Citation Nr: 21001434 Decision Date: 01/08/21 Archive Date: 01/08/21 DOCKET NO. 09-47 131 DATE: January 8, 2021 ORDER Entitlement to service connection for right foot plantar warts is denied. REMANDED Entitlement to service connection for an acquired psychiatric disorder is remanded. Entitlement to service connection for a right shoulder disorder is remanded. Entitlement to service connection for a left shoulder disorder is remanded. Entitlement to service connection for a lower back disorder is remanded. Entitlement to service connection for a cervical spine is remanded. Entitlement to service connection for a right knee disorder is remanded. Entitlement to service connection for a left knee disorder is remanded. Entitlement to service connection for a bilateral shin disorder is remanded. Entitlement to service connection for a gastrointestinal disorder is remanded. Entitlement to service connection for a skin disorder is remanded. Entitlement to service connection for sleep apnea is remanded. FINDING OF FACT The preponderance of the evidence of record is against finding that the Veteran has, or has had at any time during the appeal, a current diagnosis of plantar warts. CONCLUSION OF LAW The criteria for entitlement to service connection for plantar warts have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active military service from February 1979 to approximately November 1982. As discussed in the February 2020 Board decision, the exact dates of service are unknown. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2008 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). This case was previously before the Board in July 2014, August 2016, November 2017, and February 2020, at which times the issues currently on appeal were remanded for additional development. The case has now been returned to the Board for further appellate action. Service Connection Generally, to establish service connection, a claimant must show: (1) a present disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service, the so-called “nexus” requirement. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303; see also Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). A disability that is proximately due to, the result of, or aggravated by a service-connected disease or injury shall be service connected. 38 C.F.R. § 3.310. Pertinent to a claim for service connection, such a determination requires a finding of a current disability that is related to an injury or disease in service. Watson v. Brown, 4 Vet. App. 309 (1993); see also Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); Rabideau v. Derwinski, 2 Vet. App. 141, 143 (1992). Under applicable regulation, the term “disability” means impairment in earning capacity resulting from diseases and injuries and their residual conditions. 38 C.F.R. § 4.1; see also Hunt v. Derwinski, 1 Vet. App. 292, 296 (1991); Allen v. Brown, 7 Vet. App. 439 (1995); Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018) (the term “disability” as used in 38 U.S.C. § 1110 “refers to the functional impairment of earning capacity, not the underlying cause of said disability,” and held that “pain alone can serve as a functional impairment and therefore qualify as a disability”). In McClain v. Nicholson, 21 Vet. App. 319, 321 (2007), the United States Court of Appeals for Veterans Claims (Court) held that the requirement of the existence of a current disability is satisfied when a claimant has a disability at the time he files his claim for service connection or during the pendency of that claim, even if the disability resolves prior to adjudication of the claim. However, in Romanowsky v. Shinseki, 26 Vet. App. 289 (2013), the Court held that when the record contains a recent diagnosis of disability prior to a claimant filing a claim for benefits based on that disability, the report of diagnosis is relevant evidence that the Board must address in determining whether a current disability existed at the time the claim was filed or during its pendency. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Plantar Warts The Veteran generally asserts that he has a plantar warts disability that is related to his period of active service. Specific argument in support of this appeal has not been submitted. In his July 2008 VA Form 21-526EZ (Application for VA disability benefits), the Veteran indicated that he was applying for VA benefits related to right foot plantar warts. The application did not contain any additional detail with regard to his claimed plantar warts. The Veteran’s service treatment records show that the Veteran complained of plantar warts on several occasions. However, the Veteran’s post-service medical records are absent any complaints or treatment for plantar warts. In October 2014, the Veteran was afforded a VA examination with regard to the etiology of any currently present plantar warts. At that time, the Veteran reported that he may have been treated at some point for plantar warts, but that he did not currently experience plantar warts. The Veteran denied any reoccurrence of sinusitis symptoms following his in-service diagnosis. Following examination, the examiner reported that the Veteran did not have a diagnosis of plantar warts, and that the Veteran did not experience functional impairment related to plantar warts. At a September 2019 VA examination, the Veteran reported that warts first appeared on his feet in 1982; however, the Veteran reported that he had never sought treatment for the warts. On examination, there was no evidence of plantar warts or associated functional impairment. In a corresponding medical opinion, the examiner opined that the Veteran did not have plantar warts that were related to service. In this regard, the examiner commented that the Veteran’s complaints of plantar warts were subjective only and that objective examination found no evidence of plantar warts. As the record does not reflect a current diagnosis of plantar warts, the cornerstone element of service connection has not been met, and service connection is not warranted. In the absence of proof of a present disability (and, if so, of a nexus between that disability and service), there can be no valid claim for service connection. See Boyer v. West, supra; Brammer v. Derwinski, supra. The Board has considered the evidence in light of the case of Saunders v. Wilkie in which the United States Court of Appeals for the Federal Circuit addressed “the legal issue [of] whether pain without an accompanying pathology can constitute a “disability” under [38 U.S.C.] § 1110.” 886 F.3d 1356, 1363-64 (Fed. Cir. 2018). The Federal Circuit held that the Veterans Court erred “as a matter of law in holding that pain alone, without an accompanying diagnosis or identifiable condition, cannot constitute a ‘disability’ under [38 U.S.C.] § 1131, because pain in the absence of a presently-diagnosed condition can cause functional impairment.” The Federal Circuit “conclude[d] that pain is an impairment because it diminishes the body’s ability to function, and that pain need not be diagnosed as connected to a current underlying condition to function as an impairment.” Further, the Federal Circuit held that “[w]e do not hold that a veteran could demonstrate service connection simply by asserting subjective pain to establish a disability, the veteran’s pain must amount to a functional impairment. To establish the presence of a disability, a veteran will need to show that pain reaches the level of a functional impairment of earning capacity.” In this case, there is no credible persuasive evidence or allegation that the Veteran suffers from plantar warts that are productive of functional impairment. To that end, the record contains no evidence or allegation that the Veteran experiences functional impairment associated with plantar warts. Indeed, the Veteran denied that he experienced symptoms related to plantar warts at the October 2014 and September 2019 VA examinations. See Saunders v. Wilkie, supra. In addition, the record does not reflect, and the Veteran has not alleged, that he suffers from impairment of earning capacity due to his claimed plantar warts that is of similar severity, frequency, and duration as those VA has determined by regulation would cause impaired earning capacity in an average person. Wait v. Wilkie, 2020 U.S. App. Vet. Claims LEXIS 1609, __ Vet.App. __, 2020 WL 5200689. In addition, the October 2014 and September 2019 VA examiners found no evidence of plantar warts on examination. Therefore, based on the foregoing, the Board finds that the Veteran’s does not have, nor has he had at any time proximate to or during the course of this appeal, a current disability manifested by plantar warts. Consequently, as there is no separate current disability manifested by gastrointestinal and/or sinusitis symptoms, service connection for such is not warranted. See Brammer, supra. To the extent that the Veteran believes that he has a current plantar warts disability, he is not competent to provide a diagnosis in this case. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Rather, a diagnosis of plantar warts requires expertise that the Veteran has not established. Therefore, the Board gives more probative weight to the competent medical evidence. In the absence of competent evidence that a current plantar wart disability exists which was caused by the Veteran’s military service, the criteria for establishing service connection for such have not been established. Accordingly, the Board finds that the preponderance of the evidence is against the claim and entitlement to service connection for plantar warts is not warranted. 38 U.S.C. § 5107: 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. REASONS FOR REMAND The Board finds that additional development is required before the remaining claims on appeal are decided. Service Connection Acquired Psychiatric Disorder In September 2019, the Veteran was afforded a VA examination. The examiner did not diagnose any acquired psychiatric disorders and no etiology opinion was provided. While the September 2019 VA examiner did not diagnose an acquired psychiatric disorder, treatment records indicate that the Veteran has been diagnosed with posttraumatic stress disorder (PTSD), major depressive disorder, and anxiety during the appeal period. Therefore, the Board finds that a new VA medical opinion is warranted to address the nature and etiology of any currently present acquired psychiatric disorder. Right and Left Shoulders In September 2019 VA opinions, the examiner opined that the Veteran’s right and left shoulder disorders were not related to service. The Board finds that the September 2019 VA opinions are inadequate for adjudication purposes. In this regard, the examiner commented that the Veteran’s shoulder conditions during service were acute and not chronic. In support of this conclusion, the examiner relied solely on the absence of post-service treatment for several years as the sole rationale for the negative nexus opinions. Therefore, the Board finds that new VA medical opinions are warranted to address the nature and etiology of the Veteran’s right and left shoulder disorders. Stegall v. West, 11 Vet. App. 268 (1998) (holding that a remand by the Board confers the right to compliance with remand orders). Lumbar Spine In a September 2020 VA opinion, the examiner opined that the Veteran’s lumbar spine disorder was not related to an October 1981 in-service muscle strain. In reaching this conclusion, the examiner commented that the available medical literature did not support a finding that the Veteran’s lumbar spine degenerative disc disease was related to the October 1981 muscle strain. However, no rationale was provided for this opinion. Therefore, the Board finds that a new VA medical opinion is warranted to address the nature and etiology of the Veteran’s lumbar spine disorder. Stegall, 11 Vet. App. 268. Cervical Spine In a September 2019 VA opinion, the examiner opined that the Veteran’s degenerative arthritis of the cervical spine was not related to service. In reaching this conclusion, the examiner commented that the Veteran’s service treatment records were silent for complaints and treatment of a neck condition, and that the Veteran did not seek treatment for a cervical spine disorder until several years following his separation from service. The Board finds that the September 2019 VA medical opinion is inadequate for adjudication purposes. See Dalton v. Nicholson, 21 Vet. App. 23 (2007) (an examination was inadequate where the examiner did not comment on a Veteran's reports of in-service injury and instead relied on the absence of evidence in a Veteran's service treatment records to provide a negative opinion). In this regard, the examiner relied solely on the absence of in-service treatment, and post-service treatment for several years as the rationale for the negative nexus opinion. Therefore, the Board finds that a new VA medical opinion is warranted to address the nature and etiology of the Veteran’s neck disorder. Stegall, 11 Vet. App. 268. Right and Left Knees In a September 2019 VA opinion, the examiner opined that the Veteran’s right and left knee disorders were not related to service. In reaching this conclusion, the examiner commented that the Veteran’s service treatment records were silent for complaints and treatment of a knee condition, and that the Veteran did not seek treatment for a right or left knee condition until several years following his separation from service. The Board finds that the September 2019 VA medical opinion is inadequate for adjudication purposes. In this regard, the examiner relied solely on the absence of in-service treatment, and post-service treatment for several years as the rationale for the negative nexus opinion. See Dalton v. Nicholson, supra. Therefore, the Board finds that a new VA medical opinion is warranted to address the nature and etiology of the Veteran’s right and left knee disorders. Stegall, 11 Vet. App. 268. Shin Splints At a September 2019 VA examination, the examiner noted that the Veteran’s bilateral shin splints had resolved. However, the Veteran reported that he continued to experience shin splints following prolonged standing. In a corresponding medical opinion, the examiner opined that the Veteran’s bilateral shin splints were not related to service. In reaching this conclusion, the examiner commented that the Veteran’s service treatment records were silent for complaints and treatment of a shin condition, and that there was no evidence of chronicity of care following his separation from service. The Board finds that the September 2019 VA medical opinion is inadequate for adjudication purposes. In this regard, the examiner relied solely on the absence of in-service treatment, and post-service treatment for several years as the rationale for the negative nexus opinion. See Dalton v. Nicholson, supra. Therefore, the Board finds that a new VA medical opinion is warranted to address the nature and etiology of the Veteran’s bilateral shin splints. Stegall, 11 Vet. App. 268. Gastrointestinal Disorder In a September 2020 VA medical opinion, the examiner opined that the Veteran’s gastrointestinal disorder was not related to service, to include in-service treatment for gastroesophageal reflux disease (GERD) and a hiatal hernia. In support of this conclusion, the examiner commented that the Veteran’s in-service gastroenteritis was acute, and that there was no evidence of chronicity of care. The Board finds that the September 2020 VA medical opinion is inadequate for adjudication purposes. In this regard, the examiner relied solely on the post-service treatment for several years as the rationale for the negative nexus opinion. See Dalton v. Nicholson, supra. Therefore, the Board finds that a new VA medical opinion is warranted to address the nature and etiology of the Veteran’s gastrointestinal disorder. Stegall, 11 Vet. App. 268. Skin Disorder The Veteran asserts that he has a skin disorder that is related to his period of active service. In his July 2008 VA Form 21-526EZ, the Veteran indicated that he was applying for VA benefits related to skin rash on his groin. Service treatment records show complaints of an inguinal rash. An October 2013 VA treatment note shows that the Veteran experienced itching on his groin and thighs. A December 2013 VA treatment note indicates that the Veteran had a rash, although its location was not provided. At an October 2014 VA examination, the Veteran indicated that he experienced a rash on his groin that he treated with topical creams. On examination, the examiner noted that the Veteran did not experience a skin condition; however, the examiner commented that the Veteran’s groin exam was consistent with that of previous eruption of tinea cruris without any active disease present, and that the skin was hyperpigmented. No nexus opinion was provided. In September 2019 the Veteran was afforded a VA skin examination; however, it appears that examination focused solely on the Veteran’s claimed plantar warts and did not address the Veteran’s claim skin disorder related to the groin area. Therefore, the Board finds that a VA medical opinion is warranted to address the nature and etiology of the Veteran’s claimed skin disorder. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). Sleep Apnea In a September 2019 VA medical opinion, the examiner opined that the Veteran’s sleep apnea was not related to service. In support of this conclusion, the examiner commented that the Veteran did not seek treatment for sleep difficulties until several years following his separation from service, and that his morbid obesity contributed to his sleep apnea. The Board finds that the September 2019 VA medical opinion is inadequate for adjudication purposes. In this regard, the examiner relied solely on the post-service treatment for several years as the rationale for the negative nexus opinion. See Dalton v. Nicholson, supra. Therefore, the Board finds that a new VA medical opinion is warranted to address the nature and etiology of the Veteran’s sleep apnea. Stegall, 11 Vet. App. 268. The matters are REMANDED for the following action: 1. The Veteran should be given an opportunity to identify any outstanding private or VA treatment records relevant to the claims on appeal. After obtaining any necessary authorization from the Veteran, all outstanding records should be obtained, to include updated VA treatment records dated from July 2020 to present. For private treatment records, make at least two (2) attempts to obtain records from any identified sources. If any such records are unavailable, inform the Veteran and his representative and afford him an opportunity to submit any copies in his possession. For federal records, all reasonable attempts should be made to obtain such records. If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile, which should be documented in the claims file. The Veteran must be notified of the attempts made and why further attempts would be futile, and allowed the opportunity to provide such records, as provided in 38 U.S.C. § 5103A(b)(2) and 38 C.F.R. § 3.159(e). 2. Following the receipt of outstanding records, obtain an etiology opinion from an appropriate examiner to determine the nature and etiology of any currently present acquired psychiatric disorders, to include PTSD, major depressive disorder, and an anxiety disorder. The need for a physical examination is left to the discretion of the medical professional offering the medical opinion. The record must be made available to the examiner for review, and the examiner should indicate that the record was reviewed in connection with the examination. All indicated tests and studies should be accomplished and the findings then reported in detail. Based on the examination results and review of the record, the examiner should first identify all psychiatric disabilities present during the pendency of the appeal, or proximate thereto. Then, for each acquired psychiatric disorders identified, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that any identified disability is had its onset during the Veteran’s active service, or is otherwise etiologically related to such service. If PTSD, or a trauma- or stressor-related disorder is diagnosed, the examiner should list all traumatic events contributing to that diagnosis. A complete rationale should be given for each opinion expressed. In this regard, a discussion of the facts and medical principles involved would be considerable assistance to the Board. 3. Following the receipt of outstanding records, obtain an etiology opinion from an appropriate examiner, who has not previously examined the Veteran or provided an opinion in this appeal, to determine the nature and etiology of the Veteran’s right and left shoulder disorders. The need for a physical examination is left to the discretion of the medical professional offering the medical opinion. The record must be made available to the examiner for review, and the examiner should indicate that the record was reviewed in connection with the examination. All indicated tests and studies should be accomplished and the findings then reported in detail. Based on the review of the record, the examiner must provide an opinion as to the following: (A) Is at least as likely as not (50 percent or better probability) that any currently present right shoulder disorder, to include degenerative arthritis, had its onset during his active service or is otherwise etiologically related to such service? (B) Is at least as likely as not (50 percent or better probability) that any currently present left shoulder disorder, to include degenerative arthritis, shoulder impingement syndrome, and rotator cuff tear, had its onset during his active service or is otherwise etiologically related to such service? The examiner must consider the Veteran’s lay statements regarding the onset and continuity of his symptoms, to include his reports that he began experiencing shoulder pain during in-service physical training. The examiner should also address the Veteran’s September 1980 in-service diagnosis of a left shoulder strain. A complete rationale should be given for each opinion expressed. In this regard, a discussion of the facts and medical principles involved would be considerable assistance to the Board. 4. Following the receipt of outstanding records, obtain an etiology opinion from an appropriate examiner, who has not previously examined the Veteran or provided an opinion in this appeal, to determine the nature and etiology of the Veteran’s lumbar spine disorder. The need for a physical examination is left to the discretion of the medical professional offering the medical opinion. The record must be made available to the examiner for review, and the examiner should indicate that the record was reviewed in connection with the examination. All indicated tests and studies should be accomplished and the findings then reported in detail. Based on the review of the record, the examiner must provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that any currently present lumbar spine disorder, to include degenerative arthritis, had its onset during his active service or is otherwise etiologically related to such service? The examiner must consider the Veteran’s lay statements regarding the onset and continuity of his symptoms, to include his reports that he began experiencing lower back pain in service. The examiner should also address the Veteran’s October 1981 in-service complaint of lower back pain caused by filling and lifting sandbags. A complete rationale should be given for each opinion expressed. In this regard, a discussion of the facts and medical principles involved would be considerable assistance to the Board. 5. Following the receipt of outstanding records, obtain an etiology opinion from an appropriate examiner, who has not previously examined the Veteran or provided an opinion in this appeal, to determine the nature and etiology of the Veteran’s cervical spine disorder. The need for a physical examination is left to the discretion of the medical professional offering the medical opinion. The record must be made available to the examiner for review, and the examiner should indicate that the record was reviewed in connection with the examination. All indicated tests and studies should be accomplished and the findings then reported in detail. Based on the review of the record, the examiner must provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that any currently present cervical spine disorder, to include degenerative arthritis, had its onset during his active service or is otherwise etiologically related to such service? The examiner must consider the Veteran’s lay statements regarding the onset and continuity of his symptoms, to include his reports that he twisted his back during physical training during his period of active service. A complete rationale should be given for each opinion expressed. In this regard, a discussion of the facts and medical principles involved would be considerable assistance to the Board. 6. Following the receipt of outstanding records, obtain an etiology opinion from an appropriate examiner, who has not previously examined the Veteran or provided an opinion in this appeal, to determine the nature and etiology of the Veteran’s right and left knee disorders. The need for a physical examination is left to the discretion of the medical professional offering the medical opinion. The record must be made available to the examiner for review, and the examiner should indicate that the record was reviewed in connection with the examination. All indicated tests and studies should be accomplished and the findings then reported in detail. Based on the review of the record, the examiner must provide an opinion as to the following: (A) Is at least as likely as not (50 percent or better probability) that any currently present right knee disorder, to include a knee strain, had its onset during his active service or is otherwise etiologically related to such service? (B) Is at least as likely as not (50 percent or better probability) that any currently present left knee disorder, to include a knee strain, had its onset during his active service or is otherwise etiologically related to such service? The examiner must consider the Veteran’s lay statements regarding the onset and continuity of his symptoms, to include the October 1982 and November 1982 in-service treatment for right knee pain and locking. A complete rationale should be given for each opinion expressed. In this regard, a discussion of the facts and medical principles involved would be considerable assistance to the Board. 7. Following the receipt of outstanding records, obtain an etiology opinion from an appropriate examiner, who has not previously examined the Veteran or provided an opinion in this appeal, to determine the nature and etiology of the Veteran’s bilateral shin splints. The need for a physical examination is left to the discretion of the medical professional offering the medical opinion. The record must be made available to the examiner for review, and the examiner should indicate that the record was reviewed in connection with the examination. All indicated tests and studies should be accomplished and the findings then reported in detail. Based on the review of the record, the examiner must provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that any currently present right or left shin split disability had its onset during his active service or is otherwise etiologically related to such service? The examiner must consider the Veteran’s lay statements regarding the onset and continuity of his symptoms, to include his August 1982 in-service report of shin splints. A complete rationale should be given for each opinion expressed. In this regard, a discussion of the facts and medical principles involved would be considerable assistance to the Board. 8. Following the receipt of outstanding records, obtain an etiology opinion from an appropriate examiner, who has not previously examined the Veteran or provided an opinion in this appeal, to determine the nature and etiology of the Veteran’s gastrointestinal disorder. The need for a physical examination is left to the discretion of the medical professional offering the medical opinion. The record must be made available to the examiner for review, and the examiner should indicate that the record was reviewed in connection with the examination. All indicated tests and studies should be accomplished and the findings then reported in detail. Based on the review of the record, the examiner must provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that any currently present gastrointestinal disorder, to include GERD, and hiatal hernia, had its onset during his active service or is otherwise etiologically related to such service? The examiner must consider the Veteran’s lay statements regarding the onset and continuity of his symptoms. A complete rationale should be given for each opinion expressed. In this regard, a discussion of the facts and medical principles involved would be considerable assistance to the Board. 9. Following the receipt of outstanding records, obtain an etiology opinion from an appropriate examiner, who has not previously examined the Veteran or provided an opinion in this appeal, to determine the nature and etiology of the Veteran’s skin disorder. The need for a physical examination is left to the discretion of the medical professional offering the medical opinion. The record must be made available to the examiner for review, and the examiner should indicate that the record was reviewed in connection with the examination. All indicated tests and studies should be accomplished and the findings then reported in detail. Based on the review of the record, the examiner must provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that any currently present skin disorder of the groin, to include tinea cruris, had its onset during his active service or is otherwise etiologically related to such service? The examiner must consider the Veteran’s lay statements regarding the onset and continuity of his symptoms. A complete rationale should be given for each opinion expressed. In this regard, a discussion of the facts and medical principles involved would be considerable assistance to the Board. 10. Following the receipt of outstanding records, obtain an etiology opinion from an appropriate examiner, who has not previously examined the Veteran or provided an opinion in this appeal, to determine the nature and etiology of the Veteran’s sleep apnea. The need for a physical examination is left to the discretion of the medical professional offering the medical opinion. The record must be made available to the examiner for review, and the examiner should indicate that the record was reviewed in connection with the examination. All indicated tests and studies should be accomplished and the findings then reported in detail. (Continued on the next page)   Based on the review of the record, the examiner must provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that the Veteran’s diagnosed sleep apnea had its onset during his active service or is otherwise etiologically related to such service? The examiner must consider the Veteran’s lay statements regarding the onset and continuity of his symptoms, to include his reports that he began experiencing sleep difficulties in service. A complete rationale should be given for each opinion expressed. In this regard, a discussion of the facts and medical principles involved would be considerable assistance to the Board. KRISTY L. ZADORA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Christopher O'Donnell, 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.