Citation Nr: 21002126 Decision Date: 01/12/21 Archive Date: 01/12/21 DOCKET NO. 13-02 819 DATE: January 12, 2021 ORDER Service connection for a thoracolumbar spine disability, diagnosed as lumbosacral strain, is granted. Service connection for a right knee disability, diagnosed as a strain, is granted. Service connection for a left knee disability, diagnosed as a strain, is granted. Service connection for a right shin disability, diagnosed as shin splints, is granted. Service connection for a left shin disability, diagnosed as shin splints, is granted. Service connection for a left ankle disability, diagnosed as a deltoid ligament sprain, is granted. REMANDED Entitlement to service connection for a left wrist disability is remanded. Entitlement to service connection for a right collarbone disability is remanded. Entitlement to service connection for a left collarbone disability is remanded. Entitlement to service connection for a rib disability is remanded. Entitlement to service connection for an allergy disorder, to include a sinus condition and allergic rhinitis, is remanded. Entitlement to service connection for a gastrointestinal disorder, to include acid reflux, is remanded. Entitlement to an initial rating higher than 30 percent for dyssomnia is remanded. FINDINGS OF FACT 1. The Veteran’s thoracolumbar spine disability, diagnosed as lumbosacral strain, had its onset in service. 2. The Veteran’s right knee disability, diagnosed as a strain, had its onset in service. 3. The Veteran’s left knee disability, diagnosed as a strain, had its onset in service. 4. The Veteran’s right shin disability, diagnosed as shin splints, had its onset in service. 5. The Veteran’s left knee disability, diagnosed as shin splints, had its onset in service. 6. The Veteran’s left ankle disability, diagnosed as a deltoid ligament sprain, had its onset in service. CONCLUSIONS OF LAW 1. The criteria for service connection for a thoracolumbar spine disability, diagnosed as lumbosacral strain, have been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1117, 1131, 1137, 1154(a), 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310, 3.317. 2. The criteria for service connection for a right knee disability, diagnosed as a strain, have been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1117, 1131, 1137, 1154(a), 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310, 3.317. 3. The criteria for service connection for a left knee disability, diagnosed as a strain, have been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1117, 1131, 1137, 1154(a), 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310, 3.317. 4. The criteria for service connection for a right shin disability, diagnosed as shin splints, have been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1117, 1131, 1137, 1154(a), 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310, 3.317. 5. The criteria for service connection for a left shin disability, diagnosed as shin splints, have been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1117, 1131, 1137, 1154(a), 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310, 3.317. 6. The criteria for service connection for a left ankle disability, diagnosed as a deltoid ligament sprain, have been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1117, 1131, 1137, 1154(a), 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310, 3.317. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the Marine Corps from September 2006 to September 2010, including service in Iraq. This matter is before the Board of Veterans’ Appeals (Board) on appeal of a September 2010 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina, that granted service connection and a 10 percent rating for dyssomnia (dyssomnia, not otherwise specified), effective September 5, 2010. By this decision, the RO also denied service connection for a left wrist disability (listed as a left wrist condition); a right collarbone disability (listed as a right collarbone condition); a left collarbone disability (listed as a left collarbone condition); a thoracolumbar spine disability (listed as an upper and lower back condition); a right knee disability (listed as a right knee condition); a left knee disability (listed as a left knee condition); a right shin disability (listed as a right shin condition); a left shin disability (listed as a left shin condition); a left ankle disability (listed as a left ankle condition); a rib disability (listed as a rib condition); an allergy disorder, to include a sinus condition and allergic rhinitis (listed as a sinus condition); and for a gastrointestinal disorder, to include acid reflux (listed as acid reflux). In September 2015, the Veteran appeared at a Board videoconference hearing before the undersigned Veterans Law Judge. In February 2016, the Board granted an initial rating of at least 30 percent for the Veteran’s service-connected dyssomnia. The Board remanded the issue of entitlement to an initial rating higher than 30 percent for dyssomnia, as well as the issues of entitlement to service connection for a left wrist disability (listed as a left wrist condition); a right collarbone disability (listed as a right collarbone condition); a left collarbone disability (listed as a left collarbone condition); a thoracolumbar spine disability (listed as an upper and lower back condition); a right knee disability (listed as a right knee condition); a left knee disability (listed as a left knee condition); a right shin disability (listed as a right shin condition); a left shin disability (listed as a left shin condition); a left ankle disability (listed as a left ankle condition); a rib disability (listed as a rib condition); an allergy disorder, to include a sinus condition and allergic rhinitis (listed as an allergic condition, to include a sinus condition and allergic rhinitis); and for a gastrointestinal disorder, to include acid reflux (listed as acid reflux), for further development. In June 2018, the Board remanded the issues of entitlement to service connection for a left wrist disability; a right collarbone disability; a left collarbone disability; a thoracolumbar spine disability; a right knee disability; a left knee disability; a right shin disability; a left shin disability; a left ankle disability; a rib disability; an allergy disorder, to include a sinus condition and allergic rhinitis; and a gastrointestinal disorder, to include acid reflux (listed as acid reflux), as well as the issue of entitlement to an initial rating higher than 30 percent for dyssomnia, for further development. The Board observes that the United States Court of Appeals for Veterans Claims (Court) has held that a claim for a total disability rating based on individual unemployability (TDIU) is part of an increased rating claim when such claim is raised by the record. Rice v. Shinseki, 22 Vet. App. 447 (2009). In this case, the Veteran reported at the September 2015 Board hearing that he was working full-time and that he was not claiming entitlement to a TDIU. Therefore, the issue of entitlement to a TDIU is not currently before the Board. 1. Thoracolumbar Spine Disability Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999); Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff’d per curiam, 78 F. 3d 604 (Fed. Cir. 1996) (table). Determinations as to service connection will be based on review of the entire evidence of record, to include all pertinent medical and lay evidence, with due consideration to VA’s policy to administer the law under a broad and liberal interpretation consistent with the facts in each individual case. 38 U.S.C. § 1154(a); 38 C.F.R. § 3.303(a). Secondary service connection may be granted for a disability that is proximately due to, the result of, or aggravated by an established service-connected disability. 38 C.F.R. § 3.310 (2015); see also Allen v. Brown, 7 Vet. App. 439 (1995). The Veteran served in the Southwest Asia Theater of Operations during the Persian Gulf War, on or after August 2, 1990. Therefore, service connection may also be established under 38 U.S.C. § 1117; 38 C.F.R. § 3.317. Under those provisions, service connection may be warranted for a Persian Gulf Veteran who exhibits objective indications of a qualifying chronic disability that became manifest during active military, naval or air service in the Southwest Asia Theater of Operations during the Persian Gulf War, or to a degree of 10 percent or more not later than December 31, 2021. 38 C.F.R. § 3.317(a)(1). Under 38 C.F.R. § 3.317, compensation may be warranted on a presumptive basis for disabilities due to undiagnosed illness as well as medically unexplained chronic multisymptom illnesses. See 38 C.F.R. § 3.317 (a). This means that even if a Veteran’s symptoms are attributed to a known clinical diagnosis, the presumptive provisions related to Gulf War service still apply. In particular, the term medically unexplained chronic multisymptom illness means a diagnosed illness without conclusive pathophysiology or etiology, that is characterized by overlapping symptoms and signs and has features such as fatigue, pain, or disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities. 38 C.F.R. § 3.317(a)(2)(ii). Therefore, even if a multisymptom illness has a diagnosis, consideration should still be given as to whether the disability has no known etiology, or has a known, partially understood etiology. Chronic multisymptom illnesses of partially understood etiology and pathophysiology, such as diabetes and multiple sclerosis, will not be considered medically unexplained. Id. In making all determinations, the Board must fully consider the lay assertions of record. A layperson is competent to report on the onset and recurrence of symptoms. See Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a Veteran is competent to report on that of which he or she has personal knowledge). Lay evidence can also be competent and sufficient evidence of a diagnosis or to establish etiology if (1) the layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). When considering whether lay evidence is competent the Board must determine, on a case by case basis, whether the Veteran’s particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d at 1377 (Fed. Cir. 2007) (holding that “[w]hether lay evidence is competent and sufficient in a particular case is a factual issue to be addressed by the Board”). The Board is charged with the duty to assess the credibility and weight given to evidence. Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997), cert. denied, 523 U.S. 1046 (1998); Wensch v. Principi, 15 Vet. App. 362, 367 (2001). Indeed, in Jefferson v. Principi, 271 F.3d 1072 (Fed. Cir. 2001), the United States Court of Appeals for the Federal Circuit (Federal Circuit), citing its decision in Madden, recognized that that Board had inherent fact-finding ability. Id. at 1076; see also 38 U.S.C. § 7104(a) (West 2002). Moreover, the United States Court of Appeals for Veterans Claims (Court) has declared that in adjudicating a claim, the Board has the responsibility to weigh and assess the evidence. Bryan v. West, 13 Vet. App. 482, 488-89 (2000); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992). As a finder of fact, when considering whether lay evidence is satisfactory, the Board may also properly consider internal inconsistency of the statements, facial plausibility, consistency with other evidence submitted on behalf of the Veteran, and the Veteran’s demeanor when testifying at a hearing. See Dalton v. Nicholson, 21 Vet. App. 23, 38 (2007); Caluza v. Brown, 7 Vet. App. 498, 511 (1995), aff’d per curiam, 78 F.3d 604 (Fed. Cir. 1996). In determining the probative value to be assigned to a medical opinion, the Board must consider three factors. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The initial inquiry in determining probative value is to assess whether a medical expert was fully informed of the pertinent factual premises (i.e., medical history) of the case. A review of the claims file is not required, since a medical professional can also become aware of the relevant medical history by having treated a Veteran for a long period of time or through a factually accurate medical history reported by a Veteran. See Id. at 303-04. The second inquiry involves consideration of whether the medical expert provided a fully articulated opinion. See Id. A medical opinion that is equivocal in nature or expressed in speculative language does not provide the degree of certainty required for medical nexus evidence. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). The third and final factor in determining the probative value of an opinion involves consideration of whether the opinion is supported by a reasoned analysis. The most probative value of a medical opinion comes from its reasoning. Therefore, a medical opinion containing only data and conclusions is not entitled to any weight. In fact, a review of the claims file does not substitute for a lack of a reasoned analysis. See Nieves-Rodriguez, 22 Vet. App. at 304; see also Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (“[A] medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions.”). The Veteran is service-connected for right plantar fasciitis and for left plantar fasciitis. He is also service-connected for dyssomnia; tension headaches; nocturnal bruxism, and residuals of a chin injury; a groin condition; erectile dysfunction; bilateral tinea pedis; and for tinnitus. The Veteran contends that he has a thoracolumbar spine disability that is related to service. He specifically maintains that he was on a big gun that was blown up, that he was knocked out, and that when he came to, his back hurt. The Veteran reports that his back has been painful since his period of service. He also indicates that during training, while carrying his backpack, he suffered pain throughout his back. The Veteran further states that he had constant pain in his lower back where his armor plate was located. He essentially asserts that he suffered from thoracolumbar spine problems during service and since service. The Veteran served on active duty in the Marine Corps from September 2006 to September 2010, including service in Iraq. His DD Form 214 lists his occupational specialty as a rifleman for three years and six months. The Veteran’s service treatment records do not specifically show treatment for any low back problems. A May 2010 VA general medical examination report, during the Veteran’s period of service, does show treatment for a possible thoracolumbar spine problem. A May 2010 VA general medical examination report, during the Veteran’s period of service, does not include a notation that his claims file was reviewed. He reported that he had suffered problems with his thoracolumbar spine for over two years. He stated that during training, he was carrying his back pain and had pain throughout his back. He indicated that he had stiffness, and decreased motion, in his back. He maintained that the pain went up and down, and into his lower back, and that it was moderate in nature. It was noted that the pain was brought on by physical activity and stress, but that the pain could also occur spontaneously. The Veteran stated that the pain was relieved by rest. He reported that he would have a stabbing pain throughout his back that would limit his ability to perform activities of daily living. The diagnosis was thoracolumbar spine strain, currently resolved, with no current residuals. The examiner reported, for subjective factors, that the Veteran had a history of pain and stiffness in his upper and lower back. As to objective factors, it was noted that there were no current objective factors. The examiner also indicated that there was no evidence of intervertebral disc disease. The examiner stated that there was no erectile, bowel, or bladder dysfunction. Post-service VA treatment records, including a VA examination report, show treatment for variously diagnosed thoracolumbar spine disabilities, including minimal degenerative changes, with straightening, of the lumbosacral spine; and lumbosacral strain. A July 2016 VA back examination report includes a notation that the Veteran’s claims file was reviewed. The Veteran reported that in 2008, he was on a big gun that was blown up, and that he was knocked out. He stated that when he came to, his back hurt. The Veteran indicated that his back always hurt, and that the pain was in the lumbar area. He maintained that he did not know what triggered his back pain, but that he thought it might be sitting for long periods of time. He reported that the constant pain limited his ability to bend over and to be active. The diagnosis was lumbosacral strain. The examiner indicated that the Veteran did not have intervertebral disc syndrome. The examiner also reported that imaging studies of the Veteran’s thoracolumbar spine had been performed, and that arthritis was not documented. The Board observes that the service treatment records do not specifically show treatment for any thoracolumbar spine problems. The Board notes, however, that a May 2010 VA general medical examination report, performed during the Veteran’s period of service, indicates that he reported that he had suffered problems with his thoracolumbar spine for over two years. The diagnosis was thoracolumbar spine strain, currently resolved, with no current residuals. The examiner stated that for subjective factors, the Veteran had a history of pain and stiffness in his upper and lower back. As to objective factors, the examiner noted that there were no current objective factors. The Board observes that there is no indication that the examiner reviewed the Veteran’s claims file. Although claims file review is not necessary, the probative value of a medical opinion is based on its reasoning and its predicate in the record so that the opinion is fully informed. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Additionally, the Board notes that it is unclear why the examiner diagnosed the Veteran with thoracolumbar spine strain, but also found no current residuals. The examiner did not specifically address the Veteran’s reports of thoracolumbar spine problems during his period of service. The Board observes that the Veteran is competent to report thoracolumbar spine problems during service and since service. See Davidson, 581 F.3d at 1313. Therefore, the finds that the examiner’s statement, as to no current residuals, to be less probative in his matter. The Board notes that post-service treatment records show treatment for variously diagnosed thoracolumbar spine problems, including lumbosacral strain. The Board observes that the Veteran is currently diagnosed with a thoracolumbar spine disability, diagnosed as lumbosacral strain. The Board finds the Veteran’s reports of thoracolumbar spine problems during and since his period of service to be credible. See Jandreau v. Nicholson, 492 F.3d 1372 (2007) (holding that lay evidence can be competent and sufficient to establish a diagnosis of a condition when a lay person is competent to identify the medical condition, or reporting a contemporaneous medical diagnosis, or the lay testimony describing symptoms at the time supports a later diagnosis by a medical professional). Resolving any doubt in the Veteran’s favor, the Board finds that the evidence is at least in equipoise as to whether the Veteran’s thoracolumbar spine disability, diagnosed as lumbosacral strain, commenced during his period of service. In light of the evidence, the Board cannot conclude that the preponderance of the evidence is against granting service connection for a thoracolumbar spine disability, diagnosed as lumbosacral strain. Therefore, service connection for a thoracolumbar spine disability, diagnosed as lumbosacral strain, is warranted. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. As the Board has granted direct service connection in this matter, it need not address other theories of service connection. 2. Right Knee Disability and Left Knee Disability The Veteran is service-connected for right plantar fasciitis and for left plantar fasciitis. He is also service-connected for dyssomnia; tension headaches; nocturnal bruxism, and residuals of a chin injury; a groin condition; erectile dysfunction; bilateral tinea pedis; and for tinnitus. As discussed above, the Veteran is also now service-connected for a thoracolumbar spine disability, diagnosed as lumbosacral strain. The Veteran contends that he has a right knee disability and a left knee disability that are related to service. He specifically maintains that he suffered pain in both of his knees after jumping out of a MRAP vehicle. The Veteran states that he saw a medic/corpsman, at that time, but continued on duty. He also indicates that he suffered right and knee problems for three and a half years during service, and that his knees began to hurt after a hike. The Veteran essentially asserts that he suffered right knee and left knee problems during service and since service. The Veteran served on active duty in the Marine Corps from September 2006 to September 2010, including service in Iraq. His DD Form 214 lists his occupational specialty as a rifleman for three years and six months. The Veteran’s service treatment records do not specifically show treatment for right knee problems or for left knee problems. A May 2010 VA general medical examination report, during the Veteran’s period of service, does show treatment for possible right knee problems and left knee problems. A May 2010 VA general medical examination report, during the Veteran’s period of service, does not include a notation that his claims file was reviewed. The Veteran reported that he had right knee problems and left problems for three and a half years. He stated that while he was on a hike, his knees began to hurt, and that, lateral that day, his knees began to grind. The Veteran indicated that he had suffered problems with his bilateral knees since that time. He maintained that he had weakness, stiffness, swelling, giving way, lack of endurance, locking, popping, cracking, and tenderness of both knees. The Veteran reported that his knee symptoms were brought on by physical activity, as well as spontaneously. He stated that his knee symptoms were relieved with rest and spontaneously. The diagnosis was chronic intermittent tendinitis of the knees, bilaterally, currently resolved. The examiner reported that there were no current residuals. The examiner indicated, as to subjective factors, that the Veteran had a history of pain and stiffness in the knees, intermittently, which was associated with physical activity. The examiner stated that there were no current objective factors. Post-service VA treatment records, including a VA examination report, show treatment for right knee and left knee disabilities, including bilateral knee pain; minimal osteoarthritis of the knees; right knee strain; and left knee strain. A July 2016 VA knee and lower leg conditions examination report includes a notation that the Veteran’s claims file was reviewed. The Veteran reported that he suffered pain in both knees after jumping out of an MRAP vehicle in 2009. He stated that he saw a medic/corpsman, at that time, and continued on duty. The Veteran indicated that his knees hurt in the patellar tendon areas, as well as posteriorly. He related that he would have popping at the extremes of range of motion. The Veteran stated that his bilateral knees would swell, as well as lock one to two times per week. He reported that his bilateral knees rarely gave way. The diagnoses were right knee strain and left knee strain. The examiner indicated that imaging studies had been performed, as to the Veteran’s bilateral knees, and that degenerative or traumatic arthritis was not documented. The Board observes that the Veteran’s service treatment records do not specifically show treatment for any right knee problems or left knee problems. The Board notes, however, that a May 2010 VA general medical examination report, performed during the Veteran’s period of service, indicates that the Veteran reported that he had right knee problems and left problems for three and a half years during service, and that he had suffered problems with his bilateral knees since that time. The diagnosis was chronic intermittent tendinitis of the knees, bilaterally, currently resolved. The examiner reported that there were no current residuals. The examiner indicated, as to subjective factors, that the Veteran had a history of pain and stiffness in the knees, intermittently, which was associated with physical activity. The examiner stated that there were no current objective factors. The Board observes that there is no indication that the examiner reviewed the Veteran’s claims file. Although claims file review is not necessary, the probative value of a medical opinion is based on its reasoning and its predicate in the record so that the opinion is fully informed. See Nieves-Rodriguez, 22 Vet. App. at 295. Additionally, the Board notes that it is unclear why the examiner diagnosed the Veteran with chronic intermittent tendinitis of the knees, bilaterally, but also found no current residuals. The examiner did not specifically address the Veteran’s reports of right knee problems and left knee problems during his period of service. The Board observes that the Veteran is competent to report right knee problems and left knee problems during service and since service. See Davidson, 581 F.3d at 1313. Therefore, the finds that the examiner’s statement, as to no current residuals, to be less probative in his matter. The Board notes that post-service treatment records show treatment for variously diagnosed right knee problems and left knee problems, including right knee strain and left knee strain. The Board observes that the Veteran is currently diagnosed with a right knee disability, diagnosed as a strain, and with a left knee disability, diagnosed as a strain. The Board finds the Veteran’s reports of right knee and left knee problems during and since service to be credible. See Jandreau, 492 F.3d at 1372 (holding that lay evidence can be competent and sufficient to establish a diagnosis of a condition when a lay person is competent to identify the medical condition, or reporting a contemporaneous medical diagnosis, or the lay testimony describing symptoms at the time supports a later diagnosis by a medical professional). Resolving any doubt in the Veteran’s favor, the Board finds that the evidence is at least in equipoise as to whether the Veteran’s right knee disability, diagnosed as a strain, and his left knee disability, diagnosed as a strain, commenced during his period of service. In light of the evidence, the Board cannot conclude that the preponderance of the evidence is against granting service connection for a right knee disability, diagnosed as a strain, and a left knee disability, diagnosed as a strain. Therefore, service connection for a right knee disability, diagnosed as a strain, and for a left knee disability, diagnosed as a strain, is warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. As the Board has granted direct service connection in this matter, it need not address other theories of service connection. 3. Right Shin Disability and Left Shin Disability The Veteran is service-connected for right plantar fasciitis and for left plantar fasciitis. He is also service-connected for dyssomnia; tension headaches; nocturnal bruxism, and residuals of a chin injury; a groin condition; erectile dysfunction; bilateral tinea pedis; and for tinnitus. As discussed above, the Veteran is also now service-connected for a thoracolumbar spine disability, diagnosed as lumbosacral strain; a right knee disability, diagnosed as a strain; and a left knee disability, diagnosed as a strain. The Veteran contends that he has a right shin disability and a left shin disability that are related to service. He specifically maintains that his right shin disability and left shin disability began in 2007 during his period of service. He also reports that he had bilateral shin problems for three and a half years during service. He states that during his runs in boot camp, his bilateral shins began to bother him and that they would hurt all day. The Veteran essentially asserts that he suffered right shin and left shin problems during service and since service. The Veteran served on active duty in the Marine Corps from September 2006 to September 2010, including service in Iraq. His DD Form 214 lists his occupational specialty as a rifleman for three years and six months. The service treatment records do not specifically show treatment for right shin problems or for left shin problems. A May 2010 VA general medical examination report, during the Veteran’s period of service, does show treatment for possible right shin problems and left shin problems. A May 2010 VA general medical examination report, conducted while he was in service, reflects that the Veteran reported that he had right shin problems and left shin problems for three and a half years. He stated that during runs in boot camp, his bilateral shins began to bother him, and that they would hurt all day. He stated that he had pain in his shins, ankles, and knees and in the mid shin area, intermittently, three times a day and that it would last for an hour. The Veteran described a crushing, aching, cramping, sharp pain that was burning at times. He indicated that the pain was brought on by physical activity and stress, as well as spontaneously. He stated that the pain was relieved by rest and also spontaneously. The diagnosis was chronic, recurrent shin splints, currently resolved. The examiner reported that there were no current residuals. The examiner indicated, as to subjective factors, that the Veteran had a history of pain in his shins, which was associated with physical activity. The examiner stated that there were no current objective factors. Post-service VA treatment records, including VA examination reports, show treatment for right shin splints and left shin splints. A July 2016 VA knee and lower leg conditions examination report includes a notation that the Veteran’s claims file was reviewed. The examiner reported that the Veteran did presently have, and had in the past, recurrent patellar dislocation, shin splints (medial tibial stress syndrome); stress fractures, chronic exertional compartment syndrome, or any other tibial or fibular impairment. The examiner specifically indicated that the Veteran had bilateral shin splints (medial tibial stress syndrome). A July 2016 VA ankle conditions examination report includes a notation that the Veteran’s claims file was reviewed. The examiner reported that the Veteran did presently have, and had in the past, recurrent patellar dislocation, shin splints; stress fractures, Achilles tendonitis; Achilles tendon rupture; malunion of the calcaneus (os calcis) or talus (astragalus), or had a talectomy (astragalectomy). The examiner specifically indicated that the Veteran had bilateral shin splints (medial tibial stress syndrome). The examiner stated that the Veteran indicated that his bilateral shins splints began in 2007, while he was in the Marine Corps, and that he stated that they would become worse with weather changes, weightbearing activities, and sports. The service treatment records do not specifically show treatment for any right shin problems or left shin problems. The Board notes, however, that a May 2010 VA general medical examination report, performed during the Veteran’s period of service, notes that the Veteran reported that he had right shin problems and left shin problems for three and a half years. He stated that during runs in boot camp, his bilateral shins began to bother him, and that they would hurt all day. The diagnosis was chronic, recurrent shin splints, currently resolved. The examiner reported that there were no current residuals. The examiner indicated, as to subjective factors, that the Veteran had a history of pain in his shins, which was associated with physical activity. The examiner stated that there were no current objective factors. The Board observes that there is no indication that the examiner reviewed the Veteran’s claims file. Although claims file review is not necessary, the probative value of a medical opinion is based on its reasoning and its predicate in the record so that the opinion is fully informed. See Nieves-Rodriguez, 22 Vet. App. at 295. Additionally, the Board notes that it is unclear why the examiner diagnosed the Veteran with chronic, recurrent shin splints, but also found no current residuals. The examiner did not specifically address the Veteran’s reports of right shin problems and left shin problems during his period of service. The Board observes that the Veteran is competent to report right shin problems and left shin problems during service and since service. See Davidson, 581 F.3d at 1313. Therefore, the finds that the examiner’s statement, as to no current residuals, to be less probative in his matter. The Board notes that post-service treatment records show treatment for right shin splints and left shin splints. In fact, a July 2016 VA knee and lower leg condition examination report and a July 2016 VA ankle conditions examination report, respectively, both indicate that the Veteran has bilateral shin splints. The Board observes that the Veteran is currently diagnosed with a right knee shin disability, diagnosed as shin splints, and with a left knee disability, diagnosed shin splints. The Board finds the Veteran’s reports of right shin and left shin problems during and since service to be credible. See Jandreau, 492 F.3d at 1372 (holding that lay evidence can be competent and sufficient to establish a diagnosis of a condition when a lay person is competent to identify the medical condition, or reporting a contemporaneous medical diagnosis, or the lay testimony describing symptoms at the time supports a later diagnosis by a medical professional). Resolving any doubt in the Veteran’s favor, the Board finds that the evidence is at least in equipoise as to whether the Veteran’s right shin disability, diagnosed as shin splints, and his left shin disability, diagnosed as shin splints, commenced during his period of service. In light of the evidence, the Board cannot conclude that the preponderance of the evidence is against granting service connection for a right shin disability, diagnosed as shin splints, and a left knee disability, diagnosed as shin splints. Thus, service connection for a right knee disability, diagnosed as shin splints, and for a left shin disability, diagnosed as shin splints, is warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. As the Board has granted direct service connection in this matter, it need not address other theories of entitlement. 4. Left Ankle Disability The Veteran is service-connected for right plantar fasciitis and for left plantar fasciitis. He is also service-connected for dyssomnia; tension headaches; nocturnal bruxism, and residuals of a chin injury; a groin condition; erectile dysfunction; bilateral tinea pedis; and for tinnitus. As discussed above, the Veteran is also now service-connected for a thoracolumbar spine disability, diagnosed as lumbosacral strain; a right knee disability, diagnosed as a strain; a left knee disability, diagnosed as a strain; a right shin disability, diagnosed as shin splints; and a left shin disability, diagnosed as shin splints. The Veteran contends that he has left ankle disability that is related to service. He specifically maintains that he jumped over a barrier while serving in Iraq, and that he landed wrong on his left ankle. He reports that he suffered swelling and pain in his left ankle at that time. The Veteran also indicates that he had left ankle problems for his last two years of service. The Veteran essentially asserts that he suffered from left ankle problems during service and since service. The Veteran served on active duty in the Marine Corps from September 2006 to September 2010, including service in Iraq. His DD Form 214 lists his occupational specialty as a rifleman for three years and six months. The service treatment records do not specifically show treatment for any left ankle problems. A May 2010 VA general medical examination report, during the Veteran’s period of service, does show treatment for a possible left ankle problem. A May 2010 VA general medical examination report, during the Veteran’s period of service, does not include a notation that his claims file was reviewed. The Veteran reported that he had a left ankle problem for two years. He stated that he was in Iraq performing a combat operation, that he jumped over a barrier, and that he landed on the wrong side and twisted his ankle. The Veteran indicated that he had weakness, stiffness, swelling, pain, lack of endurance, locking and tenderness in his left ankle. He maintained that the left ankle would flare up three times a day, which would last for one or two hours. The Veteran reported that the pain was brought on by physical activity, but that it would also occur spontaneously. He stated that left ankle pain was relieved by rest, and also spontaneously. The diagnosis was recurrent left ankle sprains, currently resolved. The examiner reported that there were no current residuals. The examiner indicated, as to subjective factors, that the Veteran reported that he suffered an injury to his left ankle when he twisted it in the past, and that he presently felt as if it was unstable at times. The examiner maintained that there were no objective factors. A post-service VA examination report shows treatment for left ankle problems, with a diagnosis of a deltoid ligament sprain. A July 2016 VA ankle conditions examination report includes a notation that the Veteran’s claims file was reviewed. The Veteran reported that he jumped over a barrier while serving in Iraq, and that he landed wrong on his left ankle. He stated that he suffered swelling and pain in his left ankle, and that he was treated with Ibuprofen and ice, at that time. The Veteran indicated that he currently used an ankle brace as needed. He related that weightbearing activities, such as soccer and twisting, would cause pain in his left ankle. He stated that the pain was in the medial left ankle and in the plantar fascia proximal to the calcaneus. The diagnosis was a deltoid ligament sprain of the left ankle, chronic and recurrent. The examiner reported that the date of the diagnosis was 2008. The examiner stated that imaging studies, as to the Veteran’s left ankle, were performed, and that degenerative or traumatic arthritis was not documented. The Board observes that the Veteran’s service treatment records do not specifically show treatment for any left ankle problems. The Board notes, however, that a May 2010 VA general medical examination report, performed during the Veteran’s period of service, indicates that he reported that he had a left ankle problem for two years. He specifically stated that he was in Iraq performing a combat operation, that he jumped over a barrier, and that he landed on the wrong side and twisted his ankle. The diagnosis was recurrent left ankle sprains, currently resolved. The examiner reported that there were no current residuals. The examiner indicated, as to subjective factors, that the Veteran reported that he suffered an injury to his left ankle when he twisted it in the past, and that he presently felt as if it was unstable at times. The examiner maintained that there were no objective factors. The Board observes that there is no indication that the examiner reviewed the Veteran’s claims file. Although claims file review is not necessary, the probative value of a medical opinion is based on its reasoning and its predicate in the record so that the opinion is fully informed. See Nieves-Rodriguez, 22 Vet. App. at 295. Additionally, the Board notes that it is unclear why the examiner diagnosed the Veteran with recurrent left ankle sprains, but also found no current residuals. The examiner did not specifically address the Veteran’s reports of left ankle problems during his period of service. The Board observes that the Veteran is competent to report left ankle problems during service and since service. See Davidson, 581 F.3d at 1313. Therefore, the finds that the examiner’s statement, as to no current residuals, to be less probative in his matter. The Board notes that a post-service July 2016 VA ankle conditions examination report relates a diagnoses of a left deltoid ligament sprain, chronic and recurrent, with a date of diagnosis in 2008. The Veteran is currently diagnosed with a left ankle disability, diagnosed as a left deltoid ligament sprain. The Board finds that his reports of left ankle problems during and since service to be credible. See Jandreau, 492 F.3d at 1372 (holding that lay evidence can be competent and sufficient to establish a diagnosis of a condition when a lay person is competent to identify the medical condition, or reporting a contemporaneous medical diagnosis, or the lay testimony describing symptoms at the time supports a later diagnosis by a medical professional). Resolving any doubt in the Veteran’s favor, the Board finds that the evidence is at least in equipoise as to whether the Veteran’s left ankle disability, diagnosed as a deltoid ligament sprain, commenced during his period of service. In light of the evidence, the Board cannot conclude that the preponderance of the evidence is against granting service connection for a left ankle disability, diagnosed as a deltoid ligament sprain. Therefore, service connection for a left ankle disability, diagnosed as a deltoid ligament sprain, is warranted. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. As the Board has granted direct service connection in this matter, it need not address other theories of service connection. REASONS FOR REMAND The remaining issues on appeal are entitlement to service connection for a left wrist disability; a right collarbone disability; a left collar bone disability; a rib disability; an allergy disorder, to include a sinus condition and allergic rhinitis; and for a gastrointestinal disorder, to include acid reflux, as well as entitlement to an initial rating higher than 30 percent for dyssomnia. As discussed above, the Board has granted service connection for a thoracolumbar spine disability, diagnosed as lumbosacral strain; a right knee disability, diagnosed as a strain; a left knee disability, diagnosed as a strain; a right shin disability, diagnosed as shin splints; a left shin disability, diagnosed as shin splints; and for a left ankle disability, diagnosed as a deltoid ligament sprain. This case was remanded in June 2018, partly to schedule the Veteran for an appropriate VA examination, or examinations, to determine the nature and likely etiology of his claimed left wrist disability; right collarbone disability; left collarbone disability; rib disability; allergy disorder, to include a sinus condition and allergic rhinitis; and gastrointestinal disorder, to include acid reflux. Based on the results of the examination, or examinations, the examiner, or examiners, was/were asked to address a series of questions. This case was also remanded in June 2018, to schedule the Veteran for a VA examination to determine the extent and severity of his dyssomnia. The Board observes that, pursuant to the June 2018 Board remand, the RO attempted to schedule the Veteran for numerous VA examinations. There are numerous notations in the record, dated in July 2019, which indicate that the Veteran did not show for the scheduled examinations. A July 2019 report of general information notes that the Veteran was called to reschedule his examinations. It was noted that the Veteran’s address had changed again, and that his current address was presently in Olive Branch, Mississippi. The Veteran was informed that requests for examinations would be resubmitted, and that he would be hearing from the examination contractors in coming days. The Board notes that there are subsequent September 2019 notations in the record that the Veteran did not show for numerous scheduled VA examinations. The Board notes, however, that those notations do not specifically indicate the address that was used to notify the Veteran. As discussed above, the Veteran’s address was only changed less than two months earlier. The Board emphasizes that it is important that the Veteran report for his scheduled VA examination(s). His failure to attend any scheduled VA examination without showing good cause may adversely affect his claim. 38 C.F.R. § 3.655. Examples of good cause include, but are not limited to, the illness or hospitalization of a claimant and death of an immediate family member. 38 C.F.R. § 3.655(a). In light of the above, and the lack of adequate VA examinations of record, the Board finds that another attempt should be made to schedule a VA examination, or examinations, with the opportunity to obtain responsive etiological opinions, following a thorough review of the record, as to the Veteran’s claims for service connection for a left wrist disability; a right collarbone disability; a left collarbone disability; a rib disability; an allergy disorder, to include a sinus condition and allergic rhinitis; and for a gastrointestinal disorder, to include acid reflux. Additionally, an attempt should be made to schedule the Veteran for a VA examination, as to his service-connected dyssomnia. See also Stegall v. West, 11 Vet. App. 268, 271 (1998). The matters are REMANDED for the following action: 1. Ask the Veteran to identify all medical providers who have treated him for a left wrist disability; a right collarbone disability; a left collarbone disability; a rib disability; an allergy disorder, to include a sinus condition and allergic rhinitis; a gastrointestinal disorder, to include acid reflux; and for psychiatric problems, since October 2017. After receiving this information and any necessary releases, obtain copies of the related medical records which are not already in the claims folder. Document any unsuccessful efforts to obtain the records, inform the Veteran of such, and advise him that he may obtain and submit those records himself. 2. Notify the Veteran that he may submit lay statements from himself and from other individuals who have first-hand knowledge, and/or were contemporaneously informed of his in-service and post-service symptomatology regarding his claimed left wrist disability; right collarbone disability; left collarbone disability; rib disability; allergy disorder, to include a sinus condition and allergic rhinitis; and gastrointestinal disorder, to include acid reflux, as well as the nature, extent, and severity of his service-connected dyssomnia and the impact of that condition on his ability to work. The Veteran should be provided an appropriate amount of time to submit this lay evidence 3. Schedule the Veteran for an appropriate VA examination(s) (or telehealth interview, review of the record, etc., if an in-person examination is not feasible), a physical examination is not necessary unless the examiner(s) deems it necessary, to determine the nature, onset and likely etiology of his claimed left wrist disability; right collarbone disability; left collarbone disability; rib disability; allergy disorder, to include a sinus condition and allergic rhinitis; and gastrointestinal disorder, to include acid reflux. The entire claims file must be reviewed by the examiner(s). Then, based on the results of the examination(s), the examiner(s) is (are) asked to address each of the following questions: (a) Please state whether the symptoms of each claimed condition are attributable to a known clinical diagnosis. If the Veteran does not now have, but previously had any such condition, when did that condition resolve? (b) Is the Veteran’s disability pattern consistent with: (1) a diagnosable but medically unexplained chronic multisymptom illness of unknown etiology, (2) a diagnosable chronic multisymptom illness with a partially explained etiology, or (3) a disease with a clear and specific etiology and diagnosis? (c) If, after examining the Veteran and reviewing the claims file, it is determined that the Veteran’s disability pattern is either (2) a diagnosable chronic multisymptom illness with a partially explained etiology, or (3) a disease with a clear and specific etiology and diagnosis, then please provide an expert opinion as to whether it is related to a presumed environmental exposures experienced by the Veteran during service in Southwest Asia. (d) Is it at least as likely as not that any diagnosed disorder had its onset directly during the Veteran’s service or is otherwise causally related to any event or circumstance of his service, including environmental exposures during service in Southwest Asia during the Persian Gulf War? (e) If not directly related to service on the basis of questions (b)-(d), is any medical condition proximately due to, the result of, or caused by any service-connected disability(ies)? (f) If not caused by another medical condition, has any disorder been aggravated (made permanently worse or increased in severity) by any service-connected disability(ies)? If yes, was that increase in severity due to the natural progress of the disease. In responding to the above inquiries, please acknowledge and discuss a May 2010 VA general medical examination report, prior to the Veteran’s separation from service in September 2010, which includes diagnoses of chronic intermittent tendinitis of the left wrist; a left rib strain; and sinusitis, albeit all currently resolved, as well as reports of the Veteran of left wrist problems; right and left collarbone problems; rib problems; allergy and sinus problems; and gastrointestinal problems, during and since service. 4. Schedule the Veteran for an appropriate VA examination (or telehealth interview, review of the record, etc., if an in-person examination is not feasible) to determine the extent and severity of his service-connected dyssomnia. STEVEN D. REISS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. D. Regan, 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.