Citation Nr: 18158727 Decision Date: 12/18/18 Archive Date: 12/17/18 DOCKET NO. 17-57 966 DATE: December 18, 2018 ORDER Service connection for a right shoulder disability is denied. Service connection for a right knee disability, to include as secondary to a left knee disability, is granted. Service connection for a breathing disability is denied. Service connection for sleep apnea is denied. A rating in excess of 10 percent for gastroesophageal reflux disease (GERD) is denied. A rating of 50 percent, but no higher, for a bilateral foot disability is granted. A compensable rating for headaches is denied. A rating in excess of 50 percent for posttraumatic stress disorder (PTSD) is denied. A rating in excess of 30 percent for sinusitis is denied. A rating in excess of 10 percent for allergic rhinitis is denied. A compensable rating for left knee scars is denied. A compensable rating for a right shoulder scar is denied. REMANDED A rating in excess of 10 percent for a left knee disability is remanded. A total disability rating based on individual unemployability (TDIU) is remanded. FINDINGS OF FACT 1. The Veteran’s right shoulder disability was not incurred in or due to his time in service. 2. The Veteran’s right knee disability is proximately due to his service connected left knee disability. 3. The Veteran’s breathing disability was not incurred in or due to his time in service. 4. The Veteran’s sleep apnea was not incurred in or due to his time in service. 5. The Veteran’s GERD is not manifested by persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health. 6. The Veteran’s bilateral flat foot is manifested by marked pronation. 7. The Veteran’s headaches are not manifested by characteristic prostrating attacks averaging one in two months over the last several months. 8. The Veteran’s PTSD is not manifested by occupational and social impairment with deficiencies in most areas. 9. The Veteran’s sinusitis is not manifested by surgery with chronic osteomyelitis or near constant sinusitis characterized by headaches, pain and tenderness of affected sinus, and purulent discharge or crusting after repeated surgeries. 10. The Veteran’s rhinitis is not manifested by rhinitis without polyps, but greater than 50 percent obstruction of nasal passage on both sides or complete obstruction on one side. 11. The Veteran’s left knee scar is not painful or unstable. 12. The Veteran’s right shoulder scar is not painful or unstable. CONCLUSIONS OF LAW 1. The criteria for service connection for a right shoulder disability are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. § 3.303, 3.310, 3.317. 2. The criteria for service connection for a right knee disability are met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. § 3.303, 3.310. 3. The criteria for service connection for a breathing disability are not met. 38 U.S.C. §§ 1110, 1131, 1117, 5107(b); 38 C.F.R. §§ 3.303, 3.317. 4. The criteria for service connection for sleep apnea disability are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. § 3.303, 3.310, 3.317. 5. The criteria for a rating in excess of 10 percent for GERD are not met. 38 U.S.C. §§ 5107; 38 C.F.R. §§ 3.102, 3.321, 4.1, 4.3, 4.7, 4.85, 4.130, Diagnostic Code (DC) 7346. 6. The criteria for a rating of 50 percent, but no higher, for bilateral flatfoot are met. 38 U.S.C. §§ 5107; 38 C.F.R. §§ 3.102, 3.321, 4.1, 4.3, 4.7, 4.85, 4.130, DC 5276. 7. The criteria for a compensable rating for headaches are not met. 38 U.S.C. §§ 5107; 38 C.F.R. §§ 3.102, 3.321, 4.1, 4.3, 4.7, 4.85, 4.130, DC 8100. 8. The criteria for a rating in excess of 50 percent for PTSD are not met. 38 U.S.C. §§ 5107; 38 C.F.R. §§ 3.102, 3.321, 4.1, 4.3, 4.7, 4.85, 4.130, DC 9411. 9. The criteria for a rating in excess of 30 percent for sinusitis are not met. 38 U.S.C. §§ 5107; 38 C.F.R. §§ 3.102, 3.321, 4.1, 4.3, 4.7, 4.85, 4.130, DC 6510. 10. The criteria for a compensable rating for allergic rhinitis are not met. 38 U.S.C. §§ 5107; 38 C.F.R. §§ 3.102, 3.321, 4.1, 4.3, 4.7, 4.85, 4.130, DC 6522. 11. The criteria for a compensable rating for a left knee scar are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321, 3.385, 4.1, 4.3, 4.7, 4.85, 4.86, DC 7805. 12. The criteria for a compensable rating for a right shoulder scar are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321, 3.385, 4.1, 4.3, 4.7, 4.85, 4.86, DC 7805. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from October 1977 to February 1978 and from January 1979 to September 1998. Service Connection Generally, to prevail on a claim of service connection on the merits, there must be competent evidence of (1) 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 or other competent evidence of a nexus between the claimed in-service disease or injury and the present disease or injury. See Hickson v. West, 12 Vet. App. 247 (1999); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). To establish service connection on a secondary basis, the evidence must show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. 38 C.F.R. § 3.310(a)(b) (2016), Allen v. Brown, 7 Vet. App. 439 (1995) (en banc). Service connection may be warranted for a Persian Gulf War veteran who exhibits objective indications of a qualifying chronic disability that became manifest during active military, naval or air service in the Southwest Asia theater of operations during the Persian Gulf War, or to a degree of 10 percent or more not later than not later than December 31, 2021. 38 C.F.R. § 3.317(a)(1)(i). For purposes of 38 C.F.R. § 3.317, there are three types of qualifying chronic disabilities: (1) an undiagnosed illness; (2) a medically unexplained chronic multi symptom illness; and (3) a diagnosed illness that the Secretary determines in regulations prescribed under 38 U.S.C. § 1117(d) warrants a presumption of service connection. An undiagnosed illness is defined as a condition that by history, physical examination, and laboratory tests cannot be attributed to a known clinical diagnosis. 38 C.F.R. § 3.317(a)(1)(ii). Right Shoulder The Veteran has been diagnosed with a right shoulder disability. The Veteran’s service treatment records (STRs), including his separation examination, are negative for mention of symptoms or treatment of a right shoulder disability. The Veteran reported he had surgery on his right shoulder while in service. However, this surgery was for a lipoma excision, not a shoulder disability. The Veteran was afforded an examination for his right shoulder disability in July 2015. The Veteran reported limited motion in the joint, pain with lifting or raising the right shoulder, and no longer being able to do push-ups. The examiner opined the Veteran’s right shoulder disability was less likely than not incurred in or caused by the Veteran’s time in service, including as due to his time in the Gulf War. The examiner explained the Veteran’s right shoulder strain is a disease with a clear and specific etiology and diagnosis. The examiner also explained the Veteran’s shoulder condition was not corroborated as having occurred during the Veteran’s military service. The examiner did note the Veteran had treatment on his left shoulder while in service. In September 2016, another examiner evaluated the Veteran’s right shoulder condition. The Veteran reported he sustained a right shoulder injury in a fall during basic training. The examiner said the onset of this condition while in service which persists to the present should qualify the Veteran for service connection. However, there is no objective evidence of a chronic right shoulder disability that had its onset during the Veteran’s time in service. Because of this and because the Veteran’s right shoulder disability does not qualify for service connection under the Gulf War presumption, the claim will be denied. Right Knee The Veteran contends his right knee condition is proximately due to his service connected left knee disability. The Veteran has stated his knees caused him problems due to his many years marching with heavy rucksacks in service. (See January 2015 statement.) A November 2016 examiner diagnosed the Veteran with a right knee disability. The Veteran’s STRs are negative for treatment or complaint of right knee problems while in service. Therefore, service connection on a direct basis will be denied. In September 2016, an examiner opined the Veteran’s right knee disability was more likely than not directly and causally related to the constant and chronic compensation and adaptation to the weight shifting and altered gait caused by the Veteran’s service connected left knee. Therefore, service connection for a right knee condition as proximately due to the Veteran’s service connected left knee disability will be granted. Breathing Disability The Veteran contends he has a breathing disability that was incurred in and due to his time in service. In September 2016, an examiner diagnosed the Veteran with a breathing disability and opined it was more likely than not due to his exposure to toxins and contaminated air while he was deployed in Kuwait. The Veteran’s military personnel records indicate he was deployed to Kuwait. However, the Veteran’s STRs are negative for symptoms or treatment for a breathing disorder. In a June 1997 examination, the Veteran indicated he was in good health and denied asthma, shortness of breath, or chronic cough trouble. The examiner indicated the Veteran’s lungs and chest were normal. In a May 1998 separation examination, an examiner again found the Veteran’s lungs and chest to be normal. The Veteran denied shortness of breath, chronic cough, or pain in his chest but did report several other medical conditions. The Board notes the Veteran had service in the Southwest Asia theater. The Veteran has not been afforded a Gulf War examination for his breathing disability. The Board notes the Veteran has been diagnosed with chronic obstructive pulmonary disease (COPD) and bronchial asthma. The Board notes that neither of these disabilities qualifies as an undiagnosed illness, a medically unexplained chronic multi-symptom illness, or a diagnosed illness under § 1117(d) that warrants a presumption of service connection. Therefore, the Board finds a remand for a Gulf War examination is not warranted. Because the Veteran’s STRs do not show an incurrence of a breathing disability in service, the claim will be denied. The Board understands the September 2016 examiner opined the Veteran’s breathing condition was due to his time in service, but without objective evidence of an onset of the Veteran’s breathing condition in service, the claim cannot be granted. The best evidence simply does not indicate a problem related to service. Sleep Apnea The Veteran contends he has sleep apnea that was incurred in and due to his time in service or is proximately due to his breathing disability. The Veteran states he has been diagnosed with sleep apnea. The Board did not find any documented diagnosis of sleep apnea in the Veteran’s file. However, even if the Veteran has been diagnosed with sleep apnea, there are several other reasons for denying service connection as discussed below. The Veteran’s STRs, including his separation examination and multiple other examinations, are negative for symptoms or treatment of a sleep disability. Without an in-service incurrence of the Veteran’s sleep disability, service connection cannot be granted. Turning to the Veteran’s claim of secondary service connection for his sleep apnea, in September 2016, an examiner opined the Veteran’s sleep apnea was more likely than not due to the Veteran’s breathing disorder. However, the Board notes the Veteran is not service connected for a breathing disorder and therefore, it cannot be the basis for a finding of secondary service connection for sleep apnea. The Veteran’s record is negative for any evidence showing his sleep apnea is proximately due to any of his service connected disabilities. Therefore, the claim must also be denied on a secondary basis. Regarding the service connection claims above, in multiple examinations while in service, including his separation examination, the Veteran reported and examiners found no problems with his lungs or that the Veteran had breathing problems while also noting other medical conditions. The Veteran also did not report any trouble with his right shoulder or his sleep. In these examinations, the Veteran reported multiple other health conditions, such as a right ankle condition, a left knee condition, and indigestion. It would not appear to be reasonable for the Veteran to cite multiple other problems, but then hide other issues. 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; 38 C.F.R. §§ 4.1, 4.2, 4.10. 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. Where entitlement to compensation already has 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 a claim for a greater original rating after an initial award of service connection, all the evidence submitted in support of the Veteran’s claim is to be considered. Fenderson v. West, 12 Vet. App. 119, 126 (1999). GERD The Veteran contends his GERD is worse than indicated by his 10 percent rating. The Veteran filed his present claim for an increased rating for his GERD in October 2016. The Veteran’s rating for GERD was increased to 10 percent in an August 2015 rating decision. The Veteran did not appeal. A December 2016 rating decision denied an increased rating in excess of 10 percent. The Veteran appealed. The Veteran’s GERD is evaluated under DC 7527. Under DC 7346, a 10 percent rating is warranted for two or more of the symptoms for the 30 percent evaluation of less severity. A 30 percent rating is warranted for persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health. A 60 percent rating is warranted with symptoms of pain, vomiting, material weight loss and hematemesis or melena with moderate anemia; or other symptom combinations productive of severe impairment of health. The Veteran was seen for his GERD in September 2016. The examiner noted the Veteran’s GERD was symptomatically active. The Veteran was afforded an examination for his GERD in November 2016. The Veteran said he had difficulty digesting food and had feelings of food being trapped in his throat. The examiner opined the Veteran’s GERD was manifested by dysphagia and reflux, but not regurgitation. The examiner opined the Veteran’s GERD did not lead to substernal, arm, or shoulder pain. The Veteran did not suffer from material weight loss, nausea, vomiting, hematemesis. The Veteran’s medical records indicate he continues to have symptoms from his GERD and continues to seek treatment. However, none of his medical records indicate he suffers from regurgitation or substernal, arm, or shoulder pain due to his GERD. The Board notes the Veteran does suffer from two or more of the symptoms that would warrant a 30 percent rating and his GERD clearly causes him problems. However, this is not sufficient to warrant a higher, 30 percent rating, and therefore, the claim will be denied. Bilateral Flatfoot The Veteran contends his bilateral flatfoot is worse than indicated by his 30 percent rating. The Veteran filed his claim for a bilateral foot condition in October 2014. The Veteran’s bilateral flatfoot is rated under DC 5276. Severe flatfoot, with objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, characteristic callosities, is rated 20 percent disabling for unilateral disability, and is rated 30 percent disabling for bilateral disability. Pronounced flatfoot, with marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement, and severe spasm of the Achilles tendon on manipulation, that is not improved by orthopedic shoes or appliances, is rated 30 percent disabling for unilateral disability, and is rated 50 percent disabling for bilateral disability. The Veteran was evaluated for his bilateral foot disability in September 2016. The examiner noted the Veteran experienced acute pain on weight bearing in the morning which lasted up to 30 minutes and impaired the Veteran’s ability to walk. The Veteran was afforded an examination for his bilateral foot disability in November 2016. The Veteran noted he often had severe pain that required him to remove his shoes. The Veteran had pain on manipulation of both feet, no swelling, no calluses, and no extreme tenderness. The examiner noted the Veteran had a bilateral marked deformity on both feet and marked pronation of both feet. However, the examiner found no inward bowing of the achilles and no marked inward displacement and severe spasm of the Achilles’ tendon on manipulation of both feet. Because the Veteran has been found to have marked pronation on both feet, a higher 50 percent rating will be granted to the date of claim. The Board notes this is the highest evaluation possible under this diagnostic code. Headaches The Veteran contends his headaches are worse than indicated by his assigned noncompensable rating. The Veteran’s headaches are rated under DC 8100. Under DC 8100, a noncompensable rating is warranted for headaches with less frequent attacks. A 10 percent disability rating is warranted for headaches with characteristic prostrating attacks averaging one in two months over the last several months. A 30 percent disability rating is warranted for headaches with characteristic prostrating attacks occurring on average once a month over the last several months. A 50 percent disability rating is warranted for headaches with frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. The Veteran was afforded an examination for his headaches in July 2015. The Veteran reported his headaches usually occurred at least once every two weeks, with sharp, throbbing pain, and that medications didn’t always help relieve his symptoms. The examiner opined the Veteran did not have characteristic prostrating attacks of migraines or non-migraine headache pain. The Veteran was seen by an examiner in September 2016 for his headaches. The examiner noted the Veteran suffered from four or more headaches per week which became constant unless medicated. These headaches usually lasted two hours with medication but medication did not always work to relieve the Veteran’s symptoms. The Veteran was afforded another examination for his headaches in November 2016. The Veteran reported constant headache pain caused by his sinuses. The headaches usually lasted less than one day on both sides of his head. The examiner opined the Veteran did not have characteristic prostrating attacks of migraine headache pain and did not have very frequent prostrating and prolonged attacks of migraine headache pain. The Veteran’s medical records indicate he continues to seek treatment for his headaches. However, none of the objective evidence of record shows the Veteran suffers from characteristic prostrating attacks of migraine headache pain averaging one in two months. Therefore, while the Board understands the Veteran’s headaches continue to cause him pain and discomfort, a higher 10 percent rating is denied. PTSD The Veteran contends his PTSD is worse than indicated by his 50 percent rating. The Veteran’s mental health disability is currently rated under DC 9411. Under DC 9411, a 50 percent evaluation for PTSD requires occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and, difficulty in establishing and maintaining effective work and social relationships. A 70 percent rating is prescribed when there is evidence of occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately, and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work like setting); and inability to establish and maintain effective relationships. A 100 percent rating is prescribed when there is evidence of total occupational and social impairment due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations, grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation as to time or place; and memory loss for names of close relatives, own occupation, or own name. The list of symptoms under the rating criteria are meant to be examples of symptoms that would warrant the rating, but are not meant to be exhaustive, and the Board need not find all or even some of the symptoms to award a specific rating. Mauerhan v. Principi, 16 Vet. App. 436, 442-3 (2002). However, a veteran may only qualify for a given disability rating under § 4.130 by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration, and that such symptoms have resulted in the type of occupational and social impairment associated with that percentage. The Veteran was afforded an examination for his PTSD in July 2015. The examiner opined the Veteran’s mental disability led to occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress. The examiner reported the Veteran’s symptoms included anxiety, chronic sleep impairment, and flattened affect. The Veteran reported he was married with children and worked in the same job he had held for about 17 years. The Veteran was seen by an examiner in September 2016 for his mental health. The Veteran reported he suffered from insomnia, sleep deprivation, anxiety, isolation, memory loss, hypervigilance, depression, and agoraphobia. However, the examiner noted the Veteran had no violent ideations. The Veteran was afforded another examination for his PTSD in October 2016. The examiner opined the Veteran’s mental health led to occupational and social impairment with reduced reliability and productivity. The Veteran’s symptoms included depressed mood, anxiety, suspiciousness, chronic sleep impairment, mild memory loss, flattened affect, speech problems, impaired abstract thinking, disturbances in motivation and mood, difficulty establishing and maintaining effective work and social relationships, and difficulty adapting to stressful circumstances. The Veteran reported a good marriage and that he had friends, though he sometimes isolated himself and felt alone and depressed. The examiner noted the Veteran had a very close loving relationship with his family. The Veteran reported he had worked full time since separating from service and worked well with his coworkers. The Veteran denied unusual disciplinary problems at work, though he had been written up a few times due to his anger. The Veteran’s medical records show he continues to be treated for his mental health problems. However, while the Veteran has reported nightmares, depressed mood, social avoidance, worry, anxiety, hypervigilance, flashbacks, the Veteran’s judgment and insight have been good, with normal mood an affect. Additionally, the Veteran has been found to be orientated to person, place, and time and has consistently denied suicidal or homicidal ideations. (See November 2015, January 2016, March 2018 medical records.) The Veteran’s record does not show his PTSD symptoms lead to occupational and social impairment with deficiencies in most areas. The Veteran has stated in examinations he has good relationships with his family and friends. Additionally, the Veteran was able to work at one job for many years with few incidents. The Veteran’s record does not indicate he suffers from suicidal ideations, obsessional rituals, speech problems, special disorientation, or near-continuous panic or depression affecting his ability to function independently, appropriately, and effectively. The Board finds the Veteran’s symptoms more closely approximate those of a 50 percent rating. Additionally, the Veteran’s most recent mental health examiner opined his symptoms led to occupational and social impairment with reduced reliability and productivity. Therefore, the Board finds a higher 70 percent rating is not warranted. Sinusitis The Veteran contends his sinusitis is worse than indicated by his 30 percent rating. The Veteran’s sinusitis is rated under DC 5210. Under DC 5210, a 30 percent evaluation is assigned where there are three or more incapacitating episodes per year of sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment, or more than six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting. A 50 percent evaluation is assigned following radical surgery with chronic osteomyelitis, or when there is near constant sinusitis characterized by headaches, pain and tenderness of affected sinus, and purulent discharge or crusting after repeated surgeries. The Schedule defines an incapacitating episode as one that requires physician-prescribed bed rest and treatment by a physician. The Veteran was afforded an examination for his sinusitis in July 2015. The examiner opined the Veteran had not had non-incapacitating or incapacitating episodes over the past 12 months. The examiner also reported the Veteran had not had sinus surgery. The Veteran was seen again for his sinusitis in September 2016. The examiner noted the Veteran’s daily symptoms were managed by medication. The Veteran was afforded another examination for his sinusitis in November 2016. The examiner noted the Veteran’s sinusitis manifested by headaches. The examiner opined the Veteran did not suffer from non-incapacitating or incapacitating episodes of sinusitis. The evidence of record, including the Veteran’s medical records, does not indicate the Veteran suffers from radical surgery with chronic osteomyelitis, or near constant sinusitis characterized by headaches, pain and tenderness of affected sinus, and purulent discharge or crusting after repeated surgeries. Therefore, a higher rating will be denied. Rhinitis The Veteran contends his rhinitis is worse than indicated by his noncompensable percent rating. The Veteran’s rhinitis is rated under DC 6522. DC 6522 provides a 10 percent rating for rhinitis without polyps, but with greater than 50 percent obstruction of nasal passage on both sides or complete obstruction on one side. A 30 percent rating is warranted for rhinitis with polyps. The Veteran was afforded an examination for his rhinitis in July 2015. The examiner opined the Veteran did not have more than 50% obstruction of the nasal passage on both sides and neither side was completely obstructed. The examiner also reported the Veteran did not have nasal polyps. In September 2016, the Veteran was seen for his rhinitis. The examiner noted the Veteran had approximately 70 percent ventilation in his left nostril and less than 10 percent in his right nostril. The Veteran was afforded another examination for his rhinitis in November 2016. The examiner noted the Veteran did not have greater than 50 percent obstruction of the nasal passage on both sides due to rhinitis, nor did he have complete obstruction of either the right or left side due to rhinitis. The examiner opined the Veteran did not have nasal polyps. The Veteran’s record, including his examinations, does not indicate the Veteran suffers from greater than 50 percent obstruction of nasal passage on both sides or complete obstruction on one side. Therefore, a compensable rating is not warranted. Left Knee Scar and Right Shoulder Scar The Veteran contends his scar disabilities are worse than indicated by his noncompensable rating. The Veteran is currently rated under DC 7805 for his scars. Under DC 7805, scars and other effects of scars are to be evaluated under DCs 7800, 7801, 7802, or 7804. DCs 7800, 7801, and 7802 all deal with scars related to burns. Therefore, the Board will evaluate the Veteran’s scars under DC 7804. DC 7804 provides a 10 percent rating for one or two scars that are unstable or painful, a 20 percent rating for three or four scars that are unstable or painful, and a 30 percent rating for five or more scars that are unstable or painful. The Veteran was afforded an examination for his scars in July 2015. The examiner noted the Veteran’s stable right shoulder scar. The examiner observed the scar was not from a burn and was linear and was not painful, unstable, or both painful and unstable. The examiner noted the size of the scar was 4.0 x .9 cm. The Veteran’s left knee examiner noted the Veteran also had a scar on his left knee. The examiner noted it was not painful or unstable and was 1.0 x .1 cm. The Veteran was afforded another examination for his scars in November 2016. The examiner opined none of the Veteran’s scars were painful or unstable and none were both unstable and painful. The examiner noted none of the scars were due to burns. None of the objective evidence of record indicates the Veteran’s scars warrant a higher 10 percent rating. The medical evidence does not show the Veteran has one or two scars that are unstable and painful. Therefore, a higher rating will be denied. Regarding all the increased rating claims above, neither the Veteran nor his representative has identified any other rating criteria that would provide a higher rating or an additional rating. However, the potential applications of various provisions of Title 38 of the Code of Federal Regulations (2016) have been considered as required by the holding of the Court in Schafrath v. Derwinski, 1 Vet. App. 589, 593 (1991). Regarding the claims above, the Board acknowledges and has considered the Veteran’s statements that his conditions bother him, cause him pain, discomfort, anxiety, depression, and his belief that his right shoulder, breathing, and sleep disabilities were caused by his time in service. The Board also recognizes the Veteran continues to seek medical treatment for his conditions. However, while the Veteran is competent to report the symptoms of his disability, he is not competent to opine on matters requiring medical knowledge, such as determining the severity, nature, and etiology of his medical conditions. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Therefore, the Board provides more weight to the competent medical evidence of record and must deny the claim. It is important for the Veteran to understand that the medical findings provide highly probative evidence against the claims that were denied above that the Board cannot, unfortunately, ignore. Lastly, regarding all the above, the Board has considered the applicability of the benefit of the doubt doctrine. Because the preponderance of the evidence is against the Veteran’s claim, the benefit of the doubt doctrine does not apply. See 38 U.S.C. §5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57(1990). REASONS FOR REMAND The Board finds a remand is necessary for the Veteran’s claim of an increased rating of a left knee disability and his claim for a TDIU. The Veteran’s left knee is currently rated as 10 percent disabling. In Correia v. McDonald, 28 Vet. App. 158 (2016), the United States Court of Appeals for Veterans Claims (Court) held that to be adequate, a VA examination of the joints must, wherever possible, include the results of the range of motion testing described in the final sentence of 38 C.F.R. § 4.59 (2017). The final sentence of section 38 C.F.R. § 4.59 (2017) directs that the joints involved should be tested for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint. Additionally, a recent Court decision addressed what constitutes an adequate explanation for an examiner’s inability to estimate motion loss in terms of degrees during periods of flare-ups. Sharp v. Shulkin, No. 16-1385 (Vet. App. Sept. 6, 2017). In Sharp, the Court held that a VA examiner must attempt to elicit information from the record and the Veteran regarding the severity, frequency, duration, or functional loss manifestations during flare-ups before determining that an estimate of motion loss in terms of degrees could not be given. It also held that any inability to furnish such an estimate must be predicated on a lack of medical knowledge among the medical community at large, rather than insufficient knowledge by the individual examiner. The Veteran had an examination for his left knee disability in November 2016. The Veteran reported flare ups of his left leg disability, but range of motion degrees were not given. The Veteran’s knee was not tested on both active and passive motion and no ranges of motion were offered for his testing on weight-bearing and non-weight-bearing. Because the examiner for the Veteran’s left knee disability did not offer opinions consistent with Correia or Sharp, the examination is inadequate and a new examination is required. The Veteran also contends he is unemployable as a result of his service-connected disabilities. The law provides that a total disability rating may be assigned where the schedular rating is less than total when the disabled person is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities, provided that, if there is only one such disability, this disability shall be ratable at 60 percent or more, or if there are two or more disabilities, there shall be at least one disability ratable at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent or more. See 38 C.F.R. § 4.16(a) (2017). The Veteran had a combined rating of 80 percent as of October 4, 2016 with his PTSD rated as 50 percent disabling. Therefore, the Veteran met the criteria for a schedular TDIU as of October 4, 2016. The Veteran is also service connected for a bilateral foot disability, sinusitis, rhinitis, GERD, a skin disability, a left knee disability, left knee and right shoulder scars, and headaches. The Veteran previously worked in security. The Veteran has had multiple examinations for his service connected disabilities. Multiple examiners have opined the Veteran’s service connected disabilities do not render him unable to work. (See July 2015 examinations, November 2016 examinations.) Some examiners have indicated the Veteran’s service connected disabilities would interfere with his ability to work. One July 2015 examiner opined the Veteran’s left knee disability and impacted his ability to work in that it caused the Veteran pain and the Veteran’s headaches also impacted his ability to work. A July 2015 mental health examiner opined the Veteran’s PTSD led to mild occupational impairment and an October 2016 examiner opined the Veteran’s PTSD led to reduced reliability and productivity in the workplace. However, because the Veteran’s left knee disability is being remanded in order to determine the current severity of his disability, the examiner’s opinion may impact whether the Veteran’s service connected knee disability renders him unemployable and is inextricably intertwined with his claim for a left knee disability rating increase. Therefore, the matter will be remanded. Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). The matters are REMANDED for the following action: 1. The AOJ should obtain any of the Veteran’s outstanding VA and private medical records and associate them with the claims file. If possible, the Veteran herself should submit any pertinent new evidence regarding the condition at issue in order to expedite the claim. 2. After completing the above development and all outstanding records have been associated with the claims file, the Veteran should be afforded an appropriate VA examination for his left knee disability. The record, to include a copy of this Remand, must be made available to and be reviewed by the examiner. The Veteran’s left knee should be tested for pain on both active and passive motion, in weight-bearing and nonweight-bearing, and, if possible, with the range of the opposite undamaged joint. If for any reason the examiner is unable to conduct the required testing or concludes that the required testing is not necessary in this case, s/he should clearly explain why that is so. The examiner must estimate any functional loss in terms of additional degrees of limited motion experienced during flare-ups and repetitive use over time. If the examiner cannot provide the above-requested opinion without resorting to speculation, s/he should state whether all procurable medical evidence has been considered, to specifically include the Veteran’s description as to the severity, frequency, duration of the flare-ups and his description as to the extent of functional loss during a flare-up and after repetitive use over time; whether the inability is due to the limits of medical community or the limits of the examiner’s medical knowledge; and whether there is additional evidence, which if obtained, would permit the opinion to be provided. The examiner should provide a complete rationale for any opinion provided. 3. After undertaking any other appropriate development deemed necessary, readjudicate the issues on appeal, to include the Veteran’s claim for a TDIU, based on the additional evidence of record. If the determinations remain adverse to the Veteran, he must be provided with a supplemental statement of the case. An appropriate period of time must then be allowed for a response before the record is returned to the Board for further review. John J. Crowley Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Snoparsky, Associate Counsel