Citation Nr: 18149613 Decision Date: 11/13/18 Archive Date: 11/09/18 DOCKET NO. 18-23 141 DATE: November 13, 2018 ORDER As new and material evidence sufficient to reopen the previously denied claim for service connection for a left shoulder condition has been received, the application to reopen is granted. As new and material evidence sufficient to reopen the previously denied claim for service connection for a right shoulder condition has been received, the application to reopen is granted. As new and material evidence sufficient to reopen the previously denied claim for service connection for a right hand condition has been received, the application to reopen is granted. Entitlement to service connection for a lateral collateral ligament (LCL) sprain of the left ankle is granted. Entitlement to service connection for scoliosis is denied. Entitlement to an effective date prior to October 27, 2014, for the grant of service connection for cervical strain is denied. Entitlement to an effective date prior to October 27, 2014, for the grant of service connection for lumbar strain is denied. Entitlement to an effective date prior to October 27, 2014, for the grant of service connection for superficial varicose veins of the left distal leg is denied. REMANDED Entitlement to service connection for varicose veins of the right leg is remanded. Entitlement to service connection for a left shoulder condition is remanded. Entitlement to service connection for a right shoulder condition is remanded. Entitlement to service connection for a right hand condition is remanded. Entitlement to service connection for neuropathy of the right lower extremity (RLE) is remanded. Entitlement to an initial rating in excess of 10 percent for cervical strain is remanded. Entitlement to an initial rating in excess of 20 percent for lumbar strain is remanded. Entitlement to an initial rating in excess of 10 percent for superficial varicose veins of the left distal leg is remanded. FINDINGS OF FACT 1. In a February 2010 rating decision, the RO denied service connection for a left shoulder condition on the basis that there was no evidence showing an in-service left shoulder injury or otherwise linking the Veteran’s current left shoulder condition to service; the Veteran did not submit new evidence or a notice of disagreement (NOD) within a year of this decision. 2. Evidence submitted subsequent to the February 2010 rating decision bears directly and substantially upon the specific matter under consideration, is not cumulative or redundant, and in connection with evidence previously assembled raises a reasonable possibility of substantiating the claim of entitlement to service connection for a left shoulder condition. 3. In a February 2010 rating decision, the RO denied service connection for a right shoulder condition on the basis that there was no evidence showing an in-service right shoulder injury or otherwise linking the Veteran’s current right shoulder condition to service; the Veteran did not submit new evidence or an NOD within a year of this decision. 4. Evidence submitted subsequent to the February 2010 rating decision bears directly and substantially upon the specific matter under consideration, is not cumulative or redundant, and in connection with evidence previously assembled raises a reasonable possibility of substantiating the claim of entitlement to service connection for a right shoulder condition. 5. In a February 2010 rating decision, the RO declined to reopen a previously denied claim of service connection for a right hand condition on the basis that there was no new and material evidence showing an in-service right hand injury or linking the Veteran’s current right hand condition to service; the Veteran did not submit new evidence or an NOD within a year of this decision. 6. Evidence submitted subsequent to the February 2010 rating decision bears directly and substantially upon the specific matter under consideration, is not cumulative or redundant, and in connection with evidence previously assembled raises a reasonable possibility of substantiating the claim of entitlement to service connection for a right hand condition. 7. Resolving reasonable doubt in the Veteran’s favor, his LCL sprain of the left ankle is related to his active service. 8. The evidence does not demonstrate that the Veteran has or had scoliosis at any time during the appeal period. 9. VA received no communication that constituted a formal or informal claim for service connection for cervical strain until October 27, 2014. 10. VA received no communication that constituted a formal or informal claim for service connection for lumbar strain until October 27, 2014. 11. VA received no communication that constituted a formal or informal claim for service connection for superficial varicose veins of the left distal leg until October 27, 2014. CONCLUSIONS OF LAW 1. The February 2010 rating decision denying service connection for a left shoulder condition is final. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.104(a), 20.1103. 2. New and material evidence sufficient to reopen the Veteran’s claim of entitlement to service connection for a left shoulder condition has been submitted. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). 3. The February 2010 rating decision denying service connection for a right shoulder condition is final. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.104(a), 20.1103. 4. New and material evidence sufficient to reopen the Veteran’s claim of entitlement to service connection for a right shoulder condition has been submitted. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). 5. The February 2010 rating decision declining to reopen the previously denied claim for service connection for a right hand condition is final. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.104(a), 20.1103. 6. New and material evidence sufficient to reopen the Veteran’s claim of entitlement to service connection for a right hand condition has been submitted. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). 7. The criteria for service connection for an LCL sprain of the left ankle are met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 8. The criteria for service connection for scoliosis are not met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 9. The criteria for an effective date earlier than October 27, 2014, for the grant of service connection for cervical strain have not been met. 38 U.S.C. §§ 5101, 5103, 5103A, 5107, 5110; 38 C.F.R. §§ 3.151, 3.155, 3.159, 3.400. 10. The criteria for an effective date earlier than October 27, 2014, for the grant of service connection for lumbar strain have not been met. 38 U.S.C. §§ 5101, 5103, 5103A, 5107, 5110; 38 C.F.R. §§ 3.151, 3.155, 3.159, 3.400. 11. The criteria for an effective date earlier than October 27, 2014, for the grant of service connection for superficial varicose veins of the left distal leg have not been met. 38 U.S.C. §§ 5101, 5103, 5103A, 5107, 5110; 38 C.F.R. §§ 3.151, 3.155, 3.159, 3.400. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from March 1978 to March 1982. The issue of entitlement to service connection for skeletal sclerosis has been raised by the record in a May 2018 statement, but has not been adjudicated by the AOJ. See Veteran affidavit, May 2018. Therefore, the Board does not have jurisdiction over it, and it is referred to the AOJ for appropriate action. 38 C.F.R. § 19.9(b). New and Material Evidence 1. Whether new and material evidence has been submitted to reopen a claim for service connection for a left shoulder condition The Veteran’s claim for service connection for a left shoulder condition was originally denied in a February 2010 rating decision. The RO determined there was no evidence showing that the Veteran had an in-service left shoulder injury or otherwise linking a current left shoulder disability to service. The Veteran did not submit an NOD or new evidence within one year of this decision. The July 2009 rating decision became final and is the last prior denial of this claim. Since the February 2010 final decision, the Board finds that the Veteran has submitted new and material evidence for the left shoulder claim. Specifically, he submitted an April 2018 letter from his private chiropractor linking his left shoulder condition to service, based on the Vetenran’s assertions of an in-service left shoulder injury. The credibility of the Veteran’s assertion is presumed at this juncture. See Justus v. Principi, 3 Vet. App. 510 (1992). As this new evidence tends to show a possible nexus between the Veteran’s current left shoulder disability and his military service, the Board will reopen this claim. Shade v. Shinseki, 24 Vet. App. 110, 118 (2010); see also Hodge v. West, 155 F.3d 1356, 1363 (Fed. Cir. 1998) (noting that new evidence could be sufficient to reopen a claim if it could contribute to a more complete picture of the circumstances surrounding the origin of a claimant’s injury or disability, even where it would not be enough to convince the Board to grant the claim). 2. Whether new and material evidence has been submitted to reopen a claim for service connection for a right shoulder condition The Veteran’s claim for service connection for a right shoulder condition was originally denied in a February 2010 rating decision. The RO determined there was no evidence showing that the Veteran had an in-service right shoulder injury or otherwise linking a current right shoulder disability to service. The Veteran did not submit an NOD or new evidence within one year of this decision. The July 2009 rating decision became final and is the last prior denial of this claim. Since the February 2010 final decision, the Board finds that the Veteran has submitted new and material evidence for the right shoulder claim. Specifically, he submitted an April 2018 letter from his private chiropractor linking his right shoulder condition to service, based on the Veteran’s assertions of an in-service right shoulder injury. The credibility of the Veteran’s assertion is presumed at this juncture. See Justus, supra. As this new evidence tends to show a possible nexus between the Veteran’s current right shoulder disability and his military service, the Board will reopen this claim. Shade, supra; see also Hodge, supra. 3. Whether new and material evidence has been submitted to reopen a claim for service connection for a right hand condition The Veteran’s claim for service connection for a right hand condition was originally denied in a June 2007 rating decision. The RO determined there was no evidence showing that the Veteran had an in-service right hand injury or otherwise linking a current right hand disability to service. The Veteran did not submit an NOD or new evidence within one year of this decision. The Veteran sought to reopen his right hand claim in August 2008. A September 2008 rating decision declined to reopen the previously denied claim finding there was no new and material evidence of an in-service injury or medical nexus. The Veteran sought reconsideration of this denial in July 2009. A February 2010 rating decision also declined to reopen the previously denied claim based on a lack of in-service event or medical nexus. The Veteran did not submit an NOD or new evidence within one year of this decision. The February 2010 rating decision became final and is the last prior denial of this claim. Since the February 2010 final decision, the Board finds that the Veteran has submitted new and material evidence for the right hand claim. Specifically, he submitted an April 2018 letter from his private chiropractor linking his right hand condition to service, based on the Veteran’s assertions of an in-service right hand injury. The credibility of the Veteran’s assertion is presumed at this juncture. See Justus, supra. As this new evidence tends to show a possible nexus between the Veteran’s current right hand disability and his military service, the Board will reopen this claim. Shade, supra; see also Hodge, supra. Service Connection Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1131. Generally, the evidence must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); Caluza v. Brown, 7 Vet. App. 498, 505 (1995); see Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013) (noting that nexus may be demonstrated by a showing of continuity of symptomatology where the disability claimed qualifies as a chronic disease listed in 38 C.F.R. § 3.309(a)). 4. Entitlement to service connection for an LCL sprain of the left ankle The Veteran contends that his left ankle disability was caused by his military service. Specifically, he argues that he suffered twisting injury to his left ankle in service and that it is related to his current left ankle diagnosis. Therefore, he believes service connection is warranted. Initially, the Board notes that the RO denied the Veteran’s left ankle claim because it was determined that his left ankle disability pre-existed service. However, the Board’s review of his November 1977 enlistment examination reveals that the Veteran reported a history of a prior left ankle fracture with no sequelae. As there was no indication of continuing problems, particularly with the LCL ligament, the Board cannot conclude that the Veteran’s left ankle sprain pre-existed service. With regard to a present disability, the Veteran has been diagnosed with a chronic/recurrent LC sprain of the left ankle. VA examination, November 2014. The first element of Shedden/Caluza is met. With regard to an in-service event, the Veteran’s service treatment records reflect treatment for a twisting injury of the left ankle and diagnosed with a left ankle sprain in April 1980. The second element of Shedden is also met. The remaining question is whether there is a medical nexus between the Veteran’s currently diagnosed left ankle disability and his in-service left ankle sprain. To support his claim, the Veteran submitted an April 2018 letter from his private chiropractor, Dr. H.R. Dr. H.R. noted the Veteran’s in-service left ankle sprain and complaints with pain with ambulation since that time. He cited a finding from the American Orthopedic Foot and Ankle Society that recurring or chronic ankle pain can be the result of incomplete healing after an ankle sprain. In light of the Veteran’s in-service sprain and continuing pain since that time, the private chiropractor was able to link his current LCL sprain of the left ankle to his military service. The only other evidence to address the etiology of the Veteran’s LCL sprain of the left ankle is a November 2014 VA examination. The VA examiner provided a negative nexus opinion. However, this was based on the inaccurate premise that the Veteran’s claimed left ankle condition (LCL sprain) pre-existed service. As discussed above, the Board has concluded that the Veteran’s LCL sprain did not pre-exist service. As such, the negative VA opinion is of limited probative value. In light of the positive evidence and lack of sufficiently probative negative evidence, the Board finds that the evidence is, at a minimum, in equipoise regarding the question of whether the Veteran’s current LCL sprain of the left ankle is related to his military service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. The benefit of the doubt will be conferred in the Veteran’s favor. The service-connection claim for an LCL sprain of the left ankle is granted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). 5. Entitlement to service connection for scoliosis A review of the medical evidence of record does not establish a diagnosis of scoliosis at any time during the appeal period or proximate thereto. See McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); Romanowsky v. Shinseki, 26 Vet. App. 289 (2013). The Veteran has not argued that he has scoliosis. In fact, in a May 2018 affidavit, he stated that he does not have scoliosis and that he did not intend to claim service connection for scoliosis, but rather for sclerosis. Veteran affidavit, May 2018. Nonetheless, he was also provided two thorough VA examinations of his cervical and lumbar spine in September 2016, including x-rays, and neither provided a diagnosis of scoliosis. Notably, the diagnoses provided were lumbar strain and cervical strain, both of which are service connected and not for consideration in his claim for scoliosis. The Board has also thoroughly reviewed the Veteran’s VA treatment records and finds that, while there are complaints of back pain, there is no diagnosis of scoliosis. There is simply no medical evidence showing a diagnosis of scoliosis, nor does the Veteran contend that he has been diagnosed with such. Although laypersons, such as the Veteran, are sometimes competent to provide opinions on certain medical questions, the specific issue in this case falls outside the realm of common knowledge of a lay person as it involves making definitive clinical diagnoses based on knowledge of a specific abnormal spinal contour in the context of other spinal diagnoses. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). While the Veteran is certainly competent to report his symptoms, he is not competent to attribute those complaints to a particular diagnosis or any diagnosis at all. See Jandreau v. Nicholson, 492 F.3s 1372, 1377 n.4 (Fed. Cir. 2007) (Lay persons are not competent to diagnose degenerative joint and disc disease and spinal stenosis as these are not manifested by external but rather internal signs visible only through medical imaging technology and requiring expertise in radiographic analysis to diagnose); see also 38 C.F.R. § 3.159 (a)(1) (competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions). He is not competent to diagnose himself with scoliosis. Further, his opinion would be significantly outweighed by the lack of diagnoses from the VA physicians, who clearly hold the level of medical expertise to address the nature and etiology of the Veteran’s complaints. As the first element of Shedden/Caluza is not met for the scoliosis claim, the remaining questions of in-service disease or injury and medical nexus are irrelevant. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claim, that doctrine is not applicable. 38 U.S.C. § 5107(b) (2012); 38 C.F.R. § 3.102 (2017); see also Ortiz, supra. Effective Date Except as otherwise provided, the effective date of an evaluation and award of compensation based on an original claim, a claim reopened after final disallowance, or a claim for an increase will be the date of receipt of the claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. If the claim for service connection is received within one year of a veteran’s discharge from service, the effective date of an award of service connection will be the day following discharge from service. 38 U.S.C. § 5110(b)(1); 38 C.F.R. § 3.400(b)(2). Otherwise, the effective date will be the later of the date of receipt of claim or the date entitlement arose. 38 U.S.C. § 5110; 38 C.F.R. § 3.400(b)(2). A specific claim in the form prescribed by the Secretary must be filed in order for benefits to be paid to any individual under the laws administered by VA. 38 U.S.C. § 5101(a); 38 C.F.R. § 3.151(a). The term “claim” or “application” means a formal or informal communication in writing requesting a determination of entitlement or evidencing a belief in entitlement to a benefit. 38 C.F.R. § 3.1(p). The Board notes that “informal claims” are no longer recognized by VA as of March 2015. 38 C.F.R. § 3.155(a). However, for claims filed prior to March 2015, as is the case here, any communication or action, indicating an intent to apply for one or more benefits under the laws administered by VA, from a claimant, his or her duly authorized representative, a Member of Congress, or some person acting as next friend of a claimant who is not sui generis may be considered an informal claim. Such an informal claim must identify the benefits sought. Upon receipt of an informal claim, if a formal claim has not been filed, an application form will be forwarded to the claimant for execution. If received within one year from the date it was sent to the claimant, it will be considered filed as of the date of receipt of the informal claim. See 38 C.F.R. § 3.155(a) (2014). 6. Entitlement to an effective date prior to October 27, 2014 for the grant of service connection for cervical strain The Veteran disagrees with the effective date assigned for the grant of service connection for cervical strain. He has not presented a specific reason for his belief that he is entitled to an earlier effective date, but only generally claimed that he is entitled to such. The Board has reviewed the entire claims file, paying particular attention to the Veteran’s submissions to VA prior to October 2014. None of his correspondence suggests an intent to file a claim for service connection for a cervical spine disability. Although he submitted applications for service-connected benefits in 2006, 2008, and 2009, these documents do not address his neck or cervical spine at all, nor reflect his intent to apply for disability benefits for his cervical spine. An informal claim must be (1) a communication in writing that (2) expresses an intent to apply for benefits, and (3) identifies the benefits sought. See Brokowski v. Shinseki, 23 Vet. App. 79, 84 (2009); 38 C.F.R. § 3.155(a) (2014); see also MacPhee v. Nicholson, 459 F.3d 1323, 1325 (Fed. Cir. 2006) (holding that VA regulations require claimant to identify benefit sought and indicate intent to apply for benefits). There is simply no evidence that can be construed as a formal or informal claim for service connection for cervical strain prior to October 27, 2014. To the extent that he may have experienced a neck disability prior to his October 2014 claim, there is no provision in the law for awarding an earlier effective date based simply on the presence of the disability. See Brannon v. West, 12 Vet. App. 32, 35 (1998) (the mere presence of medical evidence of a condition does not establish an intent on the part of the veteran to seek service connection for the disability). As noted above, the law provides that the effective date of a claim filed more than one year from discharge is the later of the date of receipt of claim or the date entitlement arose. 38 U.S.C. § 5110; 38 C.F.R. § 3.400(b)(2). In this case, the Veteran did not file a claim for service connection for his cervical strain until October 27, 2014. This is the earliest allowable effective date under VA regulations. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claim of entitlement to an effective date earlier than October 27, 2014, for the grant of service connection for cervical strain, that doctrine is not applicable. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; see also Ortiz v. Principi, 274 F.3d 1361, 1365 (Fed. Cir. 2001). 7. Entitlement to an effective date prior to October 27, 2014 for the grant of service connection for lumbar strain The Veteran disagrees with the effective date assigned for the grant of service connection for lumbar strain. He has not presented a specific reason for his belief that he is entitled to an earlier effective date, but only generally claimed that he is entitled to such. Initially, the Board notes that the Veteran previously sought service connection for his low back in 2006 and 2008. A June 2007 rating decision denied service connection for degenerative spondylotic changes at the thoracis spine. The Veteran did not file an NOD or submit new evidence within one year of this denial. A September 2008 rating decision declined to reopen the previously denied claim for service connection for degenerative spondylotic changes at the thoracic spine. Again, the Veteran did not file an NOD or submit new evidence within one year of the denial, and the denial became final. As such, the Board will consider whether he is entitled to an effective date during the period between the last final denial in September 2008 and his current effective date in October 2014. The Board has reviewed the entire claims file, paying particular attention to the Veteran’s submissions to VA between September 2008 and October 2014. None of his correspondence suggests an intent to file a claim for service connection for a lumbar spine disability. Although he submitted an application for service-connected benefits in 2009, these documents do not address his back or lumbar spine at all, nor do they in any way indicate that he believed he deserved disability benefits for his lumbar spine. As noted above, an informal claim must be (1) a communication in writing that (2) expresses an intent to apply for benefits, and (3) identifies the benefits sought. See Brokowski, supra; see also MacPhee, supra. There is simply no evidence that can be construed as a formal or informal claim for service connection for lumbar strain between September 18, 2008 (the date of the last final denial) and his current effective date of October 27, 2014. To the extent that he may have experienced a low back disability prior to his October 2014 claim, there is no provision in the law for awarding an earlier effective date based simply on the presence of the disability. See Brannon, supra. As noted above, the law provides that the effective date of a claim filed more than one year from discharge is the later of the date of receipt of claim or the date entitlement arose. 38 U.S.C. § 5110; 38 C.F.R. § 3.400(b)(2). In this case, the Veteran’s most recent final denial for a low back disability was dated September 18, 2008. Following that denial, he did not file a new claim for service connection for his lumbar strain until October 27, 2014. This is the earliest allowable effective date under VA regulations. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claim of entitlement to an effective date earlier than October 27, 2014, for the grant of service connection for lumbar strain, that doctrine is not applicable. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; see also Ortiz, supra. 8. Entitlement to an effective date prior to October 27, 2014 for the grant of service connection for superficial varicose veins of the left distal leg The Veteran disagrees with the effective date assigned for the grant of service connection for superficial varicose veins of the left distal leg. He has not presented a specific reason for his belief that he is entitled to an earlier effective date, but only generally claimed that he is entitled to such. The Board has reviewed the entire claims file, paying particular attention to the Veteran’s submissions to VA prior to October 2014. None of his correspondence suggests an intent to file a claim for service connection for varicose veins. Although he submitted applications for service-connected benefits in 2006, 2008, and 2009, these documents do not address his left leg or varicose veins at all, nor do they in any way indicate that he believed he deserved disability benefits for varicose veins of the left leg. As noted above, an informal claim must be (1) a communication in writing that (2) expresses an intent to apply for benefits, and (3) identifies the benefits sought. See Brokowski, supra; see also MacPhee, supra. There is simply no evidence that can be construed as a formal or informal claim for service connection for superficial varicose veins of the left distal leg prior to October 27, 2014. To the extent that he may have experienced left leg varicose veins prior to his October 2014 claim, there is no provision in the law for awarding an earlier effective date based simply on the presence of the disability. See Brannon, supra. As noted above, the law provides that the effective date of a claim filed more than one year from discharge is the later of the date of receipt of claim or the date entitlement arose. 38 U.S.C. § 5110; 38 C.F.R. § 3.400(b)(2). In this case, the Veteran did not file a claim for service connection for his left leg varicose veins until October 27, 2014. This is the earliest allowable effective date under VA regulations. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claim of entitlement to an effective date earlier than October 27, 2014, for the grant of service connection for superficial varicose veins of the left distal leg, that doctrine is not applicable. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; see also Ortiz, supra. REASONS FOR REMAND 1. Entitlement to service connection for varicose veins of the right leg is remanded. The Veteran claims that he has visible and symptomatic varicose veins of his right leg. See Veteran statement, September 2016. Despite this evidence of right leg varicose veins, his in-service diagnosis of left leg varicose veins, and the Veteran’s assertion that these are related, he has not been afforded a VA examination to address this claim. As such, the Board cannot make a fully-informed decision and the claim for service connection for varicose veins of the right leg must be remanded for a VA examination. 2. Entitlement to service connection for a left shoulder condition is remanded. An April 2018 letter from the Veteran’s private chiropractor indicates that the Veteran reported treatment for his bilateral shoulders at the base hospital in Panama and for his right hand at the base hospital in Fort Riley, Kansas. See private chiropractor letter, April 2018. It does not appear that the RO attempted to obtain any hospitalization records based on these reports. A remand is required to allow VA to request these potentially relevant records. 3. Entitlement to service connection for a right shoulder condition is remanded. An April 2018 letter from the Veteran’s private chiropractor indicates that the Veteran reported treatment for his bilateral shoulders at the base hospital in Panama and for his right hand at the base hospital in Fort Riley, Kansas. See private chiropractor letter, April 2018. It does not appear that the RO attempted to obtain any hospitalization records based on these reports. A remand is required to allow VA to request these potentially relevant records. 4. Entitlement to service connection for a right hand condition is remanded. An April 2018 letter from the Veteran’s private chiropractor indicates that the Veteran reported treatment for his bilateral shoulders at the base hospital in Panama and for his right hand at the base hospital in Fort Riley, Kansas. See private chiropractor letter, April 2018. It does not appear that the RO attempted to obtain any hospitalization records based on these reports. A remand is required to allow VA to request these potentially relevant records. 5. Entitlement to service connection for neuropathy of the RLE is remanded. As discussed below, the claim for an increased rating for lumbar strain is being remanded for a new VA examination below. The Veteran has claimed that his RLE neuropathy is a neurological abnormality associated with his low back disability. As the new VA examination will address any associated neurological abnormalities, this development could provide additional information on the RLE neuropathy claim and impact a decision on that issue. As such, the issues are inextricably intertwined and a remand of the RLE neuropathy claim is required. 6. Entitlement to an initial rating in excess of 10 percent for cervical strain is remanded. While the record contains a contemporaneous VA examination dated in September 2016 regarding the Veteran’s cervical strain, the examination does not comply with the requirements in Sharp v. Shulkin, 29 Vet. App. 26, 34-36 (2017). The examiner did not attempt to elicit relevant information regarding the description of the Veteran’s flare-ups and any additional functional loss suffered during flare-ups. This claim must be remanded for a new VA examination. 7. Entitlement to an initial rating in excess of 20 percent for lumbar strain is remanded. While the record contains a contemporaneous VA examination regarding the Veteran’s lumbar strain, the examination does not comply the requirements in Sharp, supra. The examiner did not attempt to elicit relevant information regarding the description of the Veteran’s flare-ups and any additional functional loss suffered during flare-ups. This claim must be remanded for a new VA examination. 8. Entitlement to an initial rating in excess of 10 percent for superficial varicose veins of the left distal leg is remanded. Finally, as noted above, the claim for service connection for right leg varicose veins is being remanded herein for a new VA examination. Because this development could provide additional information on the left leg varicose veins claim and impact a decision on that issue. As such, the issues are inextricably intertwined and a remand of the left leg varicose veins claim is also required. The matters are REMANDED for the following actions: 1. Obtain records of any inpatient treatment for the bilateral shoulders at the base hospital in Panama and for the right hand at the base hospital at Fort Riley. Contact the Veteran for additional information regarding dates of treatment as needed. Document all requests for information as well as all responses in the claims file. 2. Thereafter, schedule the Veteran for an examination(s) to determine the nature and etiology of his claimed right leg varicose veins, left and right shoulder conditions, and right hand condition and the current severity of his cervical and lumbar spine disabilities. With regard to the right leg varicose veins, left and right shoulders, and right hand, the examiner must opine whether they are at least as likely as not related to an in-service injury, event, or disease. The examiner(s) should address the April 2018 private positive opinion. With regard to the cervical and lumbar spine disabilities, the examiner must test the Veteran’s active motion, passive motion, and pain with weight-bearing and without weight-bearing. The examiner must also attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. To the extent possible, the examiner should identify any symptoms and functional impairments due to the Veteran’s cervical and lumbar spine disabilities alone and discuss the effect of these disabilities on any occupational functioning and activities of daily living. If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, or functional impairment without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). (Continued on the next page)   3. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal, including the inextricably intertwined issues of service connected for RLE neuropathy and an increased initial rating for superficial varicose veins of the left distal leg. If the benefits sought are not granted to the Veteran’s satisfaction, send the Veteran and his representative a Supplemental Statement of the Case and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. YVETTE R. WHITE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Moore, Counsel