Citation Nr: 18148500 Decision Date: 11/07/18 Archive Date: 11/07/18 DOCKET NO. 15-18 187 DATE: November 7, 2018 ORDER 1. Entitlement to service connection for PTSD is denied. 2. Entitlement to service connection for bilateral hearing loss is denied. 3. Entitlement to service connection for a sinus disorder is denied. 4. Entitlement to service connection for sleep apnea is denied. 5. Entitlement to service connection for right lower extremity radiculopathy is granted. 6. Entitlement to service connection for left lower extremity radiculopathy is granted. 7. Entitlement to a rating in excess of 20 percent for lumbar strain is denied. 8. Entitlement to a compensable rating for allergic rhinitis is denied. REMANDED 9. Entitlement to service connection for a psychiatric disability other than PTSD is remanded. 10. Entitlement to service connection for a cervical spine disability is remanded. 11. Entitlement to service connection for a right foot disability is remanded. 12. Entitlement to service connection for a left foot disability is remanded. 13. Entitlement to service connection for a right hip disability is remanded. 14. Entitlement to service connection for a left hip disability is remanded. 15. Entitlement to service connection for a right shoulder disability is remanded. 16. Entitlement to service connection for a right knee disability is remanded. 17. Entitlement to service connection for a left knee disability is remanded. 18. Entitlement to service connection for a right ankle disability is remanded. 19. Entitlement to service connection for bronchial asthma is remanded. 20. Entitlement to service connection for erectile dysfunction (ED) is remanded. FINDINGS OF FACT 1. The Veteran is not shown to have a diagnosis of PTSD. 2. The Veteran is not shown to have a hearing loss disability in either ear. 3. The Veteran is not shown to have a sinus disorder. 4. The Veteran is not shown to have sleep apnea. 5. Competent medical evidence shows that the Veteran has right lower extremity radiculopathy associated with his service-connected low back disability. 6. Competent medical evidence shows that the Veteran has left lower extremity radiculopathy associated with his service-connected low back disability. 7. Forward flexion of the Veteran's lumbar spine is to at least 50 degrees and there is no evidence of ankylosis or of neurological manifestations other than lower extremity radiculopathy. 8. The Veteran’s allergic rhinitis is not shown to result in greater than 50 percent obstruction of the nasal passages on both sides or complete obstruction on one side. CONCLUSIONS OF LAW 1. Service connection for PTSD is not warranted. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.304. 2. Service connection for bilateral hearing loss is not warranted. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.385. 3. Service connection for a sinus disorder is not warranted. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303. 4. Service connection for sleep apnea is not warranted. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303. 5. Service connection for right lower extremity radiculopathy is warranted. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.310. 6. Service connection for left lower extremity radiculopathy is warranted. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§§ 3.303. 7. A rating in excess of 20 percent for lumbar strain is not warranted. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71a, Diagnostic Codes (Codes) 5237, 5243. 8. A compensable rating for allergic rhinitis is not warranted. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.31, 4.97, Code 6522. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The appellant is a Veteran who served on active duty from July 2009 to July 2010. These matters are before the Board of Veterans' Appeals (the Board) on appeal May 2014 and July 2016 rating decisions. The Veteran's service treatment records (STRs ) show that in a June 2010 behavioral health survey he reported that he was restless and nervous, and had difficulty falling asleep. On a medical data questionnaire in June 2010 he denied having any current medical problems or issues. A June 2010 post-deployment health assessment shows that the Veteran reported being on sick call for trouble breathing and swollen or painful joints. He was not on sick call for numbness or tingling in the feet, trouble hearing, problems sleeping, trouble concentrating or for being forgetful. He denied encountering dead bodies, seeing people killed, being wounded during deployment, being in direct combat and feeling in great danger of being killed. Audiometry in June 2010 found that right ear puretone thresholds in decibels were 5, 10, 5, 5 and 5 at 500, 1,000, 2,000, 3,000 and 4,000 Hertz, respectively. Left ear puretone thresholds at corresponding frequencies were 10, 5, 5, 0 and 10. Service department records show that the Veteran was seen in September 2010, when it was noted that he was alleged to have physically and emotionally abused his spouse. He complained of sleep disturbance, irritability and symptoms of depression associated with marital conflict. Mental status evaluation found that he was alert and oriented times four. He denied suicidal/homicidal ideation at present but said he had it recently. The assessment was other specified family circumstances. VA outpatient treatment records show that in September 2010 the Veteran stated he had a quarrel with his wife and due to his aggressive outburst, she requested a restraining order. He stated that he had been suffering from insomnia for several months, even before he returned home, and that his supervisor had noted his behavioral changes since his return. An adjustment disorder with depressed mood and insomnia/sleep disorder were noted. In October 2011 he stated that he performed guard duty on the base perimeter during service. He said there was some tension but it was OK. He reported that he had been feeling depressed after his return from Africa during service, and that he felt irritable at times when people are close. The diagnosis was depressive disorder. The examiner stated that the Veteran was having difficulties four months into his transition and readjustment from a deployment and back to civilian and family life. In December 2010 the Veteran stated that he had insomnia during service, with multiple awakenings at night. He reported depressive symptoms. The diagnosis was depression, not otherwise specified. In December 2010 a PTSD screen was negative. On September 2010 VA general medical examination, systems review showed that the Veteran had no neck symptoms. He denied episodes of sinusitis in the previous 12 months. There was no history of sleep apnea. Examination found that the sinuses, feet and lower extremities were normal. There was no pertinent diagnosis. On December 2010 VA psychiatric examination the Veteran complained of insomnia, poor concentration, irritability and poor impulse control. He stated that his symptoms began in service. There was no Axis I diagnosis. The examiner noted that the Veteran's claimed stressor was not related to a fear of hostile military service. In November 2011 the VA psychiatrist who conducted the December 2010 examination reviewed the Veteran's records. She stated that the Veteran did not meet the DSM-IV symptom criteria for a formal Axis I diagnosis. VA outpatient treatment records show that in January 2011 it was noted that the Veteran was suspected of having sleep apnea. In April 2011 a past medical history of insomnia was noted. The assessment was possible sleep apnea with daytime hypersomnia. In June 2011 he was seen for sleep disorder screening; it was noted that his questionnaire showed significant signs and symptoms suggestive of sleep apnea. In January 2012 he was seen in a sleep lab. It was noted that he did not show a significant apnea/hypoapnea index and that he showed significant symptoms only in the supine position. In February 2012 a sleep study did not meet the standards for interpretation because of a decrease in sleep efficiency, but showed an essentially normal respiratory disturbance index. On February 2012 VA back examination it was noted that the Veteran did not have radicular pain or signs or symptoms of radiculopathy. In February 2012 the VA psychiatrist who conducted the December 2010 examination noted that there was no Axis I diagnosis. In July 2012 it was noted that the Veteran had low back pain with radiation to the left lower extremity. The assessment was lumbosacral radiculitis. On February 2013 VA back examination, the Veteran reported pain from his back to his left lower extremity during physical activity. Examination found no signs or symptoms of radiculopathy. In August 2013, J.T.L. Quinones, M.D. stated that he examined the Veteran in July and August 2013 and the diagnostic impression was major depressive disorder with anxiety. On April 2014 VA psychiatric examination the Veteran denied receiving mental health treatment in service. He stated that he had insomnia with multiple awakenings at night in service. The assessment was depression, not otherwise specified. VA outpatient treatment records show that in April 2014 it was noted that the Veteran was seen in a sleep lab. He did not show significant apnea/hypopnea index; moderate to loud snoring was recorded. In March 2015 a CT of the neck found minimal layering fluid in the left maxillary sinus that might reflect acute sinusitis. In November 2015 C.E.M. Quesada, M.D. noted that the Veteran complained of a hearing loss due to loud noises in service. It was noted that he presented with neck and back pain that radiated to his hips, knees and ankles. The diagnoses were cervical spine degenerative disc disease, degenerative joint disease of the right shoulder, hips, ankles and feet, and PTSD. Dr. Quesada, an internist, opined that it was more probable than not that the Veteran's severe musculoskeletal and psychiatric disabilities were secondary to service. On March 2016 VA examination audiometry found that right ear puretone thresholds in decibels were 20, 20, 15, 10 and 10 at 500, 1,000, 2,000, 3,000 and 4,000 Hertz, respectively. Left ear puretone thresholds at corresponding frequencies were 20, 15, 5, 5 and 5. It was noted that the Veteran had normal hearing in each ear. The examiner stated that a medical opinion was not possible since the Veteran did not have a hearing loss [disability]. On March 2016 VA shoulder examination the Veteran had normal range of motion of the right shoulder. On March 2016 VA back examination the Veteran stated that he was unable to bend over, sit or stand for long periods of time and could not perform duties at home. Examination found that forward flexion was to 50 degrees, extension was to 20 degrees, lateral flexion was to 20 degrees bilaterally and rotation was to 20 degrees bilaterally. Pain was noted, but did not result in functional loss. There was no evidence of pain with weight bearing. There was no objective evidence of localized tenderness or pain on palpation. The Veteran could perform repetitive use testing with no additional loss of function or range of motion after three repetitions. Pain, weakness, fatigability or incoordination did not significantly limit functional ability with repeated use over time. The Veteran did not have guarding or muscle spasm. Muscle strength testing was 5/5 throughout. There was no muscle atrophy. Reflexes were 2+ bilaterally at the knees and ankles. A sensory examination was normal in the lower extremities. Straight leg raising was negative bilaterally. The Veteran did not have signs or symptoms of radiculopathy. The lumbar spine was not ankylosed. He had intervertebral disc syndrome but had not had any episodes of acute signs or symptoms of intervertebral disc syndrome that required bed rest prescribed by a physician and treatment in the previous 12 months. The examiner noted that there were no neurological symptoms on examination. The diagnoses were lumbosacral strain, degenerative arthritis of the spine and intervertebral disc syndrome. On April 2016 VA psychiatric examination the Veteran stated that he began mental health treatment at the VA in November 2010. He said that while in service a friend of his died of an apparent overdose while on a mission. He stated that this affected him because his friend had helped him with English. The diagnosis was unspecified depressive disorder. The examiner noted that the Veteran did not have PTSD. He reviewed the record and noted that the Veteran's STRs are silent for behavioral health referrals, findings or diagnoses of a psychiatric disability. He noted that medical evaluations by several practitioners were considered and only Dr. Quesada had diagnosed PTSD. The examiner noted that Dr. Quesada is an internist, and is not qualified to diagnosis individuals with psychiatric disabilities (and that he gives the same diagnosis to all veterans). He also stated that the Veteran's June 2010 post-deployment health assessment showed that he was not exposed to explosions, did not see dead bodies, was not in direct combat, did not feel in great danger of being killed and denied PTSD symptoms. He further noted that the Veteran's symptoms do not meet the criteria for PTSD as he was not exposed to a stressor event due to combat, personal trauma or other life-threatening situations in service. On July 2016 VA nose and throat examination the Veteran stated that he was exposed to burn pits and environmental hazards during service and that he began to have nasal stuffiness associated with sneezing and clear nasal secretions. He said he went to sick call for such complaints and a nasal spray was prescribed. He denied that he was diagnosed with sinusitis. Examination found that he did not have greater than 50 percent obstruction on both sides or complete obstruction on either side due to rhinitis. There was permanent hypertrophy of the nasal turbinates. There were no nasal polyps. It was noted that a March 2015 CT showed minimal layering fluid in the left maxillary sinus that might reflect acute sinusitis. X-rays in July 2016 found that the paranasal sinuses were clear. The diagnosis was allergic rhinitis. On July 2017 VA psychiatric examination the diagnosis was unspecified depressive disorder. The examiner reiterated the opinion provided on April 2016 VA psychiatric examination, again noting that the Veteran's symptoms did not meet the DSM-V criteria for a PTSD diagnosis, as he was not exposed to a stressor event due to combat, personal trauma or other life-threatening situations in service. On July 2017 VA hearing loss examination, audiometry found that right ear puretone thresholds in decibels were 15, 15, 10, 20 and 20 at 500, 1,000, 2,000, 3,000 and 4,000 Hertz, respectively. Left ear puretone thresholds at corresponding frequencies were 15, 15, 10, 10 and 15. It was noted that the Veteran had normal hearing in each ear. The examiner opined that since the Veteran had normal hearing in each ear, the bilateral “hearing loss” was less likely as not related to service. She noted that audiological evaluations from April 2009 to March 2016 are consistent [in showing] bilateral normal hearing. On July 2017 VA back examination, the Veteran reported daily back pain that flared upon standing and driving and that he had difficulty lifting heavy objects. He also complained of intermittent bilateral leg pain with tingling and numbness. Examination found that forward flexion of the lumbar spine was to 50 degrees; extension was to 15 degrees; lateral flexion was to 15 degrees to the right and 20 degrees to the left; and rotation was to 15 degrees to the right and 20 degrees to the left. He had pain that resulted in functional loss and evidence of pain with weight-bearing. Lumbar tenderness was noted. The Veteran was able to perform repetitive use testing with no additional loss of function or range of motion after three repetitions. The examination was consistent with the Veteran's statements describing functional loss with repetitive use over time. He had guarding or muscle spasm, but it did not result in abnormal gait or abnormal spinal contour. It was noted that he had mild radiculopathy. There was no evidence of ankylosis. He had intervertebral disc syndrome, but had not had episodes of acute signs or symptoms due to it that required bed rest prescribed by a physician or treatment by a physician in the previous 12 months. The diagnoses were lumbosacral strain, degenerative arthritis of the spine, intervertebral disc syndrome and bilateral lumbar radiculopathy. The examiner opined that the Veteran's bilateral lumbar radiculopathy was at least as likely as not due to the service-connected lumbar strain and discogenic disease. Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). To substantiate a claim of service connection there must be evidence of: (1) a current disability (for which service connection is sought); (2) incurrence or aggravation of a disease or injury in service; and (3) a nexus between the claimed disability and the disease or injury in service. See Shedden v, Principi, 381 F.3d 1153, 1166-1167 (Fed. Cir. 2004). Secondary service connection is warranted for disability that has been caused or aggravated by a service-connected disability. 38 C.F.R. § 3.310. 1. Service connection for PTSD. Service connection for PTSD requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125 (a), that is, a diagnosis that conforms to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V); a link, established by medical evidence, between current symptoms and a stressor in service; and credible supporting evidence that the claimed stressor in service occurred. 38 C.F.R. § 3.304 (f). The threshold question that must be addressed in this matter is whether the Veteran has/during the pendency of the instant claim had a diagnosis of PTSD. A diagnosis of PTSD was provided by Dr. Quesada in November 2015. He noted that the Veteran had flashbacks of his experiences in service. There was no mention of a stressor in Dr. Quesada’s report; he merely diagnosed such disability (without identifying the stressor and symptoms supporting the diagnosis). The Veteran has been afforded five VA psychiatric examinations, none of which found him to have a diagnosis of PTSD. The April 2016 and July 2017 examiners specifically found that the Veteran's symptoms did not meet the criteria for [a diagnosis of] PTSD. They noted that he was not exposed to a stressor event in service (noting that he had reported in service that he was not exposed to explosions and did not see dead bodies). The April 2016 examiner also observed that Dr. Quesada, who had diagnosed PTSD, is an internist, not a psychiatrist or psychologist, and lacks the expertise to render a diagnosis of PTSD. The diagnosis of PTSD is a complex medical question; it requires medical expertise. Jandreau v. Nicholson; 492 F 3d 1372, 1377 (Fed. Cir. 2007). While the Veteran is competent to observe he has had psychiatric symptoms, he is not competent to establish by his own opinion that he has a diagnosis of PTSD. The sole medical evidence he has submitted supporting that he has such diagnosis lacks probative value (as it does not cite to the stressor and symptoms that support the diagnosis, and is by a medical provider who lacks expertise in the diagnosis and treatment of mental disorders). Service connection is limited to those cases where disease or injury in service has resulted in a current (shown during the pendency of the claim; see McClain v. Nicholson; 21 Vet. App. 319 (2007)) claimed chronic disability. In the absence of proof of the disability for which service connection is sought, there is no valid claim of service connection. See Brammer v. Derwinski, 3 Vet. App. 223 (1992). The record does not show that during the pendency of the instant claim the Veteran has had a diagnosis of PTSD in accordance with DSM-V (and there is no credible evidence supporting the occurrence of a stressor event in service). Threshold legal (see 38 C.F.R. § 3.304(f)) and factual requirements for substantiating a claim of service connection for PTSD are not met. The appeal in the matter must be denied. 2. Service connection for bilateral hearing loss Hearing loss disability for VA compensation purposes is defined in 38 C.F.R. § 3.385. Impaired hearing is a disability when the auditory threshold in any of the frequencies of 500, 1,000, 2,000, 3,000 and 4,000 Hertz is 40 decibels or greater; or when the thresholds for at least three of these frequencies are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. To establish service connection for hearing loss, it is not required that a hearing loss disability under 38 C.F.R. § 3.385 be demonstrated during service, although a hearing loss disability by such standards must be currently present [emphasis added]; service connection is possible if a current hearing loss disability can be adequately linked to service. Ledford v. Derwinski, 3 Vet. App. 87 (1992). In Hensley v. Brown, 5 Vet. App. 155, the United States Court of Appeals for Veterans Claims held that the threshold for normal hearing is from 0 to 20 decibels, and higher threshold levels indicate some degree of hearing loss. Under governing law service connection is warranted (compensation is payable) for disability [emphasis added] resulting from disease or injury incurred or aggravated in service. 38 U.S.C. §§ 1110, 1131. In the absence of proof of a present disability for which service connection is sought, there is no valid claim of service connection. See Brammer v. Derwinski, 3 Vet. App. 223 (1992). Hearing loss disability for VA compensation/service-connection purposes is defined in 38 C.F.R. § 3.385. Accordingly, the threshold question that must be addressed here is whether or not the Veteran has (or during the pendency of the instant claim has had) a hearing loss disability as defined in that regulation. Under 38 C.F.R. §§ 3.385 and 4.85, hearing loss disability must be shown by audiometry conducted in accordance with established standards. The record shows that all audiometry, during service and following service, to include on March 2016 and July 2017 VA examinations has found that the Veteran does not have a hearing loss disability. Accordingly, he has not met the threshold requirement for substantiating a claim of service connection for such disability, and the appeal in this matter must be denied. 3. Service connection for a sinus disorder. 4. Service connection for sleep apnea. The Veteran's STRs are silent for complaints or findings concerning a sinus disorder. A November 2015 neck CT included findings that might reflect acute sinusitis. Notably, on July 2016 VA examination, the Veteran denied having received a diagnosis of sinusitis; X-rays conducted found the sinuses were clear. There has been no diagnosis of chronic sinusitis either during service or at any time thereafter. The Veteran’s STRs are silent for complaints or findings pertaining to sleep apnea. He reported problems sleeping in service and has continued to describe insomnia following service. In January 2011 he was suspected of having sleep apnea and in April 2011 possible sleep apnea was noted. In June 2011 he completed a questionnaire suggesting he has sleep apnea; however, a sleep study conducted thereafter (in January 2012) found that he did not have a significant apnea index, and similar findings were noted in April 2014. Service connection is limited to those cases where disease or injury in service has resulted in a current (shown during the pendency of the claim) chronic disability; See McLain v. Nicholson, 21 Vet. App. 319 (2007). In the absence of proof of the disability for which service connection is sought, there is no valid claim of service connection. See Brammer v. Derwinski, 3 Vet. App. 223 (1992). While the Veteran has reported symptoms suggestive of sleep apnea, such disease is diagnosed based on diagnostic studies. No sleep study has found the Veteran to have sleep apnea. The record does not show that during the pendency of the instant claim the Veteran has/had a chronic sinus disorder or sleep apnea; accordingly, the threshold requirement for substantiating a claim of service connection for such disabilities is not met, and the appeals in these matters must be denied. 5. Service connection for right lower extremity radiculopathy. 6. Service connection for left lower extremity radiculopathy. The Veteran's STRs are silent for findings concerning lower extremity radiculopathy. VA examinations in February 2012, February 2013 and March 2016 found that he had no signs or symptoms of radiculopathy. However, a subsequent (July 2017) VA back examination found he has mild bilateral radiculopathy. The examiner opined that it is at least as likely as not that the Veteran's bilateral radiculopathy was due to his service-connected low back disability. The requirements for establishing secondary service connection are met; service connection for bilateral lower extremity radiculopathy is warranted. Increased rating Disability ratings are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Separate diagnostic codes identify the various disabilities. Disabilities must be reviewed in relation to their history. 38 C.F.R. § 4.1. Reasonable doubt regarding the degree of disability is to be resolved in favor of the claimant, 38 C.F.R. § 4.3. Functional impairment is to be assessed on the basis of lack of usefulness, and the effects of the disability upon the person’s ordinary activity, 38 C.F.R. § 4.10. See Schafrath v. Derwinski, 1 Vet. App. 589 (1991). 7. A rating in excess of 20 percent for lumbar strain is denied. When the appeal is from the initial rating assigned with an award of service connection, separate ratings can be assigned for separate periods of time based on the facts found – a practice known as “staged” ratings. Fenderson v. West, 12 Vet. App. 119 (1999). Under the General Formula, a 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. A 40 percent rating is warranted when forward flexion of the thoracolumbar spine is limited to 30 degrees or less, or for favorable ankylosis of the entire thoracolumbar spine. A 20 percent rating is warranted when forward flexion of the thoracolumbar spine is greater than 30 degrees but not greater than 60 degrees, or, the combined range of thoracolumbar spine motion is not greater than 120 degrees, or with muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour, such as scoliosis, reversed lordosis, or abnormal kyphosis. Pertinent notes following provide: Any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, are to be separately rated, under an appropriate diagnostic code. Normal forward flexion of the thoracolumbar spine is 0 to 90 degrees, extension is 0 to 30 degrees, left and right lateral flexion are 0 to 30 degrees, and left and right lateral rotation are 0 to 30 degrees. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, and Notes 1 and 2. Initially, the Board notes that considering the above grant of service connection for bilateral lower extremity radiculopathy (for which the agency of original jurisdiction will assign the initial ratings when it implements the awards), and because no other neurological manifestations are shown), the focus is on the orthopedic manifestations of the low back disability. The next higher (40 percent) rating for thoracolumbar spine disability is warranted when forward flexion is limited to 30 degrees or less or with favorable ankylosis of the entire thoracolumbar spine. The March 2016 and July 2017 VA examinations both found forward flexion to 50 degrees; it was specifically noted that there was no ankylosis. There is no indication in the record (nor is it alleged) that a physician has prescribed bed rest the low back disability, so as to warrant rating the disability under the incapacitating episodes alternate criteria afforded under Code 5243. The preponderance of the evidence is against a rating in excess of 20 percent for the lumbar strain; accordingly, the appeal in this matter must be denied. 8. A compensable rating for allergic rhinitis is denied. Where the appeal is from the initial rating assigned with the award of service connection, separate ratings can be assigned for separate periods of time based on the facts found – a practice known as “staged” ratings. Fenderson v. West, 12 Vet. App. 119 (1999). Different ratings may be warranted for different time periods, based on facts found. Hart v. Mansfield, 21 Vet. App. 505 (2007). A 30 percent rating is warranted for allergic or vasomotor rhinitis with polyps. Without polyps, but with greater than 50-percent obstruction of nasal passage on both sides or complete obstruction on one side, a 10 percent evaluation is warranted. 38 C.F.R. § 4.97, Code 6522. In every instance where the schedule does not provide a zero percent evaluation for a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a compensable evaluation are not met. 38 C.F.R. § 4.31. The July 2016 VA examination did not find complete obstruction of the Veteran’s nasal passages on one side or a greater than 50 percent obstruction on both sides. Accordingly, the criteria for a compensable rating for allergic rhinitis are not met. The symptoms and related functional impairment the Veteran describes in his own reports do not satisfy the schedular criteria for a rating for a compensable rating for allergic rhinitis. Accordingly, the preponderance of the evidence is against this claim. REASONS FOR REMAND 9. Service connection for a psychiatric disability other than PTSD. The Veteran's STRs show that in June 2010 he reported feeling restless and nervous (but there is no indication that he received treatment for such complaints). He asserts that he has a psychiatric disability that is related to the complaints in service or secondary to his service-connected low back disability. Opinions on VA psychiatric examinations in December 2010 and February 2012, and in November 2011, indicate that the Veteran did not have an Axis I psychiatric diagnosis. It was noted he had physical limitations and chronic low back pain, but such conditions did not constitute a mental disorder. On April 2014 VA psychiatric examination, the assessment was depression, not otherwise specified; the examiner opined that the psychiatric disability was not related to the Veteran’s or secondary to a service-connected disability. In November 2015, Dr. Quesada diagnosed generalized anxiety disorder and major depressive disorder and offered a conclusory opinion that it is more probable than not that the Veteran's psychiatric disabilities are secondary to his service. The opinions on VA examinations in April 2016 and July 2017 do not adequately address whether the Veteran's current acquired psychiatric disability is related to his complaints of nervousness in service or is secondary to his service-connected low back disability. An examination to obtain an adequate medical opinion in the matter is necessary. 10. Service connection for a cervical spine disability. 11. Service connection for a right foot disability. 12. Service connection for a left foot disability. 13. Service connection for a right hip disability. 14. Service connection for a left hip disability. 15. Service connection for a right shoulder disability. 16. Service connection for a right knee disability. 17. Service connection for a left knee disability. 18. Service connection for a right ankle disability. 19. Service connection for bronchial asthma. 20. Service connection for erectile dysfunction. Private medical records show that X-rays of the Veteran’s knees in February 2012 found mild degenerative changes. In April 2012, he was seen for chondromalacia patella. On February 2013 VA knee examination, he stated that he developed bilateral knee disability several years prior; bilateral patellofemoral pain syndrome was diagnosed. The examiner opined that it was less likely than not that the bilateral knee disability was proximately due or the result of the Veteran’s service-connected disabilities. He noted (without greater explanation) that patellofemoral pain syndrome has a different and unrelated pathophysiology than the service-connected low back disability; the same opinion was given on July 2017 VA examination. On April 2014 VA respiratory examination, the Veteran reported difficulty breathing, but denied having a diagnosis of asthma. Examination found no evidence of bronchial asthma. It was noted that he did not have a respiratory condition. In November 2015, Dr. Quesada diagnosed bronchial asthma, ED, cervical spine degenerative disc disease, and degenerative joint disease of the hips, knees, ankles and feet. He offered the conclusory opinion that it is more probable than not that the Veteran's respiratory and musculoskeletal disabilities and ED are due to his service. The VA opinions have not addressed (expressed agreement or disagreement with) Dr. Quesada’s opinion or opined whether a service-connected disability aggravated the Veteran’s bilateral knee disorder. VA examiners in April 2014 and July 2017 found that the Veteran's ED was unrelated to his service-connected lumbar strain. In April 2014, the examiner noted that the Veteran had a history of low testosterone and was on anti-depressant medication, which are risk factors for ED. As the Veteran claim of service connection for a psychiatric disability other than PTSD is being remanded (and a finding that the Veteran took anti-depressant medication for a service-connected psychiatric disability would support a secondary service connection theory of entitlement to service connection for ED, consideration of the claim of service connection for ED must be deferred. These matters are REMANDED for the following: 1. Arrange for a psychiatric examination of the Veteran to ascertain the nature and likely etiology of any current psychiatric disability. The examiner should review the record and examine/interview the Veteran, identify any (and each) psychiatric disability found by diagnosis. and opine as whether it is at least as likely as not (a 50 percent or higher probability) that any chronic acquired psychiatric disability diagnosed is etiologically related to the Veteran’s service (and his complaints of nervousness therein), or was caused or aggravated (the opinion must address aggravation) by his service connected low back disability. The examiner must include rationale with all opinions. The rationale should include comment on (expression of agreement or disagreement with) Dr. Quesada’s opinion indicating that the Veteran’s psychiatric disability is related to his service. 2. Arrange for an orthopedic examination of the Veteran to ascertain the nature and etiology of any current cervical spine disability, right shoulder disability, bilateral hip disability, right ankle disability or bilateral foot disability. The examiner should review the record and provide an opinion as to whether it is at least as likely as not (a 50 percent or higher probability) that any of these disabilities, if present, is related to the Veteran's service. Regarding the knees, the examiner must also state whether any such disability caused or aggravated (the opinion must address aggravation) by his low back disability The examiner must include rationale with all opinions. The rationale should include comment on (expression of agreement or disagreement with) Dr. Quesada’s opinion that the Veteran’s musculoskeletal disabilities are related to service. 3. Arrange for a genitourinary examination of the Veteran to ascertain the likely etiology of his ED. On examination/interview of the Veteran and review of his record, the consulting provider should opine whether it is at least as likely as not (a 50 percent or higher probability) that the Veteran’s ED was caused or aggravated (the opinion must address aggravation) by his low back disability or by medication taken for a [service-connected] psychiatric disability. The examiner must include rationale with all opinions. The rationale should include comment on (express agreement or disagreement with) Dr. Quesada’s opinion that the Veteran’s ED is related to his service 4. Arrange for a pulmonary diseases examination of the Veteran to confirm his diagnosis of bronchial asthma (and if confirmed, determine its etiology). The examiner should review the record and opine whether it is at least as likely as not (a 50 percent or higher probability) any bronchial asthma is etiologically related to his service. The examiner must include rationale with all opinions. The rationale should include comment on (express agreement or disagreement with) Dr. Quesada’s opinion indicating that the Veteran has bronchial asthma that is related to his service GEORGE R. SENYK Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD James R. Siegel, Counsel