Citation Nr: 18156455 Decision Date: 12/10/18 Archive Date: 12/10/18 DOCKET NO. 15-00 008A DATE: December 10, 2018 ORDER New and material evidence having been received, the application to reopen a claim of entitlement to service connection for a low back disability is granted. New and material evidence having been received, the application to reopen a claim of entitlement to service connection for a bilateral hip disability is granted. New and material evidence having been received, the application to reopen a claim of entitlement to service connection for a right knee disability is granted. New and material evidence has not been received in order to reopen a claim of entitlement to service connection for a nodule on the lung; as such, the application to reopen the claim is denied. New and material evidence has not been received in order to reopen a claim of entitlement to service connection for hypertension; as such, the application to reopen the claim is denied. New and material evidence having been received, the application to reopen a claim of entitlement to service connection for a neurological disability of the right leg is granted. New and material evidence has not been received in order to reopen a claim of entitlement to service connection for a cervical spine disability; as such, the application to reopen the claim is denied. New and material evidence has not been received in order to reopen a claim of entitlement to service connection for refractive error, to include myopia and presbyopia; as such, the application to reopen the claim is denied. New and material evidence having been received, the application to reopen a claim of entitlement to service connection for a sinus disorder, to include sinusitis, allergic rhinitis, and chronic laryngitis, is granted. New and material evidence has not been received in order to reopen a claim of entitlement to service connection for a dental disorder; as such, the application to reopen the claim is denied. New and material evidence having been received, the application to reopen a claim of entitlement to service connection for a right eye disability is granted. New and material evidence having been received, the application to reopen a claim of entitlement to service connection for a left eye disability is granted. Entitlement to service connection for a right or left eye disability is denied. Entitlement to service connection for undiagnosed illness due to service in Southwest Asia is denied. Entitlement to service connection for diabetes mellitus is denied. Entitlement to service connection for degenerative joint disease of the right knee is granted. REMANDED Entitlement to service connection for a low back disability is remanded. Entitlement to service connection for a hip disability is remanded. Entitlement to service connection for a left knee disability is remanded. Entitlement to service connection for a sinus disorder, to include sinusitis, allergic rhinitis, and chronic laryngitis, is remanded. Entitlement to service connection for a neurological disability of the right leg is remanded. Entitlement to service connection for an acquired psychiatric disorder, to include post-traumatic stress disorder (PTSD) and depressive disorder, is remanded. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU). FINDINGS OF FACT 1. In a November 1999 rating decision, the regional office (RO) denied entitlement to service connection for degenerative joint disease of the back and hip, patellofemoral syndrome of the right knee, hypertension, nodule on lung, and neurological impairment of the right leg. This decision was not appealed nor was additional evidence received within the appeal period. 2. Evidence received since the November 1999 rating decision is new, relates to an unestablished fact necessary to substantiate the claim of entitlement to service connection for a low back disability, and raises a reasonable possibility of substantiating the claim. 3. Evidence received since the November 1999 rating decision is new, relates to an unestablished fact necessary to substantiate the claim of entitlement to service connection for a bilateral hip disability, and raises a reasonable possibility of substantiating the claim. 4. Evidence received since the November 1999 rating decision is new, relates to an unestablished fact necessary to substantiate the claim of entitlement to service connection for a right knee disability, and raises a reasonable possibility of substantiating the claim. 5. Evidence received since the November 1999 rating decision is cumulative and redundant of the evidence of record at the time of the decision as to the nodule on the lung and therefore does not relate to an unestablished fact necessary to substantiate the claim of entitlement to service connection for a nodule on the lung. 6. Evidence received since the November 1999 rating decision is cumulative and redundant of the evidence of record at the time of the decision as to hypertension and therefore does not relate to an unestablished fact necessary to substantiate the claim of entitlement to service connection for hypertension. 7. Evidence received since the November 1999 rating decision is new, relates to an unestablished fact necessary to substantiate the claim of entitlement to service connection for neurological disability of the right leg, and raises a reasonable possibility of substantiating the claim. 8. In an October 2007 rating decision, the RO denied in relevant part service connection for degenerative joint disease (also claimed as arthritis, osteoarthritis, and muscle spasms) of the cervical spine, service connection for refractive error (myopia), service connection for sinusitis claimed as ear, throat and sinus problems and sinus disorder, and service connection for a dental disorder. This decision was not appealed nor was additional evidence received within the appeal period. 9. Evidence received since the October 2007 rating decision is cumulative and redundant of the evidence of record at the time of the decision as to the cervical spine claim and therefore does not relate to an unestablished fact necessary to substantiate the claim of entitlement to service connection for a cervical spine disability. 10. Evidence received since the October 2007 rating decision is cumulative and redundant of the evidence of record at the time of the decision as to the refractive error claim, and therefore does not related to an unestablished fact necessary to substantiate the claim of entitlement to service connection for a refractive error, to include myopia and presbyopia. 11. Evidence received since the October 2007 rating decision is new, relates to an unestablished fact necessary to substantiate the claim of entitlement to service connection for a sinus disorder, to include sinusitis, allergic rhinitis, and chronic laryngitis, and raises a reasonable possibility of substantiating the claim. 12. Evidence received since the October 2007 rating decision is cumulative and redundant of the evidence of record at the time of the decision as to the dental disability claim and therefore does not relate to an unestablished fact necessary to substantiate the claim of entitlement to service connection for a dental disorder. 13. In an April 1993 rating decision, the RO denied service connection for residuals of left eye trauma and right eye condition. This decision was not appealed nor was additional evidence received within the appeal period. 14. Evidence received since the April 1993 rating decision is new, relates to an unestablished fact necessary to substantiate the claim of entitlement to service connection for a right eye disability, and raises a reasonable possibility of substantiating the claim. 15. In a November 2010 decision, the Board of Veterans’ Appeals (Board) declined to reopen a claim of service connection for a left eye disability; the decision was not appealed, nor did the Veteran file a motion for reconsideration of the Board’s decision. 16. Evidence received since the November 2010 Board decision is new, relates to an unestablished fact necessary to substantiate the claim of entitlement to service connection for a left eye disability, and raises a reasonable possibility of substantiating the claim. 17. The preponderance of the evidence of record is against finding that the Veteran has, or has had at any time during the appeal, a current diagnosis of a right or left eye disability. 18. The preponderance of the evidence of record is against finding that the Veteran served in Southwest Asia during the Persian Gulf War. 19. The Veteran’s diabetes mellitus did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury, event, or disease. 20. The Veteran has experienced right knee pain related to degenerative joint disease or osteoarthritis of the right knee since her separation from service. CONCLUSIONS OF LAW 1. A November 1999 rating decision, which in relevant part denied service connection for degenerative joint disease of the back and hip, patellofemoral syndrome of the right knee, hypertension, nodule on lung, and neurological impairment of the right leg, is final. 38 U.S.C. § 7105(c) (1991); 38 C.F.R. §§ 3.104, 3.156(b), 20.302, 20.1103 (1999); currently 38 U.S.C. § 7105(c) (2012); 38 C.F.R. §§ 3.104, 3.156(b), 20.302, 20.1103 (2018). 2. Evidence added to the record since the November 1999 denial is new and material as to the low back disability, and the claim for entitlement to service connection for a low back disability is reopened. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). 3. Evidence added to the record since the November 1999 denial is new and material as to a bilateral hip disability, and the claim for entitlement to service connection for a bilateral hip disability is reopened. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). 4. Evidence added to the record since the November 1999 denial is new and material as to a right knee disability, and the claim for entitlement to service connection for a right knee disability reopened. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). 5. New and material evidence has not been received to reopen a claim of entitlement to service connection for a nodule on the lung. 38 U.S.C. § 5108; 38 C.F.R. §§ 3.156(a), 20.1105. 6. New and material evidence has not been received to reopen a claim of entitlement to service connection for hypertension. 38 U.S.C. § 5108; 38 C.F.R. §§ 3.156(a), 20.1105. 7. Evidence added to the record since the November 1999 denial is new and material as to the claim of neurological disability of the right leg, and the claim of entitlement to service connection for neurological disability of the right leg is reopened. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). 8. An October 2007 rating decision, which in relevant part denied service connection for degenerative joint disease (also claimed as arthritis, osteoarthritis, and muscle spasms) of the cervical spine, service connection for refractive error (myopia), service connection for sinusitis claimed as ear, throat, and sinus problems and sinus disorder, and service connection for a dental disorder, is final. 38 U.S.C. § 7105(c) (2002); 38 C.F.R. §§ 3.104, 3.156(b), 20.302, 20.1103 (1999); currently 38 U.S.C. § 7105(c) (2012); 38 C.F.R. §§ 3.104, 3.156(b), 20.302, 20.1103 (2007). 9. New and material evidence has not been received to reopen a claim of entitlement to service connection for a cervical spine disability. 38 U.S.C. § 5108; 38 C.F.R. §§ 3.156(a), 20.1105. 10. New and material evidence has not been received to reopen a claim of entitlement to service connection for refractive error, to include myopia and presbyopia. 38 U.S.C. § 5108; 38 C.F.R. §§ 3.156(a), 20.1105. 11. Evidence added to the record since the October 2007 denial is new and material as to a sinus disorder and the claim for entitlement to service connection for a sinus disorder, to include sinusitis, allergic rhinitis, and chronic laryngitis, is reopened. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). 12. New and material evidence has not been received to reopen a claim of entitlement to service connection for a dental disorder. 38 U.S.C. § 5108; 38 C.F.R. §§ 3.156(a), 20.1105. 13. An April 1993 rating decision, which in relevant part denied service connection for residuals of left eye trauma and right eye condition, is final. 38 U.S.C. § 7105(c) (1991); 38 C.F.R. §§ 3.104, 3.156(b), 20.302, 20.1103 (1992); currently 38 U.S.C. § 7105(c) (2012); 38 C.F.R. §§ 3.104, 3.156(b), 20.302, 20.1103 (2018). 14. Evidence added to the record since the April 1993 denial is new and material, and the claim for entitlement to service connection for a right eye disability is reopened. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). 15. A November 2010 Board decision, which declined to reopen a claim of service connection for a left eye disability, is final. 38 U.S.C. § 7104(b) (2002); 38 C.F.R. § 20.1100 (2009); currently 38 U.S.C. § 7104(b) (2012); 38 C.F.R. § 20.1100 (2018). 16. Evidence added to the record since the November 2010 denial is new and material, and the claim for entitlement to service connection for a left eye disability is reopened. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). 17. The criteria for service connection for a left or right eye disability are not met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 18. The criteria for service connection for undiagnosed illness due to service in Southwest Asia are not met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 19. The criteria for service connection for diabetes mellitus are not met. 38 U.S.C. §§ 1112, 1113, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a)-(b), (d), 3.307, 3.309(a). 20. The criteria for entitlement to service connection for degenerative joint disease of the right knee are met. 38 U.S.C. §§ 1112, 1113, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(b), 3.307, 3.309(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from April 1981 to April 1987. These matters come before the Board of Veterans’ Appeals (Board) on appeal from June 2003 (low back, bilateral hips, right knee, left knee, right eye, lung nodule, hypertension, neurological disability of the right leg, acquired psychiatric disorder, TDIU) and January 2012 (diabetes mellitus, cervical spine, left eye, refractive error, undiagnosed illness, sinus disorder, dental disorder) rating decisions by a Department of Veterans Affairs (VA) Regional Office (RO). The Board notes that the Board’s Veterans Appeals Control and Locator System (VACOLS) reflects that the June 2003 rating decision is final because a timely VA Form 9 was not filed as of December 31, 2004. However, the record reflects that a November 2004 VA Form 9 is of record. This VA Form 9 was filed within 60 days of the October 2004 statement of the case (SOC), and is thus a timely appeal to the Board. Therefore, the June 2003 rating decision is currently on appeal, despite any subsequent denials, including final denials, of the claims therein. Although the Veteran initially submitted a September 2010 claim to reopen the claim of entitlement to service unspecified disabilities due to participation in the Cold War, she clarified in a July 2014 statement that she intended to claim entitlement to service connection for disability due to participation in the Gulf War, not the Cold War. The Board finds that this is a different claim, rather than new evidence to reopen the previous claim for service connection for unspecified disabilities due to participation in the Cold War, and will proceed accordingly. REFERRED The issue of entitlement to outpatient dental treatment was raised in a September 2010 statement and is referred to the Agency of Original Jurisdiction (AOJ) for adjudication. The September 2010 statement is a claim of service connection for dental disorder. The U.S. Court of Appeals for Veterans Claims (Court) has specifically held that a claim for service connection for a dental disorder is also a claim for VA outpatient dental treatment. See Mays v. Brown, 5 Vet. App. 302 (1993). As the claim was filed prior to March 24, 2015, it did not need to be filed on a specific form. Cf. 38 C.F.R. § 3.155(a). New and Material Evidence A claim that is the subject of a prior denial may be reopened if new and material evidence is received with respect to that claim. New evidence means existing evidence not previously submitted to agency decision makers. Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). The evidence that is considered to determine whether new and material evidence has been received is the evidence received since the last final disallowance of the appellant’s claim on any basis. Evans v. Brown, 9 Vet. App. 273 (1996). This evidence is presumed credible for the purposes of reopening an appellant’s claim, unless it is inherently false or untrue, or, if it is in the nature of a statement or other assertion, it is beyond the competence of the person making the assertion. Duran v. Brown, 7 Vet. App. 216 (1995); Justus v. Principi, 3 Vet. App. 510 (1992). In determining whether new and material evidence has been received to reopen a claim, the Court has indicated that there is a low threshold for determining whether evidence raises a reasonable possibility of substantiating a claim. See 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 the reason why the claim was last denied, but instead should consider whether the evidence could reasonably substantiate the claim were the claim to be reopened, including by triggering VA’s duty to obtain a VA examination. Id. at 118. Moreover, the Veteran need not present evidence as to each element that was a specified basis for the last disallowance, but merely new and material evidence as to at least one of the bases of the prior disallowance. Id. at 120 (noting the assistance of 38 C.F.R. § 3.159(c)(4) would be rendered meaningless if new and material evidence required a claimant to submit medical nexus evidence when he has provided new and material evidence as to another missing element). Once a claim is reopened, the adjudicator must review it on a de novo basis, with consideration given to all the evidence of record. 38 U.S.C. § 5108; Evans v. Brown, 9 Vet. App. 273 (1996). To prevail on a direct service connection claim, there must be competent evidence of (1) a current disability, (2) in-service incurrence or aggravation of a disease or injury, and (3) a nexus between the in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). 1. Whether new and material evidence has been received to reopen a claim of entitlement to service connection for a low back disability The Veteran has put forth new and material evidence relating to an in-service event she believes is the cause of her current low back disability. The Board finds that this evidence meets the low threshold to be sufficient to reopen the claim. Service connection for degenerative joint disease of the back and hip was denied by a November 1999 rating decision, finding that the Veteran’s service treatment records (STRs) are negative for low back complaint, and the Veteran’s claim was not well-grounded. No appeal was taken from this November 1999 rating decision, and new and material evidence was not received within the one-year appeal period. As such, the decision is final. 38 U.S.C. § 7105(c) (1991); 38 C.F.R. §§ 3.104, 3.156(b), 20.302, 20.1103 (1999); currently 38 U.S.C. § 7105(c) (2012); 38 C.F.R. §§ 3.104, 3.156(b), 20.302, 20.1103 (2018). Since the last final denial, VA has received a March 2004 statement relating the Veteran’s experience of a motor vehicle accident in service in which the seat jammed against her back. The Veteran is competent to relate her experience in service, and the statement is presumed credible for the purposes of reopening her claim. Duran v. Brown, 7 Vet. App. 216 (1995); Justus v. Principi, 3 Vet. App. 510 (1992). This evidence is relevant to the existence of an in-service event that caused the Veteran’s current disability. The evidence thus relates to an unestablished fact necessary to substantiate the Veteran’s claim, and raises a reasonable possibility of establishing the claim. See 38 C.F.R. § 3.156. Therefore, the evidence is new and material. Such new and material evidence having been received, the claim of entitlement to service connection for a low back disability is reopened. See 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). 2. Whether new and material evidence has been received to reopen a claim of entitlement to service connection for a bilateral hip disability The Veteran has put forth new and material evidence relating to a nexus between service and the Veteran’s bilateral hip disability. The Board finds that this evidence meets the low threshold to be sufficient to reopen the claim. Service connection for degenerative joint disease of the back and hip was denied by a November 1999 rating decision, finding that the Veteran’s service treatment records (STRs) are negative for bilateral hip complaint, and the Veteran’s claim was not well-grounded. No appeal was taken from this November 1999 rating decision, and new and material evidence was not received within the one-year appeal period. As such, the decision is final. 38 U.S.C. § 7105(c) (1991); 38 C.F.R. §§ 3.104, 3.156(b), 20.302, 20.1103 (1999); currently 38 U.S.C. § 7105(c) (2012); 38 C.F.R. §§ 3.104, 3.156(b), 20.302, 20.1103 (2018). Since the last final denial, VA has received an August 2006 statement in which the Veteran states that her hip problems are due to a motor vehicle accident in service. The Veteran is competent to relate her experience in service, and the statement is presumed credible for the purposes of reopening her claim. Duran v. Brown, 7 Vet. App. 216 (1995); Justus v. Principi, 3 Vet. App. 510 (1992). This evidence is relevant to a nexus between the Veteran’s current disability and service. The evidence thus relates to an unestablished fact necessary to substantiate the Veteran’s claim, and raises a reasonable possibility of establishing the claim. See 38 C.F.R. § 3.156. Therefore, the evidence is new and material. Such new and material evidence having been received, the claim of entitlement to service connection for a bilateral hip disability is reopened. See 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). 3. Whether new and material evidence has been received to reopen a claim of service connection for a right knee disability The Veteran has put forth new and material evidence relating to a nexus between service and her right knee disability. The Board finds that this evidence meets the low threshold to be sufficient to reopen the claim. Service connection for patellofemoral syndrome of the right knee was denied by a November 1999 rating decision, finding that the Veteran’s service treatment records (STRs) are negative for right knee treatment and did not corroborate the Veteran’s assertion that her right knee was injured in a motor vehicle accident, and the Veteran’s claim was thus not well-grounded. No appeal was taken from this November 1999 rating decision, and new and material evidence was not received within the one-year appeal period. As such, the decision is final. 38 U.S.C. § 7105(c) (1991); 38 C.F.R. §§ 3.104, 3.156(b), 20.302, 20.1103 (1999); currently 38 U.S.C. § 7105(c) (2012); 38 C.F.R. §§ 3.104, 3.156(b), 20.302, 20.1103 (2018). Since the last final denial, VA has received September 2002 and March 2004 statements providing greater detail about the in-service motor vehicle accident that the Veteran believes caused her current right knee disability. The Veteran is competent to relate her experience in service, and her statements are presumed credible for the purposes of reopening her claim. Duran v. Brown, 7 Vet. App. 216 (1995); Justus v. Principi, 3 Vet. App. 510 (1992). This evidence is relevant to the existence of an in-service event that caused the Veteran’s current disability. The evidence thus relates to an unestablished fact necessary to substantiate the Veteran’s claim, and raises a reasonable possibility of establishing the claim. See 38 C.F.R. § 3.156. Therefore, the evidence is new and material. Such new and material evidence having been received, the claim of entitlement to service connection for a right knee disability is reopened. See 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). 4. Whether new and material evidence has been received to reopen a claim of entitlement to service connection for a nodule on the lung VA has not received new and material evidence sufficient to reopen the claim of entitlement to service connection for a nodule on the lung. Service connection for nodule on the lung was denied by a November 1999 rating decision on the grounds that the Veteran’s STRs do not contain any treatment for any nodule on the lung, meaning that there is no evidence demonstrating the condition was incurred in or aggravated by military service and the claim was thus not well-grounded. No appeal was taken from this November 1999 rating decision, and new and material evidence was not received within the one-year appeal period. As such, the decision is final. 38 U.S.C. § 7105(c) (1991); 38 C.F.R. §§ 3.104, 3.156(b), 20.302, 20.1103 (1999); currently 38 U.S.C. § 7105(c) (2012); 38 C.F.R. §§ 3.104, 3.156(b), 20.302, 20.1103 (2018). Since the November 1999 final denial, VA has received VA treatment records. However, these treatment records do not contain evidence that the Veteran’s nodule on the lung was incurred in or is otherwise related to service. Therefore, the Veteran’s treatment records are cumulative and redundant of evidence already in the record. Thus, the evidence added to the record since the November 1999 final denial does not relate to an unestablished fact necessary to substantiate the claim of service connection for a nodule on the lung, and does not raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). Accordingly, the claim of entitlement to service connection for a nodule on the lung is not reopened. As new and material evidence to reopen the finally disallowed claim of entitlement to service connection for a nodule on the lung has not been received, the benefit of the doubt doctrine is not applicable. Annoni v. Brown, 5 Vet. App. 463, 467 (1993). 5. Whether new and material evidence has been received to reopen a claim of entitlement to service connection for hypertension VA has not received new and material evidence sufficient to reopen the claim of entitlement to service connection for hypertension. Service connection for hypertension was denied by a November 1999 rating decision on the grounds that the Veteran’s STRs do not contain any treatment for or diagnosis of hypertension, nor did evidence show manifestations of hypertension within one year following discharge from service. There was no evidence demonstrating the condition was incurred in or aggravated by military service and the claim was thus not well-grounded. No appeal was taken from this November 1999 rating decision, and new and material evidence was not received within the one-year appeal period. As such, the decision is final. 38 U.S.C. § 7105(c) (1991); 38 C.F.R. §§ 3.104, 3.156(b), 20.302, 20.1103 (1999); currently 38 U.S.C. § 7105(c) (2012); 38 C.F.R. §§ 3.104, 3.156(b), 20.302, 20.1103 (2018). Since the November 1999 final denial, VA has received VA treatment records. While these treatment records indicate an ongoing hypertension diagnosis, they do not contain evidence that the Veteran’s hypertension was incurred in or is otherwise related to service, or that it manifested within one year of leaving service. Therefore, the Veteran’s VA treatment records are cumulative and redundant of evidence already in the record. Thus, the evidence added to the record since the November 1999 final denial does not relate to an unestablished fact necessary to substantiate the claim of service connection for hypertension, and does not raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). Accordingly, the claim of entitlement to service connection for hypertension is not reopened. As new and material evidence to reopen the finally disallowed claim of entitlement to service connection for hypertension has not been received, the benefit of the doubt doctrine is not applicable. Annoni v. Brown, 5 Vet. App. 463, 467 (1993). 6. Whether new and material evidence has been received to reopen a claim of entitlement to service connection for neurological disability of the right leg The Veteran has put forth new and material evidence relating to a nexus between her neurological disability of the right leg and service. Service connection for neurological impairment of the right leg was denied by a November 1999 rating decision on the grounds that the Veteran’s STRs contained a normal EMG and nerve conduction study, and the record contained no evidence demonstrating that the Veteran’s neurological impairment of the right leg was incurred in or aggravated by military service, meaning that the claim was not well-grounded. No appeal was taken from this November 1999 rating decision, and new and material evidence was not received within the one-year appeal period. As such, the decision is final. 38 U.S.C. § 7105(c) (1991); 38 C.F.R. §§ 3.104, 3.156(b), 20.302, 20.1103 (1999); currently 38 U.S.C. § 7105(c) (2012); 38 C.F.R. §§ 3.104, 3.156(b), 20.302, 20.1103 (2018). Since the last final denial, VA has received an October 2003 VA treatment note showing that an MRI of the lumbosacral spine indicated central disc protrusion skewed to the right at L5-S1 abutting the right S1 nerve root, and containing an impression of chronic low back pain with sciatica neuropathy. VA has also received statements relating the Veteran’s low back disability to an in-service motor vehicle accident, as discussed above. This evidence is relevant to the existence of an in-service event that, by causing a low back disability, also caused neurological disability of the right lower extremity secondary to the low back disability. This evidence is relevant to the existence of an in-service event that caused the Veteran’s current disability. A new theory of entitlement is not a new claim, but rather a claim to reopen. See Roebuck v. Nicholson, 20 Vet. App. 307 (2006) (multiple theories of entitlement pertaining to the same benefit for the same disability constitute the same claim). The evidence thus relates to an unestablished fact necessary to substantiate the Veteran’s claim, and raises a reasonable possibility of establishing the claim. See 38 C.F.R. § 3.156. Therefore, the evidence is new and material. Such new and material evidence having been received, the claim of entitlement to service connection for neurological disability of the right leg is reopened. See 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). 7. Whether new and material evidence has been received to reopen a claim of entitlement to service connection for a cervical spine disability VA has not received new and material evidence sufficient to reopen the claim of entitlement to service connection for a cervical spine disability. Service connection for degenerative joint disease (also claimed as arthritis, osteoarthritis, and muscle spasms) of the cervical spine was denied by an October 2007 rating decision on the grounds that there was no nexus between the in-service motor vehicle accident and the Veteran’s cervical spine disability. No appeal was taken from this October 2007 rating decision, and new and material evidence was not received within the one-year appeal period. As such, the decision is final. 38 U.S.C. § 7105(c) (2002); 38 C.F.R. §§ 3.104, 3.156(b), 20.302, 20.1103 (1999); currently 38 U.S.C. § 7105(c) (2012); 38 C.F.R. §§ 3.104, 3.156(b), 20.302, 20.1103 (2007). Since the October 2007 final denial, VA has received VA treatment records and statements from the Veteran. While these treatment records indicate ongoing cervical spine treatment, and a March 2012 VA Form 9 again asserts that an in-service motor vehicle accident caused the cervical spine injury, these documents do not contain competent evidence of a nexus between the in-service motor vehicle accident and the current cervical spine disability. The Veteran is a lay person without medical training, and is thus not competent to provide complex medical evidence such as evidence of the etiology of her cervical spine disability. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Moreover, the March 2012 reference to the motor vehicle accident does not provide any more detail than was previously of record. Therefore, the evidence received is cumulative and redundant of evidence already in the record. Thus, the evidence added to the record since the October 2007 final denial does not relate to an unestablished fact necessary to substantiate the claim of service connection for a cervical spine disability, and does not raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). Accordingly, the claim of entitlement to service connection for a cervical spine disability is not reopened. As new and material evidence to reopen the finally disallowed claim of entitlement to service connection for a cervical spine disability has not been received, the benefit of the doubt doctrine is not applicable. Annoni v. Brown, 5 Vet. App. 463, 467 (1993). 8. Whether new and material evidence has been received to reopen a claim of entitlement to service connection for refractive error, to include myopia and presbyopia VA has not received new and material evidence sufficient to reopen the claim of entitlement to service connection for refractive error. Service connection for refractive error (myopia) was denied by an October 2007 rating decision on the grounds that refractive error is not a disability which can be considered for service connection. No appeal was taken from this October 2007 rating decision, and new and material evidence was not received within the one-year appeal period. As such, the decision is final. 38 U.S.C. § 7105(c) (2002); 38 C.F.R. §§ 3.104, 3.156(b), 20.302, 20.1103 (1999); currently 38 U.S.C. § 7105(c) (2012); 38 C.F.R. §§ 3.104, 3.156(b), 20.302, 20.1103 (2007). Since the last final denial, VA has received VA treatment records, including a November 2014 VA examination report, which indicates that the Veteran reported being hit in the eye with spent brass on the firing range in service. Although this evidence is new, it is not material. This evidence is relevant to the existence of an in-service event that the Veteran believes caused her refractive error, but the existence of an in-service event of eye trauma was already established at the time of the October 2007 denial. The assertion of another in-service eye trauma does not relate to the unestablished fact that caused the claim to be denied– namely, lack of a current disability because refractive error is a congenital defect and thus not a disability for VA purposes. 38 C.F.R. 4.9. In order to reopen the claim, VA needs to receive evidence relating to an unestablished fact – the existence of a current disability for VA purposes, or a nexus between service and a current disability. In this case, no such evidence has been received. Therefore, the evidence received is cumulative and redundant of evidence already in the record. The evidence added to the record since the October 2007 final denial does not relate to an unestablished fact necessary to substantiate the claim of service connection for refractive error, and does not raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). Accordingly, the claim of entitlement to service connection for refractive error is not reopened. As new and material evidence to reopen the finally disallowed claim of entitlement to service connection for refractive error has not been received, the benefit of the doubt doctrine is not applicable. Annoni v. Brown, 5 Vet. App. 463, 467 (1993). 9. Whether new and material evidence has been received to reopen a claim of entitlement to service connection for a sinus disability, to include sinusitis, allergic rhinitis, and chronic laryngitis The Veteran has put forth new and material evidence relating to a nexus between her sinus condition and service. Service connection for sinusitis claimed as ear, throat, and sinus problems as a result of exposure to mustard gas or Lewisite and sinus disorder (on a direct incurrence basis) was denied by an October 2007 rating decision on the grounds that there is no evidence that the Veteran was exposed to mustard gas or Lewisite during her service, there is no scientific or medical evidence that the chlorine or tear gas used in the gas chamber testing described by the Veteran causes ear, throat, or sinus disorders, and because there is no evidence of continuity of symptoms and treatment from discharge in 1987 until 1998. No appeal was taken from this October 2007 rating decision, and new and material evidence was not received within the one-year appeal period. As such, the decision is final. 38 U.S.C. § 7105(c) (2002); 38 C.F.R. §§ 3.104, 3.156(b), 20.302, 20.1103 (1999); currently 38 U.S.C. § 7105(c) (2012); 38 C.F.R. §§ 3.104, 3.156(b), 20.302, 20.1103 (2007). Since the October 2007 denial, the Board has received a September 2014 examination in which the Veteran reported ongoing chronic sinus drainage since 1981. The Veteran is competent to report her symptoms, and her statements are considered credible for the purposes of reopening the claim. Duran v. Brown, 7 Vet. App. 216 (1995); Justus v. Principi, 3 Vet. App. 510 (1992). This evidence is relevant to the existence of a nexus between service and the Veteran’s sinus condition. The evidence thus relates to an unestablished fact necessary to substantiate the Veteran’s claim, and raises a reasonable possibility of establishing the claim. See 38 C.F.R. § 3.156. Therefore, the evidence is new and material. Such new and material evidence having been received, the claim of entitlement to service connection for a sinus disability, to include sinusitis, is reopened. See 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). 10. Whether new and material evidence has been received to reopen a claim of entitlement to service connection for a dental disorder VA has not received new and material evidence sufficient to reopen the claim of entitlement to service connection for a dental disorder. Service connection for dental disorder was denied by an October 2007 rating decision on the grounds that no dental condition which qualifies as a disability for compensation purposes had been shown. No appeal was taken from this October 2007 rating decision, and new and material evidence was not received within the one-year appeal period. As such, the decision is final. 38 U.S.C. § 7105(c) (2002); 38 C.F.R. §§ 3.104, 3.156(b), 20.302, 20.1103 (1999); currently 38 U.S.C. § 7105(c) (2012); 38 C.F.R. §§ 3.104, 3.156(b), 20.302, 20.1103 (2007). Since the last final denial, VA has received VA treatment records. Although these records contain dental complaints, including tooth caries in June 2009, there is no evidence of a current VA disability for compensation purposes. Treatable carious teeth, replaceable missing teeth, dental or alveolar abscesses, and periodontal disease will be considered service connected solely for the purpose of establishing eligibility for outpatient dental treatment as provided in 38 C.F.R. §§ 3.381(a)(2), 17.161. Therefore, the evidence received is cumulative and redundant of evidence already in the record. The evidence added to the record since the October 2007 final denial does not relate to an unestablished fact necessary to substantiate the claim of service connection for dental disability, and does not raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). Accordingly, the claim of entitlement to service connection for a dental disability is not reopened. As new and material evidence to reopen the finally disallowed claim of entitlement to service connection for refractive error has not been received, the benefit of the doubt doctrine is not applicable. Annoni v. Brown, 5 Vet. App. 463, 467 (1993). Moreover, as noted in the introduction of this decision, a claim of entitlement to outpatient dental treatment is referred for initial AOJ jurisdiction. 11. Whether new and material evidence has been received to reopen a claim of entitlement to service connection for a right eye disability The Veteran has put forth new and material evidence relevant to the existence of an in-service event causing eye injury. An April 1993 rating decision denied service connection for right eye condition on the grounds that a right eye condition was not shown in the service record. No appeal was taken from this April 1993 rating decision, and new and material evidence was not received within the one-year appeal period. As such, the decision is final. 38 U.S.C. § 7105(c) (1991); 38 C.F.R. §§ 3.104, 3.156(b), 20.302, 20.1103 (1992); currently 38 U.S.C. § 7105(c) (2012); 38 C.F.R. §§ 3.104, 3.156(b), 20.302, 20.1103 (2018). Since the April 1993 denial, the Board has received a November 2014 examination in which the Veteran reported being hit in the eye with spent brass on the firing range. The Veteran is competent to report her symptoms, and her statements are considered credible for the purposes of reopening the claim. Duran v. Brown, 7 Vet. App. 216 (1995); Justus v. Principi, 3 Vet. App. 510 (1992). This evidence is relevant to the existence of an in-service event that she believes caused a current right eye disability. The evidence thus relates to an unestablished fact necessary to substantiate the Veteran’s claim, and raises a reasonable possibility of establishing the claim. See 38 C.F.R. § 3.156. Therefore, the evidence is new and material. Such new and material evidence having been received, the claim of entitlement to service connection for a right eye disability is reopened. See 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). 12. Whether new and material evidence has been received to reopen a claim of entitlement to service connection for a left eye disability The Veteran has put forth new and material evidence relevant to the existence of an in-service event causing eye injury. An April 1993 rating decision denied service connection for residuals of left eye trauma on the grounds that the condition in service was temporary and resolved with treatment. No appeal was taken from this April 1993 rating decision, and new and material evidence was not received within the one-year appeal period. As such, the decision is final. 38 U.S.C. § 7105(c) (1991); 38 C.F.R. §§ 3.104, 3.156(b), 20.302, 20.1103 (1992); currently 38 U.S.C. § 7105(c) (2012); 38 C.F.R. §§ 3.104, 3.156(b), 20.302, 20.1103 (2018). A November 2010 Board decision declined to reopen a claim of service connection for a left eye disability on the grounds that new and material evidence had not been received. That decision is final. 38 U.S.C. § 7104(b) (2002); 38 C.F.R. § 20.1100 (2009); currently 38 U.S.C. § 7104(b) (2012); 38 C.F.R. § 20.1100 (2018). Since the November 2010 denial, the Board has received a November 2014 examination in which the Veteran reported being hit in the eye with spent brass on the firing range. The Veteran is competent to report her symptoms, and her statements are considered credible for the purposes of reopening the claim. Duran v. Brown, 7 Vet. App. 216 (1995); Justus v. Principi, 3 Vet. App. 510 (1992). This evidence is relevant to the existence of an in-service event that she believes caused a current left eye disability. The evidence thus relates to an unestablished fact necessary to substantiate the Veteran’s claim, and raises a reasonable possibility of establishing the claim. See 38 C.F.R. § 3.156. Therefore, the evidence is new and material. Such new and material evidence having been received, the claim of entitlement to service connection for a left eye disability is reopened. See 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). Service Connection Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service, even if the disability was initially diagnosed after service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Certain chronic diseases will be presumed related to service if they were noted as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if continuity of the same symptomatology has existed since service, with no intervening cause. 38 U.S.C. §§ 1101, 1112, 1113, 1137; Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2012); Fountain v. McDonald, 27 Vet. App. 258 (2015); 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a). 13. Entitlement to service connection for a right or left eye disability The Veteran contends that she has an eye disability that is the result of being hit in the eye with a ball or with spent brass during service. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the Veteran does not have a current diagnosis of any eye disability and has not had one at any time during the pendency of the claim or recent to the filing of the claim. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); 38 C.F.R. § 3.303(a), (d). The November 2014 VA examiner evaluated the Veteran and determined that, while she had routine refractive error with presbyopia appropriate for her age, there was no scarring or damage to either eye. Further, the Veteran’s VA treatment records do not contain evidence of any eye disability. As noted elsewhere in this decision, refractive error such as myopia and presbyopia is a congenital defect, not a disability for VA compensation purposes. 38 C.F.R. 4.9; see also Talbert v. West, 1999 U.S. App. Vet. Claims LEXIS 479, *8. Therefore, the Veteran’s myopia and presbyopia cannot be service-connected. While the Veteran believes she has a current diagnosis of an eye disability, she is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. As the preponderance of the evidence is against the Veteran's claim, there is no reasonable doubt to be resolved, and the claim is denied. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102, 4.3; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 14. Entitlement to service connection for undiagnosed illness due to service in Southwest Asia The Veteran believes that she should be service-connected for undiagnosed illness due to service during the Gulf War. Service connection may be granted on a presumptive basis for a Persian Gulf Veteran who exhibits objective indications of qualifying chronic disability, including that resulting from undiagnosed illness, that became manifest either during active service in the Southwest Asia theater of operations during the Persian Gulf War, or to a degree of 10 percent or more not later than December 31, 2021, and which by history, physical examination, and laboratory tests cannot be attributed to any known clinical diagnosis. 38 U.S.C. § 1117; 38 C.F.R. § 3.317 (a)(1). In claims based on qualifying chronic disability, unlike those for direct service connection, there is no requirement that there be competent evidence of a nexus between the claimed illness and service. Gutierrez v. Principi, 19 Vet. App. 1, 8-9 (2004). Laypersons are competent to report objective signs of illness. The term “Persian Gulf veteran” means a veteran who served on active military, naval, or air service in the Southwest Asia theater of operations during the Persian Gulf War. 38 C.F.R. § 3.317(e)(1). The Persian Gulf War is defined as beginning on August 2, 1990, through a date to be prescribed by Presidential proclamation or law. 38 C.F.R. § 3.2(i). In this case, the record does not reflect that the Veteran served in the Southwest Asia theater of operations during the Persian Gulf War. She served from April 1981 to April 1987, meaning that her service was not during the Persian Gulf War, which is defined as beginning on August 2, 1990. 38 C.F.R. § 3.2(i). Moreover, the record does not reflect any service in Southwest Asia. Because the Veteran does not have service in the Southwest Asia theater of operations during the Persian Gulf War, she may not be granted service connection for an undiagnosed illness due to service in Persian Gulf War, and it is not necessary to discuss the nuances of qualifying chronic disability or undiagnosed illness. The Board must deny the Veteran’s claim. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102, 4.3; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 15. Entitlement to service connection for diabetes mellitus The Veteran contends that she should be service-connected for diabetes mellitus. Certain chronic diseases, such as diabetes mellitus, will be presumed related to service if they were noted as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if continuity of the same symptomatology has existed since service, with no intervening cause. 38 U.S.C. §§ 1101, 1112, 1113, 1137; Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2012); Fountain v. McDonald, 27 Vet. App. 258 (2015); 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a). The question for the Board is whether the Veteran has diabetes mellitus that manifested to a compensable degree in service or within the applicable presumptive period, or whether continuity of symptomatology has existed since service, or whether her diabetes mellitus is otherwise related to service. The Board concludes that, while the Veteran has diabetes mellitus, which is a chronic disease under 38 C.F.R. § 3.309(a), it was not chronic in service or manifest to a compensable degree in service or within a presumptive period, and continuity of symptomatology is not established. VA treatment records show the Veteran was not diagnosed with diabetes mellitus until September 2006, decades after her separation from service and decades outside of the applicable presumptive period. Therefore, service connection for diabetes mellitus is not available on a presumptive basis. Service connection for diabetes mellitus may still be granted on a direct basis; however, the preponderance of the evidence is against finding that a medical nexus exists between the Veteran’s diabetes mellitus and an in-service injury, event or disease. 38 U.S.C. §§ 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). The Veteran’s STRs do not contain any reference to diabetes mellitus, and the Veteran has not asserted that her diabetes mellitus began in service or identified any event in service that she believes caused her diabetes mellitus. A VA examination was not conducted as to diabetes mellitus. In determining whether the duty to assist requires that a VA medical examination be provided or medical opinion obtained with respect to a veteran’s claim for benefits, there are four factors for consideration. These four factors are: (1) whether there is competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) whether there is evidence establishing that an event, injury, or disease occurred in service, or evidence establishing certain diseases manifesting during an applicable presumption period; (3) whether there is an indication that the disability or symptoms may be associated with the veteran’s service or with another service-connected disability; and (4) whether there is otherwise sufficient competent medical evidence of record to make a decision on the claim. 38 U.S.C. § 5013A(d); 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). In this case, a VA examination is not required because there is no competent or credible evidence of an in-service event or association with service. While the Veteran may believe that her diabetes mellitus is related to service, the Board cannot grant service connection when, as in this case, the Veteran has not identified a specific in-service event or injury that she believes caused his current disability. As the preponderance of the evidence is against the Veteran’s claim, there is no reasonable doubt to be resolved, and the claim is denied. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102, 4.3; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 16. Entitlement to service connection for degenerative joint disease of the right knee The Veteran asserts that her current degenerative joint disease or arthritis of the right knee is due to a motor vehicle accident in service. The Veteran has a current diagnosis of degenerative joint disease in the right knee, as noted in August and September 2006 VA treatment records. Degenerative joint disease, or arthritis, is a chronic disease, and will be presumed related to service if it was noted as chronic in service; or, if it manifested to a compensable degree within a presumptive period following separation from service; or, if continuity of the same symptomatology has existed since service, with no intervening cause. 38 U.S.C. §§ 1101, 1112, 1113, 1137; Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2012); Fountain v. McDonald, 27 Vet. App. 258 (2015); 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a). The Veteran contends in a September 2002 statement that she hit her right knee on the dashboard of a vehicle when the vehicle was hit from the rear in a maneuver in Germany. Although this incident is not recorded in the Veteran’s STRs, a September 1999 statement from a fellow servicemember corroborates that this accident occurred, and stated that during service the Veteran stated that her knee was bothering her at times, but that she believed that it was just a bruise and would go away. An April 1987 report of medical history indicates that the Veteran responded that she did not know whether she had a trick or locked knee. Resolving reasonable doubt in favor of the Veteran, this response indicates that she was experiencing some problem with her knee, but that she did not know whether this problem fell into the category of a trick or locked knee. VA treatment records indicate that in December 1994, the Veteran reported right knee pain off and on since an injury in a military motor vehicle accident. This treatment note is dated several years prior to her initial right knee claim, which was filed in April 1999. Moreover, it is dated before her post-service motor vehicle accident, which, based upon treatment records, occurred in September 1998. VA treatment records show that she has continued to complain of right knee pain up until the present day. Resolving reasonable doubt in the Veteran’s favor, the record reflects that it is at least as likely as not that the Veteran has experienced right knee pain, which is a compensable symptom of her degenerative joint disease of the right knee, since service. Therefore, the evidence is at least in equipoise, and a VA examination is not necessary. Presumptive service connection for the chronic disability of degenerative joint disease of the right knee is granted. REASONS FOR REMAND 1. Entitlement to service connection for a low back disability is remanded. The Board cannot make a fully-informed decision on the issue of entitlement to service connection for a low back disability because no VA examiner has opined whether the low back disability is due to an in-service motor vehicle accident. 2. Entitlement to service connection for a bilateral hip disability is remanded. The Board cannot make a fully-informed decision on the issue of entitlement to service connection for a bilateral hip disability because no VA examiner has opined whether the bilateral hip disability is due to an in-service motor vehicle accident. 3. Entitlement to service connection for a left knee disability is remanded. The Board cannot make a fully-informed decision on the issue of entitlement to service connection for a left knee disability because no VA examiner has opined whether the left knee disability is due to an in-service motor vehicle accident. 4. Entitlement to service connection for sinus disability, to include sinusitis, allergic rhinitis, and chronic laryngitis, is remanded. The September 2014 VA examination found diagnoses of allergic rhinitis and chronic laryngitis. The examiner also noted near constant sinusitis. However, the examiner declined to give a nexus opinion because there was no supporting objective evidence to support chronic sinusitis diagnosis. Upon remand, a supplemental opinion should be obtained that reconciles this finding with the earlier finding of near constant sinusitis, and provides a nexus opinion for the diagnosed disabilities, including allergic rhinitis and chronic laryngitis. 5. Entitlement to service connection for neurological disability of the right leg, to include as secondary to a low back disability, is remanded. Because a decision on the remanded issue of entitlement to service connection for a low back disability could significantly impact a decision on the issue of entitlement to service connection for neurological disability of the right leg, the issues are inextricably intertwined. A remand of the claim of entitlement to service connection for neurological disability of the right leg is required. 6. Entitlement to service connection for an acquired psychiatric disorder, to include PTSD and depressive disorder, is remanded. The Board cannot make a fully-informed decision on the issue of entitlement to service connection for an acquired psychiatric disorder because no VA examiner has opined whether it is caused or aggravated by the service-connected right knee and bilateral foot disabilities, as is implied by an August 2006 statement reporting depression due to joint pain. Moreover, the August 2014 examination provided a negative nexus opinion, noting no in-service mental health treatment noted in the claims file, and stating that the treatment noted in the claims file appears to be related to substance abuse or post-military stressors. The examiner should consider whether the Veteran’s substance abuse is indicative of psychiatric symptoms, as indicated by an April 1998 VA treatment note finding PTSD-like symptoms and stating that the Veteran has used drugs since discharge to cope with her feelings. The Veteran should also be sent VCAA notice about evidence that can be used to verify her in-service stressor of a physically and sexually abusive relationship while in service. 7. Entitlement to a TDIU Finally, because a decision on the remanded issues could significantly impact a decision on the issue of entitlement to a TDIU, the issues are inextricably intertwined. A remand of the claim of entitlement to a TDIU is required. The matters are REMANDED for the following action: 1. Send the Veteran notice required for PTSD claims based on personal assaults, and allow time for a response. Then, attempt to corroborate the Veteran’s in-service stressor based on personal assault, including a sexually and physically abusive relationship. If more details are needed, contact the Veteran to request the information. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any low back disability. The examiner must opine whether it is at least as likely as not (50 percent or greater probability) related to an in-service injury, event, or disease, including a motor vehicle accident that threw her onto the floor in a seated position or caused the seat to jam against her back, as described in a March 2004 statement. Any opinion offered must be supported by a complete rationale. The examiner is advised that a December 1994 VA treatment record references an in-service motor vehicle accident and reports low back pain for 60 days, and a January 1998 VA treatment note indicates lower right back pain for two years. VA treatment records also indicate that the Veteran was also involved in a motor vehicle accident in September 1998. 3. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any right or left hip disability. The examiner must opine whether it is at least as likely as not (50 percent or greater probability) related to an in-service injury, event, or disease, including an in-service motor vehicle accident. Any opinion offered must be supported by a complete rationale. The examiner is advised that a September 1998 VA treatment note indicates that the Veteran presented via ambulance for, among other complaints, right hip pain as a result of a motor vehicle accident. 4. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any left knee disability. The examiner must opine whether it is at least as likely as not (50 percent or greater probability) related to an in-service injury, event, or disease, including an in-service motor vehicle accident. Any opinion offered must be supported by a complete rationale. The examiner is advised that VA treatment records also indicate that the Veteran was also involved in a post-service motor vehicle accident in September 1998. 5. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran has any sinus disability, including sinusitis, allergic rhinitis, and chronic laryngitis, that is at least as likely as not (50 percent or greater probability) related to service, to include multiple reports of upper respiratory symptoms in service, and exposure to a gas chamber with an ill-fitting gas mask. Any opinion must be supported by a complete rationale. If the examiner finds that the Veteran does not have a current disability of sinusitis, he or she is asked to reconcile the contradictory findings in the September 2014 examination of a sinusitis condition but no supporting objective evidence to support chronic sinusitis. 6. After the Veteran’s reported stressors have been developed, schedule the Veteran for a psychiatric examination to determine the nature and etiology of any acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) and depressive disorder. (a.) For the PTSD diagnosis, the examiner must explain how the diagnostic criteria are met and opine whether it is at least as likely as not (50 percent or greater probability) related to a verified in-service stressor, including an in-service motor vehicle accident corroborated by an October 1999 statement from a fellow service member, and address the possibility that the Veteran has used drugs since discharge to cope with her symptoms, as indicated by an April 1998 VA treatment note. If the PTSD diagnosis is based upon the Veteran’s report of an in-service personal assault, the examiner must opine whether the evidence of record, including the Veteran’s lay statements, and the Veteran’s service records, corroborate the claim that a personal assault occurred in service (38 C.F.R. § 3.304(f)(5)). If the examiner finds that evidence indicates that a personal assault occurred during the Veteran’s active service, the examiner must opine whether any PTSD is at least as likely as not (50 percent or greater probability) related to the in-service personal assault. (b.) For depressive disorder or any other acquired psychiatric disorder that may be diagnosed, the examiner must opine whether each diagnosed disorder is at least as likely as not (50 percent or greater probability) related to an in-service injury, event, or disease, to include an in-service motor vehicle accident, which is corroborated by an October 1999 statement from a fellow service member. (c.) If the diagnosis of depressive disorder or any other acquired psychiatric disorder is found to be less likely than related to an in-service injury, event, or disease, the examiner must provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) proximately due to service-connected right knee and hallux valgus disabilities, or aggravated beyond its natural progression by service-connected right knee and hallux valgus disabilities. Each opinion offered must be supported by a complete rationale. (Continued on the next page) 7. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal, including the inextricably intertwined issues of entitlement to a TDIU and entitlement to service connection for a neurological disability of the right leg, to include as secondary to a low back disability. If any benefit sought is not granted to the Veteran’s satisfaction, send the Veteran and her representative a Supplemental Statement of the Case and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. M. Donohue Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Budd, Counsel