Citation Nr: 18157914 Decision Date: 12/13/18 Archive Date: 12/13/18 DOCKET NO. 15-43 352 DATE: December 13, 2018 ORDER New and material evidence not having been received, the Veteran’s claim for entitlement to service connection for gout is not reopened. New and material evidence having been received, the Veteran’s claim for entitlement to service connection for thoracolumbar spine degenerative arthritis is reopened; to this extent only, the appeal is granted. New and material evidence having been received, the Veteran’s claim for entitlement to service connection for left knee disability, including degenerative joint disease (DJD), is reopened; to this extent only, the appeal is granted. New and material evidence having been received, the Veteran’s claim for entitlement to service connection for right knee disability, including DJD, is reopened; to this extent only, the appeal is granted. Entitlement to service connection for thoracolumbar spine degenerative arthritis is denied. Entitlement to service connection for a left shoulder disability, to include acromioclavicular (AC) joint separation and DJD, is denied. Entitlement to service connection for a right shoulder disability, to include DJD, is denied. Entitlement to service connection for left foot pes planus and degenerative arthritis is denied. Entitlement to service connection for right foot pes planus and degenerative arthritis is denied. Entitlement to service connection for hypertension (HTN) is denied. Entitlement to service connection for diabetes mellitus (DM) is denied. Entitlement to service connection for a traumatic brain injury (TBI) is denied. Entitlement to service connection for syncope is denied. REMANDED Entitlement to service connection for a psychiatric disorder, including diagnosed posttraumatic stress disorder (PTSD), major depressive disorder (MDD) with psychotic features and/or polysubstance abuse, is remanded. Entitlement to service connection for left knee disability, including DJD, is remanded. Entitlement to service connection for right knee disability, including DJD, is remanded. FINDINGS OF FACT 1. A May 2009 rating decision denied a claim for service connection for gout; the Veteran did not timely perfect an appeal of the decision and VA did not actually or constructively receive new and material evidence within one year of its issuance. 2. Evidence received since the May 2009 rating decision is cumulative or redundant of the evidence of record at the time of that decision, does not relate to an unestablished fact necessary to substantiate the claim for service connection for gout, and does not raise a reasonable possibility of substantiating the claim. 3. A July 2005 rating decision denied a petition to reopen a claim for service connection for a back disability; the Veteran did not appeal the decision and VA did not actually or constructively receive new and material evidence within one year of its issuance. 4. Evidence received since the July 2005 rating decision relates to an unestablished fact necessary to substantiate the claim of service connection for a thoracolumbar spine disability, including degenerative arthritis. 5. A May 2009 rating decision denied a claim for service connection for a left knee disability; the Veteran did not timely perfect an appeal of the decision and VA did not actually or constructively receive new and material evidence within one year of its issuance. 6. Evidence received since the May 2009 rating decision relates to an unestablished fact necessary to substantiate the claim of service connection for a left knee disability. 7. A May 2009 rating decision denied a petition to reopen a claim for service connection for a right knee disability, including as secondary to service-connected disability; the Veteran did not timely perfect an appeal of the decision and VA did not actually or constructively receive new and material evidence within one year of its issuance. 8. Evidence received since the May 2009 rating decision relates to an unestablished fact necessary to substantiate the claim of service connection for a right knee disability. 9. The preponderance of the evidence is against finding that the Veteran has degenerative arthritis of the thoracolumbar spine which manifested in service, within one year of separation from service, or that otherwise relates to service or any in-service injury, event, or disease. 10. The Veteran’s left shoulder AC joint separation pre-existed his active service as noted at the time of his enlistment, and did not undergo any worsening beyond normal progression during his active service; the preponderance of the evidence is against finding that the Veteran has any other left shoulder disability, including DJD, which manifested in service, within one year of separation from service, or that otherwise relates to service or any in-service injury, event, or disease. 11. The preponderance of the evidence is against finding that the Veteran has a right shoulder disability, including DJD, which manifested in service, within one year of separation from service, or that otherwise relates to service or any in-service injury, event, or disease. 12. The preponderance of the evidence is against finding that the Veteran has a left foot disability, including pes planus and degenerative arthritis, which manifested in service, within one year of separation from service, or that otherwise relates to service or any in-service injury, event, or disease. 13. The preponderance of the evidence is against finding that the Veteran has diagnosed HTN which manifested in service, within one year of separation from service, or that otherwise relates to service or any in-service injury, event, or disease. 14. The preponderance of the evidence is against finding that the Veteran has diagnosed DM which manifested in service, within one year of separation from service, or that otherwise relates to service or any in-service injury, event, or disease. 15. The preponderance of the evidence of record is against finding that the Veteran has, or has had at any time during the appeal, a current diagnosis of TBI. 16. The preponderance of the evidence is against finding that the Veteran has syncope due to a disease or injury in service, to include specific in-service event, injury, or disease. CONCLUSIONS OF LAW 1. The May 2009 rating decision that denied a claim for service connection for gout is final. 38 U.S.C. § 7105(c); 38 C.F.R. §§ 3.104, 20.302, 20.1103. 2. New and material evidence has not been submitted, and the claim for service connection for gout has not been reopened. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. § 3.156(a). 3. The July 2005 rating decision that denied a claim to reopen service connection for a back disability is final. 38 U.S.C. § 7105(c); 38 C.F.R. §§ 3.104, 20.302, 20.1103. 4. New and material evidence has been received, and the claim for service connection for a thoracolumbar spine disability, to include degenerative arthritis, is reopened. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. § 3.156(a). 5. The May 2009 rating decision that denied a claim for service connection for a left knee disability is final. 38 U.S.C. § 7105(c); 38 C.F.R. §§ 3.104, 20.302, 20.1103. 6. New and material evidence has been received, and the claim for service connection for a left knee disability, to include DJD, is reopened. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. § 3.156(a). 7. The May 2009 rating decision that denied a claim to reopen service connection for a right knee disability is final. 38 U.S.C. § 7105(c); 38 C.F.R. §§ 3.104, 20.302, 20.1103. 8. New and material evidence has been received, and the claim for service connection for a right knee disability, to include DJD, is reopened. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. § 3.156(a). 9. The criteria for service connection for degenerative arthritis of the thoracolumbar spine are not met. 38 U.S.C. §§ 1101, 1112; 1113, 1116, 1131, 1137, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.307, 3.309. 10. The criteria for service connection for a left shoulder disability, including AC joint separation and DJD, are not met. 38 U.S.C. §§ 1101, 1111, 1112; 1113, 1116, 1131, 1137, 1153, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304(b), 3.306, 3.307, 3.309. 11. The criteria for service connection for a right shoulder disability, including DJD, are not met. 38 U.S.C. §§ 1101, 1112; 1113, 1116, 1131, 1137, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.307, 3.309. 12. The criteria for service connection for a left foot disability, including pes planus and degenerative arthritis, are not met. 38 U.S.C. §§ 1101, 1112; 1113, 1116, 1131, 1137, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.307, 3.309. 13. The criteria for service connection for a right foot disability, including pes planus and degenerative arthritis, are not met. 38 U.S.C. §§ 1101, 1112; 1113, 1116, 1131, 1137, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.307, 3.309. 14. The criteria for service connection for HTN are not met. 38 U.S.C. §§ 1101, 1112; 1113, 1116, 1131, 1137, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.307, 3.309. 15. The criteria for service connection for DM are not met. 38 U.S.C. §§ 1101, 1112; 1113, 1116, 1131, 1137, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.307, 3.309. 16. The criteria for service connection for TBI are not met. 38 U.S.C. §§ 1101, 1112; 1113, 1116, 1131, 1137, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.307, 3.309. 17. The criteria for service connection for syncope are not met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1983 to February 1989. These matters are on appeal of December 2013, November 2016 and September 2017 rating decisions. On his November 2015 VA Form 9 and the June 2017 VA Form 9, the Veteran requested a Board video conference hearing before a Veterans Law Judge at the Agency of Original Jurisdiction (AOJ). In correspondence received in July 2017, the Veteran indicated that he wanted his request for a Board hearing be cancelled. Thus, the Board finds his request for a hearing to be withdrawn. 38 C.F.R. § 20.704 (c). In August 2018, the Veteran submitted a timely notice of disagreement (NOD) with the assigned effective dates and initial disability ratings with regard to the June 2018 rating decision that granted service connection for chronic thoracic spine strain, chronic tenderness of the second metatarsal of the left foot status-post contusion, chronic cervical spine strain and tension headaches. The Board notes that it appears that the AOJ is undergoing further action on these issues. As such, the Board finds that it is not necessary to remand the issues of entitlement to earlier effective dates for service connection and initial increased disability ratings for these matters per Manlincon v. West, 12 Vet. App. 238, 240 (1999). New and Material Evidence Generally, when a claim is disallowed, it may not be reopened and allowed, and a claim based on the same factual basis may not be considered. 38 U.S.C. § 7105. However, a claim on which there is a final decision may be reopened if new and material evidence is submitted. 38 U.S.C. § 5108. “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). When determining whether the claim should be reopened, the credibility of the newly submitted evidence is to be presumed. Fortuck v. Principi, 17 Vet. App. 173, 179-80 (2003). The United States Court of Appeals for Veterans Claims (Court) has held that the requirement of new and material evidence is a low threshold. See Shade v. Shinseki, 24 Vet. App. 110 (2010). Regardless of the AOJ’s determination, the Board must consider whether new and material evidence has been received to reopen a claim previously denied. Jackson v. Principi, 265 F.3d 1366, 1369; Barnett v. Brown, 83 F.3d 1380, 1383. Gout The Veteran contends that he is entitled to service connection for gout. His claim was originally denied in a May 2009 rating decision on the basis that there was no evidence of gout in service or that it was caused by the Veteran’s service. The Veteran did not perfect his appeal of the issue after a statement of the case (SOC) was issued in December 2009 and VA did not actually or constructively receive new and material evidence within a year of the rating decision. Therefore, the May 2009 decision is final as to the denial of service connection for gout. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.156(b), 20.302, 20.1103. Thereafter, the Veteran filed a petition to reopen the claim in July 2017. The September 2017 rating decision declined to reopen the claim, finding new and material evidence had not been submitted. The evidence of record at the time of the May 2009 decision consisted of the Veteran’s service treatment records (STRs), post-service VA and private treatment records showing a history of gout as early as August 1996, as well as June 2005 and May 2009 VA compensation examination reports. The evidence associated with the claims file after the May 2009 decision includes ongoing VA treatment records showing intermittent treatment for gout and gouty arthritis, as well as evaluations from the Social Security Administration (SSA). The Board finds that the Veteran has not submitted new and material evidence regarding his gout since the May 2009 rating decision. At the time of the prior decision, there was evidence of gout. VA and private treatment records showing treatment for gout were already of record. Evidence confirming a prior fact is cumulative, rather than new and material. 38 C.F.R. § 3.156(a). Accordingly, the standards under 3.156(a) are not met and the Veteran’s claim for service connection for gout is not reopened. Shade, 24 Vet. App. at 110 (2010). Thoracic Spine Degenerative Arthritis The Veteran contends that his currently diagnosed degenerative arthritis of the thoracolumbar spine is the result of a documented January 1985 motor vehicular accident (MVA) in service. During the course of the appeal, service connection was granted for a chronic thoracic spine strain in a June 2018 rating decision. However, service connection for the Veteran’s diagnosed degenerative arthritis of the thoracolumbar spine remained denied. The claim for service connection for a thoracolumbar back disability was originally denied in September 2002 based on a finding that there was no evidence of the current disability being caused by his service or any incident therein, including his documented January 1985 injury. The claim was again denied in a September 2003 decision on the same basis. The Veteran did not perfect his appeal of the determination of this issue and VA did not actually or constructively receive new and material evidence within a year of the rating decision. In November 2004, the Veteran attempted to reopen the claim and it was denied in July 2005 on the basis that new and material evidence had not been submitted to reopen. The Veteran did not appeal the determination of the issue and VA did not actually or constructively receive new and material evidence within a year of the rating decision. Therefore, the July 2005 decision is final as to the denial of service connection for the thoracic back disability. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.156(b), 20.302, 20.1103. Thereafter, the Veteran filed a petition to reopen the claim in September 2016. The November 2016 rating decision declined to reopen the claim, finding new and material evidence had not been submitted. However, the later June 2018 rating decision presumably reopened the claim and granted service connection for the chronic thoracic strain while continuing to deny service connection for the diagnosed degenerative arthritis of the thoracolumbar spine. As noted above, regardless of the RO’s determination, the Board must first consider whether new and material evidence has been received to reopen the claim of entitlement to service connection for degenerative arthritis of the thoracolumbar spine, previously identified as a back disability. Jackson v. Principi, 265 F.3d 1366, 1369; Barnett v. Brown, 83 F.3d 1380, 1383. The evidence of record at the time of the July 2005 decision consisted of the Veteran’s STRs, post-service VA and private treatment records showing a history of back pain, and the June 2003 VA compensation examination report finding it less likely that the Veteran’s back disability was a result of his service or the in-service injury. The evidence associated with the claims file after the July 2005 decision includes VA treatment records indicating ongoing treatment for complaints of back pain and the August 2017 VA compensation examination addressing the etiology of the Veteran’s diagnosed chronic thoracic strain and degenerative changes to the thoracolumbar spine. The VA medical records and evaluation are new, in that they were not previously of record. They further provide evidence regarding the possibility that the Veteran’s current degenerative arthritis of the thoracolumbar spine is etiologically linked to his service. Therefore, as the lack of credible and competent evidence that the Veteran’s degenerative arthritis of the thoracolumbar spine was caused by his service or any incident therein was the basis for the denial of the claim in the prior decision, this new evidence clearly relates to an unestablished fact necessary to substantiate the claim and is material. See 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a); see also Shade, 24 Vet. App. 110. New and material evidence has been received to reopen the claim for service connection for the Veteran’s degenerative arthritis of the thoracolumbar spine, and reopening the claim is warranted. 38 C.F.R. § 3.156(a). Left and Right Knees During the course of the appeal, the Veteran contends that his bilateral knee pain is either the result of a documented February 1987 left knee in service, with the right knee disability developing secondary to the left knee disability, or the result of an earlier documented January 1985 MVA. The claims for service connection for left and right knee disabilities were originally denied in September 2003 based on a finding that there was no evidence of current chronic disabilities. The Veteran did not appeal the determination of these issues and VA did not actually or constructively receive new and material evidence within a year of the rating decision. A subsequent July 2005 rating decision again denied service connection for a left knee disability; the Veteran did not appeal the determination and VA did not actually or constructively receive new and material evidence within a year of the rating decision. A May 2009 rating decision reopened the Veteran’s claim for service connection for a left knee disability and denied service connection on the basis that the current disability was not etiologically linked to service. The rating decision further declined to reopen the claim for service connection for a right knee disability on the basis that new and material evidence had not been submitted. The Veteran did not perfect his appeal of the issues after a statement of the case (SOC) was issued in December 2009 and VA did not actually or constructively receive new and material evidence within a year of the rating decision. Therefore, the May 2009 decision is final as to the denial of service connection for left and right knee disabilities. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.156(b), 20.302, 20.1103. Thereafter, the Veteran filed a petition to reopen the claims in December 2012. The December 2013 rating decision declined to reopen the claims, finding new and material evidence had not been submitted. The evidence of record at the time of the May 2009 decision consisted of the Veteran’s STRs, post-service VA and private treatment records showing intermittent treatment for bilateral knee pain, with X-ray evidence of degenerative changes as early as October 2004, as well as June 2005 and May 2009 VA compensation examination reports. The evidence associated with the claims file after the May 2009 decision includes ongoing VA treatment records, including a November 2016 record indicating the Veteran reported intermittent numbness and tingling in both lower extremities that had been present for years since he was hit by a tank in the military, and a December 2016 treatment record noting the Veteran’s history of bilateral knee pain beginning in the 1980s while serving in the military. The Veteran’s September 2016 written statement that his bilateral knee disabilities were the result of a MVA in service was also added to the claims file after the May 2009 decision. The VA medical records and the Veteran’s written contentions that his bilateral knee pain is the result of his documented January 1985 MVA in service, are new, in that they were not previously of record. They further provide evidence regarding the possibility that the Veteran’s bilateral knee disabilities are etiologically linked to January 1985 MVA in service. Therefore, as the lack of credible and competent evidence that the Veteran’s left and right knee disabilities were caused by his service or any incident therein was the basis for the denial of the claims in the prior decision, this new evidence clearly relates to an unestablished fact necessary to substantiate the claims and is material. See 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a); see also Shade, 24 Vet. App. 110. New and material evidence has been received to reopen the claims for service connection for the Veteran’s left and right knee disabilities, and reopening the claims is warranted. 38 C.F.R. § 3.156(a). Service Connection Service connection will be granted if it is shown that the Veteran suffers from a disability resulting from personal injury suffered or disease contracted in the line of duty, or for aggravation of a pre-existing injury suffered or disease contracted in the line of duty, during active military service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. Diseases diagnosed after discharge may be service connected if all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d); see also Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). Where a veteran who served for ninety days or more during a period of war (or during peacetime service after December 31, 1946) develops certain chronic diseases, including arthritis, HTN and DM, to a degree of 10 percent or more within one year from separation from service, such diseases may be presumed to have been incurred in service even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. Alternatively, when a disease listed in 38 C.F.R. § 3.309 (a), is not shown to be chronic during service or the one-year presumptive period, service connection may also be established by showing continuity of symptomatology after service. See 38 U.S.C. §§ 1101, 1112, 1113, 1137; Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2012); Fountain v. McDonald, 27 Vet. App. 258 (2015); 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a). When there is an approximate balance in the evidence regarding the merits of an issue material to the determination of the matter, reasonable doubt will be resolved in each such issue in favor of the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. An appellant need only demonstrate that there is an approximate balance of positive and negative evidence to prevail. To deny a claim on its merits, the evidence must preponderate against the claim. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); Alemany v. Brown, 9 Vet. App. 518 (1996). 1. Degenerative Arthritis of the Thoracolumbar Spine The Veteran contends that his thoracic spine disability, including diagnosed degenerative arthritis of the thoracolumbar spine, had its onset in service or was the result of a documented January 1985 MVA. The Board concludes that, while the Veteran currently has degenerative arthritis of the thoracolumbar spine, which is a chronic disease under 38 U.S.C. § 1101(3)/38 C.F.R. § 3.309(a), it was not chronic in service or manifest to a compensable degree in service or within the presumptive one year following his discharge, and continuity of symptomatology is not established. Evidence of record shows the Veteran was not diagnosed with degenerative arthritis of the thoracolumbar spine until August 2017, 28 years after his separation from service and 27 years outside of the applicable presumptive period. The Veteran’s STRs show he was hospitalized in January 1985 for diagnosed contusion of the thoracic spine following a MVA. In a December 1988 report of medical history the Veteran denied any history of arthritis or recurrent back pain. The accompanying separation examination report indicates that clinical evaluation of the spine was normal. A June 2003 VA examiner opined that the Veteran’s back complaints were more likely unrelated to his accident in service as there were no complaints at the time of his discharge and no subsequent complaints until almost 10 years later. The examiner further opined that the back injury in service was most likely an isolated incident that completely resolved. An August 2017 VA examiner opined that, while the Veteran’s diagnosed thoracic strain was likely caused by his inservice accident, his diagnosed thoracolumbar spine arthritis was less likely caused by or the result of his service or the January 1985 injury to the mid-thoracic back in service, as the examiner noted that the degenerative changes are reportedly in the lower thoracic and lumbar spines and not at the mid-thoracic level of the original injury. While the Veteran believes his degenerative arthritis of the thoracolumbar spine is related to his in-service MVA injury, he is not competent to provide a nexus opinion in this case. This issue is also medically complex, as it requires specialized medical education and the ability to interpret complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence, particularly the August 2017 VA examiner’s opinion because it is based on an accurate medical history and provides explanations that contain clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The Veteran has provided no competent evidence etiologically linking his degenerative arthritis of the thoracolumbar spine to his service or the 1985 in-service injury. In conclusion, as the preponderance of the evidence is against the claim for service connection for degenerative arthritis of the thoracolumbar spine, the benefit of the doubt rule is not applicable, and the claim must be denied. See 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49, 56 (1990). 2. Left and Right Shoulder Disabilities The Veteran contends that his left and right shoulder disabilities, diagnosed as degenerative arthritis and left shoulder AC joint separation, status-post surgical repair, either had their onset in service or are otherwise the result of his service. A veteran will be considered to have been in sound condition when examined and accepted for service, except as to disorders noted on entrance into service, or when clear and unmistakable evidence demonstrates that the disability existed prior to service and was not aggravated by service. Only such conditions as are recorded in examination reports are to be considered as noted. 38 U.S.C. §§ 1111, 1137; 38 C.F.R. § 3.304 (b). Temporary or intermittent flare-ups during service of a pre-existing injury or disease are not sufficient to be considered “aggravation in service” unless the underlying condition, as contrasted to symptoms, is worsened. Crowe v. Brown, 7 Vet. App. 238, 247-48 (1994); Hunt v. Derwinski, 1 Vet. App. 292, 297 (1991). A pre-existing disease or injury will be found to have been aggravated by service only if the evidence shows that the underlying disability underwent an increase in severity; the occurrence of symptoms, in the absence of an increase in the underlying severity, does not constitute aggravation of the disability. Davis v. Principi, 276 F.3d 1341, 1345 (Fed. Cir. 2002); 38 C.F.R. § 3.306 (a). Evidence of the Veteran being asymptomatic on entry into service, with an exacerbation of symptoms during service, does not constitute evidence of aggravation. Green v. Derwinski, 1 Vet. App. 320, 323 (1991). If the disorder becomes worse during service and then improves due to in-service treatment to the point that it was no more disabling than it was at entrance into service, the disorder has not been aggravated by service. Verdon v. Brown, 8 Vet. App. 529 (1996). Aggravation may not be conceded where the disability underwent no increase in severity during service on the basis of all of the evidence of record pertaining to the manifestations of the disability prior to, during, and subsequent to service. 38 C.F.R. § 3.306 (b). September 1982 private treatment records show the Veteran underwent a Weaver Dunn reconstructive surgery to repair his diagnosed left AC separation, grade III. The Veteran’s June 1983 pre-enlistment report of medical history notes that he gave a history of having broken bones and undergone surgical report of a left shoulder separation. The Veteran was found acceptable for service by an orthopedic consultation. His STRs show no subsequent shoulder complaints, findings, treatment or diagnoses. Post-service VA treatment records show the Veteran complained of total body pain, including bilateral shoulder pain in November 2016. A June 2018 VA examiner opined that it was less likely than not that the Veteran’s diagnosed bilateral shoulder arthritis was incurred in or caused by any injury during service as his STRs show no treatment for any shoulder condition and subsequent VA treatment records show no treatment for a shoulder condition. The examiner further opined that the current X-ray evidence of early degenerative changes in both shoulders was more likely a result of his aging. The examiner further opined that the Veteran’s left shoulder AC separation pre-existed service as reported at the time of his 1983 enlistment examination and was less likely aggravated by service as there was no treatment for any shoulder condition in service. As outlined above, the Veteran’s June 1983 pre-induction examination revealed that he was acceptable for service despite a prior left shoulder AC joint separation. Therefore, the presumption of soundness does not attach in this case. See 38 C.F.R. § 3.304 (b). After reviewing all of the evidence of record, the Board finds that there is no evidence demonstrating that the Veteran’s pre-existing left shoulder AC joint separation underwent a chronic increase in severity (i.e., underwent a permanent increase in the underlying pathology beyond the natural progression) during his military service. His STRs reveal no complaints, findings, treatment or diagnoses associated with any left shoulder disability. While the Veteran can competently report on his observable symptoms, any opinions regarding progression, aggravation, or etiology of such symptoms requires medical expertise that he has not demonstrated. See Jandreau v. Nicholson, 492 F.3d 1372, 1376 (Fed. Cir. 2007). As such, the Board assigns no probative weight to the Veteran’s assertions. Nor has the Veteran submitted any medical opinion that his pre-existing left shoulder AC separation permanently worsened beyond the natural progression during service. In reaching a determination, the Board has afforded the greatest probative value to the June 2016 VA examiner’s opinion that the Veteran’s pre-existing left shoulder AC joint separation was not aggravated beyond its natural progression during service. The opinion is persuasive as the rationale for the opinion is based upon accurate facts and sound reasoning, and the opinion is consistent with the contemporaneous evidence. This evidence outweighs the Veteran’s lay opinion on the matter given the medical complexities to assess the natural progression of the disability. Moreover, regarding any other current left or right shoulder disability, including diagnosed bilateral shoulder degenerative arthritis, a preponderance of the medical evidence of record is against an etiological link between the Veteran’s current bilateral shoulder disability and his service, or any incident therein. Again, while he is competent to comment on his symptoms since service, the Veteran, as a layperson, is not competent to provide the necessary etiological link to either his service or any incident therein. There is no medical evidence of record indicating any left or right shoulder arthritis disability until June 2016, 27 years after the Veteran’s discharge from service, and there is no competent evidence linking any such disability to his service or any incident therein. In fact, the June 2016 VA examiner provided a persuasive expert opinion that the Veteran’s current bilateral shoulder arthritis is more likely the result of his aging process. In sum, the preponderance of the evidence is against the claims of service connection for left shoulder disability, to include AC joint separation and degenerative arthritis, and for right shoulder disability, to include degenerative arthritis; there is no doubt to be resolved; and service connection for left and right shoulder disabilities is not warranted. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. 3. Left and Right Foot Pes Planus and Degenerative Arthritis The Veteran contends that his bilateral foot disability, including diagnosed pes planus and degenerative arthritis, had its onset in service or was the result of a documented December 1984 left foot injury or a documented January 1985 MVA. During the course of the appeal, service connection was granted for chronic tenderness of the second metatarsal of the left foot, status post contusion in a June 2018 rating decision. However, service connection for the Veteran’s diagnosed left and right foot pes planus and degenerative arthritis remained denied. The evidence shows that there is no diagnosis of left or right foot degenerative arthritis in service or within a year of separation. The first report of degenerative arthritis of either foot was in November 2011, 22 years after the Veteran’s separation from service. As the evidence does not show left or right foot arthritis during service or within a year of the Veteran’s discharge, he is not entitled to service connection for left or right foot arthritis on a presumptive basis, as a chronic disease. See 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. The Veteran’s STRs show no complaints, findings, treatment or diagnoses associated with left or right foot pes planus. A December 1984 treatment record shows he injured his left ankle and foot while playing basketball. An X-ray study of the left foot was unremarkable for any fracture. The assessment was traumatic effusion of the left foot. There was no subsequent relevant complaints, findings, treatment or diagnosis and the December 1988 report of medical history shows the Veteran denied any foot problems, while the accompanying separation examination report shows that clinical evaluation of the feet was normal. None of the medical evidence of record etiologically links the Veteran’s currently diagnosed left and right foot disabilities, including pes planus and degenerative arthritis, to his service, or any incident therein. In fact, the August 2017 VA examiner, while finding that the Veteran’s left foot contusion with residual tenderness was likely a result of his in-service injury, opined that it was less likely that his current bilateral pes planus was caused by or the result of his service injury as it was likely more related to the structure of his feet. The examiner further opined that it was less likely that his bilateral foot arthritis was caused by or the result of his in-service injury. As noted previously, although he is competent to describe his symptoms since service, the Veteran, as a layperson, he is not competent to provide the necessary etiological link to either his service or any incident therein. The Board finds the opinion of the August 2017 VA examiner to be of more probative value as it was based on a review of the Veteran’s record and physical examination and provides rationale for the opinion regarding the etiology of his bilateral pes planus. Accordingly, the Board finds the evidence weighs against a finding that any current left or right foot disability, to include diagnosed pes planus and degenerative arthritis, is related to the Veteran’s military service, to include an in-service injury. The preponderance of the evidence is against the claims of service connection for a left foot or right foot disability, including pes planus and degenerative arthritis; there is no doubt to be resolved; and service connection for left and/or right foot disability, to include pes planus and degenerative arthritis, is not warranted. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. 4. HTN and DM The Veteran contends that his currently diagnosed HTN and DM either had their onset in service or are otherwise the result of his service. The evidence shows that there is no diagnosis of HTN or DM, in service or within a year of separation. The first report of HTN of record was in March 2003, 14 years after the Veteran’s separation from service. The first report of DM of record was in November 2004, 13 years after his separation from service. As the evidence does not show HTN or DM was manifest within one year of discharge, he is not entitled to service connection for HTN or DM on a presumptive basis, as a chronic disease. See 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. The Veteran’s STRs show no relevant complaints, findings, treatment or diagnoses for HTN or DM. Moreover, none of the medical evidence of record etiologically links the Veteran’s currently diagnosed HTN or DM to his service, or any incident therein. Although he is competent to describe his symptoms since service, the Veteran, as a layperson, is not competent to provide the necessary etiological link to either his service or any incident therein. Accordingly, the Board finds the evidence weighs against a finding that the currently diagnosed HTN and/or DM is related to the Veteran’s military service, to include as based on continuity of symptomatology. The preponderance of the evidence is against the claims of service connection for a HTN and DM; there is no doubt to be resolved; and service connection for HTN and DM is not warranted. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. 5. TBI The Veteran asserts that he currently has TBI, which is a result of his January 1985 in-service MVA. The first question for the Board is whether the Veteran has a current diagnosis of TBI. Although VA treatment records intermittently note the Veteran’s reported history of a head injury in service and residuals of TBI, the evidence of record does not show that he has (or during the pendency of the instant claim has had) TBI. In this respect, a September 2016 VA treatment record notes the Veteran did not report a history of TBI and an October 2016 VA examiner, while noting the Veteran gave a history of having fallen off a truck during service, after reviewing his claims file, and examining the Veteran, found that there was no diagnosed TBI. The existence of a current disability is the cornerstone of a claim for service connection and VA disability compensation. 38 U.S.C. § 1131; see Degmetich v. Brown, 104 F.3d 1328, 1332 (Fed. Cir. 1997) (holding that interpretation of sections 1110 and 1131 of the statute as requiring the existence of a present disability for VA compensation purposes cannot be considered arbitrary). Evidence must show that the Veteran currently has the disability for which benefits are being claimed. Here, a preponderance of the evidence is against a finding that the Veteran currently has TBI. Until such findings show the Veteran currently has TBI there can be no entitlement to service connection. See Degmetich v. Brown, 104 F.3d 1328 (Fed. Cir. 1997); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Therefore, the Board cannot grant his claim under any theory of entitlement. Without medical evidence of a current TBI diagnosis, a preponderance of the evidence is against the Veteran’s claim. The benefit of the doubt doctrine does not apply, and the claim for service connection for TBI must be denied. See 38 U.S.C. § 5107 (b) (2012); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert, 1 Vet. App. at 55-56. 6. Syncope The Veteran contends that his current syncope is a result of his military service. There is no medical evidence of record indicating any evidence of syncope or syncopal episode until March 2015, 26 years after the Veteran’s discharge from service. Likewise, none of the medical evidence of record etiologically links the Veteran’s currently diagnosed syncope, to his service, or any incident therein. Although he is competent to describe his symptoms since service, the Veteran, as a layperson, is not competent to provide the necessary etiological link to either his service or any incident therein. Accordingly, the Board finds the evidence weighs against a finding that any current syncope or syncopal episodes are related to the Veteran’s military service, or any incident therein. The preponderance of the evidence is against the claim of service connection for a syncope or syncopal episode; there is no doubt to be resolved; and service connection for syncope is not warranted. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. REASONS FOR REMAND VA is obligated to provide an examination and/or opinion where the record contains evidence that the claimant has a current disability, the record indicates that a disability or signs of symptoms of disability may be associated with active service or service-connected disability, and the record does not contain sufficient information to make a decision on the claim. 38 U.S.C. § 5103A (2012); 38 C.F.R. § 3.159 (c)(4) (2017); McLendon v. Nicholson, 20 Vet. App. 79 (2006). Once VA undertakes the effort to provide a medical examination or opinion, it must provide an adequate one. A medical opinion is inadequate if it does not take into account the Veteran’s reports of symptoms and history, even if recorded in the course of the examination. Dalton v. Nicholson, 21 Vet. App. 23 (2007); see also Barr v. Nicholson, 21 Vet. App. 303, 311-12 (2007). 1. A Psychiatric Disorder, to include PTSD, MDD with psychosis and polysubstance abuse. After reviewing his claims file, a VA psychologist in an October 2016 report, diagnosed the Veteran with PTSD, MDD with psychotic features and polysubstance abuse. The examiner opined that the Veteran’s diagnosed PTSD was likely related to childhood sexual abuse and not any experience in service. The examiner further opined that the Veteran’s diagnosed MDD and polysubstance abuse were less likely than not related to anything in service. The examiner provided no rationale for these opinions. The October 2016 VA opinion appears to be based on a lack of objective clinical evidence of treatment for any psychiatric complaints from immediately after service until 2001 and dismissed the Veteran’s statements that he had symptoms of depression in service and since. Nor does the examiner address the evidence that the Veteran gave a history of psychiatric symptoms at the time of his December 1988 separation examination. Likewise, the examiner did not address relevant service personnel and STRs that show the Veteran had been noted to be intoxicated on several occasions in service, had been charge with two DUIs while in service and was treated for diagnosed intoxicated gastritis on one occasion. In an April 2018 evaluation, a private psychologist opined that the Veteran did not have a current PTSD diagnosis and that his MDD likely began in service and has continued uninterrupted to the present. As the October 2016 opinion does not address the Veteran’s reported history of depression since service or the relevant STRs and personnel records, the Board finds it inadequate. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007); see also Prejean v. West, 13 Vet. App. 444, 448-49 (2000) (noting that factors for assessing the probative value of a medical opinion include the thoroughness and detail of the opinion). Another examination and opinion by an examiner who has not previously examined the Veteran should be obtained on remand. 2. Left and Right Knee Disabilities. The Veteran contends that his left and right knee disabilities, including diagnosed mild DJD of both knees, had its onset in service or was the result of his January 1985 MVA. Alternatively, he contends that his left knee disability is the result of the February 1987 injury in service and his left knee disability either caused or aggravated his right knee disability. The Veteran’s STRs show he complained of left knee pain of 1-week duration after he fell into a “turtle” ditch in February 1987. The assessment was a medial collateral ligament strain. In early March 1987, the Veteran was put on a physical profile for a healing left knee injury. There was no subsequent treatment for any knee complaints. A December 1988 report of medical history shows the Veteran denied any history of arthritis or of a trick or locked knee. The accompanying separation examination report indicates that clinical evaluation of the lower extremities was normal. A June 2005 VA examiner opined that it was not at least as likely as not that the Veteran’s current left knee disability was the result of his left knee injury in service as current X-ray studies showed he had greater arthritis in the right knee. A May 2009 VA examiner after reviewing the Veteran’s claims file and examining the Veteran, diagnosed bilateral knee pain due to DJD. The examiner noted the Veteran’s history of a left knee injury in service that was relatively mild with no further treatment until about 2004 and that he had denied any other injuries to either knee. The examiner opined that the Veteran’s current left knee condition was less likely than not the result of service based on the fact that the Veteran did not have a significant injury in service or any documented care following. The Board finds both the June 2005 and May 2009 VA opinions are inadequate as they appear to be based primarily on a lack of objective clinical evidence of treatment for left or right knee symptoms immediately after service until 2004 and do not adequately address the Veteran’s statements of symptoms in both knees while still in service since the earlier January 1985 MVA. Therefore, a new examination is necessary to assess the etiology of the Veteran’s bilateral knee disabilities. Finally, while the appeal is in remand status, all of the Veteran’s contemporaneous and relevant outstanding treatment records should also be obtained and associated with the claims file. See 38 U.S.C. § 5103A (b). The matter is REMANDED for the following action: 1. Obtain any updated VA treatment records from August 2018 to the present. After associating the above records, if any, with the electronic claims file, afford the Veteran a VA psychiatric examination by an appropriate medical professional other than the VA psychologist who conducted the October 2016 examination, to determine the current nature and etiology of any psychiatric disorder, to include diagnosed PTSD, MDD with psychosis, delusional disorder, anxiety, cyclothymia, schizophrenia, polysubstance abuse, found to be present. Based on review of all the evidence of record, and the Veteran’s elicited history, the examiner is to state: a.) Does the Veteran have a current psychiatric diagnosis, other than any drug or alcohol abuse? b.) Is it at least as likely as not (50 percent or better probability) that any currently or previously diagnosed psychiatric disorder (to include diagnosed PTSD, or MDD with psychosis) had its onset in service or is otherwise related to his active service, or any incident therein? c.) If, and only if, the examiner determines that the Veteran has a psychiatric disorder that began in or is otherwise etiologically related to his active service, then the examiner must state an opinion as to whether it is at least as likely as not (50 percent probability or more) that any diagnosed drug or alcohol abuse is a manifestation of or was caused by that psychiatric disorder. A complete rationale for all opinions must be provided that addresses the Veteran’s history of symptoms of depression since service and of using alcohol to self-medicate in service, as well as STR and service personnel records noting the Veteran’s reported history of psychiatric symptoms in December 1988 and of alcohol intoxication. If the examiner cannot provide a 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. Additionally, the examiner must indicate whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner. 3. Afford the Veteran a VA orthopedic examination to determine the current nature and etiology of any left or right knee disability, to include DJD, found to be present. The entire claims file, to include all electronic files, must be reviewed by the examiner. Based on review of all the evidence of record, and the Veteran’s elicited history, the examiner should provide the following opinions: a.) Is it at least as likely as not (50 percent or better probability) that any current left and/or right knee disability is related to his active duty service or any incident therein, including the documented January 1985 MVA accident and/or the February 1987 left knee injury? (b) If the examiner finds that it is at least as likely as not that any left knee disability is related to the Veteran’s active duty service, then is it at least as likely as not (50 percent or better probability) that any right knee disability is caused or aggravated by his left knee disability? A complete rationale for all opinions must be provided. H. N. SCHWARTZ Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD L. Wells-Green