Citation Nr: 20060303 Decision Date: 09/14/20 Archive Date: 09/14/20 DOCKET NO. 18-95 073 DATE: September 14, 2020 ORDER Entitlement to an evaluation in excess of 10 percent for a deviated nasal septum, residuals of nasal fracture (deviated septum disability), is denied. Entitlement to service connection for right hand numbness is denied. Entitlement to service connection for bilateral hearing loss is denied. The application to reopen a previously denied claim for service connection for a left thumb disability is denied. The application to reopen a previously denied claim for service connection for a left shoulder disability is denied. The application to reopen a previously denied claim for service connection for a right knee disability is granted. REMANDED Entitlement to service connection for a right knee disability is remanded. Entitlement to service connection for cervical spine arthritis is remanded. Entitlement to service connection for left hand and arm numbness, to include as secondary to a cervical spine disability, is remanded. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S. Army from March 1985 to March 1999 including service in Southwest Asia. These matters come before the Board of Veteran’s Appeals (Board) on appeal from June 2017 and August 2017 rating decisions by a Department of Veterans Affairs (VA) Regional Office (RO). See Statement of the Case (SOC), August 2018; Form 9, August 2018. The claim for service connection for depression was granted by an August 2019 rating decision. As such, there remains no issue or controversy for decision on that claim. See Holland v. Gober, 10 Vet. App. 433, 436 (1997) (grant of service connection during the appellate process is “a full award of benefits on the appeal.”). The Veteran presently has four docketed appeals before the Board. The instant case involves the above listed eight issues that were addressed by the June 2017 and August 2017 rating decisions, and an August 2018 Statement of the Case (SOC). The Veteran filed an August 2018 substantive appeal (Form 9) to the Board. Docket number 190903-48496 and docket number 191015-42867 involve an appeal of the representative’s fees. An August 2019 RO decision granted service connection for PTSD with a depressive disorder. The Veteran’s representative filed a September 2019 notice of disagreement (NOD) in a Form 10-182 under the new Appeals Modernization Act (AMA) framework with regard to failure to withhold the representative’s fees. It is not clear whether these appeals are duplicative. Docket number 191220-52336 involves entitlement to service connection for hypertension and sleep apnea, on appeal from a November 2019 rating decision. The Veteran filed a December 2019 notice of disagreement in a Form 10-182 under the new AMA framework. Recently, a January 2020 Board decision (docket number 19-08 160) decided the Veteran’s appeal of entitlement to higher ratings for his service-connected right ankle and right lower extremity scars. See SOC, January 2019; Form 9, March 2019. The January 2020 Board decision involved a separate appeal and is final, and those matters are no longer on appeal before the Board. Also, while the Board acknowledges that certain records were added to the claims file after the issuance of the August 2018 SOC, these records are either irrelevant or redundant of evidence previously of record with regard to the issues being decided in this decision. See 38 C.F.R. § 20.1304 (2019). FINDINGS OF FACT 1. The Veteran’s deviated septum disability is currently assigned a 10 percent rating, which is the maximum available schedular rating; the criteria for referral for extraschedular consideration are not met. 2. No disability manifested by right hand numbness is shown. 3. No hearing loss disability for VA compensation purposes is shown in either ear. 4. A February 2003 rating decision reopened the Veteran’s previously denied claim for service connection for left thumb disability and denied the claim on the merits; the Veteran did not file a notice of disagreement or submit new and material evidence within one year of the denial. 5. Evidence received since the February 2003 rating decision is cumulative and redundant with regard to the claimed left thumb disability. 6. An October 2006 rating decision denied the Veteran’s application to reopen a previously denied claim for service connection for a left shoulder disability; the Veteran did not file a notice of disagreement or submit new and material evidence within one year of the denial. 7. Evidence received since the October 2006 rating decision is cumulative and redundant with regard to the claimed left shoulder disability. 8. A January 2004 rating decision denied reopening the Veteran’s previously denied claim for service connection for right knee disability; the Veteran did not file a notice of disagreement or submit new and material evidence within one year of the denial. 9. Evidence received since the January 2004 rating decision is not cumulative or redundant with regard to the claimed right knee disability. CONCLUSIONS OF LAW 1. Entitlement to an evaluation in excess of 10 percent for a deviated septum disability is not warranted as a matter of law on a schedular basis; referral for extraschedular consideration is not warranted. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.97, Diagnostic Code 6502 (2019); Sabonis v. Brown, 6 Vet. App. 426 (1994). 2. The criteria for entitlement to service connection for right hand numbness have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2019). 3. The criteria for entitlement to service connection for bilateral hearing loss have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2019). 4. The February 2003 rating decision that denied service connection for a left thumb disability is final. 38 U.S.C. § 7105(c) (2012); 38 C.F.R. §§ 3.156(b), 20.302, 20.1103 (2019). 5. New and material evidence has not been received sufficient to reopen the Veteran’s claim for service connection for a left thumb disability. 38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156(a) (2019). 6. The October 2006 rating decision that denied an application to reopen a claim for service connection for a left shoulder disability is final. 38 U.S.C. § 7105(c) (2012); 38 C.F.R. §§ 3.156(b), 20.302, 20.1103 (2019). 7. New and material evidence has not been received sufficient to reopen the Veteran’s claim for service connection for a left shoulder disability. 38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156(a) (2019). 8. The January 2004 rating decision that denied reopening a claim for service connection for a right knee disability is final. 38 U.S.C. § 7105(c) (2012); 38 C.F.R. §§ 3.156(b), 20.302, 20.1103 (2019). 9. New and material evidence has been received sufficient to reopen the Veteran’s claim for service connection for a right knee disability. 38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156(a) (2019). Duty to Assist VA has a duty to assist claimants in obtaining evidence needed to substantiate a claim. See 38 U.S.C. § 5103A. In 1999, the Veteran’s service treatment records associated with the claims file included only 17 pages of records. The RO requested the Veteran’s service treatment records from the Department of the Army, but a negative reply was received in December 1999. In March 2001, the RO notified the Veteran that some of his service treatment records were unable to be found. At an August 2008 Board hearing (involving a separate appeal), the Veteran testified that he was of the understanding that only his last two years of service treatment records were able to be located at the Records Management Center (“St. Louis”). He further testified that he believed that many of his service treatment records were lost during his service when he was transferred to or from recruiter school, and were mistakenly associated with another sergeant’s file with a similar name. An August 2015 Board decision (involving a separate appeal) directed the RO to make a further attempt to obtain all available service treatment records. In September 2015, the RO requested copies of all available service records from the National Personnel Records Center (NPRC). In September 2015, several additional service treatment records were received from the NPRC and associated with the claims file (79 pages total), as well as the Veteran’s service personnel files, including his OMPF file, but regrettably, it appears that some of the Veteran’s service treatment records remain unavailable. The Board acknowledges that where service records have been lost or destroyed through no fault of a claimant, there is a heightened obligation to assist in the development of the case, a heightened obligation to explain findings and conclusions, and a heightened duty to consider carefully the benefit of the doubt rule. See Washington v. Nicholson, 19 Vet. App. 362, 369-70 (2005); Cromer v. Nicholson, 19 Vet. App. 215, 217 (2005) (citing O'Hare v. Derwinski, 1 Vet. App. 365, 367 (1991)); Cuevas v. Principi, 3 Vet. App. 542, 548 (1992). It is noted, however, that the case law does not lower the legal standard for proving a claim for service connection, but rather increases the Board’s obligation to evaluate and discuss in its decision all of the evidence that may be favorable to the claimant. See Russo v. Brown, 9 Vet. App. 46 (1996). In this case, the Board finds that this heightened duty to assist the Veteran has been satisfied, and the RO has exhausted all reasonable administrative efforts to attempt to obtain the records. The RO requested any outstanding records from the Department of the Army and from the NPRC, and all available records were associated with the claims file in September 2015. The Veteran is clearly shown to have been notified that many of his service treatment records were found to be unavailable. The Board finds that any further attempts to retrieve the records would be futile. Analysis 1. Entitlement to an evaluation in excess of 10 percent for a deviated nasal septum, residuals of nasal fracture The Veteran’s deviated septum disability is currently assigned a 10 percent rating under Diagnostic Code 6502, effective March 31, 2003 (and noncompensable prior). The Veteran seeks an increased rating. See Form 21-526, March 2017; see also Board decision, March 2016 (involving prior increased rating claim). Diagnostic Code 6502, septum, nasal, deviation of, provides a single 10 percent rating for “traumatic only, with 50 percent obstruction of the nasal passage on both sides or complete obstruction on one side.” See 38 C.F.R. § 4.97. An April 2017 VA examination report shows the examiner noted that the Veteran has a deviated septum, and that he reported experiencing sinusitis in the winter months. No sinusitis was present on examination. It was noted that the Veteran underwent a septorhinoplasty procedure in 1998. The examiner noted there was at least 50 percent obstruction of the nasal passage on both sides due to traumatic septal deviation. There was no loss of part of the nose on exam. X-rays were unremarkable. The examiner opined that the Veteran’s deviated septum disability did not affect his ability to work. The Board has also reviewed all of the other medical evidence of record, which does not show symptoms more severe than the findings shown on examination. As noted above, the Veteran is already assigned a 10 percent rating for deviated septum disability, which is the maximum schedular rating available under Diagnostic Code 6502, “septum, nasal, deviation of.” As the Veteran is already assigned the maximum schedular rating under Diagnostic Code 6502, the Board finds that entitlement to an increased rating under that code is not warranted as a matter of law. See 38 U.S.C. § 1155 (2012); Sabonis v. Brown, 6 Vet. App. 426 (1994). The Board has considered whether the Veteran would be entitled to higher ratings under any other diagnostic code. However, the Board finds that the Veteran’s deviated septum disability is most appropriately rated under Diagnostic Code 6502, which specifically contemplates “septum, nasal, deviation of.” Entitlement to a higher rating under Diagnostic Code 6503, nose, loss of part of, or scars, is not shown because no loss of part of the nose exposing both nasal passages is shown (30 percent rating). See 38 C.F.R. § 4.97. While the Board acknowledges the Veteran reported experiencing sinusitis in winter months (no sinusitis was found on examination), and that he has reported seasonal allergies to a VA clinician in April 2018, the Board notes that the Veteran is not presently service-connected for sinusitis or allergic sinusitis. The Veteran has not contended, and the evidence does not suggest, that he has experienced symptoms outside of those listed in the schedular criteria. See Doucette v. Shulkin, 28 Vet. App. 366 (2017) (Board is not obligated to analyze whether referral for extraschedular consideration is warranted if 38 C.F.R. § 3.321(b)(1) is neither specifically sought by the claimant nor reasonably raised by the facts found by the Board). Therefore, the Board finds that referral to the C&P Director for consideration of a higher rating on an extraschedular basis is not warranted. In summary, the Board concludes that entitlement to an evaluation in excess of 10 percent for a deviated septum disability on a schedular basis is denied as a matter of law, and referral to the C&P Director for extraschedular consideration is not warranted. 2. Entitlement to service connection for right hand numbness The Veteran claims that he has a disability manifested by right hand numbness due to his active service. See Form 21-526, March 2017. The Veteran’s service treatment records show no right hand complaints, including no complaints of numbness. His February 1999 separation examination report shows examination of his upper extremities was normal. See Records at p.75 of 79. None of the medical evidence from the period on appeal shows any complaints or treatment for any symptoms of right hand numbness, nor any diagnosed right hand disability. In fact, the Veteran’s CAPRI records show he has no active problem list. See, e.g., CAPRI, received November 2019 at p.1. All of the Veteran’s VA treatment records dated through November 2019 have been associated with the claims file. The threshold requirement for service connection to be granted is competent evidence of the current existence of a claimed disorder. See Degmetich v. Brown, 104 F.3d 1328 (1997); Brammer v. Derwinski, 3 Vet. App. 223 (1992). Without a current disability manifested by right hand numbness, service connection for such cannot be granted. See id. To the extent that the Veteran implicitly contends that he does in fact have a current right hand disability manifested by numbness, the Board finds such an opinion to lack probative value because no rationale has been provided, and because the Veteran is not shown to the training, medical expertise, or credentials to competently diagnose such a disability. See King v. Shinseki, 700 F.3d 1339 (2012). Therefore, as no right hand numbness disability is shown at any time during the period on appeal, the Board concludes that the preponderance of the evidence is against the claim, and service connection is denied; the benefit of the doubt rule is not for application. 3. Entitlement to service connection for bilateral hearing loss The Veteran contends that he has a bilateral hearing loss disability due to his active service. See Form 21-526, March 2017. A June 2017 VA examination report shows that the Veteran’s pure tone thresholds were as follows: Hertz (decibels) 500 1000 2000 3000 4000 RIGHT 25 15 20 25 35 LEFT 25 15 25 30 25 Speech recognition scores using Maryland CNC testing were 96 percent in the right ear, and 98 percent in the left ear. The Board has carefully reviewed all of the other medical evidence from the period on appeal, none of which includes any audiological testing. As shown above, there is no evidence of record during the period on appeal of pure tone thresholds in either ear of 26 decibels or greater in at least three of the frequencies 500, 1000, 2000, 3000, and 4000 hertz, nor thresholds of 40 decibels or greater in at least one of these frequencies. Therefore, the Board finds that the regulatory criteria set forth in 38 C.F.R. § 3.385 for a hearing loss disability for VA compensation purposes are not met in either ear. The threshold requirement for service connection to be granted is competent evidence of the current existence of a claimed disorder. See Degmetich v. Brown, 104 F.3d 1328 (1997); Brammer v. Derwinski, 3 Vet. App. 223 (1992). Without a current hearing loss disability at any time during the period on appeal in either ear, service connection for such cannot be granted. See id. The Board acknowledges that the VA examiner diagnosed bilateral sensorineural hearing loss. However, unfortunately, whether the Veteran’s hearing loss meets the regulatory criteria for a hearing loss disability is controlled by regulations that provide minimum pure tone thresholds or speech recognition scores which have not been met in the instant case. See 38 C.F.R. § 3.385. The Board acknowledges the Veteran’s assertion that he does in fact have hearing loss. There simply is not, however, any audiological evidence tending to indicate that he meets the specific pure tone threshold or speech recognition score requirements set forth by VA regulations. Therefore, the Board finds his lay opinion that he has a current hearing loss disability to have no probative value. Therefore, as no bilateral hearing loss disability is shown at any time during the period on appeal, the Board concludes that the preponderance of the evidence is against the claim, and service connection is denied; the benefit of the doubt rule is not for application. 4. Whether new and material evidence has been received sufficient to reopen a claim for service connection for a left thumb disability 5. Whether new and material evidence has been received sufficient to reopen a claim for service connection for a left shoulder disability The Veteran requests reopening of previously denied claims for service connection for a left thumb disability and left shoulder disability. For the reasons explained below, the Board finds that new and material evidence has not been received, and the applications to reopen the claims are denied. A February 2000 rating decision denied the Veteran’s original claims for service connection for left thumb and left shoulder disabilities on the basis that there was no evidence of a current disability, and therefore the claim was not well grounded. The Veteran did not file a notice of disagreement or submit new and material evidence within one year of notice of the February 2000 rating decision, which became final. See 38 U.S.C. § 7105(c) (2012); 38 C.F.R. §§ 3.156(b), 20.302, 20.1103 (2019). After the passage of legislation in November 2000, an August 2001 rating decision readjudicated the claims on the merits and denied the claims, citing the fact that there was no evidence of a current disability. The Veteran did not file a notice of disagreement or submit new and material evidence within one year of notice of the August 2001 rating decision, which became final. See 38 U.S.C. § 7105(c) (2012); 38 C.F.R. §§ 3.156(b), 20.302, 20.1103 (2019). In January 2002, the Veteran filed a request to reopen the left thumb and left shoulder claims. A February 2003 rating decision reopened the left thumb and left shoulder claims, but denied the claims on the merits, again citing the lack of evidence of a current disability. The Veteran did not file a notice of disagreement or submit new and material evidence within one year of notice of the February 2003 rating decision, which became final. See 38 U.S.C. § 7105(c) (2012); 38 C.F.R. §§ 3.156(b), 20.302, 20.1103 (2019). In March 2006, the Veteran filed another request to reopen the left shoulder claim. An October 2006 rating decision denied reopening the claim, citing the fact that the prior rating decision noted a lack of evidence of a current disability, and that no new and material evidence had been received. The Veteran did not file a notice of disagreement or submit new and material evidence within one year of notice of the October 2006 rating decision, which became final. See 38 U.S.C. § 7105(c) (2012); 38 C.F.R. §§ 3.156(b), 20.302, 20.1103 (2019). In March 2017, the Veteran filed a request to reopen the claim, which was denied by June 2017 and August 2017 rating decisions. The Veteran appealed herein. Regarding the request to reopen the left thumb claim, at the time of the last final denial in February 2003, the evidence of record included some of the Veteran’s service treatment records, and his post-service VA treatment records, none of which showed any complaints or treatment for any left thumb condition. Also of record was an August 1999 VA examination report that shows the Veteran reported left thumb pain once or twice per week, and subjective left thumb pain was diagnosed. Also of record was a January 2003 VA examination report showing a left hand x-ray showed no fracture, dislocation, or evidence of osteoarthritis, and that the examiner opined for the claimed condition, there is no diagnosis because there was no pathology to render a diagnosis. Regarding the request to reopen the left shoulder disability, at the time of the last final denial in October 2006, the evidence of record included a some of the Veteran’s service treatment records, which included his February 1999 separation report of medical history showing he reported clicking in his left shoulder, with no specific injury. See Records, March 2003 at p.2 of 17. Also of record were the Veteran’s VA treatment records, which showed no left shoulder complaints or treatment. An August 1999 VA examination report shows the Veteran reported his left shoulder pain began after falling in an obstacle course in service in 1996, and subjective left shoulder pain was diagnosed. A January 2003 VA examination report shows appearance of the left shoulder and range of motion was within normal limits, and that the examiner opined there was no left shoulder diagnosis because there was no pathology to render a diagnosis. The Veteran has also submitted a May 2003 buddy statement in which the buddy reported the Veteran injured his left shoulder in service. Since the time of the last final denials, new evidence associated with the claims file includes more recent VA treatment records dated through November 2019, none of which show any treatment for any left thumb or left shoulder complaints, or any diagnosed left thumb or left shoulder disability. Also, since the last final denial, the Veteran has not offered any new statements as to how he might have a left thumb or left shoulder disability that is related to his active service. There is simply no new, relevant evidence relating to the claims, and the applications to reopen the claims must be denied. The Board has considered whether under 38 C.F.R. § 3.156(c), the Veteran’s instant appeals as to his left thumb and left shoulder might relate back to his original claims, obviating the need for new and material evidence, based on the fact that additional service treatment records were associated with the claims file in September 2015. However, unfortunately, none of these new service treatment records are relevant to his claimed left thumb or left shoulder disability – they do not reflect any complaints or treatment in service. 38 C.F.R. § 3.156(c) (2019). Therefore, without evidence that is new and material, the applications to reopen the claims for service connection for a left thumb disability and left shoulder disability must be denied. 6. Whether new and material evidence has been received sufficient to reopen a claim for service connection for a right knee disability The Veteran requests reopening of a previously denied claim for service connection for a right knee disability. For the reasons explained below, the Board finds that new and material evidence has been received, and the claim is reopened. A February 2000 rating decision denied the Veteran’s original claim for service connection for a right knee disability on the basis that there was no evidence of a current disability. The Veteran did not file a notice of disagreement or submit new and material evidence within one year of notice of the February 2000 rating decision, which became final. See 38 U.S.C. § 7105(c) (2012); 38 C.F.R. §§ 3.156(b), 20.302, 20.1103 (2019). After the passage of legislation in November 2000, an August 2001 rating decision readjudicated the right knee claim on the merits and denied the claim, citing the fact that there was no evidence of a current disability. The Veteran did not file a notice of disagreement or submit new and material evidence within one year of notice of the August 2001 rating decision, which became final. See 38 U.S.C. § 7105(c) (2012); 38 C.F.R. §§ 3.156(b), 20.302, 20.1103 (2019). In January 2002, the Veteran filed a request to reopen the right knee claims. A February 2003 rating decision reopened the claim and denied service connection on the merits, again citing the lack of evidence of a current right knee disability. The Veteran did not file a notice of disagreement or submit new and material evidence within one year of notice of the February 2003 rating decision, which became final. See 38 U.S.C. § 7105(c) (2012); 38 C.F.R. §§ 3.156(b), 20.302, 20.1103 (2019). The Veteran submitted a May 2003 statement from a buddy in which he wrote he served with the Veteran when he injured his left shoulder in service. A January 2004 rating decision denied reopening the right knee claim, again citing the lack of evidence of a current disability. The Veteran did not file a notice of disagreement or submit new and material evidence within one year of notice of the January 2004 rating decision, which became final. See 38 U.S.C. § 7105(c) (2012); 38 C.F.R. §§ 3.156(b), 20.302, 20.1103 (2019). In March 2017, the Veteran filed a request to reopen the claim, which was denied by June 2017 and August 2017 rating decisions. The Veteran appealed herein. At the time of the last final denial in January 2004, the evidence of record included some of the Veteran’s service treatment records, which showed he incurred a right knee strain in service in September 1998. See Records, March 2003 at p.15 of 17. Also of record was an August 1999 VA examination report that shows the Veteran reported right knee pain, but no right knee condition was diagnosed. See Report at p.7. A January 2003 VA examination report showed an x-ray revealed no abnormality, and the examiner opined there was no right knee diagnosis because there was no pathology to render a diagnosis. An April 2002 private treatment record from Dr. S.K. showed a diagnosed right knee soft tissue mass, etiology unclear. See Records, received November 2002 at p.4. Finally, a May 2003 buddy statement shows the Veteran’s buddy reported the Veteran injured his right knee in service. Since the time of the last final denial in January 2004, new evidence associated with the claims file includes, but is not limited to, an April 2017 private treatment record that shows diagnosed bilateral insertional patella tendon tendonitis. See Records, received November 2017 at p.8 of 13. Because this record shows a diagnosed right knee disability, the Board finds that new and material evidence has been received, and the claim is reopened. However, before a decision can be made on the claim, the Board finds the matter should be remanded for further development, as explained below. REASONS FOR REMAND 1. Entitlement to service connection for a right knee disability The Veteran claims he has a right knee disability due to his active service. The Veteran’s service treatment record show the Veteran incurred a right knee strain in September 1998. See Records, March 2003 at p.15 of 17. Post-service, August 1999 and February 2003 VA examination reports show the Veteran reported right knee pain, but no right knee condition was found. The February 2003 report shows that x-rays of the right knee showed no abnormality. An April 2002 private treatment record, however, shows a right knee mass of unclear etiology was diagnosed. See Records, received November 2002 at p.4. A May 2003 buddy statement shows the Veteran’s buddy reported the Veteran injured his right knee in service. Most recently, the Veteran was afforded a June 2017 VA examination, and the examiner opined that the Veteran complained of left knee pain, not right knee pain, and that his right knee was normal. However, shortly after the VA examination was performed, an April 2017 private treatment record was added to the claims file that shows diagnosed bilateral insertional patella tendon tendonitis. See Records, received November 2017 at p.8 of 13. Therefore, the Board finds that it is unclear whether the Veteran has a current right knee disability related to his active service, and the claim should be remanded for a new VA examination, and the examiner should address the April 2017 private treatment record. 2. Entitlement to service connection for cervical spine arthritis 3. Entitlement to service connection for left hand and arm numbness, to include as secondary to a cervical spine disability The Veteran claims that he has a cervical spine arthritis, and a disability manifested by numbness of the left arm and hand, due to his active service. See Form 21-526, March 2017. A May 1998 service treatment record shows the Veteran complained of neck pain since an injury seven months prior, and torticollis was diagnosed. See Records at p.34 of 79. No complaints involving numbness in his right hand are shown in the service treatment records. Post-service, private treatment records from Dr. S.K. dated from April 2002 to July 2002 show the Veteran complained of neck pain and a tingling sensation in his left arm. Dr. S.K. noted that a March 2002 x-ray showed mild degenerative changes, and that an April 2002 MRI showed broad based disc bulging and herniation at C6-7, contacting and minimally pressing upon the spinal cord and narrowing the left sided lateral recess and neuroforamen. Dr. S.K. diagnosed cervical herniated nucleus pulpous, persistent left-sided radicular symptoms and subjective left arm weakness. See Records, received January 2003 at p.4-5, 7 of 11. The Veteran has not been provided with a VA examination relating to his cervical claim. In light of the evidence of complaint of neck pain in service, and evidence of diagnosed disc bulging and herniation and mild degenerative changes three years post-service, the Board finds the cervical claim should be remanded for a VA examination. The Board is also cognizant that a January 2003 VA examination report, which was performed in connection with other then-pending service connection claims, shows the Veteran reported referred pain from his neck to his left shoulder. Therefore, the Board finds that the claimed left arm and hand numbness claim should also be remanded so that the VA examiner may address whether the Veteran has a left arm or hand disability secondary to the claimed cervical disability. The matters are REMANDED for the following action: 1. Afford the Veteran a VA examination to address the nature and etiology of his claimed cervical spine, left arm and hand numbness, and right knee conditions. The complete claims folder must be provided to the examiner for review in conjunction with the examination, and the examiner must note that the claims folder has been reviewed. The examiner should opine as to whether it is “at least as likely as not” that any cervical spine, left arm, left hand, or right knee disability identified on examination is caused by the Veteran’s active service. If any disability of the left arm or hand manifested by numbness is found, the examiner should also opine whether it is “at least as likely as not” that it was caused or aggravated by a cervical spine condition. Ask the VA examiner to review and address the April 2017 private treatment record received in November 2017 showing diagnosed bilateral insertional patella tendon tendonitis. See Records, received November 2017 at p.8 of 13. Also please direct the VA examiner’s attention to a July 2018 VA treatment record showing diagnosed right insertional achilles tendonitis. Also, please direct the VA examiner’s attention to the September1998 record of a right knee sprain in service. For the cervical claim, direct the VA examiner’s attention to the May 1998 record showing complaint of neck pain. See Records, received September 2015 at p.34 of 79. Also direct his or her attention to the private records dated in 2002 showing diagnostic testing revealed mild degenerative changes in the cervical spine, disc bulging and herniation, and diagnosed cervical herniated nucleus pulpous, persistent left-sided radicular symptoms and subjective left arm weakness. See Records, received January 2003 at p.4-5, 7 of 11. Any opinion must be accompanied by a complete rationale. J.W. FRANCIS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Juliano, 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.