Citation Nr: 21002460 Decision Date: 01/13/21 Archive Date: 01/13/21 DOCKET NO. 12-23 345 DATE: January 13, 2021 ORDER Entitlement to an initial rating in excess of 30 percent since January 28, 2009, for posttraumatic stress disorder (PTSD) is denied. Entitlement to an initial compensable rating for pinguecula since January 28, 2009 is denied. Entitlement to a compensable rating since January 28, 2009 for hypertension is denied. Entitlement to a rating of 20 percent, but no higher, since January 28, 2009 for degenerative arthritis of the left ankle is granted. Entitlement to a rating in excess of 10 percent since January 28, 2009 for degenerative arthritis of the left knee is denied. Entitlement to an initial rating in excess of 10 percent since November 9, 2009 for limitation of extension of the left knee is denied. Entitlement to a separation rating of 20 percent, but no higher, since January 28, 2009 for meniscus disability of the left knee is granted. Entitlement to a rating in excess of 10 percent since January 28, 2009 for degenerative arthritis of the right knee is denied. Entitlement to an initial rating in excess of 10 percent since November 9, 2009 for limitation of extension of the right knee is denied. Entitlement to a separate rating of 20 percent, but no higher, since January 28, 2009 for meniscal disability of the right knee is granted. Entitlement to service connection for a headache disorder is granted. REMANDED The issue of entitlement to a compensable rating for degenerative joint disease of the right thumb, to include whether the reduction from 10 percent to a non-compensable rating since January 28, 2009 was proper is remanded. FINDINGS OF FACT 1. For the entire appeal period, the Veteran’s PTSD was manifested by psychiatric symptomatology resulting in occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, without more severe manifestations that more nearly approximate occupational and social impairment with reduced reliability and productivity, occupational and social impairment with deficiencies in most areas, or total occupational and social impairment. 2. The Veteran’s bilateral pinguecula does not cause visual impairment or incapacitating episodes and was not associated with conjunctivitis or disfigurement. 3. The Veteran’s hypertension requires continuous medication for control; his hypertension has not been productive of diastolic pressure predominantly 100 or more, a history of diastolic pressure predominantly 100 or more, nor systolic pressure predominately 160 or more. 4. The evidence is evenly balanced as to whether the Veteran’s left ankle disability more nearly approximated marked limitation of motion for the entire appeal period. 5. For the entire appeal period, the Veteran’s flexion of the left knee was not limited to 30 degrees or less. 6. For the entire appeal period, the Veteran’s extension of the left knee was not limited to 15 degrees or more. 7. The evidence is at least evenly balanced as to whether the Veteran’s left knee has frequent episodes of locking, pain, and effusion into the joint due to dislocated semilunar cartilage. 8. For the entire appeal period, the Veteran’s flexion of the right knee was not limited to 30 degrees or less. 9. For the entire appeal period, the Veteran’s extension of the right knee was not limited to 15 degrees or more. 10. The evidence is at least evenly balanced as to whether the Veteran’s right knee has frequent episodes of locking, pain, and effusion into the joint due to dislocated semilunar cartilage. 11. The evidence is at least evenly as balanced as to whether the Veteran’s headaches had onset while in service and are proximately due to his service-connected psychiatric disorder. CONCLUSIONS OF LAW 1. For the entire appeal period, the criteria for an initial rating in excess of 30 percent rating for PTSD have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9411. 2. The criteria for a compensable evaluation for bilateral pinguecula have not been met. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.79, Diagnostic Codes 6034, 6037. 3. The criteria for a compensable evaluation for hypertension have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.118, Diagnostic Code 7101. 4. With resolution of reasonable doubt, the criteria for a maximum 20 percent rating for left ankle disability have been met for the entire appeal period. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 4.1 4.7, 4.10, 4.40, 4.45, 4.71a, Diagnostic Code 5271. 5. The criteria for a rating in excess of 10 percent for degenerative disease of the left knee have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 4.1 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5010-5260. 6. The criteria for a rating in excess of 10 percent for limitation of extension for the left knee have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 4.1 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5261. 7. With reasonable doubt resolved in favor of the Veteran, the criteria for a separate initial 20 percent evaluation, but no higher, for left knee meniscal instability have been met since January 28, 2009. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1 - 4.7, 4.71a, Diagnostic Code 5258. 8. The criteria for a rating in excess of 10 percent for degenerative disease of the right knee have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 4.1 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5010-5260. 9. The criteria for a rating in excess of 10 percent for limitation of extension for the right knee have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 4.1 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5261. 10. With reasonable doubt resolved in favor of the Veteran, the criteria for a separate initial 20 percent evaluation, but no higher, for right knee meniscal instability have been met since January 28, 2009. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1 - 4.7, 4.71a, Diagnostic Code 5258. 11. With resolution of reasonable doubt in the Veteran’s favor, the criteria for service connection for chronic headaches as secondary to psychiatric disability have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1980 to September 1984, from March 2003 to June 2003, and from April 2006 to January 2009. He had additional service with the Army Reserve. He served in Southwest Asia and his military decorations include the Combat Action Badge. The Board previously remanded the issues for further development in December 2015 and December 2017. The case has now been returned to the Board for appellate review. Increased Rating Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155 ; 38 C.F.R., Part 4. Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the veteran working or seeking work. 38 C.F.R. § 4.2. All reasonable doubt will be resolved in the claimant’s favor. 38 C.F.R. § 4.3. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7. When the Veteran is awarded service connection and assigned an initial disability rating, separate disability ratings may be assigned for separate periods of time in accordance with the facts found. Such separate disability ratings are known as staged ratings. Fenderson v. West, 12 Vet. App. 119, 126 (1999) (noting that staged ratings are assigned at the time an initial disability rating is assigned). When the Veteran is requesting a higher rating for an already established service-connected disability, the present disability level is the primary concern and past medical reports do not take precedence over current findings. See Francisco v. Brown, 7 Vet. App. 55 (1994). However, “staged” ratings are appropriate for an increased rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007). Disability of the musculoskeletal system is primarily the inability, due to damage or inflammation of parts of the system, to perform the normal working movements of the body with normal excursion, strength, coordination, and endurance. 38 C.F.R. § 4.40. The functional loss may be due to the loss of part or all of the necessary bones, joints, and muscles, or associated structures, or to deformity, adhesions, defective innervations, or other pathology, or it may be due to pain, supported by adequate pathology, and evidenced by visible behavior of the claimant undertaking the motion. Id. Weakness is as important as limitation of motion, and a part which becomes painful on use must be regarded as seriously disabled. Other important factors include excess fatigability, or incoordination (to include during flare-ups or with repeated use), and those factors are not contemplated in the relevant rating. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also 38 C.F.R. § 4.40, 4.45, 4.59. 1. PTSD The Veteran is currently in receipt of an initial 30 percent rating for his PTSD since January 28, 2009, pursuant to Diagnostic Code 9411, which provides that such disability is evaluated pursuant to the General Rating Formula for Mental Disorders. See 38 C.F.R. § 4.130. He contends that such disability is more severe than as reflected by the currently assigned rating, and as such, a higher initial rating is warranted. Under the General Rating Formula, a 30 percent rating is warranted for occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events). A 50 percent rating is warranted when there is occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment, impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. Id. A 70 percent rating is warranted where there is occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work like setting); inability to establish and maintain effective relationships. Id. A 100 percent rating is warranted when there is total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication, persistent delusions or hallucinations, grossly inappropriate behavior, persistent danger of hurting self or others, intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene), disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. Id. The United States Court of Appeals for the Federal Circuit has held that the evaluation under 38 C.F.R. § 4.130 is “symptom-driven,” meaning that “symptomatology should be the fact-finder’s primary focus when deciding entitlement to a given disability rating” under that regulation. See Vazquez-Claudio v. Shinseki, 713 F.3d 112, 116-117 (Fed. Cir. 2013). The symptoms listed are not exhaustive, but rather “serve as examples of the type and degree of symptoms, or their effects, that would justify a particular rating.” Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). In the context of determining whether a higher disability evaluation is warranted, the analysis requires considering “not only the presence of certain symptoms, but also that those symptoms have caused occupational and social impairment in most of the referenced areas” - i.e., “the regulation...requires an ultimate factual conclusion as to the Veteran’s level of impairment in most areas.” Vazquez-Claudio, 713 F.3d at 117-118 ; 38 C.F.R. § 4.130, Diagnostic Code 9411. Further, when evaluating a mental disorder, the Board must consider the “frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the Veteran’s capacity for adjustment during periods of remission,” and must also “assign an evaluation based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner’s assessment of the level of disability at the moment of the examination.” 38 C.F.R. § 4.126 (a). Effective August 4, 2014, VA amended the portion of its Schedule for Rating Disabilities dealing with mental disorders and its adjudication regulations that define the term “psychosis” to remove outdated references to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and replace them with references to the recently updated DSM-5. See 79 Fed. Reg. 149, 45094 (August 4, 2014). The provisions of the interim final rule apply to all applications for benefits that are received by VA or that were pending before the Agency of Original Jurisdiction (AOJ) on or after August 4, 2014. VA adopted as final, without change, the interim final rule and clarified that the provisions of this interim final rule do not apply to claims that have been certified for appeal to the Board or are pending before the Board as of August 4, 2014, even if such claims are subsequently remanded to the AOJ. See 80 Fed. Reg. 53, 14308 (March 19, 2015). In the instant case, the Veteran’s claim was certified to the Board in April 2015 and, as such, the DSM-5 applies to his claim. In this regard, the Board notes that the DSM-5 removed reference to Global Assessment of Functioning (GAF) scores. After a review of the record, the Board finds that the Veteran is not entitled to an initial rating in excess of 30 percent for his PTSD. A December 2008 VA examination reflects a diagnosis of mild PTSD and adjustment disorder with mixed anxiety and depressed mood. The Veteran reported symptoms of poor sleep, recollections of the result of battle on some soldiers consulting a clinic, witnessing the aftermath of combat with casualties in Iraq in 2006. He reported that the symptoms were constant and affected his total daily functioning, which resulted in diminished capacity for work. He reported he had had trouble sleeping in the last 18 months, described as insomnia and repetitive dreams of being asked for help by a soldier and feeling unable to provide it. He also stated that since he developed his mental condition, there had been major changes in his daily activities, such as low mood and poor motivation. He was not receiving any treatment for his condition. Over the past year, he had received psychotherapy for his mental condition. There had not been any major social function changes since he had developed his mental condition. The examiner observed that affect and mood were abnormal with disturbance of motivation and mood. Communication, speech, and concentration were within normal limits. Panic attacks, suspiciousness, delusions, hallucinations, or obsessional rituals were absent. Thought processes were appropriate. Judgement was not impaired. Abstract thinking was normal. Memory was within normal limits. Suicidal or homicidal ideation was absent. The examiner determined that the Veteran’s psychiatric symptoms were mild or transient but caused occupational and social impairment with decrease in work efficiency and occupational tasks only during periods of significant stress. A February 2009 VA mental health initial assessment note indicates that the Veteran was seen for several counseling sessions prior to discharge, but received no medications. He denied a history of psychiatric hospitalizations, suicide attempts, auditory or visual hallucinations, paranoid or grandiose delusions, daily depressed mood for greater than or equal to two weeks, manic disorder, panic disorder, or obsessive compulsive disorder symptoms. He reported feeling more sensitive to things such as movies and some tearfulness a few times per month. He reported difficulty with work due to bending, squatting, and lifting. He reported he was able to concentrate in church but was easily distracted at work. He reported having initial and middle insomnia. He reported worrying about being physically able to remain at work long enough to take care of his family. The Veteran was diagnosed with subclinical PTSD. No medication was prescribed, and referral to a vet center for counseling for residuals of PTSD symptoms was made. A November 2012 VA mental health note indicates that the Veteran reported having been doing fair and still missing his mother who had died in July 2012. He reported having some troubles with nightmares or flashbacks. Citalopram was continued. A February 2015 VA mental health note indicates that the Veteran reported stress and tension at work and other stress involving his relative’s recent diagnosis of cancer. A May 2020 VA mental health initial evaluation note by a social worker indicates that the Veteran reported symptoms of anxiety and depression associated with his chronic pain and struggles dealing with pain from his injury and not feeling functional. He reported anxiety worsened when his knee pain worsened. Medication included duloxetine. The Veteran reported daily thoughts, dreams, night sweats of the in-service stressor events some days more so than the other. A September 2020 VA examination reflects a diagnosis of PTSD, in full remission, and adjustment disorder with mixed anxiety and depressed mood. The examiner stated that the Veteran no longer met the DSM 5 criteria for PTSD. The Veteran reported his symptoms have significantly subsided since his last VA examination. The examiner stated that the adjustment disorder addresses his mild anxiety with impact of chronic pain on the quality of his life at this time. Reported symptoms included depressed mood and anxiety. The examiner determined that the Veteran’s psychiatric symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication. Based on the foregoing, the Board finds that for the entire appeal period, the Veteran’s psychiatric disorder has been productive of symptoms such as depressed mood, anxiety, and chronic sleep impairment, productive of, at worst, occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. It did not manifest symptoms, in their frequency, severity, and duration, that are productive of occupational and social impairment with reduced reliability and productivity due to such symptoms as flattened affect, circumstantial, circumlocutory, or stereotyped speech, panic attacks more than once a week, difficulty understanding complex commands, impairment of short- and long-term memory, impaired judgment, impaired abstract thinking, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships. In sum, the Board finds that the preponderance of the evidence is against an initial rating in excess of 30 percent for the entire appeal period for the Veteran’s PTSD. Therefore, the benefit of the doubt doctrine is not applicable to the instant claim and his claim for a higher initial rating for his PTSD must be denied. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 2. Pinguecula The Veteran’s bilateral pinguecula is evaluated under Diagnostic Code 6099-6034. See 38 C.F.R. § 4.79. Hyphenated Diagnostic Codes are used when a rating under one Diagnostic Code requires use of an additional Diagnostic Code to identify the basis for the evaluation assigned. See 38 C.F.R. § 4.27. When an unlisted condition is encountered, it is permissible to rate under a closely related disease or injury in which not only the functions affected, but the anatomical localization and symptomatology are closely analogous. See 38 C.F.R. § 4.20. Diagnostic Code 6034 covers pterygium, and Diagnostic Code 6037 is provided for pinguecula. The Board will consider the Veteran’s pinguecula under both Diagnostic Codes. During the pendency of the appeal, VA issued a final rule revising the portion of the VA Schedule for Rating Disabilities that addresses the organs of special sense and schedule of ratings-eye. 89 Fed. Reg. 15316 (Apr. 10, 2018). The final rule went into effect May 13, 2018. Where there is a change in the rating criteria during the appeal period, the Board will consider the claim considering both the former and revised schedular rating criteria, although an increased evaluation based on the revised criteria cannot predate the effective date of the amendments. The former criteria for Diagnostic Code 6034 instructed to evaluate based on visual impairment, disfigurement (Diagnostic Code 7800), conjunctivitis (Diagnostic Code 6018), etc. depending on the particular findings. The revised criteria for Diagnostic Code 6034 instruct to evaluate based on the General Rating Formula for Diseases of the Eye, disfigurement (Diagnostic Code 7800), conjunctivitis (Diagnostic Code 6018), etc. depending on the particular findings, with all ratings to be combined pursuant to 38 C.F.R. § 4.25. Both former and revised criteria for Diagnostic Code 6037 instructs to rate based on disfigurement (Diagnostic Code 7800). Thus, evaluation under Diagnostic Code 6037 is part of the evaluation under Diagnostic Code 6034. The General Rating Formula for Diseases of the Eye instructs to rate based on incapacitating episodes or visual impairment, whichever would afford a higher rating. Thus, the change to the rating criteria effectively just added consideration of incapacitating episodes because visual impairment was to be considered in the former criteria. Regarding combining ratings under 38 C.F.R. § 4.25, this language appears to clarify how the rating criteria should be applied and does not represent a substantive change; separate disabling effects should have been combined pursuant to 38 C.F.R. § 4.25 under the former criteria. For a compensable rating based on incapacitating episodes under the General Rating Formal for Diseases of the Eye, a veteran must have required at least one but less than 3 treatment visits for his eye condition during the past 12 months. For the purposes of evaluations under 38 C.F.R. § 4.79, an incapacitating episode is an eye condition severe enough to require a clinic visit to a provider specifically for treatment purposes. 38 C.F.R. § 4.79, Note (1) (2018). Note (2) indicates that examples of treatment may include but are not limited to: systemic immunosuppressants or biologic agents; intravitreal or periocular injections; laser treatments; or other surgical interventions. 38 C.F.R. § 4.79 (2018). Here, the Veteran has not contended, and the record does not suggest, that the Veteran had undergone any treatment visits for his eye condition within 12 months of the effective date of the change in the rating criteria. Therefore, a compensable rating is not warranted based on incapacitating episodes. The evaluation of visual impairment is based on impairment of visual acuity (excluding developmental errors of refraction), visual field, and muscle function. 38 C.F.R. § 4.75 (a). The amendments made no substantive changes to how visual acuity is rated. With regard to visual field and muscle function examinations, the use of a Goldmann chart is no longer required. There are otherwise no substantive changes to how those types of visual impairment are rated. Evaluation of visual acuity is based on corrected distance vision with central fixation. 38 C.F.R. § 4.76(b)(1). The measurements for each eye are applied to the table for Impairment of Central Visual Acuity. 38 C.F.R. § 4.76(c). Diagnostic Code 6066 provides ratings where vision in one eye (the poorer eye) is 10/200 or better. Where the visual acuity in both eyes is 20/40, a 0 percent rating is warranted. Here, for the entire appeal period, the Veteran’s corrected distance vision was 20/20 in each eye, as reflected in a December 2008 VA examination and a September 2020 VA examination. Thus, a compensable rating is not available for visual acuity. Evaluation of visual field is based on the remaining field of vision in each eye. 38 C.F.R. § 4.77. Here, the Veteran has not complained of restricted field of vision in his eyes and treatment records do not note any visual field loss. Both the December 2008 and September 2020 VA examiners also noted no visual field defect. Therefore, a compensable rating is not warranted for impairment of visual field. Evaluations of visual impairment of muscle function is based on the degree of diplopia. 38 C.F.R. § 4.78(a). Here, the Veteran has not complained of diplopia and treatment records do not note any diplopia. The December 2008 and September 2020 VA examiners also indicated that the Veteran does not have diplopia. Therefore, a compensable rating is not warranted for impairment of muscle function. Disfigurement of the head, face, or neck is rated under Diagnostic Code 7800. A compensable rating requires at least one of the following characteristics of disfigurement: a scar more than 13 cm in length, a scar at least 0.6 cm wide, surface contour of scar elevated or depressed on palpation, scar adherent to underlying tissue, or any of the following in an area exceeding 39 square cm: skin hypo- or hyper-pigmented, skin texture abnormal, underlying soft tissue missing, or skin indurated and inflexible. 38 C.F.R. § 4.118. The December 2008 and September 2020 VA examinations indicate that the Veteran has no scarring or disfigurement associated with his bilateral pinguecula and the record does not otherwise reflect that he has any characteristics of disfigurement. Thus, the Board finds that the Veteran’s service-connected pinguecula does not result in any characteristics of disfigurement such that a rating would be warranted under Diagnostic Code 7800. The Board has also considered whether the Veteran is entitled to a compensable rating for conjunctivitis under Diagnostic Code 6018. Both the former and revised criteria for Diagnostic Code 6018 distinguish active and inactive disease processes. Under the former criteria, an active disease process (with objective findings, such as red, thick conjunctivitae, mucous secretion, etc.) is assigned a 10 percent rating. 38 C.F.R. § 4.79 (2008) Under the revised criteria, an active disease process is rated pursuant to the General Rating Formula for Diseases of the Eye, with a minimum rating of 10 percent. 38 C.F.R. § 4.79 (2018). Both the former and revised criteria state that inactive chronic conjunctivitis is to be rated based on residuals such as visual impairment of disfigurement. Here, the evidence does not suggest any findings indicative of any issues with conjunctiva for the entire appeal period. Thus, a compensable rating under Diagnostic Code 6018 is not warranted. Based on the forgoing, the Board finds that a preponderance of the evidence is against a compensable rating for bilateral pinguecula, for the Veteran’s service-connected eye disability does not impact his visual function to a compensable degree nor result in conjunctivitis, disfigurement, or incapacitating episodes. 3. Hypertension The Veteran is seeking a compensable rating for his service-connected hypertension. The Veteran’s service-connected hypertension has been evaluated as noncompensable under 38 C.F.R. § 4.104, Diagnostic Code 7101. Pursuant to Diagnostic Code 7101, a 10 percent rating is warranted where diastolic pressure is predominantly 100 or more, systolic pressure is predominantly 160 or more, or the individual has a history of diastolic pressure of predominantly 100 or more and requires continuous medication for control. A 20 percent disability rating requires diastolic pressure predominantly 110 or more, or systolic pressure predominantly 200 or more. A 40 percent disability rating requires diastolic pressure predominantly 120 or more. A 60 percent disability rating requires diastolic pressure predominantly 130 or more. 38 C.F.R. § 4.104. In every instance in which the Ratings Schedule does not provide a zero percent disability rating for a Diagnostic Code, a zero percent shall be assigned when the requirements for a compensable disability rating are not met. 38 C.F.R. § 4.31. Here, the evidence of record shows that for the entire appeal period, the Veteran’s hypertension requires continuous medication, but diastolic pressure was never predominantly 100 or more, systolic pressure was never predominantly 160 or more. Both December 2009 and September 2020 VA examinations did not indicate that his hypertension was worse than described in his medical treatment records. As such, the Veteran cannot be said to have a history of diastolic pressure predominantly 100 or more. Thus, a 10 percent rating is not warranted. Accordingly, the preponderance of the evidence is against the claim for a compensable rating for the Veteran’s hypertension, and the benefit-of-the-doubt doctrine does not apply. 38 U.S.C. § 5107. 4. Left ankle The Veteran’s left ankle disability is rated 10 percent under Diagnostic Code 5271, which provides for a 10 percent evaluation for moderate limitation of motion of the ankle, and a 20 percent evaluation for marked limitation of motion of the ankle. 38 C.F.R. § 4.71a, Diagnostic Code 5271. The normal range of motion of the ankle is 20 degrees of dorsiflexion and 45 degrees of plantar flexion. 38 C.F.R. § 4.71a, Plate II. The words “moderate” and “marked” used in Diagnostic Code 5271 are not defined in the Rating Schedule. Rather than applying a mechanical formula, the Board must evaluate all of the evidence to the end that its decisions are “equitable and just.” 38 C.F.R. § 4.6. In addition, Diagnostic Code 5270 provides a 30 percent evaluation for ankylosis of an ankle, in plantar flexion, between 30 degrees and 40 degrees, or in dorsiflexion, between 0 and 10 degrees; and a 40 percent evaluation is potentially available with ankylosis in plantar flexion at more than 40 degrees, or in dorsiflexion at more than 10 degrees or with abduction, adduction, inversion or eversion deformity. 38 C.F.R. Part 4, Diagnostic Code 5270. An October 2008 Physical Evaluation Board proceedings report notes left ankle pain following arthroscopic repair. Dorsiflexion was limited to 15 degrees and plantar flexion to 30 degrees. A December 2008 VA examination reflects a diagnosis of degenerative arthritis of the left ankle joints, left ankle sprain status post left ankle surgery with scarring. The Veteran reported that he originally injured his left ankle in 1983 and reinjured it in 2007. He underwent a surgery in 2008. He reported weakness, stiffness, swelling, heat, lack of endurance, and fatigability. He did not have redness, giving way, locking, or dislocation. He reported pain in the left side and rear of the ankle, which occurred constantly. The pain traveled to upper ankle and into the left side of the foot. The pain was reported crushing, burning, aching, and sharp. The pain could be elicited by physical activity and relieved by rest and by Tylenol. At the time of pain, he was able to function without medication. He was not receiving any treatment for his condition. The Veteran reported that after aggravation, he could no longer walk or stand for long periods of time. On physical examination, tenderness was noted on the left ankle with no signs of edema, effusion, weakness, redness, heat, and guarding of movement. There was no subluxation nor deformity. The range of motion was as follows: dorsiflexion to 20 degrees and plantar flexion to 45 degrees. The joint function was not additionally limited by pain, fatigue, weakness, lack of endurance, or incoordination after repetitive use. In January 2010, the Veteran stated that he still has an impingement in the left ankle even after surgery that could not effectively be removed and after having two surgeries on his ankle, he would more likely than not have to live with the pain and instability. A May 2018 VA treatment record indicates that the Veteran had a complaint of bilateral ankle and foot pain. He reported episodes of deep aching pain in the medial or lateral columns. The surgical history notes a 1983 Evans procedure in the left foot and a 2008 lateral ankle stabilization of the left ankle. Assessment was lateral ankle impingement with sinus tarsitis, right greater than left, pain in foot and ankle, right greater than left, metatarsalgia, right greater than left, history of previous Evans and left ankle stabilization, left ankle, and bilateral pes planus. Bauerfeind ankle brace was ordered for increased proprioception and support. A September 2020 VA examination reflects a diagnosis of degenerative arthritis of the left ankle, post operative with residual scar. The Veteran reported that current symptoms were continuous soreness, swelling, and pain when walking. The treatment included ibuprofen, foot and ankle support and/or ace bandages. The impact of the condition was inability to place pressure on the ankle on most days. Flareup for the left ankle was reported to occur 2 to 3 times per week in a moderate to severe degree, with each episode lasting for 1 to 4 days. The flareups were precipitated by prolonged standing and walking and alleviated by ice and heat. The Veteran reported his inability to walk normal and loss of balance due to his ankle. The range of motion for the left ankle found dorsiflexion to 15 degrees and plantar flexion to 30 degrees. The range of motion itself does not contribute to a functional loss. Pain was noted for both motions and caused functional loss. Tenderness was noted on anterior and lateral ankle. With repeated use over time and during flareup, pain caused functional loss and the loss was described as dorsiflexion to 10 degrees and plantar flexion to 25 degrees. Swelling, disturbance of locomotion, and instability of station were noted. There was no reduction in muscle strength or no muscle atrophy. There was no ankylosis. No instability or dislocation was suspected. A scar on the lateral malleolus from a surgery was noted with length 5.5 cm by width 0.5 cm; it was not painful or unstable. Constant use of braces, occasional use of crutches and canes were noted. The Veteran reported that he used a left knee brace daily and cane and crutch with prolonged standing or pain due to flareups. The examiner noted that when the condition flared, the Veteran had temporary limitations with prolonged standing and ambulation greater than 120 minutes at a time without a 15 minute sit-down or stretching break. There was objective evidence of pain on passive range of motion testing of the left ankle and no evidence of pain on non-weight bearing testing of the left ankle. The Board finds that resolving reasonable doubt in the Veteran’s favor, his left ankle disability has been manifested by marked limitation of motion for the entire appeal period, as evidenced by reduced limitation of motion in the October 2008 Physical Evaluation Board report and by further reduction during flareup and with repeated use over time in dorsiflexion to 10 degrees and plantar flexion to 25 degrees with pain, as reported in the September 2020 VA examination. A higher evaluation is not warranted because for the entire appeal period, there was no ankylosis. In sum, with resolution of reasonable doubt in the Veteran’s favor, an evaluation of 20 percent, but no higher, for the left ankle disability for the entire appeal period is granted. 5. Degenerative arthritis of left knee 6. Limitation of extension for left knee 7. Degenerative arthritis of right knee 8. Limitation of extension for right knee The Veteran’s bilateral knee disability is rated as 10 percent disabling under Diagnostic Code 5010-5260. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the evaluation assigned. The additional code is shown after a hyphen. Additional 10 percent ratings have been assigned for bilateral knee limitation of extension under Diagnostic Code 5261. The Veteran contends that his bilateral knee disability is more severe than the currently assigned ratings and that he is entitled to higher ratings. Diagnostic Code 5010 refers to Diagnostic Code 5003, which provides that degenerative arthritis will be rated based on limitation of motion under the appropriate diagnostic codes for the specific joint involved. Diagnostic Code 5003 also provides for a 20 percent rating for arthritis where X-ray evidence shows involvement of 2 or more major joints or 2 or more minor joint groups, with occasional incapacitating exacerbations. Diagnostic Code 5260 addresses limitation of flexion of the leg. Flexion limited to 60 degrees warrants a noncompensable rating. Flexion limited to 45 degrees warrants a 10 percent rating. Flexion limited to 30 degrees warrants a 20 percent rating. Flexion limited to 15 degrees warrants a 30 percent rating. 38 C.F.R. § 4.71a, Diagnostic Code 5260. Diagnostic Code 5261 addresses limitation of extension of the leg. Extension limited to 10 degrees warrants a 10 percent rating. Extension limited to 5 degrees warrants a noncompensable rating. Extension limited to 15 degrees warrants a 20 percent rating. Extension limited to 20 degrees warrants a 30 percent rating. Extension limited to 30 degrees warrants a 40 percent rating. Extension limited to 45 degrees warrants a 50 percent rating. 38 C.F.R. § 4.71a, Diagnostic Code 5261. Separate ratings may be assigned under Diagnostic Code 5260 (limitation of flexion of the leg) and Diagnostic Code 5261 (limitation of extension of the leg). VAOPGCPREC 9-2004. Lateral instability and limitation of motion of the knee may be rated separately under Diagnostic Codes 5257 and 5003. VAOPGCPREC 23-97. Under Diagnostic Code 5257, a 10 percent evaluation is assigned for slight recurrent subluxation or lateral instability. A 20 percent rating is assigned for moderate recurrent subluxation or lateral instability. A 30 percent disability rating is assigned under Diagnostic Code 5257 for severe recurrent subluxation or lateral instability. Diagnostic Code 5258 provides a 20 percent rating for dislocation of semilunar cartilage with frequent episodes of “locking,” pain, and effusion into the joint. 38 C.F.R. § 4.71a , Diagnostic Code 5258. Diagnostic Code 5259 provides a 10 percent rating for removal of semilunar cartilage that is symptomatic. Evaluation of a knee disability under Diagnostic Codes 5257 or 5261 or both does not, as a matter of law, preclude separate evaluation of a meniscal disability of same knee under Diagnostic Code 5258 or 5259, and vice versa. Lyles v. Shulkin, 28 Vet. App. 107 (2017). The Court further held that entitlement to a separate evaluation in a given case depends on whether the manifestations of disability for which a separate evaluation is being sought have already been compensated by an assigned evaluation under a different Diagnostic Code. Diagnostic Code 5263 provides a10 percent rating for genu recurvatum (acquired, traumatic, with weakness and insecurity in weight-bearing objectively demonstrated). 38 C.F.R. § 4.71a , Diagnostic Code 5263. Genu recurvatum is hyperextension of the knee. DORLAND’S ILLUSTRATED MEDICAL DICTIONARY (31st Ed. 2007) at 782. An October 2008 Physical Evaluation Board proceedings report reflects a diagnosis of degenerative arthritis of bilateral knees with range of motion from 0 to 100 degrees for the left knee and from 0 to 105 degrees on the right. A December 2008 VA examination reflects a diagnosis of degenerative arthritis of left and right knee joints and left and right knee strain and chondromalacia, status post left knee surgery with scarring. The Veteran reported symptoms of weakness, stiffness, swelling, heat, lack of endurance, and fatigability. He did not have redness, giving way, locking, and dislocation. He reported pain in the knees which occurred constantly. The pain traveled to lower thigh with swelling. The pain was burning, aching, oppressing, and sharp. The pain was elicited by physical activity and relieved by rest and Celebrex and Tylenol. On physical examination, tenderness was observed for both knees. There was no sign of edema, effusion, weakness, redness, heat, and guarding of movement for both knees. There was no subluxation for both knees. Both knees revealed crepitus. There was no genu recurvatum and locking pain for either knee. The range of motion was as follows: flexion to 140 degrees and extension to 0 degree for both knees. The joint function was not additionally limited by pain, fatigue, weakness, lack of endurance, or incoordination after repetitive use. The anterior and posterior cruciate ligaments stability test was within normal limit for both knees. The medial and lateral collateral ligaments stability test was within normal limit for both knees. A December 2009 VA examination reflects a diagnosis of mild degenerative disease of the right knee and degenerative disease of the left knee. The Veteran reported being diagnosed with patella replacement needed. Running and training had deteriorated the cartilage and bones in his knees. He reported symptoms of weakness, stiffness, swelling, heat, giving way, lack of endurance, fatigability, tenderness, and pain. He did not experience redness, locking, deformity, drainage, effusion, subluxation, and dislocation. He reported having flareups, which were precipitated by physical activity, driving, and standing and alleviated by Celebrex and Tylenol. The Veteran experienced functional impairment of difficulty in doing normal household duties and limitation of motion in bending, walking, on stairs, and on uneven ground. A linear, superficial scar from arthroscopy was noted in the anterior lateral left patella. The scar was not painful nor caused functional limitation. The range of motion testing yielded the following result: flexion was limited to 130 degrees with pain and extension was to 10 degrees for the right knee and flexion was limited to 110 degrees with pain and extension was to 20 degrees with pain for the left knee. The joint function was not additionally limited by incoordination after repetitive use. The medial/lateral collateral ligaments stability test, the anterior/posterior cruciate ligaments stability test, and the medial/lateral meniscus stability test were all within normal limit. A March 2010 workers’ compensation status form shows that the Veteran had left knee medial meniscus tear, as a result of injury incurred while working in February 2010. He was scheduled to undergo a surgery in April 2010. A February 2010 VA treatment record, dated after the February 2010 injury, shows that the Veteran had a new onset of pain to medial aspect of the left knee pain, unrelieved by medications. An August 2014 private treatment record indicates that the Veteran had complaints of bilateral knee pain. The Veteran reported bilateral knee pain due to repetitive bending and stooping. He reported that an October 2002 x ray showed beginning arthrosis, worse on the right than the left, involving the tibial femoral joint and patella femoral joint. The impression was that of early arthritic changes worse on the right than the left, patella femoral pain, and possible meniscal tear. After coming back from deployment, he was diagnosed with bilateral patella femoral joint isolated osteoarthrosis as well as severe end stage degenerative joint disease of both patella femoral joints. He reported having a surgery in March 2008 to the left knee consisting of arthroscopic debridement, partial medial meniscectomy, chondroplasty of the patella, and lateral retinacular release. He was told then that the right knee had a partial tear of posterior collateral ligament, as well as other damage, but surgery was not recommended. In 2012, he underwent a second left knee arthroscopy in 2012 due to a meniscal rupture, followed by physical therapy. The Veteran reported pain localized to the medial and lateral aspect of both knees. The pain was aggravated by kneeling, squatting, using stairs, prolonged sitting, prolonged standing, and prolonged walking. Associated symptoms included recurrent swelling in both knees, as well as weakness of both knees, especially when walking down an incline. Functional limitations were reported for kneeling, heavy lifting, reaching overhead, reaching away from the body, sitting longer than 30 minutes, squatting, ascending or descending stairs, standing longer than 10 minutes. The range of motion test found right flexion was full to 150 degrees with pain on the right and limited to 120 degrees with pain on the left. The extension was full to 0 degrees with no pain for both knees. The ligamentous testing of the knees revealed good stability in both. McMurray test was negative bilaterally and so was Lachman test. There was no intraarticular swelling. A September 2020 VA examination reflects a diagnosis of degenerative arthritis of bilateral knees and status post meniscectomy twice with mild flexion deformity of the left knee. The Veteran reported that the current symptoms were soreness and swelling and the current treatment consisted of pain medication such as ibuprofen, knee supports, braces, cane, crutches at times, and injections. The functional impact reported was inability to walk or stand without assistance and limited walking and standing most days. Flareups of the right knee occurred weekly in a moderate to severe degree, lasting for 1 to 2 weeks. They were precipitated by running and jumping and alleviated by ice, heat, pain medications, and injections. Flareups of the left knee occurred daily in a mild to severe degree, lasting for 1 to 2 weeks. They were precipitated by prolonged standing and walking and alleviated by ice, heat, supports, braces, and elevation. The Veteran reported functional use of the knees were “limited to no movement” with repeated use over time. The initial range of motion was as follows: 0 to 110 degrees for the right knee and 0 to 100 degrees for the left knee. Pain was noted with flexion and extension and caused functional loss for both knees. Mild tenderness in the medial right knee and in the anterior and lateral left knee was observed. After observed repetitive use, the flexion reduced to 105 degrees for the right knee and to 90 degrees for the left knee. The extension of the left knee reduced to 7.5 degrees. The same reduced range of motion was noted for each knee for repeated use over time and during flareups. The examiner noted swelling and disturbance of locomotion for the right knee, and pain and swelling occurred as reported with prolonged standing with pain extending down lateral along the leg to the ankle. As for the left knee, the examiner noted swelling, instability of station, and disturbance of locomotion. Mild flexion deformity of the left knee affected gait, stance, and normal ambulation. There was no muscle weakness or atrophy. No ankylosis was found. There was no history of recurrent subluxation or lateral instability for both knees. Recurrent swelling with prolonged standing, which worsened with activity, was noted. Joint stability testing was normal for both knees. As for meniscal condition, frequent episodes of joint locking, joint pain was noted for both knees. The right knee had frequent episodes of joint effusion, and the left knee had meniscal tear. There was persistent pain, locking, and swelling of bilateral knees despite two surgeries on the left knee. Four arthroscopic scars of the size 1 cm by 0.2 cm were found in the anterior left knee; they were not painful nor unstable. Constant use of brace, occasional use of crutches and cane were noted. The Veteran reported using a left knee brace daily and cane and crutch with prolonged standing or pain due to flareups. The impact on his ability to perform any occupational task was limited standing and ambulation. The examiner stated depending on the severity of the flare, the Veteran would be limited to standing and walking for 30 minutes at a time. There was objective evidence of pain on passive range of motion testing of bilateral knees, and there was no objective evidence of pain on non-weight bearing testing of the bilateral knees. The Board finds that a rating in excess of 10 percent under Diagnostic Code 5260 is not warranted for either knee, for the evidence does not show that the Veteran’s flexion was limited to 30 degrees or less for the entire appeal period. Also, a rating in excess of 10 percent under Diagnostic Code 5261 is not warranted for either knee, for the evidence does not show that the Veteran’s extension was limited to 15 degrees or more for the entire appeal period. Since the evidence does not show that the Veteran has ankylosis, impairment of tibia and fibula, or genu recurvatum, an evaluation under Diagnostic Codes 5256, 5262, and 5263 is not available. In addition to the limitation of motion and painful motion, the Veteran reports instability associated with meniscus. Although recurrent subluxation or lateral instability was not found, the Veteran consistently reported having frequent episodes of locking, pain, and effusion in both knees. As noted by the most recent VA examination in September 2020, despite multiple surgeries, he still has these conditions in both knees as a result of meniscus disability. The August 2014 private treatment record indicates that the Veteran had partial meniscectomy of the left knee and a partial tear of posterior collateral ligament in the right knee as of 2008. Further he had left knee arthroscopy in 2012 due to a meniscal rupture. Therefore, resolving reasonable doubt in the Veteran’s favor, the Board finds that under Diagnostic Code 5258, a separate evaluation of 20 percent, which is the maximum rating allowed under the Diagnostic Code, for each knee since January 28, 2009 is warranted. Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). To establish entitlement to service-connected compensation benefits, a veteran 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. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010). Service connection may be granted for any disease initially diagnosed after service when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection may also be granted for a disability that is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). This permits service connection not only for a disability caused by a service-connected disability, but for the degree of disability resulting from aggravation of a disability by a service-connected disability. See Allen v. Brown, 7 Vet. App. 439, 448 (1995). In the case of aggravation by a service-connected disability, a veteran may be compensated for the degree of disability over and above the degree of disability existing prior to the aggravation. Id; see also 38 C.F.R. § 3.310(b). In addition, for veterans with 90 days or more of active service during a war period or after December 31, 1946, certain chronic diseases, including other organic diseases of the nervous system, are presumed to have been incurred in service if they manifested to a compensable degree within one year of separation from service. 38 U.S.C. §§ 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. Pursuant to 38 C.F.R. § 3.303(b), where a chronic disease is shown as such in service, subsequent manifestations of the same chronic disease are generally service connected. If a chronic disease is noted in service but chronicity in service is not adequately supported, a showing of continuity of symptomatology after separation is required. Entitlement to service connection based on chronicity or continuity of symptomatology pursuant to 38 C.F.R. § 3.303(b) applies only when the disability for which the Veteran is claiming compensation is due to a disease enumerated on the list of chronic diseases in 38 U.S.C. § 1101 (3) or 38 C.F.R. § 3.309(a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). In its determinations, the Board must fully consider the lay assertions of record. A layperson is competent to report on the onset and continuity of his current symptomatology. 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 1372, 1376-77 (Fed. Cir. 2007). Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits. VA shall consider all information and lay and medical evidence of record in a case and when there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102 ; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). 9. Chronic headaches The Veteran contends that he has chronic headaches that are related to his service. A review of his service treatment records indicates that the Veteran started to have complaints of headaches since 2007. An October 2008 Physical Evaluation Board proceedings report does not contain evaluation for headaches. A July 2012 VA treatment record indicates that the Veteran complained balance issues when he was experiencing headaches on the right side of the head and the right eye. An August 2014 private treatment record notes a history of headaches. An April 2016 VA examination reflects a diagnosis of unspecified headaches. The Veteran reported that headaches had started in 2006 when he was in Iraq. He related them as being due to multiple bomb blasts and repeated noises. Currently, he would get headaches off and on and treat them by medication such as ibuprofen. A September 2020 VA examination reflects a diagnosis of migraine including migraine variants. The examiner noted that the condition had started in 2006. The Veteran reported worsening severity of the headaches and that he had slight headaches at the time of examination. The issue before the Board is whether the Veteran’s current headaches are etiologically related to his service or, alternatively, proximately due to or aggravated by his service-connected disability. A September 2020 VA examiner for psychiatric disability stated that the Veteran’s depression and anxiety could also contribute to sleep apnea and migraines. On the other hand, an April 2016 examiner and a September 2020 examiner provided a negative opinion. Both examiners relied on a lack of sufficient documentation in the service treatment records when providing an opinion for direct nexus. The Board finds that those opinions afford no weight as they did not consider the Veteran’s report of symptomatology of a subjective condition such as headaches when rendering the opinions. As for secondary service connection, the September 2020 VA examiner provided a negative opinion because there is no pathophysiology between headaches and any of the service-connected disabilities. The Board finds that the evidence is in equipoise as to whether the Veteran’s headaches are proximately due to or aggravated by his service-connected psychiatric disorder. Two medical professionals could reasonably disagree in an etiology of a subjective medical condition such as headaches. Moreover, although the Veteran’s headaches have been alleviated by an over-the-counter medication over the years, the Veteran’s report of having headaches since 2006 has been consistent, and his consistent report of subjective symptomatology such as headaches is given probative weight unlike other medical conditions that would require objective verification. In sum, the Board finds that the evidence presently before the Board is sufficient to grant the appeal: the Veteran has been diagnosed with headaches, and the evidence is at least evenly balanced as to whether the Veteran’s headaches started while in service and as to whether the headaches are aggravated by service-connected psychiatric disorder. As the reasonable doubt created by this relative equipoise in the evidence must be resolved in favor of the Veteran, entitlement to service connection for chronic headaches is warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. REASONS FOR REMAND The issue of entitlement to a compensable rating for degenerative joint disease of the right thumb, to include whether the reduction from 10 percent to a non-compensable rating since January 28, 2009 was proper is remanded. In December 2015 and December 2017, the Board remanded the issue above for issuance of a statement of the case. Such statement has not yet been issued, resulting in a violation of Stegall v. West, 11 Vet. App. 268 (1998). The matters are REMANDED for the following action: Issue a statement of the case to the Veteran and his accredited representative, which addresses the issue of entitlement to a compensable rating for degenerative joint disease of the right thumb, to include whether the reduction from 10 percent to a non-compensable rating since January 28, 2009, was proper. M. Miller Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Y. Taylor, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.