Citation Nr: 18152755 Decision Date: 11/27/18 Archive Date: 11/26/18 DOCKET NO. 16-29 479 DATE: November 27, 2018 ORDER Entitlement to service connection for irritable bowel syndrome (IBS) is granted. Entitlement to service connection for fibrocystic breast disease is granted. Entitlement to service connection for insomnia is granted. Entitlement to service connection for residuals, right 4th toe fracture is denied. Entitlement to service connection for tendonitis, right wrist is denied. Entitlement to service connection for tendonitis, left wrist is denied. Entitlement to service connection for fracture, left 3rd finger is denied. Entitlement to service connection for residuals, fractured right 3rd finger is denied. Entitlement to service connection for left ankle strain is denied. Entitlement to service connection for a bilateral hearing loss disability is denied. Entitlement to service connection for positive PPD, claimed as tuberculosis is denied. Entitlement to service connection for hematoma of left thumb with partial nail removal is denied. Entitlement to service connection for enlarged pituitary gland is denied. REMANDED Entitlement to service connection for chronic bronchitis is remanded. Entitlement to service connection for contact dermatitis is remanded. Entitlement to service connection for moles, claimed as dermatofibroma is remanded. Entitlement to service connection for right ingrown toenail is remanded. Entitlement to service connection for an eye disability, to include dry eyes and refractive error. Entitlement to a compensable rating for chronic low back strain is remanded. Entitlement to a compensable rating for left knee chondromalacia patella is remanded. Entitlement to a compensable rating for right knee chondromalacia patella is remanded. Entitlement to a compensable rating for hypertension is remanded. Entitlement to a compensable rating for keratitis is remanded. Entitlement to a compensable rating for hammertoes with callouses, right 5th toe is remanded. Entitlement to a compensable rating for a left 5th toe, callouses, hammertoe and hyperkeratosis is remanded. Entitlement to a compensable rating for left hamstring strain is remanded. Entitlement to a compensable rating for hemorrhoids is remanded. Entitlement to a compensable rating for hysterectomy scar is remanded. Entitlement to a compensable rating for alopecia is remanded. Entitlement to a compensable rating for migraines is remanded. FINDINGS OF FACT 1. The Veteran’s IBS had its onset in service and has been continuous since service. 2. The Veteran’s fibrocystic breast disease had its onset in service and has been continuous since service. 3. The Veteran’s insomnia had its onset in service and has been continuous since service. 4. The Veteran fractured his right fourth toe in service but no current right fourth toe disability or residuals have been shown. 5. The Veteran was treated for right wrist tendonitis in service but no current right wrist disability or residuals have been shown. 6. The Veteran was treated for left wrist tendonitis in service but no current left wrist disability or residuals have been shown. 7. The Veteran fractured her right third finger in service but no current right third finger disability or residuals have been shown. 8. The Veteran fractured her left third finger in service but no current left third finger disability or residuals have been shown. 9. The Veteran strained her left ankle in service but no current left ankle disability or residuals have been shown. 10. The evidence of record indicates the Veteran’s bilateral (left and right ear) hearing loss is not severe enough to be considered a ratable disability according to VA standards. 11. Active tuberculosis or any residuals from treatment for a positive PPD test are not shown at any time in service or post-service. 12. The Veteran was treated for hematoma of the left thumb in service but no current left thumb disability or residuals have been shown. 13. The Veteran was diagnosed with an enlarged pituitary gland in service, but no current disability manifested by an enlarged pituitary gland has been shown. CONCLUSIONS OF LAW 1. The criteria for service connection for irritable bowel syndrome have been met. 38 U.S.C. §§ 1110, 1131, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303(d) (2017). 2. The criteria for service connection for fibrocystic breast disease have been met. 38 U.S.C. §§ 1110, 1131, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303(d) (2017). 3. The criteria for service connection for insomnia have been met. 38 U.S.C. §§ 1110, 1131, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303(d) (2017). 4. The criteria for service connection for residuals, right 4th toe fracture have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303(d) (2017). 5. The criteria for service connection for tendonitis, right wrist have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303(d) (2017). 6. The criteria for service connection for tendonitis, left wrist have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303(d) (2017). 7. The criteria for service connection for fracture, left 3rd finger have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303(d) (2017). 8. The criteria for service connection for residuals, fractured right 3rd finger have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303(d) (2017). 9. The criteria for service connection for left ankle strain have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303(d) (2017). 10. The criteria for service connection for a bilateral hearing loss disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303(a), 3.385 (2017). 11. The criteria for service connection for tuberculosis, to include a positive PPD test, have not been met. 38 U.S.C. §§ 1110, 1131 (2012); 38 C.F.R. §§ 3.102, 3.303 (2017). 12. The criteria for service connection for hematoma of left thumb with partial nail removal have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303(d) (2017). 13. The criteria for service connection for a disability due to an enlarged pituitary gland have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303(d) (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1990 to July 2010. This matter came before the Board of Veterans Appeals (Board) on appeal from a June 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). Evidence in the record suggests that the Veteran has been diagnosed with multiple eye conditions; therefore, the Board will broadly construe the issue of service connection for refractive error as a claim for service connection for an eye disability, to include dry eyes and refractive error. Clemons v. Shinseki, 23 Vet. App. 1, 6 (2009). The Board acknowledges that the Veteran submitted a Rapid Appeals Modernization Program (RAMP) opt-in election form that was received by VA on April 18, 2018. However, the appeal had already been activated at the Board and is therefore no longer eligible for the RAMP program at this time. Accordingly, the Board will undertake appellate review of the case. Service Connection Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability). See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999); 38 C.F.R. § 3.303(a). 1. Entitlement to service connection for irritable bowel syndrome (IBS) The Veteran contends that her IBS began in service. The Board concludes that the Veteran has a current disability of IBS that began during active service and that service connection is therefore warranted. Service connection may be established for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes the disease was incurred in service. 38 C.F.R. § 3.303(d). June 2011 private treatment records note abdominal pain and constipation. September 2011 private treatment records note abdominal swelling and altered bowel habits, including constipation, diarrhea, gas and stomach cramps. The August 2011 VA examiner found that the Veteran developed symptoms of IBS in 2006. The examiner noted symptoms of abdominal bloating 3 to 4 times per year, diarrhea and constipation. The Veteran reported that her diarrhea and constipation resolved without treatment. The examiner diagnosed IBS and stated that “patient developed this problem while in service” and continued to have problems 3 to 4 times per year. The Board therefore finds that the competent medical evidence of record indicates that the Veteran has a current disability of IBS that was incurred during service and has continued since service. Service connection for IBS is therefore warranted. 38 C.F.R. § 3.303(d). 2. Entitlement to service connection for fibrocystic breast disease The Veteran contends that her fibrocystic breast disease began in service. The Board concludes that the Veteran has a current disability of fibrocystic breast disease that had its onset during active service and that service connection is therefore warranted. Service connection may be established for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes the disease was incurred in service. 38 C.F.R. § 3.303(d). May 1990 service treatment records note a history of cystic areas in the breast and multicystic areas were found upon examination. The Veteran was given a provisional diagnosis of fibrocystic breast disease. April 2010 service treatment records document a diagnosis of fibrocystic breast disease. November 2010 private treatment records note bilateral cyclical breast pain. The provider noted the Veteran’s history of right breast biopsy and that a mammogram showed scattered benign calcifications. The provider opined that the Veteran’s bilateral breast pain was likely fibrocystic. March 2013 private treatment records note that multiple soft masses were found upon breast examination. The August 2011 VA examination noted a history of fibrocystic breast disease and diagnosed benign breast disease. The examiner noted that a biopsy showed fibrous and cystic breast mass. The examiner did not provide an etiological opinion. The Board therefore finds that the competent evidence of record indicates that the Veteran has a current disability of fibrocystic breast disease that had its onset in service and has continued since service. Fibrocystic breast disease was not noted on entry. Service treatment records document an in-service diagnosis of fibrocystic breast disease. Private treatment records indicate that the Veteran has received ongoing treatment and evaluation for her condition since service. The August 2011 VA examination also diagnosed benign breast disease. Service connection for fibrocystic breast disease is therefore warranted. 38 C.F.R. § 3.303(d). 3. Entitlement to service connection for insomnia The Veteran contends that her insomnia began in service. The Board concludes that the Veteran has a current diagnosis of insomnia that began during active service and that service connection is therefore warranted. Service connection may be established for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes the disease was incurred in service. 38 C.F.R. § 3.303(d). The August 2011 VA examiner noted the Veteran’s reports of insomnia beginning in 2008. The Veteran reported that 2 to 3 times per week she woke and had problems falling back to sleep but had not received treatment. The examiner diagnosed insomnia and stated that “patient developed this problem while in service” and continued to have problems 2 to 3 times per week. The Board therefore finds that the competent medical evidence of record indicates that the Veteran has a current disability of insomnia that was incurred during service and has continued since service. Service connection for insomnia is therefore warranted. 38 C.F.R. § 3.303(d). 4. Entitlement to service connection for residuals, right 4th toes fracture The Veteran contends that she is entitled to service connection for a fracture of her right fourth toe. The Board concludes that the Veteran does not have a current left right fourth toe disability and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Service connection is therefore not warranted. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. § 3.303(a), (d); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The Board’s review indicates that private treatment records are silent for complaints, diagnosis or treatment of a right fourth toe disability. An August 2011 VA examination noted that the Veteran fractured her right fourth toe in 1993, but found that the fracture had healed without residuals. The Veteran denied any problems with her right fourth toe, including pain, flareups, weakness or fatigue. The Veteran did not report any current treatment. Upon examination, the examiner found no evidence of pain on range of motion testing and no range of motion limitations. The Board finds that the VA examination is adequate for appellate review. There is no evidence that the examiner was not competent or credible, and as the reports ia based on the Veteran’s statements, in-person examination and the examiners’ observations, the Board finds it is entitled to significant probative weight. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302–05 (2008). The Board finds that the medical evidence of record indicates that while the Veteran had a right fourth toe fracture in service, she does not have a current right fourth toe disability. The record is silent for ongoing right fourth toe treatment or complaints and the August 2011 VA examination found no ongoing residuals. As with all claims for service-connection, in the absence of proof of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Service connection is therefore not warranted. 38 C.F.R. § 3.303. 5. Entitlement to service connection for tendonitis, right wrist 6. Entitlement to service connection for tendonitis, left wrist The Veteran contends that she is entitled to service connection for tendonitis of her right and left wrists. The Board concludes that the Veteran does not have a current right or left wrist disability and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Service connection is therefore not warranted. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. § 3.303(a), (d); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). July 2009 service treatment records document a right wrist sprain. The Board’s review indicates that private treatment records are silent for complaints, diagnosis or treatment of a right or left wrist disability. An August 2011 VA joints examination noted an in-service diagnosis of bilateral wrist tendonitis, but found that it had resolved without residuals. The Veteran denied problems with her right and left third wrists, including pain, flareups, stiffness, swelling and weakness. Upon examination, the examiner found no evidence of pain on range of motion testing and no range of motion limitations. The Board finds that the VA examination is adequate for appellate review. There is no evidence that the examiner was not competent or credible, and as the reports ia based on the Veteran’s statements, in-person examination and the examiners’ observations, the Board finds it is entitled to significant probative weight. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302–05 (2008). The Board finds that the medical evidence of record indicates that while the Veteran had bilateral wrist tendonitis in service, she does not have a current right or left wrist disability. The record is silent for ongoing right or left wrist treatment or complaints and the August 2011 VA examination found no ongoing residuals from the in-service tendonitis. As with all claims for service-connection, in the absence of proof of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Service connection is therefore not warranted. 38 C.F.R. § 3.303. 7. Entitlement to service connection for residuals, fractured right 3rd finger The Veteran contends that she is entitled to service connection for a fracture of her right third finger. The Board concludes that the Veteran does not have a current right third finger disability and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Service connection is therefore not warranted. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. § 3.303(a), (d); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). August 1991 service treatment records document a right third finger fracture sustained while playing flickerball. It was treated with a splint. The Board’s review indicates that private treatment records are silent for complaints, diagnosis or treatment of a right third finger disability. An August 2011 VA examination noted the in-service fracture but found that it had healed without residuals. The Veteran denied problems with her right third finger, including pain, flareups, stiffness, loss of strength, and loss of motion or dexterity. Upon examination, the examiner found no evidence of pain on range of motion testing and no range of motion limitations. The Board finds that the VA examination is adequate for appellate review. There is no evidence that the examiner was not competent or credible, and as the reports ia based on the Veteran’s statements, in-person examination and the examiners’ observations, the Board finds it is entitled to significant probative weight. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302–05 (2008). The Board finds that the medical evidence of record indicates that while the Veteran had a right third finger fracture in service, she does not have a current right third finger disability. The record is silent for ongoing right third finger treatment or complaints and the August 2011 VA examination found no ongoing residuals. As with all claims for service-connection, in the absence of proof of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Service connection is therefore not warranted. 38 C.F.R. § 3.303. 8. Entitlement to service connection for fracture, left 3rd finger The Veteran contends that she is entitled to service connection for a fracture of her left third finger. The Board concludes that the Veteran does not have a current left third finger disability and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Service connection is therefore not warranted. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. § 3.303(a), (d); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The Board’s review indicates that private treatment records are silent for complaints, diagnosis or treatment of a left third finger disability. An August 2011 VA examination noted an in-service fracture, but found that the fracture had healed without residuals. The Veteran denied problems with her left third finger, including pain, flareups, stiffness, loss of strength, and loss of motion or dexterity. Upon examination, the examiner found no evidence of pain on range of motion testing and no range of motion limitations. The Board finds that the VA examination is adequate for appellate review. There is no evidence that the examiner was not competent or credible, and as the reports ia based on the Veteran’s statements, in-person examination and the examiners’ observations, the Board finds it is entitled to significant probative weight. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302–05 (2008). The Board finds that the medical evidence of record indicates that while the Veteran had a left third finger fracture in service, she does not have a current left third finger disability. The record is silent for ongoing left third finger treatment or complaints and the August 2011 VA examination found no ongoing residuals. As with all claims for service-connection, in the absence of proof of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Service connection is therefore not warranted. 38 C.F.R. § 3.303. 9. Entitlement to service connection for left ankle strain The Veteran contends that she is entitled to service connection for a left ankle strain. The Board concludes that the Veteran does not have a current left ankle disability and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Service connection is therefore not warranted. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. § 3.303(a), (d); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). October 2004 service treatment records document a diagnosis of ankle sprain after running a marathon. The provider noted that there was no deformity but found pain on palpation. May 2009 service treatment records noted no ankle abnormalities upon examination. The Board’s review indicates that private treatment records are silent for complaints, diagnosis or treatment of a left ankle disability. An August 2011 VA examination noted the 2004 left ankle strain after running a marathon. The examiner noted that the strain resolved, and the Veteran had not had any ankle problems since, including pain, flareups, stiffness, swelling or instability. On examination, the examiner found no deformity, no giving way, no instability, no pain, no stiffness, no weakness, no incoordination and no other symptoms. There were no symptoms of arthritis and no varus or valgus angulation. The examiner diagnosed a history of left ankle strain, resolved, no residuals. The Board finds that the VA examination is adequate for appellate review. There is no evidence that the examiner was not competent or credible, and as the reports ia based on the Veteran’s statements, in-person examination and the examiners’ observations, the Board finds it is entitled to significant probative weight. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302–05 (2008). The Board finds that the medical evidence of record indicates that while the Veteran had a left ankle sprain in service, she does not have a current left ankle disability. The record is silent for ongoing left ankle complaints and the August 2011 VA examination found that the strain had resolved with no ongoing residuals. As with all claims for service-connection, in the absence of proof of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Service connection is therefore not warranted. 38 C.F.R. § 3.303. 10. Entitlement to service connection for bilateral hearing loss disability The Veteran contends that she has a bilateral hearing loss disability which was caused by service. The Board concludes that while the Veteran has bilateral hearing loss, it does not meet the threshold to be considered a disability for VA purposes and that service connection is therefore not warranted. 38 C.F.R. § 3.385. Impaired hearing is considered a ratable disability for VA compensation purposes when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz is 40 decibels or greater; or when the auditory threshold for at least three of these frequencies are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. The Board’s review of the evidence relevant to this claim indicates that private treatment records are unremarkable for complaints, diagnosis or audiometric testing for bilateral hearing loss. During an August 2011 VA audiological examination puretone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 10 5 10 10 10 LEFT 5 5 5 5 10 Speech audiometry revealed speech recognition ability of 94 percent in the right ear and of 100 percent in the left ear. The Veteran was diagnosed with bilateral sensorineural hearing loss. But, ultimately, the examiner found that the Veteran’s bilateral sensorineural hearing loss disability did not meet the threshold minimum requirements for a ratable disability for VA compensation purposes. None of her puretone thresholds were 40 or 26 decibels or greater, and her speech recognition scores were not under 94 percent. As the medical evidence of record indicates that the Veteran’s bilateral hearing loss does not meet the criteria for either puretone thresholds or speech recognition ability to be considered a ratable disability for VA compensation purposes, service connection is not warranted. 38 C.F.R. § 3.385. 11. Entitlement to service connection for positive PPD, claimed as tuberculosis The Veteran contends she is entitled to service connected for a positive PPD test. The Board concludes that the Veteran does not have a current disability of tuberculosis or any residual from treatment for the positive PPD test and has not either at any time during the pendency of the claim or recent to the filing of the claim. Service connection is therefore not warranted. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. § 3.303 (a), (d). Pursuant to the regulatory provisions of 38 C.F.R. §§ 3.371 and 3.374, VA may not grant service connection for pulmonary tuberculosis (TB) unless a claimant submits VA or service physician diagnoses thereof, or submits the diagnosis of a private physician supported by clinical, X-ray, or laboratory studies or evidence of hospital treatment. Tubianosa v. Derwinski, 3 Vet. App. 181 (1992). The medical evidence of record indicates that the Veteran has never, at any point, been diagnosed with TB. Service, private and VA medical records are silent for a diagnosis of TB during or after service. October 2008 service treatment records note that the Veteran had a positive tuberculin skin test reaction. Additional October 2008 service treatment records document a negative chest x-ray and the provider found that the Veteran did not have active or infectious TB. The Veteran was diagnosed with a latent tuberculosis infection and prescribed a 9-month course of treatment with INH. December 2008 service treatment records state that the Veteran had a nonspecific reaction to a tuberculin skin test without active TB. July 2009 service treatment records note that the Veteran completed the 9 months of treatment with INH for latent TB and that she had no symptoms or complications from the treatment. An August 2011 VA examination noted the positive PPD in service and nine months of treatment. The examiner noted that there were no symptoms of TB at the time. The examiner found that the Veteran did not have any residuals from treatment and diagnosed a history of positive PPD, treated, no residuals. The Board finds that the VA examination is adequate for appellate review. There is no evidence that the examiner was not competent or credible, and as the reports ia based on the Veteran’s statements, in-person examination and the examiners’ observations, the Board finds it is entitled to significant probative weight. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302–05 (2008). While the Veteran’s STRs show a positive PPD during service, this is not an indication of current disability. A PPD test result is considered to be a laboratory finding used in exploring a possible diagnosis of tuberculosis. See DORLAND’S ILLUSTRATED MEDICAL DICTIONARY 1506, 1979 (32nd ed. 2012). Service connection applies only to diseases and the residuals of injury, not clinical findings found in laboratory test results. See 38 C.F.R. §§ 4.1, 4.10; see also 61 Fed. Reg. 20,440, 20,445 (May 7, 1996) (Diagnoses such as hyperlipidemia, elevated triglycerides, and elevated cholesterol are actually laboratory results and are not, in and of themselves, disabilities, and are not appropriate entities for the rating schedule). Thus, service connection is not warranted based solely on a showing of a positive PPD, absent a finding of active disease. As noted above, the medical record contains no evidence that the Veteran developed tuberculosis. In sum, the positive PPD test itself is not a disability for VA purposes, the Veteran never developed tuberculosis and the evidence indicates that she does not have any residuals from treatment. As with all claims for service-connection, in the absence of proof of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Service connection is therefore not warranted. 38 C.F.R. § 3.303. 12. Entitlement to service connection for hematoma of left thumb with partial nail removal The Veteran contends that she is entitled to service connection for a hematoma of her left thumb. The Board concludes that the Veteran does not have a current left thumb disability and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Service connection is therefore not warranted. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. § 3.303(a), (d); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The Board’s review indicates that private treatment records are silent for complaints, diagnosis or treatment of a left thumb disability. An August 2011 VA examination noted that the Veteran developed a hematoma underneath her left thumbnail in 2006. The nail was removed. The examiner found that the Veteran had no residual from the injury or the nail removal. The examiner diagnosed hematoma, resolved, no residuals. The Board finds that the VA examination is adequate for appellate review. There is no evidence that the examiner was not competent or credible, and as the reports ia based on the Veteran’s statements, in-person examination and the examiners’ observations, the Board finds it is entitled to significant probative weight. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302–05 (2008). The Board finds that the medical evidence of record indicates that while the Veteran had a left thumb hematoma with nail removal in service, she does not have a current left thumb disability. The record is silent for ongoing left thumb complaints and the August 2011 VA examination found no ongoing residuals. As with all claims for service-connection, in the absence of proof of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Service connection is therefore not warranted. 38 C.F.R. § 3.303. 13. Entitlement to service connection for enlarged pituitary gland The Veteran contends that she is entitled to service connection for an enlarged pituitary gland. The Board concludes that the Veteran does not have a current disability manifested by an enlarged pituitary gland and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Service connection is therefore not warranted. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. § 3.303 (a), (d). Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). A November 1991 brain MRI included a finding of a “slight fullness to the pituitary gland” and recommended clinical correlation to rule out pituitary dysfunction. November 1991 service treatment records contain an evaluation regarding the enlarged pituitary gland. The provider noted an upward bulge with a shift of the pituitary stalk to the left but found that there were no symptoms of pituitary adenoma. The provider opined that the Veteran’s enlarged pituitary gland was most likely a normal variant as 20 percent of pituitary scans showed an abnormality in the normal population. The Veteran was screened for acromegaly, cushings and tumors. December 1993 service treatment records note a history of enlarged pituitary gland in 1991 and planned a follow up MRI. June 1994 MRI results found slight enlargement of the pituitary. The provider noted that the findings might be seen with a pituitary microadenoma, but notes that the Veteran had a prior history of pituitary enlargement. The August 2011 VA examination noted the in-service finding of an enlarged pituitary gland and that no abnormalities were found. The Veteran did not report current treatment. The examiner found that the Veteran had a diagnosis of enlarged pituitary gland in service and that there were no associated problems or symptoms. The Board finds that service connection for an enlarged pituitary gland is not warranted. The first element that must be satisfied in any service connection claim is a showing of a current disability. In this case, while the Veteran was noted to have an enlarged pituitary gland in service, there is no evidence of a disability manifested by an enlarged pituitary gland. The in-service provider opined that the enlargement of the Veteran’s pituitary gland was most likely a normal variant and screenings were conducted for pituitary abnormalities. The August 2011 VA examination indicated that no abnormalities associated with the enlarged pituitary gland had been identified and the Veteran reported no symptoms or treatment. As with all claims for service-connection, in the absence of proof of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Service connection is therefore not warranted. 38 C.F.R. § 3.303. REASONS FOR REMAND 1. Entitlement to service connection for chronic bronchitis is remanded. An August 2011 VA examination found that the Veteran had episodes of bronchitis in the 1990s but that she had no episodes or treatment since that time. Subsequently, April 2013 private treatment records were added to the record which note an episode of bronchitis from February 2011 to March 2011. Remand for a new examination to consider the additional evidence is therefore required. 2. Entitlement to service connection for contact dermatitis 3. Entitlement to service connection for moles, claimed as dermatofibroma The August 2011 VA examiner noted in the report that the Veteran’s claimed skin conditions were addressed in a dermatology examination. However, the Board’s review indicates that there is no VA dermatology examination in the current record. Remand is therefore required so that the report from any VA dermatology examination may be obtained and associated with the claim file. In addition, since August 2011 medical evidence has been added to the file regarding both the Veteran’s claimed skin disabilities. May 2013 private treatment records note dermatitis of the scalp and October 2012 private treatment records indicate that a dermatofibroma was diagnosed on the back of the Veteran’s right shoulder. A new skin examination is therefore required to consider the new evidence. 4. Entitlement to service connection for recurring ingrown toenail, right great toe The Veteran contends that she has a current disability of a recurring right foot ingrown toenail. March 2010 service treatment records note an ingrown toenail on the right great toe that had persisted for around a year. Upon review, the Board notes that the August 2011 VA examination did not address this issue. Remand for a VA examination is therefore required. 5. Entitlement to service connection for an eye disability, to include dry eyes and refractive error The Board notes that the August 2011 VA eye examination found dry eyes diagnosed while on active duty and further notes that the eye disability claimed on the Veteran’s March 2011 application was recurrent eye irritation. June 2010 service treatment records note dry gritty eyes and a history of PRK. It is not clear, however, whether the Veteran’s dry eyes are a distinct and separate disability from her already service-connected keratitis. An addendum opinion to clarify the nature of the Veteran’s current eye disability should be obtained upon remand. 6. Entitlement to a compensable rating for chronic low back strain 7. Entitlement to a compensable rating for left knee chondromalacia patella 8. Entitlement to a compensable rating for right knee chondromalacia patella August 2011 VA examinations evaluated the Veteran’s low back and bilateral knee disabilities. The Board notes that since those examinations, the U.S. Court of Appeals for Veteran’s Claims (the Court) has issued the decision in Correia v. McDonald, 28 Vet. App. 158, 166 (2016) concerning the adequacy of VA orthopedic examinations. The Court in Correia held that the final sentence of 38 C.F.R. § 4.59 requires that VA examinations include joint testing for pain on both active and passive motion, in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint. The Board’s review indicates that the August 2011 VA joint examinations of record did not include the testing required under Correia and that remand for new examinations is required. 9. Entitlement to a compensable rating for hypertension An August 2011 VA examination evaluated the Veteran’s hypertension. The examiner stated that the Veteran’s blood pressure readings ran in the 120/70 range, noting readings of 123/77, 128/82 and 122/76. The Board notes that subsequent private treatment records indicate that the Veteran’s hypertension has worsened since the August 2011 examination. November 2013 private treatment records note a blood pressure reading of 138/84 and diagnosed essential hypertension- deteriorated. The records note recent readings of 130/70 in April 2012, 124/78 in September 2012, 120/72 in October 2012, 140/92 in April 2013, and 142/74 in May 2013. As the evidence of record suggests her hypertension has increased in severity since the most recent VA examination in 2011, the Board finds that the Veteran should be afforded a new examination. See Snuffer v. Gober, 10 Vet. App. 400 (1997). 10. Entitlement to a compensable rating for keratitis 11. Entitlement to a compensable rating for hammertoes with callouses, right 5th toe 12. Entitlement to a compensable rating for a left 5th toe, callouses, hammertoe and hyperkeratosis 13. Entitlement to a compensable rating for left hamstring strain 14. Entitlement to a compensable rating for hemorrhoids 15. Entitlement to a compensable rating for hysterectomy scar 16. Entitlement to a compensable rating for alopecia 17. Entitlement to a compensable rating for migraines The Veteran last underwent a VA examination to assess the severity of her service-connected keratitis, foot disabilities, left hamstring, hemorrhoids, scar, alopecia and migraines in August 2011, over seven years ago. VA must provide a new examination when the available evidence is too old to adequately evaluate the current state of the condition. See Olson v. Principi, 3 Vet. App. 480, 482 (1992) (citing Proscelle v. Derwinski, 2 Vet. App. 629, 632 (1992)). Remand for new VA examinations is therefore required. The matters are REMANDED for the following action: 1. Ask the Veteran to complete a VA Form 21-4142 for all private providers who treat her claimed disabilities. Make two requests for the authorized records from all identified providers, unless it is clear after the first request that a second request would be futile. 2. Schedule the Veteran for an appropriate VA examination, to determine the etiology of any current respiratory disability, to include chronic bronchitis. The examiner should review the file and provide a complete rationale for all opinions expressed. For any current respiratory disability found to be diagnosed, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that any such disability is related to the Veteran’s active service. In providing the opinion, the examiner should consider and discuss any lay statements of record, to include the Veteran’s statements regarding the onset and persistence of her symptoms. Attention is requested to June 2013 private treatment records noting a February 2011 to March 2011 episode of bronchitis. 3. Schedule the Veteran for an appropriate VA examination, to determine the etiology of any current skin disability, to include dermatitis and dermatofibroma. The examiner should review the file and provide a complete rationale for all opinions expressed. For any current skin disability found to be diagnosed, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that any such disability is related to the Veteran’s active service. In providing the opinion, the examiner should consider and discuss any lay statements of record, to include the Veteran’s statements regarding the onset and persistence of her symptoms. 4. Schedule the Veteran for an appropriate VA examination, to determine the etiology of any current right foot ingrown toenail disability. The examiner should review the file and provide a complete rationale for all opinions expressed. For any current right foot ingrown toenail disability found to be diagnosed, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that any such disability is related to the Veteran’s active service. In providing the opinion, the examiner should consider and discuss any lay statements of record, to include the Veteran’s statements regarding the onset and persistence of her symptoms. 5. Obtain an addendum opinion regarding whether the August 2011 examiner’s diagnosis of dry eyes constitutes a distinct and separate disability from the Veteran’s already service-connected keratitis. The provider should review the file and provide a complete rationale for all opinions expressed. 6. Schedule the Veteran for an appropriate VA examination to determine the current nature and severity of her chronic low back strain and bilateral knee disabilities. The claim file should be made available to and reviewed by the examiner and the examination report should state a review of the file was completed. All necessary tests should be performed and all findings should be reported in detail. The examiner should identify all low back and bilateral knee pathology found to be present. The examiner should conduct all indicated tests and studies, to include range of motion studies. The joints involved should be tested in both active and passive motion, in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint. If the examiner is unable to conduct the required testing or concludes that the required testing is not necessary in this case, he or she should clearly explain why that is so. The examiner should describe any pain, weakened movement, excess fatigability, instability of station and incoordination present. If pain is noted, the point during range of motion at which pain starts must be clearly indicated. The examiner should also state whether the examination is taking place during a period of flare-up. If not, the examiner should ask the Veteran to describe the flare-ups she experiences, including: frequency, duration, characteristics, precipitating and alleviating factors, severity and/or extent of functional impairment he experiences during a flare-up of symptoms and/or after repeated use over time. Based on the Veteran’s lay statements and the other evidence of record, the examiner should provide an opinion estimating any additional degrees of limited motion caused by functional loss during a flare-up or after repeated use over time. If the examiner cannot estimate the degrees of additional range of motion loss during flare-ups or after repetitive use without resorting to speculation, the examiner should state whether the need to speculate is caused by a deficiency in the state of general medical knowledge (i.e. no one could respond given medical science and the known facts) or by a deficiency in the record or the examiner (i.e. additional facts are required, or the examiner does not have the needed knowledge or training). 7. Schedule the Veteran for an appropriate VA examination to determine the current level of severity of her hypertension. The examiner should review the file and provide a complete rationale for all opinions expressed. 8. Schedule the Veteran for an appropriate VA examination to determine the current level of severity of her keratitis. The examiner should review the file and provide a complete rationale for all opinions expressed. 9. Schedule the Veteran for an appropriate VA examination to determine the current level of severity of her right 5th toe hammertoe with callouses and her left 5th toe, callouses, hammertoe and hyperkeratosis. The examiner should review the file and provide a complete rationale for all opinions expressed. 10. Schedule the Veteran for an appropriate VA examination to determine the current level of severity of her left hamstring strain. The examiner should review the file and provide a complete rationale for all opinions expressed. 11. Schedule the Veteran for an appropriate VA examination to determine the current level of severity of her hemorrhoids. The examiner should review the file and provide a complete rationale for all opinions expressed. 12. Schedule the Veteran for an appropriate VA examination to determine the current level of severity of her hysterectomy scar. The examiner should review the file and provide a complete rationale for all opinions expressed. 13. Schedule the Veteran for an appropriate VA examination to determine the current level of severity of her alopecia. The examiner should review the file and provide a complete rationale for all opinions expressed. 14. Schedule the Veteran for an appropriate VA examination to determine the current level of severity of her migraines. The examiner should review the file and provide a complete rationale for all opinions expressed. 15. If upon completion of the above action the appeal remains denied, the case should be returned to the Board after compliance with appellate procedures. E. I. VELEZ Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Arnold, Associate Counsel