Citation Nr: 21000636 Decision Date: 01/05/21 Archive Date: 01/05/21 DOCKET NO. 19-35 011 DATE: January 5, 2021 ORDER New and material has been received to reopen the claim of entitlement to service connection for a respiratory disability and, to that extent only, the appeal is granted. New and material has been received to reopen the claim of entitlement to service connection for a low back disability and, to that extent only, the appeal is granted. Entitlement to an initial compensable disability rating for a service-connected right elbow laceration scar is denied. Entitlement to an initial compensable disability rating for service-connected tinea pedis with tinea cruris is denied. Entitlement to an initial compensable disability rating for service-connected allergic rhinitis is denied. Entitlement to an initial disability rating in excess of 10 percent for a service-connected duodenal ulcer is denied. REMANDED Entitlement to service connection for a respiratory disability, to include asbestosis, chronic obstructive pulmonary disease (COPD), and bronchiectasis, is remanded. Entitlement to service connection for a low back disability is remanded. FINDINGS OF FACT 1. In a June 2015 rating decision, the Department of Veterans Affairs (VA) Regional Office (RO) denied service connection for a respiratory disability; the Veteran did not appeal the decision and new and material evidence was not received within the one year appeal period. 2. Evidence associated with the record since the June 2015 rating decision relates to unestablished facts and raises a reasonable possibility of substantiating the claim of entitlement to service connection for a respiratory disability. 3. In a November 2016 rating decision, the VA RO denied service connection for a low back disability; the Veteran did not appeal the decision and new and material evidence was not received within the one year appeal period. 4. Evidence associated with the record since the November 2016 decision relates to unestablished facts and raises a reasonable possibility of substantiating the claim of entitlement to service connection for a low back disability. 5. For the period on appeal, the Veteran’s right elbow scar has not been manifested by an area or areas of 144 square inches (929 sq. cm) or greater and is not painful or unstable. 6. For the period on appeal, the Veteran’s tinea pedis with tinea cruris has not been manifested by characteristic lesions involving at least 5 percent of the entire body or of exposed areas, and has not required intermittent systemic therapy. 7. For the period on appeal, the Veteran’s allergic rhinitis has not manifested by greater than 50 percent obstruction of the nasal passages on both sides, complete obstruction on one side, or polyps. 8. For the period on appeal, the Veteran’s duodenal ulcer has not been manifested by symptomatology of moderate severity, with recurring episodes of severe symptoms two or three times a year averaging 10 days in duration; or with continuous moderate manifestations. CONCLUSIONS OF LAW 1. New and material evidence has been received and the claim seeking service connection for a respiratory disability is reopened. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. § 3.156(a). 2. New and material evidence has been received and the claim seeking service connection for a low back disability is reopened. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. § 3.156(a). 3. The criteria for a compensable for a right elbow scar have not been satisfied. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.118, Diagnostic Code 7802. 4. The criteria for a compensable rating for tinea pedis with tinea cruris have not been satisfied. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.118, Diagnostic Code 7813. 5. The criteria for a compensable rating for allergic rhinitis have not been satisfied. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.97, Diagnostic Code 6522. 6. The criteria for a rating in excess of 10 percent for a duodenal ulcer have not been satisfied. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.114, Diagnostic Code 7305. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1963 to June 1967. This matter comes before the Board of Veterans’ Appeals (Board) from December 2017 and November 2018 rating decisions of the VA RO. The Veteran appeared at a hearing before a Veterans Law Judge in August 2020. As this VLJ is no longer at the Board, the Veteran was offered the opportunity to testify at another hearing by an October 2020 letter. The Veteran responded in November 2020 that he did not wish to have another hearing. While the Board sent the Veteran a letter in December 2020 about scheduling a virtual hearing, this letter was sent in error as the Veteran had already declined a second hearing. The Veteran has also waived RO review of new evidence. As such, the Board will proceed based on the evidence of record. Neither the Veteran nor his representative has raised any other issues with the duty to notify or duty to assist. Claims to Reopen If a claim of entitlement to service connection has been previously denied and that decision became final, the claim can be reopened and reconsidered only if new and material evidence is presented with respect to that claim. 38 U.S.C. § 5108. New evidence means existing 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). The credibility of the evidence is presumed for purposes of reopening the claim. See Justus v. Principi, 3 Vet. App. 510, 513 (1992). The threshold for reopening is low. Shade v. Shinseki, 24 Vet. App. 110, 117 (2010). 1. A respiratory disability. The Board denied the Veteran’s claim for a respiratory disability in September 2012, determining that the evidence was against a finding that Veteran had a respiratory disability that was related to his military service, to include as due to asbestos exposure. The Veteran did not appeal the Board’s decision and it became final. See 38 C.F.R. § 20.1100. The denial was continued in a June 2015 rating decision, where the Veteran was provided notice of the decision and his appellate rights but did not appeal or submit new and material evidence within one year. Therefore, the RO’s June 2015 rating decision became final. See 38 C.F.R. §§ 3.156, 20.1103 (2014). The evidence received since the previous, final denials includes evidence that is both new and material to the claim. See 38 C.F.R. § 3.156. For example, the evidence now reflects an additional VA respiratory examination in October 2016 and etiological opinion, as well as a private physician’s opinion in July 2017. This evidence addresses one of the reasons for the previous denials; i.e., a nexus to service, and raises a reasonable possibility of substantiating the claim. The credibility of this evidence is presumed for purposes of reopening the claim. See Justus v. Principi, 3 Vet. App. 510, 513 (1992). Accordingly, the claim is reopened. In evaluating the evidence and rendering a decision on the merits, the Board is required to assess the credibility and probative value of proffered evidence in the context of the record as a whole, and the Justus presumption of credibility no longer attaches. See Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997). Thus, evidence that is sufficient to reopen a claim may not be sufficient to grant the benefit being sought. See generally Hodge v. West, 155 F.3d 1356 (Fed. Cir. 1998). As explained in the Reasons for Remand section below, the Board has determined that additional development is necessary before the merits of the Veteran’s claim for service connection for a respiratory disability can be addressed. 2. A low back disability. The RO denied the Veteran’s claim of service connection for a back disability in a November 2016 rating decision, determining that the evidence was against a finding that Veteran had a back disability for service-connection purpose, as well as in-service evidence of any back injury or treatment. The Veteran was provided notice of this decision and his appellate rights but did not appeal the decision or submit new and material evidence within one year of the decision. Therefore, that decision is final. 38 C.F.R. §§ 3.156, 20.1103 (2016). The evidence received since the November 2016 rating decision includes evidence that is both new and material to the claim. See 38 C.F.R. § 3.156. For example, the evidence now reflects a current back disability for service connection purposes, as degenerative disc disease was shown upon diagnostic testing in April 2019. This evidence addresses one of the reasons for the previous denial; i.e., a current disability, and raises a reasonable possibility of substantiating the claim. The credibility of this evidence is presumed for purposes of reopening the claim. See Justus, 3 Vet. App. at 513. Accordingly, the claim is reopened. As with his respiratory claim, however, the Board has determined that additional development is necessary before the merits of the Veteran’s claim for service connection for a low back disability can be addressed. Increased Ratings Disability ratings are determined by evaluating the extent to which a Veteran’s service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Different ratings may be assigned for different periods of time for the same disorder if the facts show distinct time periods with different levels of disability. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). If two ratings are potentially applicable, the higher rating will be assigned if the disability more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. See 38 C.F.R. § 4.3. 3. A compensable rating for a right elbow scar. The Veteran was awarded service connection for a right elbow laceration scar in the November 2018 rating decision on appeal, where a noncompensable (zero percent) rating was assigned. He asserts that the severity of his scar warrants a higher initial rating. For the below reasons, the Board finds that a higher rating is not warranted. Diagnostic Codes 7800 to 7805 pertain to scars. 38 C.F.R. § 4.118. The Schedule of ratings for the skin were amended effective August 13, 2018. See 83 Fed. Reg. 32,592 (July 13, 2018). Here, the Veteran’s initial service connection claim was filed in September 2018. Thus, only the amended codes apply. The Veteran’s right elbow scar is rated under Diagnostic Code 7802 for burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are not associated with underlying soft tissue damage. 38 C.F.R. § 4.118. For a higher, and maximum 10 percent rating to be warranted under this code, the Veteran’s scar must be manifest by an area or areas of 144 square inches (929 sq. cm.) or greater. At the Veteran’s hearing, he was asked if his scar was painful but did not indicate any pain associated with the scar. He did testify that his scar itches and at times the scar will come open if he itches too much. The Board does not associate this with instability of the scar and rather an outside force causing the area to open up. While the Veteran testified to treatment for the scar, this consisted of a cream which is topical in nature. The above is consistent with VA examination findings. Upon VA examination in October 2018, the Veteran’s right elbow laceration scar was noted to be 10 cm long by 1 cm. wide. It was not found to be painful or unstable, or resulting in limitation of function. The Veteran’s treatment records are consistent with the above findings upon examination. Although a history of his elbow laceration scar was noted during the appeal, his treatment records are silent for any evidence of an increase in symptomology that would suggest that a higher rating may be warranted under the applicable criteria. As such, a higher, 10 percent rating is not warranted under Diagnostic Code 7802. The Board has considered the other Diagnostic Codes pertaining to scars. However, the Veteran’s right elbow scar is not of the head, face, or neck, is not deep and non-linear, and is not associated with underlying soft tissue damage. Moreover, the Veteran’s scar is not unstable or painful. Therefore, Diagnostic Codes 7800, 7801, and 7804 are inapplicable. Finally, the evidence of record shows there are no other disabling effect(s) not considered in a rating provided under Diagnostic Codes 7800-04 as contemplated by Diagnostic Code 7805. 38 C.F.R. § 4.118. Thus, as the preponderance of the evidence is against the Veteran’s claim for a compensable rating for his right elbow scar, the claim for an increased rating must be denied. 38 C.F.R. §§ 4.3, 4.7. 4. A compensable rating for tinea pedis with tinea cruris. The Veteran was awarded service connection for tinea pedis with tinea cruris in the November 2018 rating decision on appeal, where a noncompensable rating was assigned. He asserts that the severity of this skin disability warrants a higher initial rating. For the below reasons, the Board finds that a higher rating is not warranted. The Veteran’s tinea pedis with tinea cruris is rated under Diagnostic Code 7813 for dermatophytosis. 38 C.F.R. § 4.118. As noted in the above analysis of the Veteran’s right elbow scar, the amended codes for the skin effective August 31, 2018, apply. Under Diagnostic Code 7813, a noncompensable rating is assigned for no more than topical therapy required over the past 12-month period and at least one of the following: characteristic lesions involving less than 5 percent of the entire body affected; or characteristic lesions involving less than 5 percent of exposed areas affected. A 10 percent rating is assigned for at least one of the following: characteristic lesions involving at least 5 percent, but less than 20 percent, of the entire body affected; or at least 5 percent, but less than 20 percent, of exposed areas affected; or intermittent systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, psoralen with long-wave ultraviolet-A light (PUVA), or other immunosuppressive drugs required for a total duration of less than 6 weeks over the past 12- month period. A 30 percent rating is assigned at least one of the following: characteristic lesions involving more than 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected; or systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of 6 weeks or more, but not constantly, over the past 12-month period. A 60 percent rating is assigned for at least one of the following: characteristic lesions involving more than 40 percent of the entire body or more than 40 percent of exposed areas affected; or constant or near-constant systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required over the past 12-month period. VA regulations explicitly state that systemic therapy is treatment that is administered through any route other than the skin, and topical therapy is treatment that is administered through the skin. 38 C.F.R. § 4.118(a). Upon VA skin diseases examination in November 2018, the examiner noted the Veteran’s in-service diagnoses of tinea pedis on his feet and tinea cruris in the groin area. The Veteran reported that his tinea pedis currently manifested cracked and dry skin and thick and ragged toenails. His tinea cruris manifested a scaly, itchy, red rash on the thighs and inguinal groin areas. He also noted treating his skin conditions with constant/near-constant use of topical medications, and the examination report is negative for corticosteroids or other immunosuppressive medications. Physical examination revealed that both his tinea pedis and tinea cruris each covered less than 5 percent of his total body area, with a combined area of 4.7 percent. His conditions affected no exposed areas. The Veteran’s treatment records are consistent with the above findings upon examination. Although a history of the Veteran’s skin disabilities is noted during the appeal, his treatment records are silent for any evidence of an increase in symptomology that would suggest that a higher rating may be warranted under the applicable criteria. As such, the Board finds that the evidence is against the assignment of a compensable evaluation because the Veteran’s tinea pedis and tinea cruris do not more nearly approximate: (1) characteristic lesions involving at least 5 percent of the entire body affected; or (2) at least 5 percent of exposed areas affected; or (3) any intermittent systemic therapy. The Board has considered whether any other Diagnostic Codes related to disabilities of the skin would provide for a higher disability evaluation. However, the evidence does not reflect that he would warrant a higher rating under a different diagnostic code. See 38 C.F.R. § 4.118. Thus, as the preponderance of the evidence is against the Veteran’s claim for a compensable rating for his tinea pedis with tinea cruris, the claim for an increased initial rating must be denied. 38 C.F.R. §§ 4.3, 4.7. 5. A compensable rating for allergic rhinitis. The Veteran was awarded service connection for allergic rhinitis in the November 2018 rating decision on appeal, where a noncompensable rating was assigned. He asserts that the severity of this allergic rhinitis warrants a higher initial rating. For the below reasons, the Board finds that a higher rating is not warranted. The Veteran’s allergic rhinitis is rated under 38 C.F.R. § 4.97, Diagnostic code 6522. Pursuant to Diagnostic code 6522 for allergic rhinitis, a 10 percent rating is warranted for allergic or vasomotor rhinitis without polyps, but with greater than 50 percent obstruction of nasal passage on both sides or complete obstruction on one side. A 30 percent rating is warranted for allergic or vasomotor rhinitis with polyps. 38 C.F.R. § 4.97, Diagnostic Code 6522. VA examinations were afforded to the Veteran in November 2018 and in January 2019, where both allergic rhinitis and sinusitis were diagnosed. The Veteran reported coughing, fatigue, headache, facial tenderness, itchy eyes, phlegm, scratchy throat, post-nasal drip, and a stuffy and itchy nose. He also reported treatment with nasal inhalers. Upon physical examination, the examiner did not find that the Veteran had an obstruction greater than 50 percent on both sides of the nasal passage or complete obstruction on one side. The examiner also noted no hypertrophy of nasal turbinates, nasal polyps, or any granulomatous conditions. The Veteran’s treatment records are consistent with the above findings upon examination. Although a history of rhinitis was noted during the appeal, his treatment records are silent for any evidence of an increase in symptomology that would suggest that a higher rating may be warranted under the applicable criteria. Based on the foregoing, the Board finds the evidence is against a finding that the Veteran has had greater than 50 percent obstruction of both nasal passages or complete obstruction of either nasal passage, the criteria for a higher rating under Diagnostic Code 6522. 38 C.F.R. § 4.97. The clinical evidence also does not establish the presence of nasal polyps during the appeal period. The Board has considered whether there is any other schedular basis for granting a compensable rating but has found none. While the Veteran was also awarded as separate 30 percent rating for sinusitis in the November 2018 rating decision, the Veteran has not appealed this rating. Regardless, the above VA examinations did not reflect either: (1) sinusitis following radical surgery with chronic osteomyelitis, or (2) near constant sinusitis characterized by headaches, pain and tenderness of affected sinus, and purulent discharge or crusting after repeated surgeries to warrant the next higher rating under the General Rating Formula for Sinusitis (Diagnostic Codes 6510 to 6514). 38 C.F.R. § 4.97. The Veteran’s sinusitis was shown to only be episodic. Thus, as the preponderance of the evidence is against the Veteran’s claim for a compensable rating for his allergic rhinitis, the claim for an increased initial rating must be denied. 38 C.F.R. §§ 4.3, 4.7. 6. A rating in excess of 10 percent for a duodenal ulcer. The Veteran was awarded service connection for a duodenal ulcer in the November 2018 rating decision on appeal, where a 10 percent rating was assigned. He asserts that the severity of this disability warrants a higher initial rating. For the below reasons, the Board finds that a higher rating is not warranted. The Veteran’s duodenal ulcer is currently rated pursuant to Diagnostic Code 7305. A higher, 20 percent rating is assigned for moderate symptoms of a duodenal ulcer with recurring episodes of severe symptoms two or three times a year averaging 10 days in duration; or with continuous moderate manifestations. A 40 percent rating is assigned for moderately severe symptoms of a duodenal ulcer, or less than severe symptoms but with impairment of health manifested by anemia and weight loss; or recurrent incapacitating episodes averaging 10 days or more in duration at least four or more times a year. A 60 percent rating is assigned for severe symptoms of a duodenal ulcer with pain only partially relieved by standard ulcer therapy, periodic vomiting, recurrent hematemesis or melena, with manifestations of anemia and weight loss productive of definite impairment of health. 38 C.F.R. § 4.114, Diagnostic Code 7305. The Veteran was afforded VA stomach and duodenal conditions examinations in November 2018 and January 2019. At that time, the Veteran reported that he experienced recurrent periods of abdominal pain, particularly with certain foods, as well as nausea and vomiting. The examiners both indicated that the Veteran’s duodenal ulcer manifested abdominal pain and nausea, and did not result in any incapacitating episodes. The 2018 examiner also noted mild vomiting. Neither examiner indicated recurring episodes of severe symptoms, and none of his symptoms were noted to be continuous. The Veteran’s treatment records are consistent with the above findings upon examination. Although a history of his ulcer was noted during the appeal, his treatment records are silent for any evidence of an increase in symptomology that would suggest that a higher rating may be warranted under the applicable criteria. Based on the foregoing, the Board finds that a rating in excess of 10 percent for the Veteran’s service-connected doudenal ulcer is not warranted. In this regard, the Veteran’s symptoms do not result in at least recurring episodes of severe symptoms two or three times a year averaging 10 days in duration, or with continuous moderate manifestations. 38 C.F.R. § 4.114, Diagnostic Code 7305. Thus, as the preponderance of the evidence is against the Veteran’s claim for rating in excess of 10 percent for his duodenal ulcer, the claim for an increased initial rating must be denied. 38 C.F.R. §§ 4.3, 4.7. Regarding all of the above increased rating claims, the Board is sympathetic to the Veteran’s lay statements that his disabilities are worse than currently evaluated and those statements have been considered. The Veteran is competent to report observable symptoms because this requires only personal knowledge as it comes to him through his senses. Layno v. Brown, 6 Vet. App. 465 (1994). He is not, however, competent to identify a specific level of disability according to the appropriate diagnostic codes. Such competent evidence concerning the nature and extent of the Veteran’s disabilities have been provided by the medical personnel who have examined him during the current appeal and who have rendered pertinent opinions in conjunction with the evaluations. The medical findings (as provided in the examination reports and the clinical records) directly address the criteria under which the disabilities are evaluated. The medical and lay evidence has been assessed by the Board in determining the overall disability ratings. Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. REASONS FOR REMAND While the Board regrets further delay, the Veteran’s reopened service connection claim for respiratory and low back disabilities must be remanded for additional development. 1. A respiratory disability. The Veteran’s respiratory disability claim was previously denied by the Board based, in part, on the findings of a VA examiner in February 2010 who diagnosed the Veteran with restrictive lung disease and opined that this condition was “likely secondary to his GERD.” As GERD (gastroesophageal reflux disease) was not service-connected at the time, no actual medical opinion was provided that provides a thorough opinion and rationale as to this potential theory of entitlement. As noted above, however, the Veteran was awarded service connection for a duodenal ulcer in the November 2018 rating decision on appeal. Further, the Board notes that a more recent VA examination that addressed the relationship between the Veteran’s respiratory disability and an in-service upper respiratory infection diagnosed bronchiectasis, a chronic obstructive lung disease different from his previously-diagnosed restrictive lung disease. As such, an additional VA examination is necessary that that determines the nature and etiology of any current respiratory disability, to include as secondary to his service-connected ulcer. See 38 C.F.R. § 3.310. 2. A low back disability. The Veteran has not been afforded a VA examination in connection with his claim for service connection for a low back disability. Generally, a VA medical examination or opinion is necessary when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) evidence establishing that an event, injury, or disease occurred in service, or establishing certain diseases manifesting during an applicable presumptive period for which the veteran qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran’s service or with another service-connected disability, but (4) there is insufficient competent medical evidence on file for VA to make a decision on the claim. 38 U.S.C. § 5103A(d)(2); 38 C.F.R. § 3.159(c)(4)(i); see also McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). As noted above, the Veteran’s claim was denied based, in part, on the absence of a disability for service connection purposes. An April 2019 VA treatment record notes a diagnosis of degenerative disc disease of the lumbar spine. Thus, as the record contains in-service treatment for a lumbar strain and a current disability, a VA examination is warranted. The Board notes for the record that, while his degenerative disc disease was only diagnosed recently, the Veteran has a history of ongoing back pain. The matters are therefore REMANDED for the following actions: 1. Ask the Veteran to identify all outstanding treatment records relevant to his respiratory and low back disability claims. All identified VA records should be added to the claims file. All other properly identified records should be obtained if the necessary authorization to obtain the records is provided by the Veteran. If any records are not available, or the Veteran identifies sources of treatment but does not provide authorization to obtain records, appropriate action should be taken (see 38 C.F.R. § 3.159(c)-(e)), to include notifying the Veteran of the unavailability any records. 2. After records development is completed, schedule the Veteran for a VA examination to determine whether it is at least as likely as not (50 percent probability or greater) that any current respiratory disability onset during service or is otherwise related to an in-service injury, event, or disease. The Board notes that, as it previously resolved all doubt in the Veteran’s favor in September 2012 as to his in-service exposure to hazardous substances in his Military Occupational Specialty as a Painter, exposure to asbestos has been conceded. Should the examiner opine that the Veteran does not have a diagnosis of asbestosis, any opinion provided should nevertheless discuss any relationship between asbestos exposure and any diagnosed respiratory disability. The examiner should also address whether any current respiratory disability is at least as likely as not (a) caused, or (b) aggravated (i.e., worsened beyond its natural progression) by the Veteran’s service-connected duodenal ulcer. The examiner should elicit a full history from the Veteran and consider the lay statements of record. The Veteran is competent to attest to factual matters of which he has first-hand knowledge, and if there is a medical basis to support or doubt the history provided by the Veteran the examiner should provide a fully reasoned explanation. A rationale for all opinions expressed is requested as adjudicators are precluded from making any medical findings. 3. After records development is completed, schedule the Veteran for a VA examination to determine whether it is at least as likely as not (50 percent probability or greater) that any current low back disability onset during service or is otherwise related to an in-service injury, event, or disease, to include any in-service reports of back pain. The examiner should elicit a full history from the Veteran and consider the lay statements of record. The Veteran is competent to attest to factual matters of which he has first-hand knowledge, and if there is a medical basis to support or doubt the history provided by the Veteran the examiner should provide a fully reasoned explanation. A rationale for all opinions expressed is requested as adjudicators are precluded from making any medical findings. Nathan Kroes Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. Scarduzio, 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.