Citation Nr: 18148062 Decision Date: 11/06/18 Archive Date: 11/06/18 DOCKET NO. 10-10 210 DATE: November 6, 2018 ORDER The claim for entitlement to service connection for gastroesophageal reflux disease (GERD) is granted. The claim for entitlement to service connection for a left hand disability is denied. The claim for entitlement to service connection for a right hand disability is denied. The claim for entitlement to service connection for erectile dysfunction, to include as secondary to service-connected disability, is denied. The claim for entitlement to an initial rating higher than 30 percent for bilateral pes planus is denied. The claim for entitlement to a 10 percent rating, but not higher, for allergic rhinitis with intermittent sinusitis is granted. The claim for entitlement to a total disability rating due to individual unemployability resulting from service-connected disability (TDIU) is granted. REMANDED The claim for entitlement to service connection for a bilateral eye disability, to include photophobia, is remanded. The claim for entitlement to service connection for residuals of a cold weather injury of the bilateral upper extremities is remanded. The claim for entitlement to service connection for residuals of a cold weather injury to the bilateral lower extremities is remanded. The claim for entitlement to service connection for left median neuropathy, to include carpal tunnel syndrome (CTS) as secondary to service-connected disability, is remanded. The claim for entitlement to service connection for left ulnar neuropathy, to include as secondary to service-connected disability, is remanded. FINDINGS OF FACT 1. The Veteran’s GERD was incurred secondary to medications used to treated service-connected disabilities. 2. A chronic disability of the left hand was demonstrated years after service and is not etiologically related to a disease or injury in service. 3. A chronic disability of the right hand was demonstrated years after service and is not etiologically related to a disease or injury in service. 4. The Veteran does not have chronic erectile dysfunction. 5. The Veteran’s bilateral pes planus most nearly approximates severe bilateral flatfoot with objective evidence of pain on manipulation and use improved with orthopedic shoes or appliances. 6. The Veteran’s allergic rhinitis manifests nasal congestion, postnasal drip, and a greater than 50-percent obstruction of the nasal passage on both sides without polyps; the Veteran also experiences three to six episodes of sinusitis per year characterized by headaches, pain, and discharge or crusting. 7. The Veteran’s service-connected disabilities preclude him from performing gainful employment for which his education and occupational experience otherwise qualify him. CONCLUSIONS OF LAW 1. Service connection for GERD on a secondary basis is warranted. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.310. 2. A chronic left hand disability was not incurred or aggravated during active duty service and its incurrence or aggravation may not be presumed. 38 U.S.C. §§ 1110, 1112, 1131, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. 3. A chronic right hand disability was not incurred or aggravated during active duty service and its incurrence or aggravation may not be presumed. 38 U.S.C. §§ 1110, 1112, 1131, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. 4. Chronic erectile dysfunction was not incurred or aggravated during active duty service and is not caused or aggravated by a service-connected disability. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.310. 5. The criteria for an initial rating higher than 30 percent for bilateral pes planus are not met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.71a, Diagnostic Code 5276. 6. The criteria for a rating of 10 percent, but not higher, for allergic rhinitis with intermittent sinusitis are met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.97, Diagnostic Codes 6513, 6522. 7. The criteria for an award of a TDIU are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1974 to February 1992 and from July 2004 to May 2006. This case comes before the Board of Veterans’ Appeals (Board) on appeal from July 2008, May 2010, February 2014, and September 2015 rating decisions issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran was scheduled for a videoconference hearing before a Veterans Law Judge (VLJ) in April 2018. In December 2017, the Veteran withdrew his request for a hearing in accordance with 38 C.F.R. § 20.702(e). The Board will therefore proceed with a decision in this case without providing the Veteran a hearing. Service Connection Service connection is granted for disability resulting from disease or injury incurred in or aggravated by active military service in the line of duty. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). To establish a right to compensation for a present disability, a Veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a relevant disease or an injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service” —the so-called “nexus” requirement. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). See also Davidson v. Shinseki, 581 F.3d 1313 (Fed.Cir.2009); Jandreau v. Nicholson, 492 F.3d 1372 (Fed.Cir.2007). Service connection is also provided for a disability which is proximately due to, the result of, or aggravated by a service-connected disease or injury. 38 C.F.R. § 3.310. 1. Entitlement to service connection for GERD with a cyst of the liver. The Veteran contends that service connection is warranted for GERD as the condition was incurred secondary to medications used to treat his various service-connected disabilities. After review of the evidence, the Board finds that service connection is warranted for the Veteran’s GERD as the record contains medical evidence indicating the condition is etiologically related to the numerous medications used to treat the Veteran’s service-connected disabilities. The claims file documents symptoms of GERD beginning in August 2007, when the Veteran was found to have a history of GERD. Later that year, his complaints of epigastric chest pain were considered GERD-type symptoms in December 2007. Treatment records from the VA Medical Center (VAMC) dated from 2012 to the present consistently show a diagnosis of GERD. The record also contains evidence of a medical nexus between the Veteran’s GERD and the medications used to treat his service-connected conditions. In December 2012, during a VAMC gastroenterology consultation, the Veteran’s treating physician found that his symptoms were “at least partially related to polypharmacy (taking 28 [medications] now).” The Board observes that the Veteran is service-connected for multiple disabilities including orthopedic disabilities of the cervical spine, left shoulder, bilateral knees, feet, and lumbar spine, as well as PTSD and allergic rhinitis. These disabilities are all treated with large numbers of medications. The Board will therefore resolve any doubt in favor of the Veteran and finds that service connection is warranted for the Veteran’s GERD on a secondary basis. To the extent the Veteran’s claim was characterized by the agency of original jurisdiction (AOJ) to include a liver cyst, the Board finds that the award of service connection in this case is limited to symptoms and manifestations specifically associated with GERD. In November 2010, a CT of the Veteran’s liver was performed at the VAMC. The scan showed small septated cystic liver lesion. An MRI performed later that same month confirmed the presence of the cyst and a biopsy was negative. The Veteran’s physician concluded the cyst was benign and follow-up examinations confirm that the cystic lesion is stable with no underlying liver disease. There is no competent evidence the cyst is related to the Veteran’s service or service-connected disabilities, to include the now service-connected GERD. The award of service connection for GERD in this case is therefore limited to the Veteran’s symptoms of epigastric pain, heartburn, and reflux, and does not include the benign cystic liver lesion. 2. Entitlement to service connection for a left hand disability. 3. Entitlement to service connection for a right hand disability. The Veteran contends that service connection is warranted for disabilities of the hands as they were incurred due to injuries during active duty service. The Board notes that the Veteran is currently in receipt of service connection for residuals of injuries to the right and left thumbs. The Board will therefore limit its consideration to any currently present disabilities of the hands and other fingers. Similarly, the Veteran also claims service connection for disabilities manifested by neurological impairment of the upper extremities. This decision is therefore limited to the Veteran’s claims regarding orthopedic impairment of the hands. The questions for the Board are whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury or a service-connected disability. The Board concludes that while the Veteran has a current diagnosis of orthopedic hand disabilities and injuries to the fingers during service, the preponderance of the evidence weighs against finding that the Veteran’s hand disabilities began during service or are otherwise related to an in-service injury. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). A current orthopedic disability is established for the left and right hands. Since 2007, the Veteran has complained of left and right hand pain, swelling, and a feeling of fullness in the hands at the VAMC. X-rays performed throughout the claims period are negative for chronic joint abnormalities such as arthritis. However, a VA orthopedist noted fullness in the finger joints and indications of early Heberden’s nodes in November 2008 and February 2009. No orthopedic diagnosis was rendered, but similar symptoms were noted by a VA rheumatologist in August 2009. The rheumatologist diagnosed osteoarthritic changes and mechanical bony swelling of the hands. Despite the absence of arthritis on the hand X-rays performed during the claims period, the Board will resolve any doubt in favor of the Veteran and finds that current hand disabilities are demonstrated. In-service injuries are also present. Service treatment records show that the Veteran incurred multiple injuries to his fingers during active duty. In August 1977 he fell and injured his right middle finger and was diagnosed and treated for a sprain and torn tendon. The Veteran also sprained an unspecified finger in September 1977 and re-injured his right middle finger in November 1977. An orthopedist who examined the finger in November 1977 confirmed a diagnosis of tendonitis. A month later, in December 1977, the Veteran injured his left fourth finger when he accidently struck it with a sledgehammer. In-service injuries are therefore demonstrated and the second element of service connection is established. Turning to the third element of service connection—a link between the current disabilities and in-service injuries—service and post-service records weigh against the claims. Service records document several acute injuries to the fingers of both hands, but are negative for a chronic hand disability. The Veteran was seen on several occasions in 1977 for injuries of the fingers and was diagnosed with tendonitis in November 1977, but there are other instances of complaints or treatment involving the fingers or hands. The Veteran’s hands were also normal upon examination for retirement in March 2006. The Board therefore finds that service records are negative for evidence of chronic hand disabilities. Post-service records also do not support the claims. The Veteran incurred several post-service injuries to the hands and fingers and right finger fractures were documented on VAMC X-rays in June 2003 (between the Veteran’s periods of active service) and during a May 2008 VA examination. There are also no documented complaints of hand pain until October 2007, more than a year after the Veteran’s retirement from active military service. There are no findings of arthritis until August 2009, and this diagnosis was rendered without X-ray confirmation. As such, the Board cannot conclude that the Veteran manifested an arthritic condition to a compensable degree within a year after his retirement from active military service. Thus, service connection for arthritis on a presumptive basis as a chronic disease is not warranted. 38 U.S.C. §§ 1101, 1131; 38 C.F.R. §§ 3.307(a), 3.309(a). The record also does not contain any competent medical opinions in support of the claims. None of the Veteran’s treating physicians have connected the Veteran’s current hand disabilities to injuries during service. A March 2010 VA examiner also specifically found that the Veteran’s in-service hand and finger injuries (including tendonitis) healed without residuals. This opinion provides competent medical evidence weighing against service connection for the claimed hand disabilities. Service connection is possible for certain chronic disabilities under 38 C.F.R. § 3.303(b) based on a continuity of symptomatology. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Arthritis is a chronic disease listed in 38 C.F.R. § 3.309(a). However, the Veteran has not reported a history of continuous symptoms since service. Service connection for a chronic disability based on a continuity of a symptoms is therefore not possible. The Board also finds that the Veteran is not competent to opine as to medical etiology or render medical opinions. Barr v. Nicholson, 21 Vet. App. 303 (2007); see Grover v. West, 12 Vet. App. 109, 112 (1999). The Board acknowledges that the Veteran is competent to report observable symptoms, such as hand and finger pain, but finds that his opinions regarding whether his disability is etiologically related to active duty cannot be accepted as competent evidence in this case. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-1377 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1131, 1336 (Fed. Cir. 2006). The competent evidence of record is therefore against a nexus between the Veteran’s hand disabilities and active duty service. Accordingly, the Board must conclude that the preponderance of the evidence is against the claims for service connection and they are denied. 4. Entitlement to service connection for erectile dysfunction, to include as secondary to service-connected disability. The Veteran contends that service connection is warranted for erectile dysfunction as the condition is related to service-connected PTSD. The Board concludes that the Veteran does not have chronic erectile dysfunction. Although erectile dysfunction was identified on one occasion during the claims period, the weight of the evidence is against the finding of a chronic disability and service connection is not possible. Service connection requires the presence of a chronic disability during the pendency of the claim or recent to the filing of the claim. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); 38 C.F.R. § 3.303(a), (d). VAMC treatment records document one finding of erectile dysfunction during a March 2014 urology consultation. At that time, the Veteran reported having difficulty obtaining a firm and lasting erection. Earlier records from VAMC show that the Veteran was treated for a bladder neck obstruction and an overactive bladder with medication that resulted in Peyronie’s disease with a dorsal curvature of the penis. The Veteran’s acute erectile dysfunction was related to this condition, but resolved with treatment. After 2014, the Veteran was not seen by a VAMC urologist until December 2016, at which time he reported he was able to achieve an erection without assistance. The Veteran was also provided a VA examination in January 2014, but was found to have no pathology or diagnosis of any erectile dysfunction condition. The Board therefore concludes that the Veteran’s erectile dysfunction noted in March 2014 was temporary and fully resolved during the claims period. Therefore, a chronic condition is not present. The Board has considered the Veteran’s statements and finds that he is competent to report the symptoms of erectile dysfunction. However, he has never provided any specific statements in support of his claim. As such, the Board finds that the weight of the competent evidence is against the finding of a chronic disability. Absent proof of the existence of the disability being claimed, there can be no valid claim. See Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998); Degmitech v. Brown, 104 F.3d 1328 (Fed. Cir. 1997); Brammer v. Derwinski, 3 Vet. App. 223 (1992); Rabideau v. Derwinski, 2 Vet. App. 141 (1992). Accordingly, the preponderance of the evidence is against the claim and it is denied. Increased Rating Disability evaluations are determined by comparing a Veteran’s present symptomatology with criteria set forth in VA’s Schedule for Rating Disabilities (Rating Schedule), which is based on average impairment in earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. When a question arises as to which of two ratings apply under a particular diagnostic code, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3. The Veteran’s entire history is reviewed when making disability ratings. See generally 38 C.F.R. 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Where entitlement to compensation already has been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, consideration of the appropriateness of a “staged rating” is also required. See Fenderson v. West, 12 Vet. App. 119, 126 (1999). 4. Entitlement to an initial rating higher than 30 percent for bilateral pes planus. The Veteran contends that an initial rating higher than 30 percent is warranted for the service-connected bilateral pes planus. Service connection for bilateral pes planus was awarded in the February 2014 rating decision on appeal with an initial noncompensable evaluation assigned effective October 12, 2012. The current 30 percent evaluation was assigned in a January 2016 rating decision, also effective October 12, 2012. The Veteran’s bilateral pes planus is currently rated as 30 percent disabling under Diagnostic Code 5276 pertaining to acquired flatfoot. Under this diagnostic code, severe bilateral flatfoot, with objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, characteristic callosities, is rated 30 percent disabling. Pronounced flatfoot, with marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement, and severe spasm of the tendo Achilles on manipulation, that is not improved by orthopedic shoes or appliances, is rated 50 percent disabling for bilateral disability. 38 C.F.R. § 4.71a. After review of the evidence of record, the Board finds that the Veteran’s service-connected bilateral pes planus most nearly approximates a severe flatfoot disability and the current 30 percent rating. The competent lay and medical evidence establishes that the Veteran experiences bilateral foot pain with use and with manipulation of the feet related to pes planus. The Veteran’s symptoms are not relieved with the use of inserts and orthotics and result in limitations to prolonged standing and walking. These manifestations of the service-connected disability are contemplated by the current 30 percent evaluation. There is also no evidence of the criteria associated with a maximum 50 percent evaluation; VA examiners in January 2014 and November 2015 specifically found that the Veteran did not manifest marked pronation, extreme tenderness of the plantar surfaces, inward displacement and/or severe spasm of the tendo Achilles. Additionally, the record contains evidence that the Veteran’s symptoms are helped with the use of inserts. In April 2012, the Veteran reported to his VAMC podiatrist that wider shoes with pads rendered his pain “bearable,” and the January 2014 VA examiner found that arch supports helped the Veteran’s foot pain. Therefore, the Board cannot conclude that the Veteran’s pes planus is not improved by orthopedic shoes or appliances as required for a 50 percent evaluation. The Board has considered the Veteran’s lay statements that his foot pain is not relieved with the use of arch supports and he has sought private medical care to help treat his pes planus. As noted above, the use of shoe inserts that do not fully relieve the symptoms of pes planus is a manifestation contemplated by the current 30 percent evaluation. The Board also observes that the Veteran’s private treatment records document several nonservice-connected foot conditions that have caused foot pain, including bunion deformities of the bilateral feet, arthritis, and plantar fasciitis. The November 2015 VA examiner specifically found that these disabilities were not related to the service-connected pes planus. As the Veteran’s disability most nearly approximates severe flatfeet, a rating in excess of 30 percent is not warranted at any time during the claims period. The Board has considered whether there is any other schedular basis for granting a higher rating, but has found none. In addition, the Board has considered the doctrine of reasonable doubt, but it is not applicable because the preponderance of the evidence is against the claim. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.7, 4.21. 5. Entitlement to a compensable rating for allergic rhinitis with intermittent sinusitis. Service connection for allergic rhinitis (claimed as sinusitis) was granted in a June 2006 rating decision with an initial noncompensable evaluation assigned effective June 1, 2006. The September 2015 rating decision on appeal continued the noncompensable evaluation and recharacterized the disability as allergic rhinitis with intermittent sinusitis. The Veteran contends that a higher rating is warranted for allergic rhinitis as he experiences year-round problems with rhinitis and sinusitis symptoms that requires daily medication. The Veteran’s allergic rhinitis is currently rated as noncompensably disabling under Diagnostic Code 6522. Allergic or vasomotor rhinitis without polyps, but with greater than 50-percent obstruction of nasal passage on both sides or complete obstruction on one side, is rated 10 percent disabling. Allergic or vasomotor rhinitis with polyps is rated 30 percent disabling. 38 C.F.R. § 4.97. As Diagnostic Code 6522 does not provide for a zero percent rating, the Veteran’s noncompensable evaluation was assigned in accordance with 38 C.F.R. § 4.31 (a zero percent evaluation is assigned if the Veteran does not meet the requirements for a compensable evaluation). The Board finds that a 10 percent rating is warranted for the Veteran’s allergic rhinitis with intermittent sinusitis throughout the claims period as the Veteran’s disability manifests a greater than 50-percent obstruction of the nasal passage on both sides. The February 2015 VA examiner identified this manifestation of the disability along with permanent hypertrophy of the nasal turbinates. A rating higher than 10 percent is not warranted as there is no evidence of nasal polyps associated with the Veteran’s service-connected disability. VAMC medical records show that the Veteran has received regular treatment with the allergy clinic and physical examination has never disclosed the presence of nasal polyps associated with rhinitis. Sinus CTs dating from February 2008 and April 2015 indicated the presence of a maxillary sinus mucous retention cyst or polyp, but a February 2008 VAMC ear, nose, and throat (ENT) provider determined that it was not contributing to the Veteran’s symptomatology. The Veteran’s treating physician also determined in April 2017 that the Veteran’s allergic rhinitis was “overall controlled” with current medication, even with weather change triggers. The Board therefore finds that awarding a higher rating of 30 percent for allergic rhinitis based on the incidental finding of a mucous cyst or sinus polyp is not appropriate. The Board has also considered whether a rating in excess of 10 percent is warranted for the Veteran’s service-connected disability under the diagnostic codes for rating sinusitis and the General Rating Formula for Sinusitis. 38 C.F.R. §§ 4.97, Diagnostic Codes 6510-6514. Under the general rating formula, a 10 percent rating is assigned for one or two incapacitating episodes per year of sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment, or; three to six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting. A disability rating of 30 percent is assigned when the disability manifests in three or more incapacitating episodes per year of sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment; or more than six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting. A disability rating of 50 percent is assigned following radical surgery with chronic osteomyelitis, or when the disability manifests in near constant sinusitis characterized by headaches, pain, and tenderness of affected sinus, and purulent discharge or crusting after repeated surgeries. 38 C.F.R. § 4.97, General Rating Formula for Sinusitis. An incapacitating episode of sinusitis means one that requires bed rest and treatment by a physician. Id. at Note. The Veteran’s service-connected allergic rhinitis was recharacterized to include sinusitis in the September 2015 rating decision on appeal. The Veteran’s treatment records and VA examinations establish that he experiences episodes of sinusitis with congestion, significant pain, and intermittent headaches two to three times a year. The February 2015 VA examiner specifically found that the Veteran did not experience incapacitating or non-incapacitating bouts of sinusitis and there is no indication that the Veteran’s sinusitis has required antibiotic treatment. The Veteran reports that his congestion is present all year and is worse with cold weather. These symptoms are contemplated by the current 10 percent rating under the general rating formula and the criteria for rating rhinitis. There is no evidence indicating that the Veteran manifests more than three episodes of sinusitis per year such that a higher 30 percent evaluation would be appropriate under the general rating formula. The Board has considered whether there is any other schedular basis for granting a higher rating, but has found none. In addition, the Board has considered the doctrine of reasonable doubt but has determined that it is not applicable because the preponderance of the evidence is against a rating in excess of the 10 percent evaluation granted above. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.7, 4.21. 6. Entitlement to TDIU. The Veteran contends that he is unemployable due to service-connected disabilities, specifically his numerous orthopedic disabilities and service-connected PTSD. VA will grant a TDIU when the evidence shows that the Veteran is precluded due to his service-connected disabilities from obtaining or maintaining “substantially gainful employment” consistent with his education and occupational experience. 38 C.F.R. §§ 3.340, 3.341, 4.16; VAOPGCPREC 75-91; 57 Fed. Reg. 2317 (1992). The Veteran meets the schedular criteria for an award of TDIU; he is service-connected for multiple disabilities with a combined evaluation for compensation of 70 percent from April 14, 2014 and 80 percent from February 4, 2015. 38 C.F.R. § 4.16(a) (providing that the schedular criteria are met if there are two or more service-connected disabilities with one disability ratable at 40 percent or more and sufficient additional disability to bring the combined rating to 70 percent or more); 38 C.F.R. § 4.25, Table I (Combined Ratings Table). After review of the evidence, the Board resolves any doubt in the Veteran’s favor and finds that he is unemployable due to service-connected disabilities. The record establishes that the Veteran last held substantially gainful employment in 2006 when he worked as a vehicle and power generator mechanic on active duty service. The Veteran credibly reported that he was unable to continue with this type of employment due to functional impairments associated with his service-connected left shoulder, cervical spine, bilateral knee, bilateral foot, and low back disabilities. The Veteran is in receipt of disability compensation from the Social Security Administration (SSA) and graduated high school, but only completed the equivalent of two years of college. Treatment records from private and VA health care providers show that the Veteran has severe service-connected disabilities. VA examinations of the Veteran’s orthopedic conditions in 2008, 2014, and 2015 indicate severe functional impairments to include limitations to standing, walking, and working overhead. The April 2015 VA examination of the low back showed that the Veteran could only stand for 20 minutes at a time for a maximum of 50 minutes during the entire day. The Veteran also experiences pain associated with his bilateral pes planus that impacts his ability to stand and ambulate. Although the record contains some evidence indicating that the Veteran is capable of performing sedentary employment, the Board notes that he has only worked as a mechanic and this job required heavy lifting and long periods of standing. Based on the Veteran’s limited work and education history, the Board finds that the evidence is at least in equipoise regarding the question of unemployability. The Board will therefore resolve reasonable doubt in favor of the Veteran and grant the claim. See 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). REASONS FOR REMAND The Board finds that additional development is necessary before a decision may be rendered with respect to the remaining claims on appeal. Specifically, VA examinations and medical opinions must be obtained to determine the nature and etiology of the Veteran’s claimed eye disability and neurological impairment of the upper and lower extremities. The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of the claimed bilateral eye injury. The examiner must identify all currently present eye disabilities and determine whether they are at least as likely as not related to an in-service injury, to include the Veteran’s reports of photophobia in September 1976 and documented eye infection. The examiner should also identify any and all symptomatology associated with the Veteran’s allergic chronic conjunctivitis and determine whether this condition is at least as likely as not caused or aggravated by service-connected allergic rhinitis. The Veteran contends that service connection is warranted for photophobia as a residual of an eye infection during service. The Veteran reports that he was treated with antibiotics for an eye infection during active duty after getting pesticides in his eyes while serving in Panama. Personnel records confirm that the Veteran served in Panama for several years during the period from 1974 to 1980. Service records do not document specific treatment for an eye infection, but note a history of photophobia in September 1976 and the Veteran’s reports of eye trouble due to a resolving eye infection in March 1998. He also complained of photophobia at the VAMC between periods of active duty in February 2003. During his later period of service, the Veteran complained of photophobia as a residual of a 1979 eye injury involving a substance that appears to be identified as defoliant. Physical examination of the Veteran’s eyes was normal at the March 2006 retirement examination. He has continued to report symptoms of photophobia after service, as well as dry eyes, and was diagnosed with meibomianitis by the June 2008 VA examiner to account for his symptoms of ocular irritation and light sensitivity. The examiner provided a medical opinion against service connection, but did not address the in-service findings of an eye infection. For the purposes of this opinion, the examiner should assume that the Veteran was exposed to chemicals due to his overseas service and was treated for an eye infection during active duty. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of the Veteran’s neurological impairment of the upper and lower extremities. The examiner must identify all current neurological impairments to the bilateral upper and lower extremities and determine whether they are at least as likely as not related to an in-service injury, to include the Veteran’s reports of cold weather injuries and his work as a mechanic, which the Board finds required repetitive twisting motions of the wrists and elbows. The examiner should also determine whether the Veteran’s service-connected cervical and lumbar spine disabilities manifest radiculopathy of the upper or lower extremities, and to the extent possible, determine the severity of the radiculopathy as separate from any other present neurological impairment. The Veteran contends that he was exposed to cold temperatures while serving in Kosovo, Germany, and in various places in the United States. His duties required that he repair vehicles outside without gloves and spend the night in foxholes in the cold. For the purposes of this opinion, the examiner should accept the Veteran was exposed to some cold conditions, though he was never treated during service for a cold weather injury. The Veteran’s service as a mechanic also required repetitive and twisting motions with his wrists and elbows, as well as heavy lifting. VAMC records show that the Veteran is diagnosed with several mononeuropathies, including left-sided ulnar neuropathy and bilateral median neuropathy consistent with CTS. Lumbar and cervical radiculopathy have also been diagnosed. The Veteran’s diagnosed conditions are all confirmed by various VAMC nerve conduction studies conducted throughout the claims period. The record contains medical opinions from VA examiners in January 2010, March 2010, and August 2015, but none of these opinions are adequate. M. H. HAWLEY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Riley, Counsel