Citation Nr: 21001780 Decision Date: 01/11/21 Archive Date: 01/11/21 DOCKET NO. 15-03 550A DATE: January 11, 2021 ORDER The petition to reopen the previously denied claim for entitlement to service connection for a right shoulder disability is granted. The petition to reopen the previously denied claim for entitlement to service connection for a low back disability is granted. The petition to reopen the previously denied claim for entitlement to service connection for a left ankle disability is granted. The petition to reopen the previously denied claim for entitlement to service connection for a right ankle disability is denied. The petition to reopen the previously denied claim for entitlement to service connection for a left leg disability is denied. The petition to reopen the previously denied claim for entitlement to service connection for a right leg disability is denied. The petition to reopen the previously denied claim for entitlement to service connection for residuals of frostbite of the bilateral feet is denied. Entitlement to service connection for tinnitus is granted. Entitlement to service connection for a right shoulder disability is denied. Entitlement to service connection for a low back disability is denied. Entitlement to service connection for a bilateral hip disability is denied. Entitlement to service connection for a left ankle disability is denied. Entitlement to service connection for pes planus is denied. Entitlement to service connection for an inguinal injury is denied. Entitlement to service connection for sterility is denied. Entitlement to service connection for right ear hearing loss is denied. Entitlement to a rating of 10 percent for left knee chondromalacia is granted from February 28, 2010. Entitlement to a rating in excess of 10 percent for left knee chondromalacia is denied. REMANDED Entitlement to service connection for pseudofolliculitis barbae is remanded. Entitlement to service connection for left ear hearing loss is remanded. FINDINGS OF FACT 1. A November 1985 Board decision denied the Veteran’s original claims for entitlement to service connection for disabilities of the ankles, legs, and low back and for residuals of frostbite of the bilateral feet. 2. New and material evidence has been received since the November 1985 Board decision as to the claims for entitlement to service connection for disabilities of the left ankle and low back. 3. New and material evidence has not been received since the November 1985 Board decision as to the claims for entitlement to service connection for disabilities of the legs and right ankle and for residuals of frostbite of the bilateral feet. 4. An unappealed May 2009 rating decision denied the Veteran’s original claim for entitlement to service connection for a right shoulder disability. 5. New and material evidence has been received since the May 2009 rating decision as to the claim for entitlement to service connection for a right shoulder disability. 6. The Veteran’s tinnitus began during his active service. 7. The preponderance of the evidence is against finding that the Veteran’s current right shoulder disability began during his active service, or is otherwise related to an in-service injury or disease. 8. The preponderance of the evidence is against finding that the Veteran’s current low back disability began during his active service, or is otherwise related to an in-service injury or disease. 9. The preponderance of the evidence is against finding that the Veteran’s current bilateral hip disability began during his active service, or is otherwise related to an in-service injury or disease. 10. The preponderance of the evidence is against finding that the Veteran’s current left ankle disability began during his active service, or is otherwise related to an in-service injury or disease. 11. The preponderance of the evidence is against finding that the Veteran’s pes planus began during his first period of active service or that his pes planus that was noted upon his entrance into his second period of active service was aggravated by that period of active service. 12. The preponderance of the evidence of record is against finding that the Veteran has had an inguinal injury at any time during or proximate to the pendency of the claim. 13. The preponderance of the evidence is against finding that the Veteran’s sterility began during his active service, or is otherwise related to an in-service injury or disease. 14. The preponderance of the evidence is against finding that the Veteran’s preservice right ear hearing loss was aggravated by his active service. 15. It was factually ascertainable that the Veteran’s left knee chondromalacia manifested in painful motion that was not compensable under the relevant rating criteria during the one-year period prior to his February 28, 2011 claim for an increased rating. 16. Throughout the relevant rating period, the Veteran’s left knee chondromalacia was manifested by painful motion that is not compensable under the relevant rating criteria. CONCLUSIONS OF LAW 1. The November 1985 Board decision is final. 38 U.S.C. §§ 7104, 7105; 38 C.F.R. §§ 3.156, 20.1100. 2. The criteria for reopening the previously denied claims for entitlement to service connection for a low back disability and a left ankle disability have been met. 38 U.S.C. §§ 1131, 5108; 38 C.F.R. §§ 3.156, 3.303. 3. The criteria for reopening the previously denied claims for entitlement to service connection for a left leg disability, a right leg disability, a right ankle disability, and residuals of frostbite of the bilateral feet have been not met. 38 U.S.C. §§ 1131, 5108; 38 C.F.R. §§ 3.156, 3.303. 4. The May 2009 rating decision is final. 38 U.S.C. §§ 7104, 7105; 38 C.F.R. §§ 3.156, 19.20, 19.21, 19.52, 20.1103. 5. The criteria for reopening the previously denied claim for entitlement to service connection for a right shoulder disability have been met. 38 U.S.C. §§ 1131, 5108; 38 C.F.R. §§ 3.156, 3.303. 6. The criteria for entitlement to service connection for tinnitus have been met. 38 U.S.C. §§ 1131, 5103, 5107A; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309. 7. The criteria for entitlement to service connection for a right shoulder disability have not been met. 38 U.S.C. §§ 1131, 5103, 5107A; 38 C.F.R. §§ 3.102, 3.159, 3.303. 8. The criteria for entitlement to service connection for a low back disability have not been met. 38 U.S.C. §§ 1131, 5103, 5107A; 38 C.F.R. §§ 3.102, 3.159, 3.303. 9. The criteria for entitlement to service connection for a bilateral hip disability have not been met. 38 U.S.C. §§ 1131, 5103, 5107A; 38 C.F.R. §§ 3.102, 3.159, 3.303. 10. The criteria for entitlement to service connection for a left ankle disability have not been met. 38 U.S.C. §§ 1131, 5103, 5107A; 38 C.F.R. §§ 3.102, 3.159, 3.303. 11. The criteria for entitlement to service connection for pes planus have not been met. 38 U.S.C. §§ 1131, 5103, 5107A; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.306. 12. The criteria for entitlement to service connection for an inguinal injury have not been met. 38 U.S.C. §§ 1131, 5103, 5107A; 38 C.F.R. §§ 3.102, 3.159, 3.303. 13. The criteria for entitlement to service connection for sterility have not been met. 38 U.S.C. §§ 1131, 5103, 5107A; 38 C.F.R. §§ 3.102, 3.159, 3.303. 14. The criteria for entitlement to service connection for right ear hearing loss have not been met. 38 U.S.C. §§ 1131, 5103, 5107A; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.306. 15. The criteria for to a rating of 10 percent for left knee chondromalacia were met from February 28, 2010. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.400, 4.3, 4.7, 4.14, 4.21, 4.71a, Diagnostic Code 5260. 16. The criteria for entitlement to a rating in excess of 10 percent for left knee chondromalacia have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.400, 4.3, 4.7, 4.14, 4.21, 4.71a, Diagnostic Code 5260. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from May 1975 to May 1978 and from October 1981 to June 1984. In March 2019, the Veteran testified at a hearing before the undersigned Veterans Law Judge as to the issues of entitlement to service connection for a right shoulder disability, a low back disability, bilateral hip disabilities, bilateral leg disabilities, a left ankle disability, residuals of frostbite of the feet, an inguinal injury, and sterility and entitlement to increased ratings for left knee chondromalacia. A transcript of the hearing is associated with the record. The Board remanded the issues of entitlement to service connection for a right shoulder disability, a low back disability, bilateral hip disabilities, bilateral leg disabilities, a left ankle disability, residuals of frostbite of the feet, an inguinal injury, and sterility and entitlement to increased ratings for left knee chondromalacia in August 2019. The remand directed the Agency of Original Jurisdiction (AOJ) to obtain the Veteran’s outstanding VA treatment records; make appropriate efforts to obtain any separately stored clinical hospitalization records from the military hospitals in Landstuhl, Germany, and Ramstein, Germany, for any treatment records dated September 1983 through June 1984; afford the Veteran VA examinations to determine the etiology of his claimed bilateral hip disabilities, inguinal injury, and sterility; and provide the Veteran an examination to determine the current severity of his left knee chondromalacia. Pursuant to the August 2019 remand, the AOJ obtained the Veteran’s outstanding VA treatment records and associated them with the record and, in January 2020, afforded the Veteran appropriate VA examinations as to his claimed bilateral hip disabilities, inguinal injury, and sterility and as to his service-connected left knee chondromalacia. The AOJ also made appropriate requests for any treatment records from the military hospitals in Landstuhl and Ramstein, Germany, in August 2019. In November 2019, the AOJ was informed that no such records could be located. In December 2019, the AOJ sent the Veteran a letter notifying him that the records could not be located, explaining the steps taken in the attempt to obtain those records, and inviting him to submit any such records he may have in his possession. See 38 C.F.R. § 3.159(e). Accordingly, the Board finds that VA at least substantially complied with the August 2019 Board remand. See 38 U.S.C. § 5103A(b); Stegall v. West, 11 Vet. App. 268, 271 (1998); D’Aries v. Peake, 22 Vet. App. 97, 105 (2008). Neither the Veteran nor his representative has raised any issues with regard to the duty to notify or duty to assist as they pertain to the issues denied in this decision. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board . . . to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). In that regard, the Board notes that the development directed in the Remand section below pertains to the remanded issues, and there is no indication that evidence developed as part of those actions may be relevant to the issues denied in this decision. The analysis in this decision focuses on the most relevant evidence and on what the evidence shows or does not show with respect to the issues denied in this decision. The Veteran should not assume that evidence that is not explicitly discussed in the decision has been overlooked. See Timberlake v. Gober, 14 Vet. App. 122 (2000) (noting that the law requires only that reasons for rejecting evidence favorable to the claimant be addressed). Reopening Issues The Veteran seeks to reopen his previously denied claims for entitlement to service connection for disabilities of the right shoulder, ankles, legs, and low back and for residuals of frostbite of the bilateral feet. In general, rating decisions that are not timely appealed are final. See 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. In addition, a Board decision is final unless the Chairman of the Board orders reconsideration. See 38 U.S.C. §§ 7103(a), 7104; 38 C.F.R. § 20.1100. However, under 38 U.S.C. § 5108, if new and material evidence is presented or secured with respect to a claim that has been disallowed, the Secretary shall reopen the claim and review the former disposition of the claim. The question of whether new and material evidence has been received to reopen a previously denied claim must be addressed by the Board in the first instance because the issue goes to the Board’s jurisdiction to reach and adjudicate the underlying claim on a de novo basis. See Jackson v. Principi, 265 F.3d 1366 (Fed. Cir. 2001); Barnett v. Brown, 83 F.3d 1380 (Fed. Cir. 1996). If the Board finds that no such evidence has been offered, that is where the analysis must end, and further analysis beyond consideration of whether the evidence received is new and material is neither required nor permitted. Barnett, 83 F.3d at 1384. New evidence is existing evidence not previously considered by VA. Material evidence is 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). In determining whether evidence is new and material, the credibility of the evidence is generally presumed. Justus v. Principi, 3 Vet. App. 510, 512-13 (1992). In Elkins v. West, 12 Vet. App. 209 (1999), the United States Court of Appeals for Veterans Claims (Court) held that the Board must first determine whether the appellant has presented new and material evidence under 38 C.F.R. § 3.156(a) to have a finally denied claim reopened under 38 U.S.C. § 5108. The Court has also held that the law should be interpreted as enabling reopening of a claim, rather than to precluding it. See Shade v. Shinseki, 24 Vet. App. 110 (2010). The focus is not exclusively on whether evidence remedies the principal reason for denial in the last prior final decision, but on whether the evidence, taken together, could at least trigger the duty to assist or consideration of a new theory of entitlement. Id. at 118. In general, service connection may be established for a disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. 1. Whether new and material evidence has been received to reopen the previously denied claims for entitlement to service connection for disabilities of the ankles, legs, and low back and for residuals of frostbite of the bilateral feet VA received the Veteran’s original claim for entitlement to service connection for residuals of frostbite of the bilateral feet in June 1984 and his original claims for entitlement to service connection for disabilities of the ankles, legs, and low back in August 1984. In support of those claims, the Veteran completed a VA Form 21-4176, Report of Accidental Injury, in September 1984 detailing an in-service incident in which a military vehicle carrying a Vulcan gun first struck him and then ran over him. In October 1984, he was provided a VA examination. At that examination, the Veteran reported a history of frostbite in January 1976 and that, since then, he his feet would ache whenever it got cold. He also reported pain in his back and legs since the in-service injury involving the Vulcan gun. The examiner found no bony changes in the Veteran’s back or legs and determined that the Veteran had chondromalacia of the bilateral patellas. Although the Veteran provided a history of low back pain and leg pain, the condition was not clinically apparent or limiting on examination. The examiner noted that the condition described was compatible with muscle strain syndrome. In November 1985, the Board issued a decision denying the Veteran’s claims. With regard to the frostbite injury claim, the Board acknowledged that the Veteran’s service treatment records show that he reported a history of frostbite injury to both feet in December 1981, that he was put on a limited physical profile due to that reported injury, and that the profile noted that the frostbite occurred in 1976; however, the Board concluded that any frostbite the Veteran may have had in service resolved without residuals, as no residuals of frostbite were found on VA examination in October 1984. With regard to the ankle, leg, and low back claims, the Board acknowledged that the Veteran had in-service complaints relating to the ankles, legs, and low back, but found that he had no such condition on VA examination in October 1984. The Veteran has not filed a motion for reconsideration of the November 1985 Board decision, nor has such reconsideration been ordered by the Chairman of the Board. The Veteran did not appeal the November 1985 Board decision to the Court. Accordingly, the November 1985 Board decision is final. See 38 U.S.C. § 7104; 38 C.F.R. § 20.1100. The Board notes that, in the November 1985 decision, the Board framed the leg claim on appeal as “Entitlement to service connection for residuals of an injury to the legs.” However, the Board did not specifically deny entitlement to service connection for a leg disability. Instead, the Board granted entitlement to service connection for left knee chondromalacia. The Board concludes that the Veteran’s claim for entitlement to service connection for a leg disability other than left knee chondromalacia was deemed denied by the November 1985 Board decision. Specifically, the leg disability claim is closely related to any claim for entitlement to service connection for a knee disability because the knee is part of the leg. In addition, the Board decision reflects consideration of all possible in-service injuries to the legs, and not just injury to the left knee. The language the Board used to frame the issue on appeal further reflects that the decision was not limited to consideration of the left knee, but rather encompassed any disability of either leg. Finally, the Veteran was represented at the time of the November 1985 Board decision by the American Legion. See Cogburn v. Shinseki, 24 Vet. App. 205, 212-13 (2010). Therefore, the Board’s grant of entitlement to service connection for left knee chondromalacia but not for any other leg disability provided adequate notice such that a reasonable person would understand that service connection was being denied for any leg disability other than left knee chondromalacia. See Adams v. Shinseki, 568 F.3d 956, 963-65 (Fed. Cir. 2009). Accordingly, the November 1985 Board decision is final as to the claim for entitlement to service connection for a leg disability other than left knee chondromalacia. See Andrews v. Nicholson, 421 F.3d 1278, 1281 (Fed. Cir. 2005); Deshotel v. Nicholson, 457 F.3d 1258 (Fed. Cir. 2006). Evidence that has been associated with the record since issuance of the final November 1985 Board decision and that is relevant to the issues of entitlement to service connection for disabilities of the low back and left ankle includes April 2012 VA examinations that provide diagnoses of lumbar spondylosis and enthesopathy of the left lateral ankle. The Board finds that this evidence is new and material as to the previously denied claims for entitlement to service connection for a low back disability and a left ankle disability because it was not previously considered by VA and shows that the Veteran now has diagnosed conditions related to the low back and left ankle. Therefore, the previously denied claims for entitlement to a low back disability and a left ankle disability are reopened. 38 C.F.R. § 3.156(a). However, the Board finds that the evidence received since the final November 1985 Board decision is not new and material as to the previously denied claims for entitlement to service connection for disabilities of the right ankle and legs and entitlement to service connection for residuals of frostbite of the feet. Specifically, evidence received since the final November 1985 Board decision that is relevant to those previously denied claims includes additional medical treatment records; VA examinations provided in April 2012, September 2012, and April 2015; a VA opinion obtained in May 2015; and the Veteran’s contentions as to why he believes service connection is warranted. The Veteran’s assertions to the effect that he has current right ankle and bilateral leg disabilities that are related to the in-service injury involving the Vulcan gun are the same as those he made in support of his original claims denied in the final November 1985 Board decision. His assertions to the effect that he has experienced sensitivity to cold in his feet ever since suffering a frostbite injury in 1976 are also the same as those he made in support of his original claim denied in the final November 1985 Board decision. Those assertions are therefore redundant of evidence previously considered and are not considered to be new evidence. Furthermore, the additional medical treatment records do not show a current disability not previously considered or any link between a current leg, right ankle, or frostbite-related foot disability and the Veteran’s active service or a service-connected disability. They merely show continued complaints of and treatment for various conditions. Thus, the medical treatment records are new in the sense that they were not previously considered by VA. However, they are not material because they do not relate to an unestablished fact necessary to substantiate the previously denied claims and/or do not raise a reasonable possibility of substantiating the previously denied claims, as they are cumulative of evidence previously considered. 38 C.F.R. § 3.156. The April 2012, September 2012, and April 2015 VA examinations and the May 2015 VA opinion are also not new and material evidence. The April 2012 VA examiner determined that the Veteran had a current diagnosis of enthesopathy of the left lateral ankle, but provided no diagnosis for the Veteran’s right ankle, as an Xray of the right ankle showed no significant osseous or articular findings and was considered normal. The September 2012 VA examiner determined that the Veteran had no new or chronic conditions or symptoms of the legs. That examiner provided a negative nexus opinion as to the Veteran’s claimed leg disabilities. Such an opinion does not raise a reasonable possibility of substantiating the previously denied claims. The April 2015 VA examiner found no evidence of current residuals of the Veteran’s reported in-service frostbite injuries to the feet. She noted that physical examination of the Veteran’s feet and X-rays obtained in April 2015 did not show such residuals. She provided a negative nexus opinion in May 2015. Such an opinion does not raise a reasonable possibility of substantiating the previously denied claims. The Board acknowledges the Veteran’s assertions that he has a bilateral leg disability that is caused by his low back disability. However, the Veteran has not been service connected for a low back disability and, as is discussed below, the Board denies his current claim for entitlement to service connection for a low back disability. Therefore, his assertions in that regard to not raise a viable new theory of entitlement and do not constitute new and material evidence as to the issue. The Board also acknowledges the Veteran’s representative’s arguments that the April 2015 VA examination and May 2015 VA opinion are inadequate for decision-making purposes. However, the VA’s duty to assist in providing an examination for requests to reopen a finally adjudicated claim applies only if new and material evidence is presented. 38 C.F.R. § 3.159(c)(4)(iii). In this case, the Board finds that no new and material evidence has been received as to the Veteran’s previously denied claim for entitlement to service connection for residuals of frostbite of both feet. Therefore, any question as to the adequacy of the April 2015 VA examination and May 2015 VA opinion is not a viable issue. See also Woehlaert v. Nicholson, 21 Vet. App. 456, 461 (2007). In view of the foregoing, the Board finds that the evidence of record contains no new and material evidence received since the final November 1985 Board decision as to the previously denied claims for entitlement to service connection for disabilities of the right ankle and legs and for entitlement to service connection for residuals of frostbite of the feet. Therefore, new and material evidence to reopen those finally denied claims has not been received, the benefit-of-the-doubt doctrine is not for application, and the claims for entitlement to service connection for disabilities of the right ankle and legs and entitlement to service connection for residuals of frostbite of the feet are not reopened. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 2. Whether new and material evidence has been received to reopen the previously denied claim for entitlement to service connection for a right shoulder disability The Veteran’s original claim for entitlement to service connection for a right shoulder disability was received in November 2008. The Regional Office denied the Veteran’s claim in the May 2009 rating decision, finding that the evidence did not show an in-service right shoulder injury and that there was no evidence of a current right shoulder disability. The Veteran did not submit a timely notice of disagreement as to the May 2009 rating decision, and new and material evidence as to the issue was not received within the one-year appeal period following issuance of the May 2009 rating decision. As such, the Veteran did not complete a timely appeal of the May 2009 rating decision, and the decision is final. See 38 U.S.C. § 7105; 38 C.F.R. §§ 3.156(b), 19.20, 19.21, 19.52, 20.1103. Evidence received since the May 2009 rating decision that is relevant to the issue of entitlement to service connection for a right shoulder disability includes an April 2012 VA examination that includes a diagnosis of right acromion impingement resulting in tendinitis of the right shoulder. The Board finds that this evidence is new and material as to the previously denied claim for entitlement to service connection for a right shoulder disability because it was not previously considered by VA and shows that the Veteran now has a diagnosed condition related to the right shoulder. Therefore, the previously denied claim for entitlement to a right shoulder disability is reopened. 38 C.F.R. § 3.156(a). Service Connection Issues Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). A preexisting injury or disease will be considered to have been aggravated by active military, naval, or air service, where there is an increase in disability during such service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease. 38 C.F.R. § 3.306. Clear and unmistakable evidence is required to rebut the presumption of aggravation where the preexisting disability underwent an increase in severity during service. However, aggravation may not be conceded where the disability underwent no increase in severity during service. 38 C.F.R. § 3.306(b). In addition, temporary flare-ups, even in service, will not be considered sufficient to establish an increase in severity unless the underlying condition, as contrasted with the symptoms, is worsened. Hunt v. Derwinski, 1 Vet. App. 292 (1991). The existence of a current disability is the cornerstone of a claim for VA disability compensation. 38 U.S.C. §§ 1131; see Degmetich v. Brown, 104 F.3d 1328, 1332 (1997) (holding that interpretation of section 1131 of the statute as requiring the existence of a present disability for VA compensation purposes cannot be considered arbitrary). In the absence of proof of a current disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). 3. Entitlement to service connection for tinnitus The Veteran seeks entitlement to service connection for tinnitus. He reported to a December 2018 VA examiner that the tinnitus had its onset in 1982 and that he believes it is due to in-service exposure to noise from artillery. With respect to the current disability element of service connection, tinnitus is readily observable by laypersons, and medical expertise is not required to establish its existence. See Charles v. Principi, 16 Vet. App. 370 (2002). Therefore, the Veteran’s assertion that he currently has tinnitus constitutes competent evidence of a current disability of tinnitus. Furthermore, the Board finds that nothing in the record impugns the Veteran’s credibility on the matter, and concludes that the Veteran has a current disability of tinnitus. With respect to an in-service injury or disease, the Veteran’s service treatment records do not reflect complaint of or treatment for tinnitus. Nevertheless, he has stated that the condition had its onset during his active service. As noted above, the Veteran’s statements as to the presence of tinnitus constitute competent evidence of its existence. The Board finds that nothing in the record impugns the Veteran’s credibility as to the onset of the condition. See Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006) (lack of contemporaneous medical evidence does not, in and of itself, render lay evidence not credible). Therefore, the Veteran’s statement is competent and credible evidence that his tinnitus began during his active service. Tinnitus, as an organic disease of the nervous system, may be service connected where it is first shown in service and has subsequent manifestations. See 38 C.F.R. §§ 3.303(b), 3.307(a)(3), 3.309(a); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). In this case, the Veteran has credibly reported that his tinnitus began during his active service and has persisted through the present. The Board resolves any remaining doubt in the Veteran’s favor and finds that the claim for entitlement to service connection for tinnitus must be granted as a presumptive chronic condition. 38 U.S.C. § 5107(b); see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 4. Entitlement to service connection for disabilities of the right shoulder, low back, bilateral hips, and left ankle The Veteran seeks entitlement to service connection for disabilities of the right shoulder, low back, bilateral hips, and left ankle, which he contends are the result of the in the in-service injury involving the Vulcan gun. According to the Veteran, the injury occurred when he was securing a gas canister during a simulation exercise. The recoil of the Vulcan gun hit his right shoulder and caused his foot to be pinned under the vehicle’s tires. He fell to the ground, and the vehicle rolled over his mid-section at a 45-degree angle. The service treatment records show that the Veteran was fitted with an air splint of the right leg and with crutches in September 1983 after a vehicle ran over his back and legs. X-rays taken at that time were negative. Later in September 1983, he reported ongoing swelling in the left ankle and pain with bending, walking, and stooping. In early October 1983, he was placed on a temporary profile due to left ankle sprain, right hip bruise, right in-step strain, and back pain. The profile was continued through the end of January 1984. The Veteran reported recurrent back pain and pain in both legs and the left ankle on an April 1984 report of medical history for separation from active service. At an April 1984 medical examination for separation from active service, he had a swollen left ankle, but otherwise had normal clinical evaluations of the spine, lower extremities, and feet. At the October 1984 VA examination, he reported that the incident occurred on soft ground and therefore sunk down into the ground under the vehicle and did not suffer from bone fractures. At that examination, he reported current symptoms of pain the back and numbness down the medial calf areas bilaterally with prolonged sitting or driving. At the March 2019 Board hearing, he testified that his right shoulder “cramps up” at times and will become sore. Those problems have been occurring for the past 10 years. He has problems with his right shoulder “only when I try to do something. Like, if I try to pick up 100 pounds, it’s going to bother me.” He further testified that he has had problems with his back since the in-service injury, but that the problems do not occur unless he does something strenuous. With regard to the claimed bilateral hip disability, he testified that he has numbness starting at the hips, and that the hips hurt when he turns a certain way. With regard to the left ankle, he testified that the ankle swells at times and that he has numbness in the left foot. This occurs when he stays on the ankle too long or when he mows the law. He did not know when the left ankle symptoms began, and stated, “I can’t say it’s been going on since 1983 now.” Initially, the Board notes that, although the AOJ found that new and material evidence had not been received to reopen the previously denied claims for entitlement to service connection for a right shoulder disability, a low back disability, and a left ankle disability in a June 2020 supplemental statement of the case, it adjudicated those issues on the merit in the first instance in the October 2012 rating decision on appeal, as well as in a January 2015 statement of the case and a December 2016 supplemental statement of the case. Therefore, the Board may proceed with appellate consideration of those issues on the merits. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, although the Veteran has current diagnoses of left ankle enthesopathy (minor spurring), degenerative joint disease of the bilateral sacroiliac joints, lumbar spondylosis/disc space narrowing, and right acromion impingement resulting in tendinitis of the shoulder, and the evidence shows that the in-service injury involving a Vulcan gun did occur, the preponderance of the evidence weighs against finding that the Veteran’s currently diagnosed right shoulder, low back, bilateral hip, and left ankle disabilities began during service or are otherwise related to an in-service injury, event, or disease. The medical evidence of record does not show that the Veteran’s current right shoulder, low back, bilateral hip, and left ankle disabilities were diagnosed until decades after his separation from active service. Although the Veteran is competent to report having experienced symptoms of pain and swelling intermittently since service, he is not competent to provide a diagnosis in this case or to determine that those symptoms were manifestations of the currently diagnosed right shoulder, low back, bilateral hip, and left ankle disabilities. The issue is medically complex, as it requires specialized knowledge in the interpretation of complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). The Board instead must rely on the competent medical evidence of record to determine whether there is a causal relationship between the in-service injury and the current disabilities. With regard to the Veteran’s right shoulder, the April 2012 VA examiner opined that the currently diagnosed right acromion impingement resulting in tendinitis of the shoulder was less likely than not incurred in or caused by an in-service injury, event, or illness. As a rationale for that opinion, the examiner explained that the diagnosed condition is new and separate from any in-service injury or condition because it is caused by the shape of the acromion joint. Accordingly, the examiner indicated that the current right shoulder disability is due to the shape of the shoulder rather than to a single in-service injury. With regard to the Veteran’s low back, the April 2012 VA examiner opined that the currently diagnosed lumbar spondylosis/disc space narrowing was less likely than not incurred in or caused by an in-service injury, event, or illness. As a rationale for that opinion, the examiner acknowledged that the Veteran reported a history of back aches on the April 1984 report of medical history for separation from active service and that the Veteran currently complains of ongoing low back pain with physical activity, but explained that the Veteran’s lumbar spondylosis represents a new condition separate from any in-service injury or condition, as spondylosis is a natural process of aging and is seen in 10 percent of individuals by the age of 25 years and in 95 percent of individuals by the age of 65 years. Thus, the Veteran’s lumbar spondylosis/disc space narrowing is most likely due to the natural process of aging. With regard to the Veteran’s bilateral hips, the April 2012 VA examiner opined that the currently diagnosed degenerative joint disease of the bilateral sacroiliac joints was less likely than not incurred in or caused by an in-service injury, event, or illness. As a rationale for that opinion, the examiner explained that the medical treatment records do not show a chronic hip or pelvic condition since the in-service injury, and it is less than likely that an injury would cause degenerative changes to both sacroiliac joints. Rather, the most likely etiology of the Veteran’s degenerative joint disease of the bilateral sacroiliac joints is the normal aging process, as radiographic evidence of osteoarthritis is found in up to 85 percent of people older than 65 percent and autopsies have indicated evidence of osteoarthritis in the weight-bearing joints of almost all persons by the age of 45 years. With regard to the Veteran’s left ankle, the April 2012 VA examiner opined that the currently diagnosed left ankle enthesopathy (minor spurring) was less likely than not incurred in or caused by the in-service injury, event, or illness. As a rationale for that opinion, the examiner acknowledged that the Veteran had left ankle swelling at the time of the medical examination for separation from active service in April 1984, but explained that the medical treatment records do not show a chronic left ankle condition and that ankle enthesopathy is a new and separate condition from any in-service condition, as enthesopathy, spurring, or osteophytes occur as a result of repeated trauma to the area or from mechanical stress to the overlying tendons. Accordingly, the examiner indicated that the Veteran’s current enthesopathy of the left ankle is the result of repeated trauma or mechanical stress to the ankle rather than the result of a single in-service injury. Another VA examiner opined in January 2020 that the Veteran’s degenerative joint disease of the bilateral sacroiliac joints was incurred in or caused by the in-service injury involving a Vulcan gun. However, the rationale for that opinion references only the Veteran’s knees and does not explain why the current disability of the bilateral hips is not related to the in-service injury. The Board finds the April 2012 VA examiner’s opinions to be probative because they are based on an accurate medical history and are supported by explanations that contain clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). However, the Board does not afford probative value to the January 2020 VA examiner’s opinion regarding the Veteran’s degenerative joint disease of the bilateral sacroiliac joint because it is not supported by rationale. Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007) (for a medical opinion to be probative decision-making purposes, it must be supported by a rationale and explanation for the conclusion reached). The Board has considered the Veteran’s assertions that his current right shoulder, low back, bilateral hip, and left ankle disabilities are related to his in-service injury. In this case, the Veteran is not considered competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires interpretation of complicated diagnostic medical testing and knowledge of the pathology and development of musculoskeletal conditions. Therefore, it is outside the competence of the Veteran because the record does not show that he has the medical training or credentials to make such a determination. Jandreau, 492 F.3d at 1377 n.4; see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Veteran’s statements are not due probative value, and they do not weigh against the probative value of the April 2012 VA examiner’s opinions. In summary, the preponderance of the evidence is against finding that the Veteran’s current right shoulder, low back, bilateral hip, and left ankle disabilities began during his active service, or are otherwise related to an in-service injury or disease. In view of the foregoing, the Board concludes that the preponderance of the evidence is against the claims for entitlement to service connection for right shoulder, low back, bilateral hip, and left ankle disabilities. Because the preponderance of the evidence is against the claims, the doctrine of reasonable doubt is not for application, and the claims must be denied. 38 U.S.C. § 5107(b); see also Gilbert, 1 Vet. App. 49. 5. Entitlement to service connection for pes planus The Veteran seeks entitlement to service connection for pes planus. In his claim, he contended that the condition is due to “Day to day wearing Boots” during training in his second period of active service. The Veteran’s service treatment records do not show complaint of or treatment for pes planus during his first period of active service. The May 1975 entrance examination report and April 1978 separation examination report for that period of active service both reflect that the Veteran had normal clinical evaluations of the feet. The record does not show, and the Veteran has not alleged, that the claimed current pes planus had its onset during his first period of active service or may be etiologically related to an event, injury, or illness during that period of active service. As such, service connection based on the Veteran’s first period of active service is not warranted. The August 1981 entrance examination for the Veteran’s second period of active service reflects that he had mild, asymptomatic pes planus at that time. Accordingly, the Veteran was noted upon examination for entrance into his second period of active service as having mild pes planus, and the Veteran may only be service connected for pes planus on the basis of in-service aggravation under 38 U.S.C. § 1153 and 38 C.F.R. § 3.306. VA obtained a medical opinion in October 2018 to determine whether the service treatment records reflect an aggravation of the Veteran’s preservice pes planus. The examiner noted that the service treatment records do no show treatment for the pes planus reported on the August 1981 entrance examination. She concluded that there was no aggravation of the Veteran’s preservice pes planus because there was no treatment for that condition during his active service and because the April 1984 reports of medical history and medical examination for separation from active service were both negative for pes planus. The examiner’s opinion is consistent with the record and was based on the examiner’s knowledge and expertise as a medical professional. The examiner’s opinion is therefore considered probative evidence that the Veteran’s preservice pes planus was not aggravated by his active service. See Nieves-Rodriguez, 22 Vet. App. 295. The Board has considered the Veteran’s assertions that his preservice pes planus was aggravated by his active service. The Veteran is competent to report subjective symptoms such as foot pain. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). The Board does not question his credibility in that regard. However, the Veteran is not considered competent to assess the relative severity of pes planus, to include any increase in severity during his active service, as doing so involves medical testing and medical knowledge the Veteran has not been shown to possess. See Kahana, 24 Vet. App. at 435; Buchanan, 451 F.3d at 1336-37. The objective medical evidence of record, as interpreted by the October 2018 VA examiner, does not show an in-service aggravation of the preservice pes planus. Therefore, in that regard, the Veteran’s statements are contradicted by the objective, probative medical evidence of record. In summary, the probative evidence of record indicates that the pes planus noted at the time of the Veteran’s examination for entrance into his second period of active service did not increase in severity during his active service beyond its natural progression. As the probative evidence is against finding that the preservice pes planus increased in severity during the Veteran’s active service, aggravation may not be conceded. 38 C.F.R. § 3.306(b). The preponderance of the evidence therefore is against the claim, the doctrine of reasonable doubt is not for application, and the claim must be denied. See 38 U.S.C. § 5107(b); Gilbert, 1 Vet. App. at 57. 6. Entitlement to service connection for an inguinal injury The Veteran seeks entitlement to service connection for an inguinal injury. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the Veteran does not have a current diagnosis of an inguinal injury or residuals of such an injury and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). In January 2020, the Veteran underwent a VA hernias examination. The VA examiner evaluated the Veteran and noted that the Veteran denied any current symptoms or history of hernias. The examiner therefore determined that the Veteran does not have a diagnosis of an inguinal hernia or other inguinal injury. Furthermore, the Veteran’s medical treatment records do not show complaint of, treatment for, or diagnosis of such a condition. Accordingly, the competent medical evidence of record does not show that the Veteran had a diagnosis of an inguinal injury during or in proximity to the relevant appeal period. See McClain v. Nicholson, 21 Vet. App. 319 (2007); Romanowsky v. Shinseki, 26 Vet. App. 289 (2013). As noted above, in the absence of proof of a current disability, there can be no valid claim for entitlement to service connection. Brammer, 3 Vet. App. at 225. In view of the foregoing, the Board concludes that the preponderance of the evidence is against the claim for entitlement to service connection for an inguinal injury. Because the preponderance of the evidence is against the claim, the doctrine of reasonable doubt is not for application, and the claim must be denied. 38 U.S.C. § 5107(b); see also Gilbert, 1 Vet. App. 49. 7. Entitlement to service connection for sterility The Veteran seeks entitlement to service connection cor sterility, which he contends is due to the multiple X-rays he underwent following the in-service injury involving a Vulcan gun. At the March 2019 Board hearing, he testified that the technician who took those X-rays told him not to expect to have children in the future “because we’re going to light you up like a Christmas tree.” The medical evidence of record shows that a semen analysis conducted in June 2000 showed the Veteran’s sperm count to be below the normal range. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, although the June 2000 semen analysis showed a low sperm count and the evidence shows that the Veteran had in-service X-rays, the preponderance of the evidence weighs against finding that the Veteran’s infertility began during service or is otherwise related to an in-service injury, event, or disease. The service treatment records do not show that the Veteran was diagnosed with or treated for sterility or infertility during his active service. The June 2000 semen analysis was conducted more than a decade and a half after the Veteran’s separation from active service. Therefore, the evidence does not show that the Veteran’s infertility or sterility began during his active service. The January 2020 VA examiner opined that the Veteran’s claimed sterility was less likely than not incurred in or caused by the in-service injury involving a Vulcan gun. As a rationale for that opinion, the examiner acknowledged the Veteran’s reports of what he was told by the Xray technician following the in-service injury, but explained that such a statement would have been “a pathetic attempt by an unprofessional technician to humor” the patient because X-rays represent such a minimal exposure with “hardly any chance of causing sterility.” The examiner’s opinion is probative because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez, 22 Vet. App. at 304. The examiner explained that X-rays cause a minimal exposure that have very little chance of causing sterility. The Board has considered the Veteran’s assertions that he is sterile due to in-service X-rays. In this case, the Veteran is not considered competent to provide a nexus opinion regarding the issue. The issue is medically complex, as it requires specialized knowledge concerning exposure risks posed by medical testing and how those exposures affect fertility. Therefore, it is outside the competence of the Veteran because the record does not show that he has the medical training or credentials to make such a determination. Jandreau, 492 F.3d 1377 n.4; see also Kahana, 24. Vet. App. 428. Consequently, the Veteran’s statements are not due probative value, and they do not weigh against the probative value of the January 2020 VA examiner’s opinion. In summary, the preponderance of the evidence is against finding that the Veteran’s sterility began during his active service, or is otherwise related to an in-service injury or disease. In view of the foregoing, the Board concludes that the preponderance of the evidence is against the claim for entitlement to service connection for sterility. Because the preponderance of the evidence is against the claim, the doctrine of reasonable doubt is not for application, and the claim must be denied. 38 U.S.C. § 5107(b); see also Gilbert, 1 Vet. App. 49. 8. Entitlement to service connection for right ear hearing loss The Veteran seeks entitlement to service connection for right ear hearing loss. He contends that the hearing loss is due to in-service exposure to noise from artillery. For the purposes of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies of 500, 1,000, 2,000, 3,000 and 4,000 Hertz (Hz) is 40 decibels (dB) or greater; or when the thresholds for at least three of these frequencies are 26 dB or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. The Veteran’s service treatment records include a May 1975 report of medical examination for entrance into active service showing that the Veteran had a puretone threshold of 40 dB at 4,000 Hz in the right ear, which is a hearing loss disability for VA purposes under 38 C.F.R. § 3.385. Accordingly, the Veteran was noted upon examination for entrance into service as having a right ear hearing loss disability, and he may only be service connected for the right ear hearing loss on the basis of in-service aggravation under 38 U.S.C. § 1153 and 38 C.F.R. § 3.306. The service treatment records do not show complaint of or treatment for hearing loss during the Veteran’s active service. They include audiometric results for testing conducted in April 1978 at the time of separation from the Veteran’s first period of active service, in August 1981 at the time of entrance into his second period of active service, and in April 1984 at the time of separation from his second period of active service. They showed the following puretone thresholds for the right ear, measured in decibels: April 1978 HERTZ 500 1000 2000 3000 4000 RIGHT 10 10 10 10 25 August 1981 HERTZ 500 1000 2000 3000 4000 RIGHT 10 5 5 0 0 April 1984 HERTZ 500 1000 2000 3000 4000 RIGHT 5 10 5 10 40 VA obtained a medical opinion in December 2018 to determine whether the service treatment records show an aggravation of the Veteran’s preservice right ear hearing loss. The examiner interviewed the Veteran, examined the Veteran, and reviewed the record. She concluded that the Veteran’s preservice right ear hearing loss was not aggravated beyond normal progression in military service. As a rationale for that conclusion, she explained that the May 1975 audiological examination showed right ear hearing acuity that was within normal limits at 500 to 2,000 Hz and mild hearing loss at 4,000 Hz and that the April 1984 separation audiological examination showed the same with no significant threshold shifts. The examiner’s opinion is consistent with the record and was based on the examiner’s knowledge and expertise as an audiologist. The examiner’s opinion is therefore considered probative evidence that the Veteran’s preservice right ear hearing loss was not aggravated by his active service. Nieves-Rodriguez, 22 Vet. App. at 304. The Board has considered the Veteran’s assertions that his preservice right ear hearing loss was aggravated by noise exposure during his active service. The Veteran is competent to report subjective symptoms such as difficulty hearing, to include perceived decreases in hearing acuity. See Layno, 6 Vet. App. at 469. The Board does not question his credibility in that regard. However, the Veteran is not considered competent to assess the relative severity of hearing loss, to include any increase in severity during his active service, as doing so involves medical testing and medical knowledge the Veteran has not been shown to possess. See Kahana, 24 Vet. App. at 435; Buchanan, 451 F.3d at 1336-37. The objective medical evidence of record, as interpreted by the December 2018 VA examiner, does not show an in-service aggravation of the preservice right ear hearing loss disability. Therefore, in that regard, the Veteran’s statements are contradicted by the objective, probative medical evidence of record. In summary, the probative evidence of record shows that the Veteran had a right ear hearing loss disability for VA purposes on entrance into active service and, despite the Veteran’s in-service exposure to noise, the condition did not increase in severity during his active service beyond its natural progression. As the probative evidence is against finding that the right ear hearing loss disability increased in severity during the Veteran’s active service, aggravation may not be conceded. 38 C.F.R. § 3.306(b). The preponderance of the evidence therefore is against the claim, the doctrine of reasonable doubt is not for application, and the claim must be denied. See 38 U.S.C. § 5107(b); Gilbert, 1 Vet. App. at 57. Increased Rating Issue 9. Entitlement to increased ratings for left knee chondromalacia The Veteran seeks increased ratings for left knee chondromalacia. The applicable rating period is from February 28, 2010, one year prior to receipt of the claim, through the present. See 38 C.F.R. § 3.400(o)(2). At the March 2019 Board hearing, the Veteran testified that his knees will become sore if he squats and turns a certain way and that he must take breaks while climbing stairs due to his left knee pain. He described the left knee pain as sharp and needle-like. He testified that he does not have problems with walking, but will have problems when he pushes a lawnmower. In addition, he at times has muscle spasms that cause the leg to “lock up”. He indicated that his left knee symptoms have been this way for about 15 years. Disability ratings are determined by the application of VA’s Schedule for Rating Disabilities (Schedule), which is based on the average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Pertinent regulations do not require that all cases show all findings specified by the Schedule, but that findings sufficient to identify the disease and the resulting disability and, above all, coordination of the rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21; see also Mauerhan v. Principi, 16 Vet. App. 436 (2002). When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant. 38 C.F.R. § 4.3. Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Board will consider whether separate ratings may be assigned for separate periods of time based on facts found, a practice known as “staged ratings,” in all claims for increased ratings. Hart v. Mansfield, 21 Vet. App. 505, 519 (2007). The Board notes that the Veteran’s service-connected left knee disability was previously rated as noncompensable under 38 C.F.R. § 4.71a, Diagnostic Code 5257, which pertains to recurrent subluxation or lateral instability of the knee. In a June 2020 rating decision, the AOJ increased the rating for the Veteran’s left knee chondromalacia to 10 percent from February 28, 2011, based on painful motion of the knee. In so doing, the AOJ changed the diagnostic code under which the disability is rated from Diagnostic Code 5257 to Diagnostic Code 5260, which pertains to limited flexion of the knee. The Board finds that the change in diagnostic code was appropriate given that Diagnostic Code 5260 more accurately describes the functional limitation of painful motion that is caused by the Veteran’s left knee chondromalacia. See Butts v. Brown, 5 Vet. App. 532, 538 (1993) (The assignment of a particular diagnostic code to rate a disability is “completely dependent on the facts of a particular case.”). The Veteran’s left knee chondromalacia is currently rated as noncompensable prior to February 28, 2011, and as 10 percent disabling from that date. Under Diagnostic Code 5260, a noncompensable rating is warranted for flexion limited to 60 degrees. A 10 percent rating is warranted for flexion limited to 45 degrees. A 20 percent rating is warranted for flexion limited to 30 degrees. A 30 percent rating is warranted for flexion limited to 15 degrees. When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) (“[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran’s disability, after which a rating is determined based on the § 4.71a criteria.”). Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011). For a higher rating to be awarded during the one-year period prior to the February 28, 2011 claim, it must be factually ascertainable that an increase in disability occurred during that period such that the higher rating may be awarded. 38 C.F.R. § 3.400(o)(2). The Board finds that the criteria for entitlement to a rating of 10 percent were met for the entire one-year period prior to the February 28, 2011 claim. However, the preponderance of the evidence is against a rating in excess of 10 percent for left knee chondromalacia at any time during the relevant rating period. Regarding the one-year period prior to February 28, 2011, the Veteran testified at the March 2019 Board hearing that, for the prior 15 years, he experienced pain in the knees with certain movements and on climbing stairs. The Board finds the Veteran’s testimony to be credible evidence sufficient to establish that it is factually ascertainable that he had painful motion of the left knee from February 28, 2010, such that a rating of 10 percent is warranted from that date. That rating is assigned under Diagnostic Code 5260, which represents a change from the previously assigned Diagnostic Code of 5257. This change is made to more accurately reflect the functional limitation of painful motion that is caused by the Veteran’s left knee chondromalacia. See Butts, 5 Vet. App. at 538. Regarding whether a rating in excess of 10 percent was warranted at any time during the relevant period on appeal, the Board acknowledges the Veteran’s lay reports of symptoms and that there was functional loss due to pain. However, even considering the Veteran’s lay reports of symptoms and noted functional loss, the degree of additional limitation reflected by the Veteran’s reported symptoms would not result in limitation of motion more nearly approximating flexion limited to 30 degrees or greater, as is required for a rating in excess of 10 percent under Diagnostic Code 5260. The medical evidence of record also does not show that the criteria for a rating in excess of 10 percent were met at any time during the relevant period. The Veteran had left knee extension to 0 degrees and flexion to 115 degrees without pain at an April 2011 VA examination. At a February 2018 VA examination, he had had left knee extension to 0 degrees and flexion to 130 degrees with pain that did not result in additional functional loss. He did not have additional functional loss on repetitive-use testing. The examiner opined that the Veteran would not have additional functional loss on repeated use over time. The Veteran did not have pain with non-weight bearing or with passive range of motion that results in additional functional loss. At a January 2020 VA examination, he had had left knee extension to 0 degrees and flexion to 140 degrees with no pain noted on examination. He did not have additional functional loss on repetitive-use testing. The examiner opined that the Veteran would not have additional functional loss on repeated use over time or during flare-ups. The Veteran did not have pain with non-weight bearing, and his passive range of motion was the same as his active range of motion. The Board has also considered the other diagnostic codes pertaining to the knee and leg. However, the record does not show that the Veteran’s left knee chondromalacia has manifested in symptoms that are compensable under another diagnostic code. Specifically, the record does not show that he has ankylosis, recurrent subluxation or lateral instability, a disability of the semilunar cartilage, or extension limited to 10 degrees or more in the left knee due to the service-connected disability. See 38 C.F.R. § 4.71a, Diagnostic Codes 5256, 5257, 5258, 5259, and 5261. Neither the Veteran nor his representative has raised any other issues with regard to the rating for the service-connected left knee chondromalacia, nor have any other such issues been reasonably raised by the record. See Yancy v. McDonald, 27 Vet. App. 484, 495 (2016); Doucette v. Shulkin, 38 Vet. App. 366, 369-70 (2017). The Board therefore finds that the criteria for a 10 percent rating under Diagnostic Code 5260 were met from February 28, 2010, but that the criteria for entitlement to a rating in excess of 10 percent were not met at any time during the relevant rating period. To the extent the Veteran seeks ratings higher than those assigned in this decision and previously assigned, the preponderance of the evidence is against the claim, the doctrine of reasonable doubt is not for application, and the claim must be denied. 38 U.S.C. § 5107(b); see also Gilbert, 1 Vet. App. 49. REASONS FOR REMAND 1. Entitlement to service connection for pseudofolliculitis barbae is remanded. The Veteran seeks entitlement to service connection for pseudofolliculitis barbae. The service treatment records show that he was placed on temporary shaving profiles throughout his second period of active service due to pseudofolliculitis barbae. In a June 2020 written brief presentation, the Veteran’s representative states that the Veteran’s pseudofolliculitis barbae “was shown in service and the Veteran claims a current similar condition may be the same”. Given the in-service profiles for pseudofolliculitis barbae and the representative’s June 2020 statement, the Board finds that the requirements for provision of a VA examination as to the Veteran’s claimed pseudofolliculitis barbae have been met, and the issue must be remanded so that such an examination may be provided. See 38 U.S.C. § 5103A(d)(2); 38 C.F.R. § 3.159(c)(4)(i); McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). 2. Entitlement to service connection left ear hearing loss is remanded. The December 2018 VA examiner opined that the Veteran’s left ear hearing loss is less likely than not cause by or a result of an event in service. As a rationale for that opinion, the examiner explained that the Veteran’s left ear hearing acuity was within normal limits at entrance and separation from active service and did not show a significant threshold shift during his active service. Under applicable law, the absence of in-service evidence of a hearing loss disability is not always fatal to a service connection claim. See Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992). Evidence of a current hearing loss disability and a medically sound basis for attributing that disability to service may serve as a basis for a grant of service connection for hearing loss where there is credible evidence of acoustic trauma due to significant noise exposure in service. See Hensley v. Brown, 5 Vet. App. 155, 159 (1993). In this case, the Veteran has presented competent and credible evidence of in-service acoustic trauma from noise exposure. The VA examiner essentially based her negative nexus opinion on the fact that the Veteran’s service treatment records do not show an in-service hearing loss. The examiner did not explain why evidence showing an in-service hearing loss is required to determine that the Veteran’s hearing loss was incurred in active service or is otherwise etiologically related to his active service, to include the reported exposure to noise. The Board therefore finds the December 2018 VA examination to be inadequate, and that a remand is required so that an addendum opinion may be obtained. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination for his claimed pseudofolliculitis barbae. The examiner must review the claims file. If the Veteran has a current diagnosis of pseudofolliculitis barbae or other similar skin condition, the examiner is asked to provide a response to the following: Is the diagnosed pseudofolliculitis barbae or other similar skin condition at least as likely as not (50 percent probability or greater) related to service, including the in-service pseudofolliculitis barbae. Provide a rationale to support the opinion. 2. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s left ear hearing loss is at least as likely as not (50 percent probability or greater) related to his in-service exposure to noise. The clinician must note that, under applicable law, the absence of in-service evidence of a hearing loss disability is not always fatal to a service connection claim. See Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992). Evidence of a current hearing disability and a medically sound basis for attributing that disability to service may serve as a basis for a grant of service connection for hearing loss where there is credible evidence of acoustic trauma due to significant noise exposure in service. See Hensley v. Brown, 5 Vet. App. 155, 159 (1993). Therefore, the fact that there are no audiometric test results showing that the Veteran had in-service hearing loss is not on its own a sufficient basis for determining that the Veteran’s current left ear hearing loss is not etiologically related to his active service. The clinician’s opinion should reflect consideration of whether, given the in-service noise exposure, the evidence establishes that the Veteran’s left ear hearing loss was incurred in active service or is otherwise etiologically related to his active service, such as being the delayed result of the in-service noise exposure. See 38 C.F.R. § 3.303(d). MICHAEL MARTIN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. J. Anthony, 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.