Citation Nr: 20021219 Decision Date: 03/25/20 Archive Date: 03/25/20 DOCKET NO. 19-28 308 DATE: March 25, 2020 ORDER New and material evidence having been received, the application to reopen the claim of service connection for cardiac arrhythmia is granted. New and material evidence not having been received, the application to reopen the claim of service connection for diverticulosis is denied. New and material evidence not having been received, the application to reopen the claim of service connection for bilateral feet and toe fungus, diagnosed as tinea unguium, is denied. New and material evidence not having been received, the application to reopen the claim of service connection for a left elbow disorder is denied. New and material evidence not having been received, the application to reopen the claim of service connection for pes planus is denied. Service connection for right elbow disorder is denied. Service connection for left ankle disorder is denied. Service connection for insomnia is denied. Service connection for an acquired psychiatric disorder is denied. Service connection for non-Hodgkin’s lymphoma is denied. A rating in excess of 20 percent for left knee degenerative joint disease (DJD) is denied. A rating in excess of 30 percent for dyspepsia, hiatal hernia is denied. A 20 percent rating for right fibular stress fracture is granted, subject to the law and regulations governing the award of monetary benefits. A rating in excess of 10 percent for right wrist sprain is denied. REMANDED Service connection for cardiac arrhythmia. Entitlement to a total disability rating due to individual unemployability (TDIU). FINDINGS OF FACT 1. The Veteran retired from active duty in January 1996 with over 20 years of service. 2. A September 2013 rating decision denied service connection for cardiac arrhythmia on the basis of no current disability, and diverticulosis, tinea unguium, a left elbow disorder, and pes planus on the basis of no nexus to service. The Veteran did not appeal this decision, and no new and material evidence was submitted within one year of this decision and it became final. 3. Evidence associated with the record includes new evidence that relates to an unestablished fact necessary to substantiate the claim for a cardiac disorder, and raises a reasonable possibility of substantiating the claim. 4. Evidence received since the September 2013 rating decision is cumulative and redundant of the evidence previously of record, such that it does not relate to unestablished facts necessary to substantiate the claims for diverticulosis, tinea unguium, a left elbow disorder, and pes planus, or raise a reasonable possibility of substantiating the claims. 5. A right elbow disorder, a left ankle disorder, and insomnia are not shown. 6. An acquired psychiatric disorder was not shown in service. The reported in-service posttraumatic stress disorder (PTSD) stressor is not substantiated by credible evidence. 7. Non-Hodgkin’s lymphoma was not shown in service, was not shown to a compensable degree within one year of service, symptoms not continuous since service; a current diagnosis of lymphoma is not causally or etiologically related to service. 8. A left knee disability has manifested by subjective complaints of increased pain with walking and an inability to kneel or bend without problems; objective findings include flexion to 15 degrees at worse, but no localized tenderness or evidence of crepitus or pain with weight-bearing. 9. Dyspepsia/hiatal hernia has been manifested by subjective complaints of persistently recurrent epigastric distress, pyrosis, reflux, regurgitation, pain in his left shoulder, and sleep disturbance; objective findings include no symptoms productive of considerable impairment of health, persistently recurrent epigastric distress or material weight loss. 10. A right ankle disability has been manifested by subjective complaints of intermittent stabbing pain radiating to the foot, weakness, and an inability to walk more than 30 minutes; objective findings include ankylosis with an inversion deformity to 30 degrees and plantar flexion to 15 degrees. 11. A right wrist disability has been manifested by subjective complaints of pain with motion; objective findings include palmar flexion limited to no worse than 30 degrees and dorsiflexion limited to no worse than 50 degrees but no ankylosis. CONCLUSIONS OF LAW 1. The September 2013 rating decision is final. 38 U.S.C. § 7105(c) (2012); 38 C.F.R. §§ 3.104, 20.302, 20.1103 (2019). 2. New and material evidence having been received, the claim of service connection for cardiac arrhythmia is reopened. 38 U.S.C. §§ 5108, 7105 (2012); 38 C.F.R. § 3.156 (2019). 3. New and material evidence having not been received, the claim of service connection for diverticulosis is not reopened. 38 U.S.C. §§ 5108, 7105 (2012); 38 C.F.R. § 3.156 (2019). 4. New and material evidence having not been received, the claim of service connection for tinea unguium is not reopened. 38 U.S.C. §§ 5108, 7105 (2012); 38 C.F.R. § 3.156 (2019). 5. New and material evidence having not been received, the claim of service connection for a left elbow disorder is not reopened. 38 U.S.C. §§ 5108, 7105 (2012); 38 C.F.R. § 3.156 (2019). 6. New and material evidence having not been received, the claim of service connection for pes planus is not reopened. 38 U.S.C. §§ 5108, 7105 (2012); 38 C.F.R. § 3.156 (2019). 7. A right elbow disorder was not incurred in service. 38 U.S.C. §§ 1101, 1110, 1112 (2012); 38 C.F.R. §§ 3.303, 3.309 (2019). 8. A left ankle disorder was not incurred in service. 38 U.S.C. §§ 1101, 1110, 1112 (2012); 38 C.F.R. §§ 3.303, 3.309 (2019). 9. Insomnia was not incurred in service. 38 U.S.C. §§ 1101, 1110, 1112 (2012); 38 C.F.R. §§ 3.303, 3.309 (2019). 10. An acquired psychiatric disorder was not incurred in service. 38 U.S.C. §§ 1110, 1131, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.303, 3.310(a), 4.127 (2019). 11. Non-Hodgkin’s lymphoma not incurred in service and is not presumed to have been in service. 38 U.S.C. §§ 1110, 1131, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.303, 3.310(a), 4.127 (2019). 12. The criteria for a rating in excess of 20 percent for left knee DJD have not been met. 38 U.S.C. §§ 1155, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§§ 4.1, 4.3, 4.7, 4.40, 4.45, 4.49, 4.71a, Diagnostic Code (DC) 5010-5261 (2019). 13. The criteria for a rating in excess of 30 percent for dyspepsia, hiatal hernia have not been met. 38 U.S.C. §§ 1155, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.114, DC 7346 (2019). 14. The criteria for a 20 rating, but no more, for right fibular stress fracture have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 4.59, 4.71a, DC 5262-5271 (2019). 15. The criteria for a rating in excess of 10 percent for a right wrist sprain have not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 3.159, 4.71a, DC 5215 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS New and Material Evidence to Reopen Claims Prior unappealed rating decisions may not be reopened absent the submission of new and material evidence warranting revision of the previous decision. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. “New” evidence means evidence “not previously submitted to agency decisionmakers.” “Material” evidence means “evidence that, by itself or when considered with previous evidence of record, related to an unestablished fact necessary to substantiate the claim.” 38 C.F.R. § 3.156 (a). In order to be “new and material” evidence, the evidence must not be cumulative or redundant, and “must raise a reasonable possibility of substantiating the claim,” which has been found to be enabling, not preclusive. See Shade v. Shinseki, 24 Vet. App. 110 (2010). When determining whether the claim should be reopened, the credibility of the newly submitted evidence is to be presumed. Justus v. Principi, 3 Vet. App. 510, 513 (1991). Service connection for cardiac arrhythmia, diverticulosis, tinea unguium, left elbow, and pes planus were initially denied in a September 2013 rating decision. Service connection for cardiac arrhythmia was denied due to lack of a current diagnosis. Service connection for diverticulosis was denied due to lack of in-service incurrence. Service connection for tinea unguium, left elbow, and pes planus was denied on basis of no medical nexus. The Veteran filed a timely notice of disagreement (NOD) and a statement of the case (SOC) was issued in May 2016; however, he did not file a substantive appeal, nor was new and material evidence received within one year of the rating action. Therefore, the September 2013 rating action became final. Cardiac Arrhythmia Regarding cardiac arrhythmia, the claim was originally denied on the basis that there was no evidence of a cardiac disorder. Evidence received since the September 2013 rating decisions includes extensive VA and private medical records and statements by the Veteran. Accordingly, this evidence is new. Moreover, a November 2017 Active Problem List includes cardiac dysrhythmia. As the claim was denied for a lack of diagnosis and a current diagnosis is shown, the appeal to reopen the claim for cardiac arrhythmia is granted. Diverticulosis, Tinea Unguium, Left Elbow, and Pes Planus The evidence added to the claims file since the September 2013 rating decision includes duplicate service treatment records (STRs), lay statements, and VA and private treatment records spanning the period on appeal. This evidence is new as it was not of record at the time of the final decisions; however, the evidence is not material as it does not raise a reasonable possibility of substantiating the claims. The Veteran has largely submitted only VA and private treatment records in support of his claims. Specifically, these new records show ongoing treatment for diverticulosis, tinea unguium, left elbow, and pes planus; however, the presence of current disorders were not in question as the September 2013 rating decision denied service connection due to a lack of nexus between the current disabilities and active service. None of the newly-submitted records establish a medical nexus between service and current complaints. Accordingly, while new evidence has been submitted in support of the claims, it is not material in that it does not raise a reasonable possibility of substantiating the claims by establishing a nexus to the Veteran’s active service. Therefore, the appeals are denied. Service Connection Claims Service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (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 in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). Service connection may be granted on a presumptive basis for diseases listed in § 3.309 under the following circumstances: (1) where a chronic disease or injury is shown in service and subsequent manifestations of the same disease or injury are shown at a later date unless clearly attributable to an intercurrent cause; or (2) where there is continuity of symptomatology since service; or (3) by showing that the disorder manifested itself to a degree of 10 percent or more within one year from the date of separation from service. See 38 C.F.R. § 3.307. Right Elbow, Left Ankle, Insomnia The first element of service connection under any theory of entitlement is a current disability. The Veteran has claimed he has a right elbow disorder, left ankle disorder, and insomnia all caused by service. A review of the VA medical records does not show a current disability for right elbow disorder, left ankle disorder, or insomnia. The most recent Active Problem List includes lymphoma, callus, posttraumatic stress, acute abdomen, tinea unguium, mild depression, chest pain, alcohol dependence, shortness of breath, cardiac dysrhythmia, and essential hypertension. Without a current disability, the medical evidence does not support service connection under any theory of entitlement. Accordingly, the appeals are denied. Acquired Psychiatric Disorder Service connection for PTSD requires medical evidence establishing a diagnosis of the condition, credible supporting evidence that the claimed in-service stressor actually occurred, and a link, established by medical evidence, between the current symptomatology and the claimed in-service stressor. 38 C.F.R. § 3.304(f). In adjudicating a claim for service connection for PTSD, the evidence necessary to establish the incurrence of a stressor during service will vary depending on whether or not the veteran was “engaged in combat with the enemy.” Hayes v. Brown, 5 Vet. App. 60, 66 (1993). If the veteran did not engage in combat with the enemy, or the claimed stressor is not related to combat, then the veteran’s testimony alone does not suffice to establish the occurrence of the alleged stressor; instead, the veteran must corroborate his testimony by credible supporting evidence. Stone v. Nicholson, 480 F.3d 1111 (Fed. Cir. 2007) (finding no error in Board determination that a non-combat veteran’s “own statements cannot serve as ‘corroboration’ of the facts contained in those statements”). Zarycki v. Brown, 6 Vet. App. 91, 98 (1993). The Board has rephrased the Veteran’s claim broadly as a claim of entitlement to service connection for an acquired psychiatric disorder. See Clemons v. Shinseki, 23 Vet. App. 1 (2009) (finding that the scope of a mental health disability claim includes any mental health disability that may reasonably be encompassed by the claimant’s description of the claim, reported symptoms, and the other information of record). As to the existence of a present disability, the Veteran has a current diagnosis of PTSD. Specifically, VA treatment notes reflect that the Veteran was diagnosed with PTSD in May 2017. Therefore, the first element of service connection has been met. Turning to the second element, the service treatment records (STRs) do not reflect a diagnosis of or treatment of any psychiatric disorders. Therefore, the medical evidence does not support the claim on a direct basis. Further, the evidence does not show, nor does the Veteran allege, that he engaged in combat with the enemy. Rather, he has reported that his stressor included responding to the scene of a fellow servicemember who committed suicide after driving his vehicle into a concrete barricade. A review of the military personnel file show that the Veteran worked as a chemical operations specialist. Despite attempts to verify the stressors, there are no records available which corroborate his statements regarding responded to the scene of a fellow servicemember who committed suicide. Although the medical evidence establishes a diagnosis of PTSD, the record fails to establish that the stressor actually occurred. Absent credible supporting evidence that the claimed in-service stressors as described by the Veteran actually occurred, an essential element for a grant of service connection is missing and the appeal is denied. Non-Hodgkin’s Lymphoma The Veteran’s contends that he developed lymphoma as a result of exposure to nerve gas and other chemicals during service. In an August 2018 statement, he reported that he was assigned to decontaminate the Pershing Missile following training exercises and he was also responsible for organizing and conducting chemical surety exercises. Service personnel records show that he served as a chemical operations specialist. As to a current diagnosis, the Veteran was diagnosed with diffuse large B-cell lymphoma in the right neck extending into the tonsil in November 2016. Therefore, a current diagnosis has been shown. As to an in-service incurrence, the STRs are negative for complaints of, treatment for, or a diagnosis of lymphoma nor has the Veteran contended that the disorder started in service. Therefore, the evidence does not support service connection on a direct basis. Rather, the Veteran’s primary contention is the lymphoma was caused by nerve gas exposure. To that end, in a November 2018 VA examination, he reported that he was found to have a mass in the left neck in 2016 and a biopsy showed non-Hodgkin’s lymphoma. At the time of the examination, he was in remission. After a physical examination, the examiner opined that lymphoma was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. In support of his opinion, the examiner opined that the current literature indicated that there was no direct linkage of exposure to nerve gas and lymphoma. There is no contradictory medical opinion. Therefore, the medical evidence does not support service connection as due to nerve gas exposure. As the Veteran has been diagnosed with a malignant tumor, presumptive service connection applies. Nonetheless, no chronic disease or injury related to non-Hodgkin’s lymphoma was shown in service, nor does the Veteran so contend. Therefore, the medical evidence does not support presumptive service connection on a “chronic disease or injury shown in service” basis. Next, the medical evidence does not support presumptive service connected based on continuity of symptomatology since service. Specifically, the Veteran was discharged from service in 1996 and not diagnosed with lymphoma until 2016, some 20 years later. Moreover, the evidence indicates that the left neck mass developed in 2016, and he was diagnosed with lymphoma that same year. This suggests an onset of symptoms in 2016. As he was discharged in 1996 and symptoms were not identified until 2016, the medical evidence does not support service connection on a “continuity of symptomatology” basis. Further, the disorder did not manifest itself to a degree of 10 percent or more within one year from the date of separation of service. As noted, the Veteran separated from service in 1996 but did not note symptoms until 2016, with treatment beginning that same year. This evidence does not support presumptive service connection on a “manifest within one-year from separation” basis. Therefore, presumptive service connection on any basis is not supported by the medical evidence. With respect to all the service connection claims, the Board has considered the Veteran’s lay statements that that his disorders were caused by service. He is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses; however, he is not competent to offer an opinion as to the etiology of his current disorders due to the medical complexity of the matters involved. Such competent evidence has been provided by the service records, clinical evidence, and examinations obtained and associated with the claims file. Here, the Board attaches greater probative weight to the clinical findings than to his statements. In light of the above, the preponderance of the evidence is against the claims for service connection and there is no doubt to be otherwise resolved. As such, the appeals are denied. Increased Rating Claims Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities. Left Knee The Veteran is currently rated at 20 percent under DC 5010-5261 for limitation of extension. As ankylosis, meniscus involvement, tibia and fibula impairment, and lateral instability and subluxation have not been shown, DCs 5256, 5257, 5258, 5259, and 5262 are not for application. Under DC 5261, a 30 percent rating is assigned for extension limited to 20 degrees; a 40 percent rating is assigned for extension limited to 30 degrees; and the highest rating of 50 percent is assigned for extension limited to 45 degrees. For VA purposes, normal range of motion of the knee is from 0 degrees of extension to 140 degrees of flexion. 38 C.F.R. § 4.71a, Plate II. Turning to the evidence, in a September 2017 examination, the Veteran denied flare-ups. Upon examination, range of motion testing was noted as flexion to 15 degrees with pain noted on examination that resulted in functional loss, without evidence of localized tenderness, or objective evidence of crepitus, or pain with weight-bearing. After repetitive testing, there was no additional change in functional loss or range of motion. Muscle strength testing shown a 4 out of 5 for flexion and extension with no evidence of muscle atrophy, ankylosis, history of recurrent subluxation, lateral instability, or effusion shown. The examiner specifically addressed the Correia criteria, and noted that there was no evidence of pain on passive range of motion testing, and no evidence of pain of joint when used in non-weight bearing. In an August 2018 examination, the Veteran reported flare-ups, described as increase pain with walking and reports of function loss/impairment, described as the inability to kneel or bend without problems. Upon examination, the range of motion testing showed flexion to flexion 0 degrees (anatomically normal) with pain and functional loss but without objective evidence of localized tenderness, evidence of pain on weight-bearing or crepitus. The examiner noted that the examination was medically consistent with the Veteran’s statements describing functional loss with repetitive use over time. Pain, fatigue, weakness, and lack of endurance significantly limited functional ability with repetitive use. Muscle strength was normal, with no evidence of muscle atrophy, ankylosis, history of recurrent subluxation, lateral instability, or effusion shown. The clinical records show complaints of left knee pain but do not include specific range of motion measurements. As such, this evidence neither supports nor weighs against the claim. Based on the above, the medical evidence does not support a higher rating. Flexion has been documented at 15 degrees of flexion, at worse, and most recently as anatomically normal. Further, the evidence shows no additional limitation based on pain or functional impairment. Therefore, the medical evidence does not support a rating in excess of 20 percent. Dyspepsia, Hiatal Hernia The Veteran’s dyspepsia, hiatal hernia is rated at 30 percent pursuant to DC 7346. The next higher 60 percent rating will be warranted when the objective medical evidence shows symptoms of vomiting, material weight loss, and hematemesis or melena with moderate anemia or other symptom combinations productive of severe impairment of health. September 2017 VA treatment records show the Veteran’s complained of pain in his left shoulder related to his dyspepsia, hiatal hernia. At a December 2017 VA examination, he endorsed symptoms of persistently recurrent epigastric distress, pyrosis, reflux, regurgitation, pain in his left shoulder, and sleep disturbance associated with his dyspepsia/hiatal hernia. Upon examination, there was no material weight loss, nausea or vomiting, evidence of esophageal stricture, esophageal spasm, or acquired diverticulum of the esophagus. In an August 2018 Stomach and Duodenal examination, the Veteran reported symptoms of pain in his left shoulder but denied any symptoms of nausea or reflux. He reported taking Rolaids and Tums for his condition. Upon examination, there was no evidence of symptoms productive of considerable impairment of health, persistently recurrent epigastric distress, material weight loss, nausea or vomiting, esophageal stricture, esophageal spasm, or acquired diverticulum of the esophagus. Based on the above, the medical evidence does not support a higher rating. At no time does the medical evidence reflect that the Veteran has experienced material weight loss, anemia, or severe impairment of health due to the hiatal hernia. While it is apparent that he requires medication for treatment on a daily basis, the symptoms are most consistent with the current 30 percent rating. The Board has considered all potentially relevant diagnostic codes but finds that a higher rating is not warranted.   Right Fibular Stress Fracture The Veteran’s right ankle disability is rated as 10 percent disabling under DC 5262-5271. Under DC 5271, 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. Terms such as “mild,” “moderate,” and “marked” are not defined in the Rating Schedule. Under DC 5270, a 20 percent rating is warranted for ankylosis of the ankle in plantar flexion less than 30 degrees. A 30 percent rating is warranted with ankylosis in plantar flexion between 30 and 40 degrees, or in dorsiflexion between 0 and 10 degrees. Turning to the evidence, in a September 2017 VA examination, the Veteran reported that he experienced an intermittent stabbing pain that caused his ankle to ache and radiated to his foot. He indicated that he experienced pain when standing and that he wore a splint 3 to 4 times a week on his right ankle. He denied experiencing any flare-ups. Upon examination, dorsiflexion was to 15 degrees and plantar flexion to 30 degrees. The examiner noted that the range of motion did not contribute to functional loss. There was dorsiflexion ankylosis of the right ankle with an inversion deformity to 30 degrees and plantar flexion to 15 degrees. Additionally, there was no evidence of right ankle instability. There was no evidence of pain on non-weight bearing and passive range of motion was normal with pain on dorsiflexion. In an August 2018 VA examination, the Veteran reported weakness and intermittent pain with increased activity and weather changes and that he was unable to stand/walk for more than thirty minutes. He further reported flare-ups with increased activity and weather changes. Upon examination, dorsiflexion was to 20 degrees and plantar flexion to 35 degrees. Pain was noted on examination that resulted in functional loss. There was no evidence of pain with weight bearing. The Veteran was able to perform repetitive use testing without additional loss of range of motion. He did not have ankylosis of the right ankle. There was no evidence of pain on non-weight bearing and passive range of motion was normal with pain on dorsiflexion. The clinical records reflect the Veteran’s report of right ankle pain; however, they do not contain specific range of motion measurements for the right ankle or any description as to whether the right ankle range of motion is marked or moderate. As such, clinical records neither support nor weigh against the claim. Based on the above, a 20 percent rating is based on ankylosis in dorsiflexion less than 30 degrees under DC 5270. A higher rating is not warranted as ankylosis is not shown to be between 30 and 40 degrees of plantar flexion or between 0 and 10 degrees of dorsiflexion as dorsiflexion is shown to be at 15 degrees. As such, a 20 percent rating, but no more, is granted. Right Wrist Sprain The Veteran’s right wrist disability is rated at 10 percent pursuant to DC 5215. Under DC 5215, with respect to the major extremity, a 10 percent rating is warranted for dorsiflexion less than 15 degrees, or palmar flexion limited in line with the forearm. As this is the highest rating under DC 5215, no higher rating is available regardless of the symptoms. The Board has also considered whether a higher rating is available under DC 5214 for ankylosis of the wrist, which provides for a 30 percent rating for favorable ankylosis in 20 to 30 degrees dorsiflexion. A 40 percent rating is warranted for ankylosis in any other position, except favorable. A maximum, 50 percent rating is warranted for unfavorable ankylosis in any degree of palmar flexion, or with ulnar or radial deviation. DC 5214. Normal range of motion of the wrist includes dorsiflexion (extension) from 0 to 70 degrees; plantar flexion from 0 to 80 degrees; ulnar deviation from 0 to 45 degrees; and radial deviation from 0 to 20 degrees. The medical evidence reflects that the Veteran is right-handed. As such, his right wrist is dominant/major. In a December 2017 Wrist DBQ, palmar flexion of the right wrist was from 0 to 30 degrees, dorsiflexion from 0 to 50 degrees, ulnar deviation from 0 to 10 degrees, and radial deviation was from 0 to 10 degrees. There was pain on all ranges of motion. The examiner indicated that pain was noted, but it did not result in/cause functional loss. There was no pain with weight-bearing and there was objective evidence of localized tenderness and pain on palpation of the joint and associated soft tissue. There was also no evidence of crepitus. The Veteran was able to complete repetitive use testing with at least three repetitions. There was no additional loss of function or range of motion after three repetitions. Muscle strength testing was 4/5 for right wrist flexion and extension. The Veteran regularly used a cane as an assistive device. The examiner stated that ankylosis was not present. There was no pain on passive range of motion or when the joint was used in non-weight-bearing. In terms of the functional impact of the disability, he reported that if he were still employed, then the pain and weakness in his right wrist would interfere with his ability to safely perform his duties. Based on the foregoing, a rating in excess of 10 percent is not warranted. Significantly, the medical evidence does not support a higher rating based on ankylosis of the right wrist. Rather, the VA examination reports contains specific findings of no ankylosis. Therefore, the medical evidence does not support the claim. The Board has also considered the Veteran’s lay statements that his disabilities are worse. While he is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses, he is not competent to identify a specific level of disability of these disorders according to the appropriate diagnostic codes. Such competent evidence concerning the nature and extent of the Veteran’s disabilities has been provided by the medical personnel who have examined him during the current appeal and who have rendered pertinent opinions in conjunction with the evaluations. The medical findings (as provided in the examination reports and other clinical evidence) directly address the criteria under which these disabilities are evaluated. Moreover, as the examiners had the requisite medical expertise to render medical opinions regarding the degree of impairment caused by the disabilities and had sufficient facts and data on which to base the conclusions, the Board affords the medical opinions great probative value. As such, these records are more probative than the Veteran’s subjective complaints of increased symptomatology. In sum, after a careful review of the evidence of record, the benefit of the doubt rule is not applicable and the appeals, except for the right ankle, are denied. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board’s consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (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 Having reopened the claim, service connection for cardiac arrhythmia will be remanded for an examination and medical opinion. Specifically, the STRs show an in-service report of sinus bradycardia and nonspecific intraventricular conduction delay in September 1995. Further, the Veteran is currently diagnosed with dysrhythmia and coronary atherosclerosis. As such, a medical opinion is needed to determine whether there is a causal link between the two. Finally, the issue of entitlement to TDIU is inextricably intertwined with the pending claim for service connection. Therefore, the TDIU claim will also be remanded. The matters are REMANDED for the following actions: 1. Associate with the claims file any outstanding, relevant treatment notes. 2. Schedule the Veteran for an examination to determine the nature and etiology of any heart disorder to include cardiac arrhythmia. All relevant documents should be made available to the examiner. Based on a review of the records, the examiner is asked to offer an opinion as to whether it is as likely as not (i.e., to at least a 50 percent degree of probability) that a current heart disorder had its onset during service or was otherwise causally or etiologically related to service, including a reference to an intraventricular conduction delay in service. A rationale should be provided for all opinions given, and the factors upon which each medical opinion is based should be set forth in the report. If the examiner is unable to provide any required opinion, he or she should explain why. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation as to why this is so. If the inability to provide a more definitive opinion is the result of a need for additional information, the examiner should identify the additional information that is needed. L. HOWELL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Grzeczkowicz The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.