Citation Nr: 18154389 Decision Date: 11/29/18 Archive Date: 11/29/18 DOCKET NO. 16-40 185 DATE: November 29, 2018 ORDER Service connection for degenerative disc disease in the lumbar spine (lumbar spine disability) is denied. Service connection for a right shoulder disability is denied. Service connection for a left shoulder disability is denied. Service connection for arthritis in the cervical spine (neck disability) is denied. Service connection for cervical radiculopathy is denied. Service connection for a left knee disability is denied. REMANDED Service connection for peripheral neuropathy in the lower extremities is remanded. Service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), depression, and anxiety, is remanded. FINDINGS OF FACT 1. Scoliosis preexisted service entry and was “noted” at service entrance; lumbar spine disabilities of degenerative disc disease and spondylosis, which were not “noted” at service entrance, did not clearly and unmistakably preexist service. 2. The Veteran is currently diagnosed with degenerative disc disease and spondylosis in the lumbar spine; the Veteran did not sustain a superimposed back injury during service; symptoms of the current lumbar spine disability were not chronic in service, were not continuous since service separation, and did not manifest to a compensable degree within one year of service separation; the current lumbar spine disability is not otherwise etiologically related to active service. 3. The Veteran is currently diagnosed with traumatic impingement syndrome and arthritis in the right shoulder; symptoms of the current right shoulder disability were not chronic in service, were not continuous since service separation, and did not manifest to a compensable degree within one year of service separation; the current right shoulder disability is not otherwise etiologically related to active service. 4. The Veteran is currently diagnosed with impingement syndrome in the left shoulder; the current left shoulder disability did not have its onset during service and is not otherwise etiologically related to active service. 5. The Veteran is currently diagnosed with degenerative disc disease, stenosis, and arthritis in the cervical spine; symptoms of the current cervical spine disability were not chronic in service, were not continuous since service separation, and did not manifest to a compensable degree within one year of service separation; the current cervical spine disability is not otherwise etiologically related to active service. 6. The Veteran is currently diagnosed with cervical radiculopathy; the current cervical radiculopathy is caused by the non-service-connected cervical spine disability; the current cervical radiculopathy is not otherwise etiologically related to active service. 7. The Veteran is currently diagnosed with septic arthritis in the left knee; symptoms of the left knee disability were not chronic in service, were not continuous since service separation, and did not manifest to a compensable degree within one year of service separation; the current left knee disability is not otherwise etiologically related to active service. CONCLUSIONS OF LAW 1. The criteria for service connection for a lumbar spine disability have not been met. 38 U.S.C. §§ 1112, 1131, 1153, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.306, 3.307, 3.309. 2. The criteria for service connection for a right shoulder disability have not been met. 38 U.S.C. §§ 1112, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.307, 3.309. 3. The criteria for service connection for a left shoulder disability have not been met. 38 U.S.C. §§ 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304. 4. The criteria for service connection for a neck disability have not been met. 38 U.S.C. §§ 1112, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.307, 3.309. 5. The criteria for service connection for cervical radiculopathy have not been met. 38 U.S.C. §§ 1112, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.307, 3.309. 6. The criteria for service connection for a left knee disability have not been met. 38 U.S.C. §§ 1112, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran, who is the appellant, served on active duty from September 1976 to September 1979. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in service disease or injury and the current disability. A veteran will be considered to have been in sound condition when examined, accepted, and enrolled for service, except as to defects, infirmities, or disorders noted at entrance into service, or where clear and unmistakable evidence demonstrates that an injury or disease existed prior thereto and was not aggravated by service. 38 U.S.C. § 1111. Only such conditions as are recorded in examination reports are to be considered as noted. 38 C.F.R. § 3.304(b). Where such defects, infirmities or disorders are not noted when examined, accepted, and enrolled for service, pursuant to 38 U.S.C. § 1111 and 38 C.F.R. § 3.304, in order to rebut the presumption of soundness on entry into service, VA must show by clear and unmistakable evidence both that the disease or injury existed prior to service and that the disease or injury was not aggravated by service. See Wagner v. Principi, 370 F.3d 1089 (Fed. Cir. 2004); VAOPGCPREC 3-03. Scoliosis was “noted” at service entrance; therefore, scoliosis preexisted service entry. Accordingly, in order to establish service connection for the lumbar spine disability, there has to be a showing of aggravation (worsening beyond normal progression) of the lumbar spine disability during service. 38 U.S.C. § 1153; 38 C.F.R. § 3.306. The Veteran is currently diagnosed with spondylosis in the lumbar spine (as arthritis), arthritis in the cervical spine, right shoulder, and left knee, which is a “chronic disease” under 38 C.F.R. § 3.309(a). Therefore, the presumptive provisions of 38 C.F.R. § 3.303(b) for “chronic” in service symptoms and “continuous” post service symptoms apply. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Where the evidence shows a “chronic disease” in service or “continuity of symptoms” after service, the disease shall be presumed to have been incurred in service. For the showing of “chronic” disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. With chronic disease as such in service, subsequent manifestations of the same chronic disease at any later date, however remote, are service-connected, unless clearly attributable to intercurrent causes. If a condition noted during service is not shown to be chronic, then generally, a showing of “continuity of symptoms” after service is required for service connection. 38 C.F.R. § 3.303(b). Additionally, where a veteran served ninety days or more of active service, and certain chronic diseases, such as arthritis, become manifest to a degree of 10 percent or more within one year after the date of separation from such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 C.F.R. §§ 3.307, 3.309(a). While the disease need not be diagnosed within the presumption period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. Id. 1. Service connection for a lumbar spine disability The Veteran contends that a current lumbar spine disability developed as a result of lifting heavy objects during active service. See January 2014 Statement. Alternatively, the Veteran asserts that he was involved in a fatal motor vehicle accident and was transported to the hospital. See April 2015 Notice of Disagreement. As discussed above, scoliosis was “noted” at service entrance, therefore, scoliosis preexisted service. On an August 1976 service entrance examination, the Veteran was found to have scoliosis that was not considered disqualifying. On a corresponding August 1976 Report of Medical History, the Veteran denied symptoms of recurrent back pain. Scoliosis is a congenital defect. Congenital or developmental “defects” are considered to have preexisted service. 38 C.F.R. §§ 3.303 (c), 4.9. Because scoliosis was “noted” at service entrance or examination, the question is whether there was superimposed injury to the spine during active service. Service connection is generally precluded by regulation for such “defects” because they are not “diseases” or “injuries” within the meaning of applicable legislation. 38 C.F.R. §§ 3.303 (c), 4.9, 4.127; accord Terry v. Principi, 340 F.3d 1378, 1383-84 (Fed. Cir. 2003); Palczewski v. Nicholson, 21 Vet. App. 174, 179 (2007). To establish service connection for a congenital defect, the evidence must show superimposed disease or injury during service. VAOPGCPREC 82-90. Defects are defined as “structural or inherent abnormalities or conditions which are more or less stationary in nature.” VAOPGCPREC 82-90. A defect differs from a disease in that a defect is “more or less stationary in nature,” while a disease is “capable of improving or deteriorating.” See VAOPGCPREC 82-90 at para. 2. The presumption of soundness does not apply to congenital defects because such defects “are not diseases or injuries” within the meaning of 38 U.S.C. §§ 1131 and 1111. See 38 C.F.R. § 3.303(c); Terry, 340 F.3d at 1385-86 (holding that the presumption of soundness does not apply to congenital defects); Winn v. Brown, 8 Vet. App. 510, 516 (1996) (holding that a non-disease or non-injury entity such as a congenital defect is “not the type of disease- or injury-related defect to which the presumption of soundness can apply”). Initially, the Board finds the Veteran is currently diagnosed with degenerative disc disease and spondylosis in the lumbar spine. See April 2002 Social Security Administration (SSA) record. After a review of all the evidence, the Board finds that the weight of the evidence shows that the Veteran did not sustain a superimposed injury to the lower back during service. Although the Veteran asserts that he was involved in a motor vehicle accident and was transported to the hospital, service treatment records do not show that the Veteran was involved in any motor vehicle accidents at any time during active service. The Board further finds that the weight of the evidence does not demonstrate that the Veteran experienced worsening back pain during service. Service treatment records do not reflect any complaints, symptoms, diagnosis, or treatment for back pain or any back injuries during service. A June 1977 service examination and a September 1979 service separation examination found the Veteran’s spine and other musculoskeletal systems were found to be clinically normal. A June 1977 Report of Medical History shows the Veteran endorsed symptoms of swollen and painful joints, described as occurring in the feet, but denied symptoms of recurrent back pain. The same evidence above also does not demonstrate chronic symptoms of a lumbar spine disability during service. The lay and medical evidence weighs against a finding of continuous symptoms of a lumbar spine disability since service separation; therefore, presumptive service connection under the provisions of 38 C.F.R. § 3.303(b) is not warranted based on either “chronic” in-service or “continuous” post service symptoms. As discussed above, neither the service treatment records, the June 1977 service examination, or the September 1979 service separation examination indicated any findings or diagnosis for a lumbar spine disability, or any other issues with the lower back. The earliest evidence of a lumbar spine disability is not indicated until 1993 in a May 2001 SSA record showing the Veteran reported a lower back strain that required treatment in 1993. Other SSA records show the Veteran reported a lower back strain in 1993 that required some treatment, but denied any lower back symptoms or treatment since 1993 until he sustained a work-related back injury in May 2001. See August 2002 SSA record. The earliest evidence of arthritis in the lumbar spine appears in an August 2001 VA treatment record following the May 2001 workplace injury, nearly 22 years after service separation and nearly 21 years outside of the applicable presumptive period. On the question of direct nexus between the current lumbar spine disability and service, the Board finds that the preponderance of the lay and medical evidence is against a finding that the current lumbar spine disability is causally related to service. The weight of the evidence shows that the current lumbar spine disability did not have its onset active service, that the Veteran was not treated for a lumbar spine disability until after service following a May 2001 workplace accident, and was not diagnosed with arthritis in the lumbar spine until August 2001. As the evidence of record does not contain a competent medical opinion establishing a medical nexus between the current lumbar spine disability and an injury, disease, or event during service, the Board finds that the weight of the evidence is against service connection for a lumbar spine disability, and the claim must be denied. 2. Service connection for a right shoulder disability The Veteran contends that a right shoulder disability is the result of lifting heavy items on a daily basis during active service; alternatively, the Veteran asserts a right shoulder disability is the result of being involved in a fatal motor vehicle accident during service. See April 2015 Notice of Disagreement. An October 2002 SSA record shows the Veteran is currently diagnosed with traumatic impingement syndrome and arthritis in the right shoulder. After reviewing all the lay and medical evidence of record, the Board finds that the current right shoulder disability did not have its onset during service, and is not otherwise etiologically related to active service. A June 1977 Report of Medical History reflects the only complaint of a painful or “trick” shoulder during service, which was described as shoulder pain after receiving a shot and when lifting heavy objects. Service treatment records do not show any other complaints, symptoms, diagnosis, or treatment for right shoulder pain or any shoulder injuries; as discussed above, service treatment records do not reflect treatment following a motor vehicle accident at any time during active service. The June 1977 service examination and September 1979 service separation examination found the upper extremities and other musculoskeletal systems to be clinically normal. As such, the above evidence does not demonstrate chronic symptoms of a right shoulder disability during service. The lay and medical evidence weighs against a finding of continuous symptoms of a right shoulder disability since service separation; therefore, presumptive service connection under the provisions of 38 C.F.R. § 3.303(b) is not warranted based on either “chronic” in-service or “continuous” post service symptoms. As discussed above, neither the service treatment records nor the September 1979 service separation examination report indicated any findings or diagnosis for a right shoulder disability, or any other issues with the right shoulder. The earliest evidence of any right shoulder problems appears in a May 2001 SSA record that shows the Veteran complained of bilateral shoulder pain following a workplace accident earlier that month; an August 2001 VA treatment record reflects X-rays of the right shoulder were normal. An August 2002 SSA record shows the Veteran denied experiencing any right shoulder pain prior to the May 2001 workplace accident. The earliest evidence of arthritis in the right shoulder appears in the October 2002 SSA record showing X-rays of the right shoulder revealed traumatic impingement syndrome and mild acromioclavicular joint arthritis in the right shoulder, over 23 years after service separation and 22 years outside of the applicable presumptive period. On the question of direct nexus between the current right shoulder disability and service, the Board finds that the preponderance of the lay and medical evidence is against a finding that the currently diagnosed right shoulder disability is causally related to service. The weight of the evidence shows that the right shoulder disability had its onset after active service, that the Veteran was not treated for right shoulder pain until many years after service following a workplace accident in May 2001, and was not diagnosed with right shoulder arthritis until October 2002. As the evidence of record does not contain a competent medical opinion establishing a medical nexus between the current right shoulder disability and an injury, disease, or event during service, the Board finds that the weight of the evidence is against service connection for a right shoulder disability, and the claim must be denied. 3. Service connection for a left shoulder disability The Veteran contends that a left shoulder disability is the result of lifting heavy items on a daily basis during active service; alternatively, the Veteran asserts a left shoulder disability is the result of being involved in a fatal motor vehicle accident during service. See April 2015 Notice of Disagreement. An January 2013 VA treatment record shows the Veteran is currently diagnosed with impingement syndrome in the left shoulder. After a review of all the lay and medical evidence of record, the Board finds that the weight of the evidence demonstrates the current left shoulder disability is not related to active service. As discussed above, a June 1977 Report of Medical History reflects the only complaint of a painful or “trick” shoulder during service, which was described as shoulder pain after receiving a shot and when lifting heavy objects. Service treatment records do not show any other complaints, symptoms, diagnosis, or treatment for left shoulder pain or any shoulder injuries; service treatment records also do not reflect treatment following a motor vehicle accident at any time during active service. Furthermore, the June 1977 service examination and September 1979 service separation examination found the upper extremities and other musculoskeletal systems to be clinically normal. Post-service SSA treatment records show the Veteran complained of bilateral shoulder pain following a May 2001 workplace accident, but that the Veteran was not diagnosed with a left shoulder disability at that time. Thereafter, a July 2012 VA treatment record shows the Veteran complained of left shoulder and left knee pain after falling at the lake earlier that month; a September 2012 VA treatment record shows the Veteran reported left shoulder pain for the past six months; an October 2012 VA treatment record reflects the Veteran reported left shoulder pain since July 2012. A January 2013 VA treatment record shows X-rays of the left shoulder revealed impingement syndrome. Furthermore, the evidence of record does not contain any competent medical opinion establishing a medical nexus between the current left shoulder disability to any injury, disease, or event during service. For these reasons, the Board finds that the weight of the evidence demonstrates that the current left shoulder disability was not incurred in or otherwise caused by active service. As the preponderance of the evidence is against the claim for service connection for a left shoulder disability, the claim must be denied. 4. Service connection for a neck disability The Veteran asserts that a neck disability is the result of lifting heavy items on a daily basis during active service; alternatively, the Veteran asserts a neck disability is the result of being involved in a fatal motor vehicle accident during service. See April 2015 Notice of Disagreement. The Veteran is currently diagnosed with degenerative disc disease, stenosis, and arthritis in the cervical spine. See May 2001 SSA record; August 2001 SSA record; December 2001 SSA record. After reviewing all the lay and medical evidence of record, the Board finds that the current neck disability did not have its onset during service, and is not otherwise etiologically related to active service. Service treatment records do not show any other complaints, symptoms, diagnosis, or treatment for neck pain or any neck injuries; as discussed above, service treatment records do not reflect treatment following a motor vehicle accident at any time during active service. A June 1977 Report of Medical History reflects the Veteran endorsed swollen or painful joints, and a history of bone, joint or other deformity, which was described as swollen joints in the feet. The June 1977 service examination and September 1979 service separation examination found the neck and other musculoskeletal systems to be clinically normal. As such, the above evidence does not demonstrate chronic symptoms of a neck disability during service. The lay and medical evidence weighs against a finding of continuous symptoms of a neck disability since service separation; therefore, presumptive service connection under the provisions of 38 C.F.R. § 3.303(b) is not warranted based on either “chronic” in-service or “continuous” post service symptoms. As discussed above, neither the service treatment records nor the September 1979 service separation examination report indicated any findings or diagnosis for a neck disability, or any other issues with the neck. The earliest evidence of any neck problems appears in a May 2001 SSA record that shows the Veteran had a workplace accident where he fell into a two foot deep drain pit and sustained multiple injuries to several parts of the body. Although examination of the neck done the day of the workplace accident found range of motion in the cervical spine to be completely normal, X-rays of the neck revealed degenerative changes in the cervical spine, nearly 22 years after service separation and 21 years outside of the applicable presumptive period. On the question of direct nexus between the current neck disability and service, the Board finds that the preponderance of the lay and medical evidence is against a finding that the currently diagnosed neck disability is causally related to service. The weight of the evidence shows that the neck disability had its onset after active service, that the Veteran was not treated for neck pain until many years after service following a workplace accident in May 2001, and was not diagnosed with arthritis in the cervical spine until May 2001. As the evidence of record does not contain a competent medical opinion establishing a medical nexus between the current neck disability and an injury, disease, or event during service, the Board finds that the weight of the evidence is against service connection for a neck disability, and the claim must be denied. 5. Service connection for cervical radiculopathy The Veteran asserts that cervical radiculopathy is the result of lifting heavy items on a daily basis during active service; alternatively, the Veteran asserts cervical radiculopathy is the result of being involved in a fatal motor vehicle accident during service. See April 2015 Notice of Disagreement. VA treatment records throughout the claim period on appeal reflect the Veteran is currently diagnosed with cervical radiculopathy. See e.g. November 2014 VA treatment record. Upon review of all the lay and medical evidence of record, the Board finds that the weight of the evidence demonstrates the current cervical radiculopathy is the result of a neck disability, for which service connection has been denied in the Board’s instant decision above. SSA treatment records reflect that the Veteran complained of numbness and tingling in the fingers and hands following the May 2001 workplace accident described above. A December 2001 SSA treatment record shows that an MRI of the cervical spine revealed bilateral neural foraminal stenosis due to protruding osteophytes and overgrown facets. A March 2015 VA treatment record reflects cervical radiculopathy was currently stable with no new neurological sequelae. As the lay and medical evidence of record demonstrates that the current cervical radiculopathy is the result of the non-service-connected neck disability, the Board finds that the criteria for service connection for cervical radiculopathy has not been met and the claim must be denied. 6. Service connection for a left knee disability The Veteran asserts that a left knee disability is the result of lifting heavy items on a daily basis during active service; alternatively, the Veteran asserts a left knee disability is the result of being involved in a fatal motor vehicle accident during service. See April 2015 Notice of Disagreement. The Veteran is currently diagnosed with septic arthritis in the left knee. See July 2012 VA treatment record. After reviewing all the lay and medical evidence of record, the Board finds that the current left knee disability did not have its onset during service, and is not otherwise etiologically related to active service. Service treatment records do not show any other complaints, symptoms, diagnosis, or treatment for left knee pain or any knee injuries; as discussed above, service treatment records do not reflect treatment following a motor vehicle accident at any time during active service. A June 1977 Report of Medical History reflects the Veteran denied symptoms of a “trick” or locked knee. The June 1977 service examination and September 1979 service separation examination found the lower extremities and other musculoskeletal systems to be clinically normal. As such, the above evidence does not demonstrate chronic symptoms of a left knee disability during service. The lay and medical evidence weighs against a finding of continuous symptoms of a left knee disability since service separation; therefore, presumptive service connection under the provisions of 38 C.F.R. § 3.303(b) is not warranted based on either “chronic” in-service or “continuous” post service symptoms. As discussed above, neither the service treatment records nor the September 1979 service separation examination report indicated any findings or diagnosis for a left knee disability, or any other issues with the left knee. The earliest evidence of any left problems appears in a May 2001 SSA record that shows the Veteran had a workplace accident where he fell into a two foot deep drain pit and sustained multiple injuries to several parts of the body, and complained of knee pain following the accident. Furthermore, a January 2002 SSA treatment record shows the Veteran denied sustaining any injuries to the knees prior to the May 2001 workplace accident; upon examination of the Veteran, the January 2002 private provider found the left knee had decreased range of motion in all planes measured, deep tendon reflexes were depressed, strength was diminished, and sensory findings were positive. After examining the Veteran and review of medical records, the January 2002 private provider opined, based upon reasonable medical certainty, that the Veteran sustained an injury to the knees from the May 2001 workplace accident. The earliest evidence of left knee arthritis appears in the July 2012 VA treatment record discussed above, which shows the Veteran complained of left knee pain after falling at the lake earlier that month, nearly 33 years after service separation and 32 years outside of the applicable presumptive period. On the question of direct nexus between the current left knee disability and service, the Board finds that the preponderance of the lay and medical evidence is against a finding that the currently diagnosed left knee disability is causally related to service. The weight of the evidence shows that the left disability had its onset after active service, that the Veteran was not treated for left knee pain until many years after service following a workplace accident in May 2001, and was not diagnosed with arthritis in the left knee until July 2012 after falling at the lake earlier that month. As the evidence of record does not contain a competent medical opinion establishing a medical nexus between the current left knee disability and an injury, disease, or event during service, the Board finds that the weight of the evidence is against service connection for a left knee disability, and the claim must be denied. REASONS FOR REMAND 1. Service connection for peripheral neuropathy in the lower extremities The Veteran contends that peripheral neuropathy in the lower extremities is the result of a right ankle injury sustained during active service. The Veteran asserts that the right ankle is unable to support him through his daily activities and has resulted in frequent ankle sprains, which caused the development of peripheral neuropathy in the lower extremities. See April 2015 Notice of Disagreement. A June 1979 service treatment record reflects the Veteran sustained a right ankle sprain from stepping out of a five-ton truck. The record shows the Veteran has not been provided a VA examination to help determine the etiology of the current peripheral neuropathy in the lower extremities. As such, the Board finds that remand for a VA examination is needed. 2. Service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), depression, and anxiety is remanded. The Veteran generally asserts having developed an acquired psychiatric disorder as a result of military service (claimed as service connection for PTSD). A September 2009 VA treatment record reflects a diagnosis of PTSD. In a January 2014 statement, the Veteran identified a stressor event he asserts occurred during military service. Specifically, the Veteran contends he was involved in a vehicle accident while stationed in Germany in September 1977. In a September 2014 administrative decision, the Regional Office found the information the Veteran provided was insufficient to provide to the Joint Services Records Research Center (JSRRC) and/or insufficient to allow for meaningful research of Marine Corps or National Archives and Records Administration records. The record indicates that the Veteran has also been diagnosed with depression and anxiety disorder, which have a lower evidentiary standard to support a service connection disability claim. Additionally, a June 1977 Report of Medical History shows the Veteran endorsed symptoms of nervous trouble. As such, the Board finds remand necessary to obtain a VA examination assessing all of the Veteran’s current acquired psychiatric disorders, and whether any of the disorders are related to the reported in-service stressor and/or symptoms of nervous trouble. The matters are REMANDED for the following actions: 1. Schedule the appropriate VA examination in order to assess the nature and etiology of the claimed peripheral neuropathy in the lower extremities. The examiner should provide the following opinion: Is it at least as likely as not (i.e. probability of 50 percent or more) that the current peripheral neuropathy in the lower extremities is etiologically related to active service, to include the right ankle sprain sustained in June 1979? 2. Schedule a VA examination in order to assess the Veteran’s current acquired psychiatric disorder(s). The VA examiner should diagnose all acquired psychiatric disorders and then provide the following opinions: Does the Veteran have a current diagnosis of any acquired psychiatric disorder(s), other than PTSD? If so, it is at least as likely as not (i.e., probability of 50 percent or more) that any such acquired psychiatric disorder is related to active service, including to the reported service stressor and/or the symptoms of nervous trouble endorsed on the June 1977 Report of Medical History? J. PARKER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD E. Choi, Associate Counsel