Citation Nr: 18149050 Decision Date: 11/08/18 Archive Date: 11/08/18 DOCKET NO. 17-33 288 DATE: November 8, 2018 ORDER Entitlement to service connection for a bilateral hearing loss disability is denied. Entitlement to service connection for tinnitus is granted. Entitlement to service connection for a left ankle disability is denied. Entitlement to service connection for a right hip disability is denied. Entitlement to service connection for a left hip disability is denied. Entitlement to service connection for a right knee disability is denied. Entitlement to service connection for a left knee disability is denied. Entitlement to service connection for hepatitis C is denied. Entitlement to an initial rating in excess of 10 percent for a right ankle collateral ligament sprain is denied. REMANDED The issue of entitlement to service connection for hypertensive cardiovascular disease is remanded. The issue of entitlement to service connection for asthma is remanded. Entitlement to service connection for a right foot disability is remanded. Entitlement to service connection for a left foot disability is remanded. Entitlement to secondary service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), generalized anxiety disorder, and major depressive disorder, is remanded. Entitlement to an initial rating in excess of 10 percent for a lumbar strain with degenerative disc disease (lumbar spine disability) is remanded FINDINGS OF FACT 1. The competent evidence of record indicates that the Veteran does not have a bilateral hearing loss disability for VA compensation purposes. 2. The evidence is at least in relative equipoise as to whether the Veteran’s tinnitus had its onset during active service. 3. The most probative evidence of record is against finding that the Veteran has a left ankle disability that was incurred during or is otherwise related to an in-service injury, event, or disease. 4. The most probative evidence of record is against finding that the Veteran has a right hip disability that was incurred during or is otherwise related to an in-service injury, event, or disease. 5. The most probative evidence of record is against finding that the Veteran has a left hip disability that was incurred during or is otherwise related to an in-service injury, event, or disease. 6. The most probative evidence of record is against finding that the Veteran has a right knee disability that was incurred during or is otherwise related to an in-service injury, event, or disease. 7. The most probative evidence of record is against finding that the Veteran has a left knee disability that was incurred during or is otherwise related to an in-service injury, event, or disease. 8. The most probative evidence of record is against finding that the Veteran has hepatitis C that was incurred during or is otherwise related to an in-service injury, event, or disease. 9. Throughout the relevant rating period, the Veteran’s right ankle lateral collateral ligament sprain was manifested by, at is most, pain, swelling, and moderate limitation of right ankle motion; it has not manifested by marked limitation of motion or ankylosis. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a bilateral hearing loss disability have not been met. 38 U.S.C. §§ 1101, 1131, 5103, 5103A, 5107 (b) (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2018). 2. The criteria for service connection for tinnitus have been met. 38 U.S.C. §§ 1110, 5107 (b) (2012). 38 C.F.R. §§ 3.102, 3.303 (2018). 3. The criteria for entitlement to service connection for a left ankle disability have not been met. 38 U.S.C. §§ 1101, 1131, 5103, 5103A, 5107 (b) (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2018). 4. The criteria for entitlement to service connection for a right hip disability have not been met. 38 U.S.C. §§ 1101, 1131, 5103, 5103A, 5107 (b) (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2018). 5. The criteria for entitlement to service connection for a left hip disability have not been met. 38 U.S.C. §§ 1101, 1131, 5103, 5103A, 5107 (b) (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2018). 6. The criteria for entitlement to service connection for a right knee disability have not been met. 38 U.S.C. §§ 1101, 1131, 5103, 5103A, 5107 (b) (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2018). 7. The criteria for entitlement to service connection for a left knee disability have not been met. 38 U.S.C. §§ 1101, 1131, 5103, 5103A, 5107 (b) (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2018). 8. The criteria for entitlement to service connection for hepatitis C have not been met. 38 U.S.C. §§ 1101, 1131, 5103, 5103A, 5107 (b) (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2018). 9. The criteria for entitlement to an initial rating in excess of 10 percent for right ankle disability have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 4.59, 4.71a, Diagnostic Code 5271 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 1981 to October 1984. He also had subsequent service in the Army Reserves. These matters come before the Board of Veterans’ Appeals (Board) on appeal of September 2016 and November 2016 rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO) in San Juan, Puerto Rico. The Veteran initially filed a claim for service connection for PTSD. Nevertheless, as the record notes other psychiatric diagnoses, the Board has expanded the Veteran's claim to include all acquired psychiatric disabilities, and the issue has been recharacterized. Clemons v. Shinseki, 23 Vet. App. 1 (2009). Service Connection Generally, service connection may be established for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1131 (2012); 38 C.F.R. § 3.303 (2018). To establish service connection for a disability, the Veteran must show: (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the disease or injury incurred in or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The existence of a current disability is the cornerstone of a claim for VA disability compensation. 38 U.S.C. § 1131; see Degmetich v. Brown, 104 F.3d 1328, 1332 (1997) (holding that interpretation of sections 1110 and 1131 as requiring the existence of a current disability for VA compensation purposes cannot be considered arbitrary). In the absence of proof of a current disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). 1. Entitlement to service connection for a bilateral hearing loss disability The Veteran contends that he has bilateral hearing loss that is directly related to his active service. 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 (Hz) is 40 decibels (dB) or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hz are 26 dB or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385 (2018). Thus, a hearing loss disability for VA purposes is defined by 38 C.F.R. § 3.385 and is based on objective audiometric and speech recognition testing. In this case, the record is absent for evidence of current hearing loss disability of either ear as defined under 38 C.F.R. § 3.385 at any time during the appeal period or in proximity to the claim for service connection. See McClain v. Nicholson, 21 Vet. App. 319 (2007); Romanowsky v. Shinseki, 26 Vet. App. 289 (2013). Specifically, the July 2016 VA examination includes an audiogram report revealing the following audiometric findings, measured in decibels: HERTZ 500 1000 2000 3000 4000 RIGHT 15 15 15 20 20 LEFT 15 15 25 20 20 The Veteran had 100 percent speech discrimination in the right ear and 100 percent speech discrimination in the left ear using the Maryland CNC word list. Thus, the audiological testing conducted in conjunction with the July 2016 VA examination did not reveal findings consistent with a hearing loss disability for VA purposes under 38 C.F.R. § 3.385 in either ear. The Veteran was provided a private audiological examination in December 2016 revealing the following audiometric findings, measured in decibels: HERTZ 500 1000 2000 3000 4000 RIGHT 20 20 20 25 25 LEFT 20 20 25 25 25 The Veteran had 96 percent speech discrimination in the right ear and 96 percent speech discrimination in the left ear. Thus, the audiological testing conducted in conjunction with the December 2016 private examination also did not reveal findings consistent with a hearing loss disability for VA purposes under 38 C.F.R. § 3.385 (2018) in either ear. There are no other audiological measurements of record dated any time during or in close proximity to the appeal period that shows a hearing loss disability for VA purposes in either ear. The Board has considered the Veteran’s contention that he has hearing loss that is due to his active service. The Veteran, as a lay person, is competent to report that he has difficulty hearing; however, he is not competent to diagnose a hearing loss disability for VA purposes. See Kahana, 24 Vet. App. at 435; Buchanan, 451 F.3d at 1336-37. Diagnosing a hearing loss disability for VA purposes involves diagnostic testing and medical knowledge, which the Veteran has not been shown to possess. Therefore, the Veteran’s reports of hearing loss do not constitute competent evidence of bilateral hearing loss disability for VA purposes under 38 C.F.R. § 3.385 (2018). As noted above, in the absence of proof of a current disability, there can be no valid claim. Brammer, 3 Vet. App. at 225. Without evidence of current bilateral hearing loss disability for VA purposes, the Board need not address the other elements of service connection. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not for application, and the claim must be denied. 38 U.S.C. § 5107 (b) (2012); see also Gilbert, 1 Vet. App. 49. 2. Entitlement to service connection for tinnitus The Veteran contends that his tinnitus that is related to his active service. Specifically, he reported that he has had tinnitus since his active military service. See Private treatment record, received November 2015. Tinnitus is readily observable by laypersons and medical expertise is not required to establish its existence. See Charles v. Principi, 16 Vet. App. 370 (2002). Therefore, the Veteran is competent to describe his tinnitus symptomatology during and after service, and such subjective complaints have been documented in a November 2015 private treatment record. The Veteran has not indicated that he sought treatment for tinnitus during service, and his service treatment records are absent for any reference to tinnitus. However, the Veteran has asserted that he has experienced tinnitus since active service. As tinnitus is capable of lay observation, the Veteran is competent to report that experienced tinnitus during actives. The Board acknowledges that the first documented report of tinnitus of record is a November 2015 private treatment record, which is approximately 30 years after the Veteran’s separation from active service. Nevertheless, the absence of contemporaneous evidence in support of his assertions does not contradict the Veteran’s assertions that he has experienced symptoms continuously since active service. Accordingly, the Board finds that the evidence is at least in relative equipoise as to whether the Veteran’s tinnitus began during active service. Resolve reasonable doubt in favor of the Veteran, the service connection for tinnitus is granted. 38 U.S.C. § 5107 (b) (2012); 38 C.F.R. § 3.102 (2018). 3. Entitlement to service connection for bilateral knee, bilateral hip, and left ankle disabilities The Veteran contends that he has bilateral knee, bilateral hip, and left ankle disabilities that are related to his active service. See VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits, received March 2016. In this case, a left knee x-ray from January 2017 indicates that there were no acute abnormalities and that the Veteran’s joint spaces were well preserved. However, it does indicate that the Veteran had intercondylar eminence spurs and a posterior patellar spur. Accordingly, the first Shedden element is met for the Veteran’s left knee claim. Turning to his other joint claims, the evidence of record does not contain probative evidence of right knee, bilateral hip, or left ankle disabilities at any time proximate to or during the pendency of the claim. Regarding his left ankle, an August 2016 VA ankle examination report is silent for any diagnosis related to the Veteran’s left ankle. Moreover, he did not report any left ankle pain or demonstrate any reduction in left ankle range-of-motion. Likewise, VA treatment records are silent as to any complaints or treatment for right knee, bilateral hip, or left ankle disabilities. To the contrary, the consistently indicate that upon musculoskeletal examination the Veteran’s range of motion was “intact” and that no deformities were evident. The only evidence of record that the Veteran has current right knee, bilateral hip, or left ankle disabilities is a November 2015 private treatment record from Dr. C. Q. that lists medical diagnosis of degenerative joint disease of the hips, knees, and ankles. While the treatment record references a radiology report in support of the diagnosis, the x-rays provided with the treatment record do not pertain to the Veteran’s right knee, hips, or right ankle. Additionally, the February 2002 x-ray of the Veteran’s left heel did not show any ankle joint abnormality. As such, the Board concludes that there is no competent evidence of record showing that the Veteran has been diagnosed with left ankle, bilateral hip, or right knee disabilities at any time during or in proximity to the appeal period. As such, the first Shedden element is not met for the Veteran’s right knee, bilateral hip, and left ankle claims. The Board has considered the recent holding in Saunders v. Wilkie that where pain causes functional impairment, a disability for VA compensation purposes exists, even if there is no underlying diagnosis. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). However, the Veteran does not claim, nor do his medical records show that he experiences any functional impairment due to his right knee, bilateral hip, or left ankle. As such, any right knee, bilateral hip, or left ankle pain, to the extent it exists, does not amount to a functional impairment of earning capacity, and Saunders is not applicable in this case. Turning to the second Shedden element, while Dr. C. Q.’s statement indicated that the Veteran’s joint disabilities were related to service, he cited no in-service incidents that could be related to the present disabilities, nor did he provide a rationale for his opinion. The Veteran’s service treatment records are silent for any bilateral knee, bilateral hip, or left ankle diagnoses or symptomatology. Moreover, an April 1986 report of medical examination for retention in the Army reserves reflects that clinical evaluation of the Veteran’s lower extremities was within normal limits. Additionally, on the corresponding report of medical history, the Veteran stated he was in good health and expressly denied ever having or presently having swollen or painful joints; cramps in his leg; lameness; arthritis, rheumatism, or bursitis; bone, joint, or other deformity; or trick or locked knee. As the evidence is against finding that the Veteran had an in-service event, injury, or disease related to his bilateral knees, bilateral hips, or left ankle, Dr. C. M. Q.’s opinion is of no probative value. Thus, the third Shedden element is not met for the Veteran’s bilateral knee, bilateral hip, and left ankle claims. As the most probative evidence is against finding that the Veteran has current bilateral knee, bilateral hip, or left ankle disability that were incurred during or are otherwise related to active service, service connection for bilateral knee, bilateral hip, and left ankle disabilities must be denied. The Board acknowledges that the Veteran was not afforded a VA examination relating directly to his bilateral hip and bilateral knee claims. On these facts, however, an examination is not required. VA will provide a medical examination or obtain a medical opinion if the evidence indicates the existence of a current disability or persistent or recurrent symptoms of a disability that may be associated with an event, injury, or disease in service, but the record does not contain sufficient medical evidence to decide the claim. 38 U.S.C. § 5103A (d) (2); 38 C.F.R. § 3.159 (c) (4) (i); McLendon v. Nicholson, 20 Vet. App. 79 (2006). In this case, the claim does not meet these requirements for obtaining a VA medical opinion. Because the weight of the evidence demonstrates no indication of a current bilateral hip or right knee disabilities, no examination is required. While the record notes a current left knee disability, in the absence of probative evidence indicating that the Veteran’s disability may be related to an in-service event, injury, or disease, the Board finds that a VA examination or opinion is not necessary for disposition of the claim. Accordingly, the Board finds that VA’s duty to assist with respect to obtaining a VA examination or opinion with respect to the Veteran’s claim for entitlement to service connection for bilateral knee, bilateral hip, and left ankle disabilities. 38 C.F.R. § 3.159 (c) (4) (2018). The Board has not overlooked the Veteran’s assertions that he has a current bilateral knee, bilateral hip, and left ankle disabilities that are related to his military service. However, he has not been shown to have the medical training and knowledge required to diagnose such conditions or to render a medical opinion related any such disability to his military service. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011); Buchanan v. Nicholson, 451 F. 3d 1331, 1336-37. Therefore, his assertions are not considered competent and do not weigh against the probative value of the August 2016 VA examinations, VA treatment records, and service treatment records, which do not show a diagnosis of right knee, bilateral hip, or left ankle disabilities or an in-service occurrence that could be related to his claimed bilateral knees, bilateral hips, and left ankle disabilities. In view of the foregoing, the Board concludes that the preponderance of the evidence is against the claims for entitlement to service connection for bilateral knee, bilateral hip, and left ankle disabilities. Because the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not for application, and the claim must be denied. 38 U.S.C. § 5107 (b) (2012); see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 4. Entitlement to service connection for hepatitis C The Veteran contends that he has hepatis C that is directly related to his active service. The evidence of record shows that the Veteran has a current diagnosis of a hepatitis C. See, e.g., VA treatment record dated December 11, 2003. As to an in-service event, injury or disease, a review of the Veteran’s service treatment records does not reflect any symptoms, complaints or treatment for hepatitis C. The Veteran was not provided a separation examination; however, an April 1985 VA report of medical examination noted that the Veteran’s digestive system was within normal limits. Likewise, an April 1986 report of medical examination for retention in the Army reserves reflects that clinical evaluation of the Veteran’s digestive system as well serology tests were within normal limits. Additionally, on the corresponding report of medical history, the Veteran stated he was in good health and that he had not and did not have jaundice or hepatitis. The earliest indication in the record that the Veteran suffers from hepatitis C is the March 2004 VA treatment record, which notes that he was diagnosed with it in October 2003. In summary, the service treatment records do not reflect in-service diagnosis, treatment, or symptoms of hepatitis C, and the medical evidence indicates the Veteran was diagnosed with hepatitis C in October 2003; nearly 20 years after the Veteran’s separation from active service. Therefore, while there is evidence of a current diagnosis of hepatitis C, there is no evidence of an in-service injury, illness or disease to which the current disability may be medically attributed. Rather, the evidence suggests that the Veteran did not have hepatitis C until almost two decades after his active military service. The Board has not overlooked the November 2015 letter from Dr. C. Q. indicating that the Veteran’s “infectious diseases” were more probable than not secondary to his military service. However, he cited no in-service incidents or risk factors that could be related to the Veteran’s present hepatitis C, nor did he provide any rationale for his opinion. As the evidence is against finding that the Veteran had an in-service event, injury, or disease pertaining hepatitis C, Dr. C. Q.’s opinion is of no probative value. The Board acknowledges that Veteran’s assertions indicating an association between the current hepatitis C and his active service. It is well established that a layperson without medical training is not qualified to render a medical opinion regarding the diagnosis or etiology of certain disorders and disabilities. See 38 C.F.R. § 3.159 (a) (1). In certain instances, lay testimony may be competent to establish medical etiology or nexus. See Jandreau v. Nicholson, 492 F. 3d 1372, 1377 (Fed. Cir. 2007). However, the origin or cause of hepatitis C is not a simple question that can be determined based on personal observation by a lay person. It is not shown that the Veteran is qualified through specialized education, training, or experience to offer a medical opinion as to the etiology of hepatitis C. Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). Hence, the Veteran’s lay statement is not competent to establish medical etiology or nexus. Id. As such, the Board finds the question of whether the Veteran’s current hepatitis C is related to his active service does not lie within the range of common experience or common knowledge but requires special experience or special knowledge. The Board acknowledges that the Veteran was not afforded a VA examination relating directly to his hepatitis C. On these facts, however, an examination is not required because the weight of the evidence demonstrates no event, injury, or disease during service related to hepatitis C, and no probative evidence indicating that the Veteran’s current condition may be associated with service. Accordingly, the Board finds that VA’s duty to assist with respect to obtaining a VA examination or opinion with respect to the Veteran’s claim for entitlement to service connection for hepatitis C has been met. 38 C.F.R. § 3.159 (c) (4) (2018). In view of the foregoing, the Board concludes that the preponderance of the evidence is against the claim for entitlement to service connection for hepatitis C. Because the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not for application, and the claim must be denied. 38 U.S.C. § 5107 (b) (2012); see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Increased Rating Disability ratings are determined by the application of VA’s Schedule for Rating Disabilities (Schedule), which is based on the average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155 (2012); 38 C.F.R. Part 4 (2018). Pertinent regulations do not require that all cases show all findings specified by the Schedule, but that findings sufficient to identify the disease and the resulting disability and, above all, coordination of the rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21; see also Mauerhan v. Principi, 16 Vet. App. 436 (2002). When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant. 38 C.F.R. § 4.3 (2018). Where there is a question as to which of two ratings shall be applied, the higher rating 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). The Board will consider whether separate ratings may be assigned for separate periods of time based on facts found, a practice known as “staged ratings,” in all claims for increased ratings. Fenderson v. West, 12 Vet. App. 119, 126-27 (1999). In rating disabilities of the musculoskeletal system, it is necessary to consider, along with the schedular criteria, functional loss due to flare-ups of pain, fatigability, incoordination, pain on movement, and weakness. DeLuca v. Brown, 8 Vet. App. 202 (1995). The functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated innervation, or other 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 (2018). Pain on movement, swelling, deformity, or atrophy of disuse as well as instability of station, disturbance of locomotion, interference with sitting, standing, and weight bearing are relevant considerations for determination of joint disabilities. 38 C.F.R. § 4.45 (2018). Painful, unstable, or malaligned joints, due to healed injury, are entitled to at least the minimal compensable rating for the joint. 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1 (2011) (holding that 38 C.F.R. § 4.59 applies to disabilities other than arthritis). However, painful motion alone is not a functional loss without some restriction of the normal working movements of the body. Mitchell v. Shinseki, 25 Vet. App. 32, 43 (2011). 5. Entitlement to an increased initial rating for a right ankle lateral collateral ligament sprain The Veteran seeks a higher initial rating for his service-connected right ankle lateral collateral ligament sprain. The Veteran’s right ankle disability is rated as 10 percent disabling under 38 C.F.R. § 4.71a, Diagnostic Code 5271 (2018), effective from November 25, 2015. The applicable rating period is from November 25, 2015, the effective date for the award of service connection for right ankle disability, through the present. See 38 C.F.R. § 3.400 (2018). Under Diagnostic Code 5271, a 10 percent rating is assigned for moderate limitation of motion of the ankle; a 20 percent rating is assigned for marked limitation of motion of the ankle. Normal ranges of motion of the ankle are dorsiflexion from 0 degrees to 20 degrees, and plantar flexion from 0 degrees to 45 degrees. 38 C.F.R. § 4.71, Plate II (2018). Terms such as “mild,” “moderate,” and “marked” are not defined in the Rating Schedule. Rather than applying a mechanical formula, VA must evaluate all evidence so that decisions will be equitable and just. 38 C.F.R. § 4.6 (2018). Although the use of similar terminology by medical professionals should be considered, it is not dispositive of an issue. Instead, all evidence must be evaluated in arriving at a decision regarding a request for an increased disability rating. 38 U.S.C. § 7104 (2012); 38 C.F.R. §§ 4.2, 4.6 (2018). Turning to the relevant evidence of record, the medical treatment records dated during the relevant period show that the Veteran has reported right ankle pain. However, they do not contain specific range-of-motion measurements for the right ankle or any description as to whether the Veteran’s right ankle range-of-motion is marked or moderate. Nevertheless, numerous VA treatment records consistently indicate that upon musculoskeletal examination the Veteran’s range of motion was “intact.” As such, the medical treatment evidence of record weigh against a finding that the Veteran had “marked” right ankle motion or ankylosis. The Veteran was provided a VA examination in August 2016. The VA examiner reviewed the record, interviewed the Veteran, and conducted an in-person examination. The Veteran reported recurrent pain, swelling, and a giving away sensation. He reported that his right ankle pain was intermittent and associated with activities such as stair use. The Veteran further reported that his right ankle pain fluctuated from a five to seven out of ten. He reported flare-ups that limit his ability to wear shoes. Upon examination, the Veteran demonstrated right ankle dorsiflexion to 20 degrees and right ankle plantar flexion to 40 degrees. The VA examiner noted pain during the examination, but opined that it did not result in functional loss. Upon repetitive use testing, the Veteran had right ankle dorsiflexion to 15 degrees and right ankle plantar flexion to 40 degrees. The Veteran did not have ankylosis of the right ankle. Having reviewed the complete record, the Board finds that the evidence does not support the criteria for a disability rating in excess of 10 percent during the period on appeal for the Veteran’s service-connected right ankle disability under Diagnostic Code 5271. The evidence shows that Veteran’s right ankle range-of-motion was dorsiflexion to 20 degrees and plantar flexion to 40 degrees. Upon repetitive use testing the Veteran’s right ankle dorsiflexion decreased to 15 degrees. Based on the range-of-motion findings at the August 2016 VA examination, in comparison to the normal range of motion of the ankle indicated in 38 C.F.R. § 4.71, Plate II, the Board concludes that such limitation in dorsiflexion and plantar flexion represents moderate limited motion. The Board has considered whether the Veteran was entitled to a higher rating at any time during the relevant period under the criteria set forth in DeLuca. The August 2016 VA examiner found that, following repetitive-use testing, the Veteran’s dorsiflexion decreased to 15 degrees due to pain, fatigability, incoordination, pain on movement, or weakness. The Board finds that although the Veteran experienced a reduced range-of-motion upon repetitive use testing, such reduced range-of-motion did not manifest to a degree that more nearly approximates marked limited range-of-motion under Diagnostic Code 5271 even after repetitive use and upon repetitive use over time. See DeLuca, 8 Vet. App. 202. The Board finds that the Veteran’s reduced range-of-motion of the right ankle upon repetitive use testing did not impair his functioning to a degree such that the criteria for a rating in excess of 10 percent were more closely approximate. See Mitchell, 25 Vet. App. 32. The Board has considered whether the Veteran was entitled to higher or additional ratings for the service-connected right ankle disability under other diagnostic codes pertaining to the ankle. However, those codes, Diagnostic Codes 5270, 5272, 5273, and 5274, are not for application in the present case as the record is absent for evidence of ankylosis of the right ankle, ankylosis of the right subastragalar or tarsal joint, malunion of the right os calcis or astragalus, or right astragalectomy. In making its determinations in this case, the Board has carefully considered the Veteran’s contentions with respect to the nature and severity of his service-connected right ankle disability at issue, and notes that his lay testimony is competent to describe certain symptoms associated with this disability. The Veteran’s history and symptom reports have been considered, including as presented in the medical evidence discussed above, and are noted to be contemplated by the criteria for the disability rating for which the Veteran has been found entitled by the Board. Moreover, the competent medical evidence offering detailed specific findings pertinent to the rating criteria is the more probative evidence with regard to evaluating the pertinent symptoms of the service-connected disability at issue. As such, while the Board accepts the Veteran’s statements regarding the matters he is competent to address, the Board relies upon the competent medical evidence with regard to the specialized evaluation of functional impairment, symptom severity, and details of clinical features of the service-connected condition at issue. The Board therefore finds that the criteria for a rating in excess of 10 percent for the Veteran’s service-connected right ankle lateral collateral ligament sprain have not been met at any time during the rating period. Accordingly, there is no basis for staged ratings of the Veteran’s right ankle disability pursuant to Fenderson, 12 Vet. App. at 126-27, and a higher rating must be denied. As the preponderance of the evidence is against the assignment of a higher rating, the benefit-of-the-doubt doctrine is not for application, and the claim must be denied. 38 U.S.C. § 5107 (b); see also Gilbert v. Derwinski, 1 Ver. App. 49 (1990). The Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record. See Yancy v. McDonald, 27 Vet. App. 484, 495 (2016); Doucette v. Shulkin, 38 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 1. Entitlement to service connection for hypertensive cardiovascular disease is remanded. 2. Entitlement to service connection for asthma is remanded. 3. Entitlement to service connection for a right foot disability is remanded. 4. Entitlement to service connection for a left foot disability is remanded. 5. Entitlement to secondary service connection for an acquired psychiatric disorder, to include PTSD, generalized anxiety disorder, major depressive disorder is remanded. 6. Entitlement to an initial rating in excess of 10 percent for a lumbar spine disability is remanded. The Veteran contends that he has hypertensive cardiovascular disease that was incurred during or is otherwise related to his active service. The evidence of record reflects that the Veteran has a current diagnosis of hypertension. See, e.g., VA treatment record dated February 2008. While his service treatment records do not show a diagnosis of hypertension, they do reflect that he had elevated blood pressure readings during active service. For example, a July 1984 service treatment record reflects a blood pressure reading of 128/80 and a June 1982 service treatment record reflect blood pressure readings of 100/80. Such readings meet the criteria for prehypertension, which is defined as moderately increased blood pressure with systolic pressure of 120 to 139 or a diastolic pressure of 80 to 89. See Dorland’s Illustrated Medical Dictionary 1510 (32nd ed. 2012). Thus, the Board cannot make a fully-informed decision on the issue because no VA examiner has opined whether the Veteran’s hypertension was incurred during or is otherwise related to active service. Accordingly, a remand for a VA examination and opinion is required. The Veteran seeks entitlement to service connection for asthma. The Veteran was provided a VA examination in July 2016. The VA examiner noted that the had AN April 1986 report of medical history noted a history of asthma from age 8 to 12. The VA examiner opined that the claimed condition, which clearly and unmistakably existed prior to service, was not aggravated by its natural progression by an in-service event, injury or illness. Nevertheless, the Veteran’s July 1981 report of medical examination at enlistment does not indicate that he had asthma that preexisted active service. Accordingly, it must be shown by clear and unmistakable evidence that the Veteran’s asthma both pre-existed service and was not aggravated by his active service. 38 U.S.C. § 1153 (2012); 38 C.F.R. § 3.306 (2018); also see Wagner, 370 F. 3d at 1096. As the July 2016 VA examiner did not address the Veteran’s July 1981 entrance examination, the medical examination and opinion are inadequate. Accordingly, on remand, it is necessary to clarify whether the Veteran’s asthma clearly and unmistakably preexisted active service, and if so, whether clear and unmistakable evidence shows that the condition was not aggravated by service. Regarding his foot claims, the Veteran was provided a VA examination in August 2016. The VA examiner opined that the Veteran did not have a diagnosed right or left disability. A March 2017 treatment record from Dr. L. M. indicates that x-rays of the Veteran’s bilateral feet revealed posterior and plantar calcaneal spurs. Accordingly, the Board cannot make a fully-informed decision on these issues because no VA examiner has opined whether the Veteran’s bilateral posterior and plantar calcaneal spurs are related to his in-service foot pain. As such, a remand to obtain a medical opinion is required. In a November 2015 letter, Dr. C. Q. opined that the Veteran had PTSD, generalized anxiety disorder, and major depressive disorder that were more probable than not secondary to his military service. As Dr. C. Q. did not provide any rationale in support of his positive opinion, it is insufficient to adjudicate the claim. Nevertheless, Dr. C. Q.’s opinion, in combination with a February 1984 service treatment record noting that the Veteran was in a physical altercation triggers VA’s duty to assist to provide an examination and opinion. McLendon v. Nicholson, 20 Vet. App. 79, 81-83 (2006). Regarding his lumbar spine disability, the record contains conflicting findings as to whether the Veteran has radiculopathy associated with his lumbar spine disability. While the July 2016 VA examiner indicated that the Veteran did not have any signs or symptoms of radiculopathy, the examiner did not perform and electromyography (EMG) or address or acknowledge the June 2016 EMG report noting findings “compatible with” a left S1 radiculopathy. Accordingly, a remand is required to reconcile the conflicting findings. These matters are REMANDED for the following actions: 1. Ask the Veteran to provide the names and addresses of all medical care providers who have recently treated him for his claimed disabilities. After securing any necessary releases, the AOJ should request any relevant records identified. In addition, obtain updated any VA treatment records. If any requested records are unavailable, the Veteran should be notified of such. 2. After the above development, schedule the Veteran for a VA examination to determine the nature and relationship to service, if any, of his current hypertension. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed, as well as the functional impairment, to include as to ability to maintain substantially gainful employment. The examiner should express an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s hypertension was incurred during or is otherwise related to active service. In so opining, the VA examiner should address the elevated blood pressure readings noted in the Veteran’s service treatment records. A complete rationale should be provided for all opinions given. 3. Forward the record and a copy of this remand to the examiner who provided the July 2016 VA examination, or if the examiner is unavailable, another qualified clinician, to obtain an addendum opinion. If it is determined that another in-person examination of the Veteran is required to provide the below-requested information, then such an examination should be scheduled. Following review of the record, the clinician should address the following: (a.) State whether the Veteran’s asthma clearly and unmistakably preexisted his entrance into active service. (b.) If the Veteran’s asthma preexisted service, the state whether the Veteran’s asthma was clearly and unmistakably not aggravated beyond the normal progression of the disorder as a result of service. (c.) If the Veteran’s asthma preexisted service and was permanently worsened during service, state whether that worsening was clearly and unmistakably due to the natural progress of the disability. (d.) If the clinician determines that the Veteran’s asthma did not preexist service, state whether it is at least as likely as not (50 percent or greater probability) that the asthma had its onset during service or is otherwise related to active service. A complete rationale for all opinions expressed should be provided. 4. Forward the claims file to a VA clinician to obtain an addendum opinion regarding the Veteran's bilateral posterior and plantar calcaneal spurs. If an examination is deemed necessary to respond to the questions presented, one should be scheduled. Following review of the claims file, the clinician should opine whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s right or left posterior and plantar calcaneal spurs had its onset during service or is otherwise related to service, including his in-service foot symptomatology. A complete rationale should be provided for all opinions and conclusions expressed. 5. Schedule the Veteran for a VA PTSD examination. The claims file should be reviewed by the examiner in conjunction with the examination. All indicated tests should be conducted and the results reported. Following review of the claims file and examination of the Veteran, the examiner should identify all psychiatric disorders present and then respond to the questions presented: (a.) If the Veteran is diagnosed with PTSD, the examiner should indicate the stressor(s) upon which the diagnosis is based. (b.) For each diagnosed psychiatric condition other than PTSD, to include major depressive disorder and generalized anxiety which are noted in private treatment records, state whether it is at least as likely as not that the conditions arose during service or are otherwise related to the Veteran’s military service. A rationale for all opinions expressed should be provided. 6. Schedule the Veteran for a VA thoracolumbar spine examination to determine the current severity of the Veteran’s lumbar spine disability and any associated neurological abnormalities. The claims file should be reviewed by the examiner. All necessary tests should be performed and the results reported. All symptomatology associated with the Veteran’s lumbar spine disability should be reported. The examiner is requested to address whether the Veteran has radiculopathy and to reconcile the conflicting June 20, 2016 EMG report and July 2016 VA examiner’s opinion regarding such diagnosis. A complete rationale should be provided for all opinions and conclusions expressed. J. A. Anderson Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD B. G. LeMoine, Associate Counsel