Citation Nr: 21001423 Decision Date: 01/08/21 Archive Date: 01/08/21 DOCKET NO. 17-08 262 DATE: January 8, 2021 ISSUES 1. Entitlement to service connection for a right elbow disability. 2. Entitlement to service connection for a left ankle disability. 3. Entitlement to service connection for right ankle disability. 4. Entitlement to a compensable rating for bilateral hearing loss. 5. Entitlement to service connection for a left knee disability. 6. Entitlement to service connection for a right knee disability 7. Entitlement to service connection for erectile dysfunction. 8. Entitlement to service connection for gum disease. ORDER Entitlement to service connection for a right elbow disability is denied. Entitlement to service connection for a left ankle disability is denied. Entitlement to service connection for a right ankle disability is denied. REMANDED Entitlement to a compensable rating for a bilateral hearing loss disability is remanded. Entitlement to service connection for a left knee disability is remanded. Entitlement to service connection for a right knee disability is remanded. Entitlement to service connection for erectile dysfunction is remanded. Entitlement to service connection for gum disease is remanded. FINDINGS OF FACT 1. The Veteran's currently diagnosed right elbow epicondylitis did not have its onset during service or within the first post-service year and is not otherwise related to any disease or injury in service. 2. The Veteran's currently diagnosed left ankle sprain or weakness did not have its onset during service or within the first post-service year and is not otherwise related to any disease or injury in service. 3. The preponderance of the evidence of record is against finding that the Veteran has had a current right ankle disability at any time during or approximate to the pendency of the claims which is causally related to, or aggravated by, service. CONCLUSIONS OF LAW 1. The criteria for service connection for a right elbow condition are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for a left ankle condition are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for service connection for a right ankle condition are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from December 1971 to December 1975 This case comes before the Board of Veterans' Appeals (the Board) from a July 2016 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran had a hearing before the undersigned Veterans Law Judge (VLJ) in February 2020. At this February 2020 Board Hearing, the Veteran was accompanied by his son, who also provided testimony. A transcript of that proceeding has been associated with the claims file. The Board notes that additional documentary evidence was added to the claims file by the Veteran and his representative at this February 2020 hearing. The Veteran and his attorney elected to waive initial consideration by the Regional Office of this additional documentary evidence. The undersigned Veterans Law Judge held the record open for a 60-day period following the hearing to allow for the submission of additional evidence. See February 2020 Board Hearing transcript, pgs. 2 & 14-15 & 23. At the outset, the Board notes that the Veteran’s bilateral hearing loss, left and right knee disabilities, erectile dysfunction and gum disease disabilities will be addressed in the Remand section of this decision. The Board also notes that it has reviewed all of the evidence in the record, with an emphasis on the evidence relevant to this appeal. Although the Board has an obligation to provide reasons and bases supporting its decision, there is no need to discuss, in detail, every piece of evidence of record. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Hence, the Board will summarize the relevant evidence as appropriate, and the Board's analysis will focus specifically on what the evidence shows, or fails to show, as to the claims being decided. The Board begins its discussion and analysis with the Veteran’s service connection claims for a right elbow disability, followed by discussion and analysis of the Veteran’s left ankle disability and right ankle disability claims. Service Connection Applicable law provides that service connection will be granted if it is shown that the Veteran suffers from disability resulting from an injury suffered or disease contracted in line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty, in the military, naval, or air service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. §§ 1110, 1131 (2012); 38 C.F.R. § 3.303 (a) (2018). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004); see also Hickson v. West, 12 Vet. App. 247, 253 (1999), citing Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd, 78 F.3d 604 (Fed. Cir. 1996). The determination as to whether these requirements are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. Baldwin v. West, 13 Vet. App. 1 (1999); 38 C.F.R. § 3.303 (a). VA has established certain rules and presumptions for chronic diseases, such as arthritis. See 38 C.F.R. §§ 3.303 (b), 3.307, 3.309(a); Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). With chronic diseases shown as such in service so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless attributable to intercurrent causes. 38 C.F.R. § 3.303 (b). If chronicity in service is not established, a showing of continuity of symptoms after discharge may support the claim. 38 C.F.R. § 3.303 (b). In addition, for veterans who have served 90 days or more of active service during a war period or after December 31, 1946, chronic diseases are presumed to have been incurred in service if they manifested to a compensable degree within one year of separation from service. 38 C.F.R. §§ 3.307 (a)(3), 3.309(a). When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. When all of the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the appellant prevailing in either event, or whether a fair preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990) Entitlement to service connection for a right elbow disability The Veteran contends that his right elbow disability stems from the physical rigors associated with his Military Occupational Specialty (MOS) as an avionics technician. See February 2020 Board Hearing transcript, pgs. 6. See also DD-214. The Veteran testified that a common job during service was installing and removing aircraft parts. The Veteran testified that he was often in awkward positions in performing his duties. The Veteran testified that one aircraft part in particular, (e.g., Cutler hammer box) weighed approximately 80 to 90 lbs. The Veteran asserts that he overused his joints during service. Id. at 6. For reasons that will be discussed below, the Board finds that the preponderance of the evidence shows that the Veteran’s right elbow disability did not have its onset during service or within the first post-service year and is not otherwise related to any disease or injury in service. Significantly, the Board finds that the second prong of service connection has not been met in this present case. With regards to a current disability, June 2010 treatment records show that the Veteran has a past medical history of right tennis elbow. See June 2010 treatment records. September 2012 treatment records show that the Veteran has treated for right elbow pain, localized. The Veteran was diagnosed with right elbow epicondylitis. See September 2012 treatment records. January 2013 the post service treatment records show that the Veteran complained of right elbow pain that began in the last 6 to 8 months. The Veteran reported that his right elbow pain had actually been resolving. His pain was initially 0-8/10, now 0-3/10. His pain is worse in the morning hours with significant stiffness and improves after about an hour of moving his right elbow. It is actually better with movement. The Veteran denied any trauma to the elbow. The January 2013 treatment record reported that the Veteran is an inventor and does a lot of manual dexterity with his arms. The treatment record reported that the Veteran is not typically active in any type of sports activities that brought on his elbow pain. The Veteran reported that he states his pain is in the lateral aspect of the elbow. The Veteran was diagnosed of right elbow lateral epicondylitis. See January 2013 treatment records. November 2013 treatment records show complaints of elbow pain, especially with extension and lifting. The Veteran stated that he had been remodeling his house and his elbows are very sore. The Veteran denied any acute injury but does report recent overuse. See November 2013 treatment records. March and April 2014 treatment records show that the Veteran has been treated, by history for elbow pain with a diagnosis of lateral epicondylitis (tennis elbow). See April 2014 treatment records. April 2016 treatment records show that the Veteran reports taking naproxen for elbow pain. See April 2016 treatment records. Hence, the Board finds that the first prong of service connection, a current disability, has arguably been met in this case. See Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004) The Board notes however that the Veteran’s service treatment records, including his December 1971 enlistment and November 1975 Separation examinations are silent regarding any injury, complaint, treatment or diagnoses for the Veteran’s right elbow. The Board notes that the Veteran’s diagnosis for his right elbow epicondylitis did not occur until more than 30 years after service. See June 2010 treatment records. While the Veteran has testified that his right elbow epicondylitis stems from the rigors of service as an aviation technician and specifically overuse, the Board finds the Veteran’s testimony unpersuasive as to the etiology of his right elbow epicondylitis. More to the point: The Board assigns no probative weight to the Veteran’s testimony with regard to the nature and etiology of the Veteran’s right elbow epicondylitis. Even with full consideration of the Veteran’s contention that the Veteran’s right elbow disability stems from overuse, the Board observes that the Veteran has not pointed to any incident in service where he complained of an overuse injury or received treatment in connection with an overuse injury, other than asserting that his current right elbow disability stems from the physical rigors associated with his MOS. See also Musculoskeletal Injuries Fact Sheet (Document type: Correspondence, Receipt Date, February 27, 2020.). The Board is also cognizant that the Veteran testified that post service, his employment history included, inter alia, work as a stereo salesman (showroom), work as bulk plant cement foreman for BJ Hughes, for down hole cement in the operation of hole drilling and work as an oil rig electrician for Penn Rock Drilling Company (no physical strain). See February 2020 Board Hearing transcript, pg. 10. Here, the Board finds that the preponderance of the evidence shows that the Veteran’s right elbow conditions occurred many years after service, and there is no credible, competent evidence of record to establish that the Veteran’s right elbow disability resulted from in-service occurrence of a disease or injury. The preponderance of the evidence shows that the Veteran’s claimed conditions did not manifest or have their onset during service or within the first post-service year, nor has chronicity of symptomology been shown. See 38 C.F.R. § 3.303 (b). Further, a negative inference may be drawn from the absence of complaints or treatment for an extended period. Maxson v. West, 12 Vet. App. 453, 459 (1999), aff'd sub nom. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). Given the lay and medical evidence of record, the Board finds the second prong of service connection is not met for the Veteran's claims for entitlement to service connection for a right elbow disability, as there is no evidence of the existence of a relevant disease or injury in service. See Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). The Board notes that the Veteran has not been afforded VA examinations pertaining to his right elbow service connection claim. In this case, no examination is necessary in order to adjudicate this claim. Although the record does reflect a current diagnosis of right elbow epicondylitis, there is no credible evidence of an in-service disease or injury or evidence suggesting that such diagnosis may somehow be related to military service. Therefore, a medical examination would serve no useful purpose in this case given that there are no credible bases and no records of an in-service disease or injury for the examiner to review to formulate an opinion. Nor has the Veteran asserted any continuity of symptoms associated with a right elbow injury or its overuse during service. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). Based upon the above, and after consideration of the evidence of record, the Board finds that the preponderance of the evidence weighs against the Veteran's claims for entitlement to service connection for a right elbow disability. Therefore, there is no reasonable doubt to be resolved, and the claims must be denied. See 38 U.S.C. § 5107 (b) (2012); 38 C.F.R. § 3.102 (2017); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Entitlement to service connection for a left ankle disability The Board incorporates by reference, the discussion from above. The Veteran contends that his left ankle disability stem from the physical rigors associated with his Military Occupational Specialty (MOS) as an avionics technician. The Veteran asserts that he overused his joints during service. See February 2020 Board Hearing transcript at 6. See also DD-214 (missile systems technician). As noted above in this decision, the Veteran testified that a common job during service was installing and removing aircraft parts from awkward positions. The Veteran testified that one part in particular, Cutler hammer box, weighed approximately 80 to 90 lbs. Id. at 6. The Board finds that the preponderance of the evidence shows that the Veteran’s left ankle disability did not have its onset during service or within the first post-service year and is not otherwise related to any disease or injury in service. Once again, the Board finds that the second prong of service connection has not been met in this case. As to the issue of a current disability, post service treatment records show that the Veteran was diagnosed with a left ankle sprain in November 2008. X-rays of the ankle and foot were negative for a fracture. See November 22, 2008 treatment record. December 2008 post service treatment records show that the Veteran has a past medical history of a left ankle sprain, one month. See December 18, 2008 treatment record. August 2011, March and June 2012 treatment records show that the Veteran has a history of a left ankle sprain. See August 2011, March 2012 and June 2012 treatment record. November 2015 treatment records from podiatry shows that the Veteran had 5/5 strength noted in all quadrants at the level of the left and right ankle. The Veteran was evaluated for a painful in-grown toenail. See November 2015 treatment record, Podiatry Consult. April 2016 treatment records show that the Veteran was treated for bursitis. See April 2016 treatment records. August 2017 treatment records show that the Veteran complained of weak joints and knees, left and right ankles get tired. See August 10, 2017 treatment records. On physical examination, July 2018 treatment records show that the Veteran’s left ankle and right ankle are stable with full range of motion and strength. Achilles tendons, nontender. The Veteran was treated for plantar fascitis. See July 9, 2018 treatment records. Assuming arguendo that the Veteran has a current left ankle disability (left ankle sprain or weakness) the Board finds that service connection is still not warranted. The Board finds that the second prong of service connection has not been met in this case for the following reasons. First, the Board notes that the Veteran’s service treatment records are negative for any complaint, injury or treatment for a left ankle condition during service. See also December 1971 enlistment examination and November 1975 Separation examination. Second, on x-ray, the Veteran was not diagnosed with a left ankle sprain until November 2008, more than 35 years since separation his from service. Further, treatment records show that the Veteran’s left ankle sprain resulted from a fall down some stairs earlier that evening. On x-ray, no fracture was indicated. See November 2008 treatment record. Subsequent post service treatment records show that the Veteran has a left ankle sprain by history and that his left ankle gets tired after walking a mile. While the Veteran has testified that his left ankle disability resulted from the rigors of service, and specifically overuse, the Board finds the Veteran’s testimony as to the etiology of his left ankle disability unpersuasive as the record shows that the Veteran did not have complaints of a left ankle sprain or left ankle weakness until more than 30 years after service. The Board assigns no probative weight to the Veteran’s testimony with regard to the nature and etiology of the Veteran’s left ankle disability. Even with full consideration of the Veteran’s contention that his left ankle disability stems from overuse, the Board observes that the Veteran has not pointed to any incident in service where he complained of an injury or received treatment for a left ankle condition or overuse of his left ankle, in connection with his duties as an avionics technician. See August 10, 2017 treatment records; See Board Hearing transcript pg. 6. See also Musculoskeletal Injuries Fact Sheet (Document type: Correspondence, Receipt Date, February 27, 2020.). As referenced above in this decision, the Board is also cognizant that the Veteran testified that post service, his employment history included, inter alia, work as a stereo salesman (showroom), work as a bulk plant cement foreman for BJ Hughes, for down hole cement in the operation of hole drilling and work for Penn Rock Drilling Company as a rig electrician on oil rigs out on the Gulf of Mexico (no physical strain). See February 2020 Board Hearing transcript, pg. 10. Moreover, as noted earlier, November 2008 treatment records show that the Veteran’s left ankle sprain resulted from a fall down some stairs earlier that evening. On x-ray, no fracture was indicated. See November 22, 2008 treatment record. Here, the preponderance of the evidence shows that the Veteran’s left ankle disability did not manifest or have their onset during service or within the first post-service year, nor has chronicity of symptomology been shown. See 38 C.F.R. § 3.303 (b). The preponderance of the evidence shows that the Veteran’s left ankle disability occurred many years after service, and there is no credible, competent evidence of record to establish that the Veteran’s left ankle sprain or weakness resulted from an inservice occurrence, disease or injury. Any insinuations by the Veteran that he sustained a left ankle injury in connection with his duties as an avionics technician aviation are refuted by the contemporaneous record. Thus, given the lay and medical evidence of record, the Board finds the second prong of service connection is not met for the Veteran's claims for entitlement to service connection for a left ankle disability, as there is no evidence of the existence of a relevant disease or injury in service. See Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). The Board notes that the Veteran has not been afforded VA examinations pertaining to his service connection claims. In this case, no examination is necessary in order to adjudicate the claims. Although the record does reflect current diagnoses, there is no credible evidence of an in-service disease or injury or evidence suggesting that such diagnoses may somehow be related to military service. Therefore, medical examinations would serve no useful purpose in this case given that there are no credible bases and no records of an in-service disease or injury for the examiner to review to formulate an opinion. Nor has the Veteran asserted a continuity of symptoms associated his left ankle condition or its overuse during service. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). Based upon the above, and after consideration of the evidence of record, the Board finds that the preponderance of the evidence weighs against the Veteran's claims for entitlement to service connection for a left ankle disability. Therefore, there is no reasonable doubt to be resolved, and the claim must be denied. See 38 U.S.C. § 5107 (b) (2012); 38 C.F.R. § 3.102 (2017); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Entitlement to service connection for a right ankle disability. The Veteran asserts that his right ankle disability stems from the rigors of his service as an avionics technician. The Veteran testified that as part of his duties as an avionics technician he was required to install, remove and lift heavy aircraft parts, often from awkward positions. The Veteran has testified that one aircraft part in particular (e.g., Cutler hammer box) weighed approximately 80 to 90 lbs. The Veteran asserts that he overused his joints during service. See Board Hearing transcript, pg. 6. The Veteran filed a claim for service connection for a right ankle condition in December 2015. See December 2015 VA Form 21-526 EZ re: right ankle pain. The Veteran’s service treatment records are negative for any complaint, injury or treatment for a right ankle condition during service. See December 1971 Enlistment examination and November 1975 Separation examination. Review of the Veteran's VA treatment records do not show a diagnosis for a right ankle condition. Thus, there is no competent evidence of a current diagnosis. See August 10, 2017 treatment records re: complaint of right ankle weakness after walking 1 mile. July 2018 treatment records show that the Veteran’s right ankle is stable with full range of motion and strength. See July 9, 2018 treatment records. The Board notes that although the Veteran is competent to report complaints such as pain; the medical records are negative for credible evidence of complaints since service. Moreover, although the Veteran is competent to report symptoms, he has not been shown to have the experience, training, or education necessary to make a diagnosis and/or etiology opinion to the claimed disability in the absence of clinical findings. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011); See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). The evidence of record is against a finding of a right ankle disability upon separation or in the three decades after separation from service. Moreover, there is no competent and credible evidence of a current right ankle disability for VA purposes. In Saunders v. Wilkie 886 F.3d 1356, 1368 (Fed. Cir. 2018), the Court found that pain alone can constitute a disability. However, the Court in Saunders cautioned that a Veteran cannot demonstrate service connection simply by asserting subjective pain. Rather, the Court stated "[t]o establish the presence of a disability, the veteran will need to show that [his or] her pain reaches the level of functional impairment of earning capacity." Id. Specifically, with regards to the Veteran’s right ankle, there is no competent and credible evidence of such in the claims file. See e.g., August 10, 2017 treatment; see also, July 9, 2018 treatment records. Even assuming arguendo that the Veteran has a current right ankle disability on the basis of pain, there is no competent and credible evidence that any such disability is causally related to service. The Board observes that the Veteran has not pointed to any incident in service where he complained of an injury or received treatment for a right ankle condition, ankle pain or overuse of his right ankle, in connection with his duties as an avionics technician. See Board Hearing transcript pg. 6; See also Musculoskeletal Injuries Fact Sheet (Document type: Correspondence, Receipt Date, February 27, 2020.). In sum, the Board finds that the most probative evidence shows that the Veteran does not have a current right ankle disability, nor has he been diagnosed with such disability during or approximate to the appeal period. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) (disallowing service connection where there was no current disability). See also McClain v. Nicholson, 21 Vet. App. 319 (2007); Romanowsky v. Shinseki, 26 Vet. App. 289 (2013). As the preponderance of the evidence is against service connection, the benefit of the doubt doctrine does not apply, and the claim for a right ankle condition must be denied. 38 C.F.R. § §§ 3.102, 3.303. REASONS FOR REMAND Entitlement to a compensable rating for a bilateral hearing loss disability is remanded. The Veteran contends that his bilateral hearing loss warrants a compensable disability rating. See October 2016 Notice of Disagreement (NOD). Additionally, the Veteran asserts that his bilateral hearing loss has gotten worse since his last VA audiological examination. See February 2020 Board Hearing transcript, pgs. 18-19. The Veteran was last afforded audiological examination for his bilateral hearing loss disability in June 2016. See June 26, 2016 audiological examination. Since the Veteran contends that his hearing has gotten worse, a new exam is needed. A new examination is appropriate when there is an assertion (and indication) of an increase in severity since the last examination. 38 C.F.R. § 3.159 (2018); see also Palczewski v. Nicholson, 21 Vet. App. 174, 181 (2007). Here, the Veteran has asserted that his hearing has gotten worse since his last audiological examination. The Veteran’s son also testified at his February 2020 Board Hearing that he often has to repeat himself when talking to his Father. The Veteran’s son testified that that the Veteran turns the volume up on his television so loud that he can hear the Veteran’s TV from his own RV, which is 50 feet away. Id. at pgs. 19-20. The Veteran’s representative also asserts that in the last audiological examination, the Veteran was not asked about his symptoms of ear pain, dizziness, loss of balance and social isolation due to difficulties communicating. The Veteran’s representative asserts that the Veteran’s bilateral hearing loss may warrant extraschedular consideration. See Board Hearing transcript, pgs. 20-21. Reexamination will be requested whenever VA determines that there is a need to verify the current severity of a disability. 38 C.F.R. § 3.327 (a) (2018). In light of the Veteran’s assertion that his bilateral hearing loss disability has gotten worse since his last VA audiological examination, the Veteran’s son’s testimony indicating an increase in severity of the Veteran's service-connected bilateral hearing loss, and the assertion that his last audiological examination did not fully address the functional impact of the Veteran’s hearing loss, which may warrant extraschedular consideration, remand is required to afford the Veteran a new VA examination to address the current nature and severity of his bilateral hearing loss disability. Entitlement to service connection for a left and right knee disability is remanded. The Veteran states that his left and right knee disability stems from the physical rigors associated with his Military Occupational Specialty (MOS) as an avionics technician. See Board Hearing transcript at 6. See also DD-214. October 1974 service treatment records show that the Veteran complained of numbness in his knees, including an episode in which his knees gave out. This treatment record reported that the Veteran had minor problems with his knees in high school, but no further problems until this time. The Veteran was diagnosed with chondromalacia, both knees. See October 1974, Service Treatment Record. At his November 1975 Separation examination, the Veteran was diagnosed with chondromalacia of both knees, with a recommendation for follow-up at the VA. See November 1975 Separation examination. The Veteran was afforded a Knee and Lower leg examination in April 2016 to determine the etiology of his left and right knee disability. The examiner concluded that the Veteran did not have a current diagnosis associated with his left and right knee. See April 2016 Knee and Lower leg, 2016 Disability Benefits Questionnaire, pgs. 1-2. The examiner further stated that the Veteran did not have a diagnosis other than knee pain at this time. The examiner indicated that the Veteran’s physical exam does not give any specific clues as to the cause of his pain. The examiner reported that there is no diagnosis because there is no pathology to render a diagnosis. See April 2016 Knee and Lower leg Disability Benefits Questionnaire, pgs. 2-3. The Veteran was afforded an April 2016 Medical Opinion with regards to the etiology of his left and right knee. The examiner rendered a negative linkage opinion to service. The examiner indicated that they were unable to find any recent knee evaluation and diagnosis on review of available records at this time. The examiner noted records of 9/16/04, 0/15/05 and separation medical history 5/1/09, which were silent to any knee complaints/condition. The examiner concluded that the Veteran’s left and right knee pain is less likely as not incurred in or caused by diagnosis of chondromalacia that occurred in service. See April 2016 Medical Opinion, pgs. 2 & 5. The Board finds this examination inadequate for the following reasons: First, as referenced above, October 1974 treatment records, and the Veteran’s November 1975 separation examination shows that the Veteran been treated for left and right knee chondromalacia during service. Second, the Board notes while the Veteran’s left and right knee pain alone may not constitute a disability, such symptomatology may rise to a level of functional impairment that impacts earning capacity, which would then qualify left and right knee pain as a disability. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). In this case, there is competent evidence of left and right knee pain and therefore the potential presence of a disability under Saunders. The Board observes that the April 2016 examiner on medical history described the onset of the Veteran’s symptoms in 1972, during boot camp. The Veteran reported to the examiner that his knees started hurting and that he had trouble sleeping due to pain after running and physical activities. The examiner reported that the condition has worsened as time has passed. The examiner reported that this condition worsened beyond distraction to near disability. See April 2016 Knee and Lower Leg Disability Benefits Questionnaire, pg. 3. The Board also observes that post treatment records show that the Veteran has a diagnosis of probable early osteoarthritis. See June 24, 2011 treatment records. For the reasons stated above, remand for a new VA examination to assess the current nature and etiology of the Veteran’s left and right knee condition is warranted. Once VA undertakes to provide an examination, it is obligated to ensure the examination is adequate. Barr v. Nicholson, 21 Vet. App. 303 (2007). Entitlement to service connection for erectile dysfunction is remanded. The Veteran asserts that his erectile dysfunction and gum stems from his exposure to Trichloroethylene (TCE). The Veteran asserts that his exposure occurred at the El Toro Marine base during the time in which he was responsible for cleaning aircraft parts. The Veteran also asserts that his exposure resulted from drinking, bathing, and consuming the water table base. See February 2020 Board Hearing transcript pgs. 5, 7-9 & 15-16. The Veteran submitted articles indicating that El Toro Marine Base was found to have sites where the soil was contaminated with chemicals, to include dioxins. The articles indicated that El Toro Marine Base was placed on the Federal Superfund National Priorities List in 1990 due to groundwater contamination due to the presence of hazardous substances in soil and groundwater. See also El Toro Marine Corps Air Station Superfund Site Profile U.S. Environment Protection Agency (October 17, 2014). The Veteran contends he served on this base in his role as an avionics technician. Military Personnel records show that the Veteran was stationed at the El Tora Marine Corps Base during a period of active duty service. See Military Personnel Records (1975). The Veteran has not been afforded a VA examination in conjunction with his erectile dysfunction claim. Post-service treatment records reveal a diagnosis of erectile dysfunction. See May 9, 2017 treatment record re: Male erectile disorder. Based on the foregoing, the Board finds that a remand is warranted to afford the Veteran VA examination to determine whether the Veteran has an erectile dysfunction, which is related to exposure to alleged toxic chemicals during this period of service. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159; see also McLendon v. Nicholson, 20 Vet. App. 79, 83-86 (2006). Entitlement to service connection for gum disease is remanded. The Board incorporates by reference, the discussion from above. The Veteran asserts that his gum disease stems from his exposure to TCE during service. The Veteran also asserts that his exposure resulted from drinking and consuming the water table base. See February 2020 Board Hearing transcript pgs. 5, 7-9 & 15-16. As referenced above, the Veteran submitted articles indicating that El Toro Marine Base was found to have sites where the soil was contaminated with chemicals, to include dioxins. The articles indicated that El Toro Marine Base was placed on the Federal Superfund National Priorities List in 1990 due to groundwater contamination due to the presence of hazardous substances in soil and groundwater. See El Toro Marine Corps Air Station Superfund Site Profile U.S. Environment Protection Agency (October 17, 2014). Military Personnel records show that the Veteran was stationed at the El Tora Marine Corps Base during a period of active duty service. See Military Personnel Records (1975); See also DD-214, re: last duty assignment. Dental Disabilities Compensation is available for dental disabilities that are the result of osteomyelitis or osteoradionecrosis, or due to the loss, malunion, or limited motion of the mandible, maxilla, ramus, condyloid process, or hard palate, or due to the loss of teeth due to loss of substance of the upper or lower jaw. 38 C.F.R. § 4.150. Compensation is not available for treatable carious teeth, replaceable missing teeth, dental or alveolar abscesses, or periodontal disease. 38 C.F.R. § 3.381. The Veteran was diagnosed with herpetic gingivostomatitis during service. See February 2, 1972 service treatment records, re: herpetic gingivostomatitis (Dental consult for follow-up). The Veteran’s April 1974 Report of Medical Examination shows a diagnosis of gingivitis. See April 24, 1974 Report of Medical examination. The Veteran testified at his February 2020 Board Hearing that during service he passed out during mess hall duty. The Veteran testified that after this incident, he was required to see a physician for a couple of weeks. The Veteran testified that he later noticed that his teeth were longer, and his gums had receded maybe a quarter of an inch. The Veteran reports that at this time, he was diagnosed with herpetic gingivostomatitis. The Veteran has testified that currently, nothing can be done for his dental condition. The Veteran testified that he has had skin grafts and gums grafts for this condition. See Board Hearing transcript, pg. 16. The Veteran’s Board Hearing testimony, in conjunction with the Veteran’s service record reflects that the Veteran experiences various dental problems, including generalized periodontal support loss. Hence, the evidence suggests that he may have a current dental disability for compensation purposes. The Board also notes that the Veteran has indicated that he has had skin and gum grafts for his gum disease disability. The Board finds that these additional treatment records should be obtained in order for the Board to make a fully informed decision about this Veteran’s service connection claim for his gum disease (dental disability). In light of this evidence, and the fact that the issue of entitlement to service connection for a gum disease disability is otherwise being remanded to obtain additional treatment records, the Board finds an examination should be conducted upon remand in order to assess the nature and etiology of any current dental disability. See also McLendon v. Nicholson, 20 Vet. App. 79, 83-86 (2006). Lastly, all outstanding VA treatment records should be secured upon remand. Accordingly, these matters are REMANDED for the following action: 1. Ask the Veteran to identify the location and name of any VA or private medical facility where he has received treatment for his bilateral hearing disability, left and right knee disability, erectile dysfunction and gum disease disability, to include the dates of any such treatment. 2. Ask the Veteran to complete a VA Form 21-4142 for all records of his treatment for his bilateral hearing disability, left and right knee disability, erectile dysfunction and gum disease disability. Make two requests for any authorized records, unless it is clear after the first request that a second request would be futile. 3. After all efforts have been exhausted to obtain and associate with the claims file any additional treatment records, schedule the Veteran for a VA audiological examination by an appropriate clinician to determine the current nature and severity of his service-connected bilateral hearing loss disability. The examiner should perform all indicated tests and studies and report all clinical findings in detail. The VA examiner should review the entire claims file, including a copy of this remand and indicate in the report whether the claims file was reviewed. The examiner should address any functional impairment resulting from the Veteran's bilateral hearing loss and its effects on his ordinary activities, ability to function, and perform tasks in a work setting. (Please note review of the Veteran’s February 2020 Board Hearing transcript re: ear pain, loss of balance and social isolation resulting from difficulties communicating, pgs. 20-21.) The examiner must provide reasons for any opinion given. 4. After all efforts have been exhausted to obtain and associate with the claims file any additional treatment records, schedule the Veteran for an examination by an appropriate clinician to determine the existence and nature and etiology of any left and right knee disability during the period of the claim. Based on the review of the record and examination of the Veteran, the examiner should state a medical opinion as to the following: Is it at least as likely as not (i.e., whether there is a 50 percent or better probability) that any left knee and right knee disability present during the period of the claim originated during active service or is otherwise etiologically related to events noted in service records or described by the Veteran in written or oral statements? Note: If no specific disability is identified upon examination, the examiner is reminded that pain alone can be considered a disability if there is associated functional loss. If the only identified disability is reported pain, the examiner is to identify and describe any and all functional loss associated with this reported pain. Please also see February 2020 Board Hearing transcript, testimony, pg. 13 re: knees. The examiner is also invited to review the Medical History (Section II) in the April 2016 Knee and Lower Leg Disability Benefits Questionnaire, pg. 3. The examiner must provide reasons for any opinion given. 5. After all efforts have been exhausted to obtain and associate with the claims file any additional treatment records, schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any erectile dysfunction disability. Based on the review of the record and examination of the Veteran, the examiner should state a medical opinion as to the following: Is it at least as likely as not (a 50 percent probability or greater) that any erectile dysfunction disability is related to his active service, to include exposure to toxic chemicals, and solvents, to include TCE while stationed at El Tora Marine Corps Base? The examiner must review and consider documentation submitted by the Veteran. (See e.g., Contamination at U.S. Military Bases: Profiles and Responses, 2017: Document type, Correspondence, Receipt Date, February 27, 2020; See also, National Toxicology Program, Trichloroethylene: Document type, Correspondence, Receipt Date, February 27, 2020.) Please note review of articles submitted by Veteran. The examiner must provide reasons for any opinion given. 6. After all efforts have been exhausted to obtain and associate with the claims file any additional treatment records, schedule the Veteran for a dental examination by an appropriate clinician to determine the nature and etiology of any gum disease disability. Based on the review of the record and examination of the Veteran, the examiner should state a medical opinion as to the following: Is it at least as likely as not (a 50 percent probability or greater) that any current gum disease disability is related to his active service, to include exposure to toxic chemicals, and solvents, to include TCE while stationed at El Tora Marine Corps Base? (See e.g., Contamination at U.S. Military Bases: Profiles and Responses, 2017: Document type, Correspondence, Receipt Date, February 27, 2020; See also, National Toxicology Program, Trichloroethylene: Document type, Correspondence, Receipt Date, February 27, 2020.) Please note review of articles submitted by Veteran. The examiner must provide reasons for any opinion given. 7. After completing the above actions, readjudicate the claims on appeal. If the benefits sought on appeal remain denied, the Veteran and his representative should be furnished an appropriate Supplemental Statement of the Case and be provided an opportunity to respond. Michael A. Pappas Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Little, Associate 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.