Citation Nr: 18151769 Decision Date: 11/20/18 Archive Date: 11/20/18 DOCKET NO. 16-15 448A DATE: November 20, 2018 ORDER Entitlement to service connection for a right knee disability is denied. Entitlement to service connection for a left ankle disability is denied. Entitlement to service connection for tinnitus is denied. Entitlement to service connection for sleep apnea is denied. Entitlement to service connection for a skin condition of the total body is denied. Entitlement to service connection for erectile dysfunction is granted. Entitlement to service connection for functional impairment due to pain of the right shoulder is granted. Entitlement to service connection for functional impairment due to pain of the left shoulder is granted. Entitlement to service connection for functional impairment due to pain of the neck is granted. Entitlement to service connection for functional impairment due to pain of the back is granted. Entitlement to service connection for functional impairment due to pain of the head is granted. Entitlement to a compensable initial rating for an inguinal hernia is denied. Entitlement to an initial rating of 10 percent, and no higher, for ingrown toenail of a left toe is granted. REMANDED Entitlement to a rating in excess of 10 percent for left knee degenerative arthritis is remanded. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that a right knee disability began during active service, or is otherwise related to an in-service injury, event, or disease. 2. The preponderance of the evidence is against finding that the Veteran has a left ankle disability due to an injury, event, or disease in service, to include an in-service motor vehicle accident. 3. The preponderance of the evidence is against finding that the Veteran’s tinnitus began during his active service, or is otherwise related to an in-service injury, event, or disease. 4. The preponderance of the evidence is against finding that the Veteran’s sleep apnea began during active service, or is otherwise related to an in-service injury, event, or disease. 5. The preponderance of the evidence is against finding that the Veteran has a skin disability due to an injury, event, or disease in service, to include exposure to contaminated drinking water while serving at Camp Lejeune. 6. The probative evidence reflects that the Veteran’s erectile dysfunction is caused by his service-connected idiopathic retroperitoneal fibrosis. 7. The probative evidence of record reflects that the Veteran has functional impairment due to right shoulder pain, left shoulder pain, neck pain, back pain, and head pain that is caused by his service-connected idiopathic retroperitoneal fibrosis. 8. The Veteran’s post-operative inguinal hernia has not been recurrent at any time during the relevant rating period. 9. The Veteran’s ingrown toenail of a left toe has been analogous to a single painful scar throughout the relevant rating period. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a right knee disability have not been met. 38 U.S.C. §§ 1110, 1131, 5103, 5107A; 38 C.F.R. §§ 3.102, 3.159, 3.303. 2. The criteria for entitlement to service connection for a left ankle disability have not been met. 38 U.S.C. §§ 1110, 1131, 5103, 5107A; 38 C.F.R. §§ 3.102, 3.159, 3.303. 3. The criteria for entitlement to service connection for tinnitus have not been met. 38 U.S.C. §§ 1110, 1131, 5103, 5107A; 38 C.F.R. §§ 3.102, 3.159, 3.303. 4. The criteria for entitlement to service connection for sleep apnea have not been met. 38 U.S.C. §§ 1110, 1131, 5103, 5107A; 38 C.F.R. §§ 3.102, 3.159, 3.303. 5. The criteria for entitlement to service connection for a skin condition of the total body have not been met. 38 U.S.C. §§ 1110, 1131, 5103, 5107A; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309. 6. The criteria for entitlement to service connection for erectile dysfunction have been met. 38 U.S.C. §§ 1110, 1131, 5103, 5107A; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310. 7. The criteria for entitlement to service connection for limitation of the right shoulder have been met. 38 U.S.C. §§ 1110, 1131, 5103, 5107A; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310. 8. The criteria for entitlement to service connection for limitation of the left shoulder have been met. 38 U.S.C. §§ 1110, 1131, 5103, 5107A; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310. 9. The criteria for entitlement to service connection for limitation of the neck have been met. 38 U.S.C. §§ 1110, 1131, 5103, 5107A; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310. 10. The criteria for entitlement to service connection for limitation of the back have been met. 38 U.S.C. §§ 1110, 1131, 5103, 5107A; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310. 11. The criteria for entitlement to service connection for head pain have been met. 38 U.S.C. §§ 1110, 1131, 5103, 5107A; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310. 12. The criteria for entitlement to a compensable initial rating for inguinal hernia have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.400, 4.3, 4.7, 4.14, 4.21, 4.114, Diagnostic Code 7338. 13. The criteria for entitlement to an initial rating of 10 percent, and no higher, for ingrown toenail of a left toe have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.400, 4.3, 4.7, 4.14, 4.21, 4.118, Diagnostic Codes 7899-7813 and 7804. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from September 1974 to January 1995. In multiple statements, the Veteran’s previous representative generally argued that the VA examinations provided to the Veteran were inadequate for decision-making purposes and that the Veteran should be provided VA examinations in relation to his claims for which VA examinations have not yet been provided. The previous representative did not identify any specific deficiencies in the previously provided examinations. However, the Board has reviewed the record and concludes that the examinations of record provide the information necessary to fully adjudicate the issues decided herein and therefore are adequate for decision-making purposes as to those issues. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). With regard to the claims for which a VA examination has not yet been provided, either there is no indication that the disability may be associated with the Veteran’s service or the only such evidence is the Veteran’s conclusory and generalized lay statements suggesting a nexus with his active service. As such, no examination is required as to those issues. See 38 U.S.C. § 5103A(d)(2); 38 C.F.R. § 3.159(c)(4)(i); McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006); Waters v. Shinseki, 601 F.3d 1274, 1278-79 (Fed. Cir. 2010). In addition, the record reflects that the Veteran was scheduled for a VA examination in February 2016 for the purpose of determining whether he has a skin disability that may be secondary to his service-connected idiopathic retroperitoneal fibrosis. In February 2016, prior to the scheduled examination, the Veteran contacted VA and stated that he did not feel it necessary to attend another VA examination because he was already rated as 100 percent disabled. The Veteran did not attend the scheduled February 2016 VA examination and has not presented good cause for not attending. Therefore, the issue of entitlement to service connection for a skin disability will be decided based on the evidence of record. See 38 C.F.R. §3.655. Neither the Veteran nor his current representative has raised any other issues with regard to the duty to notify or duty to assist as they pertain to the issue decided herein. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board . . . to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). In that regard, the Board notes that the development directed in the Remand section below pertains to the issues remanded herein, and there is no indication that evidence developed as part of those actions may be relevant to the issues decided herein. The analysis in this decision focuses on the most relevant evidence and on what the evidence shows or does not show with respect to the issues decided herein. The Veteran should not assume that evidence that is not explicitly discussed herein has been overlooked. See Timberlake v. Gober, 14 Vet. App. 122 (2000) (noting that the law requires only that reasons for rejecting evidence favorable to the claimant be addressed). Service Connection Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service, even if the disability was initially diagnosed after service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. A disability which is proximately due to or the result of a service-connected disease or injury shall be service connected. When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. 38 C.F.R. § 3.310(a). Any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease, will also be service connected. 38 C.F.R. § 3.310(b). The diseases listed in 38 C.F.R. § 3.309(f) have been associated with exposure to contaminants in the water supply at Camp Lejeune and may be service connected on a presumptive basis for veterans who had no less than 30 days of service at Camp Lejeune during the period from August 1, 1953, to December 31, 1987. 38 C.F.R. § 3.309. 1. Entitlement to service connection for a right knee disability, a left ankle disability, tinnitus, sleep apnea, and a skin condition of the total body The Veteran seeks entitlement to service connection for a right knee disability, a left ankle disability, tinnitus, and a skin condition of the total body. He contends that the left ankle disability is related to an in-service motor vehicle accident. He contends that the skin condition either is due to exposure to contaminated drinking water while serving at Camp Lejeune or is secondary to his service-connected idiopathic retroperitoneal fibrosis. He has not presented any specific theories as to how the claimed right knee disability, tinnitus, and sleep apnea are related to his active service. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. With regard to the issue of entitlement to service connection for a skin condition of the entire body, the Board must also consider whether the Veteran has such a disability that is proximately due to, the result of, or aggravated by his service-connected idiopathic retroperitoneal fibrosis. The Board concludes that the preponderance of the evidence is against finding that any current right knee disability, left ankle disability, tinnitus, sleep apnea, or skin condition began during the Veteran’s active service, or is otherwise related to an in-service injury, event, or disease; or that any current skin disability is caused or aggravated by the Veteran’s service-connected idiopathic retroperitoneal fibrosis. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). The Board has considered the Veteran’s assertions that he has a right knee disability, left ankle disability, tinnitus, sleep apnea, and skin condition that are etiologically related to his active service. Although the Veteran is competent to report his current symptoms, see Layno v. Brown, 6 Vet. App. 465, 469 (1994), he is not considered competent to render an opinion as to the likely etiology of any right knee disability, left ankle disability, tinnitus, sleep apnea, or skin condition, as doing so requires specialized medical knowledge and expertise he has not been shown to possess. See Kahana v. Shinseki, 24 Vet. App. 428 (2011); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Therefore, the Board instead turns to the competent medical evidence of record to determine whether such an etiological connection exists. The Veteran’s service treatment records are absent for complaint of or treatment for a right knee disability or tinnitus. The Veteran has not presented any argument as to how those disabilities are related to his active service and the Board finds no evidence of record to support a finding that they are related to his active service. As such, the Board concludes that the preponderance of the evidence is against finding that the Veteran has a right knee disability or tinnitus that began during his active service, or is otherwise related to an in-service injury, event, or disease, and entitlement to service connection for a right knee disability and for tinnitus must be denied. 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The Veteran’s service treatment records are also absent for complaint of or treatment for sleep apnea or any other sleep-related conditions. The Veteran has not presented any argument as to how those disabilities are related to his active service. Nevertheless, in May 2011, J. Roser, D.O., provided an opinion that “It is likely as not that [the Veteran’s] sleep apnea condition was present while on active duty, but went undiagnosed until” a sleep study was performed in April 2011. Dr. Roser provided no rationale to support his opinion or to explain the conclusion that the Veteran’s sleep apnea was present during his active service. Furthermore, Dr. Roser’s opinion is not supported by the record, as the Veteran’s service treatment records show no sleep-related complaints, and the Veteran has not himself argued that his sleep apnea had its onset during his active service. As such, the Board attributes no probative weight to Dr. Roser’s May 2011 opinion, and does not interpret that opinion as evidence establishing that an event, injury, or disease occurred in service that may be associated with the Veteran’s current sleep apnea. There is no other competent evidence of record indicating that the Veteran’s sleep apnea may be etiologically related to his active service. As such, the Board concludes that the preponderance of the evidence is against finding that the Veteran has sleep apnea that began during his active service, or is otherwise related to an in-service injury, event, or disease, and that entitlement to service connection for sleep apnea must be denied. 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. 49 (1990). The Veteran’s service treatment records reflect that he complained of left ankle pain following an October 1984 motor vehicle accident. X-rays taken following the accident were within normal limits, and no diagnosis was provided in relation to the left ankle. At a follow-up appointment approximately two weeks after the motor vehicle accident, he reported that he was feeling much better. He was assessed with cervical paraspinal strain, resolving. No diagnosis was provided in relation to the left ankle. A January 2012 VA examiner diagnosed the Veteran with left ankle sprain and opined that the condition is less likely than not incurred in or caused by an in-service injury, event, or illness. In support of that opinion, the examiner noted the October 1984 complaint of left ankle pain, but explained that the x-rays were within normal limits, that the Veteran did not have any further complaints of left ankle pain, and that there was no further documentation in the service treatment records that would account for the current left ankle disability. The Board affords probative weight the examiner’s opinion because the examiner demonstrated an accurate understanding of the Veteran’s medical history, based the opinion on his specialized knowledge and understanding of medical conditions and procedures, and provided rationale to explain his conclusions. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000) (the thoroughness and detail of a medical opinion is a factor in assessing the probative value of the opinion). There is no probative evidence of record that weighs against the value of the January 2012 VA examiner’s opinion. Accordingly, the Board finds that the preponderance of the evidence is against finding that the Veteran has a left ankle disability that is due to an injury, event, or disease in service, to include an in-service motor vehicle accident, and that entitlement to service connection for a left ankle disability must also be denied. 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. 49. The Veteran’s service treatment records show that he was diagnosed with tinea versicolor in February 1978 and with acne vulgaris in August 1981 and April 1984. The Veteran was provided a VA examination in January 2012 in relation to his reported skin condition. The examiner stated that the Veteran did not have a rash present on the day of the examination, and that the Veteran reported that, in the past, by the time he has seen a doctor for his rash, the rash has disappeared. He has not received a formal diagnosis for the rash. Accordingly, the examiner could not provide a diagnosis for the reported skin condition, and did not provide an opinion as to whether a skin condition may be related to the Veteran’s active service. In addition, although the Veteran has reported that the reported skin condition has been medically attributed to his service-connected idiopathic retroperitoneal fibrosis, there is no such medical opinion of record that would allow the Board to conclude that the Veteran has a skin disability that is secondary to the service-connected idiopathic retroperitoneal fibrosis. Furthermore, there are no skin conditions among the diseases associated with exposure to contaminants in the water supply at Camp Lejeune. See 38 C.F.R. § 3.309(f). Thus, no skin conditions may be service connected on a presumptive basis as due to such exposure. There is no competent medical evidence of record showing that the Veteran has a skin disability that is related to exposure to contaminated water during his active service. Accordingly, the Board finds that the preponderance of the evidence is against finding that the Veteran has a skin disability that is due to an injury, event, or disease in service, to include exposure to contaminated drinking water while serving at Camp Lejeune, and that entitlement to service connection for a skin disability must also be denied. 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. 49. The Board reiterates that the Veteran was scheduled for a further VA examination as to his claimed skin disability in February 2016. However, the Veteran did not attend the scheduled examination, and a decision must therefore be made on the evidence of record. See 38 C.F.R. § 3.655. 2. Entitlement to service connection for a disability of the reproductive system The Veteran initially submitted a claim for entitlement to service connection for “loss of reproductive organ”. However, further correspondence from the Veteran indicates that he intended the claim to encompass all disabilities of the reproductive system. A November 2010 VA genitourinary examiner diagnosed the Veteran with erectile dysfunction and opined that the condition is most likely etiologically related to surgery performed in relation to the Veteran’s service-connected idiopathic retroperitoneal fibrosis. The Board accepts the November 2010 VA examiner’s opinion as probative evidence that the Veteran has erectile dysfunction that was proximately due to or the result of his service-connected idiopathic retroperitoneal fibrosis. There is no probative evidence of record that controverts the November 2010 VA examiner’s probative opinion. Therefore, the Board concludes that the probative evidence reflects that the Veteran’s erectile dysfunction is caused by his service-connected idiopathic retroperitoneal fibrosis, and that service connection is warranted. See 38 C.F.R. § 3.310. 3. Entitlement to service connection for disabilities of the right shoulder, left shoulder, neck, back, and head The Veteran seeks entitlement to service connection for disabilities of the right shoulder, left shoulder, neck, back, and head. He underwent a VA examination as to those claimed disabilities in January 2012. At the examination, the Veteran reported that he had pain in the right shoulder, left shoulder, neck, and back. He also reported pain that radiates from his neck to his head and is akin to headaches. Testing conducted at the examination revealed limited, painful motion of the right shoulder, left shoulder, neck, and back. The examiner stated that the Veteran’s right shoulder, left shoulder, neck, and back symptoms occur in response to muscle tension caused by his idiopathic retroperitoneal fibrosis. With regard to the Veteran’s reported head pain, the examiner stated that “the headaches are actually a part of the pain he gets in his back, and neck, radiating to his head, from his retroperitoneal fibrosis problem.” For VA disability compensation purposes, the term “disability” refers to the functional impairment of earning capacity, rather than the underlying cause of the impairment. Therefore, pain alone may constitute a disability when it results in functional impairment of earning capacity. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). In this case, the January 2012 VA examination report reflects that the Veteran has pain in the right shoulder, left shoulder, neck, back, and head result in functional impairment of earning capacity. Therefore, that pain alone constitutes a disability for which service connection may be granted. See id. Furthermore, the January 2012 VA examiner opined that the Veteran’s pain in the right shoulder, left shoulder, neck, back, and head and the associated functional impairment is due to muscle tension caused by the Veteran’s service-connected idiopathic retroperitoneal fibrosis. Accordingly, the Board concludes that the criteria for entitlement to service connection for functional impairment of the right shoulder, left shoulder, neck, back, and head, as secondarily caused by the service-connected idiopathic retroperitoneal fibrosis, have been met. The benefit of the doubt is resolved in the Veteran’s favor, and the Board therefore concludes that service connection for the functional impairment from pain of the right shoulder, left shoulder, neck, back, and head must be granted. 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. 49. Increased Ratings Disability ratings are determined by the application of VA’s Schedule for Rating Disabilities (Schedule), which is based on the average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Pertinent regulations do not require that all cases show all findings specified by the Schedule, but that findings sufficient to identify the disease and the resulting disability and, above all, coordination of the rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21; see also Mauerhan v. Principi, 16 Vet. App. 436 (2002). When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant. 38 C.F.R. § 4.3. Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Board will consider whether separate ratings may be assigned for separate periods of time based on facts found, a practice known as “staged ratings,” in all claims for increased ratings. Fenderson v. West, 12 Vet. App. 119, 126-27 (1999). 4. Entitlement to a compensable initial rating for inguinal hernia The Veteran seeks a compensable initial rating for inguinal hernia. The applicable rating period is from March 30, 2011, the effective date for the award of service connection for inguinal hernia, through the present. See 38 C.F.R. § 3.400. The Veteran’s inguinal hernia is currently rated as noncompensable under 38 C.F.R. § 4.114, Diagnostic Code 7338. Under Diagnostic Code 7388, a noncompensable rating is assigned for an inguinal hernia that has not been operated upon, but is remediable, or that is small, reducible, or without true hernia protrusion. A 10 percent rating is assigned for a post-operative inguinal hernia that is recurrent, readily reducible, and well supported by a truss or belt. A 30 percent rating is assigned for an inguinal hernia that is small, post-operative, and recurrent or unoperated and irremediable, and not well supported by a truss, or that is not readily reducible. A 60 percent rating is assigned for an inguinal hernia that is large, post-operative, recurrent, not well supported under ordinary conditions, and not readily reducible, or that is considered inoperable. Turning to the relevant evidence of record, a November 2010 VA examination noted that the Veteran had a well healed right inguinal herniorraphy scar and that there had been no recurrent hernia. A January 2012 VA examiner indicated that the Veteran underwent surgery for repair of a right inguinal hernia in 1991, but that on current examination there was no right or left hernia detected. The examiner did not indicate that the Veteran had recurrent hernia following the surgical repair, or that the Veteran’s left hernia was inoperable or irremediable. The surgical scar was well healed, nontender, and measured 11 centimeters. The Veteran reported bilateral groin pain, but the examiner attributed the pain to the Veteran’s bilateral stents that were put in place to treat a ureteral obstruction due to his service-connected idiopathic retroperitoneal fibrosis. The examiner opined that, due to the post-operative hernia, the Veteran is not a candidate for manual labor involving heavy lifting, but the residuals of his hernia surgery do not impact his ability to work at a desk job. The Veteran told a March 2014 VA examiner that he has severe constant right groin pain and that the scar from his hernia surgery itches at times. On examination, there was no right or left hernia detected, and the surgical scar was not tender. The Veteran’s medical treatment records do not reflect that the Veteran’s service-connected inguinal hernia recurred at any time during the relevant rating period. In view of the foregoing, the Board concludes that the relevant evidence of record indicates that the Veteran’s post-operative inguinal hernia has not been recurrent at any time during the relevant rating period. The Veteran reported groin pain, but the pain was medically attributed to his bilateral stents rather than to the post-operative inguinal hernia. In addition, the evidence does not show that the Veteran’s scar from his hernia surgery was nonlinear, stable, or painful, during the relevant rating period, or that the scar caused any other disabling effects. See 38 C.F.R. § 4.118, Diagnostic Codes 7801, 7802, 7804, and 7805. Neither the Veteran nor his representative has raised any other issues with regard to the rating for the service-connected inguinal hernia, nor have any other such issues been reasonably raised by the record. See Yancy v. McDonald, 27 Vet. App. 484, 495 (2016); Doucette v. Shulkin, 38 Vet. App. 366, 369-70 (2017). The Board therefore finds that the criteria for entitlement to a compensable initial rating for the Veteran’s inguinal hernia and its associated surgical scar have not been met at any time during the rating period. Accordingly, there is no basis for staged rating of the Veteran’s service-connected inguinal hernia pursuant to Fenderson, 12 Vet. App. at 126-27. As the preponderance of the evidence is against the assignment of a compensable initial rating, the benefit-of-the-doubt doctrine is not for application, and the appeal must be denied. 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. 49. 5. Entitlement to a compensable initial rating for ingrown toenail of a left toe The Veteran seeks a compensable initial rating for ingrown toenail of a left toe. The applicable rating period is from March 30, 2011, the effective date for the award of service connection for ingrown toenail of a left toe, through the present. See 38 C.F.R. § 3.400. The Veteran’s ingrown toenail of a left toe is currently rated as noncompensable under 38 C.F.R. § 4.118, Diagnostic Code 7899-7813. Hyphenated diagnostic codes are used when a rating under one code requires use of an additional diagnostic code to identify the basis for the rating assigned. 38 C.F.R. § 4.27. In this case, the use of Diagnostic Code 7899-7813 reflects that the Veteran’s specific service-connected condition is an unlisted condition and that a diagnostic code was therefore “built-up” using 78, the two digits used for disabilities of the skin, and 99. Id. The Veteran’s ingrown toenail of a left toe is rated using the criteria listed under Diagnostic Code 7813, which pertains to dermatophytosis. Diagnostic Code 7813 directs the rater to rate the disability as a disfigurement of the head, face, or neck (under Diagnostic Code 7800), scars (under Diagnostic Codes 7801, 7802, 7804, or 7805), or dermatitis (under Diagnostic Code 7806), depending upon the predominant disability. In this case, the record does not show that the Veteran’s ingrown toenail is analogous to a nonlinear scar or dermatitis, or that the condition causes any disabling effect other than pain. Therefore, the Board concludes that Diagnostic Codes 7800, 7801, 7802, 7805, and 7806 are not for application in this case. Under Diagnostic Code 7804, a 10 percent rating is assigned for one or two scars that are unstable or painful. Higher ratings, up to a maximum 30 percent, are warranted for additional scars that are unstable or painful. If one or more scars are both unstable and painful, 10 percent is to be added to the rating that is based on the total number of unstable or painful scars. 38 C.F.R. § 4.118, Diagnostic Code 7804, Note (2). Turning to the relevant evidence of record, the Veteran told the January 2012 VA examiner that he has had recurrent ingrown nails in the left great toe since approximately the early 1990s. On examination, the Veteran’s left great toe had a partial re-growing toenail that was discolored, thick, brittle, and mycotic. Both the medial and lateral nail borders were tender and showed evidence of a recent ingrown toenail procedure. The examiner opined that the Veteran’s ingrown toenail of a left toe does not impact his ability to work. The Veteran told the March 2014 VA examiner that he had recurrent ingrown toenails since approximately 3 to 4 years prior to separating from active service. He reported that he has pain in the left big toe when the nail grows back. On examination, the Veteran’s left great toe nail was curled at the upper medial border, but was not ingrown. The examiner opined that the Veteran’s ingrown toenail of a left toe does not impact his ability to work. In view of the January 2012 VA examiner’s finding of tenderness in the left great toe and the Veteran’s reports that he has recurrent ingrown toenails that are painful as they grow back, the Board concludes that the Veteran’s ingrown toenail of a left toe has been analogous to a single painful scar throughout the relevant rating period. Therefore, the criteria for entitlement to a rating of 10 percent, and no higher, have been met under 38 C.F.R. § 4.118, Diagnostic Code 7804. Neither the Veteran nor his representative has raised any other issues with regard to the rating for the service-connected ingrown toenail of a left toe, nor have any other such issues been reasonably raised by the record. See Yancy, 27 Vet. App. at 495; Doucette, 38 Vet. App. at 369-70. There is no basis for staged rating of the Veteran’s ingrown toenail of a left toe pursuant to Fenderson, 12 Vet. App. at 126-27. To the extent the Veteran seeks entitlement to an initial rating in excess of 10 percent for ingrown toenail of a left toe, the preponderance of the evidence is against the assignment of a higher rating, the benefit-of-the-doubt doctrine is not for application, and the appeal must be denied. 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. 49. REASONS FOR REMAND Entitlement to a rating in excess of 10 percent for left knee degenerative arthritis is remanded. Although the record contains a contemporaneous VA examination regarding the Veteran’s left knee degenerative arthritis, the examination does not comply with the requirements in Correia v. McDonald, 28 Vet. App. 158, 168 (2016) and Sharp v. Shulkin, 29 Vet. App. 26, 34-36 (2017). The examination does not contain passive range of motion measurements or results for testing of pain on weight-bearing. In addition, the examiner noted the Veteran’s reports of flare-ups in his left knee symptoms and opined that the Veteran’s service-connected left knee disability “could significantly limit functional ability during flare-ups,” but concluded that that any such additional limitation could not be expressed in terms of degrees of additional range-of-motion loss “as no additional loss of ROM was noted on repetitive use testing.” The examiner did not explain why the information requested could not be provided based on the Veteran’s description of his symptoms during flare-ups. A remand is therefore required so that the Veteran may be provided a new VA examination as to his service-connected left knee disability. The matters are REMANDED for the following action: Schedule the Veteran for an examination of the current severity of his left knee degenerative arthritis. 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 left knee degenerative arthritis alone and discuss the effect of the disability 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). MICHAEL MARTIN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. J. Anthony, Counsel