Citation Nr: 21002446 Decision Date: 01/13/21 Archive Date: 01/13/21 DOCKET NO. 13-13 814 DATE: January 13, 2021 ORDER Service connection for a cervical spine (neck) disability is denied. Service connection for a left shoulder disability is denied. Service connection for a right shoulder disability is denied. Service connection for a left elbow disability is denied. Service connection for a right elbow disability is denied. Entitlement to a compensable rating for residuals of a left foot chip fracture with degenerative arthritis (a left foot disability) prior to September 1, 2015, and in excess of 10 percent thereafter is denied. FINDINGS OF FACT 1. The preponderance of the most probative evidence weighs against a finding that the Veteran’s cervical spine disability began during or is etiologically related to his active duty service. 2. The preponderance of the most probative evidence weighs against a finding that the Veteran has a left shoulder disability which began during or is etiologically related to his active duty service. 3. The preponderance of the most probative evidence weighs against a finding that the Veteran has a right shoulder disability which began during or is etiologically related to his active duty service. 4. The preponderance of the most probative evidence weighs against a finding that the Veteran has a left elbow disability which began during or is etiologically related to his active duty service. 5. The preponderance of the most probative evidence weighs against a finding that the Veteran has a right elbow disability which began during or is etiologically related to his active duty service. 6. Prior to September 1, 2015, the preponderance of the most probative evidence weighs against a finding the Veteran’s left foot disability has been manifested by symptoms causing functional impairment that has been more than mild. 7. Beginning September 1, 2015, the preponderance of the most probative evidence weighs against a finding the Veteran’s left foot disability has been manifested by more than moderate symptoms. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a cervical spine disability have not been met. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310. 2. The criteria for entitlement to service connection for a left shoulder disability have not been met. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.310. 3. The criteria for entitlement to service connection for a right shoulder disability have not been met. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.310. 4. The criteria for entitlement to service connection for a left elbow disability have not been met. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.310. 5. The criteria for entitlement to service connection for a right elbow disability have not been met. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.310. 6. Prior to September 1, 2015, the criteria for a compensable rating for a left foot disability have not been met. 38 U.S.C. § 1151; 38 C.F.R. §§ 4.71a, Diagnostic Codes 5276-5284. 7. Beginning September 1, 2015, the criteria for rating in excess of 10 percent for a left foot disability have not been met. 38 U.S.C. § 1151; 38 C.F.R. §§ 4.71a, Diagnostic Codes 5276-5284. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1979 to May 1980 and from June 1980 to April 1988 with additional service in the Reserves and National Guard. These claims are on appeal from a December 2011 rating decision. In April 2016, the Veteran testified at a hearing before a Veterans Law Judge (VLJ) regarding his claim for an increased rating for his left foot disability, and that VLJ issued the prior November 2017 remand with respect to that issue. The VLJ who held that hearing is no longer employed by the Board of Veterans’ Appeals (Board), and in November 2018, the Veteran verified he did not wish to appear at a new hearing on that issue. With respect to his service connection claims, in his May 2016 Substantive Appeal (VA Form 9) and again in an August 2018 statement, the Veteran and his representative requested a Board hearing. In an August 2018 letter, the Veteran was notified that his hearing was scheduled for the following month; this letter was sent to his last known address, with a copy to his representative, and was not returned as undeliverable. The Veteran did not appear for his hearing scheduled in September 2018 and he has not provided good cause for why he missed his hearing, nor has he requested it be rescheduled, even after he was notified of such several times. See September 2018 Supplemental Statement of the Case (SSOC); see also January 2019 Board remand. Similarly, in a September 2018 Informal Hearing Presentation (IHP), the Veteran’s representative acknowledged his failure to appear for the hearing and did not provide good cause or request that it be rescheduled. Thus, the Board finds the Veteran’s request for a hearing with respect to the service-connection issues has been withdrawn. The Veteran’s claim for an increased rating for his left foot disability was remanded by the Board in November 2017 to attempt to obtain identified outstanding private treatment records and, if newly received evidence indicated a change in his disability, he was to be afforded an examination. In February 2018, the Veteran called VA to request an update on the status of the aforementioned Board remand; a VA employee telephoned him back and asked if he had any more medical records to add to his claim, and he responded that VA already had all available records, to include those from Kaiser Permanente and a private chiropractor. VA also sent the Veteran a letter in February 2018 and requested he complete authorizations to allow VA to attempt to obtain private records pursuant to the remand directives or, in the alternative, to inform the Veteran he may submit these records himself. The Veteran responded to this letter indicating he had nothing new to add and that VA already had medical authorizations for each of his providers. In January 2019, the Veteran’s claim for an increased rating for his left foot disability and his service connection claims were remanded by the Board. The Board found that since the last examination performed to evaluate the severity of his left foot disability, in September 2015, more recent evidence suggested worsening, to include potentially new related diagnoses and manifestations; accordingly, an examination was ordered. With respect to the service connection claims, the Board ordered examinations and opinions to determine whether the Veteran had current disabilities and, if so, whether they were related to his active service. While the claims were in remand status, the Board again directed the AOJ to contact the Veteran to attempt to obtain outstanding treatment records. In a September 2019 letter, the AOJ requested the Veteran complete authorizations to allow VA to obtain private records pursuant to the remand directives or, in the alternative, to submit these records himself; he did not respond to that letter and it was not returned as undeliverable. Attempts were made to schedule the Veteran for examinations in October 2019 and January 2020; however, he did not respond to letters sent to him, which were also not returned as undeliverable, and he was also unable to be reached by telephone. In pertinent part, VA regulation provides that when entitlement or continued entitlement to a benefit cannot be established or confirmed without a current VA examination or reexamination and a claimant, without good cause, fails to report for such examination, or reexamination, action shall be taken in accordance with paragraph 38 C.F.R. § 3.655(b) or (c) as appropriate. 38 C.F.R. § 3.655 (a). Examples of good cause include, but are not limited to, the illness or hospitalization of the claimant, death of an immediate family member, etc. Id. When a claimant fails to report for an examination scheduled in conjunction with an original compensation claim, the claim shall be rated based on the evidence of record. When the examination was scheduled in conjunction with any other original claim, a supplemental claim for a benefit which was previously disallowed, or a claim for increase, the claim shall be denied. 38 C.F.R. § 3.655(b). Significantly, a claim for a higher initial rating is considered an “original compensation claim” and not a “claim for increase” for the purposes of 38 C.F.R. § 3.655(b), and therefore, all the Veteran’s claims will be decided based on the evidence of record. See Turk v. Peake, 21 Vet. App. 565, 570 (2008). In the case at hand, the January 2019 Board remand explained why new examinations were needed to decide the Veteran’s claims. The June 2020 SSOC notes that the Veteran did not appear for scheduled examinations which were attempted to be scheduled in October 2019 and January 2020. This SSOC was mailed to the Veteran’s last known address of record and was not returned as undeliverable; the Veteran has not disputed the fact that he missed any examinations or requested that they be rescheduled. Moreover, in an October 2020 brief, the Veteran’s representative acknowledged that VA received notification from the examination contractor that the Veteran did not report for his scheduled examinations. The representative also conceded that evidence expected from these examinations that might have been material to the outcome of the Veteran’s claim could not be considered. However, the representative did not provide good cause for why the Veteran failed to appear for these examinations and did not request that they be rescheduled. The Board notes that VA’s duty to assist is not a one-way street; if the Veteran wishes help, he cannot passively wait for it in circumstances where his own actions are essential in obtaining putative evidence. See Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). Further, a claimant has the burden to keep VA apprised of his or her whereabouts and if he or she does not do so, VA is not obligated to “turn up heaven and earth to find him.” See Hyson v. Brown, 5 Vet. App. 262, 265 (1993). Unfortunately, the Veteran’s failure to report for scheduled examinations and to provide requested private medical records (or, in the alternative, updated authorizations) has resulted in VA’s inability to obtain evidence which may have lent support to his claims. There has been no request from the Veteran to change his mailing address in the record and no documents sent to him have been returned as undeliverable. Even following additional notification in the June 2020 SSOC that he failed to appear for examinations, neither he nor his representative have provided good cause for why he missed these examinations or requested that they be rescheduled. Based on the foregoing, the Board finds that the Veteran’s failure to keep VA apprised of his whereabouts and failure to provide good cause for why he missed examinations has resulted in VA’s inability to comply with the Board’s prior remand directives, through no fault of VA. See Hyson, 5 Vet. App. at 265; cf. Stegall v. West, 11 Vet. App. 268, 271 (1998). Thus, the Board will proceed with adjudication of the claims considering the available evidence of record. See 38 C.F.R. § 3.655(b). As explained more fully below, the Board finds that the record contains several internal inconsistencies with the Veteran’s lay statements and the contemporaneous medical evidence of record, and therefore, finds the Veteran is not credible. See Caluza v. Brown, 7 Vet. App. 498, 510-11 (1995) (holding that in weighing credibility, VA may consider inconsistent statements, internal inconsistency, and consistency with other evidence of record); see also Curry v. Brown, 7 Vet. App. 59, 68 (1994) (holding that contemporaneous evidence has greater probative value than history as reported by a claimant); see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) (finding that while the Board may not ignore a veteran’s testimony simply because he or she is an interested party and stands to gain monetary benefits, personal interest may affect the credibility of evidence). The Board has the authority to assess the credibility and weight of all evidence, including the medical evidence, to determine its probative value, accounting for the evidence which it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant.  Caluza, 7 Vet. App. at 506.  Equal weight is not afforded to each piece of evidence contained in the record, and every item of evidence does not hold the same probative value.  Gilbert v. Derwinski, 1 Vet. App. 49, 56 (1990).  Further, the Board is permitted to weigh a claimant’s lay statements against the absence of contemporary medical evidence.  Fountain v. McDonald, 27 Vet. App. 258, 272 (2015); Buchanan v. Nicholson, 451 F.3d 1331. 36-37 (Fed. Cir. 2006).  However, it must first establish a proper foundation for drawing inferences against a claimant from an absence of documentation.  Horn v. Shinseki, 25 Vet. App. 231, 239 (2012).  The absence of a record of an event which would ordinarily have been recorded gives rise to a legitimate negative inference that the event did not occur.  A.Z. v. Shinseki, 731 F.3d 1303, 1315 (Fed. Cir. 2013).  Although all the evidence of record has been thoroughly reviewed, only the most relevant and salient evidence is discussed below. See Gonzales v. West, 218 F.3d 1378 (Fed. Cir. 2000). The analysis in this decision focuses on what the evidence shows or fails to show with respect to the matters decided herein. The Veteran should not assume that pieces of evidence not explicitly discussed herein have been overlooked. See Allday v. Brown, 7 Vet. App. 517, 527 (1995). Service Connection Claims Legal Criteria Service connection may be established for disability due to a disease or injury that was incurred in or aggravated by active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Service connection may also be granted for any disease initially diagnosed after service, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). In general, in order to prevail on the issue of service connection the evidence must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). In the absence of proof of a current disability, there can be no valid claim for service connection. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) (finding service connection presupposes a current diagnosis of the condition claimed). The requirement that a current disability be present is satisfied “when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim... even though the disability resolves prior to the Secretary’s adjudication of the claim.” McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). Factual Background & Analysis The Veteran is claiming service connection for a cervical spine (neck) disability, bilateral shoulder disabilities, and bilateral elbow disabilities. The Veteran has stated he believes that while he was carrying a two by four during a typhoon during service, he injured his neck, low back, shoulders, and elbows. See October 2015 Statement. Notably, VA has denied service connection for a thoracolumbar spine disability, and that issue is not before the Board. See January 2019 Board decision. The Veteran has also claimed he believes he injured his back, shoulders, and elbows when he suffered an in-service left foot injury, which caused him to twist his body. See October 2015 Statement. Additionally, he has stated he believes his service-connected left foot disability affects his gait and has affected his neck, shoulders, and elbows. See May 2016 Statement. In January 1980, the Veteran injured his left foot when a 4100 trailer ran over it; x-rays revealed a chip fracture to the foot and a normal ankle. Contemporaneous medical records do not reflect that the Veteran complained of any pain to his neck, back, or upper extremities in connection with this incident. Service treatment records dated in 1982 contain complaints of aches, pains, stiffness, tightness, and weakness in his shoulders, upper extremities, and neck in conjunction with headaches, chest pain, and fainting; the assessment was muscle cramping due to anxiety. On June 15, 1983, the Veteran sought treatment for low back pain for the past two weeks; he denied trauma or any identifiable precipitating event. The examiner diagnosed low back pain, likely mechanical in nature, and possibly related to stress. On June 22, 1983, the Veteran was referred to physical therapy for his low back pain and placed on light duty for the same reason. At this appointment, he informed the provider he first noticed the pain approximately three weeks ago after performing heavy lifting at work. By July 5, 1983, the Veteran reported his pain had decreased. By July 14, 1983, he had no complaints of pain and indicated he continued with his back exercises at home; he was discharged from physical therapy on that day and instructed to return if the pain recurred. None of these records reflect the Veteran complained of neck or upper extremity injuries, pain, or symptoms. At a March 1988 examination performed for the purposes of separation from active duty, the Veteran’s neck and upper extremities were normal. On an accompanying report of medical history, he indicated he was in “excellent” health and did not take any medications. In response to whether he has ever had or currently has swollen or painful joints, he checked the box “don’t know.” He denied arthritis, rheumatism, or bursitis; and also denied any bone, joint, or other deformity. In a May 1989 report of medical history for the purposes Reserve service, the Veteran stated he was in “very good health” and denied swollen or painful joints; arthritis, rheumatism, or bursitis; and any bone, joint, or other deformity. On an accompanying physical examination, his spine and upper extremities were normal. On a December 1993 Reserves medical history form, the Veteran indicated he was in “good” health; he denied swollen or painful joints; arthritis, rheumatism, or bursitis; and any bone, joint, or other deformity. The accompanying examination report reflects his spine and upper extremities were normal. An October 1994 treatment record indicates the Veteran experienced right shoulder pain for one week after lifting computers and chopping wood; the diagnosis was muscle related pain. A March 1996 new patient physical reflects the Veteran was healthy; he made no complaints about neck or upper extremity pain. In August 1998, at a family physician appointment, the Veteran requested a refill of Nortriptyline for sleep. He stated he noticed it had helped with back pain; he did not voice any complaints of neck or upper extremity pain. At a November 1998 family physician appointment to follow-up on his psychiatric medication, the Veteran indicated he recently been experiencing pain in his right knee when running and exercising, which he did on a regular basis. He did not voice any complaints of neck or upper extremity pain. On a December 1998 Reserves medical history form, the Veteran indicated he was in “good” health; he denied swollen or painful joints; arthritis, rheumatism, or bursitis; and any bone, joint, or other deformity. The accompanying examination report reflects the Veteran’s spine and upper extremities were normal. At a June 1999 family physician appointment, the Veteran presented complaining of insomnia/dysthymia and knee pain. He indicated he had been exercising aggressively bicycling five to seven days a week; he did not report any pain or symptoms in his neck or upper extremities. A February 2000 Reserves treatment record indicates the Veteran had experienced chronic back pain since 1984 related to a line of duty incident involving lifting with subsequent physical therapy; the Veteran did not voice any complaints regarding his neck, shoulders, or elbows. At a November 2000 periodic family physician examination, the Veteran reported chronic back pain; there was no mention of any neck or upper extremity pain or symptoms. At a July 2001 family physician appointment, the Veteran presented requesting a refill of Nortriptyline; he informed his provider he had been taking this medication since 1994 for sleep and some nonspecific myalgia (muscle aches and pain). He also complained of a one-week history of upper neck and back pain. He stated he had been fairly active doing martial arts and had not had any history of trauma or injury to the upper back or neck. He denied any major interference with his activities due to pain or symptoms. The examiner diagnosed an upper trapezius muscle strain. In September 2002, the Veteran presented to his family physician complaining of back pain after performing a tornado kick in martial arts the previous day. On examination, there was good range of motion of the back with tenderness to palpation to the upper lumbar, lower thoracic, and left paraspinal areas. There was no mention of any neck or upper extremity pain or symptoms. An October 2002 private chiropractic record documents the Veteran was involved in a motor vehicle accident in March 2002 and he had pain in the low back, neck, and joints. On an accompanying automobile accident questionnaire, in response to the question asking whether he had ever had any complaints in the involved areas before, he responded no. October 2002 x-rays demonstrated degenerative changes in the cervical spine and the examiner also diagnosed a cervical sprain/strain and cervical radiculitis. The record contains a December 2009 letter from this private chiropractor, who reported providing treatment to the Veteran off and on for cervical, thoracic, and lumbar pain since October 9, 2002. A February 2003 chiropractic note indicates the Veteran’s cervical spine pain was much improved and he informed the provider he was asymptomatic. In response to the question asking him to classify his improvement since beginning care, he checked the box “excellent.” On a scale of one to ten, with ten being the best, he rated his improvement as an “8+.” He further stated his back and neck were not painful and that he had increased strength. The examiner described the Veteran’s response as 95 percent improvement and indicated the prognosis was good. At a July 2005 family physician health maintenance appointment, the Veteran reported a medical history of a foot fracture and indicated he experienced chronic back pain and saw a chiropractor twice a week for this. There was no mention of any neck or upper extremity pain. He reported he exercised by bicycling five miles a day but had not done so recently because it had been too hot. At a May 2009 family physician health maintenance appointment, the Veteran did not report any pain or symptoms in his neck or upper extremities; he indicated he exercised by performing martial arts. In August 2009, the Veteran sought treatment with his family physician following a motor vehicle accident; he indicated he hit his left shoulder against the door and following the accident developed neck and low back pain. In a January 2010 statement, the Veteran reported he injured his lower back in connection with a typhoon incident; he made no mention of injuring his neck or upper extremities. At a January 2011 VA examination to evaluate his claim for a sinus condition and his left foot disability, he indicated he avoided running and other gym work because of knee and back problems but stated he did participate in weather-permitting road bicycling for exercise. In a December 2011 statement, the Veteran reported injuring his lower back during service and that he felt this has progressed to affect his neck, shoulders, and elbows; he did not claim to injure his neck, shoulders, or elbows in connection with the claimed typhoon incident. In February 2012, the Veteran transferred his primary care from Kaiser to VA; he informed the provider his main complaint was his right knee; there was no mention of any neck or upper extremity complaints. At his first psychiatric appointment with VA in March 2012, he reported “current significant pain problems” in his back, knee, and foot. He informed the provider he was lifting a piece of plywood during a typhoon and the wind picked up, “spun him like a top,” and he had six months of physical therapy, but still required chiropractic care weekly. A head injury screen performed reflects the Veteran reported the following: he wacked his head on a two by four in his basement and received a few stitches, but did not experience loss of consciousness; he injured his neck in an automobile accident requiring physical therapy; and he fell off a ladder 26 feet, experienced momentary loss of consciousness, and broke his ribs. The record contains a November 2014 private medical opinion from C.B., M.D. regarding, inter alia, the Veteran’s cervical spine, bilateral shoulders, and bilateral elbows. Dr. C.B. notes that this opinion is “partially justified based on the Veteran’s verified account of what he was exposed to in service.” November 2014 Private Opinion, 1 (emphasis in original). Dr. C.B. further noted the Veteran’s “relevant and critical” medical facts contained in his medical records, testimony, lay statements, and personnel records were reviewed, including an in-person history/clinical interview. Id. Regarding the claims for bilateral shoulder and elbow disabilities, Dr. C.B. noted that the Veteran was involved in a typhoon where he likely worked in 100+ mile an hour winds and that he was blown over while carrying a 4 by 8 piece of plywood. Dr. C.B. further indicated that this injury is likely akin to a car accident whereby many body parts are injured simultaneously. The Veteran described crepitus in the shoulders and elbows, which is consistent with osteoarthritis, and Dr. C.B. referenced medical literature stating that osteoarthritis is caused by trauma. Dr. C.B. opined “considering every possible sound medical etiology/principle, to at least the 90% level of probability that [the Veteran’s] current [bilateral shoulder and bilateral elbow] joint osteoarthritis is under-rated.” Dr. C.B. reasoned the Veteran was sound on entry and that this opinion is consistent with the Veteran’s subjective lay statements concerning a “major trauma in service due to high winds,” which is akin to a motor vehicle accident where “tremendous forces effect [sic] many parts of the body simultaneously.” Dr. C.B. further reasoned that this opinion was consistent with “the objective findings/imaging tests/diagnoses,” yet contradictorily stated the Veteran’s joints each warranted a 10 percent disability rating “due to the crepitus and likely positive x-ray changes.” November 2014 Private Opinion, 1 (emphasis added). Regarding the Veteran’s claim for a cervical spine disability, Dr. C.B. indicated that during a typhoon during service, where the Veteran likely worked in 100+ mile an hour winds, he injured his neck and back and that these injuries have been chronic ever since. Dr. C.B. indicated that it was at least 90 percent probably that the Veteran’s cervical and lumbar spine problems (degenerative disc disease) were due to the auto accident trauma the Veteran experienced during service. Dr. C.B. reasoned the Veteran was sound on entry, “likely acquired a neck injury and lumbar injury during the typhoon” as he remembered pain in both areas following the accident, typhoons are known to cause multi-trauma with injuries in several body regions simultaneously, service records and lay statements document his in-service spine injuries, and that the cumulative effect of the Veteran’s military service likely injured his cervical and lumbar spine. In a May 2016 statement in support of his claim for an increased rating for his left foot disability, the Veteran indicated he felt that his left foot and ankle affected his “hips, knees, spine and elbows, shoulders, lower/mid/upper back and neck.” He stated he used a cane or forearm crutches to assist in walking and that his left foot and ankle give out on him, causing him to stumble, trip, and/or fall. The Veteran stated that Dr. C.B. had diagnosed him with degenerative arthritis and agreed and supported these diagnoses made by private physicians and in-service providers. The Veteran further stated he had evidence from several separate doctors outside of the VA Compensation and Pension examination unit that have diagnosed him with the above illnesses (degenerative arthritis, gout) and that are service connected. Regarding the 1980 left foot injury, the Veteran stated he also injured his ankle and slammed his knees into the runway; he made no mention of injuring his neck or upper extremities in this incident. Regarding the 1983 claimed typhoon injury, he stated he was carrying a piece of plywood and a heavy wind caught the plywood and “then twisted [him causing injury to his] lower, upper back, legs, ankle, feet.” He did not claim to injure his neck or upper extremities in this incident. At an August 2016 VA appointment, the Veteran reported he was very active; he stated he cut firewood the prior day and hunts elk and pheasant. At a June 2017 VA primary care appointment, the Veteran stated he was “doing well,” that he exercised regularly, hiked a high altitude, and worked without shoes. He stated he recently fell from a ladder and had been seeing his chiropractor for sore muscles but is improving. He did not voice any specific complaints relating to his neck or upper extremities. In November 2017, the Veteran presented at VA appointment and informed the provider he was recently involved in a rollover motor vehicle accident, where his truck rolled five times down an embankment. He sustained a closed head injury with concussion and multiple strains and contusions; he reported seeing a private chiropractor with steady progress. At a November 2018 VA appointment, the Veteran reported he slipped and fell while shoveling snow and that he experienced pain in his low back up to his neck. At an August 2019 VA primary care appointment, the Veteran stated he was feeling “pretty good” but that his blood pressure was up today because he had been non-stop working on mowing and weed eating since his arrival back home from Mexico the prior weekend. He reported enjoying scuba diving, spear fishing, and swimming in the ocean multiple days a week while there. Back in Colorado, he performed snow removal and took care of his ranch/farm, which he rented out most of the time when in Mexico. He also stated he fell while mowing and that he thinks he popped his right shoulder out; he complained of neck and shoulder pain. A May 2020 VA treatment note reflects the Veteran had a high activity level and that he continuing to fish, scuba dive, and run his farm. At a May 2020 VA primary care telehealth appointment, the Veteran denied any complaints of pain, rating it a zero out of ten. 1. Service connection for a cervical spine disability The Veteran’s statements, compared to contemporaneous medical evidence, are inconsistent, and therefore, the Board finds he is not credible. Notably, at the times of his 1980 foot injury and his 1983 low back injury, the Veteran did not voice any complaints of neck pain. In fact, his physical therapy in 1983 was focused on his low back with no focus on neck pain. Moreover, service records dated in 1983 reflect the Veteran first reported noticing back pain after performing heavy lifting at work and there is no mention of any typhoon; he received less than one month of physical therapy and was instructed to return of the pain occurred, which he did not. This conflicts with his statement at a March 2012 VA primary care appointment that during service the wind picked up, “spun him like a top,” and that he had six months of physical therapy and still required weekly chiropractic care. Although he reported complaints of aches, pains, stiffness, tightness, and weakness in his shoulders, upper extremities, and neck in conjunction with headaches, chest pain, and fainting, the assessment was muscle cramping due to anxiety and medical records fail to document a chronicity of complaints. Moreover, several dated from 1988 (at his separation from service) and prior to July 2001 do not contain complaints of or treatment for neck pain. On his March 1988 report of medical history (for purposes of separation from active duty), he stated he was in excellent health. Although he checked the box “don’t know” regarding whether he had or has a history of swollen or painful joints, in May 1989, December 1993, and December 1998 reports of medical history (for Reserve service), he stated he was in either “very good health” or “good health,” and denied swollen or painful joints; arthritis, rheumatism, or bursitis; and any bone, joint, or other deformity. On examination in March 1988, May 1989, and December 1993 examinations, his spine was normal. A private family physician record dated in June 1999 reflects the Veteran had been aggressively bicycling five to seven days a week; his only complaints were related to insomnia/dysthymia and knee pain. At a November 2000 periodic family physician appointment, the Veteran reported chronic back pain but made no mention of neck pain. At a July 2001 family physician appointment, the Veteran complained of a one-week history of upper neck and back pain; he stated he had been fairly active doing martial arts and specifically denied any history of trauma or injury to the upper back or neck. In September 2002, the Veteran presented to his family physician complaining of back pain after performing a tornado kick in martial arts the previous day; there was no mention of any complaints of neck pain or symptoms. The Veteran began seeing a private chiropractor in October 2002 complaining of pain in his low back, neck, and joints; on an accompanying automobile accident questionnaire, in response to the question asking whether he had ever had any complaints in the involved areas before, he responded no. X-rays revealed degenerative changes in the cervical spine and the examiner also diagnosed a cervical sprain/strain and cervical radiculitis. A July 2005 family physician health maintenance appointment reflects the Veteran reported low back pain and saw a chiropractor for this; however, he did not report any neck pain and stated he continued to exercise by bicycling five miles a day but had not done so recently because it had been too hot. At a May 2009 family physician appointment, the Veteran indicated he exercised by performing martial arts and did not report any neck pain or symptoms. When transferring from private to VA care in February 2012 initial appointment, the Veteran informed his provider his main complaint was his right knee and did not voice any neck complaints. At his first March 2012 psychiatric appointment, he reported “current significant pain problems” in his back, knee, and foot; he did not report injuring his neck in that incident. Moreover, in response to a head injury screen, the Veteran did not report injuring his neck in connection with the 1980 or 1983 incidents. The Board finds that had the Veteran injured his neck during service and/or experienced neck symptoms since then, he would have informed his providers of such, particularly at July 2001 appointment where he only recounted a one-week history of neck pain and at his October 2002 chiropractor appointment where he denied any prior neck injuries. See A.Z., 731 F.3d at 1315; see also Buczynski v. Shinseki, 24 Vet. App. 221, 224 (2011) (holding that a lack of notation where it would be expected, to include during treatment or examination, is noteworthy). Moreover, he gave that history well before he filed his VA claim for disability, when there was no incentive to fabricate information for personal gain financial or otherwise. See Cartwright v. Derwinski, 2 Vet. App. 24, 25 (1991) (finding that a pecuniary interest may affect the credibility of a claimant’s testimony); Fed. R. Evid. 803(4) (recognizing that statements made for the purpose of medical treatment generally are reliable); see also Rucker v. Brown, 10 Vet. App. 67, 73 (1997) (“[R]ecourse to the [Federal] Rules [of Evidence] is appropriate where they will assist in the articulation of the Board’s reasons.”)). Courts have recognized how medical history recounted in the course of medical evaluation and treatment is especially probative (trustworthy) because the declarant has inherent incentive to give the most accurate history to, in turn, receive the best or most appropriate medical care. See Rucker, 10 Vet. App. at 73 (statements made to physicians for purposes of diagnosis and treatment are exceptionally trustworthy because the declarant has a strong motive to tell the truth in order to receive proper care). None of the records contemporaneous with these 1980 and 1983 in-service incidents reflect the Veteran injured his neck. The Board concludes that a claimant’s statements (or lack thereof) regarding neck pain during and since service have been inconsistent; therefore, they are more probative than subsequent statements made for compensation purposes.  See Harvey v. Brown, 6 Vet. App. 390, 394 (1994); see also Cartwright, 2 Vet. App. at 25. The Board has considered the opinion from Dr. C.B. and finds that it is not probative evidence in support of the Veteran’s claim for service connection for a cervical spine disability. In this regard, the Board notes that Dr. C.B. acknowledged this opinion was “partially justified based on the Veteran’s verified account of what he was exposed to in service.” November 2014 private opinion, 1 (emphasis in original). Dr. C.B. indicated the Veteran was involved in a typhoon where he likely worked in 100+ mile an hour winds and that he was blown over while carrying a piece of plywood and that this injury is likely akin to a car accident whereby many body parts are injured simultaneously. Part of the reasoning was also based on the Veteran’s reports that he remembered injuring his neck during service and that service records and lay statements document his in-service spine injuries. As discussed above, the Board has found the Veteran not to be credible, and therefore, because Dr. C.B. relied on his statements regarding his in-service injury and continuity of symptoms, the November 2014 opinion is also not credible. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (holding that the Board may reject a medical opinion based on an incomplete or inaccurate factual premise). Moreover, as noted in its prior remand, Dr. C.B.’s report is internally inconsistent, stating that the Veteran’s cervical spine disability was due to “his auto accident trauma that [he] had during military service.” While Dr. C.B. stated that the typhoon incident during service was “akin” to a motor vehicles accident, the Board notes that the Veteran was not involved in any auto accidents during service. Thus, this opinion is internally inconsistent. Finally, the Board notes that while a review of the claims file is not required, since a medical professional can become aware of relevant history by, for example, factually accurate medical history reported by the Veteran, that is not the case here. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Here, the Board has determined that the Veteran did not provide Dr. C.B. with a factually accurate medical history and Dr. C.B. failed to account for the actual motor vehicle accidents the Veteran was involved in post-service, most significantly the October 2002 accident where the Veteran injured his neck and contemporaneously denied a history of neck trauma. Thus, Dr. C.B.’s opinion is not based on a complete and accurate understanding of the Veteran’s medical history, and therefore, it is not probative. See Nieves-Rodriguez, 22 Vet. App. at 304. The Veteran has not been shown to have the experience, training, or education necessary to give a probative etiology opinion his claimed cervical spine disability. Although lay persons are competent to provide opinions on some medical issues, the Board finds that a lay person is not competent to provide a probative opinion as to the specific issues in this case in light of the education and training necessary to make a finding with regard to the complexities of the spine, to include as due to remote trauma and/or aging. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011); see Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). In sum, there are no records prior to 2001 suggesting a cervical spine complaint or diagnosis. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (holding that a prolonged period without medical complaint can be considered, along with other factors concerning a claimant’s health and medical treatment during and after military service, as evidence of whether an injury or a disease was incurred in service which resulted in any chronic or persistent disability). There is also no probative opinion (i.e., a clinical opinion based on review of pertinent records) that it is as likely as not that the Veteran has a neck/cervical spine disability in any way related to his service, to include his Reserve service, or that it is secondary to his left foot disability, and his statements asserting continuity of symptoms since service are not credible. See Mense v. Derwinski, 1 Vet. App. 354 (1991) (holding that VA did not err in denying service connection when a veteran failed to provide evidence demonstrating continuity of symptomatology and had failed to account for the lengthy time period following his service during which there was no clinical documentation of the claimed disorder). To the extent that service connection may be warranted on a presumptive basis if degenerative changes of the cervical spine manifested within one year of the Veteran’s separation from active duty, service connection is also not warranted on this basis. The first evidence of degenerative changes is in 2002, well over a decade after the Veteran’s active service. Unfortunately, the Veteran’s failed to report for his VA examination in connection with this claim has resulted in the inability to obtain opinions to resolve whether his arthritis manifested within one year of separation from active service or whether it is secondary to his service-connected left foot disability. See Wood, 1 Vet. App. at 193. Consideration has been given to the benefit of the doubt doctrine; however, as the preponderance of the evidence is against the Veteran’s claim, it is not applicable. See 38 U.S.C. § 5107(b); see also Gilbert v. Derwinski, 1 Vet. App. 49, 56 (1990). 2. Service connection for a left shoulder disability 3. Service connection for a right shoulder disability 4. Service connection for a left elbow disability 5. Service connection for a right elbow disability Notably, at the time of his 1980 foot injury and his 1983 low back injury (with subsequent physical therapy), the Veteran did not voice any complaints of upper extremity (to include shoulder or elbow) pain or symptoms. In fact, there are no complaints of shoulder or elbow pain in his active duty treatment records. Several post-service private records and Reserve records dated from 1988 (at his separation from service) and prior to 1994 do not contain complaints of or treatment for upper extremity pain or symptoms. On his March 1988 report of medical history (for purposes of separation from active duty), he stated he was in excellent health. Although he checked the box “don’t know” regarding whether he had or has a history of swollen or painful joints, in May 1989, December 1993, and December 1998 reports of medical history (for Reserve service), he stated he was in either “very good health” or “good health,” and denied swollen or painful joints; arthritis, rheumatism, or bursitis; and any bone, joint, or other deformity. On examination in March 1988, May 1989, and December 1993 examinations, his upper extremities were normal. In October 1994, the Veteran reported a one-week history of right shoulder pain after lifting computers and chopping wood; the diagnosis was muscle related pain. He did not mention any pain or symptoms in his left shoulder or bilateral elbows. On a December 1998 Reserves medical history form, the Veteran indicated he was in “good” health; he denied swollen or painful joints; arthritis, rheumatism, or bursitis; and any bone, joint, or other deformity. The accompanying examination report reflects the Veteran’s upper extremities were normal. When the Veteran sought treatment in July 2001 with a one-week history of upper neck and back pain, he did not endorse any symptoms relating to his shoulders or elbows. During his treatment following the October 2002 motor vehicle accident, there is no mention of any shoulder or elbow pain or symptoms. In August 2009, the Veteran reported he injured his left shoulder when he was involved in a motor vehicle accident; he made no mention of a history of left shoulder pain. In August 2019, the Veteran stated he fell while mowing his lawn and believed he popped his right shoulder out. In the November 2014 opinion, Dr. C.B. indicated that the Veteran had degenerative changes of the bilateral shoulders and elbows, as shown by X-rays, and provided positive medical opinions relating to these claims. However, VA and private medical records associated with the evidence do not document any diagnosis of either the elbows or shoulders during the appeal period or indicate that the Veteran ever received X-rays of such areas. Additionally, as Dr. Bash did not physically examine the Veteran for those disorders (as indicated in his medical report), the record is unclear as to where such X-rays would have been obtained. Dr. C.B. reasoned that this opinion was consistent with “the objective findings/imaging tests/diagnoses,” (although it is unclear where these imaging tests are located), yet contradictorily stated the Veteran’s joints each warranted a 10 percent disability rating “due to the crepitus and likely positive x-ray changes.” Thus, it appears that Dr. C.B. found the Veteran’s lay statements alone warranted diagnoses of degenerative changes, and the Board notes that this is not probative as a diagnosis of degenerative arthritis must be established by x-ray findings. See 38 C.F.R. § 4.71a, Diagnostic Code 5003. The preponderance of the evidence weighs against a finding that the Veteran has any diagnosed bilateral shoulder or bilateral elbow disabilities which are began during or related to his service, to include Reserve service, or that they are secondary to his left foot disability. While the Board recently remanded these issues to obtain medical evidence which may have substantiated his claims, as discussed above, the Veteran failed to report for those examinations. See Wood, 1 Vet. App. at 193. While the Veteran is competent to report symptoms, such as pain, he has not shown he has the experience, training, or education necessary to provide a probative opinion that he has diagnosed bilateral shoulder and bilateral elbow disabilities, particularly arthritis, which, as noted above, requires x-ray evidence. See Kahana, 24 Vet. App. at 435; see Jandreau v. Nicholson, 492 F.3d at 1377 n.4. The Board recognizes the recent decision in Saunders v. Wilkie that “pain alone can serve as a functional impairment and therefore qualify as a disability.”  886 F.3d 1356, 1363-64 (Fed. Cir. 2018).  However, the Court cautioned that a veteran cannot demonstrate service connection simply by asserting subjective pain; rather, “[t]o establish the presence of a disability, [a] veteran will need to show that [his or] her pain reaches the level of functional impairment of earning capacity.”  Id. at 1367-68. Significantly, in January 2011 he indicated he avoided running and other gym work because of knee and back problems but did participate in weather-permitting road bicycling. At an August 2016 VA appointment, the Veteran reported he was very active; he stated he cut firewood the prior day and hunts elk and pheasant. At a June 2017 VA primary care appointment, the Veteran stated he was “doing well,” that he exercised regularly, hiked a high altitude, and worked without shoes. At an August 2019 VA treatment appointment, the Veteran stated he had been non-stop working on mowing and weed eating since returning from Mexico the prior weekend. He reported he splits his time between Colorado and Mexico; while in Mexico, he enjoyed spear fishing, scuba diving, and swimming and while in Colorado he worked on taking care of his ranch/farm and performing snow removal services. See August 2019 and May 2020 VA treatment notes. Significantly, at a May 2020 VA telehealth appointment, the Veteran reported he had a high activity level and denied any complaints of pain. Considering this recent holding, the Board finds the preponderance of the evidence weighs against a finding that the Veteran’s bilateral shoulders and elbows have caused functional impairment of earning capacity. Absent a diagnosed disability or a disability rising to the level of functional impairment in earning capacity, service connection must be denied. Even assuming, for the sake of argument, that the Veteran does have diagnosed shoulder and elbow disabilities, which the preponderance of the evidence weighs against, the etiology opinion provided by Dr. C.B. is found to be inadequate for the same reasons discussed above pertaining to the cervical spine. As noted, the Veteran is not credible regarding the severity of the extent of his in-service injury or the continuity of symptomatology, and therefore, the Board finds the opinion is also not credible. There is no probative opinion (i.e., a clinical opinion based on review of pertinent records) that it is as likely as not that the Veteran has bilateral shoulder and elbow disabilities which are in any way related to his service, to include his Reserve service, or secondary to his left foot disability, and his statements asserting continuity of symptoms since service are not credible. See Mense v. Derwinski, 1 Vet. App. 354 (1991) (holding that VA did not err in denying service connection when a veteran failed to provide evidence demonstrating continuity of symptomatology and had failed to account for the lengthy time period following his service during which there was no clinical documentation of the claimed disorder). Given that the preponderance of the evidence weighs against a finding that service connection is warranted for bilateral shoulder and bilateral elbow disabilities, the benefit of the doubt doctrine is not applicable. See 38 U.S.C. § 5107(b); see also Gilbert, 1 Vet. App. at 56. Additional Consideration In April 2016, the Veteran submitted a medical opinion from Dr. C.B. which included argument of clear and unmistakable error (CUE) in a 2009 rating decision. Dr. C.B. is not the Veteran’s representative. Additionally, the Board notes that any claim of CUE must be plead with specificity, which has not been done here. See Andre v. West, 14 Vet. App. 7, 10 (2000), aff’d sub nom, Andre v. Principi, 301 F.3d 1354 (Fed. Cir. 2002). Therefore, the Board finds no specific CUE claim has been filed by or on behalf of the Veteran. Increased Rating Claim Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule). 38 C.F.R. Part 4. The Rating Schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. 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. 6. Entitlement to a compensable rating for a left foot disability prior to September 1, 2015, and in excess of 10 percent thereafter The Veteran is claiming higher ratings are warranted for his left foot disability, to include consideration of his left ankle and other manifestations involving his feet. Initially, the Board notes that service connection for a left ankle disability (diagnosed as mild degenerative changes) was denied in an unappealed July 2016 rating decision. The Veteran’s left foot disability is rated under Diagnostic Codes 5010-5284. See 38 C.F.R. § 4.71a. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires the use of an additional diagnostic code to identify the basis for the rating assigned; the additional code is shown after the hyphen. 38 C.F.R. § 4.27. Diagnostic Code 5010 contemplates arthritis due to trauma while Diagnostic Code 5284 is used to evaluate residuals of foot injuries. Diagnostic Code 5284 provides for 10, 20, or 30 percent evaluations for moderate, moderately severe, and severe effects on the use of the foot, respectively. 38 C.F.R. § 4.71a. In every instance where the schedule does not provide a zero percent evaluation for a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a compensable evaluation are not met. 38 C.F.R. § 4.31. Words such as “moderate,” “moderately severe,” and “severe” are not defined in the Rating Schedule. Although the use of similar terminology by medical professionals should be considered, it is not dispositive of an issue. Rather than applying a mechanical formula, VA must evaluate all the evidence in arriving at a decision regarding a request for an increased disability rating. 38 U.S.C. § 7104; 38 C.F.R. §§ 4.2, 4.6. Historically, while on active duty in January 1980, the Veteran was loading equipment onto an airplane and the lorry he was pulling ran over his left foot resulting in a chip fracture of the talonavicular joint. At a January 2011 VA foot examination, the Veteran described current symptoms as achiness and stiffness, particularly with weather changes and wrong-sized shoes. He described some occasional bilateral pedal edema but no particular unilateral swelling of the left foot over the area of involvement and no locking or instability. He indicated his activities were not impaired by this condition and he was able to function at his usual occupation, with most of his sick leave being taken for other conditions (posttraumatic stress disorder, back condition, sinus condition). The Veteran’s gait was normal. Examination revealed mild tenderness along the medial aspect of the left foot. There was no edema, weakness, or instability and no deformities such as hammertoes, high arches, or bunions. Weight-bearing was normal with no pronation or arch collapse and no valgus or varus deformity. There was no tenderness along the metatarsal heads or heels and no evidence of joint ankylosis. Toes revealed normal range of motion and dorsalis pedis pulses were normal bilaterally. X-rays revealed two enthesophytes (bony projections attached to a tendon or ligament) and mild degenerative changes; there were no bony deformities, fractures, dislocation, or bone destruction. There was no change in active or passive range of motion during repeat testing x3 against resistance; and no additional losses of range of motion are observed for the left foot and left ankle due to painful motion, weakness, impaired endurance, incoordination, or instability. The Veteran submitted a private November 2014 report from Dr. C.B. who indicated that the Veteran’s left foot disability was under-rated. In pertinent part, Dr. C.B. indicated the Veteran reported he limped and had pain and instability of the foot and ankle and that he should be assigned a 20 percent rating for degenerative changes of his left foot and instability, limping, and having to wear special shoes/inserts. Dr. C.B. stated this opinion was consistent with the Veteran’s subjective lay statements and objective findings/imaging/diagnoses. The Board notes that Dr. C.B. did not physically examine the Veteran in connection with this report; rather, it was based on a telephonic interview. At a September 2015 VA foot examination, the examiner found an additional diagnosis of plantar fasciitis (a condition involving inflammation of a thick band of tissue that runs across the bottom of the foot and connects the heel bone to the toes), in addition to the already service-connected left foot diagnoses of residuals of a chip fracture with degenerative arthritis. The Veteran stated that his left foot was painful in the mid portion when weather changes occurred and can cause his foot to be painful for up to a week. He stated at times he feels he has a ball under his left foot with weight-bearing and that he experienced discomfort over his plantar fascia area in the morning, which can last for thirty minutes, causing him to feel like his foot is broken and limp. Regarding functional impairment, he indicated he was unable to exercise as he used to due to left foot discomfort after 15 minutes of walking or any kind of regular weight-bearing exercise. Examination revealed tenderness over the plantar fascia on the left and the arch medially; there was no swelling or edema. There were minimally collapsed arches without significant pronation, callouses, or valgus/varus deformity. There was no metatarsal tenderness and no hammertoes or bunions. At his April 2016 hearing before the Board, the Veteran stated he used arch supports and Dr. C.B., who testified after examining the Veteran, reported the Veteran had a severe gallop. The Veteran indicated he used a cane and crutches due to his feet and that he was unable to stand more than 15 minutes or exercise. He stated when the weather changes it feels like his foot dislocates and he will “hobble around for a month.” In support of his claim, the Veteran submitted a private April 2016 Disability Benefits Questionnaire (DBQ) pertaining to the feet, which was completed by Dr. C.B. and noted diagnoses of pes planus (flat feet), metatarsalgia, and plantar fasciitis. It was also noted the Veteran had malunion or nonunion of the tarsal or metatarsal bone and Dr. C.B. simultaneously checked the boxes describing the severity as “moderate” and “moderately severe.” Dr. C.B. noted the Veteran reported pain and that flare-ups result in decreased range of motion, increased pain, and decreased strength. It was noted the Veteran used arch supports and built-up shoes; for assisted devices it was noted the Veteran used a cane “constantly,” and also used crutches, yet the frequency of use of crutches is unclear. Dr. C.B. further found the Veteran had decreased longitudinal arch height on weight-bearing, objective evidence of marked deformity of one or both feet, and marked pronation; additionally, it was found the weightbearing line fell over or medial to the great toe. No range of motion measurements were performed. Functional loss and limitation of motion were described as less movement than normal; weakened movement; incoordination/impaired ability to execute skilled movements smoothly; pain on movement, weight-bearing, and nonweight-bearing; swelling; instability of station; and disturbance of locomotion. An April 2016 DBQ pertaining to the left ankle was also completed by Dr. C.B.; however, as noted previously, service connection for a left ankle disability was denied in a July 2016 rating decision, and that issue is not before the Board. Dr. C.B. determined that the Veteran’s plantar fasciitis/flat feet were due to his in-service injury where his foot was rolled over. This opinion was based, in part, on the Veteran’s lay statements, which showed chronicity of symptoms and the objective findings/imaging tests/diagnoses. In that same opinion pertaining to the Veteran’s ability to work, Dr. C.B. stated that the Veteran was unable to walk without a cane, that his gait due to his service-connected disabilities has caused him to be at risk for falls, and that “[m]anual labor is out of the question.” As noted above, the Board has found the Veteran not credible, particularly with his claims of continuity of symptomatology. Thus, Dr. C.B.’s opinion which found that the Veteran’s plantar fasciitis and flat feet (diagnosed in 2015/2016) were due to an incident which occurred in 1980, thirty-five years prior, and which was based in part on the Veteran’s report of continuous symptoms, to also be not credible. Notably, although metatarsalgia and nonunion/malunion of the metatarsal bones was indicated to be found, there are no opinions regarding these diagnoses. Notably, when the Veteran’s claim was last before the Board, it was remanded to obtain a new examination to reconcile the findings in the September 2015 VA examination and the April 2016 private examination. Unfortunately, as described previously, the Veteran’s failure to report for this examination resulted in the inability to obtain crucial evidence which may have lent support to his claims. See Wood, 1 Vet. App. at 193. Following a thorough review of the evidence of record, the Board finds that prior to September 1, 2015, a compensable rating for a left foot disability is not warranted. At his January 2011 VA foot examination, he described achiness and stiffness, particularly with weather changes and wrong-sized shoes; he stated his activities were not impaired by this condition and he was able to perform his usual occupation. November 2011 treatment record shows the Veteran enjoyed woodworking, home improvement projects, bicycling, and martial arts. At his February 2012 VA appointment to establish care with VA, his main complaint was right knee pain and he acknowledged continuing to exercise five days a week bike riding. While he acknowledged foot pain at a March 2012 VA mental health appointment, he did not indicate it prevented him from performing any activities and noted he had recently lost 45 pounds after joining the gym. To the extent that the Dr. C.B. indicated in the November 2014 opinion that the Veteran experienced instability and limping, the Board has found the Veteran’s statements not credible, and therefore, the fact that Dr. C.B. recorded what the Veteran has claimed to experience does not therefore become credible or competent evidence. Thus, a higher 10 percent rating is not warranted during this time as the preponderance of the evidence weighs against a finding the Veteran’s has experienced functional impairment due to this disability. Beginning September 1, 2015, a rating in excess of 10 percent is not warranted because preponderance of the evidence weighs against a finding that the Veteran’s impairment has more than moderate. Several VA treatment records reflect a normal gait with no deficits. See August 2016, August 2017, October 2018, and September 2019 Mental Health Notes; see also August 2019 and May 2020 Primary Care Physician Notes. These records do not indicate the Veteran used assistive devices such as a cane or crutches or that he limped; notably, an August 2018 treatment record for low back pain reflects he ambulated unassisted with no significant antalgia. Further, the alleged impairment described due to the Veteran’s left foot in the September 2015 and April 2016 reports is extremely contradictory with other evidence of record. Most significantly, in September 2015 the Veteran claimed to be limited to standing for 15 minutes and in April 2016 he informed Dr. C.B. he used a cane “constantly.” However, other evidence of record demonstrates the Veteran’s left foot does not cause the impairment he has claimed. At an August 2016 VA appointment, the Veteran reported he was very active; he stated he cut firewood the prior day and hunts elk and pheasant. A September 2016 Mental Health Note reflects the Veteran kept busy around his property cutting wood and concrete stamping. Significantly, at a June 2017 VA primary care appointment, the Veteran indicated he exercised regularly, hiked at high altitudes, and worked with no shoes. Records further reflects the Veteran enjoys spear fishing, scuba diving, and swimming while in Mexico and that while in Colorado he works on taking care of his ranch/farm and performing snow removal services. See August 2019 and May 2020 VA treatment notes. Significantly, at a May 2020 VA telehealth appointment, the Veteran reported he had a high activity level and denied any complaints of pain. This evidence clearly refutes Dr. C.B.’s assertions that the Veteran would be precluded from performing any manual labor. Thus, the Board finds the medical treatment records to be more probative than the Veteran’s statements at examinations for compensation purposes. The Board notes that in August 2019, the Veteran sought VA treatment because he fell while mowing and believed he popped his shoulder out. In fact, he stated he had been non-stop mowing and weed-eating since he returned from Mexico the prior week. The Board finds that had the Veteran felt his left foot disability caused this fall, he would have informed providers of this in order to receive proper care. Based on the foregoing, a compensable rating prior to September 1, 2015, and a rating in excess of 10 percent thereafter for a left foot disability is not warranted. The Board has considered whether rating the Veteran’s left foot disability under an alternative diagnostic code would warrant him a higher rating. However, the Board has found no probative evidence that his pes planus or plantar fasciitis are related to his service-connected left foot disability, to include the in-service injury. There is no indication that any loss of range of motion in his left ankle is related to his left foot disability. While Dr. C.B. found malunion or nonunion of the tarsal or metatarsal bones, there is no competent opinion linking this to the Veteran’s service or his service-connected left foot disability. Further, there is no probative evidence of weak foot, hammer toe, claw foot (pes cavus), hallux valgus, or hallux rigidus. See 38 C.F.R. § 4.71a, Diagnostic Codes 5278-84. There is no probative evidence of metatarsalgia prior to September 1, 2015, which would warrant a compensable rating and even considering, for the sake of argument that the Veteran’s metatarsalgia (first diagnosed in April 2016) is related to his service-connected left foot disability, to provide a separate rating absent separate manifestations of impairment would be pyramiding, which is prohibited. See 38 C.F.R. § 4.14. Consideration has also been given to the benefit of the doubt doctrine; however, as the preponderance of the evidence is against higher ratings for the Veteran’s left foot disability, it is not applicable. See 38 U.S.C. § 5107(b); see also Gilbert, 1 Vet. App. at 56. Additional Considerations In the November 2014 medical opinion, Dr. C.B. argues that there was CUE with respect to the 2011 rating decision which assigned a noncompensable rating for the Veteran’s left foot disability. Dr. C.B., who is not the Veteran’s representative, argued that the rater incorrectly applied the facts in the claims file by assigning the wrong rating, but did not make any actual arguments as to why CUE may be warranted. As noted previously, any claim of CUE must be plead with specificity, which has not been done here. See Andre, 14 Vet. App. at 10, aff’d sub nom, Andre, 301 F.3d 1354. Therefore, the Board finds no specific CUE claim has been filed by or on behalf of the Veteran; if the Veteran wishes to file a CUE claim with the AOJ, he or his representative must specify the specific rating decision being challenged and on what specific basis. Although Dr. C.B. has claimed that the Veteran’s left foot disability has caused him to be unemployable, entitlement to a total disability rating based on individual unemployability (TDIU) is in effect beginning March 20, 2010, the day following the date the Veteran last worked. Thus, entitlement to TDIU prior to then is not before the Board. Jennifer White Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board O'Connell, Jessica L. 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.