Citation Nr: 18155226
Decision Date: 12/03/18	Archive Date: 12/03/18

DOCKET NO. 15-12 976
DATE:	December 3, 2018

ORDER
Service connection for lumbar facet arthropathy (claimed as chronic low back pain T-spine with degenerative disk disease and sciatic arthritis of low back L5-S1) is denied.
Service connection for headaches is denied. 
Service connection for diabetes is denied.
Service connection for a right ankle disorder is denied.
Service connection for radical retro-pubic prostatectomy, status post prostate cancer is denied.
Service connection for obstructive sleep apnea is denied.
Service connection for an acquired psychiatric disorder is granted.
Service connection for chronic sinusitis is denied.
An initial disability rating in excess of 20 percent for a left knee strain is denied.
A separate 10 percent rating for left knee instability is granted.
An initial disability rating in excess of 20 percent for a left ankle disorder is denied.
An initial disability rating in excess of 10 percent for residuals of a right-hand fracture is denied.
A compensable rating for status-post right wrist cyst removal is denied.
An initial disability rating in excess of 10 percent for a right knee disorder, characterized as right knee osteoarthritis for the period prior to July 7, 2015 is denied.
A disability rating in excess of 30 percent for a right knee disorder, characterized as status post total right knee replacement, from January 1, 2017 is denied. 
A temporary total evaluation based on treatment for a right wrist disability is denied.  
An effective date of July 29, 2012, but no earlier, for the grant of service connection for a left knee strain is granted.
An effective date of July 29, 2012, but no earlier, for the grant of service connection for a left ankle disorder is granted.
An effective date of July 29, 2012, but no earlier, for the grant of service connection for residuals of a right-hand fracture is granted.
An effective date of July 29, 2012, but no earlier, for the grant of service connection for right wrist cyst removal is granted.
An effective date prior to March 2, 2010, for the award of service connection for right knee osteoarthritis is denied.
A temporary total disability rating due to surgical treatment which required a convalescence period is denied. 

REMANDED
The claim of entitlement to service connection for bilateral hearing loss is remanded.
The claim of entitlement to service connection for tinnitus is remanded. 
The claim of entitlement to service connection for hypertension is remanded.
The claim of entitlement to a total disability rating based on individual unemployability due to service connected disability (TDIU) is remanded. 

FINDINGS OF FACT
1. The Veteran received a dishonorable discharge for his period of service spanning from March 12, 1982 to August 25, 1989.
2. There is no competent and probative evidence that the Veteran’s lumbar facet arthropathy began during his periods of qualifying active duty service or is etiologically related to his periods of qualifying active duty service, and there is no evidence that arthritis manifested within one year of separation. 
3. There is no competent and probative evidence that the Veteran’s headaches began during his periods of qualifying active duty service, or that it is etiologically related to his periods of qualifying active duty service.  
4. There is no competent and probative evidence that the Veteran’s diabetes began during his periods of qualifying active duty service, or that it is etiologically related to his periods of qualifying active duty service.  
5. There is no competent and probative evidence that the Veteran’s right ankle disability began during his periods of qualifying active duty service or is etiologically related to his periods of qualifying active duty service, and there is no evidence that arthritis manifested within one year of separation. 
6. There is no competent and probative evidence that the Veteran’s prostate cancer and its associated residuals began during his periods of qualifying active duty service, or that it is etiologically related to his periods of qualifying active duty service.  
7.  There is no competent and probative evidence that the Veteran’s obstructive sleep apnea began during his periods of qualifying active duty service, or that it is etiologically related to his periods of qualifying active duty service.  
8. The Veteran’s acquired psychiatric disorder is proximately due to or aggravated beyond its natural progression by his service-connected disabilities. 
9.  There is no competent and probative evidence that the Veteran’s sinusitis began during his periods of qualifying active duty service, or that it is etiologically related to his periods of qualifying active duty service.  
10. The Veteran is in receipt of the highest disability rating under DC 5258 for his left knee disability; the evidence of record does not reflect that the left knee is ankylosed, that the semilunar cartilage is dislocated with frequent episodes of locking, pain, and joint effusion, that the semilunar cartilage has been removed, that there is malunion or nonunion of the tibia and fibula, that there is a current diagnosis of genu recurvatum, and/or that the Veteran’s left knee disability has been manifested by limitation of flexion or extension to a compensable degree
11. The Veteran’s left knee disability has been manifested by instability.
12. The Veteran is in receipt of the highest disability rating under DC 5273 for his left ankle; the evidence of record does not show ankylosis of the left ankle.
13. The Veteran’s service-connected right wrist disability is manifested by complaints of pain and difficulty bending, as well as objective evidence of limitation of motion; no ankylosis of the wrist is apparent.  
14. The Veteran’s right wrist scar has not been unstable or painful and has not caused any limitation of motion or loss of function of the right wrist. 
15. Prior to July 7, 2015, the Veteran’s right knee disability was characterized as right knee osteoarthritis.  Flexion limited to 30 degrees or less; extension limited to 15 degrees or more; recurrent subluxation or objective evidence of slight lateral instability; dislocated semilunar cartilage with frequent locking, pain, or effusion into the joint; or impairment of the tibia or fibula, prior to his July 2015 total knee replacement have not been shown. 
16. Beginning January 1, 2017, the Veteran’s right knee disability was characterized as status post knee replacement; extremely unfavorable ankylosis in flexion between 10 and 20 degrees, limitation of extension to 30 degrees, and impairment of the tibia and fibula, have not been shown.
17. On July 29, 2012, the Veteran filed informal service connection claims for claims for a left knee disorder, left ankle disorder, residuals of a right-hand fracture, and right wrist cyst removal.
18. The Veteran filed a claim for right knee osteoarthritis on March 2, 2010.
19. The Veteran underwent surgery for a ganglion cyst excision in 1980 and right-sided carpal tunnel release in December 2012, but the record evidence does not indicate that any of the Veteran’s right wrist disability required hospitalization or convalescence following treatment for his service-connected right wrist disability.

CONCLUSIONS OF LAW
1. The Veteran’s period of service from March 12, 1982 to August 25, 1989 is considered dishonorable for VA purposes and serves as a bar to the payment of VA compensation benefits. 38 U.S.C. §§ 101, 5303; 38 C.F.R. §§ 3.1, 3.12, 3.354.
2. The criteria for service connection for lumbar facet arthropathy are not met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.
3. The character of the Veteran’s service is a bar to benefits for entitlement to service connection for headaches. 38 U.S.C, §§ 101, 5107; 38 C.F.R. §§ 3.1, 3.12, 3.13, 3.102, 3.203, 3.354.
4. The criteria for service connection for diabetes are not met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.
5. The character of the Veteran’s service is a bar to benefits for entitlement to service connection for a right ankle disability. 38 U.S.C, §§ 101, 5107; 38 C.F.R. §§ 3.1, 3.12, 3.13, 3.102, 3.203, 3.354.
6. The criteria for service connection for residuals of prostate cancer status postradical retropubic prostatectomy are not met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.
7. The criteria for entitlement to service connection for obstructive sleep apnea have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.
8. The criteria for secondary service connection for an acquired psychiatric disorder are met.  38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3, 303, 3.307, 3.309, 3.310.
9. The criteria for service connection for chronic sinusitis are not met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.
10. The criteria for a rating in excess of 20 percent for a left knee disability have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.71a, Diagnostic Code (DC) 5258.
11. Resolving all reasonable doubt in favor of the Veteran, the criteria for a separate 10 percent disability rating for slight instability of the left knee have been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.102, 3.159, 3.321, 3.326(a), 4.1, 4.3, 4.7, 4.10, 4.14, 4.21, 4.71a, DC 5257.
12. The criteria for a rating in excess of 20 percent for a left ankle disability have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.71a, DC 5271.
13. The criteria for an evaluation in excess of 10 percent for residuals of a right wrist fracture have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.321 (b)(1), 4.1, 4.10, 4.40, 4,.45, 4.59, 4.71a, DC 5215.
14. The criteria for a compensable evaluation for status post right wrist cyst removal have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.321 (b)(1), 4.1, 4.10, 4.40, 4,.45, 4.59, 4.118, DC 7805.
15. Prior to July 7, 2015, the criteria for an evaluation in excess of 10 percent for a right knee disorder have not been met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 3.400(o), 4.3, 4.7, 4.20, 4.71a, DCs 5010-5261.
16. Beginning January 1, 2017, the criteria for an evaluation in excess of 30 percent for a right knee disorder have not been met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 3.400(o), 4.3, 4.7, 4.20, 4.71a, DC 5055.
17. The criteria for the assignment of an effective date of July 29, 2012, but not earlier, for the grant of service connection for a left knee disorder have been met. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.155, 3.400.
18. The criteria for the assignment of an effective date of July 29, 2012, but not earlier, for the grant of service connection for a left ankle disorder have been met. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.155, 3.400.
19. The criteria for the assignment of an effective date of July 29, 2012, but not earlier, for the grant of service connection for residuals of a right-hand fracture have been met. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.155, 3.400.
20. The criteria for the assignment of an effective date of July 29, 2012, but not earlier, for the grant of service connection for right wrist cyst removal have been met. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.155, 3.400.
21. The criteria for the assignment of an effective date of earlier than March 2, 2010 for the grant of service connection for right knee osteoarthritis have not been met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. §§ 3.155, 3.157 (in effect prior to March 24, 2015), 3.400.
22. The criteria for entitlement to a temporary total disability rating based on the need for hospitalization or convalescence of a service-connected disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.29, 4.30.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS
The Veteran served on active duty from September 1975 to April 1978; from April 1978 to November 1978; and from April 1980 to March 11, 1982.  The Veteran also served on active duty from March 12, 1982 to August 25, 1989, at which time he received a bad conduct discharge pursuant to a special court-martial.  His last period of service has been determined to constitute dishonorable service, and is a bar to the payment of VA benefits based upon that final period of service.
This matter comes before the Board of Veterans’ Appeals (Board) on appeal from rating decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO).
The Board notes that the Veteran’s psychiatric disorder was initially claimed as PTSD; however, the Board has broadened that issue on appeal to include other diagnosed acquired psychiatric disorders, and combined it into one issue as reflected above. Clemons v. Shinseki, 23 Vet. App. 1 (2009).
Service Connection
Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303.  Evidence of continuity of symptomatology from the time of service until the present is required where the chronicity of a chronic condition manifested during service either has not been established or might reasonably be questioned. 38 C.F.R. § 3.303 (b); see also Walker v. Shinseki, 708 F.3d 1331, 1340 (Fed.Cir.2013) (holding that only conditions listed as chronic diseases in § 3.309(a) may be considered for service connection under 38 C.F.R. § 3.303 (b) (2017).  Regulations also provide that service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303 (d).
Generally, in order to prove service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999).
Service connection may also be established for a disability which is proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310 (a). Further, a disability which is aggravated by a service-connected disability may be service-connected to the degree that the aggravation is shown. Allen v. Brown, 7 Vet. App. 439 (1995).
For benefits purposes, a “Veteran” is a person discharged or released from active service under conditions other than dishonorable. 38 U.S.C. § 101 (2); 38 C.F.R. § 3.1 (d) (2017).  VA benefits are not payable unless the period of service upon which the claim is based was terminated by discharge or release under conditions other than dishonorable. 38 C.F.R. § 3.12 (a).  A claimant receiving a discharge under conditions other than honorable may be considered to have been discharged under dishonorable conditions in certain circumstances. 38 U.S.C. § 5303; 38 C.F.R. § 3.12.  A discharge or release because of willful and persistent misconduct is considered to have been issued under dishonorable conditions. 38 C.F.R. § 3.12 (d)(4).  An act is willful misconduct when it involves deliberate or intentional wrongdoing with knowledge of, or wanton and reckless disregard for, its probable consequences. 38 C.F.R. § 3.1 (n).  A discharge because of a minor offense, however, is not considered willful and persistent misconduct if service was otherwise honest, faithful, and meritorious. 
A discharge under dishonorable conditions bars the payment of benefits unless it is found that the person was insane at the time of committing the offense. 38 C.F.R. § 3.12 (b).  An “insane” person is one who, while not mentally defective or constitutionally psychopathic, except when a psychosis has been engrafted upon such basic condition, exhibits, due to disease, a more or less prolonged deviation from his normal method of behavior; or who interferes with the peace of society; or who has departed (become antisocial) from the accepted standards of the community to which by birth and education he belongs so as to lack the adaptability to make further adjustment to the social customs of the community in which he resides. 38 C.F.R. § 3.354 (a).
Regulations also provide that service connection may be presumed for malignant tumors, including prostate cancer, that manifests to a compensable degree within one year of separation from active service. See 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309.
1. Entitlement to service connection for lumbar facet arthropathy
The Veteran contends that service connection is warranted for lumbar facet arthropathy. 
The Veteran’s service treatment records are silent for any signs or symptoms of lumbar facet arthropathy.  The Veteran’s reenlistment Report of Medical Examination, dated March 8, 1982, indicates a normal clinical evaluation for the back.  In the accompanying Report of Medical History, the Veteran denied recurrent back pain and denied having any illness or injury other than those noted.    
The Veteran’s post-service treatment records show a diagnosis of lumbar facet arthropathy in January 2013. 
The Board finds that service connection for the Veteran’s lumbar facet arthropathy has not been established by the evidence of record.
As noted above, the Veteran’s service treatment records dated September 1975 to November 1978 and April 1980 to March 1982 are silent for any symptoms or treatment for a back disorder, to include lumbar facet arthropathy.  Additionally, the Veteran’s post-service treatment records are silent for any treatment for lumbar facet arthropathy until 2013, over 30 years following his separation from active duty.  Such a lapse of time is a factor for consideration in deciding a service connection claim. Maxson v. Gober, 230 F.3rd 1330, 1333 (Fed. Cir. 2000). 
The Board also acknowledges the February 1984 notation of a low back pain, which lasted two days in duration.  The assessment revealed that of a muscular strain.  In a May 1987 service treatment record, the Veteran complained of left lower thoracic back pain, which began when he was turning on the television.  A July 1988 service treatment record also reveals complaints of back pain.  While the Board acknowledges these in-service complaints, this period of service has been deemed as dishonorable for VA purposes and serves as a bar to the payment of VA compensation.  In other words, even if the Veteran showed that his current condition was related to the complaints made in February 1984, May 1987, and July 1988, he would still be precluded from payment of VA compensation during this period of time. 
The Board acknowledges that no examination was provided with regard to this issue.  VA must provide a medical examination and medical opinion when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, and (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the Veteran’s service or with another service-connected disability, but (4) insufficient competent medical evidence on file for the VA to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79, 81-82 (2006).  Here, there is no persuasive medical evidence linking the Veteran’s post-service diagnosis of lumbar facet arthropathy to his active service.  Instead, the Veteran’s claim for service connection consists of his own assertion that his lumbar facet arthropathy is related to his military service.  As there is no evidence establishing the requisite injury, disease, or event during service, no examination is necessary.  See 38 U.S.C. § 5103A (d); 38 C.F.R. § 3.159 (c)(4); McLendon.
The Board has considered the Veteran’s contention that his lumbar facet arthropathy is related to service.  The Veteran is competent to report on symptoms that are within the realm of his personal experience. See 38 C.F.R. § 3.159; see also Layno v. Brown, 6 Vet. App. 465, 469-71 (1994).  However, the etiology of his lumbar facet arthropathy is a medically complex question.  The Veteran has not shown that he is qualified through education, training, or experience to offer a nexus opinion on a complex medical condition.  Accordingly, he is not competent to offer an opinion as to its etiology and his opinion in this regard cannot be ascribed probative value. See Davidson, 581 F.3d at 1316; Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); Woehlaert v. Nicholson, 21 Vet. App. 456 (2007).  
For the reasons stated above, the Board finds that the preponderance of evidence is against the Veteran’s claim of entitlement to service connection for lumbar facet arthropathy and his appeal must be denied.  There is no reasonable doubt to be resolved as to this issue. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990).
2. Entitlement to service connection for headaches 
The Veteran contends that service connection is warranted for headaches.
The Veteran’s service treatment records reveal that he presented in November 1976 with complaints of headaches, nausea, and vomiting.  He was assessed with probable mild reaction to flu symptoms.  In May 1977, the Veteran presented with complaints of a headache, following a bump on the head.  He was assessed with tension headaches.  In March 1978, the Veteran reported symptoms of a headache, sore throat, and chest ache.  He was assessed with flu syndrome.  In February 1981, the Veteran presented for a follow-up for an upper respiratory infection and he presented with complaints of headaches and dyspnea.  In January 1981, the Veteran complained again of headaches.  He was assessed with viral gastroenteritis.  
A March 8, 1982 Report of Medical Examination, revealed a normal clinical evaluation.  Further, in Reports of Medical History, dated in March 1980; March 1982; February 1988; and December 1988, the Veteran marked “no” to having frequent or severe headaches.  
During the Veteran’s disqualifying period of service, in June 1985, he complained of a headache, following a car accident.  In June 1988, the Veteran noted complaints of a headache.  He was assessed with a viral syndrome.  
In the February 1988 Report, the Veteran marked “yes” to a head injury, and upon clinical evaluation, the examiner noted that the Veteran suffered a head injury at the age of two.   
In a May 2001 VA treatment record, the Veteran reported right-sided face numbness resulting from being stricken with the butt of a gun as well as head injuries resulting from other traumatic injuries, to include that of a motor vehicle accident in September 2000.  The Veteran also reported that he had intermittent migraine headaches which often lasted two to three days, and which were excruciating and incapacitating in severity.
In February 2006, the Veteran noted headaches since running out of blood pressure medication.
In a March 2013 VA treatment note, the Veteran was evaluated for migraine headaches and referred to a traumatic brain injury (TBI) clinic.  
In a July 2013 VA treatment note, the Veteran was diagnosed with migraine headaches, TBI, and post-traumatic headaches.
In a September 2014 VA headache examination, the examiner diagnosed the Veteran with migraine and post-traumatic headaches.  The Veteran reported that his headaches began in 1982 and that he suffered head trauma as a result of a fall on the stairwell, as well as an accidental strike by a “hatch over-hand” while serving aboard the USS Enterprise in the Navy.  The examiner opined that the condition was at least as likely as not incurred in or caused by an in-service injury, event, or illness.  The examiner based his opinion on the preponderance of VA medical records that indicate head trauma/TBI which was at least as likely as not incurred during military service and was etiologically related to the Veteran’s headache condition.     
In May 2018, the Veteran stated that he continued to have left-sided nasal congestion, which caused facial pain and headaches.
The Board acknowledges the Veteran’s in-service complaints, as well as the VA examiner’s favorable opinion.  Yet, the Board also notes that the physician related the Veteran’s headaches to his period of disqualifying service, rather than to the complaints made and diagnosis of headaches during his qualifying period of service.
The Board also acknowledges the Veteran’s beliefs that his headaches are related to service.  At the outset, the Veteran is not competent to speak to the etiology of his headaches.  Further, the Board does not doubt that the Veteran’s headaches are related to service, and such is supported by the medical evidence of record.  However, his headaches, again, are not related to his qualifying period of service for which VA compensation is permitted.
The Board acknowledges the September 2014 VA examiner’s opinion, but notes that the examiner related the Veteran’s headaches to his disqualifying period of service for which he is not entitled to VA compensation.  
For these reasons, service connection for headaches is denied.  As the preponderance of the evidence is against the claim, the claim must be denied. 38 U.S.C. § 5107 (b); Gilbert.
3. Entitlement to service connection for diabetes
The Veteran contends that service connection is warranted for diabetes.
The Veteran’s service treatment records are silent for any signs or symptoms of diabetes.  Specifically, a March 1980 Report of Medical Evaluation notes a normal clinical evaluation of the endocrine system.  Further, the Veteran’s reenlistment Report of Medical Examination, dated March 8, 1982, indicates a normal clinical evaluation for the endocrine system.   
The Veteran’s post-service treatment records show a diagnosis of diabetes mellitus in 2010. 
The Board finds that service connection for the Veteran’s diabetes has not been established by the evidence of record.
As noted above, the Veteran’s service treatment records are silent for any symptoms or treatment for diabetes.  Additionally, the Veteran’s post-service treatment records are silent for any treatment for diabetes until 2010, over 30 years following his separation from active duty.  Such a lapse of time is a factor for consideration in deciding a service connection claim. Maxson, 230 F.3rd at 1333. 
The Board acknowledges that no examination was provided with regard to this issue.  As above, VA must provide a medical examination and medical opinion when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, and (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the Veteran’s service or with another service-connected disability, but (4) insufficient competent medical evidence on file for the VA to make a decision on the claim. McLendon, 20 Vet. App. at 81-82.  Here, there is no persuasive medical evidence linking the Veteran’s post-service diagnosis of diabetes to his active service.  Instead, the Veteran’s claim for service connection consists of his own assertion that his diabetes is related to his military service.  As there is no evidence establishing the requisite injury, disease, or event during service, no examination is necessary.  See 38 U.S.C. § 5103A (d); 38 C.F.R. § 3.159 (c)(4); McLendon.
The Board has considered the Veteran’s contention that his diabetes is related to service.  The Veteran is competent to report on symptoms that are within the realm of his personal experience. See 38 C.F.R. § 3.159; see also Layno, 6 Vet. App. at 469-71.  However, the etiology of his diabetes is a medically complex question.  The Veteran has not shown that he is qualified through education, training, or experience to offer a nexus opinion on a complex medical condition. Accordingly, he is not competent to offer an opinion as to its etiology and his opinion in this regard cannot be ascribed probative value. See Davidson, 581 F.3d. at 1316; Jandreau, 492 F.3d. at 1377; Woehlaert. 
For the reasons stated above, the Board finds that the preponderance of evidence is against the Veteran’s claim of entitlement to service connection for diabetes and his appeal must be denied.  There is no reasonable doubt to be resolved as to this issue. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert.
4. Entitlement to service connection for a right ankle disability
The Veteran contends that service connection is warranted for a right ankle disorder.
The Veteran’s service treatment records are silent as to complaints of or treatment for a right ankle disorder.  Further, a March 1980 Report of Medical Examination shows a normal clinical evaluation of the lower extremities.  Also, in a March 1982 reenlistment Report of Medical Examination, there was a normal clinical evaluation of the lower extremities.  In the accompanying Report of Medical History, the Veteran complained of swollen or painful joints, but denied broken bones; arthritis; bone, joint, or other deformity, and foot trouble. 
The Veteran was afforded a VA ankle examination in November 2015.  While a left ankle disorder was noted, with an onset date of 2015, a right ankle disorder was not diagnosed.  In the medical history section of the report, the Veteran reported that the date of onset of his ankle symptoms was in 1976 and that he was injured playing baseball.  
The Veteran was also afforded a VA examination in October 2016.  The Veteran was assessed with a lateral collateral ligament sprain of the right and left ankles.  The examiner noted an onset date of August 1985 in relation to the right ankle.  During the examination, the Veteran again related a history of a sports-related injury and reported that he continued to have left ankle pain.  No etiology opinion was provided.
The Board also acknowledges a September 6, 1985 notation of right foot pain which was related to an injury that the Veteran sustained while playing baseball one week prior.  While the Board acknowledges this in-service complaint, this period of service has been deemed as dishonorable for VA purposes and serves as a bar to the payment of VA compensation.  In other words, even if the Veteran showed that his current condition was related to the complaints made in February September 1985, he would still be precluded from payment of VA compensation during this period of time.
The Board has considered the Veteran’s contention that his right ankle disorder is related to service.  The Veteran is competent to report on symptoms that are within the realm of his personal experience. See 38 C.F.R. § 3.159; see also Layno, 6 Vet. App. at 469-71.  However, the etiology of his right ankle disorder is a medically complex question.  The Veteran has not shown that he is qualified through education, training, or experience to offer a nexus opinion on a complex medical condition.  Accordingly, he is not competent to offer an opinion as to its etiology and his opinion in this regard cannot be ascribed probative value. See Davidson; Jandreau; Woehlaert.  Rather, medical evidence on this point is required.
Here, the evidence of record shows that the Veteran did not have complaints of or treatment for a right ankle disorder during his qualifying period of service.  Specifically, his examinations during his qualifying periods of service were silent as to a right ankle disorder, even though he complained of and was treated for a left leg disorder and several other maladies.  Additionally, there is evidence in the record of a right foot/leg injury occurring during the Veteran’s period of non-qualifying service.  Further, the medical evidence of record indicates that the Veteran’s right ankle disorder did not onset until at least 1985, three years following his qualifying period of service.    
For the reasons stated above, the Board finds that the preponderance of evidence is against the Veteran’s claim of entitlement to service connection for a right ankle disorder and his appeal must be denied.  There is no reasonable doubt to be resolved as to this issue. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert.
5. Entitlement to service connection for radical retro pubic prostatectomy status post prostate cancer
The Veteran contends that service connection is warranted for radical retro-pubic prostatectomy, status post prostate cancer.
The Veteran’s service treatment records are silent for any signs or symptoms of prostate cancer, prostatitis, or a high prostate specific antigen.  Specifically, a March 1980 Report of Medical Evaluation notes a normal clinical evaluation of the genitourinary system.  Further, the Veteran’s reenlistment Report of Medical Examination, dated March 8, 1982, indicates a normal clinical evaluation for the genitourinary system.  In the accompanying Report of Medical History, the Veteran noted that he had a tumor, growth, cyst or cancer.  He clarified that he had a ganglion cyst removed from his right wrist in 1981.  No mention of prostate cancer was noted.    
In a December 1988 Dental Health Questionnaire, the Veteran denied cancer and/or radiation therapy.  
The Veteran’s post-service treatment records show a diagnosis of prostate cancer in April 2010.  The Veteran had a prostatectomy in November 2010.   
The Board finds that service connection for the Veteran’s radical retro-pubic prostatectomy, status post prostate cancer has not been established by the evidence of record.
As noted above, the Veteran’s service treatment records dated September 1975 to November 1978 and April 2018 to March 1982 are silent for any symptoms or treatment for prostate cancer.  Additionally, the Veteran’s post-service treatment records are silent for any treatment for prostate cancer until 2010, over 30 years following his separation from active duty.  Such a lapse of time is a factor for consideration in deciding a service connection claim. Maxson, 230 F.3rd at 1333. 
The Board acknowledges that no examination was provided with regard to this issue.  As above, VA must provide a medical examination and medical opinion when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, and (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the Veteran’s service or with another service-connected disability, but (4) insufficient competent medical evidence on file for the VA to make a decision on the claim. McLendon, 20 Vet. App. at 81-82.  
Here, there is no persuasive medical evidence linking the Veteran’s post-service diagnosis of radical retro-pubic prostatectomy, status post prostate cancer to his active service.  Instead, the Veteran’s claim for service connection consists of his own assertion that his prostate cancer and its residuals are related to his military service.  As there is no evidence establishing the requisite injury, disease, or event during service, no examination is necessary.  See 38 U.S.C. § 5103A (d); 38 C.F.R. § 3.159 (c)(4); McLendon.  
The Board further notes that presumptive service connection is not warranted as the Veteran had no foreign service, as indicated on his DD Form 214s, or exposure to herbicide agents.  
The Board has also considered the Veteran’s contention that his radical retro-pubic prostatectomy, status post prostate cancer is related to service.  The Veteran is competent to report on symptoms that are within the realm of his personal experience. See 38 C.F.R. § 3.159; see also Layno, 6 Vet. App. at 469-71.  However, the etiology of his radical retro-pubic prostatectomy, status post prostate cancer is a medically complex question.  The Veteran has not shown that he is qualified through education, training, or experience to offer a nexus opinion on a complex medical condition.  Accordingly, he is not competent to offer an opinion as to its etiology and his opinion in this regard cannot be ascribed probative value. See Davidson; Jandreau; Woehlaert.  
For the reasons stated above, the Board finds that the preponderance of evidence is against the Veteran’s claim of entitlement to service connection for radical retro-pubic prostatectomy, status post prostate cancer and his appeal must be denied.  There is no reasonable doubt to be resolved as to this issue. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert.
6. Entitlement to service connection for obstructive sleep apnea 
The Veteran contends that service connection is warranted for sleep apnea.
The Veteran’s service treatment records are silent for any signs or symptoms of diabetes.  In Report of Medical History forms, dated in March 1980, March 1982, February 1988, and December 1988, the Veteran marked “no” to “frequent trouble sleeping.” 
The Veteran was diagnosed with sleep apnea May 2014, following a sleep study.  
In an August 2016 VA treatment record, however, the Veteran denied difficulty breathing and also denied sleep apnea. 
The Veteran’s post-service VA treatment records, dated in June 2017, show a past medical history of sleep apnea.  
The Board finds that service connection for the Veteran’s obstructive sleep apnea has not been established by the evidence of record.
As noted above, the Veteran’s service treatment records are silent for any symptoms or treatment for sleep apnea.  Additionally, the Veteran’s post-service treatment records are silent for any treatment for sleep apnea until 2014, over 30 years following his separation from active duty.  Such a lapse of time is a factor for consideration in deciding a service connection claim. Maxson, 230 F.3rd at 1333. 
The Board acknowledges that no examination was provided with regard to this issue.  As above, VA must provide a medical examination and medical opinion when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, and (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the Veteran’s service or with another service-connected disability, but (4) insufficient competent medical evidence on file for the VA to make a decision on the claim. McLendon, 20 Vet. App. at 81-82.  Here, there is no persuasive medical evidence linking the Veteran’s post-service diagnosis of obstructive sleep apnea to his active service.  Instead, the Veteran’s claim for service connection consists of his own assertion that his sleep apnea is related to his military service.  As there is no evidence establishing the requisite injury, disease, or event during service, no examination is necessary.  See 38 U.S.C. § 5103A (d); 38 C.F.R. § 3.159 (c)(4); McLendon.
The Board has considered the Veteran’s contention that his sleep apnea is related to service.  The Veteran is competent to report on symptoms that are within the realm of his personal experience. See 38 C.F.R. § 3.159; see also Layno, 6 Vet. App. at 469-71.  However, the etiology of his sleep apnea is a medically complex question.  The Veteran has not shown that he is qualified through education, training, or experience to offer a nexus opinion on a complex medical condition.  Accordingly, he is not competent to offer an opinion as to its etiology and his opinion in this regard cannot be ascribed probative value. See Davidson, 581 F.3d at 1316; Jandreau, 492 F.3d at 1377; Woehlaert. 
For the reasons stated above, the Board finds that the preponderance of evidence is against the Veteran’s claim of entitlement to service connection for sleep apnea and his appeal must be denied.  There is no reasonable doubt to be resolved as to this issue. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert.
7. Entitlement to service connection for an acquired psychiatric disorder
The Veteran contends that service connection is warranted for an acquired psychiatric disorder. 
VA mental health treatment records, dated in 2013 and 2014, reveal diagnoses of depression NOS, PTSD due to childhood trauma, and a substance-induced mood disorder.  
As noted in the Introduction, the Board has recharacterized the Veteran’s claim for PTSD as one which encompasses all acquired psychiatric disorders.
The Veteran submitted a private treatment record, dated in June 2015, in which the physician noted that the Veteran had a depressive disorder.  The physician also opined that the Veteran’s service-connected right knee, left ankle, and right-hand disorders more likely than not aggravated his depressive disorder.  The physician based her opinion on a review of the Veteran’s claims file and medical journal articles indicating that there is a link between medical issues, similar to those that the Veteran struggles with, and psychiatric disorders, similar to the Veteran’s depressive disorder complaints.   
After this review of the evidence, resolving all reasonable doubt in the Veteran’s favor, the Board grants service connection for an acquired psychiatric disorder.  In summary, the Veteran currently has an acquired psychiatric disorder which was aggravated by his service-connected disorders.  After careful review of the probative opinion evidence, the Board grants service connection for an acquired psychiatric disorder.
8. Entitlement to service connection for chronic sinusitis
The Veteran contends that service connection is warranted for chronic sinusitis.
In a March 1982 Report of Medical History, the Veteran denied sinus trouble.  
A service treatment record, dated in September 1984, reveals that the Veteran reported pain and pressure over the left maxillary sinus.  A sinus series revealed that the Veteran’s sinuses were normally developed and that there was density involving the left inferior maxillary sinus, which likely represented a polyp or retention cyst or osteoma.  Also, in September 1984, the Veteran was diagnosed with maxillary sinusitis.
A March 1985 service treatment record reveals that the Veteran noted that he had sinus trouble. 
The Veteran’s VA treatment records reveal an assessment of sinusitis, as well as findings of nasal congestion and allergic rhinitis. 
The Veteran was afforded a VA examination in October 2016.  The Veteran was diagnosed with chronic sinusitis and allergic rhinitis, with an onset date of the 1980s.  The examiner also noted a diagnosis of a deviated nasal septum.  The Veteran reported that his allergy and sinus problems began in the 1980s and recalled being given Sudafed while aboard the USS Enterprise.  
In an Independent Medical Opinion, dated in March 2017, the examiner noted that the Veteran’s current diagnosis was at least as likely as not incurred in and/or caused by his deviated septum diagnosed in service.  The rationale provided was that the Veteran was seen for acute sinusitis in 1986, which is very common in patients with a deviated nasal septum, for which the Veteran still has a current diagnosis.   
While the Board acknowledges the Veteran’s in-service complaints of sinus trouble, beginning in 1984 and subsequent diagnosis of sinusitis, this period of service has been deemed as dishonorable for VA purposes and serves as a bar to the payment of VA compensation.  Thus, even though the March 2017 examiner related such to his disqualifying period of service, the Veteran is still precluded from payment of VA compensation during this period of time.
The Board also acknowledges the Veteran’s beliefs that his sinusitis is related to service.  At the outset, the Veteran is not competent to speak to the etiology of his sinusitis.  Further, the Board does not doubt that the Veteran’s sinusitis is related to service, and such is supported by the medical evidence of record.  However, his sinusitis, again, is not related to his qualifying period of service for which VA compensation is permitted.
The Board acknowledges the March 2017 examiner’s opinion, but notes that the examiner related the Veteran’s sinusitis to his disqualifying period of service for which he is not entitled to VA compensation.  
For these reasons, service connection for sinusitis is denied.  As the preponderance of the evidence is against the claim, the claim must be denied. 38 U.S.C. § 5107 (b); Gilbert.
Increased Rating
Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4.  The rating schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of, or incident to, military service.  The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1.
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 for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7.  Any reasonable doubt regarding a degree of disability will be resolved in favor of the Veteran. 38 C.F.R. § 4.3.  An appeal from the initial assignment of a disability rating requires consideration of the entire time period involved and contemplates staged ratings where warranted. Fenderson v. West, 12 Vet. App. 119 (1999).  Here, where entitlement to compensation has already been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Nevertheless, where the evidence contains factual findings that show a change in the severity of symptoms during the course of the rating period on appeal, assignment of staged ratings would be permissible. Hart v. Mansfield, 21 Vet. App. 505 (2007).
Notably, during the pendency of this appeal, a new precedential opinion that directly affects this case was issued by the United States Court of Appeals for Veterans Claims (Court).  In Correia v. McDonald, 28 Vet. App. 158 (2016), the Court held that the final sentence of 38 C.F.R. § 4.59 creates a requirement that certain range of motion testing be conducted whenever possible in cases of joint disabilities.  The final sentence provides that “[t]he joints involved should be tested for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint.” The Court found that, to be adequate, a VA examination of the joints must, wherever possible, include the results of the range of motion testing described in the final sentence of § 4.59. 
While some of the VA examinations of record failed to test passive range of motion and range of motion in non-weight-bearing conditions, the Board finds that the examinations nevertheless are adequate for VA rating purposes.  Passive range of motion is the amount of motion possible when an examiner moves a body part with no assistance from the individual being evaluated.  It is usually greater than active range of motion because the integrity of the soft tissue structures does not dictate the limits of movement.  Comparisons between passive range of motion and active range of motion provide information about the amount of motion permitted by the associated joint structures (passive range of motion) relative to the individual’s ability to produce motion at a joint (active range of motion). CYNTHIA NORKIN & D. JOYCE WHITE, MEASUREMENT OF JOINT MOTION: A GUIDE TO GONIOMETRY 8-9 (2016).  
Testing the joint under weight-bearing conditions involves movement of the body against gravity.  J. Randy Jinkins, et. al., Upright, Weight-bearing, Dynamic-kinetic Magnetic Resonance Imaging of the Spine: Initial Results, 15 J. Eur. Radiol. 1815-25 (2005).  When evaluating range of motion, it is preferable to test in weight-bearing conditions because testing in non-weight-bearing conditions underestimates the degree of pathology present.  Id. at 1823.
Because there is no indication that the structural integrity of the Veteran’s joints are compromised, such that passive range of motion in this case would be more limited than active, and because testing in weight-bearing conditions is more demonstrative of the degree of pathology, the Board finds that the failure to test for limitation of motion on passive range of motion and in non-weight-bearing is not prejudicial.  The Board will therefore evaluate the Veteran’s range of motion using the available findings of active range of motion.
9. Entitlement to a rating in excess of 20 percent for a left knee strain
The Veteran contends that a rating in excess of 20 percent is warranted for a left knee strain and asserts that his current rating percentage does not adequately represent his level of disability.
The Veteran’s left knee strain is currently rated under DC 5258.  Disabilities involving cartilage, semilunar, dislocated, with frequent episodes of locking, pain, and effusion into the joint are assigned a maximum 20 percent rating. 38 C.F.R. § 4.71a, DC 5258.  
The Veteran was afforded a VA examination in September 2015.  Range of motion testing revealed flexion to 120 degrees and extension to 0 degrees, with pain on both planes.  There was no objective evidence of localized tenderness or pain on palpation, crepitus, or pain with weight bearing.  The Veteran was able to perform repetitive use testing, with no additional loss of function or range of motion after three repetitions.  Muscle strength was normal.  There was no muscle atrophy, ankylosis, recurrent subluxation, lateral instability, or recurrent effusion.  The examiner noted that the Veteran had a meniscus condition and had symptoms of frequent episodes of joint locking, joint pain, and joint effusion.  There were no other pertinent findings, complications, conditions, signs, symptoms, or scars.  The Veteran used a brace and cane on a regular basis.
In a May 2017 VA knee examination, the examiner noted that the Veteran’s range of motion was normal in his left knee.  Flexion was noted to 140 degrees and extension to 0 degrees, with no pain noted on examination.  There was no objective evidence of localized tenderness or pain on palpation of the joint, crepitus, muscle atrophy, ankylosis, recurrent subluxation, lateral instability, recurrent effusion, or additional loss of range of motion following repetitive use testing.  Muscle strength was normal.  The examiner also noted that the Veteran did not use any assistive devices as a normal mode of locomotion.  
VA treatment records, dated in June 2017, July 2017, and April 2018 reveal complaints of left knee pain.  A June 2017 VA treatment record notes a past medical history of degenerative joint disease of the left knee.  Further, a VA treatment record, dated in October 2017, reveals that the Veteran complained of left knee pain.  The Veteran had full range of motion and imaging studies revealed no acute fracture or dislocation, joint effusion, or abnormal soft tissue calcification.  There was mild narrowing of the medial compartment.  
Also, in a November 2017 VA treatment record reveals complaints of left knee pain, that were similar to his right knee prior to his right knee replacement.  He stated that he has daily pain with occasional locking and instability.  He denied numbness or tingling, but reported that he uses a cane to ambulate.  
In a March 2018 rating decision, the Veteran’s evaluation of a left knee strain was increased to 20 percent disabling, effective July 31, 2012, based on dislocated semilunar cartilage with frequent episodes of locking, pain, and effusion into the joint.  
Here, the Veteran receives a 20 percent rating for his left knee disability.  There is no higher rating available under DC 5258.  As such, the claim must be denied as a matter of law
Separate Rating for Instability of the Left Knee
Although the Veteran is in receipt of the maximum schedular rating available for dislocation of semilunar cartilage, the Rating Schedule does not preclude, as a matter of law, separate evaluations under other DCs involving the knee.  Lyles v. Shulkin, 29 Vet. App. 107 (2017). 
Thus, the Board has also considered whether a separate disability rating is warranted for any other left knee disability.  As the evidence of record does not reflect that the left knee is ankylosed, that the semilunar cartilage has been removed, that there is malunion or nonunion of the tibia and fibula, that there is a current diagnosis of genu recurvatum, and/or that the Veteran’s left disability has been manifested by limitation of flexion or extension to a compensable degree, a separate disability rating is not warranted under DCs 5256, 5258, 5259, 5261, 5262, or 5263. 38 C.F.R. § 4.71a.
The evidence of record, however, indicates symptoms of slight left knee instability.  As noted above, in November 2017, the Veteran complained of instability and reported that he uses a cane to ambulate.  Although the examiners in the September 2015 and May 2017 VA examiners noted the absence of instability, the 2015 examiner noted that the Veteran used an assistive device to ambulate.  
After a review of all the lay and medical evidence, and resolving reasonable doubt in favor of the Veteran, the Board finds that the left knee disability has manifested in slight instability manifested primarily as unstable walking and difficulty with weight-bearing with the use of a cane to manage the disability.  Such symptomatology represents a “slight” impairment of the Veteran’s left knee functionality.  Further, in light of the November 2018 CAVC ruling in English v. Wilkie, 17-2083, DC 5257 does not require objective medical evidence of lateral instability for a rating to be assigned.  
The Board finds that, based upon all the evidence, lay and medical, and resolving all reasonable doubt in favor of the Veteran, the service-connected left knee disability has shown “slight” instability, therefore, a separate 10 percent rating for the left knee disability is warranted under DC 5257. 38 C.F.R. §§ 4.3, 4.7, 4.71a.
10. Entitlement to a rating in excess of 20 percent or a left ankle disorder
The Veteran contends that a rating in excess of 20 percent is warranted for a left ankle disorder and asserts that his current rating percentage does not adequately represent his level of disability.
In a March 2018 rating decision, the Veteran’s evaluation of a left ankle disorder was increased to 20 percent disabling, effective July 31, 2012, based on marked limited motion of the ankle.  Specifically, the rating was assigned following a November 2015 VA ankle examination in which the Veteran related that he could not completely bend at the joint and that his Achilles was sore with intermittent swelling.  Range of motion testing revealed that the Veteran’s left ankle dorsiflexion and plantar flexion were limited to 10 degrees with evidence of painful motion.  Repetitive use testing and flare-ups reduced his range of motion by 5 degrees in both directions. 
The Veteran’s left ankle disorder is currently rated under DC 5271.  Under DC 5271, a maximum rating of 20 percent is warranted when there is markedly limited motion of the ankle.  As the Veteran has been in receipt of the highest schedular rating available under 38 C.F.R. § 4.71a, DC 5271, any appeal for a higher schedular rating under that DC must be denied.
An October 2016 VA examination reveals that the Veteran was diagnosed with a lateral collateral ligament sprain of the left ankle.  The Veteran reported that he continued to have left ankle pain and reported flare-ups of the ankle with manifestations of sharp, burning pain and swelling.  The Veteran also reported that he cannot stand or walk for prolonged periods of time.  Range of motion testing revealed dorsiflexion to 15 degrees and plantar flexion to 40 degrees.  He also had evidence of pain with weight bearing and there was objective evidence of tenderness or pain on palpation of the joint or associated soft tissue.  The Veteran was able to perform repetitive use testing with at least three repetitions, but there was an additional loss of range of motion by 5 degrees in plantar flexion.  The Veteran reported flare-ups and noted that dorsiflexion was to 5 degrees and plantar flexion was to 10 degrees during flare-ups.  Muscle strength testing was normal.  The Veteran had no muscle atrophy or ankylosis.  The Veteran had instability or dislocation suspected in the left ankle, to include laxity.  The Veteran used a brace on an occasional basis and a cane on a regular basis.    
The Board has considered whether any of the other DCs pertaining to disabilities of the ankles are applicable in this case.  However, the record does not show that the Veteran has ankylosis of the left ankle or ankylosis of the subastragalar or tarsal joints; has malunion of the left os calcis or astragalus; or has undergone a left astragalectomy.  Therefore, higher or additional ratings are not available in this case under those DCs. See 38 C.F.R. § 4.71a, DCs 5270, 5272, 5273, and 5274.
The Veteran has not raised any other issues with regard to the rating for the service-connected left ankle disorder, nor have any other such issues been reasonably raised by the record. See Yancy, 27 Vet. App. at 495; Doucette, 38 Vet. App. at 369-70.  The schedular criteria used to rate that disability reasonably describe and assess the Veteran’s disability level and symptomatology.  The criteria rate the disability based on functional loss, to include painful motion and loss of range of motion, which were the Veteran’s primary symptoms attributable to the disability.
The Board therefore finds that the criteria for entitlement to a rating in excess of 20 percent for his left ankle disorder have not been met at any time during the rating period.  Accordingly, there is no basis for staged rating of the disability pursuant to Hart, 21 Vet. App. at 519.  As the preponderance of the evidence is against the assignment of a higher rating, the benefit-of-the-doubt doctrine is not for application, and the claim must be denied. 38 U.S.C. § 5107 (b); see also Gilbert, 1 Vet. App. 49.
11. Entitlement to a rating in excess of 10 percent for residuals of a right-hand fracture
The Veteran contends that a rating in excess of 10 percent is warranted for residuals of a right-hand fracture and asserts that his current rating percentage does not adequately represent his level of disability.  
In a December 2016 rating decision, the Veteran’s disability rating was increased from 0 to 10 percent, effective July 31, 2012.
The Veteran’s right-hand disability is currently rated under DC 5215.  Under DC 5215, a maximum of 10 percent is warranted for dorsiflexion less than 15 degrees; or palmar flexion limited in line with the forearm.
Here, as the Veteran is already receiving the maximum disability rating available under DC 5215 based on symptomatology that includes limitation of motion.  Thus, it is not necessary to consider whether 38 C.F.R. §§ 4.40 and 4.45 are applicable. Johnston v. Brown, 10 Vet. App. 80 (1997).
As the Veteran’s disability does not meet the criteria for an increased evaluation under DC 5215, the Board must determine whether a higher rating is warranted under the other DC that pertains to the wrist.  Under DC 5214, ankylosis of the wrist, a 30 percent evaluation is warranted for the major arm when there is favorable ankylosis of the wrist in 20 to 30 degrees of dorsiflexion. 38 C.F.R. § 4.71a.  A 40 percent rating is warranted when there is ankylosis of the wrist in any other position, except favorable.  A 50 percent rating is warranted when there is unfavorable ankylosis in any degree of palmar flexion, or with ulnar or radial deviation.  Ankylosis is the complete immobility of a joint in a fixed position, either favorable or unfavorable. Lewis v. Derwinski, 3 Vet. App. 259 (1992).
The Veteran was afforded a VA examination in November 2015.  The Veteran reported consistent pain which had since worsened to where he had difficulty completely bending his wrist.  Range of motion testing revealed that right wrist dorsiflexion and plantar flexion were limited to 20 degrees with evidence of painful motion, ulnar deviation to 15 degrees, and radial deviation to 10 degrees.  Repetitive use testing and motion during flare-ups further reduced range of motion by 5 degrees in both directions.  
Here, as the maximum rating under DC 5215 has been assigned, further consideration of functional loss is not warranted.  Additionally, his functional impairment does not cause his disability to be more closely approximated by a finding of favorable or unfavorable ankylosis, as he remains able to move his right wrist. 
Based on the evidence of record, the Board finds that a higher rating for the right wrist is not warranted.  There is no probative medical evidence that the Veteran has ankylosis, favorable or unfavorable, nor has the Veteran so asserted.  Further, the Veteran’s reported symptoms of functional impairment do not more closely approximate favorable or unfavorable ankylosis.  Therefore, the Board finds that no basis for assignment of a higher rating under DC 5214 is not warranted. 38 C.F.R. § 4.71a, DC 5214.
The evidence also does not demonstrate that the Veteran has nonunion or malunion of the radius or ulna.  Therefore, application of DC 5211 and 5212 are not for consideration. 
Consideration has also been given to assigning staged ratings.  However, at no time during the period in question has the disability warranted a higher rating than that assigned. Fenderson, 12 Vet. App. 119 (1999); Hart, 21 Vet. App. 505 (2007).
For these reasons, a disability rating greater than 10 percent for a right wrist disability is denied. 
12. Entitlement to a compensable rating for status-post right wrist cyst removal
The Veteran contends that a compensable rating is warranted for status-post right wrist cyst removal and asserts that his current rating percentage does not adequately represent his level of disability.
The Veteran's service-connected scar is rated under DC 7805 and has been assigned a noncompensable (0 percent) disability rating. 
DC 7801 evaluates scars, not of the head, face, or neck, which are deep and nonlinear.  A 10 percent rating is assigned for an area or areas of at least 6 square inches (39 square centimeters) but less than 12 square inches (77 square centimeters), with higher ratings being available for larger affected areas.  Note (1) indicates that a deep scar is one associated with underlying soft tissue damage. 38 C.F.R. § 4.118, DC 7801. 
Superficial and nonlinear scars not on the head, face, or neck are evaluated under DC 7802.  Under this DC, a compensable rating is not available unless such scars cover an area of at least 144 square inches (929 square centimeters).  Note (1) indicates that a superficial scar is one not associated with underlying soft tissue damage. 38 C.F.R. § 4.118, DC 7802. 
DC 7804 (there is no DC 7803) assigns ratings for scars that are unstable or painful.  This DC assigns a 10 percent rating for one or two qualifying scars, a 20 percent rating for three or four qualifying scars, and a 30 percent rating for five or more qualifying scars.  Note (1) provides that an unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar.  Note (2) provides that if one or more scars are both unstable and painful, 10 percent is added to the evaluation based on the total number of unstable or painful scars.  Note (3) provides that scars evaluated under DCs 7800, 7801, 7802, or 7805 may also receive an evaluation under this DC when applicable. 38 C.F.R. § 4.118, DC 7804. 
Under DC 7805, any other scars, including linear scars, are to be rated based on any disabling effects and the appropriate DC for such effects. 38 C.F.R. § 4.118, DC 7805.
A November 2015 VA examination report discussed the nature of the Veteran’s right wrist surgical scar.  The examiner noted a diagnosis of a status-post right wrist cyst removal.  The examiner noted that the Veteran’s scar measured 3.5 centimeters by 0.2 centimeters.  The scar was not painful or unstable and did not have a total area equal to or greater than 39 square centimeters.   The scar was not located on the head, face, or neck, but was instead located on the anterior and lateral right wrist.  
After reviewing the evidence, the Board finds that a compensable rating is not warranted for the right wrist surgical scar as it has been asymptomatic during the pendency of the claim.  His scar has not been unstable or painful and has not caused any limitation of motion or loss of function of the right wrist.  As the evidence throughout the appeal period does not show any disabling effects due to the scar, a compensable rating is not warranted.  The appeal is denied.
13. Entitlement to a rating in excess of 10 percent for right knee osteoarthritis prior to July 7, 2015 and in excess of 30 percent beginning January 1, 2017 for status post right total knee replacement
Period Prior to July 7, 2015
The Veteran contends that a rating in excess of 10 percent is warranted for his right knee disability prior to July 7, 2015.  As noted above, the Veteran is rated under DCs 5010-5261.
DC 5010 provides that arthritis due to trauma is to be evaluated as degenerative arthritis pursuant to DC 5003.  DC 5003 provides that degenerative arthritis substantiated by x-ray findings is rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved.  When limitation of motion is noncompensable under the appropriate diagnostic codes, a rating of 10 percent is for application for each major joint or group of minor joints affected by limitation of motion. See 38 C.F.R. § 4.71a, DCs 5003, 5010.
DC 5260 provides ratings for limitation of flexion with the following ratings assigned: 0 percent for flexion limited to 60 degrees, 10 percent for flexion limited to 45 degrees, 20 percent for flexion limited to 30 degrees, and 30 percent for flexion limited to 15 degrees. 38 C.F.R. § 4.71a, DC 5260. 
Similarly, DC 5261 provides ratings for limitation of extension with the following ratings assigned: 10 percent for limitation of extension to 10 degrees, 20 percent for limitation of extension to 15 degrees, 30 percent for limitation of extension to 20 degrees, 40 percent for limitation of extension to 30 degrees, and 50 percent for limitation of extension to 45 degrees. 38 C.F.R. § 4.71a, DC 5261.
Turning to the evidence of record, an October 2011 and December 2011 VA treatment record reveal that the Veteran was diagnosed with arthralgia of the knee.  Additionally, a November 2012 record documents knee pain on medication and for consideration of injections for knee pain. The Veteran was afforded a VA examination in December 2011.  The examiner diagnosed the Veteran with right knee early osteoarthritis.  The Veteran denied locking, joint pain.  The Veteran also did not report that flare-ups impact the function of his knee and/or lower leg.  The Veteran reported that his condition began in January 2010 and that it started with swelling and locking due to jumping, running, and climbing up and down ladders while in the military service.  Range of motion testing revealed flexion to 140 degrees with pain at 140 degrees and extension to 45 degrees with pain at 45 degrees.  The Veteran did not have tenderness to palpation, lateral instability, recurrent patellar subluxation, or dislocation of the right knee.  Muscle strength testing was normal.  Impressions revealed degenerative changes to the right knee.  The examiner also noted that the Veteran’s right knee impacted his ability to work to the extent that he could not stand or walk for long periods during flare-ups.    
Following a review of the evidence and the Veteran’s contentions, the Board finds that symptomatology and findings associated with the Veteran’s right knee does not warrant a disability rating in excess of 10 percent.
The Veteran notably did not demonstrate flexion limited to 30 degrees or extension limited to 15 degrees in his left or right knee to warrant a rating in excess of 10 percent under DCs 5260 or 5261.  Therefore, because left and right knee flexion is not limited to 30 degrees or less and left knee extension is not limited to 15 degrees or more, an increased rating is not warranted based on objective clinical findings showing decreased range of motion. 38 C.F.R. § 4.71a, DCs 5260, 5261.
The Board notes that the assignment of a disability rating should take into account consideration of limitation of functional ability during flare-ups or when a joint is used repeatedly over a period of time. See DeLuca v. Brown, 8 Vet. App. 202, 206 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). 
Notably, the December 2011 VA examiner performed the required testing and made the relevant inquiries to determine how pain impacts the Veteran.  At the examination, the Veteran was asked about pain, flare-ups, and functional limitations, and relevant testing was performed by the examiners, to include testing for pain and testing to reveal any additional functional limitations in certain circumstances, such as after repetitive use.  The report does not suggest that the specific findings on examination, in terms of range of motion, would change to the degree required for a higher rating during a flare-up, after repetitive use, due to pain, or with weight bearing, nor does any other evidence of record to include the Veteran’s lay statements.
The Veteran was afforded a VA examination in January 2012.  The examiner noted a diagnosis of early osteoarthritis.  Range of motion testing revealed right knee flexion to 140 degrees and right knee extension to 45 degrees or greater.  The Veteran was able to perform repetitive use testing with no additional loss of range of motion or pain.  The Veteran did not have tenderness or pain to palpation for joint line or soft tissues of either knee.  Muscle strength testing was normal, as was joint stability tests.  The Veteran did not evidence or history of recurrent patellar subluxation or dislocation, shin splints, a total knee joint replacement or other surgical procedure, or any other pertinent physical findings.  The examiner noted that the Veteran’s knee condition impacted his ability to work in the sense that he had difficulty standing or walking for long periods during flare-ups. 
VA treatment records, dated from December 2012 to December 2013, reveal complaints of right knee pain. 
A July 2013 VA treatment record reveals complaints of right knee swelling.  Also, in July 2013, the Veteran underwent right knee arthroscopy and was subsequently assigned a temporary 100 percent rating beginning July 5, 2013.    
In a September 2013 VA treatment record, the Veteran noted that pain had improved but that it was still present and that he was able to ambulate.  
In another September 2013 VA treatment record, the Veteran complained of right medial knee pain and described the pain as burning which had gotten progressively worse and was constant.  The Veteran noted aggravating factors to include driving, sitting, jumping, and quick lateral movements.  Range of motion testing revealed active range of motion of 105 degrees in the seated and supine positions and passive range of motion of 105 degrees in the seated position and 110 degrees in the supine position. 
Following the Veteran’s July 5, 2013 arthroscopy and temporary convalescence, his 10 percent rating resumed beginning October 1, 2013.  
VA treatment records, dated from August 2013 to May 2014 reveal complaints of knee pain.   
In addition to testing, the Veteran has been asked to describe functional loss and impairment in various situations and he has not identified that he has loss of motion to the degree required for a higher rating.
Therefore, even when considering functional limitations due to pain and the other factors identified in 38 C.F.R. §§ 4.40, 4.45, the Board does not find that the Veteran’s functional losses equate to the criteria required for a 20 percent or greater rating under either 38 C.F.R. § 4.71a, DC 5260 or DC 5261, or separate compensable ratings under these same DCs. 38 C.F.R. §§ 4.2, 4.3, 4.7, 4.45, 4.71a; DeLuca.
After taking into account the medical findings and the lay statements the evidence does not suggest that motion is limited to the requisite degree for a higher rating.  Accordingly, as the preponderance of the evidence is against the claim for a rating in excess of 10 percent for service-connected right knee disability, the benefit-of-the-doubt rule does not apply, and the claim must be denied. 38 U.S.C. § 5107(b); Gilbert.
 
Period Beginning January 1, 2017
The Veteran contends that a rating in excess of 30 percent for a right knee disorder, characterized as status post total right knee replacement, from January 1, 2017 is warranted.  For this period on appeal, the Veteran is rated under DC 5055. 
Under DC 5055, a 30 percent rating is the minimum possible rating assignable.  A 60 percent rating is warranted for a total knee replacement with chronic residuals consisting of severe painful motion or weakness in the affected extremity.  A 100 percent rating is warranted for the one year following implantation of the prosthesis. Intermediate degrees of residual weakness, pain, or limitation of motion (a level of disability in between those contemplated by the 30 and 60 percent ratings) are to be rated by analogy to DCs 5256, 5261, or 5262. 38 C.F.R. § 4.71a, DC 5055. 
Under DC 5256, a rating of 40 percent is warranted for ankylosis in flexion between 10 depress and 20 degrees; a 50 percent rating is warranted for ankylosis in flexion between 20 degrees and 45 degrees; and a 60 percent rating is warranted for extremity unfavorable ankylosis in flexion at an angle of 45 degrees or more. 38 C.F.R. § 4.71a, DC 5256. 
Under DC 5261, knee extension limited to 5 degrees warrants a 0 percent rating. Extension limited to 10 degrees warrants a 10 percent rating. Extension limited to 15 degrees warrants a 20 percent rating.  Extension limited to 20 degrees warrants a 30 percent rating.  Extension limited to 30 degrees warrants a 40 percent rating.  Extension limited to 45 degrees warrants a 50 percent rating. 38 C.F.R. § 4.71a, DC 5261.
Pursuant to DC 5262, a 30 percent rating is warranted when there is malunion of the tibia and fibula, with marked knee or ankle disability. A schedular maximum 40 percent rating is warranted when there is nonunion of the tibia and fibula, with loose motion requiring a brace. 38 C.F.R. § 4.71a, DC 5262.
Again, the Veteran underwent a total right knee replacement in July 2015.  The Veteran’s right knee disability is currently assigned a disability rating of 30 percent under 38 C.F.R. §4.71a, DC 5055 (addressing status post knee replacement).  In order to warrant an increased rating based on a knee joint replacement after one year, the evidence must show chronic residuals consisting of severe painful motion or weakness in the affected extremity or intermediate degrees of residual weakness, pain or limitation of motion (rated by analogy to DCs 5256, 5261, or 5262). See 38 C.F.R. § 4.71a.
The Veteran was afforded a VA knee examination in May 2017.  The examiner noted diagnoses of status post right total knee replacement and patellar spur of the right knee.  The examiner noted that range of motion testing could not be completed as the Veteran stated that he could not bend his knee and that he had pain on movement, to include on passive motion testing.  The examiner also stated that no effort was made by the Veteran to bend his right knee.  The examiner also reported that repetitive use testing could not be completed.  The examiner noted that there was no ankylosis, recurrent subluxation, lateral instability, recurrent patellar dislocation, or recurrent effusion.  Further, the examiner noted that the Veteran declined passive range of motion testing of the right knee and noted that there was no evidence of pain on non-weight bearing testing.  The examiner also stated that the Veteran did not have chronic residuals consisting of severe painful motion or weakness or intermediate degrees of residual weakness, pain, or limitation of motion.  Instead, the examiner noted that the Veteran had pain and a scar.  The examiner also stated that the Veteran did not have any other pertinent physical findings, complications, conditions, signs, or symptoms.  Further, the examiner reported that there was not functional impairment of his extremity such that no effective function remained other than that which would be equally well served by an amputation with prosthesis.  Additionally, neither nonunion, malunion, nor genu recurvatum have been shown.  As such, DCs 5256, 5261, 5262, and 5263 are not for application here. 
The Board also notes that there is no evidence of record to support that the Veteran needed a prosthetic replacement of the knee joint for one year following implantation of prosthesis; thus, a 100 percent rating for the period beginning January 1, 2017 is not warranted. 
After taking into account the medical findings and the lay statements the evidence does not suggest that motion is limited to the requisite degree for a higher rating.  Accordingly, as the preponderance of the evidence is against the claim for a rating in excess of 30 percent for service-connected right knee disability, the benefit-of-the-doubt rule does not apply, and the claim must be denied. 38 U.S.C. § 5107(b); Gilbert.
14. Entitlement to a temporary total disability rating based on the need for hospitalization or convalescence for a right-wrist disability
The Board finds that the Veteran’s claim of entitlement to a temporary total disability rating based on the need for hospitalization or convalescence for his right wrist disability must be denied as a matter of law.  Although his argument is not a model of clarity, it appears that the Veteran contends that he is entitled to a temporary total disability rating because his right wrist required either hospitalization for more than 21 days or convalescence during the appeal period. See generally 38 C.F.R. §§ 4.29, 4.30.  Contrary to the Veteran’s assertions, there is no indication that he was hospitalized for more than 21 days or needed convalescence as a result of his right wrist disability at any time during the appeal period. Id.  The Board observes here that a temporary total disability rating may be assigned under 38 C.F.R. § 4.29 when a service-connected disability required hospitalization for more than 21 days. 38 C.F.R. § 4.29.  The Board next observes that a temporary total disability rating also may be assigned under 38 C.F.R. § 4.30, as it appears the Veteran claims, when a convalescent period of 1, 2, or 3 months is required for treatment of a service-connected disability following a hospital discharge. 38 C.F.R. § 4.30.  To date, the record evidence does not indicate that the Veteran was hospitalized for more than 21 days or required a period of convalescence of between 1-3 months following hospitalization for treatment of any of his right wrist disability at any time during the appeal period. Thus, an analysis of the Veteran’s entitlement to a temporary total disability rating is not required in this case because he has not met the threshold requirement of needing hospitalization or convalescence for treatment for his service-connected right wrist disability.  The Veteran also has not identified or submitted any evidence demonstrating that he required hospitalization or convalescence for which he is entitled to a temporary total disability rating.  Accordingly, the Board finds that the Veteran’s claim of entitlement to a temporary total disability rating must be denied as a matter of law. See Sabonis v. Brown, 6 Vet. App. 426, 430 (1994).
Effective Date
Generally, the effective date for an award of compensation based on an original claim will be the date of receipt of the claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110; 38 C.F.R. § 3.400.
A specific claim in the form prescribed by the Secretary of VA must be filed in order for benefits to be paid or furnished to any individual under the laws administered by VA. 38 U.S.C. § 5101(a)(1); 38 C.F.R. § 3.151 (a).  For claims received on or after March 24, 2015, VA amended its regulations governing how to file a claim.  The effect of the amendment was to standardize the process of filing claims, as well as the forms accepted, in order to increase the efficiency, accuracy, and timeliness of claims processing, and to eliminate the concept of informal claims. See 38 C.F.R. § 3.155; 79 Fed. Reg. 57660-01.  However, prior to the effective date of the amendment, an informal claim was any communication or action, indicating an intent to apply for one or more benefits under the laws administered by VA.  Such informal claim must identify the benefit sought. 38 C.F.R. § 3.155 (a).
15. Entitlement to an effective date earlier than July 31, 2012, for the initial grant of service connection for a left knee strain, left ankle condition, residuals of a right-hand fracture, and for status-post right wrist cyst removal.
The Veteran contends that earlier effective dates are warranted for the initial grant of service connection for a left knee strain, left ankle condition, residuals of a right-hand fracture, and status-post right wrist cyst removal.  
As to all claims, the evidence of record shows that the Veteran filed an informal claim for service connection on July 29, 2012.  Therefore, VA laws and regulations in effect prior to March 24, 2015, govern his claims for an earlier effective date.
On July 31, 2012, the Veteran submitted a Statement in Support of Claim, in which he clarified the disabilities for which he was seeking service connection, to include those listed above.  
In a September 2013 rating decision, the RO granted service connection for the left ankle, right hand fracture (claimed as neuropathy), and right wrist cyst removal; an effective date of July 31, 2012 was assigned.
In a December 2016 rating decision, the RO granted service connection for the left knee and an effective date of July 31, 2012 was assigned.  
Here, the Board construes the Veteran’s July 29, 2012 letter as an informal claim for service connection.  Thus, an earlier effective date of July 29, 2012 is granted as to the left knee, left ankle, right hand fracture, and right wrist cyst removal, and the Board deems this as the proper date for the initial grant of service connection.  
The Board also notes that the Veteran has not alleged clear and unmistakable error (CUE), rather he solely contended that an earlier effective date for the grant of service connection for a left knee, left ankle, right hand fracture, and right wrist cyst removal should be assigned.  Further, the Board notes that clear and unmistakable error is not warranted as this rating action does not result in a change in the Veteran’s overall combined evaluation and current rate of payment.  
16. Entitlement to an effective date earlier than March 2, 2010, for the initial grant of service connection for a right knee disorder
The Veteran contends that he is entitled to an earlier effective date for the grant of service connection for a right knee disorder.
At the outset, the Board notes that the Veteran did not raise a claim of entitlement to service connection for a right knee disorder within one year from discharge.  Rather, the Veteran first raised a service connection claim for a right knee disorder, specifically DJD of the right knee, in a March 2, 2010 VA Form 21-526, Veteran’s Application for Compensation.   The RO granted service connection for a right knee disorder, and assigned a 10 percent rating, in a January 2012 rating decision.  The award was effective as of the date of the March 2, 2010 claim. 
Because the current effective date of service connection was based upon the date his March 2, 2010 correspondence, the next question before the Board is whether there are any earlier, non-final, applications for service connection upon which an earlier effective date of service connection may be granted.
The Board has carefully reviewed the evidence of record and finds that the first communication from the Veteran that can be interpreted as a request for service connection for a right knee disorder was received on March 2, 2010. 
In his March 2010 application, he did not note when the condition began, but he did identify that treatment occurred in his “STRs.”  
In a December 2011 examination, impressions revealed early osteoarthritis.  Upon examination, the Veteran reported that his condition began in January 2010.  
In a July 2013 Statement in Support of Claim, the Veteran noted that he was not working and had been unable to work due to his right knee disability since 2007.  In an April 2015 Form 9, he noted that he was entitled to an effective date prior to March 2, 2010, but did not provide a specific date for which he believed he was entitled to benefits.  
The Court has acknowledged that the effective date based on an award of service connection is not based on the date of the earliest medical evidence demonstrating a causal connection, but on the date that the application upon which service connection was eventually awarded was filed with VA. LaLonde citing Hazan v. Gober, 10 Vet. App. 511 (1997); Washington v. Gober, 10 Vet. App. 391 (1997), and Wright v. Gober, 10 Vet. App. 391 (1997).  Stated differently, based on the facts in this case, an effective date earlier than March 2, 2010 is legally precluded.
The Board recognizes that the Veteran sought treatment for his right knee in October 1981, during a period of qualifying service.  The Board also acknowledges that the Veteran’s private treatment records and VA treatment records show continued treatment for the right knee.  While the Veteran’s right knee disorder had its onset years before service connection was granted, it is not equivalent to finding a claim for that disability.  A claim, whether “formal” or “informal,” must be “in writing” in order to be considered a “claim” or “application” for benefits. Rodriguez v. West, 189 F.3d 1351, 1354 (Fed. Cir. 1999).  Moreover, the Court has explicitly stated that the “mere presence” of a diagnosis of a specific disorder in a VA medical report “does not establish an intent on the part of the Veteran” to seek service connection for that disorder. Brannon v. West, 12 Vet. App. 32, 35 (1998); see MacPhee v. Nicholson, 459 F.3d 132 (Fed. Cir. 2006) (VA medical examination reports standing alone can constitute informal claim only with regard to claims that previously have been granted service connection); 38 C.F.R. § 3.155.  Accordingly, the mere existence of medical records in a case cannot be construed as an informal claim. Id.; Ellington v. Nicholson, 22 Vet. App. 141, 145-46 (2007), aff’d Ellington v. Peake, 541 F.3d 1364 (Fed. Cir. 2008).  Accordingly, the proper effective date for the grant of service connection for a right knee disorder is the date of the claim, or March 2, 2010. 38 U.S.C. § 5110.
Again, the Board acknowledges that the Veteran’s condition onset prior to the submission of his claim for service connection on March 2, 2010.  However, the pertinent legal authority governing effective dates in this case is clear and specific, and the Board is bound by such authority.  Pursuant to that authority, the Board finds that there is no legal basis by which an effective date for the award of service connection for a right knee disorder earlier than March 2, 2010 can be assigned. Consequently, the claim for an effective date prior to March 2, 2010 must be denied.  In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine.  However, as the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert.
REASONS FOR REMAND
1. Entitlement to service connection for hearing loss
The Veteran contends that service connection is warranted for his bilateral hearing loss.  Presently, the Board cannot make a fully-informed decision on the issue of hearing loss because no VA examiner has opined on whether the Veteran’s hearing loss is related to service.
In this case, the Veteran’s DD 214 shows a military occupational specialty of cannon operator during his first two periods of service from September 1975 to November 1978.  The Veteran’s DD 214 also indicates that he earned a hand grenade badge and a rifle sharpshooter badge.  Therefore, in-service noise exposure is conceded.
On remand, a VA examiner must determine whether the Veteran has hearing loss for VA purposes and whether such is related to service, to include his in-service exposure to acoustic trauma and the possibility of delayed-onset hearing loss.   
2. Entitlement to service connection for tinnitus
The Veteran contends that service connection is warranted for his tinnitus. Presently, the Board cannot make a fully-informed decision on the issue of tinnitus because no VA examiner has opined as to whether it is related to service.
In this case, the Veteran’s DD 214 shows a military occupational specialty of cannon operator during his two first periods of service from September 1975 to November 1978.  The Veteran’s DD 214 also indicates that he earned a hand grenade badge and a rifle sharpshooter badge.  Therefore, in-service noise exposure is conceded.
On remand, a VA examiner must determine whether the Veteran has tinnitus and whether such is related to service, to include his in-service exposure to acoustic trauma.   
3. Entitlement to service connection for hypertension
The Veteran is seeking service connection for hypertension.  Specifically, the Veteran contends that his hypertension is related to his mental health condition.  See August 2011 Statement in Support of Claim. 
For VA purposes, hypertension or isolated systolic hypertension must be confirmed by readings taken two or more times on at least three different days.  The term hypertension means the diastolic blood pressure is predominantly 90 or greater, and isolated systolic hypertension means that the systolic blood pressure is predominantly 160 or greater with a diastolic blood pressure of less than 90mm. 38 C.F.R. § 4.10, DC 7101, Note 1.
The evidence of record reflects that the Veteran is diagnosed with hypertension. The Veteran’s VA outpatient records reveal a diagnosis, by subjective history, in June 2004 for the past seven years.  A diagnosis of an early systolic murmur was made in June 2004.  The Veteran’s VA treatment records note a formal diagnosis of hypertension in December 2011. 
However, there is no evidence that the Veteran had hypertension or elevated blood pressure readings in service.  The Veteran’s service treatment records show no complaints, findings, or diagnoses of hypertension.  In a March 1980 Report of Medical Examination, there were no clinical findings of high blood pressure.  In March 1980 and March 1982 Report of Medical History forms, the Veteran denied high blood pressure.  In a March 1982 reenlistment record, his blood pressure was 118/88.  A January 1984 service treatment record reveals a blood pressure reading of 118/86.  A June 1984 service treatment record reveals a blood pressure reading of 120/70.  Another June 1984 service treatment record reveals a blood pressure reading of 130/82.  Similarly, in a March 1985 dental questionnaire, he denied high blood pressure.  A May 1986 service treatment record reveals a blood pressure reading of 122/76.  In a February 1987 preanesthetic summary, there were no findings of a heart murmur, hypertension, or any other abnormality of the circulatory system.  In a December 1988 separation examination, his blood pressure was 116/82.  In June 1988 service treatment records, his blood pressure was 152/98, 150/92, and 124/92.  In a July 1988 service treatment record, his blood pressure was 120/88.  In a March 1989 service treatment record, his blood pressure was 100/72. The service treatment records show that the Veteran did not have multiple readings in service constituting a diagnosis of hypertension for VA purposes. 38 C.F.R. § 4.104, DC 7101, Note 1.  Additionally, he did not have any elevated blood pressure readings during service.
In an August 2010 VA treatment record, a clinician noted that the Veteran had high blood pressure since 1982.
The evidence of record shows that the Veteran was formally diagnosed with hypertension in 2011.
Here, there is no evidence that the Veteran’s hypertension is related to his service. Yet, as noted above the Veteran contends that his hypertension has been cause and/or aggravated by his acquired psychiatric disorder (claimed as PTSD).  As the acquired psychiatric disorder is being granted herein, a remand is necessary to determine whether the Veteran’s hypertension is secondary to his acquired psychiatric disorder. 
4. Entitlement to TDIU
The Board finds that additional information is needed as to the Veteran’s current employment status.  
The record shows that the Veteran filed an application for vocational rehabilitation in February 2012.  
In an April 2012 letter, VA indicated that action was stopped on the Veteran’s application until he appeared for an evaluation. 
In a June 2015 Medical Opinion on Service-Connected Impairments, a private physician indicated that the Veteran would have to leave early from work and miss work three or more days per week due to his mental problems.  The physician also indicated that due to psychiatric problems, the Veteran would not be able to stay focused to complete simple repetitive tasks more than three days per month and would respond inappropriately more than once per month in a non-violent way.
In a June 2015 private DBQ, the same physician opined that due to the Veteran’s right knee, left ankle, right hand, and depressive disorder, he was prevented from maintaining substantially gainful employment.  
In a September 2017 VA treatment record, the Veteran reported that he was working on his Master Degree of Psychology. 
In an April 2018 VA treatment record, the Veteran reported that he was working for child protective services. 
Based on the above, the Board has discovered inconsistent reports of unemployability pursuant to the TDIU issue on appeal, to include self-reports of employment through 2018 and reports of attending school in 2017. On remand, the AOJ should give the Veteran the opportunity to provide a VA Form 21-8940 detailing his complete work and education history, income earned, to include highest gross earnings per month, and any other information regarding employment or attempts to obtain employment.
The matter is REMANDED for the following action:
1. The Veteran should be afforded an additional VA audiology examination by an appropriate clinician.  
Upon completion of audiometric testing, the examiner is asked to provide the following opinions:
a. State whether the record support a diagnosis of hearing loss for VA purposes and/or tinnitus.
b. Is at least as likely as not that the Veteran’s hearing loss and/or tinnitus (if diagnosed) are related to his military service in the context of his pertinent history. For purposes of presenting this opinion, the examiner is to assume as true the Veteran’s conceded history of acoustic trauma.  Further, the examiner must not rely solely on the fact that the Veteran had “normal” hearing at separation from service to support the opinion.  The examiner must also discuss the possibility of delayed-onset hearing loss.
2. Obtain an opinion from an appropriate clinician regarding whether the Veteran’s hypertension is at least as likely as not related to, proximately due to, or aggravated beyond its natural progression by his service-connected acquired psychiatric disorder.  If an examination is necessary, one should be scheduled and performed.   
3. Ask the Veteran to complete and submit a VA Form 21-8940 (Veteran’s Application for Increased Compensation Based on Unemployability) that responds to all the information requested on that form, to include a complete and accurate work and education history, and exact dates of employment, names of employers, and income information, including the highest gross earnings per month.
4. Readjudicate the claim.

 
APRIL MADDOX
Acting Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	Tiffany N. Hanson, Associate Counsel