Citation Nr: 21005198 Decision Date: 01/29/21 Archive Date: 01/29/21 DOCKET NO. 20-11 387 DATE: January 29, 2021 ORDER Service connection for an acquired psychiatric disorder, to include general anxiety disorder, is granted. Service connection for headaches is denied. Service connection for a respiratory disability is denied. Service connection for gastroesophageal reflux disease (GERD) is denied. Service connection for an infection of the tonsils is denied. Service connection for irritable bowel syndrome (IBS) is denied. Service connection for fatigue is denied. Service connection for hypertension is denied. Service connection for radiculopathy of the left lower extremity is denied. Service connection for bilateral shin splints is denied. Service connection for hemorrhoids is denied. Service connection for a retracted testicle is denied. Service connection for a low sex drive is denied. An effective date prior to February 13, 2018 for service connection for a left foot bunion, a right foot bunion, and tinnitus, is denied. An effective date prior to October 31, 2018 for service connection for degenerative arthritis of the spine to include spinal stenosis, right knee posttraumatic tendinopathy, limitation of right knee flexion, and radiculopathy of the right lower extremity, is denied. An initial evaluation in excess of 10 percent for radiculopathy of the right lower extremity is denied. An initial evaluation of 10 percent, and no more, for service-connected right foot bunion is granted, subject to the laws and regulations governing the award of monetary benefits. An initial evaluation in excess of 10 percent for service-connected left foot bunion is denied. An initial evaluation in excess of 10 percent for service-connected tinnitus is denied. REMANDED The claims for service connection for flat feet, a hammertoe of the left foot, and left foot fungus, are remanded. The claim for an initial evaluation in excess of 10 percent for degenerative arthritis of the spine, to include spinal stenosis, is remanded. The claim for an initial evaluation in excess of 10 percent for limitation of right knee flexion is remanded. The claim for an initial evaluation in excess of 10 percent for right knee tendinopathy is remanded. The claim for a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is remanded. FINDINGS OF FACT 1. The Veteran does not have headaches that either began during or was otherwise caused by his military service. 2. The Veteran does not have a respiratory disability that either began during or was otherwise caused by his military service. 3. The Veteran does not have GERD that either began during or was otherwise caused by his military service. 4. The Veteran does not have an infection of the tonsils that either began during or was otherwise caused by his military service. 5. The Veteran does not have IBS that either began during or was otherwise caused by his military service. 6. The Veteran does not have fatigue that either began during or was otherwise caused by his military service. 7. The Veteran does not have hypertension that either began during or was otherwise caused by his military service. 8. The Veteran does not have radiculopathy of the left lower extremity that either began during or was otherwise caused by his military service, or that was caused or aggravated by service-connected disability. 9. The Veteran does not have shin splints that either began during or were otherwise caused by his military service. 10. The Veteran does not have hemorrhoids that either began during or was otherwise caused by his military service. 11. The Veteran does not have a retracted testicle that either began during or was otherwise caused by his military service. 12. The Veteran does not have a low sex drive that either began during or was otherwise caused by his military service. 13. On February 13, 2018, the Veteran filed claims for service connection for bilateral foot bunions and tinnitus. 14. On October 31, 2018, the Veteran filed claims for service connection for a bilateral knee disability and a back disability. 15. The Veteran’s radiculopathy, right lower extremity, is not shown to have been productive of moderate incomplete paralysis, neuritis, or neuralgia, of the sciatic nerve. 16. The Veteran’s left foot bunion has been manifested by pain, but not symptoms equivalent to a moderately severe foot injury. 17. The Veteran’s right foot bunion has been manifested by pain, but not symptoms equivalent to a moderately severe foot injury. 18. The 10 percent rating currently in effect for tinnitus is the maximum schedular rating available for the disability. 19. The Veteran generalized anxiety disorder onset during his military service. CONCLUSIONS OF LAW 1. The criteria for headaches have not been met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.317. 2. The criteria for a respiratory disability have not been met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.317. 3. The criteria for service connection for GERD have not been met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.317. 4. The criteria for service connection for an infection of the tonsils have not been met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.317. 5. The criteria for service connection for IBS have not been met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.317. 6. The criteria for service connection for fatigue have not been met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.317, 4.88. 7. The criteria for service connection for hypertension have not been met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.317. 8. The criteria for service connection for radiculopathy of the left lower extremity have not been met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.317. 9. The criteria for service connection for shin splints have not been met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.317. 10. The criteria for service connection for hemorrhoids have not been met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.317. 11. The criteria for service connection for a retracted testicle have not been met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.317. 12. The criteria for service connection for low sex drive have not been met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.317. 13. The criteria for effective dates for service connection prior to February 13, 2018 for a left foot bunion, and a right foot bunion, have not been met. 38 U.S.C. §§ 5101 (a), 5110; 38 C.F.R. §§ 3.151, 3.155, 3.400. 14. The criteria for effective dates for service connection prior to October 31, 2018 for degenerative arthritis of the spine to include spinal stenosis, right knee posttraumatic tendinopathy, limitation of right knee flexion, and radiculopathy of the right lower extremity, have not been met. 38 U.S.C. §§ 5101 (a), 5110; 38 C.F.R. §§ 3.151, 3.155, 3.400. 15. The criteria for an initial evaluation in excess of 10 percent for radiculopathy, right lower extremity, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.7, 4.124a, Diagnostic Codes 8520, 8620, 8720. 16. The criteria for an initial 10 percent evaluation, and no more, for service-connected right foot bunion have been met. 38 U.S.C. §§ 1155, 5107, 5110; 38 C.F.R. §§ 3.102, 3.159, 4.71a, Diagnostic Codes 5280, 5284. 17. The criteria for an initial evaluation in excess of 10 percent for service-connected left foot bunion have not been met. 38 U.S.C. §§ 1155, 5107, 5110; 38 C.F.R. §§ 3.102, 3.159, 4.71a, Diagnostic Codes 5280, 5284. 18. There is no legal basis for the assignment of a schedular rating higher than 10 percent for the Veteran’s tinnitus. 38 U.S.C. § 1155; 38 C.F.R. § 4.87, Diagnostic Code 6260; Smith v. Nicholson, 19 Vet. App. 63 (2005) rev’d, 451 F.3d 1344 (Fed. Cir. 2006). 19. The criteria for an acquired psychiatric disability have been met. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 2015 to September 2016. In October 2020, the Veteran’s representative requested a 90-day extension prior to adjudication of the appeal. However, in a statement, received in November 2020, the representative submitted additional evidence and waived any additional time for an extension of adjudication that had previously been requested. Service Connection The Veteran asserts that he has headaches, a respiratory disability (claimed as chronic bronchitis), gastroesophageal reflux disease (GERD), an infection of the tonsils, irritable bowel syndrome (IBS), chronic fatigue, hypertension, radiculopathy of the left lower extremity, shin splints, hemorrhoids, a retracted testicle, and a low sex drive, that were incurred in, or caused by his service. He has asserted that service connection is warranted for all claimed disabilities as both incurred during service (in August 2016), and as due to an undiagnosed illness. See Veteran’s claim (VA Form 21-526EZ), received in November 2018. The Board has construed the Veteran’s service connection claims broadly, as stated on the cover page of this decision. Clemons v. Shinseki, 23 Vet. App. 1 (2009); Brokowski v. Shinseki, 23 Vet. App. 79, 86-87 (2009). Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Service connection may also be granted on the basis of a post-service initial diagnosis of a disease, when “all of the evidence, including that pertinent to service, establishes that the disease was incurred during service.” See 38 C.F.R. § 3.303 (d). Service connection may also be established for a current disability on the basis of a presumption under the law that certain chronic diseases manifesting themselves to a certain degree within a certain time after service must have had their onset in service. 38 U.S.C. §§ 1101, 1112, 1137; 38 C.F.R. §§ 3.307, 3.309(a). Hypertension, and other organic diseases of the nervous system, can be service connected on such a basis. Service connection may be granted, on a secondary basis, for a disability, which is proximately due to, or the result of an established service-connected disorder. 38 C.F.R. § 3.310. Service connection is currently in effect for bilateral foot bunions, tinnitus, limitation of right knee flexion, right knee posttraumatic tendinopathy, degenerative arthritis of the spine with spinal stenosis, and radiculopathy of the right lower extremity. A “Persian Gulf Veteran” is one who served in the Southwest Asia Theater of operations during the Persian Gulf War. 38 C.F.R. § 3.317. The United States Congress has defined the Persian Gulf War as beginning on August 2, 1990, the date that Iraq invaded the country of Kuwait, through a date to be prescribed by Presidential proclamation of law. 38 C.F.R. § 3.2 (i). Service-connected disability compensation may be paid to (1) a claimant who is “a Persian Gulf veteran”; (2) “who exhibits objective indications of chronic disability resulting from an illness or combination of illnesses manifested by one or more signs or symptoms such as those listed in paragraph (b) of [38 C.F.R. § 3.317]”; (3) which “became manifest either during active military, naval or air service in the Southwest Asia theater of operations during the Persian Gulf War, or to a degree of 10 percent or more not later than December 31, 2021”; and (4) that such symptomatology “by history, physical examination, and laboratory tests cannot be attributed to any known clinical diagnosis.” Signs or symptoms which may be manifestations of undiagnosed illness include, but are not limited to: fatigue, signs or symptoms involving the skin, muscle or joint pain, neurologic signs or symptoms, neuropsychological signs or symptoms, signs or symptoms involving the respiratory system, and gastrointestinal signs or symptoms. 38 C.F.R. § 3.317 (a), (b). For VA purposes, the diagnosis of chronic fatigue syndrome (CFS) requires: (1) the new onset of debilitating fatigue severe enough to reduce daily activity to less than 50 percent of the usual level for at least 6 months, and (2) the exclusion, by history, physical examinations, and laboratory tests, of all other clinical conditions that may produce similar symptoms, and (3) 6 or more of the following: (i) acute onset of the condition, (ii) low grade fever, (iii) nonexudative pharyngitis, (iv) palpable or tender cervical or axillary lymph nodes, (v) generalized muscle aches or weakness, (vi) fatigue lasting 24 hours or longer after exercise, (vii) headaches (of a type, severity or pattern that is different from headaches in the pre-morbid state), (viii) migratory joint pains, (ix) neuropsychologic symptoms, and (x) sleep disturbance. 38 C.F.R. § 4.88a. The Veteran’s discharge (DD Form 214) shows that he had service in Kuwait from November 29, 2015 to February 25, 2016, and from March 6, 2016 to May 26, 2016, and from July 12, 2016 to August 14, 2016, service in Iraq from February 26, 2016 to March 5, 2016, and service in Jordan from May 27, 2016 to July 11, 2016. The Veteran is therefore shown to meet the criteria for consideration as a Persian Gulf veteran for purposes of 38 C.F.R. § 3.317. For all service connection claims, the Veteran’s relevant service treatment records include the following: A May 2016 report which shows that the Veteran was noted not to have any acute needs, was not currently on medication, and that he did not report a medical or surgical history. The Veteran’s active duty service ended in October 2016. Service treatment records include reports from post-active duty service with the National Guard. A post-deployment assessment (DD Form 2796), dated in December 2016, shows that the Veteran indicated that his health had been excellent in the past month. He indicated that he had not had any visits to a health care provider for a medical, dental, or mental health problem or concern, or any hospitalizations, since he returned from deployment. In the past month, physical health problems had not made it difficult at all for him to do his work or other regular daily activities. The Veteran indicated that he did not want to schedule an appointment with a health care provider to discuss any health concern. There were no referrals. A periodic health assessment, dated in February 2017, shows the following: The Veteran indicated that he was not on a profile and that he did not have a medical condition that keeps him from taking any part of the APFT (Army physical fitness test), that requires him to take alternate APFT event, or that keeps him from doing his military job duties. He was not taking any over-the-counter medications, prescription medications or supplements. A February 2017 dental health questionnaire (DA Form 5570 E), shows that the Veteran denied having a history of serious illness, operation or hospitalization in the past. He indicated that he was not taking any drugs or medications. A functional capacity certificate Form 507 (FCC), dated in February 2017, shows that the Veteran indicated that he was able to perform all stated tasks, to include carrying and firing an assigned weapon, riding in a military vehicle and wearing a helmet, body armor, and boots and equipment for at least 12 hours a day, wearing load-bearing equipment, running or jogging two miles, and doing APFT push-ups and sit-ups. He does not take any prescription and/or non-prescription medications. The examiner indicated that there were no current physical limitations. An adult prevention and chronic care flowsheet (DD Form 2766), dated in February 2017, indicates that the Veteran does not have any chronic illnesses, or a history of hospitalizations or surgeries. An April 2018 VA physical therapy consultation indicates that the Veteran was unable to perform many of the tasks noted in the February 2017 FCC. His problem list included pain in both feet. See also September 2018 National Guard memorandum; physical profile record (DA Form 3349-SG), received in November 2018 (in which he was deemed unable to return to duty). A May 2018 VA report states that he had been deemed to be unable to return to duty, with functional impairment due to his knees, lumbar disc disease, and foot issues. In his claim (VA Form 21-526EZ), received in November 2018, the Veteran stated that all of the claimed disabilities began, or worsened, in about August 2016. In a statement, received in January 2019, the Veteran indicated that he has had symptoms since beginning in service that are related to his claimed psychiatric, foot, headache, fatigue, low sex drive, hypertension, retracted testicles, hemorrhoids, GERD, and IBS problems. He argued that he did not report such symptoms because of his “warrior ethos,” and that he did not want to be considered “weak” or a “sick call ranger.” In November 2020, the Veteran’s representative asserted that the Veteran had been told that if he went to sick call, it would extend his deployment and that he would be stuck overseas doing rehabilitation for receiving treatment, and that he did not report his symptoms because he wanted to return home as quickly as possible. With regard to his claim for an acquired psychiatric disorder, to include PTSD, the Veteran has asserted that during service in Iraq, his base was the target of a mortar attack. The Veteran’s service treatment records are discussed infra. They do not show complaints, findings, or diagnoses involving any of the claimed conditions. This evidence includes reports created in the continental United States following the Veteran’s return from his deployment on August 14, 2016. See e.g., August 2016 separation examination report (DD Form 2808) (August 24, 2016) and associated report of medical history (DD Form 2807) (August 23, 2016), post-deployment health assessment (PDHA) (DD Form 2796) (August 17, 2016); reports associated with service in the National Guard, dated in 2017. This evidence shows that he complained of symptoms related to his knees and bunions, but that he did not report having any symptoms related to the claimed conditions. Thus, the assertion that the Veteran did not report his symptoms because he feared being “stuck overseas,” and because he did not want to be considered as having a poor work ethic, are contradicted by this evidence. In addition, the August 2016 PDHA shows that the Veteran denied ever feeling like he was in great danger of being killed, and that he denied ever experiencing symptoms due to anything that was frightening, horrible, or upsetting. He denied experiencing a blast or explosion, to include at a distance of over 100 meters. He denied symptoms in the previous month that included stomach pain, headaches, feeling tired or having low energy, becoming easily annoyed or irritable, feeling his heart pound or race, or constipation, loose bowels, or diarrhea. The Veteran repeated these responses in a December 9, 2016 PDHA (about four months after his return from deployment). In a February 2017 period health assessment (dated about six months after his return from his deployment) he denied a number of relevant symptoms, to include high blood pressure, frequent headaches, and mental health concerns, as well as nightmares, avoidance behaviors, and being on guard or easily startled. A December 2017 pre-deployment health assessment (DD Form 2795) shows that the Veteran reported back pain and bunions; there was no notation of any symptoms related to any of the claimed conditions. This evidence contradicts his claims of ongoing symptoms since his service. AZ v. Shinseki, 731 F.3d 1303 (Fed. Cir. 2013). A June 2018 VA mental conditions disability benefits questionnaire (DBQ) shows that the examiner stated that the Veteran’s responses to a MMPI-2 (Minnesota Multiphasic Personality Inventory) influenced a few indicators in the direction of exaggeration of symptoms. In a November 2020 report from K.E., Ph.D., the Veteran was noted to report that his unit experienced a “mortar attack,” and that “the entire hanger where his unit was working was shaking due to the mortar attack.” However, the Veteran gave a significantly different account over two years earlier. A February 2018 VA progress notes shows that the Veteran stated that his unit was in Iraq for approximately one month and that while he was there the most stressful event occurred when “the base started firing and he did not know what the noise was,” alternatively described as, “when the base fired mortars without warning anyone” and he “was unsure what was happening.” This report clearly shows that the indicated that the mortars were by fired from inside of his base, and that he did not report that they involved an attack on his base or any actual danger to himself. Although the Veteran has claimed to have participated in combat, the Board has determined that participation in combat is not shown. (discussed infra). VA progress notes show that the Veteran has reported that he participated in combat. However, this is contradicted by his responses in his PDHAs dated in August and December of 2016, which shows that inter alia that the Veteran denied ever engaging in direct combat where he discharged a weapon, encountering dead bodies or seeing people killed or wounded, or feeling like he was in great danger of being killed. His discharge (DD Form 214) shows that his primary specialty was plumber, and that he spent 9 days in Iraq. He is not shown to have received medals or awards evincing participation in combat. As a result, the evidence is insufficient to show that he participated in combat. See 38 U.S.C. § 1154 (b); VAOPGCPREC 12-99, 65 Fed. Reg. 6256- 6258 (2000). Therefore, participation in combat is not established and the Veteran is not entitled to the presumptions at 38 U.S.C. § 1154 (b). The Board further notes that the United States Court of Appeals for Veterans Claims (Court) has held that 38 U.S.C. § 1154 does not alter the fundamental requirements of a diagnosis, and a medical nexus to service, see Brock v. Brown, 10 Vet. App. 155, 162 (1997), and that there is no such evidence for any of the claims on appeal. 1. Acquired psychiatric disability The Veteran is seeking service connection for an acquired psychiatric disability. The evidence shows that no acquired psychiatric disability was noted at enlistment. The Veteran is currently diagnosed with a generalized anxiety disorder. A private medical opinion is of record which links the Veteran’s generalized anxiety disorder with his military service, and provides a sufficient rationale for her conclusion. The account is consistent with the Veteran’s accounts of his military service. Accordingly, the Board finds the criteria for service connection for an acquired psychiatric disability have been met and the Veteran’s claim is granted. 2. Headaches. The Veteran’s service treatment records do not show any relevant complaints, findings, or diagnoses. A post-deployment assessment (DD Form 2796), dated in August 2016, shows that he denied being bothered by headaches. The Veteran’s separation examination report (DD Form 2807), dated in August 2016, shows that his head and neurological system were clinically evaluated as normal. The associated report of medical history shows that the Veteran indicated that he did not have a history of frequent or severe headache, or “a head injury, memory loss, or amnesia.” Service treatment records associated with post-active duty in the National Guard include a post-deployment assessment (DD Form 2796), dated in December 2016, which shows that he specifically denied being bothered by headaches. A health questionnaire for dental treatment, dated in February 2017, shows that the Veteran was not noted to report frequent headaches, which are a part of the checklist. A periodic health assessment, dated in 2018, shows that the Veteran was noted not to have frequent headaches, which are a part of the checklist. VA progress notes show that in December 2017, the Veteran was noted to deny a history of TBI-related events during his deployment, and not to have a history of TBI. In May 2018, the Veteran denied having headaches. Reports dated between January and March of 2019 show that the Veteran denied having headaches, to include “chronic headaches.” An April 2019 report notes a complaint of stress headaches. The Veteran is not shown to have been treated for headache symptoms during service. Upon separation from service, headaches were not noted, and he denied having a history of headaches on multiple occasions. Accordingly, a chronic condition is not shown during service. See 38 C.F.R. § 3.303. In addition, the Board finds that the preponderance of the evidence shows that the Veteran does not have headaches due to his service. The earliest post-service medical evidence of headaches is dated in April 2019. This is over two years after separation from service, during which time the Veteran had the opportunity to report health problems. There is no competent opinion of record in favor of the claim. Accordingly, the claim for service connection for headaches is denied. 3. Respiratory disability. The Veteran’s service treatment records do not show any relevant complaints, findings, or diagnoses. A post-deployment assessment (DD Form 2796), dated in August 2016, shows that he denied being bothered by shortness of breath, or chest pain, in the past month. The Veteran’s separation examination report (DD Form 2807), dated in August 2016, shows that his lungs and chest were clinically evaluated as normal. The associated report of medical history shows that the Veteran indicated that he did not have a history of wheezing or problems with wheezing, bronchitis, or shortness of breath. Service treatment records associated with service in the National Guard include a post-deployment assessment (DD Form 2796), dated in December 2016, which shows that he denied being bothered by shortness of breath, or chest pain, in the past month. A February 2017 dental health questionnaire (DA Form 5570 E), shows that the Veteran denied having a history of asthma or shortness of breath. A periodic health assessment, and FCC, dated in February 2017, show that the Veteran denied having asthma. As for the post-service medical evidence, VA progress notes dated between January 2018 and March of 2019 show that the Veteran denied having shortness of breath, dyspnea on exertion, wheezing, chronic cough, and/or orthopnea. There was no relevant diagnosis. The Veteran is not shown to have been treated for respiratory symptoms during service. Upon separation from service, respiratory symptoms were not noted, and he did not report any relevant history of symptoms. Accordingly, a chronic condition is not shown during service. See 38 C.F.R. § 3.303. In addition, the Board finds that the preponderance of the evidence shows that the Veteran does not have a respiratory disability due to his service. Following separation from active duty service, there is no evidence to show that the Veteran has a respiratory disability. The Board therefore finds that the evidence is insufficient to show that the Veteran currently has a respiratory disability, and that the claim must be denied. See Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998). 4. GERD. The Veteran’s service treatment records do not show any relevant complaints, findings, or diagnoses. A post-deployment assessment (DD Form 2796), dated in August 2016, shows that the Veteran denied being bothered by nausea, gas, or indigestion in the past month. The Veteran’s separation examination report (DD Form 2807), dated in August 2016, shows that his abdomen and viscera were clinically evaluated as normal. The associated report of medical history shows that the Veteran indicated that he did not have a history of frequent indigestion or heartburn, or “stomach, liver intestinal trouble or ulcer.” Records associated with service in the National Guard include a post-deployment assessment (DD Form 2796), dated in December 2016, which shows that he denied being bothered by stomach pain, chest pain, nausea, gas, or indigestion in the past month. As for the post-service medical evidence, VA progress notes show that in November 2018, the Veteran received an assessment of GERD. A March 2019 report shows that the Veteran reported episodes of acid reflux intermittently. He said that he takes Zantac “off and on.” The Veteran is not shown to have been treated for GERD or reflux symptoms during service. Upon separation from service, reflux symptoms or GERD were not noted, and he did not report any relevant history of symptoms. Accordingly, a chronic condition is not shown during service. See 38 C.F.R. § 3.303. Additionally, GERD is a known clinical diagnosis and therefore is not found to be representative of an undiagnosed illness. In addition, the Board finds that the preponderance of the evidence shows that the Veteran does not have GERD due to his service. The earliest post-service medical evidence of GERD is dated in November 2018. This is over two years after separation from service. There is no competent opinion of record in favor of the claim. Accordingly, the claim must be denied. 5. Infection of the tonsils. The Veteran’s service treatment records do not show any relevant complaints, findings, or diagnoses. A post-deployment assessment (DD Form 2796), dated in August 2016, does not note any relevant complaints or findings. The Veteran’s separation examination report (DD Form 2807), dated in August 2016, and the associated report of medical history, do not note any relevant complaints, findings, or diagnoses. Records associated with service in the National Guard include a post-deployment assessment (DD Form 2796), dated in December 2016, which does not note any relevant complaints or findings. As for the post-service medical evidence, VA progress notes show that in 2018, the Veteran denied having a sore throat. In February 2019, the Veteran complained of swollen and enlarged tonsils. There was no relevant diagnosis. The Veteran is not shown to have been treated for tonsil or throat symptoms during service. Upon separation from service, a tonsil condition was not noted, and he did not report any relevant history of symptoms. Accordingly, a chronic condition is not shown during service. See 38 C.F.R. § 3.303. In addition, the Board finds that the preponderance of the evidence shows that the Veteran does not have an infection of the tonsils due to his service. The earliest post-service medical evidence of tonsil symptoms is dated in February 2019. Assuming arguendo that a chronic condition is shown as of this date, this is over two years after separation from service. There is no competent opinion of record in favor of the claim. Accordingly, the claim must be denied. IBS. The Veteran’s service treatment records do not show any relevant complaints, findings, or diagnoses. A post-deployment assessment (DD Form 2796), dated in August 2016, shows that the Veteran denied being bothered by stomach pain, “nausea, gas or indigestion,” or “constipation, loose bowels, or diarrhea,” in the past month. The Veteran’s separation examination report (DD Form 2807), dated in August 2016, shows that his abdomen and viscera were clinically evaluated as normal. The associated report of medical history shows that the Veteran indicated that he did not have a history of frequent indigestion or heartburn, or “stomach, liver intestinal trouble or ulcer.” Records associated with service in the National Guard include a post-deployment assessment (DD Form 2796), dated in December 2016, which shows that the Veteran denied being bothered by stomach pain, “nausea, gas or indigestion,” or “constipation, loose bowels, or diarrhea,” in the past month. A February 2017 health questionnaire for dental treatment indicates that the Veteran did not report having stomach symptoms. As for the post-service medical evidence, VA progress notes show that in December 2017, the Veteran complained of constipation. Problem lists note constipation, with a date of November 2018. Reports dated between January and May of 2018 show that the Veteran denied having bowel problems, hematuria, incontinence, nausea, vomiting, abdominal pain and/or problems with control of his bowel or bladder. In December 2018, he was provided with stool softeners for constipation. In February 2019, he reported constipation with loose stools twice a month, and that he had been taking a stool softener. The Veteran is not shown to have been treated for gastrointestinal symptoms during service. Upon separation from service, a gastrointestinal condition was not noted, and he did not report any relevant history of symptoms. Accordingly, a chronic condition is not shown during service. See 38 C.F.R. § 3.303. In addition, the Board finds that the preponderance of the evidence shows that the Veteran does not have IBS. Following separation from active duty service, there are some complaints of constipation, however, there is no evidence to show that the Veteran has IBS. The Board therefore finds that the evidence is insufficient to show that the Veteran currently has IBS, and that the claim must be denied. See Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998). 6. Fatigue. The Veteran’s service treatment records include a pre-deployment health assessment (DD Form 2795), dated in October 2015, which shows that the Veteran indicated that he felt tired or had little energy “few or several days” in the previous two weeks. Thereafter, the Veteran’s service treatment records do not show any relevant complaints, findings, or diagnoses. A post-deployment assessment (DD Form 2796), dated in August 2016, shows that the Veteran denied feeling tired or having low energy in the past month. The Veteran’s separation examination report (DD Form 2807), dated in August 2016, and the associated report of medical history, do not include any relevant findings or diagnoses. Records associated with service in the National Guard include a post-deployment assessment (DD Form 2796), dated in December 2016, which shows that the Veteran denied feeling tired or having low energy in the past month. As for the post-service medical evidence, VA progress notes include a February 2019 report that contains an assessment noting insomnia, fatigue, memory loss, and psychiatric symptoms. In March 2019, the Veteran complained of severe fatigue. He said that he has “been really tired since being deployed in 2016.” VA problem lists include insomnia. At most, it appears that the Veteran’s fatigue is a symptom of his acquired psychiatric disability and has not been shown to be a separately identifiable disability. The Veteran is not shown to have been treated for fatigue, or any disability manifested by fatigue, during service. Upon separation from service, fatigue was not noted, and he did not report any relevant history of symptoms. Accordingly, a chronic condition is not shown during service. See 38 C.F.R. § 3.303. The Board further finds that the preponderance of the evidence shows that the Veteran does not have chronic fatigue. Following separation from active duty service, there is a February 2019 assessment noting fatigue and which indicates that it may be associated with psychiatric symptoms, insomnia, and/or memory loss. There is no evidence to show that the Veteran has been found to have chronic fatigue. The Board therefore finds that the evidence is insufficient to show that the Veteran has chronic fatigue, and that the claim must be denied. See Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998). 7. Hypertension. The Veteran’s service treatment records do not show any relevant complaints or diagnoses. An October 2015 report notes a blood pressure reading of 122/77. A post-deployment assessment (DD Form 2796), dated in August 2016, shows that the Veteran denied being bothered by feeling his heart pound or race in the past month. The Veteran’s separation examination report (DD Form 2807), dated in August 2016, shows that his vascular system was clinically evaluated as normal and that his blood pressure was 114/73. The associated report of medical history shows that the Veteran indicated that he did not have a history of high or low blood pressure. Service treatment records associated with duty in the National Guard include a post-deployment assessment (DD Form 2796), dated in December 2016, which shows that the Veteran denied being bothered by feeling his heart pound or race in the past month. There are findings of blood pressure of 107/69 in February 2017, and 120/76 in December 2017. A health questionnaire for dental treatment, dated in February 2017, shows that the Veteran did not report having high blood pressure, which was a check-listed disorder. A periodic health assessment, dated in February 2017, shows that the Veteran indicated that he does not currently have, and has not had, high blood pressure. The Veteran is not shown to have been treated for hypertension during service. Upon separation from service, hypertension was not noted, and he did not report any relevant history of symptoms. Accordingly, a chronic condition is not shown during service. See 38 C.F.R. § 3.303. There is no evidence to show hypertension that is dated within one year of separation from active duty service. See 38 C.F.R. §§ 3.307, 3.309. Following separation from active duty service, there is no evidence to show that the Veteran has hypertension. The Board therefore finds that the evidence is insufficient to show that the Veteran has hypertension, and that the claim must be denied. See Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998). 8. Radiculopathy, left lower extremity. The Veteran’s service treatment records do not show any relevant complaints or diagnoses. A post-deployment assessment (DD Form 2796), dated in August 2016, shows that the Veteran denied being bothered by numbness or tingling in the hands or feet in the past month. The Veteran’s separation examination report (DD Form 2807), dated in August 2016, shows that his lower extremities, and neurological system, were clinically evaluated as normal. The associated report of medical history shows that the Veteran indicated that he did not have a history of impaired use of his legs, or numbness or tingling. Service treatment records associated with duty in the National Guard include a post-deployment assessment (DD Form 2796), dated in December 2016, which shows that the Veteran denied being bothered by numbness or tingling in the hands or feet in the past month. In a pre-deployment health assessment (DD Form 2795), dated in December 2017, the Veteran indicated that he had concerns about his low back and sciatic nerve. As for the post-service medical evidence, VA progress notes show that in 2018, the Veteran complained of pain in his low to mid-back, legs, and feet, with a notation of pain that went from his low back to his left knee. There was no relevant diagnosis. A VA back DBQ, dated in December 2018, shows that the Veteran was noted to have mild intermittent pain in his left lower extremity, but not constant pain, paresthesias, dysesthesias, or numbness. A sensory examination of the left lower extremity was normal. Reflexes at the left knee and left ankle were 2+. There was no muscle atrophy. Strength of the left knee was 4/5. Strength at the left ankle, and left great toe was 5/5. The examiner indicated that the Veteran does not have radiculopathy of the left lower extremity. A VA knee and lower leg DBQ, dated in December 2018, shows that on examination, strength of the left knee was 5/5. There was no muscle atrophy. VA progress notes show that in July 2019, the Veteran was noted to have strength and ranges of motion of the bilateral lower extremities that were within normal limits. Sensation of the bilateral lower extremities was intact. The Veteran is not shown to have been treated for neurological symptoms involving the left lower extremity during service. Upon separation from service, a neurological disorder of the left lower extremity was not noted, and he did not report any relevant history of symptoms. Accordingly, a chronic condition is not shown during service. See 38 C.F.R. § 3.303. There is no evidence to show an organic disease of the nervous system involving the left lower extremity that is dated within one year of separation from active duty service. See 38 C.F.R. §§ 3.307, 3.309. Following separation from active duty service, there is no evidence to show that the Veteran has radiculopathy of the left lower extremity, to include as related to his service-connected back disability. The Board therefore finds that the evidence is insufficient to show that the Veteran has radiculopathy of the left lower extremity, and that the claim must be denied. See Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998). Shin splints. The Veteran’s service treatment records do not show any relevant complaints or diagnoses. A post-deployment assessment (DD Form 2796), dated in August 2016, shows that the Veteran denied being bothered by “pain in the arms, legs, or joints (knees, hips, etc.)” in the past month. The Veteran’s separation examination report (DD Form 2807), dated in August 2016, shows that his lower extremities were clinically evaluated as normal. The associated report of medical history shows that the Veteran indicated that he did not have a history of impaired use of his legs. Service treatment records associated with duty in the National Guard include a post-deployment assessment (DD Form 2796), dated in December 2016, which shows that the Veteran denied being bothered by “pain in the arms, legs, or joints (knees, hips, etc.)” in the past month. As for the post-service medical evidence, VA progress notes show that in January 2018, the Veteran complained of symptoms that included shin splints. There was no relevant finding or diagnosis. A VA knee and lower leg DBQ, dated in December 2018, shows that the examiner determined that the Veteran does not have shin splints. The Veteran is not shown to have been treated for shin splints during service. Upon separation from service, shin splints were not noted, and he did not report any relevant history of symptoms. Accordingly, a chronic condition is not shown during service. See 38 C.F.R. § 3.303. Following separation from active duty service, there is no evidence to show that the Veteran has shin splints. The Board therefore finds that the evidence is insufficient to show that the Veteran currently has shin splints, and that the claim must be denied. See Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998). Hemorrhoids. The Veteran’s service treatment records do not show any relevant complaints, findings, or diagnoses. The Veteran’s separation examination report (DD Form 2807), dated in August 2016, shows that shows that his anus and rectum were not examined. The associated report of medical history shows that the Veteran indicated that he did not have a history of rectal diseases, hemorrhoids, or blood from the rectum. As for the post-service medical evidence, VA progress notes include a January 2018 report which shows that the Veteran denied having BRBPR (bright red blood per rectum) or melena. Between February and March of 2019, the Veteran reported having experienced hemorrhoids since the time of his deployment that had recently worsened, with some pain and bleeding. He said that he is required to continuously lift 30 to 50-pound boxes at his job, and he requested a doctor’s statement for light duty. On examination, he was found to have a hemorrhoid. The Veteran is not shown to have been treated for hemorrhoids during service. Upon separation from service, hemorrhoids were not noted, and he did not report any relevant history of symptoms. Accordingly, a chronic condition is not shown during service. See 38 C.F.R. § 3.303. In addition, the Board finds that the preponderance of the evidence shows that the Veteran does not have hemorrhoids due to his service. The earliest post-service medical evidence of the claimed disability is dated in 2019. This is about two years after separation from active duty service. There is no competent opinion of record in favor of the claim. Accordingly, the claim is denied. Retracted testicle, low sex drive. The Veteran’s service treatment records do not show any relevant complaints, findings, or diagnoses. A post-deployment assessment (DD Form 2796), dated in August 2016, shows that he denied being bothered by pain with urination, frequency of urination, or strong urge to urinate, or pain or problems during intercourse, in the past month. The Veteran’s separation examination report (DD Form 2807), dated in August 2016, shows that his external genitalia were not examined. The associated report of medical history shows that the Veteran indicated that he did not have a history of frequent or painful urination. No relevant symptoms or complaints were noted. As for the post-service medical evidence, a January 2018 report shows that the Veteran denied having hematuria, incontinence, or change in bladder function. He complained of symptoms that included his left testicle retracting up into his abdomen. There was no relevant finding or diagnosis. In February 2019, he reported hesitancy at times, and testicle pain at times. A March 2019 report shows that the Veteran reported feeling intermittent incomplete emptying of his bladder, and that he has a hard time urinating. He reported pain and tension with standing to his left inguinal area that felt like pulling to his testicles for unknown amount of time. On examination, no palpable mass was noted and there were no testicular masses with palpation. The Veteran is not shown to have been treated for a retracted testicle, or low sex drive, during service. Upon separation from service a retracted testicle and a low sex drive were not noted, and he did not report any relevant history of symptoms. Accordingly, a chronic condition is not shown during service. See 38 C.F.R. § 3.303. In addition, the Board finds that the preponderance of the evidence shows that the Veteran does not have a retracted testicle, or low sex drive, due to his service. The earliest post-service medical evidence of symptoms of either of the claimed disabilities is dated in 2019. This is about two years after separation from active duty service. There is no competent opinion of record in favor of either of the claims. Accordingly, the claim is denied. Conclusion. The Veteran has asserted that all of the claimed conditions may be related to his service in Southwest Asia, and VA progress notes show that he has indicated that he was exposed to smoke from burn pits. Post-deployment assessments (DD Form 2796s), dated in August and December of 2016, show that the Veteran indicated that he did not have a concern or worry about possible exposure to environmental concerns, including, but not limited to, fog oils, garbage, smoke from burning trash or feces, smoke from oil fire, pesticides, sand, or dust. The Veteran indicated that he did not want to schedule an appointment with a health care provider to discuss any health concern. The Veteran is shown to have service in Southwest Asia. However, the evidence does not show that the Veteran has an undiagnosed illness involving any of the claimed symptoms, to include chronic fatigue syndrome or IBS. See 38 C.F.R. §§ 3.317 (a)(2)(i), 4.88a. No medical evidence is of record to suggest that the Veteran’s complaints of headaches, gastrointestinal problems, or fatigue are consistent with an undiagnosed illness or a medically unexplained chronic multisymptom illness. Accordingly, the provisions of 38 U.S.C. § 1117 and 38 C.F.R. § 3.317 are not applicable. Stankevich v. Nicholson, 19 Vet. App. 470, 472 (2006). Earlier effective dates. In September 2018, the RO granted service connection for tinnitus, evaluated as 10 percent disabling, with an effective date for service connection of February 13, 2018. In October 2018, the RO granted service connection for left foot bunion, and a right foot bunion. The RO assigned a noncompensable evaluation for the right foot, and a 10 percent evaluation for the left foot. For each disability, the RO assigned an effective date for service connection of February 13, 2018. In February 2019, the RO granted service connection for posttraumatic tendinopathy, evaluated as 10 percent disabling, limitation of right knee flexion, evaluated as 10 percent disabling, radiculopathy of the right lower extremity, evaluated as 10 percent disabling, and degenerative arthritis of the spine to include spinal stenosis, evaluated as 10 percent disabling. In each case, the RO assigned an effective date for service connection of October 31, 2018. In each case, the Veteran has appealed the issue of entitlement to an earlier effective date and an increased initial evaluation. Generally, the effective date of an award of a claim is the date of receipt of the claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110 (a); 38 C.F.R. § 3.400. If a claim for disability compensation is received within one year after separation from service, the effective date of entitlement is the day following separation or the date entitlement arose. 38 C.F.R. § 3.400 (b)(2). An application, formal or informal, which has been allowed or disallowed by the agency of original jurisdiction and the action having become final by the expiration of 1 year after the date of notice of the disallowance, or by denial on appellate review, whichever is the earlier. 38 C.F.R. § 3.160 (d). A claim is a formal or informal communication in writing requesting a determination of entitlement or evidencing a belief in entitlement to a benefit. 38 C.F.R. § 3.1 (p). Any communication or action indicating an intent to apply for VA benefits from a claimant or representative may be considered an informal claim. Such informal claim must identify the benefit sought. 38 C.F.R. § 3.155 (a). Service connection for left foot bunion, right foot bunion, tinnitus. The Board finds that the Veteran is not entitled to an effective date earlier than February 13, 2018, for the grants of service connection for a left foot bunion, a right foot bunion, and tinnitus. The evidence shows that the Veteran first raised the issue of service connection for bilateral foot bunions and tinnitus in a claim (VA Form 21-526EZ), that was received by VA on February 13, 2018. The evidence of record does not contain any communication from the Veteran prior to February 13, 2018 that may be construed as an intent to seek or apply for service connection for a foot bunion or tinnitus, nor has the Veteran argued that he filed a claim for service connection for a foot bunion or tinnitus prior to that time. VA is not required to anticipate, or assume an intent to file, any potential claim for a particular benefit where no intention to raise it was expressed. Brannon v. West, 12 Vet. App. 32, 35 (1998). Given the foregoing, the earliest possible effective date for the grants of service connection for a left foot bunion, a right foot bunion, and tinnitus, under 38 C.F.R. § 3.400 is February 13, 2018, and the claims are denied. Service connection, degenerative arthritis of the spine to include spinal stenosis, right knee posttraumatic tendinopathy, limitation of right knee flexion, radiculopathy of the right lower extremity. The Board finds that the Veteran is not entitled to an effective date earlier than October 31, 2018, for the grants of service connection for degenerative arthritis of the spine to include spinal stenosis, right knee posttraumatic tendinopathy, limitation of right knee flexion, and radiculopathy of the right lower extremity. The evidence shows that the Veteran first raised the issue of service connection for these disabilities in a claim (VA Form 21-526EZ), received by VA on October 31, 2018. Although this form did not specifically name the claimed disabilities, it was submitted together with a May 2018 service medical report (Standard Form 513), which noted disorders of the spine and the bilateral knees. In November 2018, the Veteran submitted a second claim (VA Form 21-526EZ) which specifically claimed a bilateral knee disorder, a lumbar spine disorder, and sciatica. Under the circumstances, whether the October 31, 2018 claim is treated as a formal or informal claim makes no difference, as the RO has assigned effective dates commensurate with the receipt of the VA Form 21-526EZ received on October 31, 2018. The evidence of record does not contain any communication from the Veteran prior to October 31, 2018 that may be construed as an intent to seek or apply for service connection for a back disability, a right knee disability, or radiculopathy of the right lower extremity, nor has the Veteran argued that he filed a claim for service connection for any of these disorders prior to that time. VA is not required to anticipate, or assume an intent to file, any potential claim for a particular benefit where no intention to raise it was expressed. Brannon. Given the foregoing, the earliest possible effective date for the grants of service connection for degenerative arthritis of the spine to include spinal stenosis, right knee posttraumatic tendinopathy, limitation of right knee flexion, and radiculopathy of the right lower extremity, under 38 C.F.R. § 3.400 is October 31, 2018, and the claims are denied. Increased initial evaluation, right lower extremity radiculopathy. In February 2019, the RO granted service connection for radiculopathy of the right lower extremity, assigning a 10 percent disability rating. The Veteran’s right lower extremity radiculopathy has been evaluated under 38 C.F.R. § 4.124a, DC 8720. The Board must determine whether a higher initial evaluation is warranted under any applicable diagnostic code. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). The criteria for evaluating the severity or impairment of the sciatic nerve is set forth under Diagnostic Codes 8520, 8620, and 8720. Under DC 8520, a 10 percent rating requires mild incomplete paralysis of the sciatic nerve. A 20 percent rating requires moderate incomplete paralysis of the sciatic nerve. Diagnostic Codes 8620 and 8720 address the criteria for evaluating neuritis and neuralgia of the sciatic nerve, respectively. The criteria are consistent with the criteria for evaluating degrees of paralysis as set forth above. 38 C.F.R. § 4.124a, DC’s 8520, 8620, 8720. A note in the Rating Schedule pertaining to “Diseases of the Peripheral Nerves” provides that the term “incomplete paralysis” indicates a degree of lost or impaired function which is substantially less than that which results from complete paralysis of these nerve groups, whether the loss is due to the varied level of the nerve lesion or to partial nerve regeneration. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. 38 C.F.R. § 4.124a, DC’s 8510 through 8540. Neuritis of the peripheral nerves, characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain, at times excruciating, is to be rated on the scale provided for injury of the nerve involved, with a maximum rating equal to severe, incomplete, paralysis. The maximum rating that may be assigned for neuritis not characterized by organic changes referred to in this section will be that for moderate, or with sciatic nerve involvement, for moderately severe, incomplete paralysis. 38 C.F.R. § 4.123. Neuralgia of a peripheral nerve characterized usually by a dull and intermittent pain, of typical distribution so as to identify the nerve, is to be rated on the same scale, with a maximum equal to moderate incomplete paralysis. The term incomplete paralysis, with peripheral nerve injuries, indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. The ratings for the peripheral nerves are for unilateral involvement; when bilateral, combine with application of the bilateral factor. 38 C.F.R. § 4.124. A VA back DBQ, dated in December 2018, shows that the Veteran reported that he has a constant dull ache, intermittent radiating pain down his right lower extremity, and that his pain is near-constant during flare ups, which occur two to three times a month. On examination (all findings are for the right lower extremity) strength of right knee flexion was 5/5. Strength of knee extension was 4/5. The ankle had 5/5 strength on dorsiflexion and plantar flexion. Strength of great toe extension was 5/5. Knee and right ankle reflexes were 1+. A sensory examination was normal at the upper anterior thigh, thigh and knee, lower leg and ankle, and foot and toes. There was no constant pain. There was mild intermittent pain, mild paresthesias and/or dysesthesias, and mild numbness. The examiner characterized the Veteran’s radiculopathy as mild in severity. The Veteran does not use any assistive devices as a normal mode of locomotion. A VA knee and lower leg DBQ, dated in December 2018, shows that the Veteran’s right knee had 5/5 strength on flexion and extension. There was no muscle atrophy observed. VA progress notes include problem lists noting neuralgia of the sciatic nerve. Beginning in November 2018, the Veteran reported on several occasions that he did not have a history of falls; there are several findings that he had 5/5 strength in his extremities. The Board finds that the Veteran’s radiculopathy of the right lower extremity is not shown to have been manifested by moderate incomplete paralysis of the sciatic nerve, such that an initial evaluation in excess of 10 percent is warranted under DC 8520. The VA examiner concluded that the Veteran’s radiculopathy in his right lower extremity was no more than mild in degree. When this examiner’s characterizations are considered together with the findings as to the Veteran’s right lower extremity symptoms, the Board concludes that it is not shown that the Veteran’s service-connected right lower extremity radiculopathy has resulted in moderate paralysis of the sciatic nerve, and that the criteria for an initial evaluation in excess of 10 percent under DC 8520 have not been met. The Board also concludes that the evidence does not demonstrate that the Veteran’s right lower extremity disability is shown to have been manifested by moderate incomplete neuritis or neuralgia of the sciatic nerve, such that an initial evaluation in excess of 10 percent is warranted under DCs 8620 or DC 8720. In this regard, there is no evidence of neuritis; VA progress notes include notations of neuralgia. The Veteran has been shown to have no less than 4/5 strength in his right lower extremity (one finding), with multiple findings of 5/5 strength. There is no evidence of muscle atrophy. Given the aforementioned medical evidence, to include the findings (or lack thereof) as to strength, sensation, and reflexes, the Board finds that it is not shown that the Veteran’s service-connected right lower extremity radiculopathy has resulted in moderate neuritis or neuralgia of the sciatic nerve. An initial evaluation in excess of 10 percent for the right lower extremity is therefore not warranted under DC’s 8620 or 8720. Increased initial evaluations, bilateral foot bunions. With regard to the history of the disabilities in issue, the Veteran’s separation examination report, dated in August 2016, shows that he was noted to have bilateral bunions. VA progress notes include a January 2018 report which shows that the Veteran reported a history of surgery on his feet while in high school, in 2009, for bunions, with pins placed on the left foot. He reported having pain since that time. The RO has evaluated the Veteran’s bunions under 38 C.F.R. § 4.71a, Diagnostic Code (DC) 5280. Under DC 5280, unilateral hallux valgus is rated as 10 percent disabling if operated with resection of metatarsal head, and also as 10 percent disabling if severe, equivalent to amputation of the great toe. The 10 percent rating is the maximum rating provided for under DC 5280. Under Diagnostic Code 5284 for other foot injuries, a 10 percent rating is assigned for “moderate” injuries, and a 20 percent rating is assigned for “moderately severe” injuries. 38 C.F.R. § 4.71a, Diagnostic Code 5284. The words “mild,” “moderate,” “moderately severe,” and “severe” as used in the various Diagnostic Codes are not defined in the VA Schedule for Rating Disabilities. 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. It should also be noted that use of terminology such as “severe” by VA examiners and others, although an element of evidence to be considered by the Board, is not dispositive of an issue. All evidence must be evaluated in arriving at a decision regarding an increased rating. 38 C.F.R. §§ 4.2, 4.6. VA progress notes include a February 2018 report, which shows that the Veteran complained of foot pain. On examination, there were no ulcers or wounds (all findings are bilateral unless otherwise specified). Pedal pulses were palpable. There were no corns or calluses. Capillary filling time, and sensation, were normal. He was noted to have painful hallux valgus with weight bearing, ambulation, running and footwear. There was a moderate to severe deformity. X-rays were noted to show significant hallux valgus deformity with large bunions, and some degenerative changes to the left first metatarsal head. He was provided with Naproxen and Lidocaine, and orthotics. The need for future foot surgery was discussed. The Veteran reported that he works on-call for the railroad as a conductor. A VA foot DBQ, dated in June 2018, shows that the examiner noted that the Veteran was seen by podiatrist in February 2018 and that he was diagnosed with hallux vagus and bilateral foot pain. He was treated with inserts. His bilateral foot X-rays showed bunions. The Veteran had a history of resection of the metatarsal head, left foot, related to a bunion. The Veteran complained of constant ache to bilateral feet with intermittent throbbing, with episodes of sharp more intense pain to bilateral feet. This pain will continue if he stays on his feet. He cannot work out and get into the gym like he used to. Anything that bends his big toes causes increased pain. While at work, he has to walk a lot with heavy boots and his feet hurt. The Veteran was noted to use bilateral arch supports, built-up shoes, and orthotics. On examination, there was bilateral pain on use, and on manipulation of the feet, and decreased longitudinal arch height. There was no indication of swelling on use. There were no characteristic calluses. There was no objective evidence of marked deformity, and no marked pronation, of either foot. The weight-bearing line did not fall over or medial to the great toe for either foot. There was no lower extremity deformity other than pes planus, causing alteration of the weight-bearing line. The Veteran did not have “inward” bowing of the Achilles tendon (i.e., hindfoot valgus, with lateral deviation of the heel) of one or both feet. There was no marked inward displacement and severe spasm of the Achilles tendon (rigid hindfoot) on manipulation of either foot. There were mild or moderate symptoms of hallux valgus. Both feet had pain on movement, pain on weight bearing, swelling, and deformity. Both feet had pain, weakness, fatigability, or incoordination that significantly limits functional ability during flare-ups or when the foot is used repeatedly over a period of time, and other functional loss during flare-ups or when the foot is used repeatedly over a period of time. The examiner characterized the Veteran’s left foot symptoms as mild. She concluded that his symptoms did not chronically compromise weight bearing, nor did it require arch supports, custom orthotic inserts, or shoe modifications. The Veteran does not use any assistive devices as a normal mode of locomotion, although occasional locomotion by other methods may be possible. There was not functional impairment of an extremity due to a foot condition such that no effective function remained other than that which would be equally well served by an amputation with prosthesis. Degenerative or traumatic arthritis was not documented by imaging studies. There was no impact his ability to perform any type of occupational task (such as standing, walking, lifting, sitting, etc.). There was no evidence of pain on passive range of motion testing, or pain when the joint is used in non-weight bearing. The diagnosis was bilateral hallux valgus. VA progress notes show that in July 2019, the Veteran complained of a worsening sharp painful corn at his left second toe and that it hurts to walk. He had prominent painful metatarsal heads at the second through fifth toes, bilaterally, and enlarged first metatarsal heads, bilaterally. He was noted to be ambulating independently and to have a steady gait. In December 2019, the Veteran reported that he did not have any new problems with his feet. He was noted to be ambulating independently. The Board finds that the criteria for an initial 10 percent evaluation have been met for the right foot. The Veteran has repeatedly complained of right foot pain. The Court of Appeals for Veterans Claims has held that 38 C.F.R. § 4.59 applies to Diagnostic Code 5280. Southall-Norman v. McDonald, 28 Vet. App. 346, 352 (2016). The provisions of 38 C.F.R. § 4.59 notes that the intent of the Rating Schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. Under 38 C.F.R. § 4.59, the trigger for a minimum disability rating is a painful, unstable, or malaligned joint. Pettiti v. McDonald, 27 Vet. App. 415, 425 (2015). In this case, the evidence is sufficient to show that the Veteran’s right foot bunion has been productive of pain throughout the appeal period. As such, the Board finds that a separate 10 percent rating for the Veteran’s right foot bunion is warranted based on painful motion under 38 C.F.R. § 4.59. Id. An initial evaluation in excess of 10 percent is not warranted for either foot. The Veteran’s complaints have been considered, to include pain and swelling, and limited functional ability during flare-ups and following repeated use over a period of time. Although the Veteran is shown to have used arch supports, custom orthotic inserts, and/or shoe modifications, the VA DBQ shows that the examiner indicated that these are not required due to his bunions. The examiner’s conclusions are sufficiently supported by the findings. See generally Mittleider v. West, 11 Vet. App. 181 (1998). Specifically, the Veteran does not have characteristic calluses. There is no objective evidence of marked deformity or marked pronation of either foot. The Veteran does not use any assistive devices as a normal mode of locomotion. Degenerative or traumatic arthritis is not documented by imaging studies. His symptoms do not chronically compromise weight bearing. There was no impact his ability to perform any type of occupational task. VA progress notes show that the Veteran has been noted to be able to ambulate independently. The VA examiner characterized the Veteran’s hallux valgus symptoms as mild or moderate, and her conclusion is sufficiently supported by the aforementioned findings. The Board finds that this evidence is insufficient to show that the Veteran’s right foot bunion, or left for bunion, has resulted in a moderately severe foot injury, and that an initial evaluation in excess of 10 percent is not warranted for either foot under DC 5284. Increased initial evaluation, tinnitus. Tinnitus is evaluated under 38 C.F.R. § 4.87, Diagnostic Code (DC) 6260. This diagnostic code was revised effective June 13, 2003. The revisions were intended to codify VA’s longstanding practice of assigning a single 10 percent evaluation for recurrent tinnitus, whether the sound is perceived as being in one ear, both ears, or in the head. See Schedule for Rating Disabilities: Evaluation of Tinnitus, 68 Fed. Reg. 25,822 (May 14, 2003). This diagnostic code has not changed and continues to stipulate that only a single evaluation for recurrent tinnitus will be assigned-whether the sound is perceived in one ear, both ears, or in the head. 38 C.F.R. § 4.87, DC 6260, Note 2; Smith v. Nicholson, 451 F.3d 1344 (Fed. Cir. 2006) (affirming VA’s longstanding interpretation of DC 6260 as authorizing only a single 10 percent rating for tinnitus, whether perceived as unilateral or bilateral). As the Veteran is already assigned the maximum schedular rating available for tinnitus and does not provide any basis for further substantive consideration of this claim, the appeal thereof must be denied as a matter of law. See Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). REASONS FOR REMAND The claims for service connection for flat feet, a hammertoe of the left foot, and left foot fungus, are remanded. A VA foot conditions DBQ, dated in June 2018, shows that on examination, the Veteran had mild left foot fungus. The examiner did not provide an etiological opinion for this condition. The examiner also stated that the Veteran was not shown to have flat feet. However, subsequently dated medical evidence includes a November 2018 VA progress note, which includes a notation that X-rays showed severe bilateral flat feet. Under the circumstances, the June 2018 VA examination report is insufficient for adjudicatory purposes, and a remand is required. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). The claim for an initial evaluation in excess of 10 percent for degenerative arthritis of the spine, to include spinal stenosis, is remanded. A VA back DBQ, dated in December 2018, shows that the examiner stated that she was unable to state whether pain, weakness, fatigability or incoordination significantly limit functional ability with flare-ups without resort to mere speculation. She explained that although the Veteran had a significant limitation of motion during the examination, she was “unable to speculate what (the limitation in his range of motion) would be if not experiencing a flare up.” Before the Board can accept an examiner’s statement that an opinion cannot be provided without resorting to speculation, it must be clear that this is predicated on a lack of knowledge among the “medical community at large” and not the insufficient knowledge of the specific examiner. Sharp v. Shulkin, 29 Vet. App. 26, 36 (2017). The examiner’s opinion should indicate that he or she attempted to obtain information from a veteran as to the severity and the extent of functional impairment resulting from flare-ups. Id. Under the circumstances, the December 2018 VA back DBQ is insufficient for adjudicatory purposes, and a remand is required. Barr. The claims for separate initial evaluations in excess of 10 percent for limitation of right knee flexion, and right knee tendinopathy, are remanded. The RO has evaluated the Veteran’s limitation of right knee flexion, and right knee tendinopathy, in whole or in part, under 38 C.F.R. § 4.71a, DC s 5260 and 5261. These diagnostic codes are based on limitation of motion and therefore require analysis under DeLuca v. Brown, 8 Vet. App. 202, 204-205 (1995), to include consideration of loss of motion during flare-ups and with repeated use over time. A VA knee and lower leg DBQ, dated in December 2018, shows that the examiner stated that she was unable to state whether pain, weakness, fatigability or incoordination significantly limit functional ability with repeated use over time, or with flare-ups, without resort to mere speculation. She explained that the Veteran was “not examined after repeated use over a period of time,” and that he was not examined during a flare-up. For the reasons stated above for the claim for an increased initial evaluation for a back disability, the December 2018 VA knee and lower leg DBQ is insufficient for adjudicatory purposes, and a remand is required. Sharp; Barr. The Veteran’s claim for TDIU is inextricably intertwined with the claims that are being remanded. These claims should be considered together. Parker v. Brown, 7 Vet. App. 116 (1994). Accordingly, the case is REMANDED for the following action: 1. Schedule the Veteran for a VA foot examination. The examiner should address the following questions: a) What is/are the Veteran’s current foot diagnosis/diagnoses? b) Is it at least as likely as not (50 percent or greater) that the Veteran has a diagnosed foot condition (other than bunions) that either began during or was otherwise caused by his military service? Why or why not? c) Is it at least as likely as not (50 percent or greater) that the Veteran has a foot disorder that was caused or aggravated (made worse) by his service-connected bilateral bunions? Why or why not? If aggravation is found, the examiner should identify the baseline level of severity of the disability before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the disability. 38 C.F.R. § 3.310. If such cannot be done, it should be explained why. 3. Schedule the Veteran for a VA examination to assess the current severity of his service-connected degenerative arthritis of the spine, to include spinal stenosis, to include specific findings regarding pain on range of motion testing, and an estimation of functional loss. a) The examiner is requested to test the range of motion in active motion, passive motion, weight-bearing, and nonweight-bearing (if applicable). If the examiner is unable to conduct the required testing, or concludes testing is not necessary, he or she should clearly explain why that is so. b) The examiner must provide an opinion as to the severity of the Veteran’s back symptoms, and how those symptoms impact the Veteran’s occupational functioning. c) With regard to flare-ups, if the examination does not take place during a flare-up (and the Veteran reports flare-ups), the examiner should obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment resulting from flare-ups from the Veteran. The examiner should also record the Veteran’s complaints of symptoms with regard to any functional loss with repetitive use. d) The examiner must express an opinion as to whether or not the Veteran’s functional ability is significantly limited during flare-ups, or with repetitive use, and those determinations should, if feasible, be portrayed in terms of the degree of additional loss of range-of-motion during flare-ups or with repetitive use. e) A rationale for all requested opinions shall be provided. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation stating why this is so. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). 4. Schedule the Veteran for a VA examination to assess the current severity of his service-connected right knee disabilities, to include specific findings regarding pain on range of motion testing, and an estimation of functional loss. a) The examiner is requested to test the range of motion in active motion, passive motion, weight-bearing, and nonweight-bearing (if applicable) for both the right and the left knee (i.e., the paired joint). If the examiner is unable to conduct the required testing, or concludes testing is not necessary, he or she should clearly explain why that is so. b) The examiner must provide an opinion as to the severity of the Veteran’s right knee symptoms, and how those symptoms impact the Veteran’s occupational functioning. c) With regard to flare-ups, if the examination does not take place during a flare-up, the examiner should obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment resulting from flare-ups of the right knee from the Veteran. The examiner should also record the Veteran’s complaints of symptoms with regard to any functional loss with repetitive use. d) The examiner must express an opinion as to whether or not the Veteran’s functional ability is significantly limited during right knee flare-ups, or with repetitive use, and those determinations should, if feasible, be portrayed in terms of the degree of additional loss of range-of-motion during flare-ups or with repetitive use. e) A rationale for all requested opinions shall be provided. If the examiner cannot provide an opinion without resorting to mere speculation, he shall provide a complete explanation stating why this is so. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T.S.E., 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.