Citation Nr: 18157448 Decision Date: 12/13/18 Archive Date: 12/12/18 DOCKET NO. 16-44 722 DATE: December 13, 2018 ORDER Entitlement to service connection for a right wrist disorder, to include arthritis of the right wrist, is denied. Entitlement to service connection for a right wrist cyst is denied. Entitlement to service connection for a left elbow disorder, to include tendonitis of the left elbow, is denied. Entitlement to service connection for a right elbow disorder, to include tendonitis of the right elbow, is denied. Entitlement to service connection for a low back disorder, to include back spasms, is denied. Entitlement to service connection for sleep apnea is denied. REMANDED Entitlement to service connection for a left ankle disorder, to include arthritis of the left ankle, is remanded. Entitlement to service connection for a right ankle disorder, to include arthritis of the right ankle, is remanded. Entitlement to service connection for a left knee disorder, to include arthritis of the left knee, is remanded. Entitlement to service connection for a right knee disorder, to include arthritis of the right knee, is remanded. Entitlement to service connection for a left shoulder disorder, to include arthritis of the left shoulder, is remanded. Entitlement to service connection for a right shoulder disorder, to include arthritis of the right shoulder, is remanded. Entitlement to service connection for a psychiatric disorder, to include bipolar disorder and depression, is remanded. FINDINGS OF FACT 1. A current right wrist disorder, to include arthritis of the right wrist, of service origin has not been demonstrated. 2. A right wrist cyst of service origin has not been demonstrated. 3. A left elbow disorder, to include tendonitis of the left elbow, of service origin has not been demonstrated. 4. A right elbow disorder, to include tendonitis of the right elbow, of service origin has not been demonstrated. 5. A current low back disorder, to include back spasms, of service origin has not been demonstrated. 6. Sleep apnea of service origin has not been demonstrated. CONCLUSIONS OF LAW 1. The criteria for service connection for a right wrist disorder, to include arthritis of the right wrist, have not been met. 38 U.S.C. §§ 1101, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2017). 2. The criteria for service connection for a right wrist cyst have not been met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2017). 3. The criteria for service connection for a left elbow disorder, to include tendonitis of the left elbow, have not been met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2017). 4. The criteria for service connection for a right elbow disorder, to include tendonitis of the right elbow, have not been met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2017). 5. The criteria for service connection for a low back disorder, to include back spasms, have not been met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2017). 6. The criteria for service connection for sleep apnea have not been met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran, who is the appellant, had active service from October 1984 to October 1987. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004); see also Hickson v. West, 12 Vet. App. 247, 253 (1999), citing Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd, 78 F.3d 604 (Fed. Cir. 1996). Arthritis is a "chronic disease" listed under 38 C.F.R. § 3.309(a); therefore, the presumptive service connection provision of 38 C.F.R. § 3.303(b) apply to those claims. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). If a condition noted during service is not shown to be chronic, then generally a showing of continuity of symptomatology after service is required for service connection. 38 C.F.R. § 3.303(b). Service connection may be granted for any disease initially diagnosed after service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Arthritis will be presumed to have been incurred in service if manifested to a compensable degree within the first year following separation from active duty. 38 U.S.C.§§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. It is the defined and consistently applied policy of VA to administer the law under a broad interpretation, consistent, however, with the facts shown in every case. When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding service origin, the degree of disability, or any other point, such doubt will be resolved in favor of the claimant. 38 C.F.R. § 3.102. It is the Board's responsibility to evaluate the entire record on appeal. See 38 U.S.C. § 7104(a) (2012). In this case, the Board has thoroughly reviewed all the evidence in the Veteran's file. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, all of the evidence submitted by the Veteran or on his behalf. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (the Board must review the entire record, but does not have to discuss each piece of evidence). In evaluating the evidence in any given appeal, the Board has been charged with the duty to assess the credibility and weight given to evidence. Davidson v. Shinseki, 581 F. 3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F. 3d. 372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F. 3d 1331 (Fed. Cir. 2006); Klekar v. West, 12 Vet. App. 503, 507 (1999); Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). Indeed, the Court has declared that in adjudicating a claim, the Board has the responsibility to do so. Bryan v. West, 13 Vet. App. 482, 488-89 (2000); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992). As to the claims for service connection for a right wrist disorder, to include arthritis; a right wrist cyst; right and left elbow disorders, to include tendonitis; a low back disorder, to include back spasms; and sleep apnea, and the necessity for an examination, in determining whether the duty to assist requires that a VA medical examination be provided or medical opinion be 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 otherwise is sufficient competent medical evidence of record to make a decision on the claim. 38 U.S.C. § 5103A(d) and 38 C.F.R. § 3.159(c)(4). The Federal Circuit has addressed the appropriate standard to be applied in determining whether an examination is warranted. In Waters v. Shinseki, 601 F.3d 1274 (Fed. Cir. 2010) and Colantonio v. Shinseki, 606 F.3d 1378 (Fed. Cir. 2010), the Federal Circuit held that while there must be "medically competent" evidence of a current disability, "medically competent" evidence is not required to indicate that the current disability may be associated with service. Colantonio, 606 F.3d at 1382; Waters, 601 F.3d at 1277. On the other hand, a conclusory generalized lay statement suggesting a nexus between a current disability and service would not suffice to meet the standard of subsection (B), as this would, contrary to the intent of Congress, result in medical examinations being "routinely and virtually automatically" provided to all veterans claiming service connection. Waters, 601 F.3d at 1278-1279. Here, the only evidence that the Veteran's claimed disability is related to his military service is his own conclusory generalized lay statements, which are unsupported by even speculative medical evidence. Further, there is significant evidence against this claim, including treatment records currently on file. Accordingly, the Board finds that referral for VA medical examinations on these issues is not warranted. Right Wrist Disorder, to Include Arthritis of the Right Wrist The Veteran maintains that he currently has a right wrist disorder, to include arthritis, which started in service and has continued to the present time. A review of the Veteran's service treatment records reveals that there were no complaints or findings of right wrist problems. At the time of the Veteran’s August 1987 service separation medical examination, normal findings were reported for the upper extremities. On his August 1987 service separation report of medical history, the Veteran checked the “no” boxes when asked if he had or ever had bone, joint or other deformity; arthritis, rheumatism, or bursitis; or lameness. On his initial October 2012 application for compensation, the Veteran indicated that osteoarthritis of the right wrist did not start until 1993. Post-service treatment records contain no complaints or findings of right wrist problems, to include arthritis of the right wrist. After reviewing all the evidence both lay and medical, service connection for a right wrist disorder, to include arthritis, is not warranted. To date, there has been no medical evidence submitted or received demonstrating that the Veteran has a right wrist disorder, to include arthritis, at any time throughout the appeal period. The Veteran was afforded the opportunity to submit evidence demonstrating a relationship between any current right wrist disorder and his period of service and has not done so. Congress, as a general rule, limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability. See 38 U.S.C. §§ 1110, 1131; and see Brammer v. Derwinski, 3 Vet. App. 223 (1992). In Degmetich v. Brown, 104 F.3d 1328 (Fed. Cir. 1997), it was observed that 38 U.S.C.§ 1110, as well as other relevant statutes, only permitted payment for disabilities existing on and after the date of application for such disorders. The Federal Circuit observed that the structure of these statutes "provided strong evidence of congressional intent to restrict compensation to only presently existing conditions," and VA's interpretation of the law requiring a present disability for a grant of service connection was consistent with the statutory scheme. Degmetich, 104 F.3d at 1332; and see Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998) (holding VA's interpretation of the provisions of 38 U.S.C.§ 1110 to require evidence of a present disability to be consistent with congressional intent); Rabideau v. Derwinski, 2 Vet. App. 141 (1992) (the law limits entitlement for service-related diseases and injuries to cases where the underlying in-service incident has resulted in a disability). Simply put, the general rule is that in the absence of proof of present disability there can be no valid claim. Based on the above, to the extent that the medical evidence addresses whether the Veteran has a right wrist disorder, to include arthritis, it indicates that he does not. The Veteran is competent to report his current symptoms, but his reports must be weighed against the medical evidence of record. See Grover v. West, 12 Vet. App. 109, 112 (1999); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). To the extent that the Veteran has indicated that he currently has a right wrist disorder, to include arthritis, the medical evidence showing an absence of such a disability is of greater probative weight than the Veteran's reports made during the course of his claim for VA benefits. The weight of the evidence is against a finding that the Veteran currently has a right wrist disorder, to include arthritis. A necessary element for establishing service connection-evidence of a current disability-has not been shown. Assuming that the Veteran had a right wrist disorder at some point following service, which has not been demonstrated, the Veteran, by his own admission, has indicated that he did not receive treatment for any type of wrist disorder until 1993, more than 5 years following his separation from service. Moreover, there is also no competent medical evidence of record relating any current right wrist disorder to the Veteran's period of service. The Veteran was afforded the opportunity to submit such evidence and has not done so. Furthermore, the Veteran would also not be competent to provide a medical opinion regarding etiology of any currently diagnosed right wrist disorder. See Jandreau. For the foregoing reasons, the claim for service connection for a right wrist disorder, to include arthritis, must be denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the Veteran's claim, that doctrine is not applicable. Right Wrist Cyst The Veteran maintains that he currently has a right wrist cyst, which started in service and has continued to the present time. A review of the Veteran's service treatment records reveals that there were no complaints or findings of right wrist problems. At the time of the Veteran’s August 1987 service separation medical examination, normal findings were reported for the upper extremities. On his August 1987 service separation report of medical history, the Veteran checked the “no” boxes when asked if he had or ever had a tumor, cyst, growth, or cancer. Post-service treatment records contain no complaints or findings of right wrist problems, to include a right wrist cyst. After reviewing all the evidence both lay and medical, service connection for a right wrist cyst is not warranted. To date, there has been no medical evidence submitted or received demonstrating that the Veteran has a right wrist cyst at any time throughout the appeal period. The Veteran was afforded the opportunity to submit evidence demonstrating a relationship between any current right wrist cyst and his period of service and has not done so. Based on the above, to the extent that the medical evidence addresses whether the Veteran has a right wrist cyst disorder, it indicates that he does not. The Veteran is competent to report his current symptoms, but his reports must be weighed against the medical evidence of record. To the extent that the Veteran has indicated that he currently has a right wrist cyst disorder, the medical evidence showing an absence of such a disability is of greater probative weight than the Veteran's reports made during the course of his claim for VA benefits. The weight of the evidence is against a finding that the Veteran currently has a right wrist cyst disorder. A necessary element for establishing service connection-evidence of a current disability-has not been shown. For the foregoing reasons, the claim for service connection for a right wrist cyst disorder must be denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the Veteran's claim, that doctrine is not applicable. Left Elbow Disorder, to Include Tendonitis of the Left Elbow The Veteran maintains that he currently has a left elbow disorder, to include left elbow tendonitis, which started in service and has continued to the present time. A review of the Veteran's service treatment records reveals that there were no complaints or findings of left elbow problems. At the time of the Veteran’s August 1987 service separation examination, normal findings were reported for the upper extremities. On his August 1987 service separation report of medical history, the Veteran checked the “no” boxes when asked if he had or ever had painful or trick shoulder or elbow. Post-service treatment records, which cover the entire appeal period, contain no complaints or findings of a left elbow disorder, to include left elbow tendonitis. After reviewing all the evidence both lay and medical, service connection for a left elbow disorder, to include tendonitis, is not warranted. To date, there has been no medical evidence submitted or received demonstrating that the Veteran has a left elbow disorder at any time throughout the appeal period. The Veteran was afforded the opportunity to submit evidence demonstrating a relationship between any current left elbow disorder, to include tendonitis, and his period of service and has not done so. Based on the above, to the extent that the medical evidence addresses whether the Veteran has a left elbow disorder, it indicates that he does not. The Veteran is competent to report his current symptoms, but his reports must be weighed against the medical evidence of record. To the extent that the Veteran has indicated that he currently has a left elbow disorder, to include tendonitis, the medical evidence showing an absence of such a disability is of greater probative weight than the Veteran's reports made during the course of his claim for VA benefits. The weight of the evidence is against a finding that the Veteran currently has a left elbow disorder, to include tendonitis. A necessary element for establishing service connection-evidence of a current disability-has not been shown. Assuming that the Veteran had an elbow disorder at some point following service, which has not been demonstrated, the Veteran, by his own admission, has indicated that he did not receive treatment for any type of elbow disorder until 1993, more than 5 years following his separation from service. Moreover, there is also no competent medical evidence of record relating any current left elbow disorder to the Veteran's period of service. The Veteran was afforded the opportunity to submit such evidence and has not done so. Furthermore, the Veteran would also not competent to provide a medical opinion regarding etiology of any currently diagnosed right elbow disorder. See Jandreau. For the foregoing reasons, the claim for service connection for a left elbow disorder, to include tendonitis, must be denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the Veteran's claim, that doctrine is not applicable. Right Elbow Disorder, to Include Tendonitis of the Right Elbow The Veteran maintains that he currently has a right elbow disorder, to include right elbow tendonitis, which started in service and has continued to the present time. A review of the Veteran's service treatment records reveals that there were no complaints or findings of right elbow problems. At the time of the Veteran’s August 1987 service separation examination, normal findings were reported for the upper extremities. On his August 1987 service separation report of medical history, the Veteran checked the “no” boxes when asked if he had or ever had painful or trick shoulder or elbow. Post-service treatment records, which cover the entire appeal period, contain no complaints or findings of a right elbow disorder, to include right elbow tendonitis. After reviewing all the evidence both lay and medical, service connection for a right elbow disorder, to include tendonitis, is not warranted. To date, there has been no medical evidence submitted or received demonstrating that the Veteran had a right elbow disorder at any time throughout the appeal period. The Veteran was afforded the opportunity to submit evidence demonstrating a relationship between any current right elbow disorder, to include tendonitis, and his period of service and has not done so. Based on the above, to the extent that the medical evidence addresses whether the Veteran has a right elbow disorder, it indicates that he does not. The Veteran is competent to report his current symptoms, but his reports must be weighed against the medical evidence of record. To the extent that the Veteran has indicated that he currently has a right elbow disorder, to include tendonitis, the medical evidence showing an absence of such a disability is of greater probative weight than the Veteran's reports made during the course of his claim for VA benefits. The weight of the evidence is against a finding that the Veteran currently has a right elbow disorder, to include tendonitis. A necessary element for establishing service connection-evidence of a current disability-has not been shown. Assuming that the Veteran had an elbow disorder at some point following service, which has not been demonstrated, the Veteran, by his own admission, has indicated that he did not receive treatment for any type of elbow disorder until 1993, more than 5 years following his separation from service. Moreover, there is also no competent medical evidence of record relating any current right elbow disorder to the Veteran's period of service. The Veteran was afforded the opportunity to submit such evidence and has not done so. Furthermore, the Veteran would also not competent to provide a medical opinion regarding etiology of any currently diagnosed right elbow disorder. See Jandreau. For the foregoing reasons, the claim for service connection for a right elbow disorder, to include tendonitis, must be denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the Veteran's claim, that doctrine is not applicable. Low Back Disorder, to Include Back Spasms The Veteran maintains that he currently has a low back disorder, to include back spasms, which started in service and has continued to the present time. A review of the Veteran's service treatment records reveals that there were no complaints or findings of back problems, to include spasms. At the time of the Veteran’s August 1987 service separation medical examination, normal findings were reported for the spine. On his August 1987 service separation report of medical history, the Veteran checked the “no” box when asked if he had or ever had recurrent back pain. Post-service treatment records, which cover the entire appeal period, contain no complaints or findings of back problems, to include spasms. After reviewing all the evidence, both lay and medical, service connection for a low back disorder, to include spasms, is not warranted. To date, there has been no medical evidence submitted or received demonstrating that the Veteran has a low back disorder, to include spasms, at any time throughout the appeal period. The Veteran was afforded the opportunity to submit evidence demonstrating a relationship between any current low back disorder, to include spasms, and his period of service and has not done so. Based on the above, to the extent that the medical evidence addresses whether the Veteran has a low back disorder, to include spasms, it indicates that he does not. The Veteran is competent to report his current symptoms, but his reports must be weighed against the medical evidence of record. To the extent that the Veteran has indicated that he currently has a low back disorder, to include spasms, the medical evidence showing an absence of such a disability is of greater probative weight than the Veteran's reports made during the course of his claim for VA benefits. The weight of the evidence is against a finding that the Veteran currently has a low back disorder, to include spasms. A necessary element for establishing service connection-evidence of a current disability-has not been shown. For the foregoing reasons, the claim for service connection for a low back disorder, to include spasms, must be denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the Veteran's claim, that doctrine is not applicable. Sleep Apnea The Veteran maintains that his current sleep apnea is related to his period of service. Service treatment records reveal no complaints or findings of snoring or other difficulties sleeping during the Veteran's period of active service. At the time of the Veteran’s August 1987 service separation examination, normal findings for the nose, sinuses, mouth and throat were reported. The Veteran did not report having sleeping problems at that time. On his August 1987 service separation report of medical history, the Veteran also did not report having sleeping problems or sleep apnea symptoms. The first notation of problems with snoring/daytime somnolence was not until the Veteran reported having these problems was in 1998. On a November 1998 Sleep Interview Form, it was noted that the Veteran had been having these problems for the past 8-9 months. Upon review of all the evidence of record, the Board finds that the evidence indicates that the Veteran's sleep apnea was not incurred in, aggravated by, or is otherwise due to his active service. As evidenced in the treatment records, the Veteran did not complain of, nor were there findings of, sleep problems/sleep apnea in any treatment records, medical examination reports, or reports of medical history prior to 1998. Thus, there were no complaints or findings of sleep apnea during any period of active service. The Veteran has asserted that he has experienced sleep apnea since his period of active service. Such recent assertions, however, are inconsistent with, and outweighed by, other lay and medical evidence of record, including no reports in service treatment records of problems with snoring and/or being awoken gasping for breath, and no reports of snoring or waking gasping for breath in any reports of medical histories and/or examinations prior to 1998. See Gardin v. Shinseki, 613 F.3d 1374, 1380 (Fed. Cir. 2010) (upholding Board finding that vague and inconsistent lay statements were not credible because they were in direct contradiction to the more credible, competent, reliable, and clearly documented medical evidence); Madden v. Gober, 125 F.3d 1477, 1481 (Board entitled to discount the credibility of evidence in light of its own inherent characteristics and its relationship to other items of evidence); Caluza v. Brown, 7 Vet. App. 498, 512 1995), aff'd per curiam, 78 F.3d 604 (Fed. Cir. 1996) (upholding Board's finding that a veteran was not credible because lay evidence about a wound in service was internally inconsistent with other lay statements that he had not received any wounds in service). Insomuch as the Veteran has attempted to establish a continuity of symptomatology or nexus through his own lay assertions, the Board finds that the etiology of sleep apnea falls outside the realm of common knowledge of a layperson and the Veteran is, thus, not competent to provide evidence on the issue of causation. See Jandreau, 492 F.3d 1372, 1377 n.4. The evidence does not show clinical documentation of sleep apnea until many years after active service. Consequently, the Veteran's opinion that purports to establish continuity of symptomatology or to relate sleep apnea to active service is of no probative value. Next, service connection may be granted when the evidence establishes a medical nexus between active duty service and current complaints. In this case, there is also no competent medical evidence of record relating any current sleep apnea to the Veteran's period of service. The Veteran is not competent to provide a medical opinion regarding etiology of any currently diagnosed sleep apnea. In summary, the competent, credible evidence of record indicates that the Veteran's current sleep apnea is not related to service. Accordingly, the preponderance of the evidence is against the claim, and service connection is denied. In reaching the above conclusion, the Board has considered the applicability of the benefit of the doubt doctrine; however, as the preponderance of the evidence is against the appellant's claim, that doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b) (2012); 38 C.F.R. § 3.102 (2017); Gilbert, 1 Vet. App. at 58 (1990). REASONS FOR REMAND As it relates to the claims of service connection for right and left shoulder, right and left knee, and right and left ankle disorders, the Board notes that the Veteran has, on at least one occasion, been diagnosed as having arthritis of these joints. The Veteran maintains that he has had ongoing problems with these disorders since his period of service. As noted above, arthritis is a "chronic disease" listed under 38 C.F.R. § 3.309(a); therefore, the presumptive service connection provision of 38 C.F.R. § 3.303(b) apply to those claims. Given the diagnoses and the Veteran’s statements, the Veteran should be afforded a VA examination to determine the etiology of any current shoulder, knee, and ankle disorders, and their relationship, if any, to his period of service. Likewise, the Veteran has been diagnosed with numerous psychiatric disorders during the course of the appeal period, including bipolar disorder, which is a psychosis. Psychosis is also a "chronic disease" listed under 38 C.F.R. § 3.309(a); therefore, the presumptive service connection provision of 38 C.F.R. § 3.303(b) apply to this claim. As such, the Veteran should be afforded a VA examination to determine the etiology of any current psychiatric disorder and its relationship, if any, to his period of service. The Board further observes that the Veteran has indicated that he received treatment for his knees at VAMC-West Side in 1988. He has requested that an attempt be made to obtain these records. 1. Undertake appropriate development to obtain all outstanding VA and/or private treatment records related to the Veteran's outstanding claims. If any requested records are not available, the record should be annotated to reflect such and the Veteran notified. 2. Obtain copies of all treatment records of the Veteran from the VA Medical Center-West Side from January 1988 to the present. 3. Thereafter, schedule the Veteran for a VA examination to determine the nature and etiology of any current left and right shoulder, left and right knee, and left and right ankle disorder. All indicated tests and studies should be performed and all findings must be reported in detail. The entire record must be made available to the examiner and the examiner should note such review in his/her report. The examiner is requested to render the following opinions: (a) Does the Veteran currently have any left or right shoulder, left or right knee, or left or right ankle disorder? (b) Is it as likely as not (50 percent probability or greater) that any left or right shoulder, left or right knee, or left or right ankle disorder had its onset in service or is otherwise related to service? Detailed rationale is requested for any opinion that is rendered. 4. Schedule the Veteran for a VA examination to determine the nature and etiology of any current psychiatric disorder. All indicated tests and studies should be performed and all findings must be reported in detail. The entire record must be made available to the examiner and the examiner should note such review in his/her report. The examiner is requested to render the following opinions: (a) Does the Veteran currently have any psychiatric disorders, including depression and/or bipolar disorder? (b) Is it as likely as not (50 percent probability or greater) that any current psychiatric disorder had its onset in service or is otherwise related to service? Detailed rationale is requested for any opinion that is rendered. 5. Review the claims file. If any development is incomplete, including if the examination reports do not contain sufficient information to respond to the questions posed, take corrective action before readjudication. See Stegall v. West, 11 Vet. App. 268 (1998). K. Parakkal Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. S. Kelly, Counsel