Citation Nr: 18149407 Decision Date: 11/09/18 Archive Date: 11/09/18 DOCKET NO. 18-27 335 DATE: November 9, 2018 ORDER Service connection for a psychiatric disorder is granted. Service connection for a lumbar spine disability, diagnosed as degenerative disc disease, is granted. REMANDED Entitlement to service connection for a cervical spine disability is remanded. Entitlement to service connection for a right hip disability is remanded. Entitlement to service connection for a left hip disability is remanded. Entitlement to service connection for a right knee disability is remanded. Entitlement to service connection for a right ankle disability is remanded. Entitlement to service connection for a left ankle disability is remanded. Entitlement to service connection for a cardiovascular disorder, to include hypertensive heart disease, is remanded. Entitlement to service connection for a respiratory disorder, to include asthma and bronchitis, is remanded. Entitlement to service connection for bilateral hearing loss is remanded. Entitlement to service connection for tinnitus is remanded. FINDINGS OF FACT 1. The Veteran’s psychiatric disorder had it onset in service. 2. The Veteran’s lumbar spine disability, diagnosed as degenerative disc disease, had its onset in service. CONCLUSIONS OF LAW 1. The criteria for service connection for a psychiatric disorder have been met. 38 U.S.C. §§ 1101, 1112, 1113, 1154(a), 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309 (2017). 2. The criteria for service connection for a lumbar spine disability, diagnosed degenerative disc disease, have been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1154(a), 5107(b) (West 2014); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.317 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the Army from March 1968 to March 1970. This matter is before the Board of Veterans’ Appeals (Board) on appeal of a December 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in San Juan, Puerto Rico, that denied service connection for a psychiatric disorder (listed as an unspecified neurocognitive disorder, claimed as a generalized anxiety disorder and major depression disease, as well as posttraumatic stress disorder (PTSD)). As there are multiple other psychiatric diagnoses of record, the Board finds that it is more appropriate to characterize the claim broadly as one of entitlement to service connection for a psychiatric disorder. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). By this decision, the RO also denied service connection for a lumbar spine disability (listed as lumbar spine degenerative disc disease, claimed as chronic low back pain and chronic myositis of the para-lumbar muscles); a cervical spine disability (listed as cervical strain, claimed as chronic cervical spine pain and chronic myositis of the para-cervical spine muscles); a right hip disability (listed as sacroiliitis of the bilateral hips); a left hip disability (listed as sacroiliitis of the bilateral hips); a right knee disability (listed as right knee joint osteoarthritis, claimed as degenerative joint disease); a right ankle disability (listed as bilateral Achilles tendonitis, claimed as degenerative joint disease of the ankles); a left ankle disability (listed as bilateral Achilles tendonitis, claimed as degenerative joint disease of the ankles); a cardiovascular disorder, to include hypertensive heart disease (listed as hypertensive cardiovascular disease); a respiratory disorder, to include asthma and bronchitis (listed as asthma and chronic bronchitis); bilateral hearing loss; and for tinnitus. 1. Psychiatric Disorder Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999); Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff’d per curiam, 78 F. 3d 604 (Fed. Cir. 1996) (table). Determinations as to service connection will be based on review of the entire evidence of record, to include all pertinent medical and lay evidence, with due consideration to VA’s policy to administer the law under a broad and liberal interpretation consistent with the facts in each individual case. 38 U.S.C. § 1154(a); 38 C.F.R. § 3.303(a). Service connection for PTSD requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a) (i.e., under the criteria of DSM-IV); a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred. If the evidence establishes that the veteran engaged in combat with the enemy and the claimed stressor is related to that combat, in the absence of clear and convincing evidence to the contrary, and provided the claimed stressor is consistent with the circumstances, conditions, or hardships of the veteran’s service, the veteran’s lay testimony alone may establish the occurrence of the claimed in-service stressor. 38 C.F.R. § 3.304(f) (2017). Further, 38 C.F.R. § 3.304(f) provides that if a stressor claimed by a Veteran is related to the Veteran’s fear of hostile military or terrorist activity and a VA psychiatrist or psychologist, or a psychiatrist or psychologist with whom VA has contracted, confirms that the claimed stressor is adequate to support a diagnosis of [PTSD] and that the Veteran’s symptoms are related to the claimed stressor, in the absence of clear and convincing evidence to the contrary, and provided the claimed stressor is consistent with the places, types, and circumstances of the Veteran’s service, the Veteran’s lay testimony alone may establish the occurrence of the claimed in-service stressor. In making all determinations, the Board must fully consider the lay assertions of record. A layperson is competent to report on the onset and recurrence of symptoms. See Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a Veteran is competent to report on that of which he or she has personal knowledge). Lay evidence can also be competent and sufficient evidence of a diagnosis or to establish etiology if (1) the layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). When considering whether lay evidence is competent the Board must determine, on a case by case basis, whether the Veteran’s particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d at 1377 (Fed. Cir. 2007) (holding that “[w]hether lay evidence is competent and sufficient in a particular case is a factual issue to be addressed by the Board”). The Board is charged with the duty to assess the credibility and weight given to evidence. Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997), cert. denied, 523 U.S. 1046 (1998); Wensch v. Principi, 15 Vet. App. 362, 367 (2001). Indeed, in Jefferson v. Principi, 271 F.3d 1072 (Fed. Cir. 2001), the United States Court of Appeals for the Federal Circuit (Federal Circuit), citing its decision in Madden, recognized that that Board had inherent fact-finding ability. Id. at 1076; see also 38 U.S.C. § 7104(a) (West 2002). Moreover, the United States Court of Appeals for Veterans Claims (Court) has declared that in adjudicating a claim, the Board has the responsibility to weigh and assess the evidence. Bryan v. West, 13 Vet. App. 482, 488-89 (2000); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992). As a finder of fact, when considering whether lay evidence is satisfactory, the Board may also properly consider internal inconsistency of the statements, facial plausibility, consistency with other evidence submitted on behalf of the Veteran, and the Veteran’s demeanor when testifying at a hearing. See Dalton v. Nicholson, 21 Vet. App. 23, 38 (2007); Caluza v. Brown, 7 Vet. App. 498, 511 (1995), aff’d per curiam, 78 F.3d 604 (Fed. Cir. 1996). In determining the probative value to be assigned to a medical opinion, the Board must consider three factors. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The initial inquiry in determining probative value is to assess whether a medical expert was fully informed of the pertinent factual premises (i.e., medical history) of the case. A review of the claims file is not required, since a medical professional can also become aware of the relevant medical history by having treated a Veteran for a long period of time or through a factually accurate medical history reported by a Veteran. See Id. at 303-04. The second inquiry involves consideration of whether the medical expert provided a fully articulated opinion. See Id. A medical opinion that is equivocal in nature or expressed in speculative language does not provide the degree of certainty required for medical nexus evidence. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). The third and final factor in determining the probative value of an opinion involves consideration of whether the opinion is supported by a reasoned analysis. The most probative value of a medical opinion comes from its reasoning. Therefore, a medical opinion containing only data and conclusions is not entitled to any weight. In fact, a review of the claims file does not substitute for a lack of a reasoned analysis. See Nieves-Rodriguez, 22 Vet. App. at 304; see also Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (“[A] medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions.”). The Veteran contends that he has a psychiatric disorder that is related to service. He specifically maintains that he began feeling psychologically ill during his period of service. He reports that after he left the service, he visited a psychiatrist at a VA facility and he was prescribed medication, but that he later stopped taking the medication. The Veteran essentially asserts that he suffered from psychiatric problems during service and since that time. The Veteran served on active duty in the Army from March 1968 to March 1970. His DD Form 214 lists his occupational specialty as an infantryman. There is no indication that the Veteran was awarded decorations evidencing combat. The Veteran’s service treatment records refer to possible psychiatric problems. On a medical history form at the time of a February 1970 separation examination, the Veteran checked that he had loss of memory or amnesia and nervous trouble. The reviewing examiner indicated that there were no significant findings. The objective February 1970 separation examination report includes a notation that the Veteran’s psychiatric evaluation was normal. Post-service private and VA treatment records show that the Veteran was treated for variously diagnosed psychiatric problems, including an active psychosis (schizophrenic reaction); anxiety; a generalized anxiety disorder; an unspecified anxiety disorder; depression; a depressive disorder; an unspecified depressive disorder; a major depression disease; a major depressive disorder, single episode; a cognitive disorder; mild cognitive impairment; an unspecified neurocognitive disorder; and PTSD. A November 1970 VA treatment report, within a year of the Veteran’s separation from service, notes that the Veteran complained of increased nervousness and having symptoms of anxiety. The Veteran reported that he was always shaking, and afraid that something was going to happen without any real reason. It was noted that the Veteran indicated that he sometimes listened to voices, which involved somebody signing. The impression was an active psychosis (schizophrenic reaction). A November 2014 treatment report from C. E. Mora Quesada, M.D., indicates that the Veteran presented with nervousness; anxiety; irritability; difficulty in adapting to stressful circumstances; an inability to establish and maintain effective work and social relationships; disturbances of motivation and mood; a depressed mood; little interest or pleasure in activities; feeling down and hopeless; insomnia, with nightmares; having isolation episodes; crying easily; and having flashbacks of his traumatic experiences during his period of active duty. Dr. Mora Quesada also reported that the Veteran presented with a poor frustration tolerance; suspiciousness; poor concentration; and memory, with forgetting recent events, dates, and names of family members. It was noted that the Veteran was in comprehensive psychiatric and psychological therapy, with poor improvement. The diagnoses included a generalized anxiety disorder; a major depression disease; and PTSD. Dr. Mora Quesada indicated that the Veteran presented with psychiatric disorders which were more probably than not secondary to his military service performance. An August 2015 VA psychiatric examination report includes a notation that the Veteran’s claims file was reviewed. It was noted that the Veteran claimed service connection for anxiety and depression due to his service in the Army. The Veteran reported that he was drafted by the Army in 1968 and that he completed his basic training at Fort Benning in Georgia. He stated that he completed advanced individual training in California and that he was stationed at Fort Carlson in Colorado. The Veteran indicated that he was honorably discharged in 1970. The examiner reported that the Veteran had a history of psychiatric complaints, findings, and/or treatment at a VA facility since February 2015. The examiner stated that there was no history of hospitalization or emotional crises, and that the Veteran was being followed with psychotherapy and pharmacotherapy. The diagnosis was an unspecified neurocognitive disorder. The examiner indicated that the claimed condition was less likely as not (less than 50 percent probability) incurred in, or caused by, the claimed in-service injury, event, or illness. The examiner specifically maintained that the Veteran’s neurocognitive disorder was not due to, caused by, incurred in, or related in any way to, his military service. The examiner reported that there was no evidence of psychiatric complaints, psychiatric findings, or psychiatric treatment during the Veteran’s military service. The examiner also stated that there was no evidence of psychiatric complaints, psychiatric findings, or psychiatric treatment, within one year of the Veteran’s discharge from service. The examiner indicated that the Veteran sought psychiatric care in 2015, which was forty-five years after his military service. The examiner reported that there was no relationship between the Veteran’s military service and the neuropsychiatric condition that was diagnosed in approximately 2015. The examiner related that there was no evidence that the Veteran’s neurocognitive disorder started in service, or was related to any incident that occurred during service. The examiner maintained that the Veteran’s neurocognitive disorder was not related at all to the Veteran’s military service by etiology or pathophysiology. The examiner indicated that in regard to a rating decision in September 1971 (which listed an active psychosis), an opinion could not be provided because there was no evidence of any type of psychosis in the Veteran’s claims file. The examiner stated that there was no evidence in the Veteran’s claims file that fulfilled the DSM-5 criteria for a psychosis. The Board observes that the medical evidence indicates that the Veteran reported that he had nervous trouble at the time of his February 1970 separation examination. Additionally, a post-service November 1970 VA treatment report, within one year of the Veteran’s separation from service, relates an impression of an active psychosis (schizophrenic reaction). The Board further notes that subsequent private and VA treatment records show that the Veteran was treated for variously diagnosed psychiatric problems, including anxiety; a generalized anxiety disorder; an unspecified anxiety disorder; depression; a depressive disorder; an unspecified depressive disorder; a major depression disease; a major depressive disorder, single episode; a cognitive disorder; mild cognitive impairment; an unspecified neurocognitive disorder; and PTSD. The Board notes that the examiner, pursuant to an August 2015 VA psychiatric examination report, and following a review of the claims file, found that the Veteran’s diagnosed neurocognitive disorder was not due to, caused by, incurred in, or related in any way to, his military service. The Board notes that the examiner solely diagnosed the Veteran with a neurocognitive disorder. The Board observes, however, that, as noted above, the Veteran has actually been diagnosed with numerous psychiatric disorders. The Board notes that the “current disability” requirement for service connection is satisfied if a claimant has a disability at any time during the pendency of a claim, even if the disability resolves prior the adjudication of the claim. McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). The Board further observes that the examiner indicated that there was no evidence of psychiatric complaints, psychiatric findings, or psychiatric treatment during the Veteran’s military service, or within a year of his discharge from service. The examiner also found that there was no evidence of any type of psychosis in the Veteran’s claims file. The Board notes, however, as discussed above, the Veteran reported that he had nervous trouble at the time of his February 1970 separation examination, and a November 1970 VA treatment report, within a year of the Veteran’s separation from service, relates a diagnosis of an active psychosis (schizophrenic reaction), with a year of his separation from service. The Board observes that the examiner also did not address the reports by the Veteran of psychiatric problems during service and since service. See Davidson, 581 F.3d at 1313. Therefore, the Board finds that the opinions provided by the VA examiner, pursuant to the August 2015 VA psychiatric examination report, have no probative value in this matter. The Board observes that a prior November 2014 treatment report from Dr. Mora Quesada relates diagnoses including a generalized anxiety disorder; a major depression disease; and PTSD. Dr. Mora Quesada indicated that the Veteran presented with psychiatric disorders which were more probably than not secondary to his military service performance. The Board notes that there is no indication that Dr. Mora Quesada reviewed the Veteran’s claims file. Although claims file review is not necessary, the probative value of a medical opinion is based on its reasoning and its predicate in the record so that the opinion is fully informed. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Additionally, Dr. Mora Quesada did not provide any rationale for his opinion relating the diagnosed psychiatric disorders to the Veteran’s period of service. Therefore, the Board finds that Dr. Mora Quesada’s opinion also has little probative value in this matter. The Board observes that the medical evidence of record clearly indicates that the Veteran currently has a psychiatric disorder. Additionally, the Veteran was also diagnosed with a psychiatric disorder, an active psychosis (schizophrenic reaction) within a year of his separation from service. See 38 C.F.R. § 3.309. Additionally, the Board notes that the Veteran is competent to report symptoms of his psychiatric disorder during service and since that time. Moreover, the Board finds that the Veteran’s reports of such symptoms are credible. See Jandreau v. Nicholson, 492 F.3d 1372 (2007). Resolving any doubt in the Veteran’s favor, the Board finds that the evidence is at least in equipoise regarding whether a current psychiatric disorder commenced during his period of service. In light of the evidence of record, the Board cannot conclude that the preponderance of the evidence is against granting service connection for a psychiatric disorder. Accordingly, service connection for a psychiatric disorder is warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; See also Clemons, 23 Vet. App. at 1. 1. Lumbar Spine Disability The Veteran contends that he has a lumbar spine disability that is related to service. He specifically maintains that he began having low back pain during service. The Veteran essentially asserts that he had lumbar spine problems during and since service. The Veteran’s service treatment records indicate that he was treated for low back problems during service. A March 1969 treatment entry notes that the Veteran complained of back pain for one week. He reported that he fell approximately one week earlier. The impression was a low back injury. A July 1969 entry indicates that the Veteran complained of back pain. The examiner reported that the Veteran had a history of low back pain after heavy lifting. A diagnosis was not provided at that time. A February 1970 entry notes that the Veteran had recurring low back pain. A diagnosis was not provided at that time. On a medical history form at the time of a February 1970 separation examination, the Veteran checked that he had back trouble. The reviewing examiner indicated that there were no significant findings. The February 1970 objective separation examination report includes a notation that the Veteran’s spine, and other musculoskeletal systems, were normal. A November 2014 treatment report from Dr. Mora Quesada indicates that the Veteran presented with low back pain, with para-lumbar spine muscle stiffness; numbness; tingling, sensory loss; cramps; and weakness and instability radiating to the hips; knees; and ankles. The diagnoses included chronic low back pain and chronic myositis of the para-lumbar spine muscles. Dr. Mora Quesada indicated that the Veteran’s musculoskeletal disorders were more probably than not secondary to his military service performance. A June 2015 VA back conditions examination report includes a notation that the Veteran’s claims file was reviewed. The Veteran reported that he started having low back pain a long time ago. He stated that the pain was a stabbing sensation, which was of moderate to severe intensity. It was noted that there was no radiation of his symptoms. The diagnosis was lumbar spine degenerative disc disease. The examiner indicated that the claimed condition was less likely than not (less than 50 percent probability) incurred in, or caused by, the claimed in-service injury, event, or illness. The examiner specifically maintained that the Veteran’s lumbar spine degenerative disc disease was less likely as not related to his period of service. The examiner reported that there was evidence of low back pain in March 1969 and July 1969 during the Veteran’s period of service and that an x-ray was normal. The examiner stated that after 1969, there was no evidence of continuity or chronicity of a low back condition. The examiner maintained that the current condition was due to a normal progression of the aging process. The Board notes that the medical evidence indicates that the Veteran was treated for low back problems during his period of service, and that he was noted to have recurrent low back pain. The Veteran also reported that he had back trouble at the time of his February 1970 separation examination. Additionally, the Board notes that post-service private and VA treatment records show treatment for variously diagnosed lumbar spine problems, including degenerative disc disease of the lumbar spine. The Board observes that the examiner, pursuant to a June 2015 VA back conditions examination report, and following a review of the claims file, found that that the Veteran’s degenerative disc disease of the lumbar spine was less likely as not related to his period of service. The Board notes that the examiner indicated that although there was evidence of low back pain in March 1969 and July 1969 during the Veteran’s period of service, an x-ray was normal at that time, and that after 1969, there was no evidence of continuity or chronicity of a low back condition. The examiner specifically maintained that the current condition was due to a normal progression of the aging process. The Board observes that although the examiner indicated that there was no evidence of continuity or chronicity of a low back condition after 1969, she did not address the Veteran’s reports of low back problems during and since service. The Board observes that the Veteran is competent to report low back problems during service and since service. See Davidson, 581 F.3d at 1313. The examiner also did not provide much in the way of a rationale as to why the Veteran’s current degenerative disc disease of the lumbar spine was due to the aging process, but not due to his recurrent low back pain during service. Therefore, the Board finds that the opinions provided by the examiner, pursuant to the June 2015 VA back conditions examination report, are not very probative in this matter. The Board notes that a prior November 2014 treatment report from Dr. Mora Quesada relates diagnoses including chronic low back pain and chronic myositis of the para-lumbar spine muscles. Dr. Mora Quesada indicated that the Veteran’s musculoskeletal disorders were more probably than not secondary to his military service performance. The Board notes that there is no indication that Dr. Mora Quesada reviewed the Veteran’s claims file. See Nieves-Rodriguez, 22 Vet. App. at 295. Additionally, Dr. Mora Quesada did not provide any rationale for his opinion that the Veteran’s musculoskeletal disorders were more probably than not secondary to his military service performance. Therefore, the Board finds that the opinion from Dr. Mora Quesada is also not very probative in this matter. The Board notes that the Veteran is diagnosed with a lumbar spine disability, diagnosed as degenerative disc disease. The Board finds the Veteran’s reports of low back problems during and since his period of service to be credible. See Jandreau v. Nicholson, 492 F.3d 1372 (2007) (holding that lay evidence can be competent and sufficient to establish a diagnosis of a condition when a lay person is competent to identify the medical condition, or reporting a contemporaneous medical diagnosis, or the lay testimony describing symptoms at the time supports a later diagnosis by a medical professional). Resolving any doubt in the Veteran’s favor, the Board finds that the evidence is at least in equipoise regarding whether the current lumbar spine disability, diagnosed as degenerative disc disease, commenced during his period of active duty in the Army. In light of the evidence, as well as the deficiencies in the opinions pursuant to the June 2015 VA back conditions examination report, the Board cannot conclude that the preponderance of the evidence is against granting service connection for a lumbar spine disability, diagnosed as degenerative disc disease. Therefore, service connection for a lumbar spine disability, diagnosed as degenerative disc disease, is warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. REASONS FOR REMAND The remaining issues on appeal are entitlement to service connection for a cervical spine disability; a right hip disability; a left hip disability; a right knee disability; a right ankle disability; a left ankle disability; a cardiovascular disorder, to include hypertensive heart disease; a respiratory disorder, to include asthma and bronchitis; bilateral hearing loss; and tinnitus. As discussed above, the Veteran is now service-connected for a psychiatric disorder and for a lumbar spine disability, diagnosed as degenerative disc disease. The Veteran contends that he has a cervical spine disability; a right hip disability; a left hip disability; a right knee disability; a right ankle disability; a left ankle disability; a cardiovascular disorder, to include hypertensive heart disease; a respiratory disorder, to include asthma and bronchitis; bilateral hearing loss; and tinnitus, that are all related to service. He essentially reports that all of his claimed disabilities began during his period of service. The Veteran is competent to report having cervical spine and/or neck problems; right and left hip problems; right knee problems; right and left ankle problems; symptoms he thought were due to cardiovascular problems; respiratory problems; hearing problems; and ringing in the ears, during service and since service. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). The Veteran’s service treatment records show treatment for possible respiratory problems and cardiovascular problems. Such records do not show treatment for cervical spine and/or neck problems; right and left hip problems; right knee problems; right and left ankle problems; bilateral hearing loss under the provisions of 38 C.F.R. § 3.385 (2017); or for tinnitus. A January 1969 treatment entry notes that the Veteran complained of a sore throat, headaches, nasal congestion, and pain in his chest. The impression was an upper respiratory condition. A March 1969 treatment entry indicates that the Veteran complained of a cough, a sore throat, headaches, and pain in his chest. The impression was an upper respiratory infection. On a medical history form at the time of a February 1970 separation examination, the Veteran checked that he had chronic or frequent colds; sinusitis; a chronic cough; pain or pressure in his chest; and palpitation or pounding of his heart. The reviewing examiner indicated that there were no significant findings. The objective February 1970 separation examination report includes notation that the Veteran’s lungs and chest; heart; vascular system; lower extremities; and spine and other musculoskeletal systems, were normal. The Veteran also did not have a hearing loss disability in either ear, pursuant to 38 C.F.R. § 3.385. Post-service private and VA treatment records show treatment for cervical spine problems; right and left hip problems; right knee problems; right and left ankle problems; hypertensive cardiovascular disease; hypertension; asthma and bronchitis; bilateral hearing loss; and for tinnitus. A November 2014 treatment report from C. E. Mora Quesada indicates that the Veteran presented with neck and high back pain, with stiffness; numbness; tingling; sensory loss; cramps; and weakness of the para-cervical spine muscles radiating to the shoulders arms, elbows and wrists. Dr. Mora Quesada also indicated that the Veteran had low back pain, with para-lumbar spine muscle stiffness; numbness; tingling; sensory loss; cramps; and weakness and instability radiating to the hips; knees; and ankles. It was noted that the Veteran had undergone a surgical procedure on his right knee with poor improvement, and that he was continuing with medical therapy. Dr. Mora Quesada also reported that the Veteran presented with a chronic cough, as well as sputum; dyspnea; chest tightness; and expiratory wheezing, with rhonchi episodes, for which he was in medical therapy with poor improvement of his symptoms. Dr. Mora Quesada further stated that the Veteran referred to dizziness; sudden onset headaches; heart palpitations; diaphoresis; and chest tightness episodes for which in was in medical therapy, with poor blood pressure and serum cholesterol issues. Dr. Mora Quesada also maintained that since the Veteran’s military service, the Veteran complained of hearing loss and tinnitus secondary to loud noise during his military operations. The diagnoses included chronic cervical spine pain and chronic myositis of the para-cervical spine muscles; degenerative joint disease of the hips, knees, and ankles; osteoarthrosis of the right knee; hypertensive cardiovascular disease; asthma and chronic bronchitis; bilateral deafness; and tinnitus. Dr. Mora Quesada indicated that the Veteran’s cardiopulmonary; metabolic; and musculoskeletal disorders were more likely than not secondary to his military service performance. The Board notes that Dr. Mora Quesada maintained that Veteran’s cardiopulmonary; metabolic; and musculoskeletal disorders were more likely than not secondary to his military service performance. The Board observes that Dr. Mora Quesada also indicated that since his military service, the Veteran complained of hearing loss and tinnitus secondary to loud noise during his military operations. The Board notes that there is no indication that Dr. Mora Quesada reviewed the Veteran’s claims file. Although claims file review is not necessary, the probative value of a medical opinion is based on its reasoning and its predicate in the record so that the opinion is fully informed. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Additionally, Dr. Mora Quesada did not provide a rationale for any of his etiological opinions. A June 2015 VA neck conditions examination report includes a notation that the Veteran’s claims file was reviewed. The diagnosis was cervical strain. The examiner did not provide an etiological opinion as to the Veteran’s diagnosed cervical strain. A June 2015 VA hip and thigh conditions examination report includes a notation that the Veteran’s claims file was reviewed. The diagnosis was sacroiliitis of both hips. The examiner indicated that the claimed conditions were less likely than not (less than 50 percent probability) incurred in, or caused by, the claimed in-service injury, event, or illness. The examiner stated that no evidence of any of those conditions were seen and that the conditions were due to aging. The Board notes that the examiner indicated that there no evidence of any right or left hip disabilities. The Board notes, however, that the November 2014 report from Dr. Mora Quesada relates diagnoses including degenerative joint disease of the hips. The Board notes that the “current disability” requirement for service connection is satisfied if a claimant has a disability at any time during the pendency of a claim, even if the disability resolves prior the adjudication of the claim. McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). Additionally, the examiner did not address any reports by the Veteran of right hip problems and left hip problems during and since service. See Davidson, 581 F.3d at 1313. A June 2015 VA knee and lower leg conditions examination report includes a notation that the Veteran’s claims file was reviewed. The diagnosis was right knee joint osteoarthritis. The examiner indicated that the claimed condition was less likely than not (less than 50 percent probability) incurred in, or caused by, the claimed in-service injury, event, or illness. The examiner reported that there was no evidence of any knee conditions. The Board notes that the examiner indicated that there no evidence of any knee conditions. The Board notes, however, that the November 2014 report from Dr. Mora Quesada relates diagnoses including degenerative joint disease of the knees and osteoarthrosis of the right knee. See McClain, 21 Vet. App. at 319, 321. Additionally, the examiner did not address any reports by the Veteran of right knee problems during and since service. See Davidson, 581 F.3d at 1313. A June 2015 VA ankle conditions examination also notes that the Veteran’s claims file was reviewed. The diagnosis was bilateral Achilles tendonitis. The examiner indicated that the claimed condition was less likely than not (less than 50 percent probability) incurred in, or caused by, the claimed in-service injury, event, or illness. The examiner specifically maintained that the bilateral Achilles tendonitis was less likely than not related to the Veteran’s period of service. The examiner stated that the Veteran’s service treatment records were silent regarding any ankle complaints, imaging, or evaluations regarding ankle pain. The examiner reported that the Veteran was diagnosed with his bilateral Achilles tendonitis several years after service. The Board notes that the examiner indicated that the Veteran’s bilateral Achilles tendonitis was less likely than not related to his period of service. The Board notes, however, that the examiner did not specifically address any reports by the Veteran of right ankle and left ankle during and since service. See Davidson, 581 F.3d at 1313. Additionally, the examiner did not address the positive opinion provided by Dr. Mora Quesada. A June 2015 VA hypertension examination report includes a notation that the Veteran’s claims file was reviewed. The examiner reported that the Veteran did not have, and had never been diagnosed with, hypertension. The Board notes that the examiner indicated that the Veteran was not diagnosed with hypertension. The Board notes, however, that VA treatment records show that the Veteran was diagnosed with hypertension on numerous occasions. The Board notes that the examiner also did not address the diagnosis of hypertensive cardiovascular disease, pursuant to the November 2014 report from Dr. Mora Quesada. See McClain, 21 Vet. App. at 319, 321. Further, the examiner did not address the positive opinion provided by Dr. Mora Quesada. A June 2015 VA respiratory examination report includes a notation that the Veteran’s claims file was reviewed. The examiner indicated that the Veteran did not have, and had never been diagnosed with, a respiratory condition. The Board notes that although the examiner indicated that the Veteran had never been diagnosed with a respiratory condition, the November 2014 statement from Dr. Mora Quesada relates diagnoses of asthma and chronic bronchitis. See McClain, 21 Vet. App. at 319, 321. The examiner also did not address the positive opinion provided by Dr. Mora Quesada. Further, the examiner did not address the Veteran’s treatment for respiratory problems during service and his reports of respiratory problems since service. See Davidson, 581 F.3d at 1313. A June 2015 VA audiological examination report includes a notation that the Veteran’s claims file was reviewed. The diagnoses were sensorineural hearing loss, in the frequency range of 500 to 4000 Hertz, in the right ear, and sensorineural hearing loss, in the frequency range of 500 to 4000 Hertz, in the left ear. The examiner indicated that the Veteran did not current report tinnitus. The examiner maintained that the Veteran’s right ear hearing loss and left ear hearing loss were not at least as likely as not (50 percent probability) caused by, or a result of, an event during his military service. The examiner reported that the audiograms during the Veteran’s period of service indicate that there was normal hearing in both ears at the time of his February 1970 separation examination. The examiner stated that there was no evidence of progressive hearing loss, or complaints of or treatment for hearing loss, until November 2014, when an evaluation indicated mild to moderate hearing loss. It was noted that the Veteran’s service treatment records, as well as his private and VA treatment records, were silent as to any complaints of a hearing loss condition. The examiner maintained that it was well known that prolonged exposure to high intensity noise levels, like in the military, could cause damage to auditory structures resulting in hearing loss, but, on the other hand, the retroactive effect on hearing was not expected forty-five years after separation. The Board notes that the examiner indicated that the Veteran did not report tinnitus. The Board notes, however, that a November 2014 treatment report from Dr. Mora Quesada relates a diagnosis of tinnitus. See McClain, 21 Vet. App. at 319, 321. Additionally, the examiner appeared to indicate that the Veteran’s hearing loss was not due to his period of service because, in part, he had normal hearing in both ears at the time of his February 1970 separation examination. The Board observes, however, that, in regard to the Veteran’s bilateral hearing loss, the absence of documented hearing loss, as defined by VA, while in service is not fatal to a claim for service connection. See Ledford, 3 Vet. App. at 87. Additionally, when a Veteran does not meet the regulatory requirements for a disability at separation, he can still establish service connection by submitting evidence that a current disability is causally related to service. Hensley v. Brown, 5 Vet. App. 155, 159-160 (1993). In light of the deficiencies with the VA examination reports discussed above, the Board finds that the Veteran has not been afforded VA examinations, with the opportunity to obtain responsive etiological opinions, following a thorough review of the entire claims file, as to his claims for service connection for a cervical spine disability; a right hip disability; a left hip disability; a right knee disability; a right ankle disability; a left ankle disability; a cardiovascular disorder, to include hypertensive heart disease; a respiratory disorder, to include asthma and bronchitis; bilateral hearing loss; and tinnitus. Such examinations must be accomplished on remand. 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79 (2006). The matters are REMANDED for the following action: 1. Ask the Veteran to identify all other medical providers who have treated him for cervical spine problems; right and left hip problems; right knee problems; right and left ankle problems; a cardiovascular disorder, to include hypertension; a respiratory disorder, to include asthma and bronchitis; bilateral hearing loss; and tinnitus, since March 2018. After receiving this information and any necessary releases, obtain copies of the related medical records which are not already in the claims folder. Document any unsuccessful efforts to obtain the records, inform the Veteran of such, and advise him that he may obtain and submit those records himself. 2. Notify the Veteran that he may submit lay statements from himself and from other individuals who have first-hand knowledge, and/or were contemporaneously informed of his in-service and post-service symptomatology regarding his claimed cervical spine disability; right hip disability; left hip disability; right knee disability; right ankle disability; left ankle disability; cardiovascular disorder, to include hypertensive heart disease; respiratory disorder, to include asthma and bronchitis; bilateral hearing loss; and tinnitus. The Veteran should be provided an appropriate amount of time to submit this lay evidence. 3. Schedule the Veteran for an appropriate VA examination to determine the onset and/or etiology of his claimed cervical spine disability; right hip disability; left hip disability; right knee disability; right ankle disability; and left ankle disability. The claims file must be reviewed by the examiner. The examiner must diagnose all current cervical spine disabilities; right hip disabilities; left hip disabilities; right knee disabilities; right ankle disabilities; and left ankle disabilities. Based on a review of the claims file, examination of the Veteran, and generally accepted medical principles, the examiner must provide a medical opinion, with adequate rationale, as to whether it is at least as likely as not that any currently diagnosed cervical spine disabilities; right hip disabilities; left hip disabilities; right knee disabilities; right ankle disabilities; and left ankle disabilities are related to and/or had their onset during his period of service. The examiner must specifically acknowledge and discuss any reports by the Veteran of cervical spine and/or neck problems; right and left hip problems; right knee problems; and right and left ankle problems, during and since his period of service. The examiner must also comment on the positive opinions provided by Dr. Mora Quesada in his November 2014 report. The examiner must further opine as to whether the Veteran’s service-connected lumbar spine disability, diagnosed as degenerative joint disease, or any other service-connected disabilities, caused or aggravated any currently diagnosed cervical spine disabilities; right hip disabilities; left hip disabilities; right knee disabilities; right ankle disabilities; and left ankle disabilities. The term “aggravation” means a permanent increase in the claimed disability; that is, a worsening of the condition beyond the natural clinical course and character of the condition due to the service-connected disability as contrasted to a temporary worsening of symptoms. If aggravation of any currently diagnosed cervical spine disabilities; right hip disabilities; left hip disabilities; right knee disabilities; right ankle disabilities; and left ankle disabilities, by the Veteran’s service-connected lumbar spine disability, diagnosed as degenerative disc disease, or any other service-connected disabilities, is found, the examiner must attempt to establish a baseline level of severity of the diagnosed cervical spine disabilities; right hip disabilities; left hip disabilities; right knee disabilities; right ankle disabilities; and left ankle disabilities, prior to aggravation by the service-connected disabilities. 4. Schedule the Veteran for an appropriate VA examination(s) to determine the onset and/or etiology of his claimed cardiovascular disorder, to include hypertensive heart disease, and respiratory disorder, to include asthma and bronchitis. The claims file must be reviewed by the examiner(s). The examiner(s) must diagnose all current cardiovascular disorders, to include hypertensive heart disease, and respiratory disorders, to include asthma and bronchitis. Based on a review of the claims file, examination of the Veteran, and generally accepted medical principles, the examiner(s) must provide a medical opinion, with adequate rationale, as to whether it is at least as likely as not that any currently diagnosed cardiovascular disorders, to include hypertensive heart disease, and respiratory disorders, to include asthma and bronchitis, are related to and/or had their onset during his period of service. The examiner(s) must specifically acknowledge and discuss the Veteran’s treatment for possible respiratory and cardiovascular problems during service, and any reports by the Veteran of such claimed disabilities, during and since his period of service. The examiner must also comment on the positive opinions provided by Dr. Mora Quesada in his November 2014 report. The examiner(s) must further opine as to whether the Veteran’s service-connected psychiatric disorder, or any other service-connected conditions, caused or aggravated any currently diagnosed cardiovascular disorders, to include hypertensive heart disease, and respiratory disorders, to include asthma and bronchitis. The term “aggravation” means a permanent increase in the claimed disability; that is, a worsening of the condition beyond the natural clinical course and character of the condition due to the service-connected disability as contrasted to a temporary worsening of symptoms. If aggravation of any diagnosed cardiovascular disorders, to include hypertensive heart disease, and respiratory disorders, to include asthma and bronchitis, by the Veteran’s service-connected psychiatric disorder, or any other service-connected conditions, is found, the examiner must attempt to establish a baseline level of severity of the diagnosed cardiovascular disorders, to include hypertensive heart disease, and respiratory disorders, to include asthma and bronchitis, prior to aggravation by the service-connected disabilities. 4. Schedule the Veteran for an appropriate VA examination to determine the nature and likely etiology of his claimed bilateral hearing loss and tinnitus. The entire claims file must be reviewed by the examiner. The examiner must conduct an audiological evaluation, including speech recognition testing, to determine whether the Veteran currently has a hearing loss disability. The examiner also must indicate if the Veteran currently has tinnitus. If hearing loss and tinnitus are identified, the examiner must provide an opinion as to whether it is at least as likely as not that any current hearing loss and tinnitus were incurred during the Veteran’s period of service, or are the result of exposure to loud noise during his period of service. Additionally, the examiner must specifically acknowledge and discuss any reports by the Veteran that his hearing loss and tinnitus were first manifested during his periods of service, and has continued since service. The examiner must also comment on the November 2014 report from Dr. Mora Quesada that the Veteran had bilateral hearing loss and tinnitus since his military service secondary to loud noise during his military operations. STEVEN D. REISS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. D. Regan, Counsel