Citation Nr: 18159021
Decision Date: 12/18/18	Archive Date: 12/18/18

DOCKET NO. 15-44 022
DATE:	December 18, 2018
ORDER
As new and material evidence has been received, the claim for entitlement to service connection for a low back condition is reopened.
As new and material evidence has been received, the claim for entitlement to service connection for a neck condition is reopened.
As new and material evidence has not been received, the claim for entitlement to service connection for a left eye condition is not reopened.
As new and material evidence has been received, the claim for entitlement to service connection for a right arm condition is reopened.
As new and material evidence has not been received, the claim for entitlement to service connection for an acquired psychiatric disorder to include depression, anxiety, and bipolar disorder is not reopened.
As new and material evidence has not been received, the claim for entitlement to service connection for a dental condition is not reopened.
Entitlement to service connection for a positive tuberculosis skin test is denied.
Entitlement to service connection for hemorrhoids is denied.
Entitlement to an increased disability rating in excess of 20 percent for left epididymitis with atrophy of left testicle is denied.
Entitlement to a compensable disability rating for a broken jaw is denied.
REMANDED
Entitlement to service connection for a low back condition is remanded.
Entitlement to service connection for a neck condition is remanded.
Entitlement to service connection for a right arm condition is remanded.
Entitlement to service connection for cervical radiculopathy of the left upper extremity is remanded.
Entitlement to service connection for cervical radiculopathy of the right upper extremity is remanded.
Entitlement to service connection for left foot pes planus is remanded
Entitlement to service connection for right foot pes planus is remanded.
Entitlement to service connection for a left foot injury is remanded.
Entitlement to service connection for a right foot injury is remanded.
Entitlement to service connection for gastroesophageal reflux disease (GERD) is remanded.
FINDINGS OF FACT
1. A March 2007 rating decision denied the Veteran’s original claims for entitlement to service connection for a low back condition, neck condition, left eye condition, right arm condition, and a dental condition.  The Veteran was notified of the decision and his appellate rights, but did not timely appeal the decision or submit new and material evidence within the one year time period.
2. A December 2008 rating decision denied the Veteran’s original claim for entitlement to service connection for depression and anxiety.  The Veteran was notified of the decision and his appellate rights, but did not timely appeal the decision or submit new and material evidence within the one year time period.
3. In a May 2010 rating decision, the Veteran’s application to reopen the claims for entitlement to service connection for a low back condition and a left eye condition, was denied.  The Veteran was notified of the decision and his appellate rights, but did not timely appeal the decision or submit new and material evidence within the one year time period.
4. In a March 2011 rating decision, the Veteran’s application to reopen the claims for entitlement to service connection for depression and a dental condition was denied.  The Veteran was notified of the decision and his appellate rights, but did not timely appeal the decision or submit new and material evidence within the one year time period.
5. Evidence received since the May 2010 rating decision is not cumulative of evidence previously considered and does raise a reasonable possibility of substantiating the claim of service connection for a low back condition.
6. Evidence received since the March 2007 rating decision is not cumulative of evidence previously considered and does raise a reasonable possibility of substantiating the claim of service connection for a neck condition.
7. Evidence received since the May 2010 rating decision is not material and does not raise a reasonable possibility of substantiating the claim of service connection for a left eye condition.
8. Evidence received since the March 2007 rating decision is not cumulative of evidence previously considered and does raise a reasonable possibility of substantiating the claim of service connection for a right arm condition.
9. Evidence received since the March 2011 rating decision is not material and does not raise a reasonable possibility of substantiating the claim of service connection for an acquired psychiatric disorder to include depression, anxiety, and bipolar disorder.
10. Evidence received since the March 2011 rating decision is not material and does not raise a reasonable possibility of substantiating the claim of service connection for a dental condition.
11.  The Veteran’s positive purified protein derivative of tuberculin (PPD) skin test is not a disability and the weight of the evidence is against a finding that the Veteran has had active tuberculosis at any time during the course of his appeal.
12. The Veteran did not have hemorrhoids in service; the current disability is not linked to service.
13. Throughout the period of appeal, the Veteran’s service-connected left epididymitis with atrophy of left testicle has not been manifested by urinary tract infections, tubercular infections, complete testicular atrophy of both testicles, or voiding dysfunction. 
14. Throughout the period of appeal, the Veteran’s service-connected broken jaw was not manifested by any compensable symptoms.

CONCLUSIONS OF LAW
1. The March 2007 rating decision denying entitlement to service connection for a low back condition, neck condition, left eye condition, right arm condition, and a dental condition is final.  38 U.S.C. § 7105 (2012); 38 C.F.R. § 20.1103 (2018). 
2. The May 2010 rating decision denying entitlement to service connection for a low back condition, a neck condition and a left eye condition is final.  38 U.S.C. § 7105 (2012); 38 C.F.R. § 20.1103 (2018). 
3. The March 2011 rating decision denying entitlement to service connection for depression and a dental condition is final.  38 U.S.C. § 7105 (2012); 38 C.F.R. § 20.1103 (2018). 
4. Since the May 2010 rating decision, new and material evidence has been received to reopen the claim of entitlement to service connection for a low back condition.  38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156 (2018).
5. Since the March 2007 rating decision, new and material evidence has been received to reopen the claim of entitlement to service connection for a neck condition.  38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156 (2018).
6. Since the May 2010 rating decision, new and material evidence has not been received to reopen the claim of entitlement to service connection for a left eye condition.  38 U.S.C. §§ 5108, 7105 (2012); 38 C.F.R. §§ 3.104(a), 3.156, 3.160(d), 20.302 (2018).
7. Since the March 2007 rating decision, new and material evidence has been received to reopen the claim of entitlement to service connection for a right arm condition.  38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156 (2018).
8. Since the March 2011 rating decision, new and material evidence has not been received to reopen the claim of entitlement to service connection for an acquired psychiatric disorder, to include depression, anxiety, and bipolar disorder.  38 U.S.C. §§ 5108, 7105 (2012); 38 C.F.R. §§ 3.104(a), 3.156, 3.160(d), 20.302 (2018).
9. Since the May 2010 rating decision, new and material evidence has not been received to reopen the claim of entitlement to service connection for a dental condition.  38 U.S.C. §§ 5108, 7105 (2012); 38 C.F.R. §§ 3.104(a), 3.156, 3.160(d), 20.302 (2018).
10. The criteria for service connection for positive tuberculosis skin test are not met.  38 U.S.C. §§ 1110, 1112, 1131, 1132, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.306, 3.309 (2018).
11.  The criteria for service connection for hemorrhoids are not met.  38 U.S.C. §§ 1110, 1112, 1131, 1132, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.306 (2018).
12. The criteria for a rating in excess of 20 percent for service-connected left epididymitis with atrophy of left testicle are not met.  38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.10, 4.115a, 4.115b, Diagnostic Codes 7525-7523 (2018).
13. The criteria for an initial compensable evaluation for residuals of a jaw fracture have not been met.  38 U.S.C. §§1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, and 4.150, Diagnostic Codes 9999-9905 (2018).
REASONS AND BASES FOR FINDINGS AND CONCLUSIONS
The Veteran had active service from July 1978 to September 1988. 
This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2013 rating decision of the Department of Veterans Affairs (VA), Regional Office (RO), in Waco, Texas.
The issue of entitlement to service connection for an acquired psychiatric disorder to include depression, anxiety, and bipolar disorder has been modified as reflected above in this decision, pursuant to the holding in Clemons v. Shinseki, 23 Vet. App. 1 (2009) (scope of a disability claim includes any disability that may reasonably be encompassed by the claimant’s description of the claim, reported symptoms, and the other information of record).
Claims to Reopen
In general, decisions of the RO and the Board that are not appealed in the prescribed time period are final.  38 U.S.C. §§ 7104, 7105 (2012); 38 C.F.R. §§ 3.104, 20.1100, 20.1103 (2018).  A finally disallowed claim, however, may be reopened when new and material evidence is presented or secured with respect to that claim.  38 U.S.C. § 5108 (2012).
Regardless of the action taken by the RO, the Board must determine whether new and material evidence has been received subsequent to an unappealed RO denial.  Jackson v. Principi, 265 F.3d 1366, 1369 (Fed. Cir. 2001).  As part of this review, the Board considers evidence of record at the time of the previous final disallowance of the claim on any basis, including on the basis that there was no new and material evidence to reopen the claim, and evidence submitted since a prior final disallowance.  Evans v. Brown, 9 Vet. App. 273, 285-86 (1996).
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 (2018).  For purposes of reopening a claim, the credibility of newly submitted evidence is generally presumed.  Justus v. Principi, 3 Vet. App. 510, 513 (1992).
The threshold for determining whether new and material evidence raises a reasonable possibility of substantiating a claim is low.  Shade v. Shinseki, 24 Vet. App. 110, 117 (2010).  In determining whether this low threshold is met, VA should not limit its consideration to whether the newly submitted evidence relates specifically to the reason why the claim was last denied, but instead should ask whether the evidence could reasonably substantiate the claim were the claim to be reopened, to include by triggering the Secretary’s duty to assist or consideration of a new theory of entitlement.  Shade, 24 Vet. App. at 117-18.
Additionally, new and material evidence received prior to the expiration of the appeal period, or prior to the appellate decision if a timely appeal has been filed, will be considered as having been filed in connection with the claim which was pending at the beginning of the appeal period.  38 C.F.R. § 3.156(b).  Furthermore, at any time after VA issues a decision on a claim, if VA receives or associates with the claims file relevant official service department records that existed but were not associated with the claims file when VA first decided the claim, VA will reconsider the claim, rather than requiring new and material evidence.  38 C.F.R. § 3.156(c)(1).  A claim is not reconsidered, however, where VA could not have obtained the records when it initially decided the claim because the records did not exist at that time, or because the claimant failed to provide sufficient information to identify and obtain the records from the respective service department, the Joint Services Records Research Center, or any other official source.  38 C.F.R. § 3.156(c)(2).
The Board notes that in the July 2013 rating decision the issues of entitlement to service connection for a low back condition and a neck condition were reopened. 
Nevertheless, the question of whether new and material evidence has been received to reopen each claim must be addressed in the first instance by the Board because the issue goes to the Board’s jurisdiction to reach the underlying claim and adjudicate it on a de novo basis.  See Jackson v. Principi, 265 F.3d 1366 (Fed. Cir. 2001); see also Barnett v. Brown, 83 F.3d 1380, 1383 (Fed. Cir. 1996), aff’g 8 Vet. App. 1 (1995).  If the Board finds that no such evidence has been offered, this is where the Board’s analysis must end; hence, what the RO may have determined in this regard is irrelevant.  Jackson, 265 F.3d at 1369; Barnett, 83 F.3d at 1383.
1. Whether new and material evidence has been received to reopen the claim of entitlement to service connection for a low back condition
The Veteran’s claim for entitlement to service connection for a low back condition was initially denied in a March 2007 rating decision which determined that although the service treatment records showed he was treated for low back pain during his military service, x-rays showed normal findings with no evidence of abnormalities or fractures.  Furthermore, a VA treatment record dated in July 2006 reflected report low back pain, but a low back disability had not been diagnosed.  As evidence of a current diagnosis of a low back disorder was not made, service connection was denied. 
The Veteran did not appeal the decision.  Therefore, the March 2007 rating decision is final.  See 38 U.S.C. § 7105 (2012); 38 C.F.R. § 20.1100 (2018).
In this regard, the Board has considered the applicability of 38 C.F.R. § 3.156(b), which provides that, when new and material evidence is received prior to the expiration of the appeal period, it will be considered as having been filed in connection with the claim which was pending at the beginning of the appeal period.  However, here, such regulation is inapplicable as no new and material evidence pertaining to the Veteran’s claim for service connection for a low back condition was received prior to the expiration of the appeal period stemming from the March 2007 rating decision.  See also Bond v. Shinseki, 659 F.3d 1362, 1367 (Fed. Cir. 2011); Roebuck v. Nicholson, 20 Vet. App. 307, 316 (2006); Muehl v. West, 13 Vet. App. 159, 161-62 (1999).
The claim to reopen the Veteran’s appeal for a low back condition was denied again by the RO in May 2010 as the evidence submitted since the March 2007 rating decision (specifically additional VA treatment records) did not show a current disability or that it occurred in, or was related to, his military service.  The Veteran did not appeal the decision or submit new and material evidence within the one year time period.  Therefore, the May 2010 rating decision is final.  See 38 U.S.C. § 7105 (2012); 38 C.F.R. § 20.1100 (2018).
The May 2010 rating action, therefore, represents the last previous final decision on any basis as to the issue of whether the Veteran is entitled to service connection for a low back condition.  Evans v. Brown, 9 Vet. App. 273 (1996).
According to the record, since the final decision, the Veteran was afforded a VA examination of the back in March 2013 where a diagnosis of a herniated disc of L5-S1 with left S1 nerve root entrapment was reported and the date of diagnosis of June 2012 was noted.  
As the United States Court of Appeals for Veterans Claims (Court) stated in Shade v. Shinseki, the threshold for determining whether new and material evidence raises a reasonable possibility of substantiating a claim is “low.”  24 Vet. App. 110, 117 (2010).  When evaluating the materiality of newly submitted evidence, the focus must not be solely on whether the evidence remedies the principal reason for denial in the last prior decision; rather the determination of materiality should focus on whether the evidence, taken together, could at least trigger the duty to assist or consideration of a new theory of entitlement.  Id. 
Therefore, the Board finds that the diagnosis of a low back disability, specifically herniated disc of the L5-S1 with left S1 nerve root entrapment, does relate to an unestablished fact necessary to substantiate the claim and, thus, is material as it raises a reasonable possibility of substantiating the claim. 38 C.F.R § 3.156 (a).
Since there is new and material evidence, the claim is reopened.  38 U.S.C. § 5108; 38 C.F.R. § 3.156.  It must be readjudicated on the underlying merits, i.e., on a de novo basis.  This claim will be discussed further in the REMAND following this decision.
2. Whether new and material evidence has been received to reopen the claim of entitlement to service connection for a neck condition
The Veteran’s claim for entitlement to service connection for a neck condition was initially denied in an March 2007 rating decision which determined that although the service treatment records showed he was treated for neck pain during his military service following a motor vehicle accident, x-rays showed normal findings with no evidence of abnormalities of fractures.  Furthermore, the rating decision determined that VA treatment did not show the Veteran was diagnosed with a neck condition.  As evidence of a current diagnosis of a neck condition was not made, service connection was denied. 
The Veteran did not appeal the decision.  Therefore, the March 2007 rating decision is final.  See 38 U.S.C. § 7105 (2012); 38 C.F.R. § 20.1100 (2018).
In this regard, the Board has considered the applicability of 38 C.F.R. § 3.156(b).  However, here, such regulation is inapplicable as no new and material evidence pertaining to the Veteran’s claim for service connection for a neck condition was received prior to the expiration of the appeal period stemming from the March 2007 rating decision.  See also Bond v. Shinseki, 659 F.3d 1362, 1367 (Fed. Cir. 2011); Roebuck v. Nicholson, 20 Vet. App. 307, 316 (2006); Muehl v. West, 13 Vet. App. 159, 161-62 (1999).
The claim to reopen the Veteran’s appeal for a neck condition was denied again by the RO in May 2010 as the evidence submitted since the March 2007 rating decision (specifically additional VA treatment records) did not show a current disability or that it occurred in, or was related to, his military service.  The Veteran did not appeal the decision.  
The Board, however, finds that pursuant to 38 C.F.R. § 3.156(b) new and material evidence was received within one year of the issuance of the May 2010 rating decision.  Specifically, regarding this claim, according to an October 2010 VA treatment record MRI taken of the Veteran’s spine revealed a mild degree of degenerative osteoarthritis of the cervical spine.  As such, the new evidence reflects a current diagnosis of a neck condition, which as the basis of a denial by the RO in March 2007; the Board finds that such is new and material evidence. Therefore, the May 2010 rating decision is not final.  See also Bond, supra; Roebuck, supra; Muehl, supra.
The March 2007 rating action, therefore, represents the last previous final decision on any basis as to the issue of whether the Veteran is entitled to service connection for a neck condition.  Evans v. Brown, 9 Vet. App. 273 (1996).
As stated, the Board finds that the diagnosis of a neck disability, specifically mild degenerative osteoarthritis of the cervical spine, does relate to an unestablished fact necessary to substantiate the claim and, thus, is material as it raises a reasonable possibility of substantiating the claim.  38 C.F.R § 3.156(a).
Since there is new and material evidence, the claim is reopened.  38 U.S.C. § 5108; 38 C.F.R. § 3.156.  It must be readjudicated on the underlying merits, i.e., on a de novo basis.  This claim will be discussed further in the REMAND following this decision.
3. Whether new and material evidence has been received to reopen the claim of entitlement to service connection for a left eye condition 
Regarding the Veteran’s claim to reopen his previously denied claim for service connection for a left eye condition, he was denied service connection by a March 2007 rating decision in which the RO determined that although the evidence showed he was treated in January 1985 for blurred vision and reported a foreign body in the left eye, an examination did not find a foreign body or corneal abrasion.  Furthermore, VA treatment records reflect that the Veteran’s vision was 20/20 in the left eye and a diagnosis of presbyopia was made.  The Veteran did not appeal the decision.  Therefore, the March 2007 rating decision is final.  See 38 U.S.C. § 7105 (2012); 38 C.F.R. § 20.1100 (2018).
In this regard, the Board has considered the applicability of 38 C.F.R. § 3.156(b).  However, here, such regulation is inapplicable as no new and material evidence pertaining to the Veteran’s claim for service connection for a left eye condition was received prior to the expiration of the appeal period stemming from the March 2007 rating decision.  See also Bond v. Shinseki, 659 F.3d 1362, 1367 (Fed. Cir. 2011); Roebuck v. Nicholson, 20 Vet. App. 307, 316 (2006); Muehl v. West, 13 Vet. App. 159, 161-62 (1999).  Therefore, the March 2007 rating decision is final.  See 38 U.S.C. § 7105 (2012); 38 C.F.R. § 20.1100 (2018).
In March 2010, the Veteran submitted a claim to reopen this issue.  In May 2010 rating decision, the VA denied the Veteran’s claim to reopen as new and material evidence was not received.  Specifically, evidence received since the March 2007 rating decision did not demonstrate the Veteran’s condition began in or was caused by his military service.  The Veteran did not appeal the decision or submit new and material evidence within the one year time period.  Therefore, the May 2010 rating decision is final.  See 38 U.S.C. § 7105 (2012); 38 C.F.R. § 20.1100 (2018).
The May 2010 rating action, therefore, represents the last previous final decision on any basis as to the issue of whether the Veteran is entitled to service connection for a left eye condition.  Evans v. Brown, 9 Vet. App. 273 (1996).
According to the records received since the May 2010 rating, the Veteran continued his treatment for various disabilities.  There is no evidence of record that the Veteran’s left eye condition began during his military service and also no support of the Veteran’s contention any left eye condition resulted from an injury during his military service.
While the Board acknowledges that the evidence received since the May 2010 rating was not previously of record, it is not “material” to the Veteran’s claim as it does not establish that the Veteran’s left eye condition occurred in or was caused by his military service.  Thus, the VA treatment/examination records since the May 2010 rating decision do not address the Veteran’s contentions and there is no indication his symptoms and assessments stemmed from his military service. Therefore, the additional evidence does not raise a reasonable possibility of substantiating the claim and, while “new” it is not “material.” 
In sum, a review of the evidence of record fails to reveal any new and material evidence suggesting that the Veteran’s left eye condition is related to service.  He has not informed VA of any evidence not of record that demonstrates this unestablished fact. 
The Board recognizes the threshold for reopening a claim is low, but it is a threshold nonetheless and, as described, the evidence that has been added since May 2010 clearly does not reach that threshold.  See Shade v. Shinseki, 24 Vet. App. 110, 118 (2010).  
As new and material evidence has not been submitted, the claim of entitlement to service connection for a left eye condition is not reopened.
4. Whether new and material evidence has been received to reopen the claim of entitlement to service connection for a right arm condition 
The Veteran’s claim for entitlement to service connection for a right arm condition was initially denied in a March 2007 rating decision which determined that service treatment records did not show treatment for, or a diagnosis of, a right arm condition.  Furthermore, VA treatments revealed the Veteran reported right arm discomfort but that a right arm condition had not been diagnosed.  Therefore, service connection was denied. 
The Veteran did not appeal the decision.  Therefore, the March 2007 rating decision is final.  See 38 U.S.C. § 7105 (2012); 38 C.F.R. § 20.1100 (2018).
In this regard, the Board has considered the applicability of 38 C.F.R. § 3.156(b).  However, here, such regulation is inapplicable as no new and material evidence pertaining to the Veteran’s claim for service connection for a right arm condition was received prior to the expiration of the appeal period stemming from the March 2007 rating decision.  See also Bond v. Shinseki, 659 F.3d 1362, 1367 (Fed. Cir. 2011); Roebuck v. Nicholson, 20 Vet. App. 307, 316 (2006); Muehl v. West, 13 Vet. App. 159, 161-62 (1999).
The appeal to reopen the Veteran’s claim for service connection for a right arm condition was denied again by the RO in May 2010 as the evidence submitted since the March 2007 rating decision (specifically additional VA treatment records) did not show a current disability or that it occurred in, or was related to, his military service.  The Veteran did not appeal the decision.  
The Board, however, finds that pursuant to 38 C.F.R. § 3.156(b) new and material evidence was received within one year of the issuance of the May 2010 rating decision.  Specifically, regarding this claim, according to a December 2010 VA treatment record, pain in the Veteran’s right shoulder resulted in tightness and decreased range of motion.  As such, the new evidence reflects a possible right arm disability and functional impairment, the Board finds that such is new and material evidence.  Therefore, the May 2010 rating decision is not final.  See also Bond, supra; Roebuck, supra; Muehl, supra.
The March 2007 rating action, therefore, represents the last previous final decision on any basis as to the issue of whether the Veteran is entitled to service connection for a right arm condition.  Evans v. Brown, 9 Vet. App. 273 (1996).
Furthermore, since the March 2007 rating decision, the United States Court of Appeals for the Federal Circuit (Federal Circuit) has clarified the law regarding manifestations of pain without an underlying diagnosis.  That is, the Federal Circuit can sustain a claim for service connection based on pain without a diagnosis, but the Veteran must demonstrate some level of functional impairment of earning capacity.  Saunders v. Wilkie, 886 F. 3d 1356 (Fed. Cir. 2018).  In the May 2012 claim to reopen, the Veteran stated his right shoulder disability stemmed from motor vehicle accidents in 1984 and 1987.  The VA treatment records indicate the Veteran has been diagnosed with radiculopathy of the upper right extremity and has sought treatment at the emergency room in December 2010.  Again, the Veteran experienced tightness and decreased range of motion due to the pain at that time.  Taken together, this evidence is new, material, and raises a reasonable likelihood of substantiating the Veteran’s claim.  Therefore, the Veteran’s claim is deemed reopened.  38 U.S.C. § 5108; 38 C.F.R. § 3.156.  
5. Whether new and material evidence has been received to reopen the claim of entitlement to service connection for an acquired psychiatric disorder to include depression, anxiety, and bipolar disorder
The Veteran’s claim for entitlement to service connection for an acquired psychiatric disorder to include depression, and anxiety, also claimed secondary to the service-connected migraine headaches, was initially denied in a December 2008 rating decision which determined that although the Veteran was diagnosed with bipolar disorder and personality disorder, he failed to report to a scheduled VA examination which might have been material to the outcome of the claim.  There was also no evidence within the record that this disability was present during his military service.  Therefore, service connection was denied. 
The Veteran did not appeal the decision.  As such, the December 2008 rating decision is final.  See 38 U.S.C. § 7105 (2012); 38 C.F.R. § 20.1100 (2018).
In this regard, the Board has considered the applicability of 38 C.F.R. § 3.156(b), which provides that, when new and material evidence is received prior to the expiration of the appeal period, it will be considered as having been filed in connection with the claim which was pending at the beginning of the appeal period.  However, here, such regulation is inapplicable as no new and material evidence pertaining to the Veteran’s claim for service connection for an acquired psychiatric disorder, to include depression, anxiety and bipolar disorder was received prior to the expiration of the appeal period stemming from the December 2008 rating decision.  See also Bond v. Shinseki, 659 F.3d 1362, 1367 (Fed. Cir. 2011); Roebuck v. Nicholson, 20 Vet. App. 307, 316 (2006); Muehl v. West, 13 Vet. App. 159, 161-62 (1999).
The claim to reopen the Veteran’s appeal for depression was denied again by the RO in March 2011 as the evidence submitted since the December 2008 rating decision (specifically additional VA treatment records) did not support the Veteran’s claim that his depression was secondary to his cluster headaches or left epididymitis with atrophy of the left testicle.  The Veteran did not appeal the decision or submit new and material evidence within the one year time period.  Therefore, the March 2011 rating decision is final.  See 38 U.S.C. § 7105 (2012); 38 C.F.R. § 20.1100 (2018).
The March 2011 rating action, therefore, represents the last previous final decision on any basis as to the issue of whether the Veteran is entitled to service connection for an acquired psychiatric disorder.  Evans v. Brown, 9 Vet. App. 273 (1996).
According to the records received since the March 2011 rating decision, the Veteran continued his treatment for various disabilities and maintains his depression, anxiety, and bipolar disorder.  There is no evidence of record that the Veteran’s acquired psychiatric disorders began during his military service and also no support of the Veteran’s contention that his acquired psychiatric disorders were secondary to any service-connected disabilities.  The Board further notes that the Veteran’s VA treatment records indicate that in May 2007 the Veteran was diagnosed with adjustment disorder with mixed anxiety and depression.  In November 2008 he was diagnosed with bipolar disorder. 
While the Board acknowledges that the evidence received since the March 2011 rating decision was not previously of record, it is not “material” to the Veteran’s claim as it does not establish that the Veteran’s acquired psychiatric disorder occurred in or was caused by his military service.  Thus, the VA treatment/examination records since the March 2011 rating decision do not address the Veteran’s contentions and there is no indication his symptoms and assessments stemmed from his military service.  Furthermore, the new evidence does not support the secondary theory of entitlement, specifically that his acquired psychiatric disorder is secondary to his service-connected headaches and/or left epididymitis with atrophy of the left testicle.  Therefore, the additional evidence does not raise a reasonable possibility of substantiating the claim and, while “new” it is not “material.” 
In sum, a review of the evidence of record fails to reveal any new and material evidence suggesting that the Veteran’s acquired psychiatric disorder to include depression, anxiety, and bipolar disorder is related to his military service.  He has not informed VA of any evidence not of record that demonstrates this unestablished fact. 
The Board recognizes the threshold for reopening a claim is low, but it is a threshold nonetheless and, as described, the evidence that has been added since March 2011 clearly does not reach that threshold.  See Shade v. Shinseki, 24 Vet. App. 110, 118 (2010).  
As new and material evidence has not been submitted, the claim of entitlement to service connection for an acquired psychiatric disorder to include depression, anxiety, and bipolar disorder is not reopened.
6. Whether new and material evidence has been received to reopen the claim of entitlement to service connection for a dental condition 
Regarding the Veteran’s claim to reopen his previously denied claim for service connection for a dental condition, he was denied service connection by a March 2007 rating decision in which the RO determined that although the evidence showed he was treated during his military service for periodontal disease and poor dental hygiene.  A May 2004 VA dental examination report indicated the Veteran’s report he was in a vehicle accident in 1988 shortly before separation and injured teeth numbers 9 and 10 resulting in root canal therapy.  However, the VA dentist stated no documentary evidence within the service medical and dental records reflecting the Veteran’s contentions was found.  Furthermore, an October 2006 VA examination showed the Veteran had a partial plate for the front teeth due to decay and deterioration.  Ultimately, the Veteran’s contention that his loss of teeth due to dental trauma in service was not supported by the evidence of record and the RO denied the Veteran’s claim.  The Veteran did not appeal the decision or submit new and material evidence within the one year time period.  Therefore, the March 2007 rating decision is final.  See 38 U.S.C. § 7105 (2012); 38 C.F.R. § 20.1100 (2018).
In March 2010, the Veteran submitted a claim to reopen this issue.  In a May 2010 rating decision, the VA denied the Veteran’s claim to reopen as new and material evidence was not received.  Specifically, evidence received since the March 2007 rating decision did not demonstrate the Veteran’s condition began in or was caused by his military service.  
Following the May 2010 rating decision, the Veteran submitted private dental records from Dr. K.M. Grisby.  According to a March 2011 rating decision, these records failed to support the Veteran’s contention that his dental condition was a direct result of his military service or secondary to his service-connected broken jaw disability.  While these records were new, they were not material as they did not relate to an unestablished fact necessary to substantiate his claim and did not raise a reasonable possibility of substantiating his claim.  Therefore, the Veteran’s claim was not reopened.  The Veteran did not appeal the decision.  Therefore, the March 2011 rating decision is final.  See 38 U.S.C. § 7105 (2012); 38 C.F.R. § 20.1100 (2018).
The Board has considered the applicability of 38 C.F.R. § 3.156(b).  However, here, such regulation is inapplicable as no new and material evidence pertaining to the Veteran’s claim for service connection for a dental condition was received prior to the expiration of the appeal period stemming from the March 2007 and March 2011 rating decisions.  See also Bond v. Shinseki, 659 F.3d 1362, 1367 (Fed. Cir. 2011); Roebuck v. Nicholson, 20 Vet. App. 307, 316 (2006); Muehl v. West, 13 Vet. App. 159, 161-62 (1999).  Therefore, the March 2007 and March 2011 rating decisions are final.  See 38 U.S.C. § 7105 (2012); 38 C.F.R. § 20.1100 (2018).
The March 2011 rating action, therefore, represents the last previous final decision on any basis as to the issue of whether the Veteran is entitled to service connection for a dental condition.  Evans v. Brown, 9 Vet. App. 273 (1996).
According to the records received since the March 2011 rating, the Veteran continued his treatment for various disabilities.  There is no evidence of record that the Veteran’s dental condition resulted from an injury during his military service or is secondary to any service-connected disability.
While the Board acknowledges that the evidence received since the March 2011 rating was not previously of record, it is not “material” to the Veteran’s claim as it does not establish that the Veteran’s dental condition occurred in or was caused by his military service.  Thus, the VA treatment/examination records since the March 2011 rating decision do not address the Veteran’s contentions and there is no indication his symptoms and assessments stemmed from his military service, specifically trauma from a motor vehicle accident during service.  Therefore, the additional evidence does not raise a reasonable possibility of substantiating the claim and, while “new” it is not “material.” 
In sum, a review of the evidence of record fails to reveal any new and material evidence suggesting that the Veteran’s left eye condition is related to service.  He has not informed VA of any evidence not of record that demonstrates this unestablished fact. 
The Board recognizes the threshold for reopening a claim is low, but it is a threshold nonetheless and, as described, the evidence that has been added since May 2010 clearly does not reach that threshold.  See Shade v. Shinseki, 24 Vet. App. 110, 118 (2010).  
As new and material evidence has not been submitted, the claim of entitlement to service connection for a dental condition is not reopened.
Service Connection
Under the laws administered by VA, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service.  See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a).  Service connection may also 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 during service.  38 C.F.R. § 3.303(d).
Generally, the evidence must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service.  38 C.F.R. § 3.303(a); Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004) (citing Hansen v. Principi, 16 Vet. App. 110, 111 (2002); Caluza v. Brown, 7 Vet. App. 498, 505 (1995), aff’d, 78 F.3d 604 (Fed. Cir. 1996) (table)).
Service connection may be established under the provisions of 38 C.F.R. § 3.303(b) when the evidence, regardless of its date, shows that a veteran had a chronic condition in service, such as arthritis, or during the applicable presumptive period. In addition, certain chronic diseases may be presumed to have been incurred or aggravated during service if they become disabling to a compensable degree within one year of separation from active duty.  38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. 
For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time.  If chronicity is not established, then a showing of continuity of symptomatology after discharge is required to support the claim.  38 C.F.R. § 3.303(b).  However, the regulatory provisions pertaining to chronicity and continuity of symptomatology are constrained by 38 C.F.R. § 3.309(a), and, thus, such provisions are only available to establish service connection for the specific chronic diseases listed in 38 C.F.R. § 3.309(a).  See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013) (rejecting the argument that continuity of symptomatology in § 3.303(b) has any role other than to afford an alternative route to service connection for specific chronic diseases). 
In each case where a veteran is seeking service connection for any disability, due consideration shall be given to the places, types, and circumstances of such veteran’s service as shown by such veteran’s service record, the official history of each organization in which such veteran served, such veteran’s treatment records, and all pertinent medical and lay evidence.  See 38 U.S.C. § 1154(a) (2012).
The United States Court of Appeals for the Federal Circuit (Federal Circuit) has rejected the view that competent medical evidence is required when the determinative issue in a claim for benefits involves either medical etiology or a medical diagnosis.  Under 38 U.S.C. § 1154(a), lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional.  Davidson v. Shinseki, 581 F.3d. 1313 (Fed. Cir. 2009); see also Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331, 1335 (Fed. Cir. 2006).
The Board has thoroughly reviewed all the evidence in the Veteran’s claims file. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, all the evidence submitted by the Veteran or on his behalf.  See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (the Board must review the entire record, but does not have to discuss each piece of evidence).  The analysis below focuses on the most salient and relevant evidence and on what this evidence shows, or fails to show, on the claim.  The Veteran must not assume that the Board has overlooked pieces of evidence that are not explicitly discussed herein.  See Timberlake v. Gober, 14 Vet. App. 122 (2000) (the law requires only that the Board address its reasons for rejecting evidence favorable to the appellant).
The Board must assess the credibility and weight of all evidence, including the medical evidence, to determine its probative value, accounting for evidence, which it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the appellant.  Equal weight is not always accorded to each piece of evidence contained in the record; not every item of evidence has the same probative value.  When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the appellant prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied.  See Gilbert v. Derwinski, 1 Vet. App. 49 (1990).
1. Entitlement to service connection for a positive tuberculosis skin test
In the absence of proof of a present disability (and, if so, of a nexus between that disability and service), there can be no valid claim for service connection. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992).  This principle has been repeatedly reaffirmed by the Federal Circuit, which has stated that “a veteran seeking disability benefits must establish... the existence of a disability [and] a connection between the veteran’s service and the disability.”  Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000).  The requirement for service connection that a current disability be present is satisfied when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim even though the disability resolves prior to the Secretary’s adjudication of the claim.  McClain v. Nicholson, 21 Vet. App. 319 (2007) (a service connection claim may be granted if a diagnosis of a chronic disability was made during the pendency of the appeal, even if the most recent medical evidence suggests that the disability resolved); Romanowsky v. Shinseki, 26 Vet. App. 289 (2013).
Turning to the facts in this case, the Veteran’s service treatment records indicate tuberculosis tests conducted in January 1983 and February 1984 were negative.  Furthermore, the Veteran’s March 1988 Report of Medical Examination and Report of Medical History at separation did not indicate complaints, treatment, or diagnosis of tuberculosis.
Following service, in November 2008, it was noted that the Veteran had a positive PPD test.  However, subsequent testing conducted in the years since did not produce a positive result and there is no evidence within the claims file that the Veteran diagnosed with, or treated for, active tuberculosis.  
The Veteran stated that he had been diagnosed with tuberculosis in active duty service, however, this could not be confirmed.  The Veteran did not at that time, nor has he at any time since, alleged that he received treatment for tuberculosis or experienced active tuberculosis at any time since he filed his claim. 
Turning to an analysis of the facts in this case, while the medical evidence of record shows that the Veteran had a positive PPD test following service, such test showed only that the Veteran had developed an immune response to the bacterium that causes tuberculosis.  Subsequent testing consistently found that the Veteran did not show active evidence of tuberculosis.  The positive PPD testing is thus akin to a positive laboratory finding, which is not a disability for which service connection may be granted.
To the extent that the Veteran believes that he has experienced symptoms relating to tuberculosis, the Board has no reason to doubt that the Veteran currently experiences such symptoms.  The Veteran is competent to testify as to such. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Barr v. Nicholson, 21 Vet. App. 303 (2007).  However, the fact remains that a diagnosis of tuberculosis requires clinical testing, and the medical evidence has consistently failed to find that the Veteran has ever had active tuberculosis.  As such, the Veteran, as a layperson, is not competent to report that any symptoms that he currently experiences constitute symptoms of tuberculosis or otherwise rise to the level of a “disability” for VA purposes.  Thus, while the Veteran may experience certain symptoms, his statements are not sufficient to establish a current, chronic tuberculosis disability at this time.  Moreover, it appears that the Veteran has not reported experiencing specific symptoms, but he instead filed this claim based on his history of a positive PPD test following service.
In sum, the preponderance of the evidence is against granting service connection for a positive tuberculosis skin test.  As the preponderance of the evidence is against the claim, the claim is denied. 38 U.S.C. § 5107(b) (2012); Gilbert v. Derwinski, 1 Vet. App. 49 (1990).
2. Entitlement to service connection for hemorrhoids
The Veteran’s service treatment records are completely absent of any symptoms, treatment, or diagnoses referable to hemorrhoids.  The March 1988 Report of Medical Examination and Report of Medical History at separation revealed the Veteran denied any rectal disease.
The Veteran submitted a claim for service connection in May 2012 for hemorrhoids.
According to the post-service treatment records, the Veteran had a history of, and sought treatment for, hemorrhoids.  However, there is no competent evidence showing that his current hemorrhoids were etiologically related to his active service.
Relevant complaints, treatment, and/or diagnosis of hemorrhoids is not shown in the record until after separation from military service.  Therefore, the existence of a current disability of hemorrhoids is not in dispute.  The VA treatment records, dated October 2005, indicate a diagnosis of hemorrhoids.
After consideration of the entire record and the relevant law, the Board finds that the Veteran’s current hemorrhoids are not related to service, and service connection is not established.  The medical evidence of record as a whole supports the proposition that there is no etiological relationship between the origin of hemorrhoids and his military service.
The lay and medical evidence does not demonstrate that the Veteran’s hemorrhoids disorder has been continuous since separation from service in September 1988.  The Board recognizes the Veteran’s contention that his hemorrhoids began during service.  However, the absence of post-service complaints, findings, diagnosis or treatment for approximately seventeen years after service is one factor that tends to weigh against a finding of continuous symptoms of these conditions.  See Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006) (holding that the Board may weigh the absence of contemporaneous medical evidence as one factor in determining credibility of lay evidence, but the Board cannot determine that lay evidence lacks credibility merely because it is unaccompanied by contemporaneous medical evidence); see also Maxson v. West, 12 Vet. App. 453 (1999), aff’d, 230 F.3d 1330 (Fed. Cir. 2000) (a prolonged period without medical complaint can be considered, along with other factors, as evidence of whether an injury or a disease was incurred in service which resulted in any chronic or persistent disability).  Therefore, the Board finds that there is no in-service injury, event or disease and the second element of a claim for service connection is not satisfied.
In this case, as there is no in-service injury, event or disease, there can be no existence of a causal relationship between the Veteran’s hemorrhoids and an in-service injury, event or disease.  Thus, a discussion of the lack of a nexus is not necessary.
Overall, the Board acknowledges the Veteran’s contentions.  However, the only evidence of record in support of the Veteran’s claim consists of his own lay statements.  The Veteran is considered competent to report the observable manifestations of his claimed disability.  See Charles v. Principi, 16 Vet. App. 370, 374 (2002) (“ringing in the ears is capable of lay observation”); Layno v. Brown, 6 Vet. App. 465, 469-70 (1994) (lay testimony iterating knowledge and personal observations of witness are competent to prove that claimant exhibited certain symptoms at particular time following service).  His assertions that he experiences symptoms are also credible.  Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), as to the specific issues in this case, whether the Veteran has a current diagnosis of a claimed condition and the date of onset of such disorder, they fall outside the realm of common knowledge of a lay person.  See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007) (providing that lay persons not competent to diagnose cancer).  Accordingly, his opinions are not significantly probative and are outweighed by the medical evidence of record noted above.
As such, after weighing and balancing the evidence of record, the Board finds that the preponderance of the evidence of record is against a finding that the Veteran’s hemorrhoids disorder is related to any in-service disease, event, or injury.  See 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.310.  In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine.  See 38 U.S.C. § 5107(b).  However, the doctrine of reasonable doubt is not for application concerning this claim as the weight of the evidence is against the claim.  38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). Accordingly, the appeal of the claim for entitlement to service connection for hemorrhoids must be denied.
Increased Disability Ratings
Disability evaluations are determined by the application of VA’s Schedule for Rating Disabilities (Schedule).  38 C.F.R. Part 4 (2018).  The percentage ratings contained in the Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and the residual conditions in civil occupations.  38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 3.321(a), 4.1 (2018).  Separate diagnostic codes identify the various disabilities.
The Veteran’s entire history is reviewed when making disability evaluations.  See generally 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995).  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.  See Francisco v. Brown, 7 Vet. App. 55, 58 (1994).  The Court has held that consideration of the appropriateness of a staged rating is required. See Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007).
Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating.  Otherwise, the lower rating will be assigned.  38 C.F.R. § 4.7 (2018).
1. Entitlement to an increased disability rating in excess of 20 percent for left epididymitis with atrophy of the left testicle 
The Veteran is currently service connected for left epididymitis with atrophy of the left testicle, and his condition is evaluated as 20 percent disabling, effective March 22, 2010, under Diagnostic Codes 7525-7523.  The Veteran contends that this rating does not accurately reflect the current severity of his disability.
Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the evaluation assigned; the additional code is shown after the hyphen.  38 C.F.R. § 4.27 (2018). As the Veteran was diagnosed with epididymitis in service, the RO utilized the primary Diagnostic Code 7525 for epididymo-orchitis.  There is no specific rating associated with this code, but it in turn directs the rater to rate the condition as a urinary tract infection or in accordance with code sections appropriate for tubercular infections.  In this case, there is no evidence of tubercular infections.
Urinary tract infections requiring long-term drug therapy, one to two hospitalizations a year and/or requiring intermittent intensive management are rated as 10 percent disabling; a recurrent symptomatic infection requiring drainage/frequent hospitalization (greater than two times/year), and/or requiring continuous intensive management are rated as 30 percent disabling; infections resulting in poor renal function are to be rated as renal dysfunction.  The code also provides that for tubercular infections, rate in accordance with 38 C.F.R. §§ 4.88b or 4.89, whichever is appropriate.  In this case, there is no evidence of tubercular infections. 
As this Veteran experienced testicular atrophy secondary to that condition, the additional diagnostic code for testicular atrophy, Diagnostic Code 7523, was also assigned.  Under the rating criteria for Diagnostic Code 7523, relating to complete testicular atrophy, a noncompensable rating is assigned for one testicle and a 20 percent rating is assigned for both testicles.  38 C.F.R. § 4.115b (2018). 
However, according to the May 2010 rating decision which granted an increased disability rating, it appears the 20 percent rating, effective March 22, 2010, was assigned pursuant to voiding dysfunction given the Veteran’s symptomatology reported at the March 2010 VA examination.   
According to the May 2010 rating decision which granted an increased disability rating, while the RO continued to rate the Veteran’s disability under Diagnostic Code 7525-7523, the 20 percent rating was awarded based upon evidence of voiding dysfunction, specifically urinary frequency, caused by the Veteran’s left epididymitis with atrophy of the left testicle as evidenced at the March 2010 VA examination.  The Rating Schedule reflects that voiding dysfunction is rated as either urine leakage, frequency, or obstructed voiding.  38 C.F.R. § 4.115a.
In cases of urinary frequency, a 10 percent evaluation is assigned for a daytime voiding interval between two and three hours, or awakening to void two times per night.  A 20 percent evaluation is assigned for a daytime voiding interval between one and two hours, or awakening to void three to four times per night.  A 40 percent evaluation is assigned in cases of a daytime voiding interval less than one hour, or awakening to void five or more times per night. 
Turning to the evidence of record, the Board notes that the evidentiary record contains VA treatment records which generally note the Veteran’s diagnosis of epididymitis.  However, the VA treatment records do not contain any relevant information or evidence as to the severity of the Veteran’s disability, other than generally noting his subjective symptomatology.  
The Veteran was afforded a VA examination to examine the nature and severity of his disability in March 2013.  The examination indicates that there was no evidence of voiding dysfunction, erectile dysfunction, retrograde ejaculation, or chronic infections of the male reproductive organ.  A physical examination revealed the penis was normal, left testicle was retracted/elevated to external inguinal canal and tender to touch, and the left epididymis was tender to palpation and retracted into the inguinal canal.  There was no evidence of benign or malignant neoplasm or metastases, scars, or any other pertinent physical findings, complications, conditions, signs, or symptoms.  Finally, the VA examiner determined the Veteran’s condition did not impact his ability to work. 
Based on the foregoing, the Board finds that the Veteran’s service-connected left epididymitis with atrophy of the left testicle warrants no more than a 20 percent rating.  The preponderance of the evidence does not reflect that his disability has resulted in daytime voiding interval less than one hour, or awakening to void five or more times per night, to warrant a higher, 40 percent, rating.  Nor does the evidence reflect that his epididymitis has been manifested by voiding dysfunction that has required the use of absorbent materials, obstructive symptomology, or urinary or kidney infections to warrant a higher rating based upon urinary leakage, obstructed voiding, or urinary tract infection.  In fact, the most recent VA examination does not show current voiding dysfunction.  See 38 C.F.R. § 4.115a.
The Board initially notes that a compensable rating is not warranted under Diagnostic Code 7523, as the evidence does not reflect that the Veteran’s epididymitis is manifested by complete atrophy of both testes.  Instead, it has been concluded the Veteran’s epididymitis has been manifested by urinary frequency.
Furthermore, under Diagnostic Code 7525, which provides the criteria for chronic epididymo-orchitis and rates the condition as a urinary tract infection pursuant to 38 C.F.R. § 4.115a, there is no evidence that the Veteran’s epididymitis has been manifested by urinary tract infections.  Therefore, the Veteran is not entitled to a higher rating under Diagnostic Code 7525. 
Likewise, there is no allegation or indication that his epididymitis involves the kidneys, bladder, or urethra or has resulted in a deformity of the penis or erectile dysfunction.  Therefore, Diagnostic Codes 7500-7522 are not applicable in this case.
In evaluating this claim, the Board has considered the lay evidence of record.  Indeed, as noted, the Veteran is competent to report his symptomatology, and the record reflects that the 20 percent rating currently assigned is based, at least partially, upon the Veteran’s report of experiencing nocturia and frequency.  See Layno v. Brown, 6 Vet. App. 465, 469-71 (1994) (a lay person is competent to report symptoms based on personal observation when no special knowledge or training is required).  However, as outlined above, neither the Veteran’s reported symptomatology nor the clinical evidence of record reflect the requisite findings that would allow the award of a rating in excess of 20 percent.
The Board finds there is no basis for a staged rating of the Veteran’s left epididymitis disability, pursuant to Hart, 21 Vet. App. at 505, as the lay and medical evidence shows his disability has been consistently manifested by symptoms that more nearly approximate no higher than a 20 percent rating throughout the appeal period.
In reaching this decision the Board considered the doctrine of reasonable doubt; however, as the preponderance of the evidence is against the Veteran’s claim of entitlement to an increased disability rating in excess of 20 percent for the service-connected left epididymitis with atrophy of the left testicle, the doctrine is not for application.  Gilbert, 1 Vet. App. at 55.
Finally, neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record.  See Doucette v. Shulkin, 28 Vet. App. 366, 369-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record).
2. Entitlement to a compensable disability rating for a broken jaw 
The Veteran’s service-connected broken jaw was assigned an initial noncompensable disability evaluation pursuant to 38 C.F.R. § 4.150, Diagnostic Code 9999-9905.  A diagnostic code ending in “99” and followed by a hyphen connotes a disability which does not exist in the rating schedule and instead has been rated as analogous to a different disability which does exist in the rating schedule.  38 C.F.R. § 4.27.  The RO determined that the Veteran’s broken jaw were most appropriately rated under the criteria of Diagnostic Code 9905 for limited motion of the temporomandibular articulation.  See 38 C.F.R. § 4.150, Diagnostic Code 9905.
Under that diagnostic code, a 10 percent rating is warranted when the range of lateral excursion is limited from 0 to 4 millimeters (mm) or the inter-incisal range is limited to 31 to 40 mm; a 20 percent rating is assigned when the inter-incisal range is limited to 21 to 30 mm; a 30 percent rating is assigned when the inter-incisal range is limited to 11 to 20 mm; and a 40 percent rating is assigned when the range is limited to 0 to 10 mm.  38 C.F.R. § 4.150, Diagnostic Code 9905. Ratings for limited inter-incisal movement shall not be combined with ratings for limited lateral excursion.  38 C.F.R. § 4.150, Diagnostic Code 9905, Note.
Where the criteria for a compensable rating are not met, a noncompensable rating will be assigned.  38 C.F.R. § 4.31 (2016).
VA treatment records show that the Veteran broke his jaw during his military service.
In March 2013, the Veteran underwent a VA oral and dental conditions examination.  The VA examiner reviewed the Veteran’s medical history and noted that the Veteran fractured his mandible in 1984.  Upon physical examination, the examiner found no anatomical loss or bony injury of the mandible, maxilla, or any teeth.  Likewise, the examiner found no anatomical loss or injury of the mouth, lips, or tongue; no diagnosis of osteomyelitis or osteoradionecrosis of the mandible; no benign or malignant neoplasms or metastases; or any pertinent physical findings, scars, complications, conditions, signs, or symptoms related to the condition diagnosed by the examiner.  A panographic/intraoral imaging to demonstrate loss of teeth, mandible or maxilla was performed; the Veteran was partially edentulous.  The VA examiner reported that the Veteran’s oral/dental condition did not impact his ability to work.  
Based on the evidence of record, the Board finds that the Veteran’s service-connected broken jaw is appropriately evaluated as noncompensable.  As a diagnosed disability with no compensable symptoms, the Veteran’s service-connected broken jaw does not warrant a higher disability evaluation of 10 percent unless there is limitation of motion with an inter-incisal range of 31 to 40 millimeters; or, a range of lateral excursion of 0 to 4 millimeters; or, painful motion of the jaw upon examination.  None of these were observed by the March 2013 VA examiner or shown in the VA treatment records.  The Board notes that the March 2013 VA examination is the only medical evidence of record available that addresses the Veteran’s service-connected broken jaw.  The Board finds no basis in the record upon which to award a compensable disability rating. 
The Board has considered whether factors such as functional impairment and pain addressed under 38 C.F.R. §§ 4.10, 4.40, and 4.45 would warrant a higher rating for the Veteran’s broken jaw during the rating period under consideration.  See DeLuca v. Brown, 8 Vet. App. 202, 206-07 (1995).  The evidence of record does not show that pain caused additional restriction warranting a compensable rating.
Moreover, the Veteran is competent to describe his observable symptoms, including pain, limitations in what he could eat, loss of teeth, and dentures in place. Layno v. Brown, 6 Vet. App. 465, 470 (1994).  However, to the extent that his reported symptoms were inconsistent with the objective medical evidence of record, such statements are afforded less probative value, as the Veteran does not possess the medical or orthopedic expertise to assess the severity of his jaw condition.  See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007).  As such, the Board affords the most probative weight to the objective findings contained within the VA examination report of record. 
The Board has also considered whether another potentially applicable diagnostic code would warrant an increased disability rating at any time during the period on appeal.  See Schafrath, 1 Vet. App. at 595.  Notably, the evidence of record does not document chronic osteomyelitis or osteoradionecrosis of the maxilla or mandible; complete loss of the mandible between angles; loss of approximately one half of the mandible; nonunion of the mandible; loss of whole or part of the ramus; loss of less than one half of the substance of the ramus; loss of one or both sides of the condyloid process; loss of the coronoid process; loss of half or more of the hard palate; loss of less than half of the hard palate; loss of teeth due to loss of substance of body of the maxilla or mandible without loss of continuity; loss of more than half of the maxilla; loss of half or less of the maxilla; or malunion/nonunion of the maxilla.  Therefore, consideration under the other diagnostic codes for rating dental and oral conditions does not lead to an increased rating during any portion of the appeal period.  See 38 C.F.R. § 4.150, Diagnostic Codes 9900, 9901, 9902, 9903, 9904, 9906, 9907, 9908, 9909, 9911, 9912, 9913, 9914, 9915, and 9916 (2018). 
Having carefully considered the lay and medical evidence of record, the Board finds that the preponderance of the evidence weighs against the claim of entitlement to a compensable disability rating for the Veteran’s service-connected broken jaw.  As such, there is no reasonable doubt to be resolved, and the claim must be denied.  38 U.S.C. § 5107 (2012); 38 C.F.R. §§ 3.102, 4.3; Gilbert, 1 Vet. App. at 55.
Finally, neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record.  See Doucette v. Shulkin, 28 Vet. App. 366, 369-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record).
REASONS FOR REMAND
Unfortunately, a remand is required in this case.  Although the Board sincerely regrets the additional delay, it is necessary to ensure that there is a complete record upon which to decide the Veteran’s claims so that he is afforded every possible consideration.  VA has a duty to assist claimants in obtaining evidence needed to substantiate a claim.  38 U.S.C. §§ 5107(a), 5103A (2012); 38 C.F.R. § 3.159(c) (2018).
VA is obliged to provide an examination when the record contains competent evidence that the claimant has a current disability or signs and symptoms of a current disability, the record indicates that the disability or signs and symptoms of disability may be associated with active service; and the record does not contain sufficient information to make a decision on the claim.  38 U.S.C. § 5103A(d); McLendon v. Nicholson, 20 Vet. App. 79 (2006).
1. Entitlement to service connection for a low back condition is remanded.
According to the Veteran’s May 2012 claim, he sustained injury to his low back due to multiple vehicle accidents in 1984 and 1987.  The Veteran’s service treatment records reflect injury to his low back from motor vehicle accidents and complaints of low back pain.  The Veteran’s separation examination in March 1988 did not, however, reflect a low back disability or any injuries resulting from motor vehicle accidents during service.  The Report of Medical History does note “swollen or painful joints” but does not identify whether this is referring to the low back.
As stated above, according to a March 2013 VA examination of the back, a June 2012 diagnosis of a herniated disc of L5-S1 with left S1 nerve root entrapment was noted.  The VA examiner, however, did not provide an etiological opinion.  Therefore, given the objective medical evidence of record, including the Veteran’s lay statements of injury during service and a continuity of symptomatology, a new VA examination and opinion should be obtained. 
2. Entitlement to service connection for a neck condition is remanded.
According to the Veteran’s May 2012 claim, he sustained injury to his neck due to multiple vehicle accidents in 1984 and 1987.  The Veteran’s service treatment records reflect treatment for injuries sustained from motor vehicle accidents and complaints of neck/cervical spine pain.  The Veteran’s separation examination in March 1988 did not, however, reflect a neck disability or any injuries resulting from motor vehicle accidents during service.  The Report of Medical History does note “swollen or painful joints” but does not identify whether this is referring to the neck or cervical spine.
As discussed above, according to the October 2010 VA treatment record, an MRI taken of the Veteran’s spine revealed mild degree degenerative osteoarthritis of the cervical spine.  
Here, the Veteran has not been provided with a VA examination for his neck condition.  As there is evidence of a currently diagnosed disability, an in-service event, and an indication that the current disability may be associated with the in-service event, remand for a VA examination is required.  
3. Entitlement to service connection for a right arm condition is remanded.
4. Entitlement to service connection for cervical radiculopathy of the left upper extremity is remanded.
5. Entitlement to service connection for cervical radiculopathy of the right upper extremity is remanded.
According to the Veteran’s May 2012 claim, he sustained injury to his right shoulder due to multiple vehicle accidents in 1984 and 1987.  The Veteran’s service treatment records reflect injuries from motor vehicle accidents and complaints of soreness in the arm and shoulder.  In July 1987, a provisional diagnosis of C1 compression neuropathy and cervical radiculitis was noted.  The Veteran’s separation examination in March 1988 did not, however, reflect a right shoulder or arm disability or any injuries resulting from motor vehicle accidents during service.  The Report of Medical History note “swollen or painful joints” but does not identify whether this is referring to the right shoulder or arm.
According to the VA treatment records, the Veteran was diagnosed with cervical radiculopathy for which he has brought a service connection claim and will be discussed below in this remand.  The Veteran has also reported right shoulder pain; specifically in December 2010 he was admitted to the emergency room for his pain.  Therefore, the Board finds clarification is warranted to determine the diagnosis of any right arm/shoulder disability other than cervical radiculopathy of the upper extremities and an etiological opinion.
The Veteran has not been provided with a VA examination for his right arm/shoulder condition or his cervical radiculopathy of the left and right upper extremities.  As there is evidence of a currently diagnosed disability, an in-service event, and an indication that the current disability may be associated with the in-service event, remand for a VA examination is required.  The Board also notes that the VA examiner is asked to discuss whether the Veteran has a diagnosis of a right arm/shoulder disability other than the cervical radiculopathy of the right upper extremity.
4. Entitlement to service connection for left foot pes planus is remanded.
5. Entitlement to service connection for right foot pes planus is remanded.
6. Entitlement to service connection for a left foot injury is remanded.
7. Entitlement to service connection for a right foot injury is remanded.
Regarding the Veteran’s claims for entitlement to service connection for bilateral pes planus and injury to the feet, the Board finds additional development is warranted.
On his March 1978 entrance examination for service, the Veteran was noted to have asymptomatic pes planus.  Thus, the presumption of soundness does not apply.  38 U.S.C. § 1111 (2012); 38 C.F.R. § 3.304(b) (2018).  As such, the question becomes whether the disorder was aggravated by, rather than incurred in, active service.  See 38 U.S.C. §§ 1111, 1153; 38 C.F.R. §§ 3.304, 3.306.  Therefore, a remand is warranted to obtain a VA examination addressing this question. 
As pes planus can be congenital in nature, the opinion obtained on remand should also address whether it is considered a congenital defect or disease.  If the disorder is a congenital defect, the examiner must opine as to whether there was a superimposed disease or injury during service that resulted in additional disability.  See VAOPGCPREC 82-90 (July 18, 1990); see also Quirin v. Shinseki, 22 Vet. App. 390, 394 (2009).
Furthermore, according to the Veteran’s claim the left and right foot injuries resulted from multiple vehicle accidents in 1984 and 1987.  The Veteran’s service treatment records reflect complaints of pain in the feet and heels.  Specifically, in December 1979, the Veteran reported dropping a spring from a truck on his left foot.  An x-ray however, did not show evidence of a fracture.  
Given the reported of pain in the feet and heels during his military service, a diagnosis of pes planus, and statements of ongoing disability resulting from injury to the feet, the Board finds a new VA examination is necessary to clarify any diagnosis of disability of the feet (and whether it is separate from the Veteran’s bilateral pes planus) and provide an etiological opinion.  
8. Entitlement to service connection for GERD is remanded.
The Veteran claims is GERD is a result of his military service.  Service treatment records indicate the Veteran reported pain in the abdomen, a burning feeling in his stomach, nausea, and some regurgitation.  However, the March 1988 Report of Medical Examination and Report of Medical History is negative for stomach conditions or frequent indigestion. 
According the Veteran’s VA treatment records, a diagnosis of GERD was made in February 2006.
Here, the Veteran has not been provided with a VA examination for GERD.  As there is evidence of a currently diagnosed disability, complaints of possible symptoms related to GERD made during his military service, and an indication that the current disability may be associated with the in-service event, remand for a VA examination is required.  
The matters are REMANDED for the following action:
1.	Copies of updated treatment records should be obtained and added to the claims file.
2.	Once all outstanding records, if any, have been obtained and associated with the record, schedule the Veteran for a VA examination before an appropriate clinician to determine the nature and etiology of any diagnosed low back and neck conditions.  The Veteran’s claims file must be made available to and reviewed by the VA examiner, who must state in his/her report that such was reviewed in conjunction with this examination. 
Thereafter, the VA examiner must present the diagnosis or diagnoses, if any, that specifically describe(s) any disabling condition affecting the Veteran’s low back and neck.
The VA examiner should then provide nexus opinions, presented in the context of the medical record, with complete supportive rationales, addressing the following questions:
a.	Does the Veteran have a diagnosed low back and neck condition, including herniated disc of L5-S1 with left S1 nerve root entrapment and mild degenerative osteoarthritis of the cervical spine?  
b.	If so, then, is it at least as likely as not (50 percent or greater probability) that the diagnosed low back and neck condition revealed on examination had its/their onset during active military service or is/are otherwise related thereto, include whether caused or aggravated by any service-connected disability.
All tests and studies deemed appropriate should be performed.  A rationale for the requested opinions shall be provided.  Additionally, the VA examiner should consider and comment on the Veteran’s in-service treatment records, VA treatment records (including all prior pertinent VA Compensation and Pension examination records), and private treatment records.  The VA examiner should also discuss the Veteran’s lay statements regarding history and chronicity of symptomatology when discussing the offered opinions.
If the VA examiner cannot provide an opinion without resorting to mere speculation, he/she shall provide a complete explanation stating why this is so.  In so doing, the VA examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information or that he/she has exhausted the limits of current medical knowledge in providing an answer to the particular question.
3.	Once all outstanding records, if any, have been obtained and associated with the record, schedule the Veteran for a VA examination before an appropriate clinician to determine the nature and etiology of any diagnosed right arm/shoulder condition (other than cervical radiculopathy) and cervical radiculopathy of the left upper extremity and right upper extremity.  The VA examiner must determine whether the Veteran has a right arm/shoulder disorder separate cervical radiculopathy.  The Veteran’s claims file must be made available to and reviewed by the VA examiner, who must state in his/her report that such was reviewed in conjunction with this examination. 
The VA examiner should address each diagnosed right arm/shoulder condition and cervical radiculopathy of the left upper extremity and right upper extremity and opine as to whether it is at least as likely as not (50 percent or greater probability) that such disorder is of service onset or is otherwise related to the Veteran’s active service, to include whether it is caused or aggravated by a service-connected disability. 
All tests and studies deemed appropriate should be performed.  A rationale for the requested opinions shall be provided.  Additionally, the VA examiner should consider and comment on the Veteran’s in-service treatment records, VA treatment records (including all prior pertinent VA Compensation and Pension examination records), and private treatment records.  The VA examiner should also discuss the Veteran’s lay statements regarding history and chronicity of symptomatology when discussing the offered opinions.
If the VA examiner cannot provide an opinion without resorting to mere speculation, he/she shall provide a complete explanation stating why this is so.  In so doing, the VA examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information or that he/she has exhausted the limits of current medical knowledge in providing an answer to the particular question.
4.	Once all outstanding records, if any, have been obtained and associated with the record, schedule the Veteran for a VA examination before an appropriate clinician to determine the nature and etiology of his bilateral pes planus and any diagnosed foot injuries (other than pes planus).  The Veteran’s claims file must be made available to and reviewed by the VA examiner, who must state in his/her report that such was reviewed in conjunction with this examination. 
Regarding the Veteran’s pes planus, the VA examiner should address the following:
a.	The examiner should explain whether it is a congenital or developmental disease, a congenital or developmental defect, or a disorder not of congenital or developmental origin.
The examiner should note that a disease generally refers to a condition that is considered capable of improving or deteriorating while a defect is generally not considered capable of improving or deteriorating.
b.	If the pes planus is determined to be a congenital or developmental defect, opine as to whether it is at least as likely as not (50 percent or greater probability) that there was a superimposed disease or injury that occurred during service and resulted in additional disability.
c.	If the pes planus is determined to be a congenital or developmental disease or a disorder not of congenital/developmental origin, opine as to whether there is clear and unmistakable evidence that the pes planus was not aggravated (permanently worsened beyond the normal progress of the disease) by the Veteran’s active service, to include the Veteran’s fracture of the right fibular malleolus.
d.	If the examiner determines that the pes planus was aggravated by the Veteran’s active service, the examiner should render an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the aggravation in service is related to his current pes planus. The examiner must explain the rationale for all opinions, citing to supporting factual data and medical literature, as appropriate.
Regarding the Veteran’s injuries of the feet, the VA examiner should address whether each diagnosed disorder other than pes planus, is at least as likely as not (50 percent or greater probability) that such disorder was incurred in or is otherwise related to the Veteran’s active service, include whether it is caused or aggravated by a service-connected disability.
All tests and studies deemed appropriate should be performed.  A rationale for the requested opinions shall be provided.  Additionally, the VA examiner should consider and comment on the Veteran’s in-service treatment records, VA treatment records, and private treatment records.  Furthermore, the VA examiner should also discuss the Veteran’s lay statements regarding history and chronicity of symptomatology when discussing the offered opinions.
If the VA examiner cannot provide an opinion without resorting to mere speculation, he/she shall provide a complete explanation stating why this is so.  In so doing, the VA examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information or that he/she has exhausted the limits of current medical knowledge in providing an answer to the particular question.
5.	Once all outstanding records, if any, have been obtained and associated with the record, schedule the Veteran for an appropriate VA examination by an appropriate clinician to determine the etiology of his claimed GERD.

The VA examiner must clarify the diagnosis and must determine whether it is at least as likely as not (50 percent or greater probability) that the GERD is etiologically related to any incidents of the Veteran’s period of active service or otherwise related thereto.

All testing deemed necessary by the VA examiner should be performed and the results reported in detail.  The VA examiner should obtain a complete and detailed lay history from the Veteran.  The VA examiner is also asked to review and comment on the Veteran’s service treatment records and any post-service treatment when formulating an opinion.  A complete rationale for any opinions expressed should be provided.  The claims folder must be available for review by the VA examiner in conjunction with the examination and this fact should be acknowledged in the report.

If an opinion cannot be expressed without resort to speculation, discuss why such is the case. In this regard, indicate whether the inability to provide a definitive opinion is due to a need for further information or because the limits of medical knowledge have been exhausted regarding the etiology of the disability at issue or because of some other reason.

 
BARBARA B. COPELAND
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	H. Yoo, Counsel