Citation Nr: 18156309 Decision Date: 12/07/18 Archive Date: 12/07/18 DOCKET NO. 16-09 270 DATE: December 7, 2018 ORDER Subject to the law and regulations governing payment of monetary benefits, a 40 percent rating for the Veteran’s back disability is granted. A compensable rating for postoperative residuals of anal fissure is denied. Service connection for residuals of a dental injury for compensation purposes is denied. Service connection for residuals of a cold injury or frostbite of the right foot is denied. Service connection for residuals of a cold injury or frostbite of the left foot is denied. Service connection for a gastrointestinal disability, to include diverticulitis, is denied. A temporary total evaluation for a March 2012 gastrointestinal surgery under 38 C.F.R. § 4.30 based upon the need for convalescence is denied. REMANED Entitlement to service connection for a right-hand disability. Entitlement to service connection for a left-hand disability. Entitlement to a TDIU. FINDINGS OF FACT 1. Throughout the course of the appeal period, even considering the Veteran’s pain and corresponding functional impairment, unfavorable ankylosis of the entire thoracolumbar spine has not been shown. 2. The service-connected postoperative residuals of anal fissure have been shown to be healed. 3. The record does not reflect the Veteran had any in-service dental trauma; nor that he has a current dental disability for which service connection may be established for compensation purposes. 4. The weight of the evidence does not establish that the Veteran has a current right foot disability, claimed as frostbite, is related to service. 5. The weight of the evidence does not establish that the Veteran has a current left foot disability, claimed as frostbite, is related to service. 6. The record does not reflect that the Veteran has a gastrointestinal or bowel disability, diagnosed as diverticulitis, that is related to his active military service. 7. Service connection was not in effect for a gastrointestinal disability, to include diverticulitis, when the Veteran underwent surgery a gastrointestinal disability in March 2012. CONCLUSIONS OF LAW 1. The criteria for an initial disability of 40 percent for lumbar spondylosis have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.321, 4.1, 4.3, 4.7, 4.10, 4.40, 4.45, 4.71a Diagnostic Codes 5010, 5003, 5237 (2017). 2. The criteria for a compensable evaluation for the service-connected postoperative residuals of anal fissure have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.20, 4.114, Diagnostic Codes 7335, 7332 (2017). 3. The criteria for a grant of service connection for compensation purposes for dental disorder are not met. 38 U.S.C. § 1712 (2012); 38 C.F.R. §§ 3.381, 17.161 (2017); VAOGCPREC 5-97. 4. The criteria for entitlement to service connection for the residuals of a right foot cold injury have not been satisfied. 38 U.S.C. §§ 1110, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2017). 5. The criteria for entitlement to service connection for the residuals of a left foot cold injury have not been satisfied. 38 U.S.C. §§ 1110, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2017). 6. The criteria for a grant of service connection for a gastrointestinal disability have not been met, to include as secondary to anal fissures. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.303, 3.310 (2017). 7. The criteria for a temporary total evaluation for a 2012 post-operation gastrointestinal surgery 38 C.F.R. § 4.30 based upon the need for convalescence are not met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. § 4.30 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active military service in the US Army from January 1983 to August 1988. The Veteran requested a hearing in February 2016. In October 2018, the Veteran withdrew his hearing request in writing. Increase Rating Disability evaluations are determined by the application of a schedule of ratings which is based, as far as can practically be determined, on the average impairment of earning capacity. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.1 (2017). Each service-connected disability is rated on the basis of specific criteria identified by Diagnostic Codes. 38 C.F.R. § 4.27 (2017). When rating the Veteran’s service-connected disability, the entire medical history must be borne in mind. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where there is a question as to which of two evaluations is to be applied, 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). Where a claimant appeals the initial rating assigned following an award of service connection, evidence contemporaneous with the claim for service connection and with the rating decision granting service connection would be most probative of the degree of disability existing at the time that the initial rating was assigned and should be the evidence “used to decide whether an [initial] rating on appeal was erroneous....” Fenderson v. West, 12 Vet. App. 119, 126 (1999). If later evidence obtained during the appeal period indicates that the degree of disability increased or decreased following the assignment of the initial rating, “staged” ratings may be assigned for separate periods of time based on facts found. Id. When evaluating joint disabilities rated on the basis of limitation of motion, VA must consider granting a higher rating in cases in which functional loss due to pain, weakness, excess fatigability, or incoordination is demonstrated, and those factors are not contemplated in the relevant rating criteria. See 38 C.F.R. §§ 4.40, 4.45; DeLuca v. Brown, 8 Vet. App. 202 (1995). Although pain may be a cause or manifestation of functional loss, pain by itself does not constitute a functional loss. See Mitchell v. Shinseki, 25 Vet. App. 32 (2011). Thus, functional loss caused by pain must be rated at the same level as if the functional loss were caused by any of the other factors cited above. See id. In evaluating the severity of a joint disability, VA must determine the overall functional impairment due to these factors. Generally, painful motion is deemed to warrant the minimum compensable rating for a joint, even if there is no actual limitation of motion. See Petitti v. McDonald, 27 Vet. App. 415 (2015); Burton v. Shinseki, 25 Vet. App. 1 (2011). 1. Back Disability The Veteran has asserted entitlement to an evaluation in excess of 20 percent for his service connected back disability. The Veteran’s low back disability is currently rated under Diagnostic Codes 5010-5239 for traumatic arthritis manifesting as symptomatology akin to spondylolisthesis or segmental instability. Hyphenated Diagnostic Codes are used when a rating under one Diagnostic Code requires use of an additional code to identify the basis for the evaluation assigned. 38 C.F.R. § 4.27. Here, Diagnostic Code 5010 provides that arthritis due to trauma that is substantiated by X-ray findings is to be rated as degenerative arthritis. Diagnostic Code 5003 provides that degenerative arthritis that is established by X-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. When there is limitation of motion of the specific joint or joints that is compensable (10 percent or higher) under the appropriate diagnostic codes, the compensable limitation of motion should be rated under the appropriate diagnostic codes for the specific joint or joints involved. 38 C.F.R. § 4.71a. The General Rating Formula for Diseases and Injuries of the Spine (which includes Diagnostic Code 5239, provides a 40 percent disability rating is assigned for forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent disability rating is assigned for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent disability rating is assigned for unfavorable ankylosis of entire spine. 38 C.F.R. § 4.71a. Any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, are rated separately. 38 C.F.R. § 4.71a, Note (1). The Veteran underwent a VA examination in association with his claim for a TDIU. In January 2013, the Veteran’s back disability was examined to determine the current level of severity. The examiner noted that the Veteran had a history of intermittent low back strain since service, and his post-service treatment records are void of any significant changes in the severity of disability. During the examination, the Veteran reported chronic daily back pain with flare-ups. He stated that his pain was worse with physical activity including lifting, bending, twisting. He reported that he flare-ups 2-3 times per week and has to sit down and rest. His pain is located in the lower back and is non-radiating. He did not report any complaints of neurological symptoms. The Veteran’s forward flexion was to 70 degrees, with painful motion beginning at 70 degrees. After repetitive testing, the examiner noted that forward flexion ended at 30 degrees. The examiner reported that the Veteran experienced functional loss manifested by less movement than normal, pain on movement and instability of station. The Veteran was not diagnosed with unfavorable ankylosis of the entire thoracolumbar spine. The Veteran underwent another VA back examination in November 2013. He was diagnosed with lumbar spondylosis. At this examination is forward flexion was to 65 and was 55 after repeated testing. Otherwise the Veteran the same symptoms, increased frequency of flare-ups and functional loss of range of motion post flare-ups and continued complaints of pain on ambulation. At this examination there was objective evidence of guarding, pain and tenderness on palpation but sensory or neurological symptoms. Based on this evidence, the Board finds that a 40 percent disability rating for the Veteran’s back disability is warranted for the entire appeal period. The Board also notes that as 40 percent is the highest schedular rating for limitation of motion of the spine, the regulatory provisions (38 C.F.R. §§ 4.40, 4.45) pertaining to functional loss are not for application. Spencer v. West, 13 Vet. App. 376, 382 (2000); Johnston v. Brown, 10 Vet. App. 80, 85 (1997); see also Sharp v. Shulkin, 29 Vet. App. 26 (2017). The Board finds that the Veteran does not meet the criteria for a 50 percent rating as he has not been diagnosed with unfavorable ankylosis of the entire thoracolumbar spine. Furthermore, the record does not indicate that the Veteran has been assessed with intervertebral disc syndrome, therefore no alternate rating criteria under Diagnostic Code 5243 need be considered. Lastly, there is no evidence that the Veteran has left or right lower extremity radiculopathy, and the Veteran has expressly denied such radiating pain. Therefore, entitlement to separate compensable ratings for lower extremity radiculopathy is not warranted. 2. Compensable rating for postoperative residuals of anal fissure. The Veteran asserts entitlement to a compensable rating for post-operative residuals of anal fissure. The Veteran’s disability has been rated under Diagnostic Code (DC) 7335. This DC is for anal fistulas, and the Board is directed to rate this as impairment of sphincter control under DC 7332. Diagnostic Code 7332 provides ratings for “[r]ectum and anus, impairment of sphincter control.” 38 C.F.R. § 4.114. A 10 percent rating is warranted for constant slight, or occasional moderate leakage. Id. A 30 percent rating is warranted for occasional involuntary bowel movements, necessitating wearing of a pad. Id. A 60 percent rating is warranted for extensive leakage and fairly frequent involuntary bowel movements. Id. Finally, a 100 percent rating is warranted when there is complete loss of sphincter control. Id. The Veteran underwent VA examination in June 2012 regarding his anal fissure, and according to both of these examinations, the Veteran’s condition had resolved. Noting that the Veteran was normal with no external hemorrhoids, anal fissures or other abnormalities. Further, it was noted that the Veteran uses a colostomy and therefore does not defecate through rectum or anus. Service Connection Service connection may be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred or aggravated in active military service. This means that the facts establish that a particular injury or disease resulting in disability was incurred coincident with service in the Armed Forces, or if preexisting such service, was aggravated therein. 38 U.S.C. § 1110; 38 C.F.R. § 3.303 (2017). Establishing service connection on a direct basis requires evidence demonstrating: (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the claimed in-service disease or injury. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999); Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff’d per curiam, 78 F. 3d 604 (Fed. Cir. 1996) (table). In addition to the elements of direct service connection, service connection may also be granted on a secondary basis for a disability if it is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310 (a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). 3. Residuals of dental injury with bridge. The Veteran has asserted entitlement to service connection for a dental injury with bridge. The Veteran contends that his tooth was chipped and repaired sometime between 1984 and 1986. A review of the Veteran’s service treatment records note that on December 21, 1984 he was treated for a broken tooth resulting in restoration of tooth number 8. There is another note that the Veteran’s bridge fell out and was treated for this on July 28, 1988. Service connection for treatable carious teeth, replaceable missing teeth, dental or alveolar abscesses, or periodontal disease will be considered solely for the purpose of establishing eligibility for outpatient dental treatment. 38 C.F.R. § 3.381 (a). Service connection for compensation purposes is not available for a dental condition other than for injuries sustained as a result of dental trauma. The rating activity will consider each defective or missing tooth and each disease of the teeth and periodontal tissues separately to determine whether the condition was incurred or aggravated in the line of duty during active service. When applicable, the rating activity will determine whether the condition is due to combat or other in-service trauma, or whether the veteran was interned as a prisoner of war. 38 C.F.R. § 3.381(a), (b). Dental disabilities which may be awarded compensable disability ratings are set forth under 38 C.F.R. § 4.150. These disabilities include chronic osteomyelitis or osteoradionecrosis of the maxilla or mandible, loss of the mandible, nonunion or malunion of the mandible, limited temporomandibular motion, loss of the ramus, loss of the condyloid or coronoid processes, loss of the hard palate, loss of teeth due to the loss of substance of the body of the maxilla or mandible and where the lost masticatory surface cannot be restored by suitable prosthesis, when the bone loss is a result of trauma or disease but not the result of periodontal disease. 38 C.F.R. § 4.150, Diagnostic Codes 9900-9916. To establish entitlement to service connection for loss of a tooth, the veteran must have sustained a combat wound or other in-service trauma. 38 U.S.C. § 1712; 38 C.F.R. § 3.381 (b). The significance of finding that a dental condition is due to in-service trauma is that a veteran will be eligible for VA outpatient dental treatment, without being subject to the usual restrictions of a timely application and one-time treatment. 38 C.F.R. § 17.161 (c). The term “service trauma” does not include the intended effects of therapy or restorative dental care and treatment provided during a veteran’s active service. See 38 C.F.R. § 3.306 (b)(1); VAOGCPREC 5-97. More specifically, the term “service trauma” does not include the repair of a chipped tooth or the repair of a dental bridge. The Veteran’s service treatment records does not demonstrate any in-service dental trauma. Further, no dental impairment appears to have been noted on his April 1988 expiration of term of service examination. Moreover, the Veteran indicated on a concurrent Report of Medical History that he had not had severe tooth or gum trouble. Under current law, compensation is only available for certain types of dental and oral conditions, such as impairment of the mandible, loss of a portion of the ramus, and loss of a portion of the maxilla. See 38 C.F.R. § 4.150. Compensation is available for loss of teeth if such loss is due to the loss of substance of body of the maxilla or mandible, but only if such bone loss is due to trauma or disease (such as osteomyelitis), and not to the loss of the alveolar process as a result of periodontal disease, as such loss is not considered disabling. Id; Note to Diagnostic Code 9913. Treatable carious teeth, replaceable missing teeth, dental or alveolar abscesses, and periodontal disease are not compensable disabilities. 38 U.S.C. § 1712; 38 C.F.R. §§ 3.381, 4.150. Therefore, the Board must find that the record does not reflect the Veteran has a current dental disability for which service connection may be established for compensation purposes. In view of the foregoing, the Board finds that the claim of service connection for a dental disorder for compensation purposes must be denied. 4. Frostbite residuals The Veteran has asserted entitlement to service connection for frostbite of the right foot, and left foot. The Veteran asserts that he suffered frostbite of his left foot and right foot while he was stationed in Germany. This claim was previously denied in March 2000, because there was no record of treatment for frostbite either of the feet during service. The denial of this service connection claim was continued by September 2001, April 2002, June 2003. Where a claim of entitlement to service connection has been previously denied and that decision has become final, the claim can be reopened and reconsidered only if new and material evidence is presented as to that claim. 38 U.S.C. § 5108 (2012). The regulatory requirement that the new evidence must raise a reasonable possibility of substantiating the claim “must be read as creating a low threshold.” Shade v. Shinseki, 24 Vet. App. 110, 117 (2010). In determining whether this low threshold is met, VA should not limit its consideration to whether the newly submitted evidence relates specifically to why the claim was last denied. Id. at 118. Rather, VA should ask whether the newly submitted evidence, combined with VA assistance and considering alternative theories of entitlement, can reasonably substantiate the claim. Id. Newly submitted evidence is presumed to be credible for the purpose of determining whether evidence is sufficiently new and material. Justus v. Principi, 3 Vet. App. 510, 513 (1992). The June 2003 rating decision became final because the Veteran did not submit a Notice of Disagreement or new evidence in connection with the claims within the appeal period. See 38 C.F.R. § 3.156(b). In connection with the Veteran’s claim to reopen, he provided a statement that that he was told by a medical professional that he may have motor and sensory damage as a result of frostbite. See November 2011 Statement from Veteran. Thus, the Board finds that new and material evidence has been received sufficient to reopen his previously denied claims. 38 C.F.R. § 3.156(a); Shade v. Shinseki, 24 Vet. App. 110, 117-18 (2010); Justus v. Principi, 3 Vet. App. 510, 513 (1992). The Veteran was afforded a VA examination as to his claim for cold injury residuals. The examiner noted that the Veteran had not and did currently not have a diagnosis of any cold injury. The examiner reviewed the Veteran’s service treatment records and noted that in November 1982 he was treated for a swollen right hand and numbness, but there was no mention of a cold injury. The examiner also noted that his service treatment records indicate treatment for numbness in the Veteran’s hands in 1982 and occasional numbness in hands and feet in 1984. The medical examination performed before separation makes no mention of any cold injury or numbness in his feet. The Veteran told the examiner that since service he has had intermittent numbness and tingling in his feet. At the end of the examination, there were no residuals of a cold injury found on the Veteran’s feet. The examiner commented, that while the Veteran gives a history of a cold injury, no lasting residuals as a result of the injury are found. The examiner also attributed his symptoms of his bilateral feet to his service-connected pes planus. As such, while the Board does believe the Veteran’s account of extreme cold during his time in Germany, there is no evidence that the Veteran suffered a cold injury with lasting residuals to either foot. His current symptoms of numbness and pain in his feet is attributed to his service-connected pes planus. As such, the etiology of his current symptoms have been related to a different disability. The Veteran has himself asserted that he has current disorders of the feet resulting from cold injuries sustained in service. A layperson is competent to report observable symptomatology which comes to him via his senses. See Jandreau, 492 F.3d at 1372; see also Buchanan, 451 F.3d at 1331. Some medical issues, however, require specialized training for a determination as to diagnosis and causation, and such issues are therefore not susceptible of lay opinions on etiology, and the Veteran’s statements therein cannot be accepted as competent medical evidence. See Clemons, 23 Vet. App. at 6. Lay testimony on the etiology of current diagnoses of bilateral foot disorders is not competent in the present case, because the Veteran is not competent to state that his current disorders resulted from in-service diseases or injuries. See Davidson, 581 F.3d at 1316; Kahana, 24 Vet. App. at 433. An opinion of etiology would require knowledge of the complexities of orthopedic and vascular disabilities and the various causes of such disorders. Therefore, the Board finds that the Veteran’s opinions are less probative to issue of etiology than that of the VA examiners and medical professionals. For the reasons and bases discussed above, the Board finds that a preponderance of the lay and medical evidence that is of record weighs against the claim for service connection for any disorder of the feet resulting from in-service frostbite or cold weather injury, and this claim must be denied. Because the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 5. Diverticulitis The Veteran has asserted entitlement to service connection for a bowel disability, diagnosed as diverticulitis or chronic constipation. The Board will refer to this more generally as a gastrointestinal disability. The Veteran has asserted that he began having symptoms of gastrointestinal disability in service, manifested by chronic constipation. He specifically points to the following notations in his service medical records from February 1984, November 1984, and April 1988. A review of the treatment from these dates note treatment for the following conditions. In February 1984, he complained of pain in the abdominal area near the naval area. Normal bowel tones were heard in all four quadrants and there was no pain on palpation. In November 1984, the Veteran was treated for a urinary tract infection and abdominal pain. In April 1988, the Veteran was treated for rectal bleeding after a bowel movement. The Veteran complained of difficulty passing stool. The Veteran was diagnosed with rectal strictures at this time. While, these documents do detail that the Veteran had treatment for abdominal pain and was eventually diagnosed and treated for rectal strictures/anal fissures, the Board finds that the Veteran’s service treatment records are void of a diagnosis or treatment for diverticulitis or a gastrointestinal disability that is separate from his rectal strictures/anal fissures. The Board notes that post-service treatment records show that the Veteran had elective laparoscopic surgery as a treatment for recurrent diverticulitis. Treatment notes regarding the surgery do not related his recurrent diverticulitis to his active military service or his service-connected anal fissures. As evidence to support his claim, the Veteran submitted a letter, dated May 2012, from his treating physician at the VA in Waco, that the Veteran has been treated for chronic diverticulitis, he does not relate this condition to his active military service. The treating physician does not relate his diverticulitis to his service-connected residuals of anal fissure. The physician does state that the patients, and not the Veteran, with anal fissure and diverticular disease suffer from constipation, which is often the leading cause of these conditions; he does not state that the Veteran’s cause of his diverticular disease was constipation or that his anal fissures caused his diverticular disease. As such, the physician’s comments on this does not provide an etiological opinion on the Veteran’s diverticular disease nor does he relate the disease to the Veteran’s active military service. As such, the Board finds this letter to be relevant, it does not find it to be probative to the question of service-connection. In July 2012, a rectum/anus disability benefits questionnaire was completed. At this time, the Veteran reported a long history of constipation characterized by hard stools and recurrent rectal pain and bleeding. This questionnaire does not relate his anal fissures to his diverticulitis. The examiner was asked to provide an opinion as to whether the Veteran’s history of chronic constipation related to or based on reports of constipation complaints found in service treatment records. The examiner opined that since there was no evidence that the Veteran’s complaints of chronic constipation are related to service. Noting, that while the Veteran suffered from anal fissures, rectal bleeding, and rectal pain during service, there was no consistent documentation of hard bowel movements. Conversely, there were at least two episodes of diarrhea in service, one of which necessitated stool studies. The examiner further stated that the Veteran’s history of chronic constipation in service was accompanied by a rectal fissure requiring a sphincterotomy and recurrent episodes of rectal bleeding and pain. The Veteran told the examiner that he could not recall the date of his first episode of diverticulitis, but states that from January 2011 through January 2012 he suffered from continuous diverticulitis. Ultimately, the Veteran underwent a colectomy in February 2012 and he now has a colectomy. The Veteran has swelling and pain at the colostomy site. The examiner concluded that it was less likely than not that the Veteran’s chronic constipation, anal stricture, and severe diverticulitis is due to or the result of his service connected anal fissure, postoperative. This is based on a review of the file, which revealed no post-operative complications from his sphincterotomy and normal rectal tone without recurrent fissures. The Veteran’s recent colectomy was due to recurrent diverticulitis. The examiner also took into consideration the comments from the Veteran’s treating physician, and colorectal surgeon, noting the statements that chronic constipation may lead to diverticulitis, there was no clear evidence that the Veteran experienced significant constipation during his service. A review of private treatment notes dated from 2011 to 2012 indicate treatment for recurrent diverticulitis that began in February 2011. These treatment notes do not indicate that the Veteran’s current diagnosis was etiologically related to his abdominal pain in service. A VA examiner in March 2013 opined that the Veteran’s diverticulitis status post laparoscopic sigmoid colectomy is less likely than not incurred in or caused by anal fissures and rectal bleeding that occurred during his military service. His in-service complaints of anal fissures have no nexus or anatomical or physiologic connection to his diverticulitis. They are not related in any manner. The Veteran has himself asserted that he has current bowel disorder to include diverticulitis is related to his active military service. A layperson is competent to report observable symptomatology which comes to him via his senses. See Jandreau, 492 F.3d at 1372; see also Buchanan, 451 F.3d at 1331. Some medical issues, however, require specialized training for a determination as to diagnosis and causation, and such issues are therefore not susceptible of lay opinions on etiology, and the Veteran’s statements therein cannot be accepted as competent medical evidence. See Clemons, 23 Vet. App. at 6. Lay testimony on the etiology of current diagnoses of bowel or gastrointestinal disability is not competent in the present case, because the Veteran is not competent to state that his current disorders resulted from in-service diseases or injuries. See Davidson, 581 F.3d at 1316; Kahana, 24 Vet. App. at 433. An opinion of etiology requires knowledge of the complexities of gastrointestinal systems and the various causes of such disorders, knowledge that the Veteran is not shown to possess, even with his experience as a medic during service. The Veteran has also not alleged that he was told of such a nexus by a competent expert, and such assertions have not subsequently been verified by such an expert. For the reasons and bases discussed above, the Board finds that a preponderance of the lay and medical evidence weighs against the claim for service connection for any gastrointestinal disorder due to in-service bowel or gastrointestinal condition, and this claim must be denied. Because the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 6. Temporary Total Disability Entitlement to a temporary total rating for convalescence purposes under 38 C.F.R. § 4.30, following March 2012 gastrointestinal surgery. The law provides that a temporary total rating will be assigned without regard to other provisions of the rating schedule when it is established by report at hospital discharge or outpatient release that treatment of one or more service-connected disabilities resulted in surgery necessitating at least one month of convalescence; surgery with severe post-operative residuals such as incompletely healed surgical wounds, stumps of recent amputations, therapeutic immobilization of one major joint or more, application of a body case, or the necessity for house confinement, or the necessity for continued use of a wheelchair or crutches; or immobilization by cast, without surgery, of one major joint or more. 38 C.F.R. § 4.30. There is no dispute the Veteran underwent gastrointestinal surgery in March 2012. However, service connection was not in effect for any gastrointestinal disability at that time. Thus, the claim for a temporary total evaluation under 38 C.F.R. § 4.30 must be denied as a matter of law. Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). REASONS FOR REMAND The Veteran has repeatedly asserted that he has a right hand and left hand disability that is related to his active military service. There is evidence that the Veteran was treated in service for hand swelling and hand numbness in 1982 and again in 1984 the Veteran was treated for numbness in hands. The Board is remanding to determine if the Veteran has functional impairment of the right and/or left hands that is related to or had its onset in service, to include his complaints of swelling, numbness, and pain in his hands in 1982 and 1984. The Board is also remanding the issue of TDIU as it is inextricably intertwined with the other claim currently on appeal. Harris v. Derwinski, 1 Vet. App. 180. The matters are REMANDED for the following action: 1. Notify the Veteran that he may submit lay statements from himself and from other individuals who have first-hand knowledge of his in-service and post-service right and left hand disability symptoms as well as the impact of the Veteran’s service-connected disabilities on his ability to work. The Veteran should be provided an appropriate amount of time to submit this lay evidence. 2. Schedule the Veteran for a VA examination by an appropriate medical professional to determine the nature, onset, and etiology of his left and right hand disability. The examiner should identify all of the Veteran’s left and right hand disorders, including any functional impairments. The phrase “functional impairment” is defined as “the inability of the body or a constituent part of it to function under the ordinary conditions of daily life, including employment.” Additionally, the Board notes that pain alone can qualify as a disability “where it diminishes the body’s ability to function, even where it is not diagnosed as connected to a current underlying condition.” Thereafter the examiner must opine as to whether it is at least as likely as not that any such impairment is related to or had its onset in service. When providing the opinion, the examiner is asked to take into consideration the Veteran’s current diagnosis of carpel tunnel syndrome, as well as service treatment records from 1982 and 1984 noting the Veteran’s complaints of swelling, numbness, and pain in his left and right hand. The examiner must also acknowledge and discuss the lay evidence indicating that the Veteran has had recurrent right hand and left hand problems since service, regardless of whether any such impairment is related to any in-service cold exposure or frostbite. STEVEN D. REISS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD K. Anderson