5-6, reflected an assessment of degenerative joint disease (DJD) of the cervical spine, and included removal of a cyst from the left side of the neck in 1978 as part of his past surgical history. The RO again denied service connection for a neck disorder in a November 2013 rating decision for lack of new and material evidence. Thereafter, in July 2014, the Veteran again petitioned to reopen the previously denied neck disorder claim. Although the Veteran filed a new claim within one year from the November 2013 rating decision, no new evidence was submitted within that one-year period. Therefore, the November 2013 rating decision became final. See 38 U.S.C. § 7105(c); 38 C.F.R. § 3.104(a). In a July 2015 rating decision, the RO declined to reopen the claim, finding that new and material evidence had not been received, specifically regarding any in-service incurrence or nexus. The Veteran submitted a timely VA Form 9 after the issuance of the Statement of the Case (SOC), and the instant appeal ensued. Accordingly, based on the procedural history as reflected above, the November 2013 rating decision is the last final decision denying the Veteran’s neck disorder claim. After a review of all the evidence, the Board finds that the evidence received subsequent to the last final decision dated in November 2013, which denied service connection for a neck disorder, is cumulative and, when considered with evidence earlier of record, does not indicate that the Veteran’s neck disorder was related to service. In this regard, evidence received subsequent to the last final decision includes VA treatment records. However, the additionally received evidence is not considered new as they are duplicates of previously received evidence. Additionally, in his July 2016 VA Form 9, the Veteran stated that a cyst was taken out of his neck in Germany, which was previously reported in his January 2008 claims application and in statements from May 2008 and May 2013. The additionally received, non-duplicative evidence is new, but it is not material as it does not reflect that the Veteran’s current DJD of the cervical spine is related to his claimed in-service neck cyst and operation. The Board notes that the evidence rather continues to reflect the Veteran’s contention that his current neck disability is related to the cyst that was removed from his neck during service. However, this contention has already been considered by the RO and there is no new and material evidence that supports that contention. The Board concludes that the additional evidence received since the final decision does not constitute new and material evidence upon which the claim may be reopened. For these reasons, the Board finds that new and material evidence has not been received to reopen service connection for a neck disorder, and the claim is not reopened. 3. Whether new and material evidence has been received to reopen a claim of service connection for a right foot bunion The Board will summarize the relevant evidence. The Veteran filed an original service connection claim for a right foot bunion in May 2013. At that time, the VA service records reflected that the Veteran had a bunion on his right foot with intermittent swelling and joint pain, and his contention that it resulted from having to wear steel toe boots during service. The RO denied service connection in November 2013, finding that there was no in-service incurrence or nexus. Thereafter, in July 2014, the Veteran petitioned to reopen the previously denied right foot bunion claim. Although the Veteran filed a new claim within one year from the November 2013 rating decision, no new evidence was submitted within that one-year period. Therefore, the November 2013 rating decision became final. See 38 U.S.C. § 7105(c); 38 C.F.R. § 3.104(a). In a July 2015 rating decision, the RO denied the claim, finding that the evidence did not demonstrate an in-service incurrence or nexus. The Veteran submitted a timely VA Form 9 after the issuance of the SOC, and the instant appeal ensued. Accordingly, based on the procedural history as reflected above, the November 2013 rating decision is the last final decision denying the Veteran’s right foot bunion claim. After a review of all the evidence, the Board finds that the evidence received subsequent to the last final decision dated in November 2013, which denied service connection for a right foot bunion, is cumulative and, when considered with evidence earlier of record, does not indicate that the Veteran’s right foot bunion was related to service. In this regard, evidence received subsequent to the last final decision includes statements from the Veteran, specifically his July 2016 VA Form 9 and an August 2018 statement. However, the additionally received evidence is not new as they merely reflect his contention that his right foot bunion was the result of being required to wear steel toe boots during service. The additionally received, non-duplicative evidence is new, but it is not material as it does not reflect that the Veteran’s right foot bunion is related to being required to wear steel toe boots during service. The Board notes that the evidence rather continues to reflect the Veteran’s contention that his right foot bunion is related to having to wear steel toe boots during service, a contention already considered by the RO. However, there is no new and material evidence that supports that contention. The Board concludes that the additional evidence received since the final decision does not constitute new and material evidence upon which the claim may be reopened. For these reasons, the Board finds that new and material evidence has not been received to reopen service connection for a right foot bunion, and the claim is not reopened. 4. Whether new and material evidence has been received to reopen a claim of service connection for arthritis In November 2013, the RO denied service connection for arthritis. The Veteran most recently petitioned to reopen his claim in July 2014. Although the Veteran filed a new claim within one year from the November 2013 rating decision, no new evidence was submitted within that one-year period. Therefore, the November 2013 rating decision became final. See 38 U.S.C. § 7105(c); 38 C.F.R. § 3.104(a). In a July 2015 rating decision, the RO denied service connection for arthritis, specifically finding that there was no in-service incurrence, no nexus, and no diagnosis within one year from separation. Based on the procedural history as reflected above, the November 2013 decision is the last final decision regarding the arthritis claim. Thus, the question before the Board is whether the evidence received after the final November 2013 rating decision is new and material, as defined above. When the RO issued the November 2013 rating decision, the record included incomplete STRs, VA treatment records, and the Veteran’s statements. The evidence of record in November 2013 reflected the Veteran’s report of a right ankle sprain during service; and assessments of osteoarthritis in his wrists, hands, right shoulder, and ankles. The November 2013 rating decision denied service connection based on the lack of in-service incurrence and nexus. The pertinent evidence obtained since the November 2013 rating decision consists of the Veteran’s statements. Specifically, the Veteran stated in his July 2016 VA Form 9 that his arthritis was caused by being on guard duty for 24 hours in the cold at Fort Hood and in Germany; and in August 2018 that he developed arthritis in Germany because it was very cold, he was out in the field, and he had to take cold showers. As such, without addressing the merits of this evidence, the Board finds that the new evidence addresses the issues of in-service injury and nexus. The Board thus concludes that the evidence received subsequent to the last final decision dated in November 2013 is new and material as it is not cumulative and, when considered with evidence earlier of record, does relate to the unestablished elements necessary to substantiate the claim. For this reason, the petition to reopen is granted. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection requires: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The United States Court of Appeals for Veterans Claims has held that “Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability.... In the absence of proof of a present disability there can be no valid claim.” Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency of evidence differs from weight and credibility. VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert, supra. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the claimant. 5. Entitlement to service connection for PTSD The Veteran contends that service connection for PTSD is warranted. In his December 2014 VA Form 21-0781, the Veteran reported that in the summer of 1976, he experienced shortness of breath, tingling of the hands, sweating, and fear while going down to the field on the Autobahn in Germany. He also described an incident at his housing when German officers came and took him to the field without considering that he had a fever. He contended that that incident triggered anxiety attacks from that time to the present. He also could not drive long distances “out of town.” Additionally, in January 2018, the Veteran stated that while in basic training at Fort Leonard Wood, Missouri, in May or June 1974, he was on night duty at the barracks when he saw a man slashing the right side of the neck of a person who appeared to be sleeping. He reported that he continued to have flashbacks of that night, suffered severe panic attacks frequently, and dealt with persistent anxiety and extreme stress, especially in dark confined areas. However, based on a review of the evidence of record, the Board finds that the evidence weighs against finding in favor of the Veteran’s service connection claim for PTSD as there is no evidence of a current diagnosis of such. Service connection for PTSD requires: (1) medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a) (conforming to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) (recently amended as the DSM-V)); (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). Unfortunately, there is no medical evidence to confirm that the Veteran was diagnosed with PTSD during the appeal period. In fact, VA treatment records reflect negative PTSD screening tests from August 2009 and September 2013. Service connection under any theory requires a current diagnosis or disability. In this case, the evidence does not reflect a diagnosis of PTSD at any point in time. See Brammer, supra. The Board considered the lay evidence in this case. As a layperson, the Veteran is competent to report matters within his own personal knowledge. Layno v. Brown, 6 Vet. App. 465, 469 (1994). As such, he is competent to report symptoms, but he is not competent to provide a clinical diagnosis of PTSD, as such a determination is medical in nature and requires medical expertise to make, and there is no evidence that the Veteran has such medical training. Thus, the Veteran has not presented competent evidence showing that he has a current diagnosis of PTSD. See 38 U.S.C. § 5107(a)(“[A] claimant has the responsibility to present and support a claim for benefits.”); Fagan v. Shinseki, 573 F.3d 1282, 1287 (Fed. Cir. 2009) (holding that it is the claimant’s general evidentiary burden to establish all elements of the claim). For this reason, the Board finds that the preponderance of the evidence is against the Veteran’s service connection claim for PTSD. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 6. Entitlement to service connection for an anxiety disorder The Veteran contends that service connection for an anxiety disorder is warranted. As stated above, in his December 2014 VA Form 21-0781, the Veteran reported incidents that occurred on the Autobahn and when German officers came to take him to the field despite his fever. Unfortunately, in July 2015, the RO made a formal finding regarding a lack of information required to corroborate these stressors. Additionally, also as stated above, in January 2018, the Veteran stated that while in basic training at Fort Leonard Wood, Missouri, in May or June 1974, he was on night duty at the barracks when he saw a man slashing the right side of the neck of a person who appeared to be sleeping. Unfortunately, a search with the National Archives and Records Administration did not result in any documentation of the Veteran witnessing an attack in 1974 or 1975 at Fort Leonard Wood, Missouri, where a fellow servicemember slashed a man’s neck while sleeping. Based on a review of the evidence of record, the Board finds that the evidence weighs against the Veteran’s service connection claim for an anxiety disorder, as there is no evidence of an in-service incurrence or incident. In this case, a VA treatment record in September 2013 reflects the Veteran’s complaint that he sometimes experienced panic attacks and felt anxiety for no apparent reason and sometimes even while driving. He was assessed with panic attacks and anxiety. In January 2018, the Veteran’s wife provided a statement in which she discussed changes in the Veteran after service and his description of the incident. VA treatment records from November 2017 and January 2018 reflect a DSM-5 diagnosis of anxiety disorder not otherwise specified (NOS). The Veteran reported having “bouts of anxiety when driving,” with heavy breathing, shortness of breath, and headaches. He had increased anxiety when things did not go the way he wanted them to and while driving on the highway. As an initial matter, the Board finds that the Veteran has a current diagnosis of an anxiety disorder NOS. A veteran satisfies the current disability requirement if he has such disability at any time during the pendency of the claim. See McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). The Board notes that the Veteran’s STRs are incomplete and only consist of his enlistment examination reports. However, while the Veteran reported in-service events, which he contends are related to his current anxiety disorder, there is no evidence corroborating those events. Rather, the RO determined that there was a lack of information to corroborate his stressors of driving down the Autobahn and being forced to go to the field despite a fever while stationed in Germany. In other words, the stressors are not verifiable as reported. Additionally, the RO could not corroborate the Veteran’s statement that he witnessed an attack where a fellow servicemember slashed another man’s neck while sleeping. Although the Veteran is competent to report what he witnessed, the Board finds his statements regarding his in-service stressors to carry less credibility as there is no corroborating evidence. At any rate, there is no competent evidence of a nexus between the Veteran’s current diagnosis of anxiety disorder and his military service, to include his reported stressors. The Board does not doubt the sincerity of the Veteran’s contentions; however, based on the foregoing, the Board finds that the preponderance of the evidence is against the Veteran’s service connection claim for an anxiety disorder. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claims, that doctrine is not applicable. See 38 U.S.C. § 5107(b); Gilbert, supra. REASONS FOR REMAND 1. Entitlement to service connection for a left hand injury is remanded. The Veteran has been diagnosed with carpal tunnel syndrome and trigger finger of the third digit of the left hand. Additionally, the Veteran reports that he injured his left hand when caught his finger in the hood of a truck and broke his fingers during service. The Veteran has not yet been afforded a VA examination in order to determine whether his left hand injury is related to service. See 38 C.F.R. § 3.159(c)(4). This should be accomplished on remand. 2. Entitlement to service connection for arthritis is remanded. The Veteran is diagnosed with osteoarthritis of the wrists, hands, right shoulder, and ankles. Additionally, the Veteran reports that he sprained his right ankle during service, and more recently that his arthritis is due to exposure to cold during service. Specifically, he contends that he developed arthritis from having guard duty for long periods of time in the cold, from being out in the field, and from taking cold shoulders. The Veteran has not yet been afforded a VA examination in order to determine whether his arthritis is related to service. See 38 C.F.R. § 3.159(c)(4). This should be accomplished on remand. The matters are REMANDED for the following action: 1. After obtaining any relevant updated or otherwise necessary treatment records, provide a comprehensive VA examination by an appropriate examiner to determine the nature and etiology of the Veteran’s claimed left hand injury. The claims file, and a copy of this remand, will be available to the examiner. Although a complete review of the record is imperative, attention is called to the following: *A January 2008 VA treatment record reflecting the Veteran’s report of a left index finger fracture in Germany during service. *The January 2008 claims application in which the Veteran reported that he broke his left hand small finger in 1977, but did not go to sick call. *A December 2014 VA Form 21-0781 in which the Veteran reported that his left hand fingers were broken during service. *A May 2016 VA treatment record reflecting an assessment of carpal tunnel syndrome. *The July 2016 VA Form 9 in which the Veteran stated that he caught his finger in the hood of a 2-ton truck. *An October 2016 VA treatment record reflecting the Veteran’s complaint of pain in both hands, especially his left hand fingers; and an assessment of trigger finger of the third digit of the left hand. AFTER reviewing the claims file in its entirety and examining the Veteran, the examiner is asked to address the following: a) Identify all current diagnoses involving the left hand and/or fingers, and indicate the likely onset of each diagnosis if possible. b) For EACH left hand/finger diagnosis, provide an opinion as to whether it at least as likely as not had its onset during active service or is otherwise related to it. **In doing so, the VA examiner should consider all evidence, to include the Veteran’s contentions of an in-service left hand injury.** A complete rationale should be provided for any opinion provided. 2. Provide a comprehensive VA examination by an appropriate examiner to determine the nature and etiology of the Veteran’s claimed arthritis. The claims file, and a copy of this remand, will be available to the examiner. Although a complete review of the record is imperative, attention is called to the following: *A January 2008 VA treatment record reflecting the Veteran’s report of a right ankle sprain during service. *A September 2012 VA treatment record reflecting an assessment of osteoarthritis of the wrists and hands. *A September 2013 VA treatment record reflecting an assessment of osteoarthritis of the right shoulder and ankles. *October 2013 VA x-rays of the right shoulder revealing degenerative changes in the acromioclavicular and glenohumeral joints. *October 2013 VA x-rays of the ankles revealing calcaneal spurring. *The July 2016 VA Form 9 in which the Veteran stated that his arthritis was caused by being on guard duty for 24 hours in the cold at Fort Hood and in Germany. *An August 2018 statement in which the Veteran contended that he developed arthritis in Germany because it was very cold, he was out in the field, and he had to take cold showers. AFTER reviewing the claims file in its entirety and examining the Veteran, the examiner is asked to address the following: Whether the Veteran’s arthritis at least as likely as not had its onset during active service or is otherwise related to it. **In doing so, the VA examiner should consider all evidence, to include the Veteran’s contentions of an in-service right ankle sprain, guard duty in the cold for prolonged periods of time, and cold showers.** A complete rationale should be provided for any opinion provided. 3. Thereafter, readjudicate the remanded claims on appeal. S. B. MAYS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Jane R. Lee