Citation Nr: 18157840 Decision Date: 12/13/18 Archive Date: 12/13/18 DOCKET NO. 15-08 795A DATE: December 13, 2018 ORDER Whether new and material evidence has been submitted to reopen a previously denied claim for service connection for varicose veins is GRANTED. Entitlement to service connection for varicose veins with trace edema is DENIED. Entitlement to service connection for degenerative arthritis of the cervical spine, claimed as a neck condition is DENIED. Entitlement to initial disability rating in excess of 10 percent for left shoulder arthritis prior to August 25, 2016, and in excess of 20 percent thereafter is DENIED. Entitlement to disability rating in excess of 30 percent for allergic rhinitis, is DENIED. Entitlement to effective date prior to August 15, 2008 for the grant of a 30 percent rating for allergic rhinitis is DENIED. REMANDED Entitlement to service connection for bilateral calcaneal spurs, claimed a feet conditions is remanded. Entitlement to service connection for bronchitis, to include as secondary to service connected allergic rhinitis and sinusitis is remanded. Entitlement to service connection for a vocal cord condition, to include as secondary to service connected allergic rhinitis and sinusitis is remanded. Entitlement service connection for a sleep disorder, to include as secondary to service connected allergic rhinitis and sinusitis is remanded. Entitlement to service connection for a chest muscle condition, claimed as a strained heart muscle is remanded. Entitlement to service connection for pedal edema with chronic venous is remanded. Entitlement to service connection for a gastrointestinal disorder, claimed as bowel problems, to include as secondary to service connected allergic rhinitis and sinusitis is remanded. Entitlement to service connection for a groin condition is remanded. Entitlement to service connection for a headache condition, to include as secondary to service connected allergic rhinitis and sinusitis is remanded. FINDINGS OF FACT 1. In an unappealed August 1986 rating decision, the agency of original jurisdiction (AOJ) denied service connection for varicose veins, because the Veteran did not have a diagnosis of varicose veins. 2. The evidence received since the August 1986 rating decision, by itself, or in conjunction with previously considered evidence, relates to an unestablished fact necessary to substantiate the claim and raises a reasonable possibility of substantiating the claim for service connection for varicose veins. 3. The probative evidence of record demonstrates that the Veteran’s varicose veins did not originate in service or for many years thereafter, is not related to any incident during active service and is not caused or aggravated by his service-connected disabilities. 4. The probative evidence of record demonstrates that the Veteran’s degenerative arthritis of the cervical spine did not originate in service or for many years thereafter, is not related to any incident during active service and is not caused or aggravated by his service-connected disabilities. 5. For the time period prior to August 25, 2016, the left (minor) shoulder disability has not manifested in limitation of motion at shoulder level or midway between the Veteran’s shoulder and side. 6. For the time period on and after August 25, 2016, the left (minor) shoulder disability has not manifested in limitation of motion to 25 degrees from the Veteran’s side. 7. The Veteran is in receipt of the maximum disability rating for allergic rhinitis under Diagnostic Code 6522. 8. An October 2011 Board decision which denied a rating in excess of 10 percent for allergic rhinitis prior to August 15, 2008 is final. 9. The Veteran did not appeal the October 2011 Board decision. CONCLUSIONS OF LAW 1. The August 1986 rating decision, which denied service connection for varicose veins, is final. 38 U.S.C. § 7105 (West 2005); 38 C.F.R. § 3.105 (2005). 2. The evidence received subsequent to the August 1986 rating decision is new and material, and the issues of service connection for varicose veins are reopened. 38 U.S.C. § 5108 (West 2014); 38 C.F.R. § 3.156 (2017). 3. The criteria for service connection for varicose veins have not been met. 38 U.S.C. §§ 1110, 1116, 5107 (West 2016); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2017). 4. The criteria for service connection for degenerative arthritis of the cervical spine have not been met. 38 U.S.C. §§ 1110, 1116, 5107 (West 2016); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2017). 5. The criteria for an increased rating beyond 10 percent prior to August 25, 2016, and in excess 20 percent disabling thereafter for the left (minor) shoulder disability have not been met. 38 U.S.C. §§ 1155, 5107 (West 2014); 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.40, 4.45, 4.59, 4.71a (& Plate I), DC 5201 (2017). 6. The criteria for a disability rating in excess of 30 percent rating for allergic rhinitis have not been met. 38 U.S.C. §§ 1155, 5107, 7104 (West 2014); 38 C.F.R. §§ 4.7, 4.97, Diagnostic Code 6522 (2017). 7. The criteria for an effective date earlier than August 15, 2008 for the award of a 30 percent disability rating for allergic rhinitis are not met. 38 U.S.C. § 5110 (2012); 38 C.F.R. § 3.400 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303 (a). Service connection may also be granted for any disease diagnosed after discharge when all of the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). Certain chronic diseases, to include neuropathy (other organic diseases of the nervous system), although not shown in service, may be presumed to have incurred in or aggravated by service if they become manifested to a compensable degree within one year of separation from active duty. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. To prevail on the issue of service connection, there must be (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999). A disability can be service connected on a secondary basis if it is proximately due to or the result of a service-connected condition. 38 C.F.R. § 3.310 (a). Moreover, secondary service connection may be established, as well, by any increase in severity (i.e., aggravation) of a nonservice-connected condition that is proximately due to or the result of a service-connected condition. See 38 C.F.R. § 3.310 (b), effective October 10, 2006. See 71 Fed. Reg. 52,744 -52,747 (September 7, 2006); see also Allen v. Brown, 7 Vet. App. 439, 448 (1995). Where a service-connected disability aggravates a nonservice-connected condition, a Veteran may be compensated for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation. Allen, 7 Vet. App. at 448. In short, in order to establish entitlement to service connection on this secondary basis, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) probative evidence establishing a nexus (i.e., link) between the service-connected disability and the current disability. Wallin v. West, 11 Vet. App. 509, 512 (1998). The determination of whether the requirements of service connection have been met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. See Baldwin v. West, 13 Vet. App. 1, 8 (1999). In making these determinations, the Board must consider and assess the credibility and weight of all evidence in the claim file, including the medical and lay evidence, to determine its probative value. In doing so, the Board must provide its reasoning for rejecting any evidence favorable to the claimant. See Masors v. Derwinski, 2 Vet. App. 181 (1992); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992); Barr v. Nicholson, 21 Vet. App. 303 (2007). When there is an approximate balance of evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each issue shall be given to the claimant. See 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3. A claimant need only demonstrate an approximate balance of positive and negative evidence in order to prevail. See Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). For a claim to be denied on the merits, a preponderance of the evidence must be against the claim. See Alemany v. Brown, 9 Vet. App. 518, 519 (1996). 1. Whether new and material evidence has been submitted to reopen a previously denied claim for service connection for varicose veins In an unappealed August 1986 decision, the RO denied service connection for varicose veins, because the RO determined that the Veteran did not have a varicose veins diagnosis. In October 2005, the RO received an Application for Compensation and/or Pension from the Veteran for varicose veins, neck condition, ulcers on vocal chords, cardiomyopathy, bronchitis, sleep apnea, headaches, pedal edema, groin pain, bowels and foot spurs conditions. These claims were denied in an April 2012 rating decision. The Veteran filed a timely notice of disagreement and VA Form 9 and for the issues denied in April 2012. 38 U.S.C. § 7105 (West 2005); 38 C.F.R. § 3.105 (2005). Regardless of the RO’s actions, the Board has jurisdictional responsibility to determine whether a claim previously denied by the RO is properly reopened. See Jackson v. Principi, 265 F.3d 1366 (Fed. Cir. 2001) (citing 38 U.S.C. §§ 5108, 7105(c)). See also Barnett v. Brown, 83 F.3d 1380 (Fed. Cir. 1996) and VAOPGCPREC 05-92 (March 4, 1992). Accordingly, the Board must initially determine whether there is new and material evidence to reopen the varicose vein issue before proceeding to adjudicate the underlying merits of the claim. If the Board finds that no new and material evidence has been provided, that is where the analysis must end. A claimant may reopen a finally adjudicated claim by submitting new and material evidence. 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) (2017). The question of whether new and material evidence has been received sufficient to reopen the matter is a threshold question in any case involving a previously denied claim. Wakeford v. Brown, 8 Vet. App. 237, 239-40 (1995). The United States Court of Appeals for Veterans Claims (Court) has interpreted the language of 38 C.F.R. § 3.156 (a) as creating a low threshold, and viewed the phrase “raises a reasonable possibility of substantiating the claim” as “enabling rather than precluding reopening.” The Court emphasized that the regulation is designed to be consistent with 38 C.F.R. § 3.159 (c)(4), which “does not require new and material evidence as to each previously unproven element of a claim.” Shade v. Shinseki, 24 Vet. App. 110 (2010). See also Evans v. Brown, 9 Vet. App. 273, 284 (1996) (the newly presented evidence need not be probative of all the elements required to award the claim, but only need to be probative in regard to each element that was a specified basis for the last disallowance). That is, a finally decided claim must be reopened where the claimant submits new and material evidence relative to a fact that was unestablished at the time of the prior final decision on the claim. Shade, 24 Vet. App. at 119. For the purpose of reopening a claim, the credibility of evidence is presumed unless the evidence is inherently incredible or consists of statements that are beyond the competence of the person or persons making them. See Justus v. Principi, 3 Vet. App. 510, 513 (1992); Meyer v. Brown, 9 Vet. App. 425, 429 (1996); King v. Brown, 5 Vet. App. 19, 21 (1993). Here, the Board finds that new and material evidence within the meaning of 38 C.F.R. § 3.156 (a) has been received since the final August 1986 rating decision. Specifically, the Veteran underwent a VA veins examination in April 2010 and was diagnosed with varicose veins with edema. As a current varicose vein disability was not established at the time of the prior denial, this new evidence is neither cumulative nor redundant, as the April 2010 diagnosis went to a previously unestablished fact. For purposes of reopening a claim, the credibility of newly submitted evidence is generally presumed. See Justus v. Principi, 3 Vet. App. 510, 513 (1992). 2. Entitlement to service connection for varicose veins with trace edema The Veteran claims that his varicose veins with edema was caused by an incident in service when a bomb fell and injured his left leg. His service treatment records (STR) show that this incident occurred in August 1968. At that time the Veteran’s leg was wrapped in an ACE bandage and told to return in the morning. The next day the Veteran returned for treatment and x-rays were negative for a fracture. The ace bandage was removed and heat was applied. As noted above, the Veteran underwent a VA veins examination in April 2010 and was diagnosed with varicose veins with edema. The VA examiner performed an in-person examination and reviewed the Veteran’s claims file. He also provided a medical history relating to the Veteran’s claim and noted the Veteran’s history of left leg trauma in service. In May 2011 the same VA examiner who performed the April 2010 examination provided a medical opinion which found that it was less likely as not (less than 50 percent probability) that the Veteran’s varicose veins condition was caused by or a result of his active duty service. He reasoned that there was a lack of evidence that the Veteran’s leg trauma in service was not a one-time event and there was a lack of evidence to show any chronic residuals from these injuries, especially in the yearly examinations and exit examinations. Furthermore, if the injury was the cause of his varicose veins, this would have been apparent straight after the event and seen in service. The Board recognizes that the Veteran has set forth that his varicose veins conditions have gotten worse since service, but this claim is not supported by the record and varicose veins are not a chronic condition set forth under 38 C.F.R. §§ 3.307, 3.309. Moreover, the lack of findings pertaining to varicose veins in the service treatment record weigh heavily against the claim. Of particular note, is the Veteran’s subsequent February1969 service separation examination, August 1971 reenlistment examination, July 1974 reenlistment examination, July 1975 flight examination, February 1977 annual examination that revealed that clinical examination of the Veteran’s lower extremities was within normal limits. The Board finds that the preponderance of the evidence is against the Veteran’s claim for service connection for varicose veins must be denied. Because the preponderance of the evidence is against the claim, the benefit of the doubt doctrine does not apply. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 3. Entitlement to service connection for degenerative arthritis of the cervical spine, claimed as a neck condition The Veteran also claims that he suffered a neck injury in service when a bomb fell on him. As noted above, the Veteran sought treatment for injuries to his left leg in August 1968 after a bomb dropped on it. There were no complaints related to his neck at that time. Subsequent STRs reflect that he sought treatment for neck pain in February 1977. The Veteran complained of pain located in his mid-back between his shoulder blades that radiated up to his neck. He was diagnosed with strained trapezoid. It was noted that the Veteran denied trauma at that time. In July 2005 the Veteran was diagnosed with cervical thoracic joint disfunction with spasms, pain and restricted range of motion. Later, in October 2006, it was noted that the Veteran experienced pain, spasm and fixation at C5-C6. In April 2010 the Veteran underwent a VA spine examination and was diagnosed with mild cervical and lumbar spine degenerative arthritis. Imaging studies showed mild degenerative changes of the cervical spine, predominantly at C5-6 with small anterior osteophytes. The Veteran described a progression of symptoms since service. He described daily pain that lasts several hours and was moderate in severity. Pain was worse with lifting, bending and stooping. Flare-ups caused incapacitating episodes. In May 2011 the same VA examiner offered an opinion regarding the Veteran’s cervical spine degenerative arthritis. He stated that his cervical spine condition was less likely as not (less than 50 percent probability) caused by or a result of his active duty service. He reasoned that there was a lack of evidence that the Veteran’s neck trauma in service was not a one-time event and there was a lack of evidence to show any chronic residuals from these injuries, especially in the yearly examinations and exit examinations. Although the Veteran has stated that he has had progressing symptoms since service, the record reflects that he was not treated or diagnosed with a cervical spine condition until 2005, nearly 40 years after service. Moreover, the only competent medical opinion of record weighs against his claim. Accordingly, service connection is not warranted. In reaching this conclusion, the Board has considered the Veteran’s statements regarding the etiology of his current neck disability. However, while competent to report his symptoms, he is not competent to render opinion on complex medical questions such as the etiology of his current degenerative arthritis of the cervical spine. Accordingly, the Board has placed greater weight on the opinion reached by the VA examination that considered the Veteran’s past history of inservice injury and current complaints and examination of the Veteran. The Board finds that the preponderance of the evidence is against the Veteran’s claim for service connection for degenerative arthritis of the cervical spine must be denied. Because the preponderance of the evidence is against the claim, the benefit of the doubt doctrine does not apply. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Increased Rating Disability evaluations (ratings) are determined by evaluating the extent to which a Veteran’s service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing the symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. § 1155 (West 2014); 38 C.F.R. §§ 4.1, 4.2, 4.10 (2017). In evaluating a disability, the Board considers the current examination reports in light of the whole recorded history to ensure that the current rating accurately reflects the severity of the condition. The Board has a duty to acknowledge and consider all regulations that are potentially applicable. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). The medical as well as industrial history is to be considered, and a full description of the effects of the disability upon ordinary activity is also required. 38 C.F.R. §§ 4.1, 4.2, 4.10 (2017). Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7 (2016). Reasonable doubt regarding the degree of disability will be resolved in the Veteran’s favor. 38 C.F.R. § 4.3 (2016). Separate ratings can be assigned for separate periods of time based on facts found, a practice known as “staged” ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007). When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with a Veteran prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. 38 U.S.C. § 5107 (b) (West 2014); 38 C.F.R. § 3.102 (2017). 4. Entitlement to initial disability rating in excess of 10 percent for left shoulder arthritis prior to August 25, 2016, and in excess of 20 percent thereafter Where service connection has already been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). In determining the present level of a disability for any increased evaluation claim, the Board must consider the application of staged ratings. See Hart v. Mansfield, 21 Vet. App. 505, 509-510 (2007); Fenderson v. West, 12 Vet. App. 119, 126 (1999). The Board must consider whether there have been times when his left shoulder disability has been more severe than at others, and rate it accordingly. “The relevant temporal focus for adjudicating an increased-rating claim is on the evidence concerning the state of the disability from the time period one year before the claim was filed until VA makes a final decision on the claim.” Hart, 21 Vet. App. at 509. The Board must also assess the competence and credibility of lay statements and testimony. Barr v. Nicholson, 21 Vet. App. 303, 308 (2007). In increased rating claims, a Veteran’s lay statements alone, absent a negative credibility determination, may constitute competent evidence of worsening, at least with respect to observable symptoms. See Vazquez-Flores v. Shinseki, 24 Vet. App. 94, 102 (2010), rev’d on other grounds by Vazquez-Flores v. Shinseki, 580 F.3d 1270, 1277 (Fed. Cir. 2009). The Veteran is uniquely suited to describe the severity, frequency, and duration of his service-connected left shoulder disability. See Falzone v. Brown, 8 Vet. App. 398 (1995); Heuer v. Brown, 7 Vet. App. 379 (1995). The Veteran’s left shoulder disability is currently assigned a 20 percent rating pursuant to 38 C.F.R. § 4.71a, Diagnostic Code 5010-5201. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the specific basis for the evaluation assigned. 38 C.F.R. § 4.27. Traumatic arthritis under Diagnostic Code 5010 is rated analogous to degenerative arthritis under Diagnostic Code 5003. Degenerative arthritis, when established by X-ray findings, will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. When the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic codes, a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion to be combined, not added under Diagnostic Code 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm or satisfactory evidence of painful motion. 38 C.F.R. § 4.71a, Diagnostic Code 5003. For purposes of rating disability from arthritis, the shoulder is considered a major joint. 38 C.F.R. § 4.45 (f). The diagnostic code that focuses on limitation of motion of the shoulder is Diagnostic Code 5201. The provisions of 38 C.F.R. §§ 4.40, 4.45, and 4.59 must be considered in assigning an evaluation for degenerative or traumatic arthritis under Diagnostic Code 5003 or 5010. Rating personnel must consider functional loss and clearly explain the impact of pain on the disability. VAOPGCPREC 9-98. Normal ranges of motion of the shoulder are flexion (forward elevation) from 0 degrees to 180 degrees, abduction from 0 degrees to 180 degrees, external rotation from 0 degrees to 90 degrees, and internal rotation from 0 degrees to 90 degrees. 38 C.F.R. § 4.71, Plate I. At the outset, VA examiners have noted that the Veteran is right-hand dominant. Therefore, his service-connected left shoulder is clearly on the minor, i.e., non-dominant side. See 38 C.F.R. § 4.69. Under Diagnostic Code 5201, limitation of motion of the minor arm at the shoulder level (i.e., motion limited to 90 degrees) provides a 20 percent rating. Limitation of motion midway between the side and the shoulder level (i.e., motion limited from 45 to 90 degrees), is assigned a 20 percent evaluation. A maximum 30 percent evaluation is warranted for the minor arm when limitation of motion is limited to 25 degrees from the side. 38 C.F.R. § 4.71 (2017). A Veteran is only entitled to a single disability rating under Diagnostic Code 5201 as that diagnostic code does not provide separate ratings for limitation of motion in the flexion and abduction planes, but rather is addressed generically to limitation of motion of the arm. Yonek v. Shinseki, 722 F.3d 1355 (Fed. Cir. 2013). Under Diagnostic Code 5203, impairment of the clavicle or scapula, for a minor (non-dominant) shoulder, malunion of the clavicle or scapula is rated as 10 percent disabling. Nonunion of the clavicle or scapula, without loose movement is rated as 10 percent disabling. Nonunion of the clavicle or scapula, with loose movement is rated as 20 percent disabling. Dislocation of the clavicle or scapula is rated as 20 percent for the minor shoulder. Diagnostic Code 5203 also provides an alternative rating based on impairment of function of the contiguous joint. 38 C.F.R. § 4.71 (2017). Ankylosis of the scapulohumeral articulation is addressed under DC 5200 and other impairment of the humerus is covered under 5202. 38 C.F.R. § 4.71a. However, the record does not show such DCs are relevant for the Veteran’s left shoulder disability. When an evaluation of a disability is based on limitation of motion, the Board must also consider, in conjunction with the otherwise applicable diagnostic code, any additional functional loss the Veteran may have sustained by virtue of other factors as described in 38 C.F.R. §§ 4.40 and 4.45. DeLuca v. Brown, 8 Vet. App. 202, 206 (1995). Such factors include more or less movement than normal, weakened movement, excess fatigability, incoordination, pain on movement, swelling, and deformity or atrophy of disuse. The provisions of 38 C.F.R. § 4.40 state that disability of the musculoskeletal system is primarily the inability, due to damage or inflammation in parts of the system, to perform normal working movements of the body with normal excursion, strength, speed, coordination and endurance. A finding of functional loss due to pain must be supported by adequate pathology and evidenced by the visible behavior of the claimant. 38 C.F.R. § 4.40; Johnston v. Brown, 10 Vet. App. 80, 85 (1997). Although pain may cause functional loss, pain itself does not constitute functional loss. Rather, pain must affect some aspect of “the normal working movements of the body,” such as “excursion, strength, speed, coordination, and endurance,” in order to constitute functional loss. Mitchell v. Shinseki, 25 Vet. App. 32, 38-43 (2011) (quoting 38 C.F.R. § 4.40). With any form of arthritis, painful motion is an important factor of disability. The intent of the schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. Joints that are actually painful, unstable, or malaligned, due to healed injury, should be entitled to at least the minimum compensable rating for the joint. Special note should be taken of objective indications of pain on pressure or manipulation, muscle spasm, crepitation, and active and passive range of motion of both the damaged joint and the opposite undamaged joint. 38 C.F.R. § 4.59. Moreover, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. When § 4.59 is raised by the claimant or reasonably raised by the record, even in non-arthritis contexts, VA should address its applicability. Burton v. Shinseki, 25 Vet. App. 1, 3-5 (2011). The Veteran in currently in receipt of an initial disability rating of 10 percent prior to August 25, 2016, and of 20 percent thereafter. An October 2003 chiropractic treatment note shows that the Veteran experienced a strained left shoulder. In April 2010, the Veteran underwent a VA shoulder examination. The Veteran stated during the examination that pain began in service, but started on a more chronic basis in 2004. He experienced severe shoulder pain two to three times, which lasts for hours to days. It was worse with lifting and activities involving lifting his left arm above his head. There were not incapacitating flare-ups or incapacitating episodes reported. There was a history of trauma to the left shoulder. As noted above, the Veteran is right hand dominant. A summary of joint symptoms showed no deformity, giving way, instability, dislocation or subluxation, locking episodes, effusions, inflammation, flare-ups of joint disease and there was no effect on motion of the joint. However, symptoms included pain, stiffness, weakness, incoordination and decreased speed of motion. There were no continual symptoms of arthritis or incapacitating episodes of arthritis. The Veteran was able to stand for an hour and walk greater than a quarter mile, but less than a mile. He used no assistive devices and there was no prosthesis. The Veteran also found that there was pain at rest and guarding of movement. Range of motion testing revealed left flexion of 0 to 170 degrees, left abduction of 0 to 170 degrees, left internal rotation of 0 to 65 degrees and left external rotation of 0 to 60 degrees. There was objective evidence of pain with active motion and following repetitive motion. There were no additional limitations after three repetitive motions. The examiner found no ankylosis. X-rays showed mild to moderate degenerative changes at the AC joint with no fractures or dislocations or any significant bone or joint abnormalities otherwise evident. Soft tissues were unremarkable. The examiner noted that the Veteran was employed full time at the time of the examination and there was not significant effect on his occupation caused by his left shoulder arthritis. The effects of his shoulder arthritis on his daily activities were moderate. In May 2011 the Veteran sought treatment for bilateral shoulder pain. He experienced pain when he lifted his arm above 90 degrees. Both shoulders appeared to have some rotator cuff inflammation and pain. An April 2012 MRI showed marked degenerative changes of the Veteran’s AC joint with findings suggestive of a partial tear or tendinosis of the supraspinatus and infraspinatus and subscapularis tendons. A November 2012 private treatment record shows that the Veteran sought treatment for left shoulder pain. The examiner noted that this has been no worse for the last several years and suddenly became worse over the last month. He had pain in his left posterior scapular region of his left shoulder and his lateral posterior shoulder. The Veteran stated that he was concerned about the inability to move his left arm. His shoulder pain was described as diffuse and discomfort in the left shoulder with lateral abduction at range of motion. Exquisite tenderness was present with local palpation involving the superior medial aspect of the left scapula. There was no fracture present. He was administered a shot of Celestone/Soluspan. In August 2016, the Veteran underwent a second VA shoulder examination. His diagnosis of degenerative arthritis of the left shoulder was confirmed. A brief summary of the Veteran’s condition noted that he experienced chronic daily pain with flare-ups. He could not use his shoulder under conditions and he has to have someone do his yard and housework due to difficulty with overhead use. In the past 18 months he had three cortisone shots. Flare-ups were described as occurring once in the past year, requiring two cortisone shots. He was unable to swing his arm as he walked. Functional loss included inability to do household chores and limitation of repetitive use overhead. Initial range of motion testing showed that the Veteran’s left shoulder range of motion was abnormal or outside of normal range. Left shoulder flexion, abduction, external rotation and internal rotation were all from 0 to 90 degrees. Range of motion contributed to functional loss due to pain. Pain was present on flexion, abduction and external rotation. There was no evidence of pain with weight bearing or evidence of localized tenderness or pain on palpation of the join or associated soft tissue. There was evidence of crepitus. The Veteran was able to perform repetitive use testing with at least three repetitions, but there was no additional functional loss or range of motion. Muscle strength testing revealed normal strength on forward flexion and abduction of the left shoulder. There was no muscle atrophy present. The examiner noted that there was no ankylosis or rotator cuff conditions suspected. There was also no shoulder instability, dislocation or labral pathology suspected. The Veteran did not have a clavicle, scapula, acromioclavicular (AC) joint or sternoclavicular joint condition. The examiner found no loss of head (flail shoulder), nonunion (false flail shoulder) or fibrous union of the humerus. The examiner noted that the Veteran’s left shoulder condition would impact his ability to work, because it would impair load bearing with overhead use of the arm. Prior to August 25, 2016, the Veteran does not meet the rating criteria for a disability rating in excess of 10 percent. During the April 2010 examination, range of motion testing revealed left flexion of 0 to 170 degrees, left abduction of 0 to 170 degrees, left internal rotation of 0 to 65 degrees and left external rotation of 0 to 60 degrees. These ranges of motion showed that the Veteran was nearly capable of full range of motion on flexion and abduction and therefore capable of motion well beyond limitation of motion at shoulder level or midway between side and shoulder level required for a 20 percent rating under 5201. Although an April 2012 MRI showed marked degenerative changes of the Veteran’s AC joint with findings suggestive of a partial tear or tendinosis of the supraspinatus and infraspinatus and subscapularis tendons, there is no evidence to suggest that the Veteran experienced nonunion of the clavicle or scapula with loose movement or dislocation of the clavicle or scapula. Therefore, he does not meet the rating criteria for a 20 percent disability rating prior to August 25, 2015 under DC 5203. In reviewing the competent evidence of record on and after August 25, 2016, the Board does not find where the left arm has been limited to 25 degrees from the Veteran’s side. The Veteran has not alleged that his left shoulder condition is not accurately represented by the August 2016 VA examination. As a result, no increase may be found under DC 5201. 38 C.F.R. § 4.71a. The Board finds the Veteran’s statements describing the symptom of pain of his service-connected left shoulder are generally competent. 38 C.F.R. § 3.159 (a)(2). To the extent that his statements are consistent with the clinical evidence of record, the Board finds the Veteran credible. Pain alone does not constitute functional loss under VA regulations that evaluate disabilities based upon loss of motion. Mitchell v. Shinseki, 25 Vet. App. 32 at 38 (2011). The Veteran’s statements regarding range of motion of his arm, e.g. that he sometimes can’t his left arm above shoulder level, are generally consistent with the examiners’ findings. The Board relies on the examination findings as they are recorded in a way to best capture accurate measurement. 38 C.F.R. § 4.46 (2017). (In any case, such a range of motion would not result in an increased rating here under 38 C.F.R. § 4.71a, DC 5201.) 5. Entitlement to a disability rating in excess of 30 percent for allergic rhinitis The Veteran was assigned an initial disability rating of 10 percent for his allergic rhinitis in a November 1977 rating decision. The Veteran did not appeal this decision within one year and the decision became final. He then filed an increased rating claim by an April 1986 Statement in Support of Claim. His increased rating claim was denied by the RO in an August 1986 rating decision. He did not appeal this decision, and it also became final after one year. The Veteran filed a claim for a disability rating in excess of 10 percent in February 1997. Subsequently, in an October 2011 Board decision, the Board denied the Veteran’s claim for a disability rating in excess of 10 percent prior to August 15, 2008, but granted the Veteran a disability rating of 30 percent, but no greater, effective on and after August 15, 2008. The Veteran did not appeal this decision to Court of Appeals for Veteran’s Claims (Court), and thus, it became final. See 38 C.F.R. § 20.1100. Final Board decisions are not subject to review except as provided by statute, such as appeal to the Court or a motion for revision based upon a clear and unmistakable error (CUE). 38 C.F.R. § 20.1100 (b), 20.1400. The record does not show that the Veteran perfected an appeal to the Court or that he has filed a motion for revision of the prior Board decision based on CUE in the decision. In November 2011, the RO issued a rating decision effectuating the Board’s grant of a disability rating of 30 percent for allergic rhinitis, effective August 15, 2008. Although the Veteran filed a Notice of Disagreement in November 2012, this does not render the Board’s October 2011 non-final. Therefore, the Board is bound by its October 2011 decision granting a 30 percent disability rating, effective August 15, 2008. Accordingly, entitlement to an effective date prior to August 15, 2008 for the assignment of a 30 percent disability rating for allergic rhinitis is denied. However, the Board will address whether the Veteran has undergone an increase in severity of his allergic rhinitis since the Board’s October 2011 decision. The Veteran’s allergic rhinitis has been evaluated under Diagnostic Code 6522, which addresses both allergic and vasomotor rhinitis. 38 C.F.R. § 4.97. Under Diagnostic Code 6522, a 10 percent evaluation is assigned when there are no polyps, but with greater than 50 percent obstruction of the nasal passage on both sides or complete obstruction on one side. A 30 percent evaluation is assigned when there are polyps as well. During an October 2010 VA examination, it was noted that the Veteran had endoscopic sinus surgery in 2008. His allergy evaluation in August 2010 showed no evidence of allergies. Despite the absence of allergic rhinitis, her does have chronic rhinitis. In June 2010, he had a CT scan which showed no evidence of polyps. Recent records from June 2010 and April 2011 indicate that he has not been on antibiotic since December 2010. He coughed up some post nasal drip in the morning, but not otherwise. He also experienced some nasal crusting. During the examination, the Veteran complained that he felt that the right side of his nose was congested and felt a slightly diminished ability to breathe through it. His condition did not impact his occupational function or daily activities. Upon physical examination, his external auricles were within normal limits bilaterally. His ear canals bilaterally were clear with no drainage or flaking. His tympanic membranes were intact bilaterally. His oropharynx was not erythematous. There was no evidence of discharge. Examination of his nose showed normal mucosa. There was no crusting. There was mild inferior turbinate hypertrophy on the left. The right ear canal is clear with no drainage visualized. The veteran was diagnosed with chronic rhinitis with no evidence of polyposis. The record also contains an October 2016 sinus CT scan. The Veteran was diagnosed with allergy rhinitis with history of nasal polyposis. It was found that that the Veteran had bilateral maxillary sinus mucosal thickening, left greater than right, was present with suggestions of small left maxillary sinus air-fluid level. Mucosal thickening involving the right frontal sinus recess and bilateral ethmoid sinus and to a lesser degree right sphenoid sinus mucosal thickening was also observed. The left frontal sinus was aplastic. There was opacification of the bilateral sphenoid sinus ostia. Postsurgical changes related to bilateral maxillary antrostomies and right uncinectomy present. Inferior aspect of the right frontal sinus recess was opacified. No intraorbital inflammatory changes were identified. The impression was generalized paranasal sinus mucosal thickening with suggestion of small left maxillary sinus air-fluid level which may represent acute on chronic left maxillary sinus disease. The Board observes that given the specificity of the criteria used for the evaluation of allergic rhinitis under Diagnostic Code 6522, it is the clinical evidence that is of the most probative value, in terms of credibility and competency, in this case for purposes of evaluating this condition. The Veteran is certainly competent to report his symptoms and the frequency of his symptoms. See Barr v. Nicholson, 21 Vet. App. 303 (2007) (veteran is competent to testify as to symptomatology capable of lay observation). However, the rating criteria of DC 6522 contemplate a showing of very specific findings (polyps), the nature of which are often identified only by clinical tests, x-ray films and CT scans. Accordingly, a lay person such as the Veteran lacks the competency to accurately assess the presence or absence of such symptoms, and as such, the Board attaches greater probative weight to the clinical findings of skilled professionals, as opposed to lay statements of symptomatology, as pertains to this particular clinical finding. A 30 percent disability is the highest evaluation under Diagnostic Code 6522. The Veteran is separately service connected for sinusitis and he has not alleged an entitlement to an extraschedular rating due to an unusual disability picture. Accordingly, a rating in excess of 30 percent for allergic rhinitis is denied. 6. Entitlement to effective date prior to August 15, 2008 for service connected allergic rhinitis In general, except as otherwise provided, the effective date of an evaluation for an award of pension, compensation or dependency and indemnity compensation based on an original claim, a claim reopened after final disallowance, or a claim for increase will be the date of receipt of the claim or the date entitlement arose, whichever is the later. 38 U.S.C. § 5110 (a); 38 C.F.R. § 3.400 (emphasis added); see also Wells v. Derwinski, 3 Vet. App. 307 (1992). After a rating decision becomes final, an earlier effective date may be established only by a request for revision of that decision based on CUE. See Rudd v. Nicholson, 20 Vet. App. 296 (2006). Free-standing earlier effective date claims that could be raised at any time are impermissible because such claims would vitiate decision finality. Id. In this regard, the Board denied the Veteran’s previous claim for an earlier effective date in an October 2011 decision. The Veteran did not appeal this decision to the Court or file a motion for revision of the October 2011 board decision. Therefore, it is final. The Board finds that such earlier effective date claim is precluded by law. To seek an earlier effective date following a final decision, a Veteran must file a claim of clear and unmistakable error concerning the prior decision. Rudd v. Nicholson, 20 Vet. App. 296 (2006) (only a request for revision based on clear and unmistakable error could result in the assignment of an effective date earlier than the date of a final decision, as free-standing claims for earlier effective dates vitiate the rule of finality). This present claim was filed and developed as a free-standing claim for entitlement to an earlier effective date. The disposition of the Veteran’s effective date claim is controlled by legal precedent and is based upon the operation of law. The Board has determined that the October 2011 Board decision is final. Because the evidence does not show that the Veteran filed a clear and unmistakable error claim with regard to the final October 2011 Board decision, and has instead attempted to file a free-standing earlier effective date claim, dismissal is the appropriate remedy. The Board has no alternative but to dismiss the appeal without prejudice to the Veteran’s filing a clear and unmistakable error claim. Sabonis v. Brown, 6 Vet. App. 426 (1994). Accordingly, the Veteran’s claim for entitlement to an earlier effective date for the award of a 30 percent rating for allergic rhinitis is denied. REASONS FOR REMAND 1. Entitlement to service connection for bilateral calcaneal spurs, claimed a feet conditions is remanded. The Veteran is seeking service connection for bilateral calcaneal spurs, which he claims are due to his active duty service as an aircraft maintenance technician and carrying heavy loads. The Veteran’s military personnel records reflect that he served as a system aircraft organizational maintenance technician. His post service treatment records also reflect diagnoses of calcaneal spurs and planta fasciitis. The Veteran has not been afforded any VA examinations for these claimed disorders. The Board finds that the low threshold for obtaining a VA examination has been met with respect to his bilateral calcaneal spur claims and therefore must be remanded. See 38 U.S.C. § 5103A (d) (West 2015); McLendon v. Nicholson, 20 Vet App. 79, 81 (2006). 2. Entitlement to service connection for bronchitis, to include as secondary to service connected allergic rhinitis and sinusitis is remanded. The Veteran asserts that he is entitled to service connection for bronchitis, which he believes was caused or aggravated by his service connected allergic rhinitis or sinusitis. He has numerous bronchitis diagnoses and conflicting opinions. A May 2011 VA medical opinion stated that his bronchitis was caused by non-service connected asthma, and a January 2009 opinion stated that his bronchitis was caused by his sinusitis. In addition, none of the examiners have addressed whether the Veteran’s bronchitis was aggravated beyond its natural progression by his service connected sinusitis or allergic rhinitis. VA’s affirmative duty to assist claimants to substantiate their claims includes an obligation to provide a medical examination of obtain a medical opinion when necessary to make a decision on a claim. See 38 U.S.C. 5103 (a); See also McGee v. Peake, 511 F.3d 1352, 1357 (Fed. Cir. 2008). 3. Entitlement to service connection for a vocal cord condition, to include as secondary to service connected allergic rhinitis and sinusitis is remanded. In a March 2015 Statement in Support of Claim, the Veteran clarified that he experiences a vocal cord condition due to his service connected allergic rhinitis and sinusitis. The Veteran’s treatment records reflect a diagnosis of pharyngitis from December 2006 and notes that he experiences hoarseness of his voice during sinus infections. Therefore, the Veteran’s claim for a vocal cord condition should be remanded in order to afford the Veteran a VA examination and medical opinion addressing any diagnoses and whether they are caused or aggravated by his service connected allergic rhinitis and sinusitis. 4. Entitlement service connection for a sleep disorder, to include as secondary to service connected allergic rhinitis and sinusitis is remanded. In a March 2015 Statement in Support of Claim, the Veteran clarified that he did not intend to claim service connection for sleep apnea. Rather, he claims that he has sleep disturbance caused by his service connected allergic rhinitis and sinusitis. The Veteran’s treatment records reflect that he underwent a sleep study in May 2003, but his sleep disturbances could not be explained. However, a November 2014 medical record noted insomnia. Therefore, the Veteran’s claim for a sleep disorder should be remanded in order to afford the Veteran a VA examination and medical opinion addressing any sleep disorder diagnoses and whether they are caused or aggravated by his service connected allergic rhinitis and sinusitis. 5. Entitlement to service connection for a chest muscle condition, claimed as a strained heart muscle is remanded. The Veteran stated in a March 2015 Statement in Support of Claim that his strained heart muscle claim was more accurately described as a chest muscle condition caused by his bomb injury in service. Furthermore, the Veteran’s post service treatment records reflect that he has been treated for chest arthralgias and myalgias. Although the Veteran has been afforded a VA heart examination, in light of the Veteran’s treatment for arthralgias and myalgias, and his clarification of his claims, the Veteran should be afforded a new VA examination to adequately address his claims. When VA undertakes to provide an examination, “[the Secretary] must provide an adequate one or, at a minimum, notify the claimant why one will not or cannot be provided. The Board must ensure that the examination is adequate.” Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). 6. Entitlement to service connection for pedal edema with chronic venous is remanded. The Veteran claims that his pedal edema was caused by an injury to his left leg in service when a bomb was dropped on him. As noted above, the Veteran’s STRs show that he sought treatment in service for a left leg injury. The Veteran’s post service treatment records also reflect diagnoses of pedal edema. Although the Veteran was afforded a VA skin examination in April 2010, the examiner did not address the Veteran’s March 2010 diagnosis of pedal edema likely related to chronic venous insufficiency. Therefore, the Veteran should be afforded a VA examination to addresses these claims. 7. Entitlement to service connection for a gastrointestinal disorder, claimed as bowel problems, to include as secondary to service connected allergic rhinitis and sinusitis is remanded. The Veteran asserts that his claimed bowel problems are caused by his service connected sinusitis and allergic rhinitis. More specifically, the Veteran contends that he has a bowel condition caused by medications prescribed for his sinusitis and allergic rhinitis. His STRs reflect that he was treated for diarrhea and stomach distress while in service. Furthermore, his post service treatment records reflect that he had a diagnosis of colon polyps in December 2013. The Board finds that the low threshold for obtaining a VA examination has been met with respect to his gastrointestinal disorder claims and therefore must be remanded. See 38 U.S.C. § 5103A (d) (West 2015); McLendon v. Nicholson, 20 Vet App. 79, 81 (2006).   8. Entitlement to service connection for a groin condition is remanded. The Veteran seeks service connection for a groin condition, which he states causes erectile dysfunction. His STRs show that he sought treatment after a bomb was dropped on him. The Board finds that the low threshold for obtaining a VA examination has been met with respect to his groin condition claim and therefore must be remanded. See 38 U.S.C. § 5103A (d) (West 2015); McLendon v. Nicholson, 20 Vet App. 79, 81 (2006). 9. Entitlement to service connection for a headache condition, to include as secondary to service connected allergic rhinitis and sinusitis is remanded. The Veteran is seeking service connection for a headache condition, which he attributes to his service connected allergic rhinitis and sinusitis. His VA treatment records reflect complaints of headaches associated with his allergic rhinitis and sinusitis. He has not been afforded a VA examination for a headache condition. Therefore, the matter should be remanded in order to afford the Veteran an examination for his claimed headache condition. The matters are REMANDED for the following action: 1. Contact the Veteran’s representative in order to obtain and associate with the claims folder copies of all outstanding private and VA treatment records. 2. After the above development has been completed to the extent possible, schedule the Veteran for a VA examination or examinations to determine the nature and etiology of any current disabilities of the feet. The relevant examiner or examiners should review all pertinent records associated with the claims file, including service treatment records, post-service medical records, and statements. The examiner should then offer an opinion as to whether it is at least as likely as not (i.e. a probability of 50 percent or greater) that any current disability of the feet is related to any disease, injury or event during the Veteran’s active duty service. Any opinion provided must include an explanation of the reasons for the opinion. If the examiner indicates that he or she cannot identify any current disability of the feet, the examiner should specifically address post-service VA treatment records indicating the presence of calcaneal spurs and plantar fasciitis. 3. The AOJ should secure the appropriate VA respiratory examination, to determine the nature and etiology of his bronchitis. The electronic claims file must be provided to and reviewed by the examiner in conjunction with the examination. All necessary diagnostic testing and evaluation should be performed, and all findings set forth in detail. Based upon a review of the entirety of the claims file, the history presented by the Veteran, and the examination results, the examiner is requested to provide an opinion as to the following questions: (a) Is it at least as likely as not (i.e. a 50 percent probability or greater) that any current bronchitis disability is etiologically related to the Veteran’s active duty service? (b) Is it at least as likely as not (i.e. a 50 percent probability or greater) that any current bronchitis disability is a continuation of the Veteran’s in-service treatment for respiratory conditions? (c) Is it at least as likely as not (i.e. a 50 percent probability or greater) than any current bronchitis disability was caused, or aggravated, by his service connected sinusitis and/or allergic rhinitis. The examiner is asked to specifically address the May 2011 VA medical opinion attributing the Veteran’s bronchitis to his childhood asthma, as well as the January 2009 private treatment record attributing his bronchitis to sinusitis. The examiner must provide a complete rationale for all opinions expressed. As part of the rationale, the examiner should identify and explain the relevance or significance, as appropriate, of any history, clinical findings, medical knowledge or literature, etc., relied upon in reaching the conclusion(s). A discussion of the facts and medical principles involved would be of considerable assistance to the Board. If the examiner cannot provide the requested opinion without resorting to speculation, it must be so stated, and the examiner must provide the reasons why an opinion would require speculation. The examiner must indicate whether there was any further need for information or testing necessary to make a determination. The examiner must indicate whether an opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the examiner. 4. The AOJ should schedule the Veteran for the appropriate VA examination to determine the etiology of the Veteran’s current throat disorder(s). Access to the VBMS and Virtual VA electronic claims files must be made available to the examiner for review. The examination should include any diagnostic testing or evaluation deemed necessary, including laboratory tests. The Veteran must be interviewed. The VA examiner must provide a clear explanation for the opinion, to include any comment on any credibility issues raised by the record from a medical perspective. The VA examiner must answer the following questions: (a) Does the Veteran have any current diagnosis for a throat disorder other than sinusitis or allergic rhinitis? (b) Is it at least as likely as not (i.e., 50 percent or more probable) that the Veteran’s throat disorder is caused by, proximately due to, or the result of his service-connected sinusitis and/or allergic rhinitis? (c) Is it at least as likely as not (i.e., 50 percent or more probable) that the Veteran’s current throat disorder is aggravated by or worsened by his service-connected sinusitis and/or allergic rhinitis? The examiner must provide a complete rationale for all opinions expressed. As part of the rationale, the examiner should identify and explain the relevance or significance, as appropriate, of any history, clinical findings, medical knowledge or literature, etc., relied upon in reaching the conclusion(s). A discussion of the facts and medical principles involved would be of considerable assistance to the Board. 5. The AOJ should schedule the Veteran for the appropriate VA examination to determine the etiology of the Veteran’s claimed sleep disorder(s). Access to the VBMS and Virtual VA electronic claims files must be made available to the examiner for review. The examination should include any diagnostic testing or evaluation deemed necessary, including laboratory tests. The Veteran must be interviewed. The VA examiner must provide a clear explanation for the opinion, to include any comment on any credibility issues raised by the record from a medical perspective. The VA examiner must answer the following questions: (a) Does the Veteran have any current diagnosis for a sleep disorder? (b) Is it at least as likely as not (i.e., 50 percent or more probable) that the Veteran’s sleep disorder is caused by, proximately due to, or the result of his service-connected sinusitis and/or allergic rhinitis? (c) Is it at least as likely as not (i.e., 50 percent or more probable) that the Veteran’s current sleep disorder is aggravated by or worsened by his service-connected sinusitis and/or allergic rhinitis? The examiner must provide a complete rationale for all opinions expressed. As part of the rationale, the examiner should identify and explain the relevance or significance, as appropriate, of any history, clinical findings, medical knowledge or literature, etc., relied upon in reaching the conclusion(s). A discussion of the facts and medical principles involved would be of considerable assistance to the Board. 6. Schedule the Veteran for a VA examination or examinations to determine the nature and etiology of any current disabilities of the chest muscles. The relevant examiner or examiners should review all pertinent records associated with the claims file, including service treatment records, post-service medical records, and statements. The examiner should then offer an opinion as to whether it is at least as likely as not (i.e. a probability of 50 percent or greater) that any current disability of the chest is related to any disease, injury or event during the Veteran’s active duty service. Any opinion provided must include an explanation of the reasons for the opinion. If the examiner indicates that he or she cannot identify any current disability of the chest muscles, the examiner should specifically address post-service VA treatment records indicating the presence of chest muscle pain, arthralgias and myalgias. 7. Schedule the Veteran for a VA examination or examinations to determine the nature and etiology of any current disabilities of pedal edema. The relevant examiner or examiners should review all pertinent records associated with the claims file, including service treatment records, post-service medical records, and statements. The examiner should then offer an opinion as to whether it is at least as likely as not (i.e. a probability of 50 percent or greater) that any current disability of pedal edema is related to any disease, injury or event during the Veteran’s active duty service. Any opinion provided must include an explanation of the reasons for the opinion. If the examiner indicates that he or she cannot identify any current disability of pedal edema, the examiner should specifically address post-service VA treatment records indicating the presence of pedal edema. 8. The AOJ should secure the appropriate VA examination to determine the nature and etiology of any current gastrointestinal disorder. The electronic claims file must be provided to and reviewed by the examiner in conjunction with the examination. All necessary diagnostic testing and evaluation should be performed, and all findings set forth in detail. Based upon a review of the entirety of the claims file, the history presented by the Veteran, and the examination results, the examiner is requested to provide an opinion as to the following questions: (a) Does the Veteran have any current diagnosis for a gastrointestinal disorder? (b) Is it at least as likely as not (i.e., 50 percent or more probable) that the Veteran’s gastrointestinal disorder is caused by, proximately due to, or the result of his service-connected sinusitis and/or allergic rhinitis? (c) Is it at least as likely as not (i.e., 50 percent or more probable) that the Veteran’s gastrointestinal disorder is aggravated by or worsened by his service-connected sinusitis and/or allergic rhinitis? The examiner must provide a complete rationale for all opinions expressed. As part of the rationale, the examiner should identify and explain the relevance or significance, as appropriate, of any history, clinical findings, medical knowledge or literature, etc., relied upon in reaching the conclusion(s). A discussion of the facts and medical principles involved would be of considerable assistance to the Board. 9. Schedule the Veteran for a VA examination or examinations to determine the nature and etiology of any current disabilities of the groin, to include erectile dysfunction. The relevant examiner or examiners should review all pertinent records associated with the claims file, including service treatment records, post-service medical records, and statements. The examiner should then offer an opinion as to whether it is at least as likely as not (i.e. a probability of 50 percent or greater) that any current disability of the groin, to include erectile dysfunction, is related to any disease, injury or event during the Veteran’s active duty service. Any opinion provided must include an explanation of the reasons for the opinion. If the examiner indicates that he or she cannot identify any current disability of the groin, to include erectile dysfunction, the examiner should specifically address post-service VA treatment records indicating the presence of erectile dysfunction. 10. The AOJ should secure the appropriate VA headache examination, to determine the nature and etiology of any current headache disorder. The electronic claims file must be provided to and reviewed by the examiner in conjunction with the examination. All necessary diagnostic testing and evaluation should be performed, and all findings set forth in detail. Based upon a review of the entirety of the claims file, the history presented by the Veteran, and the examination results, the examiner is requested to provide an opinion as to the following questions: (a) Does the Veteran have any current diagnosis for a headache disorder? (b) Is it at least as likely as not (i.e., 50 percent or more probable) that the Veteran’s headache disorder is caused by, proximately due to, or the result of his service-connected sinusitis and/or allergic rhinitis? (c) Is it at least as likely as not (i.e., 50 percent or more probable) that the Veteran’s headache disorder is aggravated by or worsened by his service-connected sinusitis and/or allergic rhinitis? The examiner must provide a complete rationale for all opinions expressed. As part of the rationale, the examiner should identify and explain the relevance or significance, as appropriate, of any history, clinical findings, medical knowledge or literature, etc., relied upon in reaching the conclusion(s). A discussion of the facts and medical principles involved would be of considerable assistance to the Board. DAVID L. WIGHT Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Nelson, Associate Counsel