Citation Nr: 20043340 Decision Date: 06/26/20 Archive Date: 06/26/20 DOCKET NO. 18-10 496 DATE: June 26, 2020 ORDER Service connection for headaches is granted. An effective date earlier than March 27, 2013, for service connection for degenerative joint disease of the right knee is denied. An effective date earlier than February 27, 2015, for service connection for status post a fracture of the proximal phalanx of the right ring finger is denied. REMANDED Entitlement to service connection for epilepsy is remanded. Entitlement to service connection for a low back disability is remanded. Entitlement to an initial rating higher than 10 percent for degenerative joint disease of the right knee is remanded. Entitlement to an initial higher (compensable) rating for status post a fracture of the proximal phalanx of the right ring finger is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. FINDINGS OF FACT 1. The Veteran’s headaches had their onset in service. 2. The Veteran did not submit a claim, either formal or informal, for service connection degenerative joint disease of the right knee, until March 27, 2013. 3. The Veteran did not submit a claim, either formal or informal, for service connection for status post a fracture of the proximal phalanx of the right ring finger, until February 27, 2015. CONCLUSIONS OF LAW 1. The criteria for service connection for headaches have been met. 38 U.S.C. §§ 101(24), 1101, 1110, 1112, 1113, 1131, 1137, 1154(a), 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria for an effective date earlier than March 27, 2013, for service connection for degenerative joint disease of the right knee have not been met. 38 U.S.C. §§ 5101, 5110, 7104; 38 C.F.R. §§ 3.1(p), 3.400. 3. The criteria for an effective date earlier than February 27, 2015, for service connection for status post a fracture of the proximal phalanx of the right ring finger have not been met. 38 U.S.C. §§ 5101, 5110, 7104; 38 C.F.R. §§ 3.1(p), 3.400. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the Army from December 1976 to March 1977 and from September 1979 to May 1987. He also had additional service in the Army National Guard. This matter is before the Board of Veterans’ Appeals (Board) on appeal of July 2014 and June 2015 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in Baltimore, Maryland. The July 2014 RO decision denied service connection for headaches; epilepsy; and for a low back disability (listed as a spine injury). The June 2015 RO decision granted service connection and a 10 percent rating for degenerative joint disease of the right knee, effective March 27, 2013. By this decision, the RO also granted service connection and a noncompensable rating for status post a proximal phalanx fracture of the right ring finger (arthritis, status post a fracture of the proximal phalanx of the right finger), effective February 27, 2015. In May 2019, the Board remanded the issues of entitlement to service connection for headaches; epilepsy; and for a low back disability (listed as a spine condition) for further development. 1. Service Connection for Headaches Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999); Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff’d per curiam, 78 F. 3d 604 (Fed. Cir. 1996) (table). The term “active military, naval, or air service” includes active duty, any period of active duty for training during which the individual was disabled or died from a disease or injury incurred in or aggravated in the line of duty, and any period of inactive duty training during which the individual was disabled or died from an injury incurred in or aggravated in the line of duty. 38 U.S.C. § 101 (24). Determinations as to service connection will be based on review of the entire evidence of record, to include all pertinent medical and lay evidence, with due consideration to VA’s policy to administer the law under a broad and liberal interpretation consistent with the facts in each individual case. 38 U.S.C. § 1154(a); 38 C.F.R. § 3.303(a). Secondary service connection may be granted for a disability that is proximately due to, the result of, or aggravated by an established service-connected disability. 38 C.F.R. § 3.310 (2015); see also Allen v. Brown, 7 Vet. App. 439 (1995). In making all determinations, the Board must fully consider the lay assertions of record. A layperson is competent to report on the onset and recurrence of symptoms. See Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a Veteran is competent to report on that of which he or she has personal knowledge). Lay evidence can also be competent and sufficient evidence of a diagnosis or to establish etiology if (1) the layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). When considering whether lay evidence is competent the Board must determine, on a case by case basis, whether the Veteran’s particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d at 1377 (Fed. Cir. 2007) (holding that “[w]hether lay evidence is competent and sufficient in a particular case is a factual issue to be addressed by the Board”). The Board is charged with the duty to assess the credibility and weight given to evidence. Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997), cert. denied, 523 U.S. 1046 (1998); Wensch v. Principi, 15 Vet. App. 362, 367 (2001). Indeed, in Jefferson v. Principi, 271 F.3d 1072 (Fed. Cir. 2001), the United States Court of Appeals for the Federal Circuit (Federal Circuit), citing its decision in Madden, recognized that that Board had inherent fact-finding ability. Id. at 1076; see also 38 U.S.C. § 7104(a) (West 2002). Moreover, the United States Court of Appeals for Veterans Claims (Court) has declared that in adjudicating a claim, the Board has the responsibility to weigh and assess the evidence. Bryan v. West, 13 Vet. App. 482, 488-89 (2000); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992). As a finder of fact, when considering whether lay evidence is satisfactory, the Board may also properly consider internal inconsistency of the statements, facial plausibility, consistency with other evidence submitted on behalf of the Veteran, and the Veteran’s demeanor when testifying at a hearing. See Dalton v. Nicholson, 21 Vet. App. 23, 38 (2007); Caluza v. Brown, 7 Vet. App. 498, 511 (1995), aff’d per curiam, 78 F.3d 604 (Fed. Cir. 1996). In determining the probative value to be assigned to a medical opinion, the Board must consider three factors. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The initial inquiry in determining probative value is to assess whether a medical expert was fully informed of the pertinent factual premises (i.e., medical history) of the case. A review of the claims file is not required, since a medical professional can also become aware of the relevant medical history by having treated a Veteran for a long period of time or through a factually accurate medical history reported by a Veteran. See Id. at 303-04. The second inquiry involves consideration of whether the medical expert provided a fully articulated opinion. See Id. A medical opinion that is equivocal in nature or expressed in speculative language does not provide the degree of certainty required for medical nexus evidence. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). The third and final factor in determining the probative value of an opinion involves consideration of whether the opinion is supported by a reasoned analysis. The most probative value of a medical opinion comes from its reasoning. Therefore, a medical opinion containing only data and conclusions is not entitled to any weight. In fact, a review of the claims file does not substitute for a lack of a reasoned analysis. See Nieves-Rodriguez, 22 Vet. App. at 304; see also Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (“[A] medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions.”). The Veteran contends that he has headaches that are related to service. He specifically maintains that he spent two weeks in a hospital in Turkey during service for headaches, and other injuries, from a severe fall. The Veteran reports that he fell and landed on his head. The Veteran asserts that he has suffered from headaches since that time. The Veteran served on active duty in the Army from December 1976 to March 1977 and from September 1979 to May 1987. He also had additional service in the Army National Guard. The Veteran’s service treatment records indicate that he was treated for headaches on several occasions. An August 1981 treatment entry notes that the Veteran was seen for a headache and that he reported that he had been eating poorly, with no appetite. The Veteran stated that he had suffered two episodes of vomiting in the previous two days, and that his stomach felt like it was turning over every time he had to eat. The assessment was a viral syndrome. A January 1983 treatment entry notes that the Veteran complained of headaches and a left earache. The examiner reported that the Veteran’s headaches were in the frontal portion of his head above the eyes. The assessment was left otitis media and headaches. A February 1983 treatment entry indicates that the Veteran reported that he had a cold for the previous four days, with headaches, congestion, and a temperature of 98 degrees. The examiner referred to otitis media. An August 1983 treatment entry reflects that the Veteran reported that he was in Turkey in May 1983 and spent two weeks in a hospital for his right knee, and that fluid was drained from his right knee. The was no reference to headaches at that time. A September 1983 treatment notes that the Veteran was seen with complaints of an injury to the third digit of the right hand, swelling in the lower arm, and probable muscle strain to both thighs. The Veteran reported that he got hit playing flag football and sustained multiple injuries to his body. There was no specific reference to headaches. Post-service private and VA treatment records, including a VA examination report, show treatment for headaches; headaches and dizziness of an unspecified etiology; and for tension headaches. A March 2020 VA headaches examination report includes a notation that the Veteran’s claims file was reviewed. The Veteran reported that he had suffered from recurrent headaches since 1980. He stated that there had been no fall or trauma. He indicated that he would have headaches four to five times a month and that they would last a half hour to an hour. The Veteran related that he would take Tylenol for his headaches, and that he had no photophobia or phonophobia. The diagnosis was tension headaches. The examiner indicated that the claimed condition was less likely as not (less than 50 percent probability) incurred in, or caused by, the claimed in-service injury, event, or illness. The examiner reported that he was unable to find evidence of headaches for the Veteran while he was on active duty. The examiner stated that, pursuant to the Veteran’s statements, his headaches started in 1980, but that there were no medical records found in that regard. It was noted that the Veteran did have seizures due to epilepsy and that he started taking anti-seizure medications. The examiner maintained that it was likely that the Veteran’s headaches started from the time he had seizures due to epilepsy. The examiner stated that the Veteran most likely had tension headaches. The examiner stated that the Veteran’s epilepsy had required anti-seizure medications over many years, including Depakote, Lamotrigine, etc. The examiner reported that it was well-established that all anti-seizure medication could cause headaches. It was noted that the evidence of anti-seizure medication, includes medical reports from 1991 and 1992, and the Veteran’s statements. The Board observes that the Veteran’s service treatment records show that he was treated for headaches on several occasions, and that diagnoses included headaches. The Board notes that post-service treatment records also show that the Veteran was treated for headaches and tension headaches. The Board observes that a March 2020 VA examination report relates a diagnosis of tension headaches. The examiner, following a review of the claims file, indicated that the claimed condition was less likely as not incurred in, or caused by, the claimed in-service injury, event, or illness. The examiner reported that he was unable to find evidence of headaches for the Veteran while he was on active duty. The examiner stated that, pursuant to the Veteran’s statements, his headaches started in 1980, but that there were no medical records found in that regard. It was noted that the Veteran did have seizures due to epilepsy and that he started taking anti-seizure medications. The examiner maintained that it was likely that the Veteran’s headaches started from the time he had seizures due to epilepsy. The Board observes that the examiner specifically stated that he was unable to find evidence of headaches for the Veteran while he was on active duty. The Board notes, however, that the Veteran’s service treatment records actually show that he was treated for headaches on several occasions. Additionally, the examiner did not specifically address the Veteran’s reports of headaches during service and since service, other than finding that there were no medical records showing that his headaches started in 1980. The Board observes that the Veteran is competent to report headaches during service and since service. See Davidson, 581 F.3d at 1313. Therefore, the Board finds that the examiner’s opinions are not probative in this matter. The Board notes that the Veteran is currently diagnosed with headaches. The Board finds the Veteran’s reports of headaches during and since service to be credible. See Jandreau v. Nicholson, 492 F.3d 1372 (2007) (holding that lay evidence can be competent and sufficient to establish a diagnosis of a condition when a lay person is competent to identify the medical condition, or reporting a contemporaneous medical diagnosis, or the lay testimony describing symptoms at the time supports a later diagnosis by a medical professional). Resolving reasonable doubt in the Veteran’s favor, the Board finds that the Veteran has headaches that had their onset during her period of service. Therefore, service connection for headaches is warranted. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. 2. Effective Dates for Service Connection for Degenerative Joint Disease of the Right Knee and for Status Post a Proximal Phalanx Fracture of the Right Ring Finger The Veteran essentially contends that service connection for degenerative joint disease of the right knee should be effective earlier than March 27, 2013, and that service connection for status post a fracture of the proximal phalanx of the right ring finger should be effective earlier than February 27, 2015. See Scott v. McDonald, 789 F.3d 1375 (Fed. Cir. 2015). The Veteran’s claims arise from his disagreement with the effective dates assigned following the grant of service connection for degenerative joint disease of the right knee and for status post a fracture of the proximal phalanx of the right ring finger. The basic facts are not in dispute. As the RO noted, the Veteran’s initial applications for service connection for degenerative joint disease of the right knee was filed with VA on March 27, 2013. The Veteran’s initial application for service connection for status post a fracture of the proximal phalanx of the right ring finger was filed with VA on February 27, 2015. Indeed, the Veteran does not contend otherwise. Unless specifically provided otherwise in the statute, the effective date of an award based on an original claim for compensation benefits shall be the date of receipt of the claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400. The effective date of an award of disability compensation shall be the day following separation from service or the date entitlement arose if the claim is received within one year of separation, otherwise the date of claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110(b); 38 C.F.R. § 3.400(b)(2). A specific claim in the form prescribed by the Secretary must be filed in order for benefits to be paid or furnished to any individual under the laws administered by VA. 38 U.S.C. § 5101(a); 38 C.F.R. § 3.151(a). The term “claim” or “application” means a formal or informal communication in writing requesting a determination of entitlement or evidencing a belief in entitlement to a benefit. 38 C.F.R. § 3.1(p). Any communication or action indicating an intent to apply for one or more benefits under the laws administered by VA, from a veteran or his representative, may be considered an informal claim. Such informal claim must identify the benefit sought. Upon receipt of an informal claim, if a formal claim has not been filed, an application form will be forwarded to the claimant for execution. If received within one year from the date it was sent to the veteran, it will be considered filed as of the date of receipt of the informal claim. 38 C.F.R. § 3.155. Here, the RO granted service connection and 10 percent rating for degenerative joint disease of the right knee effective on the date that the Veteran’s original claim for service connection degenerative joint disease of the right knee was filed with VA. The RO also granted service connection and a noncompensable (0 percent) rating for status post a fracture of the proximal phalanx of the right ring finger on the date that the Veteran’s original claim for service connection for status post a fracture of the proximal phalanx of the right ring finger was filed with VA. An effective date of an award of service connection is not based on the earliest medical evidence showing a causal connection, but on the date that the application upon which service connection was eventually awarded was filed with VA. Lalonde v. West, 12 Vet. App. 377, 382 (1999). Because the Veteran did not file a formal or informal application for service connection for degenerative joint disease of the right knee prior to March 27, 2013, VA is precluded, as a matter of law, from granting an effective date prior to March 27, 2013, for service connection for degenerative joint disease of the right knee. Additionally, as the Veteran did not file a formal or informal application for service connection for status post a fracture of the proximal phalanx of the right ring finger prior to February 27, 2015, VA is precluded, as a matter of law, from granting an effective date prior to February 27, 2015, for service connection for status post a fracture of the proximal phalanx of the right ring finger. As such, these claims must be denied because the RO has already assigned the earliest possible effective dates, respectively, provided by law. REASONS FOR REMAND The remaining issues on appeal are entitlement to service connection for epilepsy; entitlement to service connection for a low back disability; entitlement to an initial rating higher than 10 percent for degenerative joint disease of the right knee; entitlement to a initial higher (compensable) rating for status post a fracture of the proximal phalanx of the right ring finger; and entitlement to a TDIU. As discussed above, the Board has granted service connection for headaches. Service connection is also granted for degenerative joint disease of the right knee and for status post a fracture of the proximal phalanx of the right ring finger. As to the Veteran’s claim for service connection for epilepsy, this case was previously remanded in May 2019, partly to afford the Veteran a VA examination to determine the nature of etiology of his claimed epilepsy. The examiner was to indicate whether it was at least as likely as not that the Veteran’s claimed epilepsy was related to an in-service injury, event, or disease. Pursuant to the May 2019 Board remand, the Veteran was afforded a VA seizures disorders examination in March 2020. There is a notation that the Veteran’s claims file was reviewed. The diagnosis was epilepsy. The examiner indicated that the claimed condition was less likely than not (less than 50 percent probability) incurred in, or caused by, the claimed in-service injury, event, or illness. The examiner reported that epilepsy was a diagnosis of exclusion, and that a seizure could and does occur due to many reasons, including an electrolyte imbalance, heat trauma, tumors, etc. The examiner stated that when everything was excluded and patient continued to have seizures, the patient was labeled as having epilepsy. The examiner maintained that the Veteran denied any injuries, tumors, or underlying problems that would link his seizures to his military duty. It was noted that a lay statement from F. C., also suggested that the Veteran stated having seizures in 1989, two years after he left active duty. The examiner maintained that due to the lack of an underlying etiology, and witnessed events in the military, it was not as likely (less than 50 percent) that the Veteran’s symptoms were service-related. The Board observes that the examiner stated that the Veteran denied any injuries, tumors, or underling problems that would like his seizures to his military duty. The Board notes, however, that the Veteran has specifically stated that he spent two weeks in hospital in Turkey because of a black out, headaches, and leg problems from a severe fall. He stated that when he fell, he landed hard on his head, and that he believed the fall led to his having seizures. Additionally, in an April 2020 statement, the Veteran’s attorney stated that the Veteran suffered a head trauma during a 1983 football injury and that the examiner did not discuss whether the Veteran’s in-service trauma to the head was a cause of his epilepsy. The Veteran’s attorney asserted that the matter should be returned to the examiner for a clarifying addendum opinion. As to the Veteran’s claim for service connection for a low back disability, this case was also previously remanded in May 2019, partly to afford the Veteran a VA examination to determine the nature of etiology of his claimed low back disability. The examiner was to indicate whether it was at least as likely as not that the Veteran’s claimed low back disability was related to an in-service injury, event, or disease. Pursuant to the May 2019 Board remand, the Veteran was afforded a VA back conditions examination in March 2020. The diagnoses were lumbosacral strain and lumbar radiculopathy. The examiner indicated that the claimed condition was less likely than not (less than 50 percent probability) incurred in, or caused by, the claimed in-service injury, event, or illness. The examiner reported that too much time had passed from August 1982 for that injury to be causing issues presently. The examiner stated that no serious trauma was noted at that time. The examiner related that, additionally, the Veteran had a fall in 2014 and that he did injure his low back as noted in medical records. The examiner maintained that it was likely that the Veteran’s symptoms were from 2014, if at all, and not from 1982. The examiner indicated that it was less likely as not (less than 50 percent) that the Veteran’s current symptoms are service-related. The Board observes that the examiner indicated that too much time had passed from an August 1982 injury to be causing the Veteran’s present low back symptoms. The Board notes, however, that the examiner did not address reports by the Veteran of low back problems during service and since service. The Veteran is competent to report low back problems during service and since service. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). Additionally, in an April 2020 statement, the Veteran’s attorney asserted that the Veteran’s moderate to markedly severe disc degeneration did not suggest a recent injury, such as the examiner pointed to in 2014, but rather a longstanding injury. The Veteran’s attorney requested that the case be returned to the examiner for a clarifying addendum opinion. In light of the above, the Board finds that the Veteran has not been afforded VA examinations, with the opportunity to obtain responsive etiological opinions, following a thorough review of the entire claims file, as to his claims for service connection for epilepsy and for a low back disability. Such examinations must be accomplished on remand. 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79 (2006); see also Stefl v. Nicholson, 21 Vet. App. 120, 125 (2007); Stegall v. West, 11 Vet. App. 268, 271 (1998). As to the Veteran’s claim for a higher rating for his degenerative joint disease of the right knee, the Board notes that he was last afforded a VA knee conditions examination in April 2015. The diagnosis was degenerative arthritis of the right knee and chondromalacia of the right knee. As to the Veteran claim for a higher rating for his status post a fracture of the proximal phalanx of the right ring finger, the Board observes that he was last afforded a VA hand and fingers examination in April 2015. The diagnoses were a fracture of the proximal phalanx of the right ring finger, and traumatic arthritis. In support of this claim, the Veteran reports having residual orthopedic as well as neurological impairment. Additionally, the Board notes that the U.S Court of Appeals for Veteran’s Claims (Court) has issued a decision in Sharp v. Shulkin, 29 Vet. App. 26 (2017) concerning the adequacy of VA examinations. The Court in Sharp held that before a VA examiner opines that he or she cannot offer an opinion as to additional functional loss during flare-ups without resorting to speculation based on the fact that the examination was not performed during a flare, the examiner must “elicit relevant information as to the veteran’s flares or ask him to describe the additional functional loss, if any, he suffered during flares and then estimate the veteran’s functional loss due to flares based on all the evidence of record, including the veteran’s lay information, or explain why she could not do so.” In light of this decision, and as the findings pursuant to the April 2015 VA knee conditions examination report, and the April 2015 hand and fingers examination report, noted above, are inadequate, the Board finds that new a VA examination should be provided addressing the Veteran’s service-connected degenerative joint disease of the right knee and status post a fracture of the proximal phalanx of the right ring finger. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007); see also Snuffer v. Gober, 10 Vet. App. 400, 403 (1997). Additionally, the Board notes that a request for a TDIU, whether expressly raised by a Veteran or reasonably raised by the record, is not a separate claim for benefits, but rather part of the adjudication of a claim for increased compensation. Rice v. Shinseki, 22 Vet. App. 447 (2009). Thus, when a TDIU is raised during the appeal of a rating for a disability, it is part of the claim for benefits of the underlying disability. Id at 454. The Board finds that the record raises the issue of a TDIU in this matter. In light of Rice and the remand of the claim for a higher rating, as well as the claims for service connection, the TDIU issue must be remanded because the claims are inextricably intertwined and must be considered together. Thus, a decision by the Board on the Veteran’s TDIU rating claim would, at this point, be premature. See Tyrues v. Shinseki, 23 Vet. App. 166, 177 (2009). Additionally, the Board finds that a remand is required to request that the Veteran complete a VA Form 21-8940, Veteran’s Application for Increased Compensation Based on Unemployability, or in order for the Veteran to provide the information requested on such form. The matters are REMANDED for the following action: 1. Ask the Veteran to identify all medical providers who have treated him for epilepsy; a low back disability; degenerative joint disease of the right knee; and status post a fracture of the proximal phalanx of the right ring finger, since April 2014. After receiving this information and any necessary releases, obtain copies of the related medical records which are not already in the claims folder. Document any unsuccessful efforts to obtain the records, inform the Veteran of such, and advise him that he may obtain and submit those records himself. 2. Request that the Veteran provide a completed VA Form 21-8940, Veteran’s Application for Increased Compensation Based on Unemployability, or a comparable statement as to the information requested on such form. 3. Notify the Veteran that he may submit lay statements from himself and from other individuals who have first-hand knowledge, and/or were contemporaneously informed of his in-service and post-service symptomatology regarding his claimed epilepsy and low back disability, as well as the nature, extent, and severity of his service-connected degenerative joint disease of the right knee and status post a fracture of the proximal phalanx of the right ring finger. The Veteran should be provided an appropriate amount of time to submit this lay evidence. 4. Schedule the Veteran for an appropriate VA examination (or telehealth interview, review of the record, etc., if an in-person examination is not feasible) to determine the onset and/or etiology of his claimed epilepsy. The entire claims file must be reviewed by the examiner. The examiner must diagnose all current seizures disorders, and specifically indicate if the Veteran has currently diagnosed epilepsy. The examiner must opine as to whether it is at least as likely as not that any currently diagnosed seizure disorders, to include epilepsy, are related to and/or had their onset during the Veteran’s periods of service. The examiner must specifically acknowledge and discuss any reports by the Veteran of treatment for symptoms he thought were due to seizure disorders, to include epilepsy, during service and since service. The examiner must state whether it is at least as likely as not that any diagnosed seizure disorders, to include epilepsy, are caused or aggravated by Veteran’s service-connected headaches, or any other service-connected disabilities. 5. Schedule the Veteran for an appropriate VA examination (or telehealth interview, review of the record, etc., if an in-person examination is not feasible) to determine the onset and/or etiology of his claimed low back disability. The claims file must be reviewed by the examiner. The examiner must diagnose all current low back disabilities The examiner must provide a medical opinion as to whether it is at least as likely as not that any currently diagnosed low back disabilities are related to and/or had their onset during the Veteran’s periods of service. The examiner must specifically acknowledge and discuss the Veteran’s treatment for low back problems during his periods of service, and the reports by the Veteran that he suffered from low back problems during service and since service. The examiner must state whether it is at least as likely as not that any diagnosed low back disabilities are caused or aggravated by Veteran’s service-connected degenerative joint disease of the right knee, or any other service-connected disabilities. 6. Schedule the Veteran for an appropriate VA examination (or telehealth interview, review of the record, etc., if an in-person examination is not feasible) to determine the extent and severity of his service-connected degenerative joint disease of the right hip and status post a fracture of the proximal phalanx of the right ring finger. All indicated tests must be conducted, including x-ray, and all symptoms associated with the Veteran’s service-connected degenerative joint disease of the right knee and status post a fracture of the proximal phalanx of the right ring finger must be described in detail. Specifically, the examiner must conduct a thorough orthopedic examination of the Veteran’s right knee and right ring finger and hand and provide diagnoses of any pathology found. The examiner must also identify all neurological impairment of t he Veteran’s right ring finger disability. This must specifically include discussing the Veteran’s report of diminished grip strength. STEVEN D. REISS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. D. Regan, 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.