Citation Nr: 18159531 Decision Date: 12/19/18 Archive Date: 12/19/18 DOCKET NO. 16-50 888 DATE: December 19, 2018 ORDER The appeals of entitlement to service connection for disabilities of the left arm, right arm, right elbow, left wrist, right wrist, left hip, right hip, right knee, and left ankle; for entitlement to higher disability ratings for the left knee disability, headaches, cervical spine degenerative disc disease, and kidney stones; and for entitlement to earlier effective dates for the award of service connection for the left knee disability, headaches, cervical spine degenerative disc disease, and kidney stones are dismissed. Entitlement to service connection for bilateral hearing loss is denied. Entitlement to service connection for tinnitus is denied. Entitlement to service connection for sleep apnea is denied. Entitlement to service connection for left heel spur is denied. Entitlement to service connection for residuals of a left elbow injury is denied. Entitlement to service connection for depressive disorder is granted. Entitlement to service connection for post-traumatic stress disorder (PTSD) is denied. Entitlement to an earlier effective date for the grant of service connection for bilateral plantar fasciitis is denied. Entitlement to a 20 percent disability rating, but not higher, for bilateral plantar fasciitis is granted. REMANDED Entitlement to service connection for a right ankle disability is remanded. Entitlement to a disability rating in excess of 20 percent for the thoracolumbar spine degenerative disc disease is remanded. Entitlement to a disability rating in excess of 20 percent for radiculopathy of right lower extremity (sciatic nerve) is remanded. Entitlement to a disability rating in excess of 20 percent for radiculopathy of left lower extremity (sciatic nerve) is remanded. Entitlement to a disability rating in excess of 20 percent for radiculopathy of left lower extremity (femoral nerve) is remanded. Entitlement to an earlier effective date for the grant of service connection for thoracolumbar spine degenerative disc disease is remanded. Entitlement to an earlier effective date for the grant of service connection for radiculopathy of right lower extremity (sciatic nerve) is remanded. Entitlement to an earlier effective date for the grant of service connection for radiculopathy of left lower extremity (sciatic nerve) is remanded. Entitlement to an earlier effective date for the grant of service connection for radiculopathy of left lower extremity (femoral nerve) is remanded. FINDINGS OF FACT 1. On November 14, 2016, prior to the promulgation of a decision by the Board, the Veteran indicated that he did not wish to continue the appeal as to the claims for service connection for a left arm, right arm, right elbow, left wrist, right wrist, left hip, right hip, right knee, and left ankle disabilities; entitlement to higher disability ratings for the left knee disability, headaches, cervical spine degenerative disc disease, and kidney stones, and entitlement to earlier effective dates for the award of service connection for the left knee disability, headaches, cervical spine degenerative disc disease, and kidney stones. 2. The Veteran was exposed to acoustic trauma while serving on active duty. 3. The Veteran’s bilateral hearing loss first manifested many years after service separation, and is not related to exposure to acoustic trauma during his period of active service or to other injury, disease, or event in active service, and is not otherwise etiologically related to active duty for training (ACDUTRA) or inactive duty for training (INACDUTRA). 4. The Veteran’s tinnitus first manifested after service separation, and is not related to exposure to acoustic trauma during his period of active service or to other injury, disease, or event in active service, and is not otherwise etiologically related to a period of ACDUTRA or INACDUTRA. 5. The Veteran’s sleep apnea first manifested many years after service separation, and is not related to injury, disease, or event in active service, and is not otherwise etiologically related to a period of ACDUTRA or INACDUTRA. 6. The Veteran’s left heel spur did not manifest in service and is not related to injury, disease, or event in active service, and is not otherwise etiologically related to a period of ACDUTRA or INACDUTRA. 7. The Veteran’s left elbow disability is not related to injury, disease, or event in active service, and is not otherwise etiologically related to a period of ACDUTRA or INACDUTRA. 8. It is as likely as not that the Veteran’s depressive disorder not otherwise specified is proximately due to the service-connected the thoracolumbar spine disability and associated radiculopathy of the lower extremities, the cervical spine disability, and the left knee disability. 9. The Veteran does not meet the criteria for a diagnosis of PTSD. 10. The Veteran first filed a claim seeking entitlement to service connection for bilateral plantar fasciitis on March 30, 2012 for which service connection was ultimately granted. 11. Prior to March 30, 2012, there was no pending formal claim, informal claim, or written intent to file a claim for service connection for a foot disability. 12. The service-connected bilateral plantar fasciitis is manifested by pain on use, pain accentuated on use, and pain on manipulation of the right foot; an indication of swelling and extreme tenderness of the plantar surface of the right foot; and improvement and relief of the symptoms by orthopedic shoes or appliances which is productive of severe unilateral disability; and the weight of the evidence does not show bilateral severe disability or pronounced unilateral or bilateral disability, marked pronation, or marked inward displacement and severe spasm of the tendo achilles on manipulation without improvement with orthopedic shoes or appliances. CONCLUSIONS OF LAW 1. The criteria for the withdrawal of the Substantive Appeal as to the appeal of the claims for service connection for a left arm, right arm, right elbow, left wrist, right wrist, left hip, right hip, right knee, and left ankle disabilities; entitlement to higher disability ratings for the left knee disability, headaches, cervical spine degenerative disc disease, and kidney stones, and entitlement to earlier effective dates for the award of service connection for the left knee disability, headaches, cervical spine degenerative disc disease, and kidney stones have been met. 38 U.S.C. § 7105 (b)(2), (d)(5) (2012); 38 C.F.R. § 20.204 (2018). 2. The criteria for the establishment of service connection for bilateral hearing loss are not met. 38 U.S.C. §§ 101, 1101, 1110, 1112, 1113, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.307, 3.309, 3.385 (2018). 3. The criteria for service connection for tinnitus are not met. 38 U.S.C. §§ 101, 1110, 1112, 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.310 (2018). 4. The criteria for service connection for sleep apnea are not met. 38 U.S.C. §§ 101, 1110, 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310 (2018). 5. The criteria for service connection for left heel spur are not met. 38 U.S.C. §§ 101, 1110, 1112, 1131, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.310 (2018). 6. The criteria for service connection for a left elbow disability are not met. 38 U.S.C. §§ 101, 1110, 1112, 1131, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.310 (2018). 7. Affording the Veteran the benefit of doubt, the criteria for service connection for depressive disorder not otherwise specified are met. 38 U.S.C. §§ 101, 1110, 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310 (2018). 8. The criteria for service connection for PTSD are not met. 38 U.S.C. §§ 101, 1110, 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304 (2018). 9. The criteria for the assignment of an earlier effective date for the grant of service connection for bilateral plantar fasciitis have not been met. 38 U.S.C. §§ 5107, 5110 (2012); 38 C.F.R. §§ 3.1, 3.102, 3.400 (2018). 10. The criteria for an initial 20 percent disability rating for bilateral plantar fasciitis have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.10, 4.20, 4.40, 4.45, 4.59, 4.63, 4.68, 4.71a, Diagnostic Codes 5276 to 5283, 5284 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from May 1977 to July 1989, from March 2003 to June 2003, and from June 7, 2004 to July 15, 2004. The Veteran also had service in the Reserve until 2011. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from rating decisions dated in October 2013 and June 2015 of the Department of Veterans Affairs (VA) Regional Office (RO) in Muskogee, Oklahoma. Entitlement to TDIU was granted from March 30, 2012. See the February 2018 rating decision. In November 2016, the Veteran submitted a waiver of agency of original jurisdiction (AOJ) consideration of new evidence pursuant to 38 C.F.R. § 20.1304 (2018). In an unappealed December 2003 rating decision, service connection for a left elbow disability was denied. In an unappealed November 2009 rating decision, service connection for bilateral hearing loss, tinnitus, sleep apnea, and a left heel spur was denied. The Veteran filed claims to reopen service connection for these disabilities in November 2011 and March 2012. However, on thorough review, the Board finds that the provisions of 38 C.F.R. § 3.156 (c) must be applied in this case. 38 C.F.R. § 3.156 (c) provides that, at any time after VA receives or associates with the claims file relevant official service department records that existed and had not been associated with the claims file when VA first decided the claim, VA will reconsider the claim notwithstanding the requirements of 38 C.F.R. § 3.156 (a) (which defines new and material evidence). When this claim was pending, service personnel records and service treatment records that existed but were not part of the record at the time of the December 2003 and November 2009 rating decisions were associated with the file; these records were associated with the file in July 2013 and April 2017. These records are relevant to the claims for service connection and pertain to the Veteran’s time period in active service. Thus, the earlier rating decisions, accordingly, are not considered to be final for the purposes of the current appeal. The Board finds that 38 C.F.R. § 3.156 (c) applies, and the claim for service connection for a left elbow disability, hearing loss, tinnitus, sleep apnea, and left heel spur must be reconsidered. The Board notes that these issues were considered on the merits on the February 2018 statement of the case. 1. Withdrawn Appeals The appeals for the claims for service connection for a left arm, right arm, right elbow, left wrist, right wrist, left hip, right hip, right knee, and left ankle disabilities; entitlement to higher disability ratings for the left knee disability, headaches, cervical spine degenerative disc disease, and kidney stones, and entitlement to earlier effective dates for the award of service connection for the left knee disability, headaches, cervical spine degenerative disc disease, and kidney stones are dismissed. The Board has jurisdiction where there is a question of law or fact on appeal to the Secretary. 38 U.S.C. § 7104 (2012); 38 C.F.R. § 20.101 (2018). Under 38 U.S.C. § 7105, the Board may dismiss any appeal that fails to allege specific error of fact or law in the determination being appealed. A Substantive Appeal may be withdrawn in writing or on the record at a hearing at any time before the Board promulgates a decision. Withdrawal may be made by the Veteran or by his authorized representative. 38 C.F.R. § 20.204. On November 14, 2016, prior to the promulgation of a decision by the Board, the Veteran indicated in writing that he did not wish to continue the appeal as to the claims for service connection for a left arm, right arm, right elbow, left wrist, right wrist, left hip, right hip, right knee, and left ankle disabilities; entitlement to higher disability ratings for the left knee disability, headaches, cervical spine degenerative disc disease, and kidney stones, and entitlement to earlier effective dates for the award of service connection for the left knee disability, headaches, cervical spine degenerative disc disease, and kidney stones. The Board finds that the Veteran’s withdrawal was explicit, unambiguous, and done with a full understanding of the consequences of such action on his part. Accordingly, the appeals are dismissed. 2. Service Connection In order to establish service connection, the facts, as shown by evidence, must demonstrate that a disease or injury resulting in current disability was incurred during service or, if pre-existing active service, was aggravated therein. 38 U.S.C. § 1110. Service connection may also be granted for a disability initially diagnosed after service when all of the evidence shows it to have been incurred in service. 38 C.F.R. § 3.303 (d) (2018). Service connection requires competent evidence showing: (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. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Where a veteran served ninety days or more of active service, and certain chronic diseases, such as arthritis, or an organic disease of the nervous system to include sensorineural hearing loss and tinnitus become manifest to a degree of 10 percent or more within one year after the date of separation from such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309(a). 38 C.F.R. § 3.303 (b) applies to the “chronic diseases” under 38 C.F.R. § 3.309 (a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Claims for disability compensation benefits comprise five elements: (1) Veteran status, (2) present disability, (3) service connection, (4) degree of disability, and (5) effective date of the disability. See D’Amico v. West, 209 F.3d 1322, 1326 (Fed. Cir. 2000). To obtain veteran status, a claimant must prove that he or she is a “veteran” for VA purposes, defined in relevant part as “a person who served in the active military, naval, or air service” and who was discharged or released under conditions other than dishonorable. 38 U.S.C. § 101 (2) (2012). Active military, naval, or air service includes any period of ACDUTRA during which the individual concerned was disabled or died from a disease or injury incurred in or aggravated in line of duty, or any period of INACDUTRA during which the individual concerned was disabled or died from injury incurred in or aggravated in line of duty. 38 U.S.C. § 101 (21), (24) (2012); 38 C.F.R. § 3.6 (a), (d) (2017); Biggins v. Derwinski, 1 Vet. App. 474 (1991). ACDUTRA is, generally, full-time duty in the Armed Forces performed by reserve for training purposes. 38 C.F.R. § 3.6 (c)(1) (2018). In other words, when a claim is based on a period of Reserve or National Guard service, it must be shown that the individual concerned became disabled (or died) as a result of a disease or injury incurred or aggravated in the line of duty on Reserve ACDUTRA/INACDUTRA or during Federalized National Guard service. Generally, the regulations concerning presumptive service connection, the presumption of soundness, and the presumption of aggravation are inapplicable to claims based upon ACDUTRA service. See Smith v. Shinseki, 24 Vet. App. 40 (2010); but see Hill v. McDonald, 28 Vet. App. 243, 250 (2016) (“once a claimant has achieved veteran status for a single disability incurred or aggravated during a period of ACDUTRA, veteran status applies to all disabilities claimed to have been incurred or aggravated during that period of ACDUTRA”). Service connection can be granted for a disability that is proximately due to or the result of by a service-connected disability. 38 C.F.R. 3.310; Allen v. Brown, 7 Vet. App. 439 (1995). When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. 38 C.F.R. 3.310 (a). Service connection can be granted for a disability that is aggravated by a service-connected disability. Compensation can be paid for any additional impairment resulting from the service-connected disability. 38 C.F.R. 3.310; Allen v. Brown, 7 Vet. App. 439 (1995). Except as provided in 38 C.F.R. 3.300 (c) (claims for secondary service connection based on the effects of tobacco products received after June 9, 1998), disability which is proximately due to or the result of a service-connected disease or injury shall be service connected. When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. 38 C.F.R. 3.310 (a). Any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease, will be service connected. 38 C.F.R. 3.310 (b). Once the evidence has been assembled, it is the Board’s responsibility to evaluate the evidence. 38 U.S.C. § 7104(a). The Secretary shall consider all information and lay and medical evidence of record in a case before the Secretary with respect to benefits under laws administered by the Secretary. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.102, 4.3. 3. Entitlement to service connection for bilateral hearing loss and tinnitus is denied. Service connection for impaired hearing shall only be established when hearing status as determined by audiometric testing meets specified pure tone and speech recognition criteria. Audiometric testing measures puretone threshold hearing levels (in decibels) over a range of frequencies (in hertz). Hensley v. Brown, 5 Vet. App. 155, 158 (1993). The determination of whether a veteran has a disability based on hearing loss is governed by 38 C.F.R. § 3.385. For the purposes of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, or 4000 hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. The Veteran contends that he incurred hearing loss and tinnitus as a result of noise exposure during service. The Veteran was in the Navy in anti-submarine warfare from 1977 to 1989. He was not involved in combat but was exposed to steam catapults, flight line, helicopter and jet engine noise with the use of hearing protection. The Veteran was in the Navy Reserves from 1991 to 1997 as an IT specialist. He returned to service in the Navy from 2001 to 2003 as an IT specialist but was a Master of Arms on the firing range every 3 months while using hearing protection. He switched to Army Reserves in 2003 to present as a truck driver instructor and was exposed to diesel engines and air horns while using hearing protection. The Veteran reported that the tinnitus began five years earlier and it was greater in the right ear. See the October 2009 VA audiometric examination report. The Board finds that the Veteran is competent to describe firsthand events such as being exposed to loud noise. The Veteran’s service records support the Veteran’s statement of noise exposure and show that he underwent audiometric evaluation due to hazardous noise exposure. For these reasons, the in-service noise exposure is established. The Board finds that the weight of the competent and credible evidence establishes that the Veteran has bilateral hearing loss as defined by 38 C.F.R. § 3.385. The findings of the October 2009 VA audiometric examination show that the Veteran meets the requirements of 38 C.F.R. § 3.385 for both ears. The VA examination report also shows a diagnosis of tinnitus. Subsequent VA treatment records show a diagnosis of tinnitus. However, the Board finds that the weight of the competent and credible evidence establishes that the Veteran’s hearing loss and tinnitus did not manifest in service but first manifested years after service separation, are not caused by an in-service event or injury and are not related to active service, ACDUTRA, or INACDUTRA. As noted, the Veteran served on active duty from May 1977 to July 1989 and from March 2003 to June 2003 and from June 7, 2004 to July 15, 2004. He served in the Reserve from 1990 to 2011. Service treatment records for active duty service and Reserve service do not document complaints or diagnosis of hearing loss as defined by VA regulations or tinnitus. Service examinations in March 1977 (enlistment exam), March 1979, May 1979, April 1982, February 1983, June 1984, January 1985, and February 1992 show that examination of the ears was normal. Audiometric examinations showed normal hearing for VA purposes. There was no diagnosis of hearing loss or tinnitus. At the examinations, the Veteran denied hearing loss or any ear trouble. Service records show that the Veteran was afforded periodic audiograms during his first period of active duty. He was afforded a reference audiogram in September 1981 due to hazardous noise exposure. He was given additional audiograms in November 1981, January 1983, November 1985, May 1989, and September 1987. The audiograms did not show hearing loss as defined by VA regulations. The reports all indicate that there was no significant threshold shift. Reserve enlistment exams dated in September 1990 and January 2002 indicate that the Veteran denied having ear trouble or hearing loss. Examination of the ears was normal. Audiograms were not performed. A March 2002 audiogram does not show hearing loss as defined by VA regulations. A March 2003 pre-deployment health assessment indicates that the Veteran denied having medical problems and he stated that he was in excellent health. A June 2003 post deployment health assessment indicates that the Veteran denied having ringing in the ears. He stated that his health in general was very good. The Veteran was afforded a VA audiometric examination in October 2009. The VA audiologist opined that it was less likely than not (less than 50/50 probability) that the Veteran’s hearing loss and tinnitus were caused by or a result of acoustic trauma in active service. The VA audiologist indicated that after carefully reviewing the claims file and the medical literature, it was his opinion that the Veteran’s hearing loss and tinnitus were less likely as not caused by or a result of acoustic trauma. The VA audiologist noted that the Veteran’s hearing at entrance in 1977 and at separation in 1989 was within normal limits bilaterally. The Veteran was called back into active duty for a 3-month deployment without actual combat noise exposure in 2003. The VA audiologist noted that the Veteran’s post-deployment health assessment dated June 6, 2003, the Veteran check-marked “no” to having ringing in his ears, and in March of 2002, he had his final audiogram on record and it revealed hearing within normal limits 500-4000 Hz bilaterally. The VA audiologist noted that the Veteran’s current audiometric configuration is not consistent with acoustic trauma. The VA audiologist further noted that one cannot rule contributions from his recreational noise exposure and aging when evaluating his current degree of hearing loss, and the Veteran was not able to correlate the onset of his tinnitus to a particular incident from his tour of duty and states that its onset was 15 years after his separation from active duty in 1989. The VA audiologist therefore concluded that he could not be more than 50 percent certain that the Veteran’s tinnitus or his hearing loss were a result of, or caused by, military acoustic trauma. The Board finds that the 2009 VA medical opinion to be highly probative since the examiner reviewed the claims folder, considered the Veteran’s report of symptoms, examined the Veteran, and provided medical conclusions based upon these findings. See Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998); see also Prejean v. West, 13 Vet. App. 444, 448-9 (2000). The medical opinion is based on sufficient facts and data. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). As an audiologist, the VA examiner has the expertise to render an opinion as to etiology and onset of hearing loss and tinnitus. Black v. Brown, 10 Vet. App. 279, 284 (1997). The Board finds that the weight of the competent and credible evidence establishes that the Veteran’s hearing loss and tinnitus first manifested many years after active service and are not related to disease, injury, or other event in active service, or ACDUTRA, or INACDUTRA. The earliest evidence of a bilateral hearing loss disability as defined by VA regulations was shown on VA audiometric examination in October 2009, six years after the Veteran’s last period of active duty. The passage of time between the Veteran’s discharge and an initial diagnosis for the claimed disorder is one factor that weighs against the Veteran’s claim. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). The Board finds that the weight of the competent and credible evidence does not establish continuous or recurrent symptoms of hearing loss and tinnitus in active service and after service separation. The service treatment records do not document complaints or symptoms of tinnitus and hearing loss. The Veteran does not provide lay evidence of such chronic symptoms in active service and since active service. The Board finds that the weight of the competent and credible lay and medical evidence establishes that the Veteran did not have chronic and recurrent hearing loss and tinnitus symptoms in service and since service. The weight of the evidence does not establish a diagnosis of hearing loss and tinnitus manifest to a degree of 10 percent or more within one year of service separation in July 1989 or June 2003. At the VA audiometric examination in October 2009, the veteran reported an onset of tinnitus five years prior. The Board finds that this is not sufficient evidence to support a finding of tinnitus manifest to a degree of 10 percent or more within one year of service separation in June 2003. The lay evidence provided by the Veteran is too general and lacks detail. Thus, service connection under 38 C.F.R. §§ 3.303 (b) and 3.309(a) is not warranted. The Veteran himself has asserted that the hearing loss and tinnitus are related to active service. As to the specific issue in this case, an opinion as to medical causation of hearing loss or tinnitus falls outside the realm of common knowledge of a lay person. The evidence does not establish that the Veteran has medical expertise. Thus, the Board finds that Veteran is not competent to provide an opinion as to etiology of hearing loss or tinnitus. The Veteran has not submitted any competent evidence to support his assertions. The Board finds that the VA medical opinions are competent and credible, and have more probative weight than the Veteran’s own lay statements as to causation. The Board has considered whether the Veteran’s hearing loss and tinnitus arose during a period of ACDUTRA or was caused by an injury during a period of INACDUTRA. As discussed above, the Veteran’s service records do not show that the Veteran complained of or received treatment for symptoms of hearing loss or tinnitus at any point during any period of ACDUTRA or INACDUTRA. The Veteran’s service records do not show a diagnosis of hearing loss or tinnitus during any period of ACDUTRA. The Board concedes that the Veteran experienced in-service acoustic trauma during that period of ACDUTRA. However, the weight of the competent and credible evidence establishes that the hearing loss and tinnitus are not related to disease or injury in ACDUTRA or INACDUTRA. See the October 2009 VA medical opinion. Accordingly, the doctrine of the benefit of the doubt is not for application and the Veteran’s claim for service connection for bilateral hearing loss and tinnitus must be denied. The Veteran’s claims are denied. 4. Entitlement to service connection for sleep apnea, left heel spur, and a left elbow disability is denied. Based upon a review of all the lay and medical evidence, the Board finds the weight of the competent and credible evidence shows that the Veteran does not have sleep apnea that is related to injury, disease, or other event in active service. Service treatment records show no treatment or diagnosis of sleep apnea. The Veteran filed the initial claim for service connection for sleep apnea in April 2009. The record shows that sleep apnea was first diagnosed by sleep study in November 2015. The Board notes that the passage of time between the Veteran’s discharge and an initial diagnosis for the claimed disorder is one factor that weighs against the Veteran’s claim. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). The weight of the competent and credible evidence establishes that the sleep apnea first manifested many years after active duty. There is no indication of an association between the sleep apnea and an injury or other event in active service, or disease or injury in ACDUTRA or injury in INACDUTRA. The Veteran himself has related his sleep apnea to his period of active service. The Veteran, as a lay person, is competent to describe observable symptoms. See Layno v. Brown, 6 Vet. App. 465 (1994). 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 issue in this case, an opinion as to the etiology and cause of sleep apnea falls outside the realm of common knowledge of a lay person. Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007). Some medical issues require specialized training for a determination as to diagnosis and causation, and such issues are therefore not susceptible of lay opinions on etiology. It is not shown that the Veteran has medical expertise to perform such testing and render a medical diagnosis. The Veteran has not provided or identified any medical evidence to support his contentions that the sleep apnea is related to active service. A VA medical opinion and examination were not provided for this issue. The Federal Circuit Court of Appeals (Federal Circuit) has recognized that there is not a duty to provide an examination in every case. See Waters v. Shinseki, 601 F.3d 1274 (Fed. Cir. 2010). Rather, the Secretary’s obligation under 38 U.S.C. § 5103A (d) to provide the Veteran with a medical examination or to obtain a medical opinion is not triggered unless there is an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the Veteran’s service or with another service-connected disability. See McLendon v. Nicholson, 20 Vet. App.79, 81 (2006). The Board finds that such an examination is not necessary to render a decision under the circumstances of this case. There is no indication of an association between sleep apnea and service. The record in this case is negative for any indication, other than the Veteran’s own general assertions, that the sleep apnea is related to service. Neither the Veteran nor his representative has produced competent evidence which indicates that there is an association between the sleep apnea and service. As such, the Board finds the weight of the competent and credible evidence shows that sleep apnea did not manifest in service, first manifested many years after active service and is not related to active service. The weight of the competent and credible evidence establishes that the sleep apnea is not related to disease or injury in ACDUTRA or INACDUTRA. Thus, the Board finds that a preponderance of the lay and medical evidence that is of record weighs against the claim for service connection for sleep apnea and the claim for service connection for sleep apnea is denied. Based upon a review of all the lay and medical evidence, the Board finds the weight of the competent and credible evidence shows that the Veteran’s claimed left elbow disability is not related to injury, disease, or other event in active service. Service treatment records for the first period of active service show no treatment or diagnosis of a left elbow disability. The Veteran separated from active service in July 1989 and he served in the Reserve until 2001 with a period of active duty from March 2003 to June 2003 and from June 7, 2004 to July 15, 2004. The evidence of record shows that the Veteran sustained an injury to the left elbow in 1990 or 1991. A November 1991 Annual Certification of Physical Condition dated in November 1991 indicates that the Veteran reported “yes” when asked if he had an injury or illness or disease within the past 12 months which required hospitalization and caused him to be absent from work or hospitalization for more than 3 consecutive days. It was noted that the Veteran had a chip fracture of the left elbow ulnar side with a 15-degree flexion contracture and he was okay to do work. A February 1992 Reserve examination report indicates that Veteran reported having a painful shoulder or elbow after falling out of a hay loft one year ago. Examination revealed history of ulnar nerve secondary to trauma from a fall. The evidence does not show and the Veteran does not allege that this injury occurred in active service or on ACDUTRA or INACDUTRA. A November 2013 VA treatment record notes symptoms of left elbow pain. An August 2015 VA primary care note indicates that the Veteran had no edema or deformity of left elbow, and he had full range of motion including pronation/supination without pain. The weight of the competent and credible evidence establishes that the left elbow injury occurred when the Veteran was not on active duty, ACDUTRA, and INACDUTRA. There is no indication of an association between the left elbow symptoms and to injury or disease or other event on active duty or injury or disease on ACDUTRA or injury on INACDUTRA. The Veteran himself has related his claimed left elbow disability to his period of service. The Veteran, as a lay person, is competent to describe observable symptoms. See Layno; supra. However, the medical evidence of record which is contemporaneous to the time of the left elbow injury does not supports the Veteran’s contentions that the left elbow injury occurred in active duty or on ACDUTRA or INACDUTRA. Further, although lay persons are competent to provide opinions on some medical issues, see Kahana, supra, as to the specific issue in this case, an opinion as to the etiology and cause of a left elbow disability falls outside the realm of common knowledge of a lay person. It is not shown that the Veteran has medical expertise to perform such testing and render a medical diagnosis as to the elbow or other joint. The Veteran has not provided or identified any medical evidence to support his contentions that he has a left elbow disability that is due to an injury in active duty, ACDUTRA, or INACDUTRA. A VA medical opinion and examination were not provided for this issue. The Board finds that such an examination is not necessary to render a decision under the circumstances of this case. There is no indication of an association between the left elbow symptoms and service. The record in this case is negative for any indication, other than the Veteran’s own general assertions, that the left elbow symptoms are related to service. The weight of the evidence establishes that the left elbow injury in the early 1990’s did not occur on active duty or during ACDUTRA or INACDUTRA. The Board finds that the Secretary’s obligation under 38 U.S.C. § 5103A (d) to provide the Veteran with a medical examination or to obtain a medical opinion is not triggered. See Waters v. Shinseki, 601 F.3d 1274 (Fed. Cir. 2010). As such, the Board finds the weight of the competent and credible evidence shows that the Veteran did not incur a left elbow injury on active duty or during ACDUTRA or INACDUTRA; a left elbow disability did not manifest in service and is not related to active service; and is not related to disease or injury in ACDUTRA or INACDUTRA. Thus, the Board finds that a preponderance of the lay and medical evidence that is of record weighs against the claim for service connection for a left elbow disability and the claim for service connection for sleep apnea is denied. Regarding service connection for a left heel spur, there is competent and credible evidence of a current diagnosis of a left heel spur. See the August 2013 VA examination report. The Board finds that while there is evidence of a current diagnosis, the preponderance of the evidence weighs against finding that this disability began during active service or is otherwise related to an injury, event, or disease in active service, or is otherwise related to an injury or disease in ACDUTRA, or an injury in INACDUTRA. Service records do not show a left heel spur diagnosis during active duty or during ACDUTRA. The record shows a diagnosis of a left heel spur in May 2004. However, the evidence of record shows that the Veteran served on active duty from June 7, 2004 to July 15, 2004. The Veteran underwent a VA examination in August 2013. The Veteran reported that the onset of the left heel spur symptoms was in 2009 and he noted pain in the left heel. The VA examiner noted that the Veteran sustained an injury to the left foot in February 1985 when the left foot was struck by a piece of metal and the Veteran experienced pain. Examination at that time was negative and there was no diagnosis. The VA examiner also noted that the Veteran had left foot sprain in July 1977 in service. The VA examiner opined that the left heel spur was less likely than not incurred in or caused by the claimed in-service injuries because the left heel spur was a bony overgrowth that can occur without preceding trauma and it was less likely than not that trauma to the metatarsal joints would cause a spur to the heel. The Board finds that the VA medical opinion to be probative because the VA examiner reviewed the Veteran’s claims file and medical history, considered the Veteran’s lay statements, and provided a rationale for the opinion. The Board finds that the opinion is based upon sufficient facts and data and is probative. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The weight of the competent and credible evidence establishes that the current left heel spur is not related to any documented event or incident or injury of active service, or an injury, event, or disease in ACDUTRA, or an injury in INACDUTRA. There is no indication of an association between the claimed left heel spur and service. The Board acknowledges that the Veteran is competent to report his symptoms and observations. The Veteran has related his claimed left heel spur to service. However, the Veteran is not competent as a layperson to provide an opinion as to the etiology and onset of a foot or bone disability. Jandreau; supra. Neither the Veteran nor his representative has produced a medical opinion or identified medical evidence that establishes a medical nexus between the claimed disability and service. There is no competent evidence that indicates an association between the disorder and any documented event or injury of service. Accordingly, on this record, the evidence is found to preponderate against the claim for service connection for a left heel spur. Therefore, service connection is denied. Because the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 5. Entitlement to service connection for PTSD is denied. Service connection for PTSD requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125 (a); a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred. If the evidence establishes that a veteran engaged in combat with the enemy and the claimed stressor is related to that combat, in the absence of clear and convincing evidence to the contrary, and provided that the claimed stressor is consistent with the circumstances, conditions, or hardships of the veteran’s service, the veteran’s lay testimony alone may establish the occurrence of the claimed in-service stressor. 38 C.F.R. § 3.304 (f) (2018). The ordinary meaning of the phrase “engaged in combat with the enemy,” as used in 38 U.S.C. § 1154 (b) (2012), requires that a veteran have participated in events constituting an actual fight or encounter with a military foe or hostile unit or instrumentality. The issue of whether any particular set of circumstances constitutes engagement in combat with the enemy for purposes of section 1154(b) must be resolved on a case-by-case basis. See VAOPGCPREC 12-99 (October 18, 1999). If a stressor claimed by a veteran is related to the veteran’s fear of hostile military or terrorist activity and a VA psychiatrist or psychologist, or a psychiatrist or psychologist with whom VA has contracted, confirms that the claimed stressor is adequate to support a diagnosis of PTSD and that the veteran’s symptoms are related to the claimed stressor, in the absence of clear and convincing evidence to the contrary, and provided the claimed stressor is consistent with the places, types, and circumstances of the veteran’s service, the veteran’s lay testimony alone may establish the occurrence of the claimed in-service stressor. 38 C.F.R. § 3.304 (f)(3) (2015). In order to grant service connection for PTSD to a non-combat veteran, there must be credible evidence to support the veteran’s assertion that the stressful event occurred. A stressor need not be corroborated in every detail. Suozzi v. Brown, 10 Vet. App. 307, 311 (1997). Moreover, a medical opinion diagnosing PTSD does not suffice to verify the occurrence of the claimed in-service stressors. Cohen v. Brown, 10 Vet. App. 128, 142 (1997); Moreau v. Brown, 9 Vet. App. 389, 395-396 (1996). 38 C.F.R. § 4.125 requires PTSD diagnoses to conform to the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) as the governing criteria for diagnosing PTSD. Parenthetically, the Board notes VA implemented DSM 5, effective August 4, 2014 and DSM 5 applies to claims certified to the Board on and after August 4, 2014. 79 Fed. Reg. 45,093, 45,094 (Aug. 4, 2014). The Board finds that the weight of the competent and credible evidence shows that the Veteran does not have a current diagnosis of PTSD in accordance with DSM. A VA psychiatric examination was conducted in March 2014 to obtain medical evidence as to the Veteran’s current DSM diagnoses and evidence as to whether the Veteran had a current diagnosis of PTSD. The VA examiner, a clinical psychologist, concluded that the Veteran did not meet the DSM-5 clinical criteria for a diagnosis of PTSD. The VA examiner stated that the Axis I diagnosis was depression disorder, not otherwise specified. The March 2018 Mental Disorders Disability Benefits Questionnaire indicates that the Veteran only had one Axis I diagnosis in accordance with the DSM-IV and the diagnosis was depressive disorder not otherwise specified. As discussed above, 38 C.F.R. § 4.125 requires PTSD diagnoses to conform to DSM-IV as the governing criteria for diagnosing PTSD. VA implemented DSM-5 effective August 4, 2014 and DSM-5 applies to claims certified to the Board on or after August 4, 2014. 79 Fed. Reg. 45,093, 45,094 (Aug. 4, 2014). In this case, the RO certified the Veteran’s appeal to the Board in October 2018 and therefore, DSM-5 is the governing directive. The Board notes that the diagnostic criteria for PTSD under DSM-5 (particularly as it relates to Criterion A) are less stringent that the diagnostic criteria for PTSD under DSM-IV. DSM-5, in pertinent part, removed the requirement under Criterion A that the person experience fear, helplessness, or horror right after the traumatic event because there was concern that certain individuals who were trained not to respond to traumatic events might have failed to meet this criterion. The removal of this requirement for Criterion A makes it easier to meet the diagnostic criteria for PTSD under DSM-5 than under DSM-IV. See DSM-IV and DSM-5. DSM-5 also sets forth four distinct diagnostic clusters for PTSD instead of the three set forth in DSM-IV (re-experiencing, avoidance, and arousal). In DSM-5, the four diagnostic clusters are described as re-experiencing, avoidance, negative cognitions and mood, and arousal. See DSM-IV and DSM-5. In the present case, the Board notes that the March 2014 VA examiner considered the less stringent diagnostic criteria for PTSD under DSM-5 and found that this criteria was not met for a diagnosis. The Board notes that the VA treatment records note positive PTSD screens. However, the Board finds the March 2014 VA psychiatric examination findings and the March 2018 assessment to have more probative weight since these assessments were made by psychologists and the psychologists were determining what the Veteran’s current Axis I diagnoses were. It is not clear in the VA treatment records who made the PTSD screen and it does not appear that the DSM criteria was considered. As such, the Board finds the March 2014 VA medical opinion and the March 2018 medical opinion to have great probative weight. The Veteran’s own implied assertions that he had PTSD are afforded limited if no probative weight in the absence of a showing that the Veteran has the expertise to render opinions about medical matters. The Veteran, as a lay person, is competent to describe observable symptoms. Although lay persons are competent to provide opinions on some medical issues, Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011); as to the specific issue in this case, an opinion as to a psychiatric diagnosis in accordance with DSM, falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Some medical issues, such as providing psychiatric diagnoses, require specialized training, and are therefore not susceptible of lay opinions on etiology. There is no evidence showing that the Veteran has medical expertise and he is not competent to provide any medical or psychiatric diagnoses or medical opinions. The weight of the evidence shows that the Veteran does not have a current diagnosis of PTSD. The Court has held that Congress specifically limited entitlement to service connected benefits to cases where there is a current disability. “In the absence of proof of a present disability, there can be no valid claim.” Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Without competent evidence of a diagnosed disability, service connection for the disorder cannot be awarded. See Brammer, supra; Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004) (holding that service connection requires a showing of current disability); see also Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998) (holding that a grant of service connection requires that there be a showing of disability at the time of the claim, as opposed to sometime in the distant past). The preponderance of the evidence establishes that the Veteran does not have a current diagnosis of PTSD. Accordingly, on this record, service connection for PTSD is not warranted. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. Gilbert, 1 Vet. App. 49. The appeal is denied. 6. Entitlement to service connection for depressive disorder is granted. The Board concludes that the evidence shows that it is as likely as not that the Veteran’s depressive disorder is proximately due to the service-connected disabilities. The March 2014 VA psychiatric examination report shows a diagnosis of depressive disorder not otherwise specified. The record includes competent evidence associating the depressive disorder to the Veteran’s medical conditions. Specifically, the March 2018 Mental Disorders Disability Benefits Questionnaire (DBQ) associates the Veteran’s depressive disorder to his medical conditions and the report lists the Veteran’s medical conditions as the thoracolumbar spine disability and associated radiculopathy of the lower extremities, the cervical spine disability, and the left knee disability. In a January 2017 evaluation report, a private psychologist concluded that the Veteran’s depressive disorder was more likely than not caused by the service-connected thoracolumbar spine disability, radiculopathy of the lower extremities, cervical spine disability, left knee disability, and plantar fasciitis. Service connection is in effect for all of these disabilities. See the February 2018 rating decision. The Board finds that the evidence supports a grant of service connection for depressive disorder not otherwise specified as secondary to the service-connected the thoracolumbar spine disability and associated radiculopathy of the lower extremities, the cervical spine disability, and the left knee disability. Resolving reasonable doubt in the Veteran’s favor, the Board finds that the criteria for service connection for depressive disorder not otherwise specified secondary to the service-connected the thoracolumbar spine disability and associated radiculopathy of the lower extremities, the cervical spine disability, and the left knee disability have been met. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. This service connection for depressive disorder not otherwise specified is granted. 7. Entitlement to an earlier effective date for the grant of service connection for bilateral plantar fasciitis is denied. Under 38 C.F.R. § 3.400 (b)(2)(i), the effective date for a grant of direct service connection will be the day following separation from active service or the date entitlement arose if the claim is received within one year after separation from service. Otherwise, the effective date is the date of receipt of claim, or date entitlement arose, whichever is later. The effective date for presumptive service connection will be the date entitlement arose, if a claim is received within one year after separation from active service. Otherwise, the effective date will be the date of receipt of the claim, or the date entitlement arose, whichever is later. 38 C.F.R. § 3.400 (b)(2). “Date of receipt” generally means the date on which a claim, information or evidence was received by VA. 38 C.F.R. § 3.1 (r). Effective on March 24, 2015, VA amended its regulations as to what constitutes a claim for benefits. Such now requires that claims be made on standard form prescribed by the Secretary, effectively eliminating informal claims. See 79 Fed. Reg. 57660 (Sept. 25, 2014). The amendments, however, are only effective for claims and appeals filed on or after March 24, 2015. As the claim in this case was filed prior to that date, the amendments are not applicable in this instance and the regulations in effect prior to March 24, 2015, will be applied. Prior to March 24, 2015, which is the time relevant time period in this appeal, the VA administrative claims process recognized formal and informal claims. A claim is a formal or informal communication in writing requesting a determination of entitlement or evidencing a belief in entitlement to a benefit. 38 C.F.R. § 3.1 (p). Any communication or action, indicating intent to apply for one or more benefits under the laws administered by VA, from a claimant, a duly authorized representative, or a person acting as next friend who is not sui juris may be considered an informal claim. 38 C.F.R. § 3.155. VA is required to identify and act on informal claims for benefits. 38 U.S.C. § 5110 (b)(3) (2012); 38 C.F.R. §§ 3.1 (p), 3.155(a); Servello v. Derwinski, 3 Vet. App. 196 (1992). Upon receipt of an informal claim, if a formal claim has not been filed, an application form will be forwarded to the claimant for execution. If received within one year from the date it was sent to the claimant, it will be considered filed as of the date of receipt of the informal claim. In the present case, the Veteran asserts that an effective date for the award of service connection for plantar fasciitis should be earlier than the date assigned. The Veteran and his attorney do not make a specific argument for the basis of this contention. Review of the record shows that on March 30, 2012, the Veteran’s initial claim for service connection for plantar fasciitis was received at VA. The Board finds that entitlement to an effective date earlier than March 30, 2012 for the grant of service connection for bilateral plantar fasciitis is not warranted. The Veteran was granted entitlement to service connection for bilateral plantar fasciitis effective the date his claim was received by VA, March 30, 2012, which was more than one year following the date of the Veteran’s separation from service. There was no formal claim, informal claim, or written intent to file a claim for bilateral plantar fasciitis prior to that date. The governing regulations dictate that the effective date will be the date of receipt of the claim or the date entitlement arose, whichever is the later, and the Board is bound by that authority. 38 U.S.C. § 5110a (2012); 38 C.F.R. § 3.400. Under the facts of the case, the effective date of service connection for bilateral plantar fasciitis can be no earlier than March 30, 2012, the date the Veteran’s claim was received by VA. Therefore, the Board concludes that the proper effective date for the award of service connection for bilateral plantar fasciitis is March 30, 2012, the date of receipt of the claim for service connection and no earlier. The preponderance of the evidence is against the claim for an earlier effective date and the appeal is denied. 8. Entitlement to an initial 20 percent disability rating for bilateral plantar fasciitis is granted. Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule) found in 38 C.F.R. Part 4. 38 U.S.C. § 1155. It is not expected that all cases will show all the findings specified; however, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances. 38 C.F.R. § 4.21. Where there is a question as to which of two evaluations (ratings) shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107 (b); 38 C.F.R. §§ 4.3, 4.7. While a veteran’s entire history is reviewed when assigning a disability rating, where service connection has already been established and an increase in the rating is at issue, it is the present level of disability that is of primary concern. Francisco v. Brown, 7 Vet. App. 55 (1994). In determining the present level of a disability for any increased rating claim, the Board must consider the application of staged ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007). VA should interpret reports of examination in light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability. 38 C.F.R. § 4.2. Any reasonable doubt regarding the degree of disability should be resolved in favor of the claimant. 38 C.F.R. § 4.3. Disability of the musculoskeletal system is primarily the inability, due to damage or infection in the parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. It is essential that the examination on which ratings are based adequately portray the anatomical damage, and the functional loss, with respect to all these elements. The functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated structures, or to deformity, adhesions, defective innervation, or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. §§ 4.40, 4.45; see also DeLuca v. Brown, 8 Vet. App. 202, 206-07 (1995). The factors involved in evaluating, and rating disabilities of the joints include weakened movement (due to muscle injury, disease or injury of peripheral nerves, divided or lengthened tendons, etc.); excess fatigability; incoordination (impaired ability to execute skilled movements smoothly); more movement than normal (from flail joint, resections, nonunion of fracture, relaxation of ligaments, etc.); less movement than normal (due to ankylosis, limitation or blocking, adhesions, tendon-tie-up, contracted scars, etc.); or pain on movement, swelling, deformity, or atrophy of disuse. 38 C.F.R. § 4.45. In DeLuca v. Brown, 8 Vet. App. 202 (1995), the Court held that for disabilities evaluated on the basis of limitation of motion, VA was required to apply the provisions of 38 C.F.R. §§ 4.40, and 4.45, pertaining to functional impairment. The Court instructed that, in applying these regulations, VA should obtain examinations in which the examiner determined whether the disability was manifested by weakened movement, excess fatigability, or incoordination. Such inquiry was not to be limited to muscles or nerves. These determinations were, if feasible, be expressed in terms of the degree of additional range-of-motion loss due to any weakened movement, excess fatigability, or incoordination. The Court held that pain must affect some aspect of the normal working movements of the body such as excursion, strength, speed, coordination and endurance to constitute functional loss. Mitchell v. Shinseki, 24 Vet. App. 32, 33, 43 (2011). Although pain may cause functional loss, pain, itself, does not constitute functional loss and is just one factor to be considered when evaluating functional impairment. Id. Disabilities of the feet are evaluated under Diagnostic Codes 5276-5284. 38 C.F.R. § 4.71a. The Veteran’s bilateral plantar fasciitis has been rated, by analogy, under Diagnostic Code 5276, flatfoot. Under Diagnostic Code 5276, for acquired flatfoot, a 20 percent evaluation is assigned for severe unilateral flatfoot and a 30 percent evaluation is assigned for severe bilateral flatfoot with objective evidence of marked deformity (pronation, abduction, etc.), accentuated pain on manipulation and use, indications of swelling on use, with characteristic callosities. A 50 percent evaluation is assigned for pronounced bilateral flatfoot, with marked pronation, extreme tenderness of the plantar surface of the feet, marked inward displacement and severe spasm of the tendo Achilles on manipulation, and not improved by orthopedic shoes or appliances. 38 C.F.R. § 4.71a, Diagnostic Code 5276 (2018). Under Diagnostic Code 5284, 10, 20, and 30 percent ratings are assigned for moderate, moderately severe, and severe foot injuries. A rating of 40 percent is warranted for actual loss of use of the foot. 38 C.F.R. § 4.71a, Diagnostic Code 5276 (2018). Diagnostic Code 5284 applies to “other” foot injuries. The term “other” refers to injuries other than those set out in Diagnostic Codes 5276-5283. See Copeland v. McDonald, 27 Vet App. 333, 337 (June 2015). The United States Court of Appeals for Veterans’ Claims (Court) has held that for conditions that are not specifically listed in the rating schedule, VA regulations provide that those conditions may be rated by analogy under the diagnostic code for “a closely related disease or injury.” Id. at 336-337. The Court cited to 38 C.F.R. § 4.20 and 38 C.F.R. § 4.27 and stated further that “Where, however, a condition is listed in the schedule, rating by analogy is not appropriate. In other words, “[a]n analogous rating...may be assigned only where the service-connected condition is ‘unlisted.’“ The Court cited to Suttman v. Brown, 5 Vet. App. 127, 134 (1993). Id. The Court specifically held that rating a listed foot condition such as pes planus under Diagnostic Code 5284 would constitute an impermissible rating by analogy; pes planus is specifically rated under Diagnostic Code 5276 and an analogous rating under Diagnostic Code 5284 is not permitted. Id. at 338. Based upon a review of the evidence, the Board concludes that an initial 20 percent disability rating is warranted for the service-connected plantar fasciitis. The weight of the competent and credible evidence establishes that for the entire period of the appeal, the service-connected plantar fasciitis is manifested by pain on use, pain accentuated on use, and pain on manipulation of the right foot; an indication of swelling and extreme tenderness of the plantar surface of the right foot; and improvement and relief of the symptoms by orthopedic shoes or appliances which is productive of severe unilateral disability. The evidence more nearly approximates the criteria for severe unilateral disability. The weight of the evidence does not show bilateral severe disability or pronounced unilateral or bilateral disability, marked pronation, or marked inward displacement and severe spasm of the tendo achilles on manipulation without improvement with orthopedic shoes or appliances. See the March 2014 VA examination report. The Board finds that the criteria for a 30 percent rating under Diagnostic Code 5284 have not been met or more nearly approximated for any portion of the rating period. Even with consideration of pain on use, the Veteran’s right foot disability has not more nearly approximated severe foot injury. See the March 2014 VA examination report. The Board has considered whether a higher disability rating is warranted on the basis of functional loss due to pain or due to weakness, fatigability, incoordination, or pain on movement of a joint under 38 C.F.R. §§ 4.40, 4.45, and 4.59; see also DeLuca. The evidence shows that, for the entire appeal period, the service-connected foot disability has been manifested by pain and ambulatory pain and these symptoms and degree of functional loss are contemplated in the 20 percent rating under Diagnostic Code 5276. 38 C.F.R. § 4.71a. The 20 percent rating contemplates the Veteran’s functional impairment in the foot disability during flare-ups or due to pain with activity. Diagnostic Code 5284 provides for a 40 percent rating if there is evidence of actual loss of use of the foot. 38 C.F.R. § 4.63 indicates that loss of use of the foot will be held to exist when no effective function remains other than that which would be equally well served by an amputation stump at the site of the election below the knee with the use of a suitable prosthetic appliance. In the present case, the medical evidence shows that the Veteran has effective function remaining in the feet. See the March 2014 VA examination report and the medical evidence dated after March 2014. Thus, a higher rating is not warranted for loss of use of the foot. The Board has also reviewed the remaining diagnostic codes relating to foot disabilities and finds that they are not applicable. Diagnostic Codes 5277 (weak foot), 5279 (metatarsalgia), 5280 (hallux valgus), 5281 (hallux rigidus), and 5282 (hammer toe) do not provide for disabilities in excess of 10 percent. A 10 percent rating is the highest possible rating under Diagnostic Code 5003 (arthritis with painful, noncompensable limitation of motion). The evidence of record does not show malunion or nonunion of the tarsal or metatarsal bones or clawfoot. Accordingly, Diagnostic Code 5283 (tarsal or metatarsal bones, malunion of, or nonunion of) and Diagnostic Code 5278 (clawfoot) do not apply. For these reasons, the Board finds that the weight of the evidence is against the Veteran’s claim for an initial schedular rating in excess of 20 percent for foot disability for the entire period of the appeal. REASONS FOR REMAND Regarding the claims for earlier effective dates for the award of service connection for a back disability and radiculopathy of the lower extremities, the claim that led to the award of service connection for the back disability and radiculopathy of the lower extremities was a claim to reopen. When this claim was pending, service personnel records and service treatment records that existed but were not part of the record at the time of the November 2009 rating decision (that denied service connection for a back disability) were associated with the file in July 2013 and April 2017. These records are relevant to the claim for service connection and pertain to the Veteran’s time period in active service. Thus, the earlier November 2009 rating decision is not considered to be final for the purposes of the current appeal. The Board finds that 38 C.F.R. § 3.156 (c) applies. The Board finds that the AOJ must consider the provisions of 38 C.F.R. § 3.156 (c) when re-adjudicating the claims for entitlement to an earlier effective date for the award of service connection for thoracolumbar degenerative disc disease and radiculopathy of the lower extremities. The Board also finds that due process mandates that these issues be remanded to the AOJ for adjudication in the first instance. See Bernard v. Brown, 4 Vet. App. 384 (1993). The issues of entitlement to higher disability ratings for the thoracolumbar degenerative disc disease and radiculopathy of the lower extremities are inextricably intertwined with the claims for earlier effective dates that are discussed in the remand. Therefore, the adjudication of the claims for higher ratings must be deferred pending resolution of the effective date claims. Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). Regarding service connection for a right ankle disability, the Board finds that a VA examination is necessary to obtain medical evidence as to whether the Veteran’s right ankle disability is related to active service to include the injury in active service. Service treatment records show that the Veteran sustained a sprain of the right ankle in service in July 1988. The July 1988 service treatment record indicates that the Veteran sustained an inversion injury to right ankle after playing volleyball; the Veteran had pain to lateral malleolus with edema. X-ray examination of the right ankle revealed no abnormalities. The diagnosis was right ankle sprain. He was placed on five days of light duty. The record shows a diagnosis of ankle tendonitis and right ankle pain in May 2011. The Veteran did not undergo exam of the right ankle. VA’s duty to assist a claimant includes providing a medical examination or obtaining a medical opinion when an examination or opinion is necessary to make a decision on the claim. 38 U.S.C. § 5103A (d)(1) (2012). Thus, the Board finds that an additional VA examination is necessary. The matter is REMANDED for the following action: 1. Schedule the Veteran for a VA examination to determine nature and likely etiology of the claimed right ankle disability. The VA examiner should provide an opinion as to whether it is at least as likely as not (50 percent probability or more) that any current right ankle disability either began during active service or are related to injury, disease, or other event in active service. The VA examiner should specifically consider the Veteran’s injury in service in which he sustained an inversion injury to right ankle after playing volleyball in July 1988 (the Veteran had pain to lateral malleolus with edema and the diagnosis was right ankle sprain). The VA examiner should provide an opinion as to whether it is as likely as not (50 percent probability or more) that the current right ankle disability is related to the diagnosis of sprain of the right ankle in service. The VA examiner should provide a rationale for all conclusions. 2. Readjudicate the issues of entitlement to an earlier effective date for the award of service connection for thoracolumbar degenerative disc disease and radiculopathy of the lower extremities with consideration of 38 C.F.R. § 3.156 (c). Readjudicate the claims for higher disability ratings for thoracolumbar degenerative disc disease and radiculopathy of the lower extremities, and service connection for a right ankle disability. If any benefit sought on appeal remains denied, the Veteran and representative should be provided a Supplemental Statement of the Case. An appropriate period of time should be allowed for response before the case is returned to the Board. THOMAS H. O'SHAY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C.L. Krasinski, Counsel