Citation Nr: 18156716
Decision Date: 12/10/18	Archive Date: 12/10/18

DOCKET NO. 18-32 375
DATE:	December 10, 2018
ORDER
New and material evidence sufficient to reopen the claim for service connection for a back condition has been submitted.
New and material evidence sufficient to reopen the claim for service connection for a left ankle condition has been submitted.
Entitlement to service connection for a back condition is granted.
Entitlement to service connection for a left ankle injury is granted.
Entitlement to service connection for a right shoulder condition is granted.
Entitlement to service connection for bilateral pes planus is denied.
Entitlement to service connection for posttraumatic stress disorder (PTSD) is denied.
Entitlement to service connection for depressive disorder is denied.
REMANDED
Entitlement to a compensable rating for pseudofolliculitis barbae is remanded.
Entitlement to service connection for a right ankle condition is remanded.
Entitlement to service connection for a left knee condition is remanded.
Entitlement to service connection for a right knee condition is remanded.
Whether new and material evidence has been received to reopen a previously denied claim of service connection for a kidney condition is remanded.
Entitlement to service connection for hearing loss is remanded.
Entitlement to service connection for tinnitus is remanded.
Entitlement to service connection for degenerative disc disease (ddd) of the cervical spine is remanded.
Entitlement to service connection for radiculopathy of the left lower extremity is remanded.
Entitlement to service connection for radiculopathy of the right lower extremity is remanded.
FINDINGS OF FACT
1. In a March 1983 rating decision, the AOJ denied the Veteran’s claim of entitlement to service connection for a back condition.
2. In a May 1984 decision, the Board denied service connection for a back condition.
3. The evidence received since the Board’s May 1984 decision relates to an unestablished fact necessary to substantiate the claim for service connection for a back condition.
4. In a June 2011 rating decision, the AOJ denied the Veteran’s claim of entitlement to service connection for a left ankle injury; the Veteran did not file a timely appeal within one year of notification.
5. The evidence received since June 2011 relates to an unestablished fact necessary to substantiate the claim for service connection for a left ankle injury.
6. The Veteran’s back condition is related to active service.
7. The Veteran’s left ankle injury is related to active service.
8. The Veteran’s right shoulder condition is related to active service.
9. The Veteran’s bilateral pes planus did not have its onset in service.
10. The Veteran does not have a diagnosis of PTSD.
11. The Veteran’s depressive disorder is not due to service.
CONCLUSIONS OF LAW
1. The May 1984 Board decision is final. 38 U.S.C. § 7104; 38 C.F.R. §§ 20.1100, 20.1104.
2. The June 2011 rating decision is final. 38 U.S.C. § 7105(c); 38 C.F.R. § 20.1103 
3. The criteria for reopening a claim of entitlement to service connection for a back condition have been met. 38 U.S.C. § 5108; 38 C.F.R. §3.156(a).
4. The criteria for reopening a claim of entitlement to service connection for a left ankle injury have been met. 38 U.S.C. § 5108; 38 C.F.R. §3.156(a).
5. The criteria for entitlement to service connection for a back condition have been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.
6. The criteria for entitlement to service connection for a left ankle condition have been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.
7. The criteria for entitlement to service connection for a right shoulder condition have been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.
8. The criteria for service connection for pes planus have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.306.
9. The criteria for entitlement to service connection for PTSD have not been met. 38 U.S.C. § 1131, 5107; 38 C.F.R. §§ 3.303, 3.304.
10. The criteria for service connection for depressive disorder have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. § 3.303.
REASONS AND BASES FOR FINDINGS AND CONCLUSIONS
The Veteran served on active duty from March 1977 to June 1980.
This case is before the Board of Veterans’ Appeals (Board) on appeal from February 2016 and April 2017 rating decisions.
As an initial matter, the Board is aware that the issues of entitlement to service connection for a right ankle, left knee, and right knee condition were characterized as requiring new and material evidence. The Regional Office (RO) previously determined that the February 2016 rating decision was not timely appealed; however, upon review, the Board finds that a notice of disagreement (NOD) was received within a year of notification of the February 2016 rating decision. Thus, the February 2016 rating decision is not final, and new and material evidence is not required with respect to the issues of service connection for disabilities of the right ankle, left knee, and right knee.
New and Material – Request to Reopen
A decision of the RO becomes final and is not subject to revision on the same factual basis unless a NOD and substantive appeal are filed within the applicable time limits. 38 U.S.C. § 7105; 38 C.F.R. §§ 20.302, 20.1103. If a claim has been previously denied and that decision became final, the claim can be reopened and reconsidered only if new and material evidence is presented with respect to that claim. 38 U.S.C. § 5108; Jackson v. Principi, 265 F.3d 1366, 1369 (Fed. Cir. 2001).
A finally adjudicated claim is an application which has been allowed or disallowed by the agency of original jurisdiction, the action having become final by the expiration of one year after the date of notice of an award or disallowance, or by denial on appellate review, whichever is the earlier. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. Board decisions are final when issued, unless the Board Chairman orders reconsideration. 38 U.S.C. § 7104; 38 C.F.R. § 20.1100.
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). Evidence “raises a reasonable possibility of substantiating the claim,” if it would trigger VA’s duty to provide an examination in adjudicating a non-final claim. Shade v. Shinseki, 24 Vet. App. 110 (2010).
1. Request to reopen - back condition.
Prior to the filing of the current claim of entitlement to service connection for a back condition, the AOJ denied this claim in a March 1983 rating decision. In the March 1983 rating decision, the Veteran was denied service connection for his back condition on the basis that the evidence failed to show that the Veteran’s disability had been clinically diagnosed. The Veteran received notification of this decision in March 1983. The Veteran filed a notice of disagreement (NOD), and the Veteran’s back condition was again denied on the basis that there was no evidence that the Veteran had a back condition incurred in or aggravated by service. The Veteran testified at a personal hearing at the RO in August 1983 regarding his claim, and in a November 1983 and March 1984 supplemental statement of the case (SSOC) the Veteran’s claim was again denied on the basis that the condition was not incurred in or aggravated by military service. In a May 1984 Board decision, the Veteran’s claim was again denied on the basis that a back disability was not manifested in service. The May 1984 Board decision is final.  
In October 2015, the Veteran filed a claim for his back condition, claimed as degenerative disc disease (ddd) of the lumbar spine. In a February 2016 rating decision, the RO denied the claim, finding that new and material evidence sufficient to reopen the previously denied claim had not been received.  In a March 2016 NOD, the Veteran stated that he injured his lower back during service. In a May 2018 SOC, the RO continued the denial of the Veteran’s claim, finding that the evidence received was not new and material. The Veteran perfected his appeal in June 2018.
With regard to the Veteran’s back claim, the Board finds that the evidence submitted since the May 1984 Board decision, the last final denial, is new and material. 38 U.S.C. §§ 5108, 7104; 38 C.F.R. § 3.156.
Evidence received since May 1984 not previously taken into consideration, includes a December 2016 private medical report of consultation and examination regarding the Veteran’s back condition, including an opinion regarding the Veteran’s current back condition and relationship to service. This evidence relates to an unestablished fact necessary to substantiate the claim, and raises a reasonable possibility of substantiating the claim.  Therefore, the evidence is new and material and sufficient to reopen the claim.

2. Request to reopen – left ankle condition
Prior to the filing of the current claim of entitlement to service connection for a left ankle condition, the AOJ denied this claim in a June 2011 rating decision. In the June 2011 rating decision, the Veteran was denied service connection for his left ankle condition on the basis that the evidence failed to show that this disability is caused or aggravated by service. The Veteran received notification of this decision in June 2011. The Veteran did not timely appeal this decision, and it became final.
In October 2015, the Veteran filed a claim for his left ankle condition. In a February 2016 rating decision, the Veteran’s claim was denied on the basis that new and material evidence sufficient to reopen the previously denied claim had not been received. In a March 2016 NOD, the Veteran stated that he injured his left ankle during service. In a May 2018 SOC, the RO continued the denial of the Veteran’s claim on the basis that evidence received was not new and material. The Veteran perfected his appeal in June 2018.
With regard to the Veteran’s left ankle claim, the Board finds that the evidence submitted since the last final denial, the June 2011 rating decision, is new and material. 38 U.S.C. §§ 5108, 7104; 38 C.F.R. § 3.156.
Evidence received since June 2011 not previously taken into consideration, includes a December 2016 private medical report of consultation and examination regarding the Veteran’s left ankle condition, including an opinion regarding his left ankle condition and relationship to service. opinion regarding the Veteran’s current back condition and relationship to service. This evidence relates to an unestablished fact necessary to substantiate the claim, and raises a reasonable possibility of substantiating the claim.  Therefore, the evidence is new and material and sufficient to reopen the claim.
Service Connection
Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1110, 1131 (2012); 38 C.F.R. § 3.303(a) (2017). “To establish a right to compensation for a present disability, a Veteran must show: “(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service”- the so-called “nexus” requirement.” Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).
Service connection for certain chronic diseases may also be established based upon a legal “presumption” by showing that the disease manifested itself to a degree of 10 percent or more within one year from the date of separation from service. 38 U.S.C. §§ 1112, 1137; 38 C.F.R. §§ 3.307, 3.309. In addition, service connection may be granted for any disease diagnosed after service when all the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).
Secondary service connection may be granted for a disability that is proximately due to, or aggravated by, a service-connected condition. 38 C.F.R. § 3.310.
3. Entitlement to service connection for a back condition
The Veteran contends that his back condition is directly related to active service.
The Board concludes that the Veteran has a current diagnosis of well advanced degenerative joint disease (djd) and osteoarthritis of the lumbar spine emphasis lumbosacral region that is related to active service. 38 U.S.C. §§ 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a).
Service treatment records (STRs) include a December 11, 1979 record indicating that the Veteran stated that he had no prior history of trauma to the back and that he just gets pains in his lower back and right side. He was assessed with back pain. A November 14, 1979 note indicates that the Veteran complained of low back pain for 2 weeks. The Veteran opted to not have a separation medical examination on May 23, 1980. His DD 214 indicates that his MOS was Administrative.
Private medical treatment records indicate that the Veteran was seen on November 19, 1979 for a backache.
A private medical record dated July 19, 1982 indicates that the Veteran’s physician, Dr. T. opined that there was definite pars defect of L5 on the left, and probably on the right, with minimal first-degree spondylolisthesis of L5 on S1. In a July 28, 1982 letter, Dr. B. stated that the Veteran reported having back pain while overseas in the service about three years ago and that he was seen at Fort Bragg and had x-rays made but never saw a doctor after the x-rays were taken. He reported that for the past four to five weeks, his back has been bothering him again. Physical examination reveals good range of motion of his lumbar spine, and that x-rays from July 19 were reviewed, showing Grade I spondylolisthesis of L-5 on S-1.
The Veteran underwent a VA examination in September 1982 for his lower back. The Veteran states he was treated for pain in the lower back and that he had x-rays taken while in the service but did not see results. Radiographic report revealed that no acute fractures of the lumbosacral spine were identified and very minimal spondylolisthesis of S1 posteriorly on L5. The report indicates no abnormality of the low back found in this examination.
The Veteran testified at the RO in August 1983 regarding his back condition. The Veteran stated that he never had back problems before service and that the first time he had trouble was a couple of weeks after a field problem and heavy lifting, when he thought he had pulled a muscle. He stated that the military give him medication for his kidney problem but it did not clear up his back ache. He stated that he complained to the military again about his back hurting and that the doctor took another urine specimen and that the doctor was concerned with why there was blood in his urine. He stated that the doctor sent him to the hospital for an x-ray of his back and that the doctor wrote a prescription for his back. He stated that “he said maybe [the Veteran] had pulled a muscle” but that he would tell him it did not feel like a pulled muscle. He stated that he did not remember feeling any popping or grinding in his back but that it was a very sharp pain. He stated that sometimes it would come and go and other times it hurt for a while until he got treatment for it. He stated that after service he went to a private doctor. He stated that he was referred to Dr. B. and that he did not know exactly what was causing the pain in the lower part of his back, but they had x-rays. He stated that the doctor gave him a book about back problems and strengthening the muscles in the lower back. The Veteran stated that his MOS was clerk-typist and that he also worked in the field, “like pool garden, put up tent and help taking them down, load up the equipment that were throwed out and unload it…” He stated that his problems began after that, but that he does not remember a specific incident.
Private treatment records from January 2011 indicate that the Veteran was assessed with low back pain. Private treatment records from March 2011 include a record from May 26, 1994 record discussing pain in the “neck, low back – resolving,” noting that he fell in his home on April 4, 1994.
Private medical records from May 2011 indicate in an April 16, 2002 record that the Veteran was complaining of pain in his back and that he reported falling 2-3 months prior. The examiner noted a diagnosis of acute lumbar strain, mild degenerative arthritis of L3.
A December 2016 private medical report of consultation and examination completed by Dr. Y. indicates that the history of his injury was that while stationed in Germany the Veteran was required to lift heavy tents to and from a truck. He stated that the tents were very heavy and difficult to manage in the manner that they were required to do the work. The report indicates that the Veteran injured his low back during this required field exercise. The examiner noted that the Veteran was seen on multiple occasions by military medical personnel for care of his injuries and was treated with medications, and he noted abnormal x-ray studies of the low back. Regarding low back pain, the examiner noted a diagnosis of well advanced degenerative joint disease and osteoarthritis of the lumbar spine emphasis lumbosacral region and stated that since the injury, the Veteran has suffered from progressive low back pain which is now constant in varying degrees, with pain concentrating in the lumbosacral region. The examiner opined that it is more likely than not that the aforementioned is directly and causally related to injury to and conditions of the lower extremities as discussed by a process of chronic and constant bio mechanical adaptation and compensation for altered gait and weight shifting. He stated that “it is accordingly more likely than not that same is directly and causally related to the Veteran’s military service. This is a permanent and progressive condition.”
Private medical records from January 2017 indicate he was seen for evaluation of cervical and lumbar pain and that “he describes gradual onset of cervical stiffness and pain beginning greater than 20 years ago. He denies any known trauma or injury prior to onset of the pain. He reported initial evaluation of his symptoms through a chiropractor approximately 20 years ago, and he states radiographs were performed which did not reveal any acute abnormalities. It indicates that the Veteran “reports first experiencing lumbar pain beginning in October 1979 while engaging in field duty in the military. He states the lumbar pain began a few days following completion of the field duty, and the pain primarily involved the right lower lumbar region.
VA treatment records from August 2018 indicate that the Veteran reported that he was able to return to work in October 2017 and reported terrible pain in his back.
Private treatment records from June 2018 indicate that the Veteran had bilateral shoulder, neck, and low back pain who has been given a diagnosis of osteoarthritis and functional back pain. The Veteran reported that he has a long history of lumbar pain that began greater than 20 years ago and denied any precipitating injury.
After a review of the record, resolving all doubt in favor to the Veteran, the Board finds that the evidence supports a nexus between the Veteran’s current back condition and service. Thus, the Board finds that the evidence of record indicates that service connection is warranted for a back condition, and the claim is granted. See 38 U.S.C. § 1131; 38 C.F.R. § 3.303(d).
4. Entitlement to service connection for a left ankle injury
The Veteran contends that his left ankle injury is directly related to service.
The Board concludes that the Veteran has a current diagnosis of post traumatic residual degenerative joint disease of the left ankle complicated by inversion instability that is related to active service. 38 U.S.C. §§ 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a).
STRs indicate complaints of pain in the ankle for four days. An annual examination in March 1979 indicated that no current complaints were noted. 
A December 2016 private medical report of consultation and examination completed by Dr. Y. indicates that during service the Veteran was required to lift heavy tents to and from a truck and that the tents were very heavy and difficult to manage. Regarding the left ankle, the examiner noted that “while running on rough terrain in Germany, the Veteran injured his left ankle. He tripped in a hole with both feet and legs causing him to fall and pull the ankle violently.” The report indicates that the Veteran was diagnosed with post traumatic residual degenerative joint disease of the left ankle complicated by inversion instability. The examiner stated that it is “more likely than not that the aforementioned is directly and causally related to injury in service. It is more likely than not that same is directly and causally related to the Veteran’s service.”
After a review of the record, resolving all doubt in favor to the Veteran, the Board finds that the evidence supports a nexus between the Veteran’s left ankle condition and service. Thus, the Board finds that the evidence of record indicates that service connection is warranted for a left ankle condition, and the claim is granted. See 38 U.S.C. § 1131; 38 C.F.R. § 3.303(d).
5. Entitlement to service connection for a right shoulder condition
The Veteran contends that his right shoulder condition is related to active service.
The Board concludes that the Veteran has a current diagnosis of post traumatic residual degenerative joint disease (djd) of the right shoulder that is related to active service. 38 U.S.C. §§ 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a).
STRs indicate that on December 11, 1979, the Veteran complained of numbness in his right arm and right leg for 6 weeks. The Veteran stated that he had no prior history of trauma to the back and that he just gets pains in his lower back and right side. The records indicate that the Veteran opted to not have a separation medical examination on May 23, 1980.
Private treatment records from January 2011 indicate that the Veteran sought treatment for right shoulder pain and was assessed with impingement syndrome. 
Private treatment records from March 2011 include a January 5, 2000 record indicating that the Veteran was seen to evaluate neck pain and right arm symptoms and that he had complaints of a radicular component in the right shoulder.
A December 2016 private medical report of consultation and examination completed by Dr. Y. indicates a diagnosis of post traumatic residual djd of the right shoulder complicated by rotator cuff tearing. The examiner noted that the history of his injury was that during service, the Veteran was required to lift heavy tents to and from a truck. He noted that the tents were “very heavy and difficult to manage.” The examiner stated that the Veteran injured his right shoulder in this required field exercise. The examiner stated that the Veteran has suffered from progressive pain and dysfunction of his right shoulder. He stated that the Veteran suffers pain on motion of the shoulder and with minor lifting. The examiner opined that it is “more likely than not that the aforementioned is directly and causally related to injury” in service and that it is “more likely than not that same is directly and causally related” to his military service.
Private medical records from January 2017 include an October 26, 2016 record indicating that the Veteran complained of right shoulder pain. “In the setting of chronic neck pain. He has history of spine issues for over 20 years. The right shoulder has hurt on and off for several years but more bothersome this past year. He was concerned it may be shoulder related and not just all neck as previously thought.” The record indicates that the Veteran described the right shoulder as “loose and sometimes popping” and denied any specific traumas or falls from a shoulder standpoint but described “back injury in the military years ago.”
VA treatment records from August 2018 indicate that the Veteran reported that in October 2017 he was able to return to work but reported “terrible pain in his neck, shoulders, and back.” The record indicates past surgical history including right rotator cuff repair on March 1, 2017.
After a review of the record, resolving all doubt in favor to the Veteran, the Board finds that the evidence supports a nexus between the Veteran’s current right shoulder condition and service. Thus, the Board finds that the evidence of record indicates that service connection is warranted for a right shoulder condition, and the claim is granted. See 38 U.S.C. § 1131; 38 C.F.R. § 3.303(d).
6. Entitlement to service connection for bilateral pes planus
The Veteran contends that his bilateral pes planus is related to active service.
The Board finds that, although the Veteran has diagnosed pes planus, the preponderance of the evidence is against a finding that the condition began during active service, or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). 
A review of the Veteran’s STRs does not indicate any complaints, symptoms, treatment, or diagnoses related to pes planus or a foot condition.
Private medical records from January 2017 indicate that the Veteran has a diagnosis of plantar fasciitis. The record indicates that the Veteran was treated for right posterior tibial tendon dysfunction and that he has been having on and off pain for several years in his right and left foot. It indicates that he has known flatfoot deformity.
A December 2016 private medical report of consultation and examination completed by Dr. Y. indicates that during service the Veteran was required to lift heavy tents to and from a truck. The report indicates a diagnosis of pes planus complicated by plantar fasciitis of the left foot. Regarding pes planus, the examiner stated that at his entrance examination, the Veteran had normal arches in his left foot. He stated that during service he developed ongoing chronic foot pain which was treated with medications and that his “left foot pain continues with extension and without hiatus to the present.” The examiner stated that the onset of the Veteran’s condition “which persists to the present during active duty military service should qualify said condition for service connection.” The Board affords this opinion no probative value. The examiner merely states that the Veteran’s condition should qualify for service connection but does not provide a rationale for this opinion nor is the opinion based on objective evidence from service records or medical treatment records.  As noted above, the Veteran’s STRs do not show that the Veteran was treated with medication for chronic foot pain in service.  
The Board has not ignored the Veteran’s contentions regarding what he believes to be the cause of his pes planus. It is well established that a layperson without medical training is not qualified to render medical opinions regarding the etiology of conditions that are complex in nature. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). The etiology of the Veteran’s pes planus cannot be determined on observation or analysis by a layperson. Thus, his nexus statements are not competent evidence.
In disability compensation claims, VA must provide a VA medical examination when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, and (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the Appellant’s service or with another service-connected disability, but (4) insufficient competent medical evidence on file for the Secretary to make a decision on the claim. See 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79 (2006). The threshold under McLendon is low.
To date, the Veteran has not been afforded a VA examination for his claimed pes planus. While the Veteran has stated that his claimed pes planus may be associated with service, there is no competent evidence establishing that an event, injury, or disease occurred in service or an indication that the disability may be associated with service. Thus, VA is not obligated to afford the Veteran an examination at this time.
For the reasons described above, the Board finds that a preponderance of the evidence is against the Veteran’s claim for service connection for pes planus; therefore, the claim must be denied. There is no reasonable doubt to be resolved as to this issue. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102.
7. Entitlement to service connection for PTSD
The Veteran contends that his claimed PTSD is related to active service.
The Veteran’s STRs are negative for any complaints, treatment, symptoms or diagnosis of PTSD or any psychiatric disorder.
The December 2016 private medical report of consultation and examination indicates that regarding PTSD, the examiner stated that the Veteran has supporting military history and symptoms of PTSD which include but are not limited to insomnia, sleep deprivation, anxiety, isolation, memory loss, hyper vigilance, depression, isolation, and agoraphobia. The report indicates a provisional diagnosis of PTSD, and the examiner stated that it is more likely than not a permanent condition which is directly and causally related to the Veteran’s service but noted that the provisional diagnosis was “in the process of being confirmed by the evaluation of the appropriately credentialed and licensed mental health professional who will publish an independent report.”
In the subsequent December 2016 PTSD disability benefits questionnaire (DBQ), the private examiner indicates that the Veteran does not have a diagnosis of PTSD but has a diagnosis of other specified depressive disorder.
In view of the foregoing, the Board concludes that the preponderance of the evidence is against the Veteran’s claim of entitlement to service connection for PTSD. As the Board finds that the requirement of a current disability has not been met, the Board need not address the other elements of service connection. See, e.g., Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998). The benefit-of-the-doubt doctrine is not for application, and the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.
8. Entitlement to service connection for depressive disorder
The Veteran contends that his depressive disorder is related to active 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, while the Veteran was diagnosed with other specified depressive disorder in December 2016, the preponderance of the evidence weighs against finding that it began during service or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1131, 5107(b); Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(a), (d).
The Veteran’s STRs are negative for any complaints, treatment, symptoms or diagnosis of depressive disorder or any other psychiatric disorder.
The December 2016 PTSD DBQ indicates that the Veteran has a diagnosis of other specified depressive disorder. The Veteran’s private examiner stated that the Veteran’s depression is “related to multiple causes, including occurrences that took place during the Veteran’s military service, physical pain resulting from injuries sustained during military service, the effects of numerous years of working on a rotating shift, and guilt related to his hesitation to perform CPR on his father just prior to his father’s death.” The examiner noted that “any prior history of psychological evaluation or counseling was not apparent.”
The Veteran first filed his claim for depressive disorder in December 2016, despite contending that his psychiatric disorder began in service. While not dispositive, the passage of so many years between discharge from active service and the objective documentation of a claimed disability is a factor that weighs against a claim for service connection. Maxson v. Gober, 230 F.3d 1330 (Fed. Cir. 2000).
The Board has not ignored the Veteran’s statements regarding what he believes to be the cause of his depressive disorder. It is well established that a layperson without medical training is not qualified to render medical opinions regarding the etiology of conditions that are complex in nature. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). The etiology of a psychiatric condition cannot be answered based on observation or analysis by a layperson. Thus, his nexus statements are not competent evidence.
The Board has considered the Veteran’s lay statements as well as the opinion of his private physician, based on the Veteran’s statements, but finds the Veteran’s STRs, medical records, and the delay in filing claims to be highly probative. In weighing the medical and lay evidence of record, the Board finds that the Veteran’s contention is outweighed by the competent and probative evidence of record.
As noted above, a psychiatric disability was not shown in service nor was such competently and credibly indicated for many years thereafter. The evidence of record first documents psychiatric symptoms in 2016, 36 years after separation from service. While the Veteran has a current diagnosis of a psychiatric disorder, the private examiner indicated that the Veteran’s disorder is related to multiple causes and did not provide a rationale for this opinion. The examiner did not provide evidence to support an in-service connection other than the Veteran’s statements. Additionally, the examiner’s opinion, statements from the Veteran, and competent medical evidence all indicate that the Veteran’s psychiatric condition began after service. Thus, the weight of the evidence reflects that the current psychiatric disability is not related to service and did not have its onset therein.
The Board notes that a VA examination was not conducted in connection with the claim for service connection for a psychiatric disability. In this case, no examination is necessary in order to adjudicate the Veteran’s claim. As indicated in the discussion above, the competent and credible evidence of record does not indicate that the Veteran’s psychiatric condition began in service. STRs do not indicate symptoms or complaints of a psychiatric condition, and the post-service medical evidence does not indicate treatment, symptoms, or diagnosis until more than 35 years after service. To the extent that the Veteran has asserted that he has a psychiatric disability that is related to service, such a conclusory generalized lay statement alleging nexus between a current disability and service does not meet the standard to warrant a VA examination. 38 U.S.C. § 5103A(d); McLendon v. Nicholson, 20 Vet. App. 79 (2006).
Based on these findings, the preponderance of the evidence is against the Veteran’s claim of service connection for depressive disorder. The Veteran was not diagnosed with a psychosis within the year following discharge from service; thus, service connection is not warranted on a presumptive basis. See 38 C.F.R. §§ 3.307, 3.309.
For the foregoing reasons, entitlement to service connection for depressive disorder is not warranted. In reaching the conclusion to deny the claim, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.
REASONS FOR REMAND
1. Entitlement to a compensable rating for pseudofolliculitis barbae
Pursuant to 38 C.F.R. § 20.1304(c), any pertinent evidence submitted to the Board by the AOJ after the certification of appeal must be referred to the AOJ for review, unless such procedural right is waived by the Veteran or the Veteran’s representative, or unless the Board determines that the benefits to which the evidence relates may be fully allowed on appeal without such referral. See also 38 C.F.R. §§ 19.31, 19.37; 38 U.S.C. § 7105(d).
On May 25, 2018, the RO issued a statement of the case (SOC) for the issues on appeal. Since issuance of the SOC, additional VA treatment records and a VA examination have been associated with the record relevant to the Veteran’s claim of entitlement to a compensable rating for pseudofolliculitis barbae. There is no automatic waiver for evidence obtained by VA, and the AOJ has not issued a supplemental statement of the case (SSOC) for the Veteran’s claim.
On July 24, 2018, the RO certified the Veteran’s appeal to the Board. On October 2, 2018, the Veteran underwent a VA examination for skin diseases. In the October 2018 rating decision, the RO continued the noncompensable rating for pseudofolliculitis barbae. Upon review of the record, the Board finds that a remand is required for further AOJ action. While the RO considered the VA examination and treatment records in its October 2018 rating decision, it did not issue an SSOC readjudicating the claim as required. See 38 C.F.R. §§ 19.31, 19.37, 20.1304(c). Rather, it treated an August 2018 “claim” as a new claim. However, all issues were on appeal to the Board, so there was no new claim but just additional evidence added to the file by VA that is relevant to this claim on appeal. As such, on remand, the AOJ must readjudicate the claim and issue an SSOC.
2. Whether new and material evidence has been received to reopen a previously denied claim of service connection for a kidney condition
Regarding this claim, the Veteran submitted a timely NOD with February 2016 notification of a February 2016 rating decision, but a SOC has not yet been issued. A remand is required for the AOJ to issue an SOC. 38 C.F.R. § 20.200; Manlincon v. West, 12 Vet. App. 238, 240-41 (1999).
3. Entitlement to service connection for hearing loss
Regarding the claim of entitlement to service connection for hearing loss, the Veteran submitted a timely NOD with February 2016 notification of a February 2016 rating decision, but a SOC has not yet been issued. A remand is required for the AOJ to issue an SOC. 38 C.F.R. § 20.200; Manlincon v. West, 12 Vet. App. 238, 240-41 (1999).
4. Entitlement to service connection for tinnitus
Regarding the claim of entitlement to service connection for tinnitus, the Veteran submitted a timely NOD with February 2016 notification of a February 2016 rating decision, but a SOC has not yet been issued. A remand is required for the AOJ to issue an SOC. 38 C.F.R. § 20.200; Manlincon v. West, 12 Vet. App. 238, 240-41 (1999).
5. Entitlement to service connection for ddd of the cervical spine
Regarding the claim of entitlement to service connection for ddd of the cervical spine, the Veteran submitted a timely NOD with February 2016 notification of a February 2016 rating decision, but a SOC has not yet been issued. A remand is required for the AOJ to issue an SOC. 38 C.F.R. § 20.200; Manlincon v. West, 12 Vet. App. 238, 240-41 (1999).
6. Entitlement to service connection for radiculopathy of the left lower extremity
Regarding the claim of entitlement to service connection for radiculopathy of the left lower extremity, the Veteran submitted a timely NOD with February 2016 notification of a February 2016 rating decision, but a SOC has not yet been issued. A remand is required for the AOJ to issue an SOC. 38 C.F.R. § 20.200; Manlincon v. West, 12 Vet. App. 238, 240-41 (1999).
7. Entitlement to service connection for radiculopathy of the right lower extremity
Regarding the claim of entitlement to service connection for radiculopathy of the right lower extremity, the Veteran submitted a timely NOD with February 2016 notification of a February 2016 rating decision, but a SOC has not yet been issued. A remand is required for the AOJ to issue an SOC. 38 C.F.R. § 20.200; Manlincon v. West, 12 Vet. App. 238, 240-41 (1999).
8. Entitlement to service connection for a right ankle condition
9. Entitlement to service connection for a left knee condition
10. Entitlement to service connection for a right knee condition
The Veteran contends that his right ankle, left knee, and right knee conditions are related to service as secondary to his back, left ankle, and kidney conditions. In the March 2016 NOD, the Veteran indicated that he was treated for his back, left ankle, and kidney problems during service and that the “remainder of [his] claimed conditions are secondary to these conditions and should be service connected on a secondary basis.”
While the Veteran’s claims of a back condition and a left ankle condition have been service connected, the record does not indicate any medical evidence indicating that the Veteran’s right ankle, left knee, or right knee conditions are due to the Veteran’s service-connected disabilities. Thus, VA examinations and opinions must be obtained addressing the Veteran’s contentions that his right ankle, left knee, and right knee conditions are secondary to his service-connected disabilities.
Additionally, these claims are inextricably intertwined with the claim of service connection for a kidney condition. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (issues are “inextricably intertwined” when a decision on one issue would have a “significant impact” on a Veteran’s claim for the second issue). Hence, the Board may not proceed with appellate review of the claims of service connection for a right ankle, left knee, or right knee condition until the claim of service connection for a kidney condition has been resolved.
The matters are REMANDED for the following action:
1. Review all evidence received since the May 2018 SOC, including, but not limited to, additional VA treatment records and the October 2018 VA examination.
2. Send the Veteran and his representative a SOC that addresses the issues of entitlement to service connection for hearing loss, tinnitus, ddd of the cervical spine, radiculopathy of the left lower extremity, radiculopathy of the right lower extremity; and, whether new and material evidence has been received to reopen a previously denied claim of service connection for a kidney disorder.
3. Schedule the Veteran for a VA examination regarding his claims of service connection for a right ankle, left knee, and right knee condition, to determine the nature and etiology of the Veteran’s condition. The examiner must review the Veteran’s claims file.
a.	Provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that the Veteran’s claimed right ankle condition was caused or aggravated by a service-connected disability.
b.	Provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that the Veteran’s claimed left knee condition was caused or aggravated by a service-connected disability.
c.	Provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that the Veteran’s claimed right knee condition was caused or aggravated by a service-connected disability.
A complete rationale for any opinion(s) expressed must be provided. If the examiner determines that an opinion cannot be provide without resorting to mere speculation, the examiner should explain the inability to provide an opinion. The examiner should comment on whether an opinion could not be provided because the limits of medical knowledge have been exhausted or whether additional testing or information could be obtained that would lead to a conclusive opinion.
 
L. B. CRYAN
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	A. Labi, Associate Counsel