Citation Nr: 18151936 Decision Date: 11/20/18 Archive Date: 11/20/18 DOCKET NO. 15-11 589 DATE: November 20, 2018 ORDER New and material evidence having been received, the claim for entitlement to a right shoulder disability is reopened. New and material evidence having been received, the claim for entitlement to service connection for a cervical spine disability is reopened. New and material evidence having been received, the claim for entitlement to service connection for vertigo is reopened. New and material evidence having been received, the claim for entitlement to service connection for a closed head injury/traumatic brain injury (TBI) is reopened. New and material evidence not having been received, the claim for entitlement to service connection for residuals of tonsillectomy is not reopened. Entitlement to an effective date earlier than April 28, 2014, for the grant of entitlement to service connection for maxillary sinusitis is denied. Entitlement to an effective date earlier than April 28, 2014, for the grant of entitlement to service connection for stress fracture of the left second metatarsal is denied. Entitlement to an effective date earlier than April 28, 2014, for the grant of entitlement to service connection for tinnitus is denied. Entitlement to service connection for a gastrointestinal condition is denied. Entitlement to service connection for vertigo/residual disequilibrium is granted. Entitlement to service connection for a closed head injury/TBI is granted. Entitlement to service connection for posttraumatic stress disorder (PTSD) is granted. Entitlement to an initial rating of 10 percent, and no higher, for stress fracture of the left second metatarsal is granted. A proper claim for entitlement to apportionment of the Veteran’s VA compensation benefits based on his incarceration was received. REMANDED Entitlement to service connection for a right shoulder disability is remanded. Entitlement to service connection for a cervical spine disability is remanded. Entitlement to service connection for a left knee disability is remanded. Entitlement to service connection for a right knee disability is remanded. Entitlement to service connection for erectile dysfunction is remanded. Entitlement to a compensable initial rating for scar of the left upper arm is remanded. Entitlement to a rating in excess of 10 percent for lymph node biopsy with injury to the ulnar nerve of the left upper extremity is remanded. Entitlement to apportionment of the Veteran’s VA compensation benefits based on his incarceration is remanded. FINDINGS OF FACT 1. A November 2000 rating decision denied the Veteran’s original claims for entitlement to service connection for stress fracture of the left second metatarsal, closed head injury with disequilibrium, residuals of tonsillectomy, and maxillary sinusitis. 2. Following issuance of the November 2000 rating decision, VA received relevant official service department records that existed and had not been associated with the record at the time of the November 2000 rating decision. 3. A March 2006 rating decision considered the Veteran’s relevant official service records and denied the Veteran’s original claims for entitlement to service connection for stress fracture of the left second metatarsal, closed head injury with disequilibrium, residuals of tonsillectomy, maxillary sinusitis, and muscle spasms of the right shoulder blade and neck; the Veteran did not timely appeal the denial; and new and material evidence was not received as to those issues within the one-year appeal period following issuance of the March 2006 rating decision. 4. An August 2008 rating decision denied the Veteran’s petition to reopen the previously denied claims for entitlement to service connection for stress fracture of the left second metatarsal, closed head injury with disequilibrium, residuals of tonsillectomy, maxillary sinusitis, and muscle spasms of the right shoulder blade and neck; the Veteran did not timely appeal the denial; and new and material evidence was not received as to those issues within the one-year appeal period following issuance of the August 2008 rating decision. 5. Evidence received since the April 2008 rating decision is new and raises a reasonable possibility of substantiating the claims for entitlement to service connection for a right shoulder disability, cervical spine strain, vertigo, and a closed head injury/TBI. 6. Evidence received since the April 2008 rating decision does not raise a reasonable possibility of substantiating the claim for entitlement to service connection for residuals of tonsillectomy. 7. No communication was received following issuance of the April 2008 rating decision and prior to April 28, 2014, that may be construed as a formal or informal claim for entitlement to service connection for maxillary sinusitis. 8. No communication was received following issuance of the April 2008 rating decision and prior to April 28, 2014, that may be construed as a formal or informal claim for entitlement to service connection for stress fracture of the left second metatarsal. 9. No communication was received from the Veteran prior to April 28, 2014, that may be construed as a formal or informal claim for entitlement to service connection for tinnitus. 10. The preponderance of the evidence of record is against finding that the Veteran has, or has had at any time during the appeal, a current diagnosis of a gastrointestinal condition. 11. Resolving reasonable doubt in the Veteran’s favor, his vertigo and residual disequilibrium are at least as likely as not related to his in-service closed head injury/TBI involving being hit in the head with a sledgehammer. 12. The most probative evidence of record indicates that the Veteran has been diagnosed with PTSD relating to an in-service stressor, and there is credible supporting evidence that the in-service stressor occurred. 13. The Veteran’s stress fracture of the left second metatarsal has been mild in severity throughout the relevant rating period and has been manifested by pain and in the metatarsal region. 14. In a February 2011 letter, the Agency of Original Jurisdiction (AOJ) notified the Veteran that his VA compensation benefits would be reduced beginning in November 2009 due to his incarceration, but that his dependents could claim an apportionment of those benefits while he was incarcerated. 15. In March 2011, the Veteran, on behalf of his spouse, applied for apportionment of his VA compensation benefits while he was incarcerated. CONCLUSIONS OF LAW 1. The March 2006 rating decision is final. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.104, 3.156, 20.200, 20.201, 20.302, 20.1103. 2. The April 2008 rating decision is final. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.104, 3.156, 20.200, 20.201, 20.302, 20.1103. 3. New and material evidence having been received, the claim for entitlement to a right shoulder disability is reopened. 38 U.S.C. §§ 1110, 5108; 38 C.F.R. § 3.303. 4. New and material evidence having been received, the claim for entitlement to service connection for a cervical spine disability is reopened. 38 U.S.C. §§ 1110, 5108; 38 C.F.R. § 3.303. 5. New and material evidence having been received, the claim for entitlement to service connection for vertigo is reopened. 38 U.S.C. §§ 1110, 5108; 38 C.F.R. § 3.303. 6. New and material evidence having been received, the claim for entitlement to service connection for a closed head injury/TBI is reopened. 38 U.S.C. §§ 1110, 5108; 38 C.F.R. § 3.303. 7. New and material evidence not having been received, the claim for entitlement to service connection for residuals of tonsillectomy is not reopened. 38 U.S.C. §§ 1110, 5108; 38 C.F.R. § 3.303. 8. The criteria for entitlement to an effective date earlier than April 28, 2014, for the grant of entitlement to service connection for maxillary sinusitis have not been met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. §§ 3.102, 3.400. 9. The criteria for entitlement to an effective date earlier than April 28, 2014, for the grant of entitlement to service connection for stress fracture of the left second metatarsal have not been met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. §§ 3.102, 3.400. 10. The criteria for entitlement to an effective date earlier than April 28, 2014, for the grant of entitlement to service connection for tinnitus have not been met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. §§ 3.102, 3.400. 11. The criteria for entitlement to service connection for a gastrointestinal condition have not been met. 38 U.S.C. §§ 1110, 5103, 5107A; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310. 12. The criteria for entitlement to service connection for vertigo/residual disequilibrium have been met. 38 U.S.C. §§ 1110, 5103, 5107A; 38 C.F.R. §§ 3.102, 3.159, 3.303. 13. The criteria for entitlement to service connection for closed head injury/TBI have been met. 38 U.S.C. §§ 1110, 5103, 5107A; 38 C.F.R. §§ 3.102, 3.159, 3.303. 14. The criteria for entitlement to service connection for PTSD have been met. 38 U.S.C. §§ 1110, 5103, 5107A; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304. 15. The criteria for entitlement to an initial rating of 10 percent, and no higher, for stress fracture of the left second metatarsal 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, 4.71a, Diagnostic Codes 5279 and 5284. 16. The Veteran submitted a proper claim for apportionment of his VA compensation benefits on his wife’s behalf, and the claim should be adjudicated on the merits. 38 C.F.R. § 3.665. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from January 1996 to January 2000. Additional evidence was associated with the record following the most recent adjudications of the issues on appeal. However, the additional evidence is not relevant to the issues denied herein. Accordingly, a remand for issuance of a supplemental statement of the case is not necessary, and the Board may proceed with appellate consideration. See 38 C.F.R. § 19.37. The Veteran’s representative has submitted statements summarizing legal principles regarding the adequacy of VA examinations; VA’s duty to assist; the benefit-of-the-doubt doctrine; a claimant’s burden of proof; VA’s consideration of favorable evidence, negative evidence, the absence of evidence, and lay statements; and secondary service connection, among other things. The statements do not include any specific contentions with regard to those principles. Therefore, the statements only generally discuss those principles, and do not raise any specific issues with regard to the duty to notify or duty to assist as they pertain to the issues denied herein. Neither the Veteran nor his representative has otherwise raised any specific issues with regard to the duty to notify or duty to assist as they pertain to the issues denied 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 denied 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). Reopening Issues The Veteran seeks to reopen his claims for entitlement to service connection for a right shoulder disability, a cervical spine disability, vertigo, a closed head injury/TBI, and residuals of tonsillectomy, which were previously denied in the November 2000, March 2006, and August 2008 rating decisions. In general, rating decisions that are not timely appealed are final. See 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. However, at any time after VA issues a decision on a claim, if VA receives or associates with the claims file relevant official service department records that existed and had not been associated with the claims file when VA first decided the claim, VA will reconsider the claim. In addition, under 38 U.S.C. § 5108, if new and material evidence is presented or secured with respect to a claim that has been disallowed, the Secretary shall reopen the claim and review the former disposition of the claim. New evidence is existing evidence not previously considered by VA. Material evidence is existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). In determining whether evidence is new and material, the credibility of the evidence is generally presumed. Justus v. Principi, 3 Vet. App. 510, 512-13 (1992). In Elkins v. West, 12 Vet. App. 209 (1999), the United States Court of Appeals for Veterans Claims (Court) held that the Board must first determine whether the appellant has presented new and material evidence under 38 C.F.R. § 3.156(a) to have a finally denied claim reopened under 38 U.S.C. § 5108. The Court has also held that the law should be interpreted as enabling reopening of a claim, rather than to precluding it. See Shade v. Shinseki, 24 Vet. App. 110 (2010). The focus is not exclusively on whether evidence remedies the principal reason for denial in the last prior final decision, but on whether the evidence, taken together, could at least trigger the duty to assist or consideration of a new theory of entitlement. Id. at 118. In general, service connection may be established for a disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. In this case, the Veteran submitted an original claim for entitlement to service connection for a stress fracture of the left second metatarsal, residuals of a tonsillectomy, and chronic sinusitis in March 2000. The AOJ denied the Veteran’s claim in the November 2000 rating decision. However, following issuance of the November 2000 rating decision, VA received relevant official service department records that existed and had not been associated with the record at the time of the November 2000 rating decision. Therefore, the original March 2000 claim remained pending despite issuance of the November 2000 rating decision. See 38 C.F.R. § 3.156(c). In March 2005, the Veteran submitted original claims for entitlement to service connection for a closed head injury with disequilibrium and for muscle spasms of the right shoulder blade and neck. In March 2006, the AOJ issued a rating decision in consideration of the Veteran’s service records that denied the Veteran’s pending original March 2000 claim and the March 2005 claims. In so doing, the AOJ explained that the Veteran’s service treatment records showed complaints of allergies, sinusitis, neck and right shoulder muscle spasm, and a head injury, and showed that the Veteran underwent a tonsillectomy. However, the conditions were not reported upon the Veteran’s separation from active service, and there was no evidence of a chronic disability diagnosed upon separation from service. In addition, the Veteran did not report to VA examinations scheduled in connection with the claims. The letter informing the Veteran of the March 2006 rating decision explained to the Veteran his right to appeal the decision and was enclosed with a VA Form 4107, Your Rights to Appeal Our Decision, which provided further guidance on appealing the decision. The Veteran did not submit a timely notice of disagreement as to the March 2006 rating decision, and new and material evidence as to the issues was not received within the one-year appeal period following issuance of the March 2006 rating decision. As such, the Veteran did not complete a timely appeal of the March 2006 rating decision, and the decision is final. See 38 U.S.C. § 7105; 38 C.F.R. §§ 3.156(b), 20.201, 20.302,20.1103. In February 2008, the Veteran submitted a petition to reopen the claims for entitlement to service connection for a closed head injury with disequilibrium, muscle spasms of the right shoulder blade and neck, stress fracture of the left second metatarsal, residuals of a tonsillectomy, and chronic sinusitis. The AOJ denied the Veteran’s petition in the August 2008 rating decision, explaining that new and material evidence had not been received as to those issues since the March 2006 rating decision. The letter informing the Veteran of the August 2008 rating decision explained to the Veteran his right to appeal the decision and was enclosed with a VA Form 4107, which provided further guidance on appealing the decision. The Veteran did not submit a timely notice of disagreement as to the August 2008 rating decision, and new and material evidence as to the issues was not received within the one-year appeal period following issuance of the August 2008 rating decision. As such, the Veteran did not complete a timely appeal of the August 2008 rating decision, and the decision is final. See 38 U.S.C. § 7105; 38 C.F.R. §§ 3.156(b), 20.201, 20.302,20.1103. 1. Reopening the claims for entitlement to a right shoulder disability and cervical spine strain The evidence associated with the record since issuance of the final August 2008 rating decision includes statements from the Veteran to the effect that his right shoulder disability and cervical spine disability are related to lifting, carrying, and dropping artillery shells; unhitching Howitzer cannons; moving a bladder full of water; and being hit in the head with a sledgehammer during his active service. He has also asserted that the right shoulder disability is secondary to his service-connected lymph node biopsy with injury to the left ulnar nerve. These statements provide a possible link between the Veteran’s active service and his current right shoulder disability and cervical spine disability, as well as a new theory of entitlement to service connection. The Board finds that the Veteran’s statements are new because they were not previously considered by VA. They are also material because they put forth new information that raises a reasonable possibility of substantiating the claims for entitlement to service connection for a right shoulder disability and a cervical spine disability. See Shade, 24 Vet. App. 110. Therefore, the Board concludes that new and material evidence has been received to reopen the Veteran’s claims for entitlement to service connection for a right shoulder disability and a cervical spine disability, and the claims are reopened. 38 C.F.R. § 3.156(a). 2. Reopening the claims for entitlement to service connection for vertigo and a closed head injury/TBI The evidence associated with the record since issuance of the final August 2008 rating decision includes an August 2015 private medical treatment note stating that the Veteran currently experiences dizziness and vertigo symptoms “with likely contribution from multiple blows to the head while in the military.” The Board finds that medical treatment note to be new because it was not previously considered by VA. It is also material because it provides medical evidence indicating that the Veteran’s vertigo may be etiologically to an in-service closed head injury. See Shade, 24 Vet. App. 110. Therefore, the Board concludes that new and material evidence has been received to reopen the Veteran’s claims for entitlement to service connection for vertigo and a closed head injury/TBI, and the claims are reopened. 38 C.F.R. § 3.156(a). 3. Reopening the claim for entitlement to service connection for residuals of tonsillectomy The evidence associated with the record since issuance of the final August 2008 rating decision includes the Veteran assertions that he underwent a tonsillectomy during his active service and that upon separation from active service he was noted as not having tonsils. The Veteran’s statements are not new because they merely repeat facts that have been previously considered by VA in the prior final decisions. The March 2006 rating decision acknowledged that the Veteran’s service treatment records show that he underwent a tonsillectomy during his active service, but concluded that the evidence showed no chronic residuals from the tonsillectomy. Therefore, the Veteran’s assertions are not new and material evidence sufficient to reopen the previously denied claim. The evidence associated with the record since issuance of the final August 2008 rating decision also includes VA treatment records, private treatment records, and a May 2015 VA examination. The VA and private treatment records do not show that the Veteran has complained of or been treated for residuals of his in-service tonsillectomy. The May 2015 VA examiner reviewed the record, examined the Veteran, and concluded that the Veteran does not have any residuals from the in-service tonsillectomy, as examination of the oropharynx revealed no residual tonsil tissue and that there was no erythema or swelling of the oropharynx. As such, the May 2015 VA examination does not show that the Veteran has current residuals from the in-service tonsillectomy. Therefore, the VA treatment records, private treatment records, and May 2015 VA examination are not new and material evidence sufficient to reopen the previously denied claim, as they also do not show that the Veteran currently has residuals from the in-service tonsillectomy. In summary, the Veteran was denied entitlement to service connection for residuals of tonsillectomy in the final March 2006 rating decision because, although the evidence showed that he underwent a tonsillectomy during his active service, the evidence did not show that he had current residuals related to that procedure. The August 2008 rating decision denied reopening of the previously denied claim. Evidence received since the August 2008 rating decision is cumulative of evidence already considered by VA, does not relate to an unestablished fact necessary to substantiate the previously denied claim, and/or does not raise a reasonable possibility of substantiating the previously denied claim. 38 C.F.R. § 3.156. The evidence of record continues to be absent for an indication that the Veteran has current residuals from the in-service tonsillectomy. Accordingly, new and material evidence to reopen the finally denied claim for entitlement to service connection for residuals of tonsillectomy has not been received, the benefit-of-the-doubt doctrine is not for application, and the claim for entitlement to service connection for residuals of tonsillectomy is not reopened. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Earlier Effective Date Issues The Veteran seeks entitlement to an effective date earlier than April 28, 2014, for the grant of entitlement to service connection for maxillary sinusitis, stress fracture of the left second metatarsal, and tinnitus. The Veteran and his representative have not presented any particular arguments as to why an earlier effective date is warranted for the grant of entitlement to service connection for tinnitus. With regard to the appeals for an earlier effective date for the grant of entitlement to service connection for maxillary sinusitis and stress fracture of the left second metatarsal, the Veteran’s representative has argued that, pursuant to 38 C.F.R. § 3.156(c)(1), the effective date should be the day on which VA received the Veteran’s original March 2000 claim for service connection because the Veteran’s service treatment records were not available for review at the time of the November 2000 rating decision that initially denied the original claim. The effective date for an award of service connection is the day following the date of separation from active service or the date entitlement arose, if the claim is received within one year after separation from service. Otherwise, the effective date is the date of receipt of the claim, or the date entitlement arose, whichever is later. 38 U.S.C. § 5110(a), (b); 38 C.F.R. § 3.400(b). The effective date of service connection based on a reopened claim is the date of receipt of the new claim or the date entitlement arose, whichever is later. 38 C.F.R. § 3.400(r). Regulations that were in effect prior to March 24, 2015, required that an informal claim “must identify the benefit sought.” See 38 C.F.R. §§ 3.155, 3.160 (2014). The regulations also provided that a claim may be either a formal or informal written communication “requesting a determination of entitlement, or evidencing a belief in entitlement, to a benefit.” 38 C.F.R. § 3.1(p) (2014). The regulations in effect since March 24, 2015, require that claims be submitted on an application form prescribed by the Secretary and do not allow for informal claims not submitted on such a form. See 38 C.F.R. §§ 3.155, 3.160 (2015). The Veteran’s appeal was pending at the time that the regulations changed. The Board will apply the regulations in effect prior to March 24, 2015, as they allowed for informal claims and are therefore more favorable to the Veteran. In this case, as discussed above, the Veteran’s original March 2000 claim for entitlement to service connection for chronic sinusitis and stress fracture of the left second metatarsal remained pending following issuance of the November 2000 rating decision because VA received relevant official service department records that existed and had not been associated with the record at the time of the November 2000 rating decision. However, the March 2006 rating decision was issued in consideration of the Veteran’s service records and denied the Veteran’s pending claims. That rating decision became final because new and material evidence was not received within one year of issuance and the Veteran did not submit a timely notice of disagreement as to the decision. Furthermore, the April 2008 rating decision denied the Veteran’s February 2008 petition to reopen the previously denied claims for entitlement to service connection for stress fracture of the left second metatarsal and chronic sinusitis. That rating decision became final because new and material evidence was not received within one year of issuance and the Veteran did not submit a timely notice of disagreement as to the decision. Because the March 2006 and February 2008 rating decisions are now final, the earlier claims cannot serve as a basis for an effective date absent a finding of clear and unmistakable error (CUE). Correspondence received from the Veteran during the period between issuance of the April 2008 rating decision and April 27, 2014, cannot reasonably be interpreted as requesting a determination of entitlement, or evidencing a belief in entitlement, to service connection for maxillary sinusitis or stress fracture of the left second metatarsal. They do not discuss sinusitis or the left second metatarsal. The first communication received from the Veteran following issuance of the April 2008 rating decision that may reasonably be construed as a claim for entitlement to service connection for maxillary sinusitis or stress fracture of the left second metatarsal is a VA Form 21-4138, Statement in Support of Claim, that was received on April 28, 2014. As noted above, in the case of a reopened claim for service connection, the effective date for the grant of service connection will be the date of receipt of the petition to reopen or the date entitlement arose, whichever is later. 38 C.F.R. § 3.400(r). Here, the Veteran’s petition to reopen the previously denied claims for entitlement to service connection for maxillary sinusitis and stress fracture of the left second metatarsal was received on April 28, 2014. Under the relevant regulations, absent a finding of CUE in the earlier final decision, April 28, 2014, the date of receipt of the petition to reopen the previously denied claims, is the earliest date on which service connection may be established for maxillary sinusitis and stress fracture of the left second metatarsal. The Board notes that there is no basis in VA law for a freestanding claim for an earlier effective date in matters addressed in a final decision. Rather, when a decision is final, only a request for a revision premised on CUE may result in the assignment of an earlier effective date based on the earlier claim. See Rudd v. Nicholson, 20 Vet. App. 296 (2006). In this case, there has been no adjudicatory finding of CUE in the final March 2006 and April 2008 rating decisions. Consequently, the Board concludes that any attempt to overcome the finality of those rating decisions by raising a freestanding claim for entitlement to an earlier effective date in conjunction with the present appeal must fail. As such, the earlier claims may not serve as a basis for an earlier effective date. The Board’s finding in this regard does not prejudice any future adjudication of a claim for CUE in the March 2006 and April 2008 rating decisions. With regard to the Veteran’s appeal for entitlement to an earlier effective date for the grant of service connection for tinnitus, the earliest communication received from the Veteran that could reasonably be construed as a request for a determination of entitlement, or that evidences a belief in entitlement, to service connection for tinnitus is the VA Form 21-4138 that was received on April 28, 2014. In that regard, the Board observes that the Veteran submitted a VA Form 21-4138 in March 2005 in which he requested service connection for “closed head injury with disequilibrium and hearing loss.” Although the form mentions service connection and hearing loss, it does not discuss tinnitus. The form therefore cannot reasonably be construed as a claim for entitlement to service connection for tinnitus. Accordingly, April 28, 2014, the date VA received the Veteran’s original claim for entitlement to service connection for tinnitus, is the earliest date on which entitlement to service connection for tinnitus may be granted. See 38 C.F.R. § 3.304. In summary, the March 2006 rating decision that denied the Veteran original claims for entitlement to service connection for chronic sinusitis and stress fracture of the left second metatarsal and the April 2008 rating decision that denied the Veteran’s petition to reopen the previously denied claims are final. Following issuance of the final April 2008 rating decision, the earliest communication from the Veteran that may reasonable be construed as a petition to reopen the previously denied claims for entitlement to service connection for maxillary sinusitis and stress fracture of the left second metatarsal was received on April 28, 2014. In addition, the earliest communication from the Veteran that may reasonable be construed as a claim for entitlement to service connection for tinnitus was received on April 28, 2014. Therefore, April 28, 2014, is the appropriate effective date for the grants of service connection for those disabilities. 38 C.F.R. § 3.400. Accordingly, the Board finds that the preponderance of the evidence is against the assignment of an effective date earlier than April 28, 2014, for the grant of entitlement to service connection for maxillary sinusitis, stress fracture of the left second metatarsal, and tinnitus, and the appeals must be denied.   Service Connection Issues Generally, service connection may be established for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. To establish service connection for a disability, the Veteran must show: (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the disease or injury incurred in or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). 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). 4. Entitlement to service connection for a gastrointestinal condition The Veteran seeks entitlement to service connection for a gastrointestinal disability, which he contends is either directly related to his active service or is secondary to his service-connected disabilities, to include the medications he takes for those disabilities. The question for the Board is whether the Veteran has a current gastrointestinal condition that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the Veteran does not currently have a diagnosed gastrointestinal condition and has not had one at any time during the pendency of the claim or recent to the filing of the claim. 38 U.S.C. §§ 1110, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); 38 C.F.R. § 3.303(a), (d). The Veteran’s private treatment records show that he reported symptoms of heartburn, reflux, stomach discomfort, and loose bowel movements in 2013 and 2014. In September 2013, he indicated that he can control the heartburn through his diet. However, he later reported that his stomach discomfort does not seem to be related to his choice of foods or the presence or absence of bowel function. The private treatment records show that the Veteran has reported gastrointestinal symptoms and that he has taken Prilosec to treat those symptoms; however, they do not show that the Veteran has been diagnosed with any particular gastrointestinal condition. The Veteran underwent a VA stomach and duodenum examination in March 2015. The examiner noted the Veteran’s reported history of developing loose stools associated with cramping abdominal pain beginning in and around 2012 when he started taking medications such as Zoloft and Depakote. The Veteran also indicated that he was currently taking Prilosec, and that he currently had occasional abdominal pain without associated loose stools. The examiner determined that the Veteran did not have a diagnosable gastrointestinal condition and opined that the Veteran’s gastrointestinal symptoms do not cause functional limitation. Although the Veteran believes he has a current gastrointestinal disability that either is directly related to his active service or is secondary to his service-connected disabilities, he is not considered competent to provide a diagnosis in this case. The issue is medically complex and requires medical knowledge and expertise the Veteran has not been shown to possess. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Veteran’s statements do not establish that he has a currently diagnosed gastrointestinal condition. In the absence of proof of a current disability, there can be no valid claim for service connection. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Thus, without evidence of a currently diagnosed gastrointestinal disability or functional impairment due to gastrointestinal symptoms, the Board need not address the other elements of service connection for a gastrointestinal condition. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not for application, and the claim must be denied. 38 U.S.C. § 5107(b); see also Gilbert, 1 Vet. App. 49. 5. Entitlement to service connection for vertigo/residual disequilibrium and for a closed head injury/TBI The Veteran seeks entitlement to service connection for vertigo and disequilibrium that he contends are related to an in-service closed head injury he suffered when he was hit in the head with a sledgehammer. The Veteran’s service treatment records reflect that in April 1997 he reported being hit in the left frontal part of the head with a sledgehammer while bending over. He fell to the ground, but did not lose consciousness. He reported residuals symptoms of dizziness and headaches. He was assessed as having a concussion to the head. Thus, the evidence reflects that the Veteran had a closed head injury during his active service, and the question remaining for consideration is whether the Veteran has a current disability relating to that in-service injury. The Veteran’s VA treatment records indicate that he has complained of disequilibrium and has a diagnosis of vertigo. In December 2016, A. Neelakantan, M.D., one of the Veteran’s private health care providers wrote that, given the timeline of events, and given that no other secondary causes for the Veteran’s vertigo have been identified despite extensive workup, the Veteran’s vertigo is likely posttraumatic in nature and secondary to the TBI he sustained in 1997 during his active service. The Board considers Dr. Neelakantan’s statement to be probative evidence that the Veteran currently has vertigo and residual disequilibrium that are etiologically related to the in-service TBI shown in the Veteran’s service treatment records. Stefl v. Nicholson, 21 Vet. App. 120, 123 (for a medical opinion to be adequate for decision-making purposes, it must be supported by a rationale and explanation for the conclusion reached). In March 2015, a VA TBI examiner stated that the Veteran does not now have, nor has he ever had a TBI or any residuals of TBI. In support of that conclusion, the examiner stated that although the Veteran reported a head injury, the service treatment records available for review at the time of the examination did not show or indicate a head injury consistent with a TBI that occurred during service, and that the Veteran’s separation medical examination performed in 2000 does not mention a complaint or report of a head injury or chronic headaches, dizziness, or vertigo. The Board finds no reason to afford greater probative value to the March 2015 VA examiner’s conclusion than to Dr. Neelakantan’s December 2016 statement because it is unclear whether the VA examiner properly considered the in-service injury involving a sledgehammer. The VA examination report makes no specific mention of that injury as it is described in the service treatment records, and the examiner did not explain why such an injury is not consistent with a TBI. Accordingly, the Board finds that the evidence is at least in relative equipoise as to whether the Veteran has a current disability relating to the in-service closed head injury/TBI. The benefit of the doubt is resolved in the Veteran’s favor, and the Board therefore concludes that entitlement to service connection for vertigo/residual disequilibrium and for a closed head injury/TBI must be granted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 6. Entitlement to service connection for PTSD The Veteran seeks entitlement to service connection for PTSD. He asserts that the condition is related to witnessing the death of a fellow service member with the last name [redacted] during a live-fire exercise. Service connection for PTSD requires (1) medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a); (2) a link, established by medical evidence, between current symptoms and an in-service stressor; and (3) credible supporting evidence that the claimed in-service stressor occurred. See 38 C.F.R. § 3.304(f). For cases certified to the Board after August 4, 2014, such as this case, the diagnosis of PTSD must be in accordance with the American Psychiatric Association’s Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition (DSM-5). 38 C.F.R. § 4.125(a); Schedule for Rating Disabilities-Mental Disorders and Definition of Psychosis for Certain VA Purposes, 79 Fed. Reg. 45,093 (Aug, 4, 2014) (Applicability Date) (updating 38 C.F.R. § 4.125 to reference the DSM-5). Turning to the relevant evidence of record, the Veteran has submitted a third party witness statement from [redacted], who attests that he served with the Veteran and also witnessed the death of the service member [redacted], who was shot during a live-fire exercise and died instantly. The record also includes a BIRLS Veteran Identification record for a service member with the last name [redacted] who died during the Veteran’s period of active service. The Board finds the statement from [redacted] and the BIRLS Veteran Identification record to be credible supporting evidence that the Veteran’s claimed in-service stressor occurred. Accordingly, the question remaining for consideration is whether the Veteran has been diagnosed with PTSD that is related to that stressor. A May 2012 VA treatment note indicates that the Veteran met criteria B, C, and D for a diagnosis of PTSD under the DSM-IV, and that a diagnosis of PTSD was suggested at that time. In October 2012, the Veteran reported symptoms of nightmares, avoiding watching military movies, and hypervigilance with hyperarousal state and feeling that the world is unsafe. Later notes reflect that he has been formally diagnosed with PTSD. A March 2013 treatment note specifies that the PTSD diagnosis is based on the trauma of having a friend killed in a live-fire exercise when they were not supposed to have live-fire munitions. A December 2014 statement from the Veteran’s private mental health care treatment provider indicates that the Veteran is considered “PTSD positive” based on his scores on the PCL-5 Weekly, and that the Veteran meets the DSM’s B, C, and D criteria for a PTSD diagnosis. The statement also describes the Veteran’s PTSD symptoms, which include anxiety over having to discuss the death of his fellow service member; feeling emotionally cut off from the others; feelings of guilt and anger; avoidance of large crowds; inability to make decisions on his own; flashbacks; avoidance of military and casualty movies; and tending to check outside the windows to make sure his home is safe. Thus, the VA and private treatment records describe the Veteran’s psychiatric symptoms, and indicate that he has been diagnosed with PTSD under the DSM-IV diagnostic criteria based on his in-service stressor of seeing a fellow service member killed. As noted above, because this case was certified to the Board after August 4, 2014, the regulations require that the Veteran’s diagnosis of PTSD conform to the criteria set forth in the DSM-5 rather than the DSM-IV. However, in this case the medical treatment evidence of records provides a detailed accounting of the Veteran’s symptoms as compared to the diagnostic criteria for PTSD under the DSM-IV. The Board has compared those symptoms to the diagnostic criteria for PTSD set forth in the DSM-5, and finds that it is highly likely that the Veteran’s psychiatric symptoms, as described in the medical treatment evidence of record, also meet the diagnostic criteria for PTSD under the DSM-5. Therefore, a remand of the issue to clarify the PTSD diagnosis would delay adjudication of the Veteran’s claim and provide little, if any, benefit to the Veteran. Accordingly, the Board extends the benefit of the doubt to the Veteran, and finds that his diagnosis of PTSD satisfies 38 C.F.R. § 4.125(a). See generally Sabonis v. Brown, 6 Vet. App. 426, 430 (1994) (remands that would only result in unnecessarily imposing additional burdens on VA with no benefit flowing to the veteran are to be avoided). The Board acknowledges that a February 2014 VA examiner determined that the Veteran does not meet the criteria for a diagnosis of PTSD under the DSM-IV or DSM-5 because he does not have the requisite intrusion symptoms, persistent avoidance of stimuli, and negative alterations in cognition and mood. The examiner diagnosed the Veteran with other psychiatric disabilities and attributed those disabilities to stressors from the Veteran’s childhood and to the Veteran’s history of multiple incarcerations. However, the VA examiner’s conclusions are contrary to the medical treatment evidence of record, which show that the Veteran has complained of intrusion symptoms, persistent avoidance of stimuli, and negative alterations in cognition and mood. Specifically, the medical treatment records show that the Veteran has reported nightmares related to the in-service stressor, avoidance of movies and other reminders of the in-service stressor, a persistent negative emotional state, and feelings of detachment from others. The Board concludes that there is no reason to afford greater probative value to the February 2014 VA examination report than to the medical treatment evidence of record. Accordingly, the Board finds that the evidence is at least in relative equipoise as to whether the Veteran has been diagnosed with PTSD that is linked to his reported in-service stressor. The benefit of the doubt is resolved in the Veteran’s favor, and the Board therefore concludes that entitlement to service connection for PTSD must be granted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Increased Rating Issue The Veteran seeks entitlement to a compensable initial rating for stress fracture of the left second metatarsal. He has indicated that he has a burning sensation in the left foot, especially when he walks a long distance and when he hikes. The disability has been rated as noncompensable since April 28, 2014, the date of receipt of his petition to reopen the previously denied claim for service connection for that disability. The applicable rating period is from April 28, 2014, the effective date for the grant of service connection for stress fracture of the left second metatarsal, through the present. See 38 C.F.R. § 3.400. 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). The Veteran’s stress fracture of the left second metatarsal is not specifically listed in the Schedule. It has therefore been rated under 38 C.F.R. § 4.71a, Diagnostic Code 5284, which provides ratings for foot injuries not otherwise contemplated by the Schedule. Under Diagnostic Code 5284, a 10 percent rating is provided when the injury is moderate, a 20 percent rating is provided when the injury is moderately severe, a 30 percent rating is provided when the injury is severe, and a 40 percent rating is provided when there is actual loss of use of the foot. Terms such as “mild”, “moderate”, and “moderately severe” are not defined in the Schedule. Rather than applying a mechanical formula, VA must evaluate all evidence so that decisions will be equitable and just. 38 C.F.R. § 4.6. Although the use of similar terminology by medical professionals should be considered, it is not dispositive of an issue. Instead, all evidence must be evaluated in arriving at a decision regarding a request for an increased disability rating. 38 U.S.C. § 7104; 38 C.F.R. §§ 4.2, 4.6. Also for consideration in this case is 38 C.F.R. § 4.71a, Diagnostic Code 5279, which pertains to anterior metatarsalgia. Metatarsalgia is defined as “pain and tenderness in the metatarsal region.” See Dorland’s Illustrated Medical Dictionary 1145 (32nd ed. 2012). In this case, the record reflects that the Veteran’s stress fracture of the left second metatarsal is manifested by pain and a burning sensation in the metatarsal region. Therefore, the condition may be rated by analogy under Diagnostic Code 5279. Under Diagnostic Code 5279, a maximum 10 percent rating is provided for unilateral or bilateral anterior metatarsalgia. Turning to the relevant evidence of record, a June 2014 private treatment record documents the Veteran’s report of “a little burning sensation” at the site of his stress fracture of the left second metatarsal. The medical treatment records do not otherwise discuss the severity of the Veteran’s stress fracture of the left second metatarsal. The Veteran underwent a VA foot conditions examination in March 2015. At the examination, the Veteran reported that he has continued to have burning pain and discomfort in the left foot after walking and hiking for long periods. He also has pain during flare-ups with jogging, running on uneven terrain, and high-impact activities. On physical examination, there was tenderness on the medial aspect of the mid-foot and on the second metatarsal bone. The examiner assessed the condition as being mild in severity, and that the condition is productive of less movement than normal and pain on movement. The Veteran’s left foot pain limits him from prolonged jogging, running on uneven terrain, and high-impact activities. In view of the foregoing, the Board concludes that the Veteran was not entitled to a compensable rating for his stress fracture of the left second metatarsal under Diagnostic Code 5284 at any time during the relevant rating period because the condition was not at least moderate in severity. Specifically, during the rating period, the Veteran reported a burning sensation and pain in the left foot that limits his ability to walk, jog, run, hike, and engage in other high-impact activities. The March 2015 VA examiner indicated that the condition is only mild in severity. Although the examiner’s use of that term is not dispositive of the issue, the Board finds it to be persuasive in view of the other evidence of record and concludes that the Veteran’s service-connected left foot disability was mild in severity throughout the rating period. As the Veteran’s service-connected left foot disability was manifested by no worse than mild symptoms throughout the rating period, he was not entitled to a compensable rating under Diagnostic Code 5284 at any time. However, the Board finds that Diagnostic Code 5279 more completely contemplates the Veteran’s left foot symptomatology than does Diagnostic Code 5284, as the record clearly show that the Veteran has pain in the metatarsal region and Diagnostic Code 5279 allows for a compensable rating for any amount of pain in the metatarsal region. See Butts v. Brown, 5 Vet. App. 532, 538 (1993) (The assignment of a particular diagnostic code to rate a disability is “completely dependent on the facts of a particular case.”). Thus, the Board finds that the Veteran has satisfied the criteria for an initial rating of 10 percent, and no higher, under Diagnostic Code 5279. The Veteran is not prejudiced by this change of diagnostic code as the change does not result in a reduction in his rating or in severing service connection for stress fracture of the left second metatarsal. See Read v. Shinseki, 651 F.3d 1296, 1302 (Fed. Cir. 2011). Neither the Veteran nor his representative has raised any other issues with regard to the rating for the service-connected stress fracture of the left second metatarsal, 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 an initial rating of 10 percent, and no higher, have been met throughout the relevant rating period for the Veteran’s stress fracture of the left second metatarsal. Accordingly, there is no basis for staged rating of the Veteran’s stress fracture of the left second metatarsal pursuant to Fenderson, 12 Vet. App. at 126-27 To the extent that the Veteran seeks a rating in excess of 10 percent for stress fracture of the left second metatarsal, the preponderance of the evidence is against the assignment of a higher initial rating, the benefit-of-the-doubt doctrine is not for application, and the appeal must be denied. 38 U.S.C. § 5107(b); see also Gilbert, 1 Vet. App. 49. Apportionment Issue The Veteran asserts that a portion of his VA compensation benefits should be apportioned to his wife for the period from November 2009 to August 2011, during which time he was incarcerated and his benefit payments were reduced pursuant to 38 C.F.R. § 3.665. By way of history, the AOJ informed the Veteran in a February 2011 letter that his benefits would be reduced retroactively beginning in November 2009 due to his incarceration, but that he could apportion the reduced benefits to a dependent. In March 2011, the Veteran submitted a VA Form 21-0788, Information Regarding Apportionment of Beneficiary’s Award, requesting that his VA compensation benefits be apportioned to his spouse for his period of incarceration. The AOJ informed the Veteran in a March 2012 letter that the March 2011 request for apportionment could not be accepted as a valid claim because it was not completed and signed by his spouse, the intended apportionee. The Veteran submitted a timely notice of disagreement as to that administrative decision, and in March 2015 the AOJ issued a statement of the case again finding that the March 2011 request could not be accepted as a valid claim for apportionment, stating “the law requires that a dependent make a claim for apportionment.” As such, the AOJ has thus far adjudicated only the issue of whether a proper claim for entitlement to apportionment of the Veteran’s VA compensation benefits based on his incarceration was received, and has not adjudicated the claim on the merits. Under 38 C.F.R. § 3.665(a), any person who is incarcerated in a Federal, state, or local penal institution in excess of 60 days for conviction of a felony shall not be paid compensation in excess of the amount specified in 38 C.F.R. § 3.665(d), beginning on the 61st day of incarceration. Under that section, a Veteran who is rated less than 20 percent shall receive one-half the rate of compensation payable under 38 U.S.C. 1114(a), which equates to one-half of the rate for a 10 percent disability rating. All or part of the compensation not paid to an incarcerated veteran may be apportioned to the veteran’s spouse, child or children and dependent parents on the basis of individual need. 38 C.F.R. § 3.665(e)(1). As noted above, the AOJ found that the Veteran’s request for apportionment did not constitute a valid claim because such a claim must be filed by the intended apportionee. However, the Board does not find any provisions in the controlling statutes and regulations setting forth such a requirement. Rather, the controlling statute, 38 C.F.R. § 3.665(e), states only that all or part of the compensation not paid to an incarcerated veteran may be apportioned to the veteran’s spouse, child or children and dependent parents on the basis of individual need. It does not require that any specific person submit the claim for such apportionment. The Board finds no provision of the law that prevents the Veteran from submitting a claim for apportionment under 38 C.F.R. § 3.665(e) on his dependents’ behalf. As such, the Board finds that the March 2011 VA Form 21-0788 constitutes a proper claim for entitlement to apportionment of the Veteran’s VA compensation benefits based on his incarceration. REASONS FOR REMAND 1. Entitlement to service connection for a right shoulder disability is remanded. The Veteran underwent a VA shoulder and arm conditions examination in February 2014. The examiner noted the Veteran’s assertion that he felt he overcompensated with his right shoulder due to his service-connected left ulnar nerve disability. She diagnosed the Veteran with right shoulder rotator cuff syndrome and opined that the Veteran’s right shoulder condition is less likely than not proximately due to the Veteran’s service-connected condition. However, she explained that there are several syndromes that can share symptoms of pain and crepitus in the shoulder area and an MRI of the affected joint “would be very helpful to determine the diagnosis”. The record does not reflect that the Veteran has undergone an MRI of the right shoulder. The Board finds the February 2014 VA examiner’s opinion to be inadequate for decision-making purposes because it is not supported by appropriate rationale, indicates that an MRI of the right shoulder may be necessary for an adequate opinion to be provided, and does not include an opinion as to whether the Veteran’s current right shoulder disability may be aggravated by his service-connected disabilities. As such, the issue must be remanded so that another examination may be provided. 2. Entitlement to service connection for a cervical spine disability, a right knee disability, and a left knee disability is remanded. The Veteran seeks entitlement to service connection for a cervical spine disability, a right knee disability, and a left knee disability. He contends that the conditions are related to lifting, carrying, and dropping artillery shells; unhitching Howitzer cannons; and moving a bladder full of water during his active service. He further contends that his current cervical spine disability is related to being hit in the head with a sledgehammer during his active service. In March 2015, he underwent VA examinations as to the claimed cervical spine and knee disabilities. With regard to the cervical spine, the examiner noted the Veteran’s contention that something dropped on his neck during service. She opined that it is less likely as not that the Veteran’s current cervical spine disability is related to his active service because the Veteran’s current employment as a laborer likely requires movement and lifting of equipment and other heavy objects and is more likely the cause of his current neck condition. With regard to the Veteran knee disabilities, the examiner noted the Veteran’s contention that his right knee symptoms began during his active service, and that he used to run a lot and jump from trucks during his active service, but that he did not have any specific injuries to his knees during his active service. She opined that it is less likely as not that the Veteran’s current right knee disability is related to his active service because the Veteran had leg pain prior to entrance into active service and did not complain of a right knee condition at the time of his examination for separation from active service. The examiner’s opinions are not adequate for decision-making purposes because they do not reflect consideration of the Veteran’s contention that the cervical spine disability, right knee disability, and left knee disabilities are related to lifting, carrying, and dropping artillery shells; unhitching Howitzer cannons; and moving a bladder full of water; or the Veteran’s contention that his cervical spine disability is related to being hit in the head with a sledgehammer during his active service. The examiner did not explain why the Veteran’s current cervical spine disability is more likely related to the Veteran’s current employment as a laborer than to the Veteran’s described duties during his active service. As such, the issues must be remanded so that an addendum opinion may be obtained. 3. Entitlement to service connection for erectile dysfunction is remanded. The Veteran seeks entitlement to service connection for erectile dysfunction, which he contends is secondary to his service-connected disabilities, to include medications he takes for those disabilities. The Board cannot make a fully-informed decision on the issue because no VA examiner has opined whether the Veteran’s diagnosed erectile dyfunction may be secondary to his service-connected disabilities. 4. Entitlement to a compensable initial rating for scar of the left upper arm is remanded. The Veteran was most recently provided an examination as to his service-connected scar of the left upper extremity in February 2014, at which time the scar was nontender and did not cause other functional limitation. In a June 2014 statement, the Veteran’s representative indicated that the Veteran’s scar is uncomfortable and tender to the touch, and that he can feel a rubber band stretching sensation at the location of the scar. The representative’s statement suggests that the Veteran’s service-connected scar may be painful and/or cause functional limitation. In light of that statement, the Board concludes that a new VA examination is required so that the current severity of the Veteran’s service-connected disability may be determined. See 38 U.S.C. § 5103A; 38 C.F.R. § 3.159; see also Green v. Derwinski, 1 Vet. App. 121, 124 (1991) (VA has a duty to provide the veteran with a thorough and contemporaneous medical examination); Weggenmann v. Brown, 5 Vet. App. 281 (1993) (VA has a duty to provide an examination when there is evidence that the disability has worsened since the previous examination). 5. Entitlement to a rating in excess of 10 percent for lymph node biopsy with injury to the ulnar nerve of the left upper extremity is remanded. The Veteran was most recently provided an examination as to his service-connected injury to the ulnar nerve of the left upper extremity in February 2014, at which time the disability was productive of constant pain and achiness, as well as reduced strength that prevented the Veteran from lifting a five-gallon bucket. Recent VA treatment records indicated that the Veteran reports his service-connected injury to the ulnar nerve of the left upper extremity causes him to drop things periodically. The Veteran’s statements suggest that the disability may have worsened since the February 2014 VA examination. In light of those statements, the Board concludes that a new VA examination is required so that the current severity of the Veteran’s service-connected disability may be determined. See 38 U.S.C. § 5103A; 38 C.F.R. § 3.159; see also Green, 1 Vet. App. at 124; Weggenmann, 5 Vet. App. 281. 6. Entitlement to apportionment of the Veteran’s VA compensation benefits based on his incarceration Given that the Board has found in the decision above that the Veteran submitted a proper claim for entitlement to apportionment of his VA compensation benefits based on his incarceration, the AOJ should now address that claim on the merits. It would be potentially prejudicial for the Board to make a determination on the merits in the first instance. See, e.g., Bernard v. Brown, 4 Vet. App. 384 (1993). The matters are REMANDED for the following action: 1. Adjudicate on the merits the Veteran’s claim for entitlement to apportionment of his VA compensation benefits based on his incarceration. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any diagnosed right shoulder disability. The examiner must opine whether it is at least as likely as not (50 percent probability or greater) that any such diagnosed disability is directly related to the Veteran’s active service, to include lifting, carrying, and dropping artillery shells; unhitching Howitzer cannons; and moving a bladder full of water. If not, the examiner must also opine as to whether it is at least as likely as not that the right shoulder disability is (1) proximately due to service-connected disability, or (2) aggravated beyond its natural progression by a service-connected disability. The opinion must address the Veteran’s contention his right shoulder disability is related to overcompensating for his service-connected lymph node biopsy with injury to the ulnar nerve of the left upper extremity. If a MRI or other diagnostic imaging is deemed necessary to properly diagnosis the Veteran’s right shoulder disability or to provide the opinions requested above, then such imaging should be performed. 3. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s cervical spine disability, right knee disability, and/or left knee disability is at least as likely as not (50 percent probability or greater) related to an in-service injury or event, to include lifting, carrying, and dropping artillery shells; unhitching Howitzer cannons; moving a bladder full of water; and eing hit in the head with a sledgehammer. 4. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of his erectile dysfunction. The examiner must opine whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s erectile dysfunction is (1) proximately due to service-connected disability, or (2) aggravated beyond its natural progression by service-connected disability. The examiner must discuss the relationship, if any, between the medications the Veteran takes for his service-connected disabilities and his erectile dysfunction. 5. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his scar of the left upper arm. The examiner should provide a full description of the disability and report all signs and symptoms necessary for rating the Veteran’s disability under the rating criteria. To the extent possible, the examiner should identify any symptoms and functional impairments due to the scar of the left upper arm alone and discuss the effect of the disability on any occupational functioning and activities of daily living. 6. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his lymph node biopsy with injury to the ulnar nerve of the left upper extremity. The examiner should provide a full description of the disability and report all signs and symptoms necessary for rating the Veteran’s disability under the rating criteria. To the extent possible, the examiner should identify any symptoms and functional impairments due to the lymph node biopsy with injury to the ulnar nerve of the left upper extremity alone and discuss the effect of the disability on any occupational functioning and activities of daily living. MICHAEL MARTIN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. J. Anthony, Counsel