Citation Nr: 18155733 Decision Date: 12/06/18 Archive Date: 12/04/18 DOCKET NO. 16-40 966 DATE: December 6, 2018 ORDER Entitlement to service connection for a generalized arthritis disorder is denied. Entitlement to service connection for a left elbow disorder is denied. Entitlement to service connection for a right elbow disorder is denied. Entitlement to service connection for a left hand disorder is denied. Entitlement to service connection for a right hand disorder is denied. Entitlement to service connection for a back disorder is denied. Entitlement to service connection for hypertension is denied. Entitlement to service connection for skin cancer is denied. Entitlement to service connection for a head disorder is denied. Entitlement to service connection for a left upper extremity disorder is denied. Entitlement to service connection for a right upper extremity disorder is denied. Entitlement to service connection for a left lower extremity disorder is denied. Entitlement to service connection for a right lower extremity disorder is denied. Entitlement to an effective date earlier than September 18, 2013 for the grant of service connection for hearing loss is denied. Entitlement to an effective date earlier than September 18, 2013 for the grant of service connection for tinnitus is denied. Entitlement to an initial compensable rating for hearing loss is denied. Entitlement to an initial rating in excess of 10 percent for tinnitus is denied. REMANDED Entitlement to service connection for a left knee disorder is remanded. Entitlement to service connection for a right knee disorder is remanded. Entitlement to service connection for a left foot disorder is remanded. Entitlement to service connection for a right foot disorder is remanded. Entitlement to service connection for an acquired psychiatric disorder is remanded. FINDINGS OF FACT 1. The evidence shows that the Veteran does not have a generalized arthritis disorder, bilateral elbow disorder, bilateral hand disorder, back disorder, bilateral lower extremity disorder, bilateral upper extremity disorder, head disorder, skin cancer, or hypertension that is in any way related to service. 2. There is no document prior to the February 3, 2014 claim for service connection for hearing loss that may be construed as a formal or informal claim of entitlement to service connection for hearing loss. 3. There is no document prior to the September 18, 2013 claim for service connection for tinnitus that may be construed as a formal or informal claim of entitlement to service connection of tinnitus. 4. Throughout the period on appeal, audiometric examination shows no greater than a level I hearing loss for the right ear and no greater than a level I hearing loss for the left ear. 5. The Veteran experiences tinnitus in each ear, for which the maximum schedular rating of 10 percent is assigned. CONCLUSIONS OF LAW 1. The criteria for establishing entitlement to service connection for a generalized arthritis disorder have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309 (2017). 2. The criteria for establishing entitlement to service connection for a left elbow disorder have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 3. The criteria for establishing entitlement to service connection for a right elbow disorder have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 4. The criteria for establishing entitlement to service connection for a left hand disorder have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 5. The criteria for establishing entitlement to service connection for a right hand disorder have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 6. The criteria for establishing entitlement to service connection for a back disorder have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 7. The criteria for establishing entitlement to service connection for hypertension have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 8. The criteria for establishing entitlement to service connection for skin cancer have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 9. The criteria for establishing entitlement to service connection for a head disorder have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 10. The criteria for establishing entitlement to service connection for a left upper extremity disorder have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 11. The criteria for establishing entitlement to service connection for a right upper extremity disorder have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 12. The criteria for establishing entitlement to service connection for a left lower extremity disorder have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 13. The criteria for establishing entitlement to service connection for a right lower extremity disorder have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 14. The criteria for an effective date earlier than September 18, 2013, for the grant of service connection for hearing loss have not been met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. §§ 3.155, 3.400 (2017). 15. The criteria for an effective date earlier than September 18, 2013, for the grant of service connection for tinnitus have not been met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. §§ 3.155, 3.400. 16. The criteria for an initial compensable rating for hearing loss have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.85, Diagnostic Code 6100, (2017). 17. The criteria for an initial rating for in excess of 10 percent for tinnitus have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.87, Diagnostic Code 6260 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Earlier Effective Date The Veteran contends that the effective dates for the grants of service connection for tinnitus and hearing loss should be earlier. He offers no specific argument in this regard but rather, in an April 2015 notice of disagreement, indicates that he disagrees with the currently assigned effective dates. Except as otherwise provided, the effective date of an evaluation and award of pension, compensation or dependency and indemnity compensation based on an original claim, a claim reopened after a final disallowance, or a claim for increase will be the date of receipt of the claim or the date entitlement arose, whichever is the later. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400. Prior to March 24, 2015, a claim was defined as a formal or informal communication in writing requesting a determination of entitlement or evidencing a belief in entitlement to a benefit. 38 C.F.R. § 3.1(p) (2014). Any communication or action indicating an intent to apply for one or more benefits administered by VA may be considered an informal claim. 38 C.F.R. § 3.155(a). The benefit sought must be identified, though it need not be specific. See Servello v. Derwinski, 3 Vet. App. 196, 199 (1992); see also Brokowski, 23 Vet. App. at 86-87. Thus, the essential elements for any claim, whether formal or informal, are “(1) an intent to apply for benefits, (2) an identification of the benefits sought, and (3) a communication in writing.” Brokowski v. Shinseki, 23 Vet. App. 79, 84 (2009). Here, the Veteran submitted a correspondence requesting service connection for tinnitus which was received by the RO on September 18, 2013. He subsequently submitted a Fully Developed Claim for service connection for tinnitus and hearing loss which was received by the RO on February 3, 2014. In a February 2015 rating decision, the RO granted service connection for both disabilities. The RO assigned an effective date of September 18, 2013 for tinnitus, noting that this was the date that the RO received the claim. The RO also assigned an effective date of September 18, 2013 for hearing loss, apparently concluding that the date of receipt of the claim for hearing loss was September 18, 2013 even though the September 2013 correspondence did not mention hearing loss. Again, the Veteran claims entitlement to earlier effective dates for both awards but has offered no specific arguments in this regard. Neither has his representative. See January 2017 Appellate Brief (stating that the Veteran “should be granted an…earlier effective date for tinnitus and hearing loss” but providing no evidence or argument as to why such entitlement is warranted). The record shows, however, that there is no document dated prior to the September 18, 2013 claim for tinnitus showing an intent to apply for benefits for ringing in the ears and that there is no document dated prior to February 3, 2014 showing an intent to apply for benefits for hearing loss. Accordingly, even though a January 2015 VA examiner suggested, by concluding that tinnitus and hearing loss were related to service, that entitlement may have arisen many years prior to the currently assigned effective dates, there is no basis to award an earlier effective date for the grants of service connection for tinnitus and hearing loss. September 18, 2013 is the date the claims were received, and is the later of the two dates – when entitlement arose and the date of claim and thus is the proper effective date under the law. 38 C.F.R. § 3.400. Accordingly, the preponderance of the evidence is against the claims. The benefit of the doubt doctrine is therefore not for application and the claims must be denied. 38 U.S.C. § 5107(b). Increased Rating Disability evaluations are determined by evaluating the extent to which a veteran’s service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities. The percentage ratings represent as far as can practicably be determined the average impairment in earning capacity resulting from such diseases and injuries and the residual conditions in civilian occupations. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the several grades of disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1 (2017). Separate diagnostic codes identify the various disabilities and the criteria for specific ratings. If two disability evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (2017). Any reasonable doubt regarding the degree of disability will be resolved in favor of the veteran. 38 C.F.R. § 4.3 (2017). Hearing Loss The Veteran claims entitlement to an initial compensable rating for hearing loss. Evaluations for defective hearing are based upon organic impairment of hearing acuity as measured by the results of controlled speech discrimination tests, along with the average hearing threshold level as measured by puretone audiometric tests in the frequencies of 1000, 2000, 3000 and 4000 cycles per second. 38 C.F.R. § 4.85. To evaluate the degree of disability for service-connected bilateral hearing loss, the rating schedule establishes eleven (11) auditory acuity levels, designated from level I for essentially normal acuity, through level XI for profound deafness. Id. Ratings for hearing impairment are derived by a mechanical application of the rating schedule to the numeric designations assigned after audiometric evaluations are rendered. See Lendenmann v. Principi, 3 Vet. App. 345 (1992). In this case, in February 2015, the Veteran was provided a VA examination. The Veteran described his hearing loss as resulting in difficulty hearing with background noise. The results of the audiological test are as follows, with puretone thresholds recorded in decibels: HERTZ 500 1000 2000 3000 4000 RIGHT 10 25 25 30 50 LEFT 15 25 25 45 55 Speech audiometry revealed speech recognition ability on the Maryland CNC word list of 100 percent in both ears. The average of the puretones between 1000-4000 Hertz was 33 for the right ear and 38 for the left. Using Table VI in 38 C.F.R. § 4.85, the Veteran received a numeric designation of I for the right ear and I for the left. Such a degree of hearing loss warrants a noncompensable rating under Table VII. Based on the above, the Board finds that the claim must be denied. The Board has considered the Veteran’s complaints regarding the impact of hearing loss on his daily life, but as noted above, the assignment of disability ratings for hearing impairment is primarily derived from a mechanical formula based on levels of puretone threshold average and speech discrimination. Lendenmann, 3 Vet. App. 345. The Veteran’s report of difficulty understanding speech with background noise is acknowledged; however, this is reflective of the type of functional difficulty that would be expected to be caused by his recorded levels of hearing loss. See Doucette v. Shulkin, 28 Vet. App. 366 (2017) (Manifestations such as difficulty hearing speech are the types of difficulties contemplated by the schedular criteria for hearing loss.). Accordingly, the examination of record is sufficiently in compliance with the provisions of VA regulations, and it is afforded great probative value in determining the Veteran’s level of hearing impairment. The most probative medical evidence as to the nature of the appellant’s hearing loss are the audiometric findings, and those discussed above reveal that the Veteran’s hearing loss does not warrant entitlement to a compensable rating. In reaching this conclusion, the Board has considered the applicability of the reasonable doubt doctrine; however, since the preponderance of the evidence is against his claim, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b). Tinnitus The Veteran also contends that his tinnitus is more disabling than the rating assigned. The Veteran’s tinnitus is rated under Diagnostic Code 6260. 38 C.F.R. § 4.87. Pursuant to Diagnostic Code 6260, a 10 percent rating is assigned for tinnitus whether the sound is perceived as being in one ear, both ears, or in the head. The maximum schedular rating available for tinnitus is 10 percent. 38 U.S.C. § 1155; 38 C.F.R. § 4.87; Smith v. Nicholson, 451 F.3d. 1344 (Fed. Cir. 2006). As above, neither the Veteran nor his representative have offered any specific argument as to why an increased rating is warranted. See April 2015 notice of disagreement; January 2017 Appellate Brief. The Board acknowledges the Veteran’s reports that his tinnitus occurs in both ears – left worse than his right – and that it affects his ability to communicate. See February 2015 VA examination. However, the Veteran has been assigned the maximum schedular rating available for tinnitus, which is assigned regardless of the extent of the tinnitus and whether the ringing is unilateral or bilateral. As there is no legal basis upon which to award a higher or separate schedular rating for each ear, the appeal must be denied. Service Connection The Veteran claims entitlement to service connection for a generalized arthritis disorder, bilateral elbow disorders, bilateral hand disorders, a back disorder, bilateral lower extremity disorder, bilateral upper extremity disorders, a head disorder, skin cancer, and hypertension. See September 2013 correspondence; February 2014 claim; October 2014 claim. Except for writing “Camp LeJune [sic] water” below the list of service connection claims in the February 2014 claim, as above, neither the Veteran nor his representative have offered any specific argument as to how or why service connection for these claimed disorders is warranted. See April 2015 notice of disagreement; August 2016 VA Form 9; January 2017 Appellate Brief. In addition, the Board notes that it has characterized the Veteran’s claim for “osteoarthritis” as a generalized arthritis disorder given that in the same correspondence, he also claimed entitlement to service connection for specific body parts which could potentially include arthritis. See September 2013 correspondence. The Board’s decision here to deny service connection for a generalized arthritis disorder should not be construed as a denial of service connection for any other issue currently on appeal, to specifically include any claims pertaining to joints. Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). To establish entitlement to service-connected compensation benefits, a veteran must show: “(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010). For veterans with 90 days or more of active service during a war period or after December 31, 1946, certain chronic diseases are presumed to have been incurred in service if they manifested to a compensable degree within one year of separation from service. 38 U.S.C. §§ 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. Pursuant to 38 C.F.R. § 3.303(b), where a chronic disease is shown as such in service, subsequent manifestations of the same chronic disease are generally service connected. If a chronic disease is noted in service but chronicity in service is not adequately supported, a showing of continuity of symptomatology after separation is required. Entitlement to service connection based on chronicity or continuity of symptomatology pursuant to 38 C.F.R. § 3.303(b) applies only when the disability for which the Veteran is claiming compensation is due to a disease enumerated on the list of chronic diseases in 38 U.S.C. § 1101(3) or 38 C.F.R. § 3.309(a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). VA laws and regulations provide that, if a Veteran was exposed to contaminated water at Camp Lejeune during service, certain listed diseases are presumptively service connected. Under the new codified 38 C.F.R. § 3.307(a)(7), certain diseases have been associated with exposure to contaminants in the water supply at Camp Lejeune: (i) For the purposes of this section, contaminants in the water supply means the volatile organic compounds trichloroethylene (TCE), perchloroethylene (PCE), benzene and vinyl chloride, that were in the on-base water-supply systems located at United States Marine Corps Base Camp Lejeune, during the period beginning on August 1, 1953, and ending on December 31, 1987; (ii) The diseases listed in §3.309(f) shall have become manifest to a degree of 10 percent or more at any time after service; (iii) A veteran, or former reservist or member of the National Guard, who had no less than 30 days (consecutive or nonconsecutive) of service at Camp Lejeune during the period beginning on August 1, 1953, and ending on December 31, 1987, shall be presumed to have been exposed during such service to the contaminants in the water supply, unless there is affirmative evidence to establish that the individual was not exposed to contaminants in the water supply during that service; (iv) Exposure described in paragraph (a)(7)(iii) of this section is an injury under 38 U.S.C. § 101 (24)(B) and (C). If an individual described in paragraph (a)(7)(iii) of this section develops a disease listed in §3.309(f), VA will presume that the individual concerned became disabled during that service for purposes of establishing that the individual served in the active military, naval, or air service. Under 38 C.F.R. §3.309(f), if a veteran, or former reservist or member of the National Guard, was exposed to contaminants in the water supply at Camp Lejeune during military service and the exposure meets the requirements of §3.307(a)(7), the following diseases shall be service-connected even though there is no record of such disease during service, subject to the rebuttable presumption provisions of §3.307(d): (1) Kidney cancer; (2) Liver cancer; (3) Non-Hodgkin’s lymphoma; (4) Adult leukemia; (5) Multiple myeloma; (6) Parkinson’s disease; (7) Aplastic anemia and other myelodysplastic syndromes; and (8) Bladder cancer. With regard to whether the Veteran meets the requirement for presumed exposure to contaminants in the water at Camp Lejeune, service personnel records indicated that the Veteran was at Camp Lejeune for at least 30 days during the requisite period. Thus, exposure to the contaminants in the water supply systems at Camp Lejeune is presumed. Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits. VA shall consider all information and lay and medical evidence of record in a case and when there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Again, the Veteran claims entitlement to service connection for a generalized arthritis disorder, bilateral elbow disorders, bilateral hand disorders, a back disorder, bilateral lower extremity disorders, bilateral upper extremity disorders, a head disorder, skin cancer, and hypertension. Although in his February 2014 claim, the Veteran wrote “Camp LeJune [sic] water” below the list of service connection claims, he has not submitted any medical evidence linking his presumed exposure to contaminated water at Camp Lejeune to any of his claimed disabilities; nor has he claimed or shown that he has been diagnosed with any of the diseases presumptively linked to contaminated water exposure. Indeed, he has submitted no post-service medical evidence showing that he has any of the claimed disorders, nor has he submitted evidence suggesting that the claimed disorders are in some way related to service. A review of his service treatment records is negative for treatment for a generalized arthritis disorder, a bilateral elbow disorder, a bilateral hand disorder, a back disorder, a bilateral lower extremity disorder, a bilateral upper extremity disorder, a head disorder, or skin cancer. A July 1970 separation examination revealed a normal head, spine, upper and lower extremities, and skin and no related defects were noted. Blood pressure was 120/84 at entrance and 116/80 at separation. The Board acknowledges that the Veteran, as a lay person, is competent to report certain observations and draw certain inferences. However, although it is error to categorically reject a lay person as competent to provide a nexus opinion, not all questions of nexus are subject to non-expert opinion. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). Whether a layperson is competent to provide a nexus opinion depends on the facts of the particular case. In Davidson, the U.S. Court of Appeals for the Federal Circuit (Federal Circuit) drew from its earlier decision in Jandreau v. Nicholson to explain its holding. Id. In that earlier decision, the Federal Circuit stated as follows: “[l]ay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional.” Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The Federal Circuit provided an example, stating that a layperson would be competent to identify a simple condition such as a broken leg, but not competent to provide evidence as to a more complex medical question such as a form of cancer. Id. at n.4. Also of note is that the Veterans Court has explained that non-expert witnesses are competent to report that which they have observed with their own senses. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). Taking Davidson, Jandreau, and Layno together, leads the Board to the conclusion that the complexity of the question and whether a nexus opinion could be rendered based on personal observation are factors in determining whether a non-expert nexus opinion or diagnosis is competent evidence. In the instant case, the lay statements of record consist of the Veteran and his representative’s assertions that service connection for the disorders at issue is warranted. See September 2013 correspondence; February 2014 claim; October 2014 claim; April 2015 notice of disagreement; August 2016 VA Form 9; January 2017 Appellate Brief. As such, these statements only demonstrate a lay person’s belief that a certain legal conclusion should be reached; notably, these lay statements do not describe the initial onset, extent or duration of pain or other observable symptoms of a given claimed disorder. Further, even if the Veteran’s statement that he has, for example, a “back problem,” see September 2013 correspondence, were sufficient to establish the current disability requirement, there are no specific contentions as to how such a disability is related to service other than the suggestion that it is associated with contaminated water at Camp Lejeune. Any such lay statement linking the claimed disabilities to his exposure to contaminated water is not competent evidence because this is a complex question that requires medical training and expertise. See Jandreau, 492 F.3d at 1377. To the extent the Veteran’s lay statements alone are sufficient to establish that he has a qualifying chronic disease, there is no indication that any such disability manifested within the presumptive period, nor has the Veteran so alleged. 38 C.F.R. §§ 3.307, 3.309. Similarly, there is no indication that any qualifying chronic disease showed a continuity of symptomatology after separation, nor has the Veteran so alleged. 38 C.F.R. § 3.303(b). The Board acknowledges that the discussion of the evidence relating to the Veteran’s service connection claims is brief; however, this reflects the evidence in the claims file. In sum, the Veteran has only submitted statements claiming entitlement to service connection for a generalized arthritis disorder, bilateral elbow disorder, bilateral hand disorder, back disorder, bilateral lower extremity disorder, bilateral upper extremity disorder, head disorder, skin cancer, and hypertension. He has submitted no evidence corroborating the current existence of any such disorder; he has submitted no medical evidence linking the claimed disorders to service; he has submitted no lay statements describing the initial onset, extent or duration of pain or other observable symptoms related to the claimed disorders; and he has not identified any VA, federal or private medical evidence that might substantiate his claims. Accordingly, the Board finds that the preponderance of the evidence is against the claims, the benefit-of-the-doubt doctrine is not for application, and the claims must be denied. 38 U.S.C. § 5107. REASONS FOR REMAND As to entitlement to service connection for an acquired psychiatric disorder, the service treatment records show that about one month before separation, the Veteran underwent a psychiatric examination where he was noted to be “an impulsive drug abuser with little motivation who has given up on the Marine Corps.” See June 1970 service treatment record. The psychiatrist there found that there was no evidence of neurosis, psychosis, brain impairment or significant depression but that the diagnosis was character and behavior disorder. The Veteran now claims that he has anxiety, an acquired psychiatric disorder, that is related to service. In light of the fact that certain behavioral changes can be markers of an in-service personal assault, the Board finds that a VA examination is warranted. See 38 C.F.R. § 3.304(f)(5). As to the claims for service connection for bilateral knee disabilities and bilateral foot disabilities, in January 2015, the RO obtained VA opinions to address the etiology of those disorders. Although the claims file contained no post-service medical records, the RO requested only a VA opinion, i.e., without an in-person examination of the Veteran. Unsurprisingly, the examiner determined that service connection for those disabilities was not warranted due to the lack of post-service medical evidence of such claimed disabilities. It also appears that the examiner did not review the claims file. Accordingly, the Board finds that the current VA opinions are inadequate and that a VA examination and etiological opinion should be obtained on remand. The matters are REMANDED for the following action: 1. Provide the Veteran with proper notice to develop a PTSD personal assault claim. 2. Schedule the Veteran for a VA examination to address to the etiology of any current left or right knee disability or any current left or right foot disability. All necessary tests should be conducted. The claims file must be sent to the examiner for review. The examiner should first diagnose all current left knee, right knee, left foot and right foot disabilities. Then, for each disability, the examiner should indicate whether it is at least as likely as not (50 percent probability or more) that it is related to or had its onset during the Veteran’s period of active duty service. The examiner is advised that lay persons are competent to report observable symptoms and that such reports must be taken into account in formulating the requested opinion. A complete rationale should accompany any opinion provided. 3. Schedule the Veteran for a VA examination to address to the etiology of any current acquired psychiatric disorder. All necessary tests should be conducted. The claims file must be sent to the examiner for review. The examiner should first diagnose all current acquired psychiatric disorders. Then, for each disability, the examiner should indicate whether it is at least as likely as not (50 percent probability or more) that it is related to or had its onset during the Veteran’s period of active duty service. A complete rationale should accompany any opinion provided. 4. After completion of the above, readjudicate the claims. If any benefit requested on appeal is not granted to the Veteran’s satisfaction, the appellant and his representative should be furnished a supplemental statement of the case, and provided an opportunity to respond. GAYLE STROMMEN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Matthew Schlickenmaier, Counsel