Citation Nr: 20022016 Decision Date: 03/30/20 Archive Date: 03/30/20 DOCKET NO. 19-25 977A DATE: March 30, 2020 ORDER New and material evidence has been presented, and the claim of entitlement to service connection for a left shoulder disorder is reopened. New and material evidence has been presented, and the claim of entitlement to service connection for a right shoulder disorder is reopened. New and material evidence has been presented, and the claim of entitlement to service connection for a left hip disorder is reopened. New and material evidence has been presented, and the claim of entitlement to service connection for a right hip disorder is reopened. New and material evidence has been presented, and the claim of entitlement to service connection for a lumbar spine disorder is reopened. New and material evidence has been presented, and the claim of entitlement to service connection for obstructive sleep apnea is reopened. New and material evidence has been presented, and the claim of entitlement to service connection for tinnitus is reopened. Service connection for a chronic lumbar spine disorder is denied. Service connection for tinnitus is denied. Service connection for allergic rhinitis is denied. Service connection for an acquired psychiatric disorder is denied. An initial rating in excess of 10 percent for bilateral pes planus is denied. A rating in excess of 10 percent for a left knee disability is denied. A rating in excess of 10 percent for a right knee disability is denied. REMANDED Entitlement to service connection for a left hip disorder is remanded. Entitlement to service connection for a right hip disorder is remanded. Entitlement to service connection for a left ankle disorder is remanded. Entitlement to service connection for a right ankle disorder is remanded. Entitlement to service connection for a left shoulder disorder is remanded. Entitlement to service connection for a cervical spine disorder is remanded. Entitlement to service connection for a right shoulder disorder is remanded. Entitlement to service connection for a left elbow disorder is remanded. Entitlement to service connection for a right elbow disorder is remanded. Entitlement to service connection for a left wrist disorder is remanded. Entitlement to service connection for a right wrist disorder is remanded. Entitlement to service connection for left carpal tunnel syndrome is remanded. Entitlement to service connection for right carpal tunnel syndrome is remanded. Entitlement to service connection for benign prostate hyperplasia is remanded. Entitlement to service connection for obstructive sleep apnea is remanded. Entitlement to a total disability rating based on individual unemployability as a result of service-connected disabilities (TDIU) is remanded. FINDINGS OF FACT 1. A March 2010 rating decision denied the Veteran’s service connection claims for a left shoulder disorder and a right shoulder disorder. 2. An April 2012 rating decision denied the Veteran’s service connection claims for a left hip disorder, a right hip disorder, and a lumbar spine disorder. 3. A December 2014 rating decision denied the Veteran’s service connection claims for obstructive sleep apnea and tinnitus. 4. The evidence received since the March 2010, April 2012, and December 2014 rating decisions includes evidence that relates to an unestablished fact necessary to substantiate the service connection claims for a left shoulder disorder, a right shoulder disorder, a left hip disorder, a right hip disorder, a lumbar spine disorder, obstructive sleep apnea, and tinnitus, is neither cumulative nor redundant of evidence already of record, and raises a reasonable possibility of substantiating the claims. 5. The weight of the evidence is against a finding that any lumbar spine disorder or tinnitus began during service, within one year of separation from service, or was otherwise caused by his active service. 6. Allergic rhinitis was not shown in service and the weight of the evidence is against a finding that this condition was related to or caused by his active service. 7. The Veteran does not have an acquired psychiatric disorder. 8. The Veteran’s bilateral pes planus does not result in objective evidence of marked deformity, pain on manipulation and use accentuated, indication of swelling on use, characteristic callosities, marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo achillis on manipulation that is not improved by orthopedic shoes or appliances. 9. The Veteran’s left knee disability is not productive of ankylosis; slight recurrent subluxation or lateral instability; dislocated or removed symptomatic semilunar cartilage; flexion functionally limited to 30 degrees or less; extension functionally limited to 10 degrees or more; an impairment of the tibia and fibula; or genu recurvatum. 10. The Veteran’s right knee disability is not productive of ankylosis; slight recurrent subluxation or lateral instability; dislocated or removed symptomatic semilunar cartilage; flexion functionally limited to 30 degrees or less; extension functionally limited to 10 degrees or more; an impairment of the tibia and fibula; or genu recurvatum. CONCLUSIONS OF LAW 1. New and material evidence has been submitted, and the Veteran’s service connection claim for a left shoulder disorder is reopened. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 2. New and material evidence has been submitted, and the Veteran’s service connection claim for a right shoulder disorder is reopened. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 3. New and material evidence has been submitted, and the Veteran’s service connection claim for a left hip disorder is reopened. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 4. New and material evidence has been submitted, and the Veteran’s service connection claim for a right hip disorder is reopened. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 5. New and material evidence has been submitted, and the Veteran’s service connection claim for a lumbar spine disorder is reopened. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 6. New and material evidence has been submitted, and the Veteran’s service connection claim for obstructive sleep apnea is reopened. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 7. New and material evidence has been submitted, and the Veteran’s service connection claim for tinnitus is reopened. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 8. The criteria for service connection for a lumbar spine disorder have not been met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.307, 3.309. 9. The criteria for service connection for tinnitus have not been met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.307, 3.309. 10. The criteria for service connection for allergic rhinitis have not been met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.307, 3.309. 11. The criteria for service connection for an acquired psychiatric disorder have not been met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.304. 12. The criteria for a schedular rating in excess of 10 percent for bilateral pes planus have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.71a, Diagnostic Codes 5276-84 13. The criteria for a rating in excess of 10 percent for the Veteran’s left knee disability have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.71a, Diagnostic Codes 5256-63. 14. The criteria for a rating in excess of 10 percent for the Veteran’s right knee disability have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.71a, Diagnostic Codes 5256-63. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from September 1969 to May 1971, to include service in the Republic of Vietnam. Reopening Claims New evidence is defined as evidence not previously submitted to agency decision makers. Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). When determining whether the claim should be reopened, the credibility of the newly submitted evidence is to be presumed. Fortuck v. Principi, 17 Vet. App. 173, 179-80 (2003); Justus v. Principi, 3 Vet. App. 510 (1992). Moreover, in Shade v. Shinseki, 24 Vet. App. 110, 117-18 (2010), the U.S. Court of Appeals for Veterans Claims (Court) clarified that the phrase “raises a reasonable possibility of substantiating the claim” is meant to create a low threshold that enables, rather than precludes, reopening. Specifically, the Court stated that reopening is required when the newly submitted evidence, combined with VA assistance and considered with the other evidence of record, raises a reasonable possibility of substantiating the claim. Id. In January 2010, the Veteran filed service connection claims for a left shoulder disorder and a right shoulder disorder, which was denied by a March 2010 rating decision. In October 2012, the Veteran filed service connection claims for a left hip disorder, a right hip disorder, and a lumbar spine disorder, which were denied by an April 2012 rating decision. In January 2014 the Veteran filed a service connection claim for tinnitus and in July 2014 filed a service connection claim for obstructive sleep apnea, which were denied by a December 2014 rating decision. He did not submit any new and material evidence pertaining to these issues within a year of the rating decision, meaning that the March 2010, April 2012, and December 2014 rating decisions became final. See 38 U.S.C. § 7105(c); 38 C.F.R. §§ 3.104, 20.302, 20.1103. At the time of the March 2010, April 2012, and December 2014 rating decisions, the evidence of record included the Veteran’s STRs and VA treatment records. The RO found that the claims file contained no evidence showing his left shoulder disorder, right shoulder disorder, left hip disorder, right hip disorder, lumbar spine disorder, obstructive sleep apnea, or tinnitus were due to his active service and denied the claims. In October 2018, the Veteran requested to reopen his previously denied service connection claims for a left shoulder disorder, a right shoulder disorder, a left hip disorder, a right hip disorder, a lumbar spine disorder, obstructive sleep apnea, and tinnitus. He asserts that these conditions are due to his active service. Evidence received since the March 2010, April 2012, and December 2014 rating decisions includes the additional VA treatment records and private treatment records, which includes a statement from the Veteran’s physician regarding etiology. This evidence is presumed credible for the limited purposes of reopening the claims, and when that is done, the new information is considered to be material and is therefore sufficient to reopen the previously-denied claims. 38 C.F.R. § 3.156(a); Shade, 24 Vet. App. 110. Accordingly, the claims are reopened. Service Connection Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. 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). Service connection may also be established under 38 C.F.R. § 3.303(b), where a condition in service is noted but is not, in fact, chronic, or where a diagnosis of chronicity may be legitimately questioned. The continuity of symptomatology provision of 38 C.F.R. § 3.303(b) has been interpreted as an alternative to service connection only for the specific chronic diseases listed in 38 C.F.R. § 3.309(a). See Walker v. Shinseki, 718 F.3d 1331 (Fed. Cir. 2013). Service connection may also be established with certain chronic diseases based upon a legal presumption by showing that the disorder manifested itself to a degree of 10 percent disabling or more within one year from the date of separation from 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, 1137; 38 C.F.R. §§ 3.307, 3.309(a). While the disease need not be diagnosed within the presumption period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. Service connection may be granted on a presumptive basis for certain diseases associated with exposure to certain herbicide agents even though there is no record of such disease during service, if they manifest to a compensable degree any time after service, in a veteran who had active military, naval, or air service for at least 90 days, during the period beginning on January 9, 1962 and ending on May 7, 1975, in the Republic of Vietnam, including the waters offshore, and other locations if the conditions of service involved duty or visitation in Vietnam. 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307, 3.309(e), 3.313. This presumption may be rebutted by affirmative evidence to the contrary. 38 U.S.C. § 1113; 38 C.F.R. §§ 3.307, 3.309. The Republic of Vietnam includes the 12 nautical mile territorial sea. See Procopio v. Wilkie, No. 17-1821 (Fed Cir. 2019). The Veteran’s service records show that he had service in the Republic of Vietnam. Thus, he is presumed to have been exposed to herbicide agents, such as Agent Orange. However, a lumbar spine disorder, tinnitus, and allergic rhinitis are not diseases subject to presumptive service connection. 38 C.F.R. § 3.309. As such, presumptive service connection based on herbicide agent exposure is not warranted. Lumbar Spine Disorder The Veteran filed a request to reopen his service connection claim for a lumbar spine disorder, which was denied by an October 2018 rating decision. The Veteran asserts that his lumbar spine disorder is due to his active service. The Veteran’s STRs show that he complained of back symptoms in February 1970, June 1970, January 1971, February 1971, and March 1971. However, STRs show that he had normal physicals at his April 1969 entrance examination and his March 1971 separation examination. While he reported having back trouble at his March 1971 separation examination, his STRs do not show a diagnosis of a chronic lumbar spine disorder during his actives service. The Veteran’s STRs from reserve service show that he had a normal physical at an October 1984 examination, and he specifically denied having any recurrent back pain. The Veteran’s treatment records show that he was diagnosed with lumbar spine arthritis in April 1999, almost three decades after his separation from active service. In January 2007, the Veteran was afforded a VA examination. He reported that his back pain was due to driving a truck over uneven surfaces. After reviewing the Veteran’s claims file, interviewing the Veteran, and conducting an examination, the examiner opined that the Veteran’s lumbar spine disorder was less likely than not due to his active service. The examiner reported that while the Veteran’s STRs showed treatment for back complaints during his active service, there was no evidence of continuous medical treatment during the year after his separation from active service. In January 2018, the Veteran’s physician reported that the Veteran was diagnosed with a lumbar spine disorder and opined that it was more probable than not that his lumbar spine disorder was due to his active service. Here two opinions are of record, both of which were provided by medical professionals who are presumed to have the training and expertise to opine on OSA. As such, each opinion is considered to constitute both competent and credible evidence, which is deemed to be probative. However, the Board must determine what evidence is the most probative. After weighing all the evidence, the Board finds the greatest probative value in the January 2007 VA examiner’s opinion, which considered the elements necessary to substantiate a service connection claim. While the Veteran’s physician opined that the Veteran’s lumbar spine disorder was more probable than not due to his active service, his physician did not provide any rational for his opinion or refer to any medical evidence that led him to his conclusion. His physician did not discuss why the Veteran’s STRs contained no diagnosis of a chronic lumbar spine disorder, why the Veteran had a normal examinations of his spine at his March 1971 separation examination and at an October 1984 examination, the Veteran’s specific denial of recurrent back pain in October 1984, and the diagnosis of arthritis in 1999, almost three decades after the Veteran’s active service. His physician also did not discuss the opinion of the January 2007 VA examiner. This appears to be highly relevant in that the Veteran’s STRs do not show a diagnosis of a chronic lumbar spine disorder and his separation physical was normal. Conversely, the January 2007 VA examiner concluded that the Veteran’s lumbar spine disorder was less likely than not due to his active service and specifically explained why. The January 2007 examiner is shown to have reviewed and considered the pertinent evidence of record, and to have provided adequate rationale for his opinion. The Veteran’s reported history was adequately considered. See Dalton v. Nicholson, 21 Vet. App. 23 (2007). The Board appreciates the opinion of the Veteran’s physician. However, ultimately, the support provided by the January 2007 VA examiner for his opinion is found to be greatly superior to the opinion of the Veteran’s physician offered in support of the Veteran’s claim, which did not provide any rational for his opinion. Given its grounding in the medical evidence in this case, the January 2007 VA examiner’s opinion is found to be the most probative evidence in this case, and therefore is afforded the greatest weight. Here, the support provided by the January 2007 VA examiner for the opinion is found to be greatly superior to the opinion of the Veteran’s physician, which found that the Veteran’s lumbar spine disorder was due to his active service, but provided no rational or explained the Veteran’s normal physical examinations at his March 1971 separation physical and October 1984 reserve service physical and the lack of treatment until the Veteran was diagnosed with lumbar spine arthritis in 1999. Given its grounding in the medical evidence in this case and the medical literature, the opinion of the January 2007 VA examiner is found to be the most probative evidence in this case, and therefore are afforded the greatest weight. Consideration has been given to the assertions that he has a chronic lumbar spine disorder as a result of his active service. He is clearly competent to report symptoms of pain as well as injury. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331. However, while the Veteran may describe back pain, he lacks the medical training or qualification to either diagnose a chronic lumbar spine or opine as to its etiology. Id. His opinion therefore cannot provide the requisite nexus and does not refute the medical opinions of record. The record does not contain evidence of a diagnosis of an ongoing chronic lumbar spine disability related to his active service. He first objective evidence of a chronic lumbar spine disorder in not until 1999. As such, the Board does not find that the evidence of record shows continuous symptomatology. The Board also notes that the Veteran is not entitled to presumptive service connection for a chronic lumbar spine disorder. The record contains no objective medical evidence of a chronic lumbar spine disorder until 1999, almost three decades after his separation from active service. In addition, the record does not contain evidence that any back injury in service resulted in a diagnosis of arthritis within one year of separation from the service. Therefore, the presumption of service connection has not been triggered. Accordingly, the criteria for service connection have not been met for a chronic lumbar spine disorder. That is, the evidence does not show that a chronic lumbar spine disorder was diagnosed in service or within a year of service, and the weight of the evidence is against a finding that any lumbar spine disorder has existed continuously since service. Therefore, the claim is denied Tinnitus The Veteran filed a request to reopen his service connection claim for tinnitus, which was denied by an October 2018 rating decision. The Veteran asserts that his tinnitus is due to his active service. The Veteran’s military noise exposure is not at issue as the Veteran had service in the Republic of Vietnam. However, for service connection to be warranted it must be shown that such noise exposure actually caused tinnitus. The Veteran’s STRs contain no complaints, symptoms, treatment, or diagnosis of tinnitus during his active service. Furthermore, the Veteran STRs show that he had normal physicals at his April 1969 entrance examination and his March 1971 separation examination. The Veteran’s STRs from reserve service show that he had a normal physical at an October 1984 examination. The Veteran’s treatment records do not show any complaints, treatment, or diagnosis for tinnitus. Indeed, he specifically denied having tinnitus at treatment visits between August 2010 and October 2014. In December 2014, the Veteran was afforded a VA examination. He reported having intermittent tinnitus for several years. After reviewing the Veteran’s claim’s file, interviewing the Veteran, and conducting an examination, the examiner opined that the Veteran’s tinnitus was less likely than not due to his active service. The examiner reported that the Veteran reported tinnitus over four decades after his separation from active service. In January 2018, the Veteran’s physician reported that the Veteran was diagnosed with tinnitus and opined that it was more probable than not that his tinnitus was due to his active service. Here two opinions are of record, both of which were provided by medical professionals who are presumed to have the training and expertise to opine on OSA. As such, each opinion is considered to constitute both competent and credible evidence, which is deemed to be probative. However, the Board must determine what evidence is the most probative. After weighing all the evidence, the Board finds the greatest probative value in the December 2014 VA examiner’s opinion, which considered the elements necessary to substantiate a service connection claim. While the Veteran’s physician opined that the Veteran’s tinnitus was more probable than not due to his active service, his physician did not provide any rational for his opinion or refer to any medical evidence that led him to his conclusion. His physician did not discuss the medical records showing the Veteran denied having tinnitus from August 2010 to October 2014. His physician did not discuss the first evidence of tinnitus was not until 2014, over four decades after the Veteran’s active service. His physician also did not discuss the opinion of the December 2014 VA examiner. This appears to be highly relevant in that the Veteran’s STRs do not show any complaints for any tinnitus and his separation physical was normal. Conversely, the December 2014 VA examiner concluded that the Veteran’s tinnitus was less likely than not due to his active service and specifically explained why. The December 2014 examiner is shown to have reviewed and considered the pertinent evidence of record, and to have provided adequate rationale for his opinion. The Veteran’s reported history was adequately considered. See Dalton, 21 Vet. App. 23. The Board appreciates the opinion of the Veteran’s physician. However, ultimately, the support provided by the December 2014 VA examiner for his opinion is found to be greatly superior to the opinion of the Veteran’s physician offered in support of the Veteran’s claim, which did not provide any rational for his opinion. Given its grounding in the medical evidence in this case, the December 2014 VA examiner’s opinion is found to be the most probative evidence in this case, and therefore is afforded the greatest weight. Here, the support provided by the December 2014 VA examiner for the opinion is found to be greatly superior to the opinion of the Veteran’s physician, which found that the Veteran’s tinnitus was due to his active service, but provided no rational or explained the Veteran’s normal physical examinations at his March 1971 separation physical and October 1984 reserve service physical, the denial of tinnitus from August 2010 to October 2014, and the first evidence of tinnitus not appearing in the record until the December 2014 VA examination. Given its grounding in the medical evidence in this case and the medical literature, the opinion of the December 2014 VA examiner is found to be the most probative evidence in this case, and therefore are afforded the greatest weight. The Veteran’s STRs are silent for any complaints or diagnoses of tinnitus. At the December 2014 VA examination, he reported that he had tinnitus for several years, while his separation from active service was in 1971, over four decades earlier. Furthermore, the Veteran consistently denied having tinnitus to his treating provider from August 2010 to October 2014. Based on the foregoing, it is not shown that the Veteran’s tinnitus had its onset in service or within one year of his separation of service. Therefore, it is also not shown that the Veteran has had tinnitus continuously since service. The Board acknowledges that the United States Court of Appeals for Veterans Claims has specifically held that tinnitus is a type of disorder associated with symptoms capable of lay observation, and that lay testimony may provide sufficient support for a claim of service connection. However, here, the Veteran has not asserted that he first noticed tinnitus in service or within one year of service separation. As such, the weight of the evidence is against a finding that the Veteran’s tinnitus either began during or was otherwise caused by his military noise exposure. Therefore, after weighing all the evidence, the Board finds great probative value in the December 2014 VA examiner’s opinion. Thus, the evidence fails to establish service connection for the Veteran’s tinnitus. Accordingly, the criteria for service connection for tinnitus has not been met, and the Veteran’s claim is denied. Allergic Rhinitis The Veteran filed a service connection claim for allergic rhinitis, which was denied by an October 2018 rating decision. The Veteran asserts that his allergic rhinitis is due to his active service. The Veteran’s STRs contain no complaints, symptoms, treatment, or diagnosis of allergic rhinitis during his active service. Furthermore, the Veteran STRs show that he had normal physicals at his April 1969 entrance examination and his March 1971 separation examination and specifically denied having any skin disease. The Veteran’s STRs from reserve service show that he had a normal physical at an October 1984 examination. The Veteran’s medical records show that he was first diagnosed with allergic rhinitis in 2016, over four after his separation from service. In January 2018, the Veteran’s physician reported that the Veteran was diagnosed with allergic rhinitis and opined that it was more probable than not that his allergic rhinitis was due to his active service. In October 2018, the Veran was afforded a VA examination. After reviewing the Veteran’s claims file, interviewing the Veteran, and conducting an examination, the examiner opined that the Veteran’s allergic rhinitis was less likely than not due to his active service. The examiner reported that the Veteran’s STRs did not show a diagnosis of rhinitis during his active service and the medical records did not show a diagnosis until more than 40 years after his separation from service. Here two opinions are of record, both of which were provided by medical professionals who are presumed to have the training and expertise to opine on an orthopedic condition. As such, each opinion is considered to constitute both competent and credible evidence, which is deemed to be probative. However, the Board must determine what evidence is the most probative. After weighing all the evidence, the Board finds the greatest probative value in the October 2018 VA examiner’s opinion, which considered the elements necessary to substantiate a service connection claim. While the Veteran’s physician opined that the Veteran’s allergic rhinitis was due to his active service, his physician provided no rationale for his opinion or referred to any medical evidence within the Veteran’s claims file that led him to his conclusion. His physician did not discuss why the first evidence of allergic rhinitis was not until 2016, over four decades after the Veteran’s active service. This appears to be highly relevant in that the Veteran’s STRs do not show any diagnosis for allergic rhinitis and his separation physical was normal. As such, the Board finds that the opinion from the Veteran’s physician is not based on any objective medical evidence or medical studies, which undermines the probative value of his opinion. Conversely, the October 2018 VA examiner concluded that the Veteran’s allergic rhinitis was less likely than not due to his active service and specifically explained why. The October 2018 VA examiner is shown to have reviewed and considered the pertinent evidence of record, referred to medical studies, and to have provided adequate rationale for the opinion. The Veteran’s reported history was adequately considered. See Dalton, 21 Vet. App. 23. The Board appreciates the opinion of the Veteran’s physician. However, ultimately, the October 2018 VA examiner’s opinion is given greater weight. The opinions by the October 2018 VA examiner was fully grounded in the medical evidence and medical literature. The October 2018 VA examiner clearly explained why the Veteran’s allergic rhinitis was not due to the Veteran’s active service. The October 2018 VA examiner opined that the Veteran’s allergic rhinitis was less likely than not due to his active service. Here, the support provided by the October 2018 VA examiner for the opinion is found to be greatly superior to the opinion of the Veteran’s physician, which found that the Veteran’s allergic rhinitis was due to his active service, but provided no rational or explained the Veteran’s normal physical examinations at his March 1971 separation physical and October 1984 reserve service physical. Given its grounding in the medical evidence in this case and the medical literature, the opinion of the October 2018 VA examiner is found to be the most probative evidence in this case, and therefore are afforded the greatest weight. Consideration has been given to the assertions of the Veteran that his allergic rhinitis is due to his active service. Although lay persons are competent to provide opinions on some medical issues, see Kahana, 24 Vet. App. 428, 435, the specific issue in this case, namely the etiology of allergic rhinitis, falls outside the realm of common knowledge of a lay person. See Jandreau, 492 F.3d 1372, 1377. Allergic rhinitis is not the type of condition that is readily amenable to mere lay diagnosis or probative comment regarding etiology, as the evidence shows that physical examinations that include objective medical tests, such as allergy studies, are needed to properly assess and diagnose the disorder. See Davidson, 581 F.3d 1313); Jandreau, 492 F.3d 1372, 1377; Woehlaert, 21 Vet. App. 456, 462. That is, although the Board readily acknowledges that Veteran is competent to report allergic rhinitis, such as a runny nose or watery eyes, to the extent they are identifiable by observation, he has not been shown to possess the requisite medical training, expertise, or credentials needed to render a diagnosis or a competent opinion as to medical causation. Nothing in the record demonstrates that he received any special training or acquired any medical expertise in evaluating allergy disorders. See King v. Shinseki, 700 F.3d 1339, 1345 (Fed. Cir. 2012). Accordingly, this lay evidence does not constitute competent medical evidence and lacks probative value. Accordingly, the criteria for service connection have not been met for allergic rhinitis have not been met, and the Veteran’s claim is denied. Acquired Psychiatric Disorder The Veteran filed a service connection claim for an acquired psychiatric disorder, which was denied by a October 2018 rating decision. He asserts that he has an acquired psychiatric disorder due to his active service. The Veteran’s STRs show that the Veteran normal psychiatric examinations at his April 1969 entrance physical and his March 1971 separation physical. He also specifically denied having any nervous trouble of any sort at his March 1971 separation physical. The Veteran’s STRs from his reserve service show he had a normal psychiatric examination at an October 1984 physical. He also specifically denied having any depression nor excessive worry. After his separation from active service, his medical records show that he denied having any depression in August 2001, October 2010, March 2011, July 2011, October 2011, September 2011, February 2012, February 2014, June 2014, and October 2014. He also had negative psychiatric screens in February 2010, March 2011, February 2014, and June 2014. In January 2018, the Veteran’s physician reported that the Veteran was diagnosed with an acquired psychiatric disorder and opined that it was more probable than not that his allergic rhinitis was due to his active service. In August 2018, the Veteran was afforded a VA examination. After reviewing the Veteran’s claims file, interviewing the Veteran, and conducting an examination, the examiner reported that the Veteran did not have a mental disorder that conformed to with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), criteria. While the Veteran asserts that he has an acquired psychiatric disorder, the diagnosis of such disability requires clinical testing and medical expertise, and cannot simply be diagnosed by lay observation alone; and the Veteran is not considered competent (meaning medically qualified by training or experience) to diagnose this condition or relate this condition to any incident during his active service. See Jandreau, 492 F.3d 1372. As such, there is then no need to address whether his lay statements in this regard are also credible. Id. In the absence of proof of a current disability, there can be no valid claim for service connection. Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000); Giplin v. West, 155 F.3d 1353 (Fed. Cir. 1998); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The requirement that a current disability be present is satisfied “when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim...even though the disability resolves prior to the Secretary’s adjudication of the claim.” McClain v. Nicholson, 21 Vet. App. 319 (2007); see also Romanowsky v. Shinseki, 26 Vet. App. 289 (2013). Here the Veteran has not shown by medical evidence the presence of an acquired psychiatric disorder. Nor does the evidence establish any physical functional impairment that would suggest a disability even in the absence of a diagnosis. See Saunders v. Wilkie, No. 17-1466 (Fed. Cir. 2018). As such, the claims file does not show any symptoms, treatment, or diagnosis for an acquired psychiatric disorder; in the absence of objective indications of a disorder, the Board finds that service connection is not warranted. Accordingly, the Board finds that the evidence is against the claim and entitlement to service connection for an acquired psychiatric disorder is denied. Increased Rating Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R., Part 4. Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the appellant working or seeking work. 38 C.F.R. § 4.2. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7. Pes Planus The Veteran filed a service connection claim for bilateral pes planus in March 2018. An October 2018 rating decision granted service connection and assigned an initial rating of 10 percent under Diagnostic Code 5276 effective March 6, 2018, the date the Veteran’s service connection claim was received by VA. He asserts that he is entitled to a higher rating. Under Diagnostic Code 5276 for pes planus, a 10 percent rating is assigned for moderate bilateral pes planus with weight-bearing line over or medial to great toe, inward bowing of the tendo achillis, and pain on manipulation and use of the feet. A 30 percent rating is assigned for severe bilateral pes planus with objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated indication of swelling on use, and characteristic callosities. A 50 percent rating, the maximum rating available, is assigned when there is pronounced bilateral pes planus with marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo achillis on manipulation, not improved by orthopedic shoes or appliances. Diagnostic Code 5277 evaluates weak foot, Diagnostic Code 5278 evaluates pes cavus, Diagnostic Code 5279 evaluates metatarsalgia or Morton’s disease, Diagnostic Code 5280 evaluates hallux valgus, Diagnostic Code 5281 evaluates hallux rigidus, Diagnostic Code 5282 evaluates hammer toe, Diagnostic Code 5283 evaluates malunion or nonunion of the tarsal or metatarsal bones, and Diagnostic Code 5284 evaluates other foot injuries. The medical record does not document any of these conditions. Therefore, these Diagnostic Codes are not applicable and will not be discussed further. The Veteran’s treatment records do not document bilateral pes planus symptoms consistent with a rating in excess of 10 percent. In October 2018, the Veteran was afforded a VA examination. He reported having functional loss that resulted in decreased endurance to standing and walking due to foot pain. The examiner indicated that the Veteran had accentuated pain on use of both feet and had decreased longitudinal arch height of both feet. The examiner indicated that the Veteran did not have swelling on use of both feet, characteristic calluses of both feet, extreme tenderness of plantar surfaces of both feet, marked deformity, marked pronation, a weight bearing line fall over or medial to the great toe, or marked inward displacement and severe spasm of the Achilles’ tendon. The examiner indicated that orthotics relieved the Veteran’s symptoms. While the examiner indicated that the Veteran’s bilateral pes planus resulted in functional loss during flare-ups or repetitive use, the examiner reported that to express functional limitation due to pain, weakness, fatigability or incoordination was not possible since it should be documented during a flare up and/or immediately after repeated use over time. The examiner reported that an estimation of additional functional limitation could not be expressed because it would be mere speculation in view that he was neither in a flare up or had been in a repeated use over time situation. The evidence of record does not establish that the Veteran’s bilateral pes planus results in objective evidence of marked deformity, pain on manipulation and use accentuated, indication of swelling on use, characteristic callosities, marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo achillis on manipulation that is not improved by orthopedic shoes or appliances, which is equivalent to a rating in excess of 10 percent. Accordingly, a schedular rating in excess of 10 percent for the Veteran’s bilateral pes planus has not been met, and the claim is denied. Knee Disabilities The Veteran filed service connection claims for bilateral knee disabilities in March 2018. An October 2018 rating decision granted service connection and assigned an initial rating of 10 percent for each knee under Diagnostic Code 5260 effective March 6, 2018, the date the Veteran’s service connection claims was received by VA. He asserts that he is entitled to higher ratings. Diagnostic Code 5260 evaluates limitation of knee flexion. A noncompensable rating is assigned for extension limited to 60 degrees. A 10 percent rating is assigned for flexion limited to 45 degrees. A 20 percent rating is assigned for flexion limited to 30 degrees or extension limited to 15 degrees. A 30 percent rating is assigned for either flexion limited to 15 degrees or extension limited to 20 degrees. Diagnostic Code 5261 evaluates limitation of knee extension. A noncompensable rating is assigned for extension limited to 5 degrees. A 10 percent rating is assigned for extension limited to 10 degrees. A 20 percent rating is assigned for extension limited to 15 degrees. A 30 percent rating is assigned for extension limited to 20 degrees. A 40 percent rating is assigned for extension limited to 30 degrees. A 50 percent rating is assigned for extension limited to 45 degrees. Of note, separate compensable ratings may be assigned for limitation of flexion and for limitation of extension, without violating the rule against pyramiding. See 38 C.F.R. § 4.14. Diagnostic Code 5256 evaluates ankylosis of the knee, Diagnostic Code evaluates recurrent subluxation or lateral instability, Diagnostic Codes 5258 and 5259 evaluate impairments of the semilunar cartilage, Diagnostic Code 5262 evaluates impairment of the tibia and fibula, and Diagnostic Code 5263 evaluates genu recurvatum. The medical record does not document any of these conditions. Therefore, these Diagnostic Codes are not applicable and will not be discussed further. Normal ranges of motion of the knee are to 0 degrees in extension, and to 140 degrees in flexion. 38 C.F.R. § 4.71, Plate II. The Veteran’s medical records show treatment for his knee symptoms, but his medical records do not show findings consistent with higher ratings. In October 2018, the Veteran was afforded a VA examination. He reported bilateral knee pain that increased with prolonged sitting. He reported having flare-ups that resulted in increased knee pain when standing or walking. The examiner reported that the Veteran was diagnosed with bilateral patellofemoral pain syndrome. On examination, he demonstrated left knee flexion to 130 degrees and normal extension to 0 degrees. He demonstrated right knee flexion to 130 degrees and normal extension to 0 degrees. The examiner indicated that there was no evidence of pain with weight bearing. The examiner indicated that there was objective evidence of localized tenderness or pain on palpation. The examiner indicated that the Veteran was unable to perform repetitive use testing. He retained normal 5/5 right knee strength with no muscle atrophy. The examiner indicated that the Veteran did not have ankylosis. The examiner indicated that the Veteran had normal joint stability tests. The examiner indicated that the Veteran had no evidence or history of recurrent patellar dislocation, shin splits, stress fracture, chronic exertional compartment syndrome, or genu recurvatum. The examiner indicated that the Veteran had a left knee meniscus tear in 2003 but did not indicate that the Veteran had a dislocated or removed meniscus. The Board finds that the criteria to assign ratings in excess of 10 percent for the Veteran’s left knee disability and right knee disability is not warranted. The Veteran has been assigned 10 percent ratings under Diagnostic Code 5260 for his bilateral knee pain. Regarding limitation of flexion, the October 2018 VA examiner indicated that the Veteran demonstrated bilateral flexion, at worst, limited to 130 degrees, which exceeds the 45 degree limitation equivalent to a 10 percent rating. Accordingly, the Veteran is not found to meet the criteria for compensable ratings under Diagnostic Code 5260, which requires flexion to be limited to 45 degrees. Turning to limitation of extension, the Board finds that the criteria to assign separate compensable ratings under Diagnostic Code 5261 have not been met. The October 2018 VA examiner indicated that the Veteran had normal extension to 0 degrees. As such, the Veteran consistently demonstrated normal extension in his bilateral knees. Accordingly, the Veteran is not found to meet the criteria for compensable ratings under Diagnostic Code 5261, which requires extension to be limited to 10 degrees. The Board has considered whether higher disability evaluations are 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 and 4.45 for either knee. See also DeLuca, 8 Vet. App. 202. Functional loss contemplates the inability of the body to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance, and must be manifested by adequate evidence of disabling pathology, especially when it is due to pain. 38 C.F.R. § 4.40. Additionally, painful motion is an important factor of disability; and joints that are actually painful, unstable, or malaligned, due to healed injury, should be entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59. The VA examination and the Veteran’s treatment records do not document flexion or extension equivalent to even compensable ratings. As such, the evidence simply does not support the conclusion that the Veteran’s left knee disability or right knee disability results in findings consistent with higher ratings. Thus, greater ratings for limitations of flexion and extension are not warranted under DeLuca. While the Veteran has been shown to experience bilateral knee pain, the Court has held that even if range of motion was slightly limited by pain, pain alone is not sufficient to warrant a higher rating, as pain may cause a functional loss, but pain itself does not constitute functional loss. Mitchell v. Shinseki, 25 Vet. App. 32, 36-38 (2011). Rather, pain must affect some aspect of “the normal working movements of the body” such as “excursion, strength, speed, coordination, and endurance,” in order to constitute functional loss. Id. at 43; see 38 C.F.R. § 4.40. Here, the Veteran consistently retained flexion and extension in excess of compensable ratings. As such, there is no basis for higher ratings under Diagnostic Codes 5260 or 5261. To the extent that it is argued that the Veteran’s range of motion is painful and therefore would merit a separate compensable rating under 38 C.F.R. § 4.59, that provision states that it is the intention to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. However, here, the Veteran is currently assigned the minimum compensable rating and is in receipt of a 10 percent rating under Diagnostic Code 5260 for his left knee pain and for his right knee pain, and ratings in excess of 10 percent based on pain alone is not warranted. Accordingly, a schedular rating in excess of 10 percent for the Veteran’s left knee disability and a schedular rating in excess of 10 percent for the Veteran’s right knee disability have not been met, and the claims are denied. REASONS FOR REMAND Regarding the Veteran’s Entitlement to service connection for a left hip disorder, a right hip disorder, a left ankle disorder, a right ankle disorder, a cervical spine disorder, a left shoulder disorder, a right shoulder disorder, a left elbow disorder, a right elbow disorder, a left wrist disorder, a right wrist disorder, left carpal tunnel syndrome, right carpal tunnel syndrome, benign prostate hyperplasia, and obstructive sleep apnea, in January 2018, the Veteran’s physician reported that the Veteran was diagnosed with these conditions and opined that these conditions were more probable than not that his allergic rhinitis was due to his active service. The Veteran was afforded a VA examination for his benign prostate hyperplasia in April 2018. Unfortunately, the examiner did not offer an opinion on etiology. As such, a remand is required to afford the Veteran VA examinations regarding the etiology of these conditions. Regarding the Veteran’s claim for a TDIU, in February 2019, the Veteran reported that he was unable to work and was entitled to a TDIU due to his service-connected disabilities. Pursuant to Rice v. Shinseki, 22 Vet. App. 447 (2009), a claim for a TDIU either expressly raised by the Veteran or reasonably raised by the record involves an attempt to obtain an appropriate rating for a disability and is part of the claim for an increased rating. As such, the RO should adjudicate the issue of entitlement to a TDIU. The matters are REMANDED for the following action: 1. Obtain all outstanding VA and/or private medical records regarding any left hip disorder, right hip disorder, left ankle disorder, right ankle disorder, cervical spine disorder, left shoulder disorder, right shoulder disorder, left elbow disorder, right elbow disorder, left wrist disorder, right wrist disorder, left carpal tunnel syndrome, right carpal tunnel syndrome, benign prostate hyperplasia, and obstructive sleep apnea and associate them with the claims file. 2. Then, schedule the Veteran for a VA examination for any left hip disorder, right hip disorder, left ankle disorder, right ankle disorder, cervical spine disorder, left shoulder disorder, right shoulder disorder, left elbow disorder, right elbow disorder, left wrist disorder, right wrist disorder, left carpal tunnel syndrome, and/or right carpal tunnel syndrome. The examiner should opine as to whether it is at least as likely as not (50 percent or better probability) that any current left hip disorder, right hip disorder, left ankle disorder, right ankle disorder, left shoulder disorder, right shoulder disorder, left elbow disorder, right elbow disorder, left wrist disorder, right wrist disorder, left carpal tunnel syndrome, and/or right carpal tunnel syndrome either began during or was otherwise caused by the Veteran’s active service. Why or why not? The examiner should discuss the medical opinion of the Veteran’s physician. 3. Schedule the Veteran for a VA examination for any prostate disorder, to include benign prostate hypertrophy. The examiner should opine as to whether it is at least as likely as not (50 percent or better probability) that any prostate disorder was related to his active service, to include his presumed herbicide agent exposure? Why or why not? The examiner should discuss the medical opinion of the Veteran’s physician. 4. Obtain a medical opinion to address the etiology of the Veteran’s obstructive sleep apnea. If an examination is needed to address the Board’s question, one should be scheduled. The examiner should offer the following opinions: a. Is it at least as likely as not (50 percent or greater probability) that the Veteran’s obstructive sleep apnea was caused by his active service? Why or why not? b. Is it at least as likely as not (50 percent or greater probability) that the Veteran’s obstructive sleep apnea was caused by a service-connected disability? Why or why not? The examiner should discuss the medical opinion of the Veteran’s physician. c. Is it at least as likely as not (50 percent or greater probability) that the Veteran’s obstructive sleep apnea was aggravated (i.e. made worse) by a service-connected disability? Why or why not? 5. Adjudicate the issue of entitlement to a TDIU. Thomas H. O'Shay Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Berryman, Counsel 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.