Citation Nr: 18158599 Decision Date: 12/17/18 Archive Date: 12/17/18 DOCKET NO. 15-20 102 DATE: December 17, 2018 ORDER The claim of entitlement to service connection for tinnitus is granted. The claim of entitlement to service connection for pes planus is granted. REMANDED The claim of entitlement to service connection for bilateral hearing loss is remanded. The claim of entitlement to service connection for right knee disability, to include as secondary to bilateral foot disability, is remanded. The claim of entitlement to service connection for left knee disability, to include as secondary to bilateral foot disability, is remanded. The claim of entitlement to service connection for right thigh disability, to include as secondary to bilateral foot disability, is remanded. The claim of entitlement to service connection for left thigh disability, to include as secondary to bilateral foot disability, is remanded. The claim of entitlement to a right thumb disability is remanded. The claim of entitlement to service connection for a bilateral testicle disability is remanded. The claim of entitlement to cervical spine disability is remanded. The claim of entitlement to headaches, to include as secondary to cervical spine disability, is remanded. FINDINGS OF FACT 1. The Veteran’s assertions of in-service noise exposure are credible and consistent with the circumstances of his service. 2. The Veteran currently has bilateral tinnitus and are the record includes his competent, credible and probative lay assertions that he began to experience symptoms of tinnitus in service (coincident with noise exposure), and that such symptoms have recurred to the present. 3. Bilateral pes planus was first diagnosed during active service. CONCLUSIONS OF LAW 1. Resolving all reasonable doubt in the Veteran’s favor, the criteria for service connection for bilateral tinnitus are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 2. Resolving all reasonable doubt in the Veteran’s favor, the criteria for service connection for bilateral pes planus are met. 38 U.S.C. §§ 1110, 1131, 1154, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1982 to September 1984. This appeal to the Board of Veterans’ Appeals (Board) arose from a July 2012 decision in which the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida denied service connection for the above disabilities. In July 2012, the Veteran filed a notice of disagreement (NOD) as to the denials of service connection. In March 2015, a statement of the case (SOC) was issued and the appellant filed a substantive appeal (via a VA Form 9, Appeal to the Board of Veterans’ Appeals) in May 2015. In February 2018, the Veteran testified during a Board video-conference hearing before the undersigned Veterans Law Judge; a transcript of that hearing is of record. I. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Service connection may be granted for any disease diagnosed after discharge from service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Generally, to establish service connection, there must be competent, credible and probative evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). Laypersons, such as the Veteran, are competent to report on matters observed or within his or her personal knowledge, to include the occurrence of injury, and as to the nature, onset, and continuity of symptoms experienced or observed. See 38 C.F.R. § 3.159(a)(2). See also Charles v. Principi, 16 Vet. App. 370 (2002); Layno v. Brown, 6 Vet. App. 465, 470 (1994). The Board, however, retains the discretion to determine the competency, credibility and probative value of all evidence of record, including lay evidence. See Buchanan v. Nicholson, 451 F.3d 1331, 1335 (Fed. Cir. 2006). In adjudicating a claim for VA benefits, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with a claimant prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). A. Tinnitus The Veteran asserts that service connection for tinnitus is warranted. In addition to the above-cited legal authority, it is noted that, when a chronic disease, such as an organic disease of the nervous system, becomes manifest to a degree of 10 percent within one year of separation from active service, then it is presumed to have been incurred during active service, even though there is no evidence of such disease during service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C. §§ 1101, 1111, 1112, 1113, 1137; 38 C.F.R. § 3.307, 3.309. The United States Court of Appeals for Veterans Claims (Court) has held that, with evidence of acoustic trauma, tinnitus is considered an organic disease of the nervous system, falling within the parameters of 38 C.F.R. § 3.309(a). Fountain v. McDonald, 27 Vet. App. 258, 259 (2015). With chronic disease shown as such in service (or within the presumptive period under 38 C.F.R. § 3.307) to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service-connected, unless clearly attributed to intercurrent causes. 38 C.F.R. § 3.303(b). Continuity of symptomatology is required only where the condition noted during service (or in the presumptive period) is not, in fact, shown to be chronic, or when the diagnosis of chronicity may be legitimately questioned. Id. When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. Id. The United States Court of Appeals for the Federal Circuit (Federal Circuit) has clarified that the provisions of 38 C.F.R. § 3.303(b) pertaining to the award of service connection based on continuity of symptomatology (in lieu of a medical nexus opinion) apply only to chronic diseases as defined in 38 C.F.R. § 3.309(a). See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Considering the pertinent evidence in light of the governing legal authority, and affording the Veteran the benefit of the doubt on certain elements of the claim, the Board finds that service connection for bilateral tinnitus is warranted. With respect to the matter of current disability, the June 2012 VA audiology examination report documents the Veteran's report that he experienced recurrent tinnitus, and the Veteran similarly reported that he experiences recurrent bilateral tinnitus during his 2018 Board hearing. This evidence establishes a current bilateral tinnitus disability. With respect the in-service injury or disease requirement, while in the Army, the Veteran’s military occupational specialty (MOS) was single channel radio operator. The Veteran testified that he was often on the range without any hearing protection. See Board Hearing Transcript (Tr.) at 4. His Form DD-214 shows that he was qualified as a sharpshooter on the rifle M16 and a hand grenade marksman. The Veteran’s reports of in-service noise exposure are consistent with his circumstances of service. See 38 U.S.C. § 1154(a). As the Board finds no reason to question the veracity of the Veteran’s assertions in this regard, they are also considered credible. Regarding the third criterion of whether there exists a medical nexus between current tinnitus and service, the Board notes that there is only one medical opinion to address this point of record. In the June 2012 VA examination report, the examiner opined that it was less likely than not that tinnitus was related to military noise exposure. As rationale, the examiner stated the Veteran’s hearing was “normal” for several years following service and there was no evidence to support a finding of delayed-onset hearing loss. The Board finds that the June 2012 VA examiner’s opinion is not probative. Indeed, the examiner’s rationale solely relates to the etiology of hearing loss, not tinnitus. Further, the examiner made no attempt to discuss the Veteran's assertions of continuity of symptomatology in offering an opinion. See Buchanan v. Nicholson, 451 F.3d 1331, 1336 n. 1 (Fed. Cir. 2006) (noting that VA examiner’s opinion, which relied on the absence of contemporaneous medical evidence, “failed to consider whether the lay statements presented sufficient evidence of the etiology of [the Veteran’s] disability such that his claim for service connection could be proven without contemporaneous medical evidence”); Dalton v. Nicholson, 21 Vet. App. 23 (2007) (“the medical examiner cannot rely on the absence of medical records corroborating that injury to conclude that there is no relationship between the appellant's current disability and his military service.”). For those reasons, the Board concludes that the June 2012 examiner’s opinion is not probative. As such, there is no persuasive etiology opinion of record. The Board notes that the Veteran has consistently stated that he has experienced ringing in the ears since service, when ringing had its onset. See Board Hearing Tr. at 5. The Veteran is competent to attest to such and the Board finds no reason to doubt the Veteran’s credibility on this point. As such, his statements regarding the onset of tinnitus in service and continuing since that time are credible and probative. To that end, the Board notes that lay evidence may serve as a basis to establish the tinnitus claim. See Charles, supra; Savage v. Grober, 10 Vet. App. 488, 495-97 (1997). Tinnitus is a rare type of disability for which, in the vast majority of cases, service connection may be established when there is credible lay evidence of continuity of symptomatology since service. See Charles, supra. Given the nature of the disability, as explained above, and the evidence currently of record, the Board finds that the Veteran has provided competent and credible, and hence, probative lay evidence that he first experienced tinnitus during service-coincident with significant in service-noise exposure (and possible associated acoustic trauma)-and, that at he has as had continuous symptoms of tinnitus since his discharge from active duty service. See id; see also 38 C.F.R. § 3.303; Fountain, supra. When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding service origin, the degree of disability, or any other point, such doubt will be resolved in favor of the claimant. See 38 C.F.R. § 3.102; see also 38 U.S.C. § 5107; Gilbert, 1 Vet. App. at 53-56. Given the facts noted above, and resolving any reasonable doubt on certain elements of the claim in the Veteran’s favor, the Board concludes that the criteria for service connection for bilateral tinnitus are met. B. Pes Planus The Veteran asserts that service connection for bilateral pes planus is warranted. Every person employed in the active military, naval, or air service shall be taken to have been in sound condition when examined, accepted and enrolled for service, except as to defects, infirmities, or disorders noted at the time of the examination, acceptance and enrollment, or where clear and unmistakable evidence demonstrates that the injury or disease existed before acceptance and enrollment and was not aggravated by such service. 38 U.S.C. § 1111. Here, the evidence reflects a current diagnosis of bilateral pes planus at the June 2012 VA examination. In service, the Veteran’s entrance report of medical examination in 1982 showed that the Veteran’s feet were evaluated as clinically normal upon entrance. No feet problems, let alone pes planus, were noted upon entrance. Thus, he is considered sound upon entrance regarding any bilateral pes planus. In-service, a June 1983 screening note of acute medical care shows the Veteran’s complaints of bilateral foot pain. The Veteran reported ongoing pain for the prior month. The Veteran was diagnosed with mild bilateral pes planus and placed on limited duty. Notably, the Veteran did not undergo a separation examination in 1984. However, a report of medical history, conducted in 1987 during reserve service, showed a diagnosis of flat feet. The June 2012 VA examiner opined that it was less likely than not that pes planus was related to service. As rationale, the examiner stated that service treatment records (STRs) are silent for any pes planus. Further, the examiner noted there were no traumatic injuries to the feet in service. The examiner explained that the first report of pes planus was not until a 1987 report of medical examination, during reserve service, but no symptoms were noted at that time. The evidence reflects that the Veteran was sound at entrance with respect to any bilateral pes planus. The evidence also reflects a current diagnosis of bilateral pes planus, and that bilateral pes planus was first diagnosed during service, in 1983. See 38 C.F.R. § 3.303. Notably, the June 2012 VA examiner’s negative etiology opinion was based on an inaccurate factual premise. Indeed, as discussed above and below, the Veteran was, in fact, diagnosed with pes planus during active service. Thus, the opinion is of no probative value. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (an opinion based on an inaccurate factual premise has no probative value). Given the facts noted above, and resolving any reasonable doubt on certain elements of the claim in the Veteran’s favor, the Board concludes that the criteria for service connection for bilateral pes planus are met. REASONS FOR REMAND The Board’s review of the claims file reveals that further agency of original jurisdiction (AOJ) action on the remaining claims on appeal is warranted. Regarding the claim for service connection for bilateral hearing loss, the Veteran was afforded a VA audiological examination in June 2012. Regarding a current disability, the examiner stated that the Veteran’s hearing acuity could not be tested due to inconsistent responses, despite detailed instructions. Nonetheless, the examiner opined that it was less likely than not that any hearing loss was related to service. As rationale, the examiner explained that the Veteran’s hearing was “normal” for five years following separation and there is no evidence to support a finding of delayed-onset hearing loss. The Board finds the examiner’s opinion as to the etiology of bilateral hearing loss inadequate. The examiner’s description of the Veteran’s hearing as “normal” does not indicate consideration of the report of a November 1990 medical examination, conducted during the Veteran’s reserve service, documenting, on audiometric testing, a pure tone threshold of 25 decibels at 500 Hertz. See Hensley v. Brown, 5 Vet. App. 155, 158 (1993) (noting that the threshold for normal hearing is from 0 to 20 decibels and that higher threshold levels indicate some degree of hearing loss). The Board notes that the Veteran submitted an April 2018 private medical opinion, which concluded that hearing loss was “possibly” related to military service. However, as this opinion is speculative, it is not sufficient evidence of nexus. See Bloom v. West, 12 Vet. App. 185, 187 (1999) (use of term “could,” without other rationale or supporting data, is speculative). Given the above, the Board finds that the medical evidence currently of record is insufficient to resolve the claim for service connection for bilateral hearing loss, and that outstanding questions pertaining to whether there exists a medical nexus between any current hearing loss and service. Accordingly, the Board finds that further medical examination and opinion-based on full consideration of the Veteran’s documented medical history and assertions, and supported by complete, clearly-stated rationale-is needed to resolve the claim. See 38 U.S.C. § 5103A; 38 C.F.R. § 3.159; McLendon v. Nicholson, 20 Vet. App. 79 (2006). See also Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (holding that, once VA undertakes the effort to obtain such an opinion when developing a service connection claim, even if not statutorily obligated to do so, it must obtain one that is adequate for purposes of the determination being made). As for the claims for service connection for right and left knee and thigh disabilities, the Veteran has asserted that those disabilities are secondary to his newly service-connected bilateral pes planus. See Board Hearing Tr. at 8. Further, a February 2018 opinion from a physician’s assistant notes that pes planus “has very well possibly caused him to have bilateral upper leg, knee and lower leg pains on a regular basis.” This opinion, however, is speculative and not a sufficient basis upon which to grant service connection. See Bloom, supra. Hn light of the above, the AOJ should obtain an addendum opinion from the June 2012 VA examiner as to whether secondary service connection for any knee or thigh disability is warranted. See McLendon, supra. Regarding the claim for service connection for a right thumb disability, the Veteran was afforded a VA examination in June 2012, following which he was diagnosed with right thumb strain. The examiner opined that it was less likely than not that the right thumb strain was related to service. As rationale, the examiner explained that STRs documented a jammed right thumb during service, but X-rays were negative and there were no residuals noted. The examiner stated that as there were no reports of evaluation or treatment following separation, there was no basis to attribute the Veteran’s right thumb strain to service. The Board finds this opinion inadequate. The examiner’s rationale appears to be largely based on the finding that the Veteran did not receive any evaluation for his right thumb problems following service. However, the Veteran testified that he has experienced thumb numbness and tingling since service. See Board Hearing Tr. at 11. The examiner based his opinion on a lack of contemporaneous medical evidence, without acknowledging the Veteran’s reports of continuity of symptomatology. See Buchanan, supra; Dalton, supra. As such, an addendum addressing those complaints of continuity of symptomatology is necessary. See McLendon, supra. As for the claim for service connection for a bilateral testicle disability, the Veteran was afforded a VA examination in June 2012. There, he was diagnosed with prostatitis with recurrent left testicle pain. The examiner opined that it would be resorting to mere speculation to opine that the Veteran’s testicle disability was incurred in or caused by military service. The examiner, however, did not provide an explanation as to why an opinion could not be provided without resorting to mere speculation. See Jones v. Shinseki, 23 Vet. App. 382 (2010) (if the examiner cannot state an opinion without resorting to speculation, he or she must provide a rationale for why that is so). Regarding the claim for service connection for a cervical spine disability, the Veteran was afforded a VA examination in June 2012. There, he was diagnosed with cervical strain. The examiner opined that it was less likely than not that cervical strain was related to service. As rationale, the examiner noted an episode of neck pain during service in 1983. The examiner then pointed to an absence of records thereafter showing neck pain and noted that most cervical strains are transient and there was no basis for attributing the cervical strain to service. The Board finds this opinion inadequate. The examiner’s rationale is based largely on the finding that the Veteran did not receive any evaluation for his cervical spine problems following service. However, the Veteran testified that he has experienced thumb numbness and tingling since service. See Board Hearing Tr. at 12. The examiner based his opinion on a lack of contemporaneous medical evidence, without acknowledging the Veteran’s reports of continuity of symptomatology. See Buchanan, supra; Dalton, supra. As such, an addendum addressing those complaints of continuity of symptomatology is necessary. See McLendon, supra. Accordingly, the Board finds that additional AOJ action to obtain appropriate medical examinations and/or opinions—based on full consideration of the Veteran’s documented medical history and assertions, and supported by complete, clearly-stated rationale—is necessary. See 38 U.S.C. § 5103A; 38 C.F.R. § 3.159; McLendon v. Nicholson, 20 Vet. App. 79 (2006). As for the claim for service connection for headaches, the Veteran asserts that headaches are secondary to the cervical spine disability. See Board Hearing Tr. at 15. Thus, the claims are inextricably intertwined and the Board will defer adjudication of the headaches claim pending the development of the cervical spine claim. See Parker v. Brown, 7 Vet. App. 116 (1994); Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (two issues are “inextricably intertwined” when they are so closely tied together that a final Board decision cannot be rendered unless both are adjudicated). Hence this claim is being remanded, as well. Prior to undertaking action responsive to the above, to ensure that all due process requirements are met, and that the record is complete, the AOJ should also give the Veteran another opportunity to provide additional information and/or evidence pertinent to the remaining claims on appeal, explaining that he has a full one-year period for response. See 38 U.S.C. § 5103(b)(1); but see also 38 U.S.C § 5103(b)(3) (clarifying that VA may decide a claim before the expiration of the one-year notice period). Thereafter, the AOJ should attempt to obtain any additional evidence for which the Veteran provides sufficient information, and, if needed, authorization, following the current procedures prescribed in 38 C.F.R. § 3.159. The actions identified herein are consistent with the duties imposed by the Veterans Claims Assistance Act of 2000 (VCAA). See 38 U.S.C. §§ 5103, 5103A; 38 C.F.R. § 3.156. However, identification of specific actions requested on remand does not relieve the AOJ of the responsibility to ensure full compliance with the VCAA and its implementing regulations. Hence, in addition to the actions requested above, the AOJ should also undertake any other development and/or notification action deemed warranted by the VCAA prior to adjudicating the remaining claims on appeal. The matters are hereby REMANDED for the following action: 1. Furnish to the Veteran and his representative a letter requesting that the Veteran provide information concerning, and, if necessary, authorization to enable VA to obtain, any additional evidence pertinent to any remaining claim(s) on appeal that is not currently of record. Specifically request that the Veteran furnish, or furnish appropriate authorization to obtain, all outstanding pertinent private (non-VA) medical records. Clearly explain to the Veteran that he has a full one-year period to respond (although VA may decide the matter within the one-year period). 2. If the Veteran responds, obtain all identified records, following the procedures set forth in 38 C.F.R. § 3.159. All records and responses received should be associated with the file. If any records sought are not obtained, notify the Veteran and his representative of the records that were not obtained, explain the efforts taken to obtain them, and describe further action to be taken. 3. After all records and/or responses received from each contacted entity have been associated with the claims file, arrange for the Veteran to undergo a VA audiology examination, by an audiologist or appropriate physician, for evaluation of any bilateral hearing loss. The contents of the entire, electronic claims file, to include a complete copy of this REMAND, must be made available to the designated individual, and the examination report should include discussion of the Veteran’s documented history and lay assertions. All indicated tests and studies should be accomplished (with all findings made available to the examiner prior to the completion of his or her report), and all clinical findings should be reported in detail. The examiner should state whether the Veteran has hearing loss to an extent recognized as a disability for VA purposes (as defined in 38 C.F.R. § 3.385). If the Veteran’s hearing cannot be accurately tested, the examiner should explain why. For any hearing loss disability, the examiner should render an opinion, consistent with sound medical judgment, as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that disability had its onset in service or is otherwise medically-related to service—to particularly include in-service noise exposure from his time on the firing range, without ear protection. In addressing the above, the examiner must consider and discuss all relevant medical evidence, to include the 25-decibel reading in the right ear at 500 Hertz on November 1990 audiometric testing, following active duty service. The examiner must also consider and discuss all lay assertions—to include the Veteran’s competent assertions as to in-service injury (here, noise exposure), and as to the nature, onset, and continuity of symptoms of diminished hearing. If lay assertions in any regard are discounted, the examiner should clearly so state and explain why. All examination findings/testing results, along with complete, clearly-stated rationale for the conclusions reached, must be provided. 4. After all records and/or responses received from each contacted entity have been associated with the claims file, arrange to obtain from the June 2012 VA examiner an addendum addressing the etiology of the Veteran’s bilateral knee, bilateral thigh, right thumb, and cervical spine disabilities. If that individual is no longer employed by VA or is otherwise unavailable, document that fact in the record, and arrange to obtain an addendum opinion from an appropriate physician based on claims file review (to the extent possible). Only arrange for the Veteran to undergo examination if one is deemed necessary in the judgment of the physician designated to provide the addendum opinion. The contents of the entire, electronic claims file, to include a complete copy of this REMAND, must be made available to the designated individual, and the addendum opinion/examination report should include discussion of the Veteran’s documented history and lay assertions. If the Veteran is examined, all indicated tests and studies should be accomplished (with all results made available to the requesting physician prior to the completion of his or her report), and clinical findings should be reported in detail. The examiner should offer opinions as to the following: a. With respect to diagnosed bilateral hamstring strain, the examiner is requested to provide an opinion, consistent with sound medical principles, as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that bilateral hamstring strain was caused OR is or has been aggravated (worsened beyond natural progression) by the Veteran’s service-connected bilateral pes planus. If aggravation is found, the physician should attempt quantify the degree of additional disability resulting from aggravation, to include by identifying, to the extent possible, the baseline level of disability prior to the aggravation. b. With respect to each diagnosed knee disability, to include left knee strain and right knee internal derangement, the examiner should provide an opinion, consistent with sound medical principles, as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that any diagnosed knee disability was caused OR is or has been aggravated (worsened beyond natural progression) by the Veteran’s service-connected bilateral pes planus. If aggravation is found, the physician should attempt quantify the degree of additional disability resulting from aggravation, to include by identifying, to the extent possible, the baseline level of disability prior to the aggravation. c. With respect to diagnosed right thumb strain, the examiner is requested to provide an opinion, consistent with sound medical principles, as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that the disability had its onset during active service or is otherwise related to service. In offering this opinion, the examiner must comment on the in-service episode when the Veteran’s right thumb was jammed and the Veteran’s report of right thumb numbness and tingling since active service. d. With respect to cervical strain, the examiner is requested to provide an opinion, consistent with sound medical principles, as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that the disability had its onset during active service or is otherwise related to service. In offering this opinion, the examiner must comment on the in-service complaint of neck pain and the Veteran’s report of neck pain since active service. e. If it is determined that cervical strain is related to service, the examiner is requested to provide an opinion, consistent with sound medical principles, as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that headaches was caused OR is or has been aggravated (worsened beyond natural progression) by the Veteran’s cervical strain If aggravation is found, the physician should attempt quantify the degree of additional disability resulting from aggravation, to include by identifying, to the extent possible, the baseline level of disability prior to the aggravation. The physician is advised that the Veteran is competent to report matters within his personal knowledge, to include symptoms and events), and that lay assertions in this regard must be considered in formulating the requested opinion. If lay assertions in any regard are discounted, the physician should clearly so state, and explain why. Complete, clearly-stated rationale for the conclusions reached must be provided. 5. After all records and/or responses received from each contacted entity have been associated with the claims file, arrange to obtain from a physician other than the June 2012 examiner an addendum addressing the etiology of the Veteran’s bilateral testicle disability. Only arrange for the Veteran to undergo examination if one is deemed necessary in the judgment of the physician designated to provide the addendum opinion. The contents of the entire, electronic claims file, to include a complete copy of this REMAND, must be made available to the designated individual, and the addendum opinion/examination report should include discussion of the Veteran’s documented history and lay assertions. If the Veteran is examined, all indicated tests and studies should be accomplished (with all results made available to the requesting physician prior to the completion of his or her report), and clinical findings should be reported in detail. With respect to diagnosed prostatitis with recurrent left testicle pain, the examiner is requested to provide an opinion, consistent with sound medical principles, as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that the disability had its onset during active service or is otherwise related to service. The physician is advised that the Veteran is competent to report matters within his personal knowledge, to include symptoms and events), and that lay assertions in this regard must be considered in formulating the requested opinion. If lay assertions in any regard are discounted, the physician should clearly so state, and explain why. Complete, clearly-stated rationale for the conclusions reached must be provided. 6. To help avoid future remand, ensure that all requested actions have been accomplished (to the extent possible) in compliance with this REMAND. If any action is not undertaken, or is taken in a deficient manner, appropriate corrective action should be undertaken. See Stegall v. West, 11 Vet. App. 268, 271 (1998). 7. After completing the requested actions, and any additional notification and/or development deemed warranted, adjudicate the remaining claims on appeal considering all pertinent evidence (to include all evidence added to the electronic claims file since the last adjudication) and legal authority. JACQUELINE E. MONROE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Michael Sanford, Counsel