Citation Nr: A21017115 Decision Date: 10/21/21 Archive Date: 10/21/21 DOCKET NO. 200517-84399 DATE: October 21, 2021 ORDER The claim for an initial compensable rating for pseudofolliculitis barbae (PFB) is denied. The claim for service connection for sinusitis is granted. The claim for service connection for a chronic headache disability is denied. The claim for service connection for a left arm disability is denied. The claim for service connection for fibromyalgia is denied. The claim for service connection for a gastrointestinal disability, including irritable bowel syndrome (IBS) is denied. The claim for service connection for arthritis of the of left upper extremity, including the hand, wrist, and fingers is denied. The claim for service connection for arthritis of the left lower extremity, including the ankle, foot, and toes is denied. The claim for service connection for tinnitus is denied. The claim for service connection for bilateral pes planus is denied. REMANDED The claim for service connection for a left ankle disability other than psoriatic arthritis, to include a ligament sprain, is remanded. The claim for service connection for bilateral plantar fasciitis is remanded. FINDINGS OF FACT 1. The Veteran's PFB manifests hyperpigmentation of the beard and neck area affecting less than 5 percent of his total body and exposed areas. 2. The Veteran does not have a chronic headache disability. 3. The Veteran does not have fibromyalgia. 4. The Veteran does not have a chronic left arm disability. 5. The Veteran does not have a chronic gastrointestinal disability, to include IBS. 6. The Veteran's sinusitis had its onset during active military service. 7. The Veteran does not have arthritis of the left fingers, ankle, foot, or toes, to include psoriatic arthritis. 8. Arthritis of the of the left hand and left wrist was not present in service or until years thereafter and is not etiologically related to any incident of active military service. 9. Tinnitus was not present in service or until years thereafter and is not etiologically related to any incident of active military service. 10. Preexisting bilateral pes planus was noted on the Veteran's examination for entrance into service and competent evidence does not establish an increase in severity during active duty service. CONCLUSIONS OF LAW 1. The criteria for an initial compensable rating for PFB are not met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.118, Diagnostic Code 7813. 2. A chronic headache disability was not incurred or aggravated during active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. 3. A left arm disability was not incurred or aggravated during active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. 4. Fibromyalgia was not incurred or aggravated during active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.317. 5. A gastrointestinal disability, to include IBS, was not incurred or aggravated during active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. 6. Service connection for sinusitis is warranted. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.104, 3.303. 7. Arthritis of the of left upper extremity, including the hand, wrist, and fingers was not incurred in or aggravated by active service, nor may its incurrence or aggravation be presumed. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.104, 3.303, 3.307, 3.309. 8. Arthritis of the of left lower extremity, including the ankle, foot, and toes was not incurred in or aggravated by active service, nor may its incurrence or aggravation be presumed. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.104, 3.303, 3.307, 3.309. 9. Tinnitus was not incurred in or aggravated by active service, nor may its incurrence or aggravation be presumed. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.104, 3.303, 3.307, 3.309. 10. Bilateral pes planus was not incurred in or aggravated by service. 38 U.S.C. §§ 101, 1110, 1111, 1131, 1153; 38 C.F.R. §§ 3.303, 3.306. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from April 1987 to August 1997. This case comes before the Board of Veterans' Appeals (Board) on appeal from November 2019 and January 2020 rating decisions issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran's claims were developed in accordance with VA's modernized appeals system. Following the November 2019 and January 2020 rating decisions, the Veteran opted to appeal his claim for service connection to the Board through the Direct Review process. The evidentiary record is therefore closed as of the date of the rating decisions on appeal and the Board cannot consider any additional evidence added to the record after this date. The Veteran generally claimed service connection for a left foot disability, as well as disabilities of the left hand, wrist, fingers, foot, ankle, and toes as part of a systemic arthritic process characterized as psoriatic arthritis. The Board will address whether the evidence establishes the presence of an arthritic process, but will also address any individual diagnoses supported by the evidence of record including pes planus and plantar fasciitis of both feet. In addition, as there is evidence of a separate non-arthritic left ankle disability, the Board has included a separate claim for service connection for a left ankle sprain to ensure the Veteran's contentions are fully addressed. See Clemons v. Shinseki, 23 Vet. App. 1 (2009) (when a Veteran seeks benefits for a specific condition and is then diagnosed with a different but potentially related condition while the claim is being processed, VA may not reflexively treat the different conditions as separate claims); see also Grimes v. McDonough, 34 Vet. App. 84 (2021) (Clemons applies even when the diagnosis for a related condition referenced by the claimant is provided after the issuance of the decision on appeal for the original claim). Increased Rating 1. Entitlement to an initial compensable rating for PFB. Service connection for PFB was awarded in the November 2019 rating decision on appeal with an initial noncompensable (0 percent) evaluation assigned effective March 14, 2019. The Veteran contends that an initial compensable evaluation is appropriate. Disability evaluations are determined by evaluating the extent to which a Veteran's service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing his symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. Where the evidence contains factual findings that demonstrate distinct time periods in which the service-connected disability exhibits symptoms that would warrant different evaluations at any point during the appeal, the assignment of staged ratings is appropriate. See Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). PFB is not specifically listed in the current VA rating schedule in 38 C.F.R. Part 4. Unlisted conditions are rated under a closely related disease or injury in which not only the functions affected, but the anatomical localization and symptomatology are closely analogous. 38 C.F.R. § 4.20. In this case, the RO rated PFB as noncompensable under Diagnostic Code 7813 pertaining to dermatophytosis (tinea barbae affecting the beard area). Diagnostic Code 7813 provides for evaluating dermatophytosis under the General Rating Formula for the Skin. The General Rating Formula for the Skin applies to Diagnostic Codes 7806, 7809, 7813 to 7816, 7820 to 7822, and 7824. See 38 C.F.R. § 4.118. Under this formula, a noncompensable rating is assigned for no more than topical therapy required over the past 12-month period and at least one of the following: characteristic lesions involving less than 5 percent of the entire body affected; or characteristic lesions involving less than 5 percent of exposed areas affected. A 10 percent rating is assigned for at least one of the following: characteristic lesions involving at least 5 percent, but less than 20 percent, of the entire body affected; or at least 5 percent, but less than 20 percent, of exposed areas affected; or intermittent systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of less than 6 weeks over the past 12- month period. A 30 percent rating is assigned at least one of the following: characteristic lesions involving more than 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected; or systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of 6 weeks or more, but not constantly, over the past 12-month period. A 60 percent rating is assigned for at least one of the following: characteristic lesions involving more than 40 percent of the entire body or more than 40 percent of exposed areas affected; or constant or near-constant systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, psoralen with long-wave ultraviolet-A light (PUVA), or other immunosuppressive drugs required over the past 12-month period. Or, the disability may also be rated as disfigurement of the head, face, or neck (Diagnostic Code 7800) or scars (Diagnostic Codes 7801, 7802, 7803, 7804, or 7805), depending on the predominant disability. 38 C.F.R. § 4.118, General Rating for the Skin for Diagnostic Codes 7806, 7809, 7813-7816, 7820-7822, and 7824. The Board finds that an initial noncompensable rating is not appropriated for the Veteran's PFB under the general rating formula. Upon VA examination in August 2019, the Veteran's PFB was found to manifest hyperpigmented areas of the beard and neck affecting less than five percent of the entire body and less than five percent of exposed areas. The examiner also found that the PFB did not include scarring or disfigurement of the head, face, or neck, and has not required any treatment during the last 12 months, including medication. Characteristic lesions involving less than five percent of the entire body or less than five percent of exposed areas are specifically contemplated by the current noncompensable evaluation under the general rating formula. As the Veteran's condition does not affect between five and 20 percent of the entire body or exposed areas and has not required any treatment, it does not most nearly approximate the criteria associated with a 10 percent evaluation. The Board therefore concludes that the criteria for a compensable evaluation are not met at any time during the claims period and the claim for a higher initial rating is denied. The Board has considered whether there is any other schedular basis for granting a higher rating, but has found none. In addition, the Board has considered the doctrine of reasonable doubt but has determined that it is not applicable to this period because the preponderance of the evidence is against the claim. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.7, 4.21. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). 2. Entitlement to service connection for sinusitis. The Veteran contends that service connection is warranted for sinusitis as the condition had its onset during active service. The Board agrees and finds that service connection is warranted for sinusitis. In the November 2019 rating decision on appeal, the RO found that a current disability was established by the August 2019 VA examiner's diagnosis of episodic sinusitis. The Board is bound by this favorable finding unless the record contains clear and unmistakable error. 38 C.F.R. § 3.104(c). The Board further finds that an in-service disease is demonstrated. Service records document multiple complaints of sinus congestion in February, August, and November 1988. The Veteran was also diagnosed with sinusitis in February 1988. The first two elements of service connectiona current disability and an in-service diseaseare therefore present in this case. The Board also finds that the evidence establishes a link between the Veteran's current episodic sinusitis and service. As noted above, sinusitis was first diagnosed during the Veteran's active service in February 1988. 10 years later, just prior to his discharge from service, the Veteran reported experiencing a history of sinus problems on a dental health questionnaire. The Veteran also stated during an August 2019 VA examination that he started having problems with his sinuses during service that have continued intermittently since that time. The Veteran is competent to report the symptoms he experiences, as well as when these symptoms started. The Board finds that this history is credible in light of the contents of the service records which document a diagnosis of sinusitis in February 1988, multiple reports of sinus congestion and headaches, and the Veteran's report in May 1997 of sinus problems. Although the August 2019 VA examiner provided a medical opinion against the claim, this opinion is of reduced probative value as it does not take into consideration the Veteran's credible history regarding the onset of his condition or the May 1997 report of sinus problems just prior to discharge. The Board finds that that the VA opinion is outweighed by the Veteran's competent and credible lay evidence, as well as the contents of the service records. As such, the evidence weighs in favor of a nexus between the Veteran's sinusitis and service and the claim is granted. 3. Entitlement to service connection for a chronic headache disability. 4. Entitlement to service connection for a left arm disability. 5. Entitlement to service connection for fibromyalgia. 6. Entitlement to service connection for a gastrointestinal disability, to include IBS. The Veteran contends that service connection is warranted for a chronic headache disability, a left arm disability, fibromyalgia, and a gastrointestinal condition claimed as IBS. The question for the Board is whether the Veteran has current disabilities that began during service or are at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the Veteran does not have the disabilities claimed, and has not had the conditions at any time during the pendency of the claims or recent to the filing of the claims. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); 38 C.F.R. § 3.303(a), (d). Service treatment records document several complaints relevant to the current claims: headaches in February and November 1988 and a viral syndrome and gastroenteritis in April 1990. However, the headaches were associated with nasal congestion and identified as symptoms of upper respiratory infections; no headache or migraine condition was diagnosed. Similarly, the Veteran's viral syndrome and gastroenteritis were acute events that fully resolved several days later. There are no complaints or findings related to the claimed fibromyalgia or the left arm. The Veteran stated during an August 2019 VA examination that he injured his left shoulder playing basketball in 1990, but no such injury is documented in the claims file. The Veteran incurred a left ankle sprain in February 1995 while playing basketball, but service records are negative for complaints related to the left shoulder or arm. There are also no relevant abnormalities on the May 1997 separation examination. Rather, his upper extremities, head, abdomen and viscera, neurological system, and musculoskeletal systems were examined and determined to be normal. Moreover, on an accompanying report of medical history, the Veteran specifically denied experiencing a history of frequent or severe headaches, painful or "trick" shoulder, frequent indigestion, or stomach trouble. The Veteran also did not report any symptoms related to fibromyalgia. Thus, service records do not support the Veteran's claims. Additionally, the Board observes that injuries and conditions documented during active service are not sufficient to establish the presence of a current disability. The requirement of a current disability is met by evidence of symptomatology at the time of filing or at any point during the pendency of the claim. McClain v. Nicholson, 21 Vet. App. 319, 323 (2007); Romanowsky v. Shinseki, 26 Vet. App. 289, 293 (2013) (finding that the Board must address pre-claim evidence in assessing whether a current disability existed, for purposes of service connection, at the time the claim was filed or during its pendency). Thus, while service records may show some complaints of symptoms related to the current claims, they cannot serve to establish the presence of a current disability as they pertain to a period more than 20 years prior to receipt of the Veteran's claims in March 2019. The post-service evidence also does not establish the presence of the disabilities claimed by the Veteran. The record does not contain any post-service medical records documenting treatment for headaches, a left arm disability, fibromyalgia, or a gastrointestinal condition such as IBS. An August 2019 VA examiner concluded the Veteran did not have a current headache disability or a left arm disability. The examiner noted the Veteran's complaints of headaches and a left shoulder injury during service, but noted that the Veteran had "no current problems with [the] shoulder" and with respect to headaches, "reports no current problems. Condition resolved." There is also no post-service lay or medical evidence of gastrointestinal complaints or diagnoses. To the extent the Veteran contends that he has fibromyalgia (a medically unexplained chronic multisymptom illness under 38 C.F.R. § 3.317(a)(2)(i)(B)(1)), there is simply no competent lay or medical evidence in the post-service record to support this claim. The Board further observes there is no lay or medical evidence of actual functional impairment related to the Veteran's claimed disabilities. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir., 2018) (holding that the term "disability" as used in 38 U.S.C. § 1110 "refers to the functional impairment of earning capacity, not the underlying cause of said disability," and that "pain alone can serve as a functional impairment and therefore qualify as a disability."). In this case, the Veteran has not described any impairment during the applicable claims period related to the claimed headache, left arm, fibromyalgia, or gastrointestinal disabilities. Thus, the record does not establish any actual impairment associated with the claimed conditions. The Board has also considered the Veteran's statements, but notes that he has not provided any specific lay evidence in support of the claims. In general, the Veteran lacks the expertise to specifically diagnose himself with any chronic disability. See Charles v. Principi, 16 Vet. App. 370, 374 (2002) (finding veteran competent to testify as to ringing in the ears (tinnitus); Jandreau v. Nicholson, 492 F.3d 1372, 1377, Note 4 (Fed. Cir. 2007). The Veteran is competent to describe the symptoms he experiences, but has not provided any lay evidence in support of his claims, to include a description of any current symptoms or a report that a clinician has diagnosed him as having any of the currently claimed disabilities. Therefore, the record establishes that the Veteran does not have a chronic headache disability, a left arm disability, fibromyalgia, or a gastrointestinal disability including IBS. Absent proof of the existence of the disability being claimed, there can be no valid claim. See Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998); Degmitech v. Brown, 104 F.3d 1328 (Fed. Cir. 1997); Brammer v. Derwinski, 3 Vet. App. 223 (1992); Rabideau v. Derwinski, 2 Vet. App. 141 (1992). Accordingly, the preponderance of the evidence is against the claims and they are denied. 7. Entitlement to service connection for arthritis of the of left upper extremity, including the hand, wrist, and fingers. 8. Entitlement to service connection for arthritis of the left lower extremity, including the feet, ankles, and toes. 9. Entitlement to service connection for tinnitus. The Veteran contends that service connection is warranted for psoriatic arthritis affecting specific joints of the upper and lower left extremities, as well as for tinnitus. He contends that his arthritis is related to injuries of the hand, wrist, fingers, feet, ankles, and toes during service, while his tinnitus is related to active- duty noise exposure. The November 2019 and January 2020 rating decisions on appeal included several favorable findings in this case with respect to the first and second elements of service connection. The Board is bound by the RO's favorable findings, absent clear and unmistakable error. 38 C.F.R. § 3.104(c). Turning first to the presence of a current disability, the RO in the November 2019 rating decision found that tinnitus was identified as a current disability by the August 2019 VA examiner. The January 2020 rating decision also included findings of left-hand arthritis, as diagnosed by the August 2019 VA examiner. In addition to the disabilities found by the RO, the Board further finds the presence of arthritis of the left wrist is established as identified by the VA examiner and in August 2019 X-rays. To the extent the Veteran claims service connection for arthritis of the left fingers, ankle, foot, and toes, there is no competent evidence of these conditions, or of psoriatic arthritis affecting multiple joints. The post-service medical record is negative for evidence of arthritis in the left fingers, ankle, foot and toes, and the August 2019 VA examiner also specifically found that the Veteran does not manifest an arthritic process, to include inflammatory, autoimmune, crystalline or infectious arthritis, or dysbaric osteonecrosis conditions. The Veteran has not provided any statements describing the symptoms or impairment he may experience related to these claimed disabilities and as a lay person, he is not competent to diagnose himself with a specific type of arthritis. Jandreau at 1377; Saunders at 1367-69. The Board therefore finds that arthritic disabilities of the left fingers, ankle, foot, and toes are not present and service connection is not possible for the claimed arthritis of these joints. Similarly, psoriatic arthritis and any similar non-degenerative arthritis process are not present in this case. However, as degenerative arthritis is demonstrated in the left hand and wrist, the Board will continue with its analysis of these claims, along with the claim for tinnitus. The RO also made favorable findings regarding the presence of in-service injuries in the November 2019 and January 2020 rating decisions with respect to the claimed left-hand disability. Service records show that the Veteran was seen in October 1996 with complaints of left-hand pain. He denied any specific injuries, but was diagnosed with a left-hand contusion/tendonitis in 1996. Although service records do not document any specific injuries related to the Veteran's hearing or left wrist, the Veteran described experiencing in-service noise exposure at the August 2019 VA examination, as well as wrist pain associated with the left-hand contusion. The Veteran is competent to report injuries incurred during service and his statements are deemed credible. The Board therefore finds that in-service injuries are established, and the first two elements or service connection are present with respect to the claimed disabilities of the left hand, left wrist, and tinnitus. The remaining question in this case is whether a causal relationship exists between the Veteran's disabilities and active duty service. The Board finds that the weight of the competent evidence is against an award of service connection and the claims must be denied. Service and post-service records do not support the claims; while service records document acute injuries and treatment during active duty, they do not establish the presence of tinnitus or any chronic disability of the left hand or wrist. The Veteran was seen for left hand pain on October 3, 1996 and diagnosed with a left-hand contusion/tendonitis. The contusion was characterized as resolved five days later on October 8, 1996. Furthermore, as discussed above, there are no specific findings pertaining to the wrist or tinnitus during service. Physical examination of the Veteran's ears, hearing, and upper extremities was normal at the May 1997 separation examination and the Veteran specifically denied experiencing any ear trouble, hearing loss, joint pain, or arthritis on the accompanying report of medical history. There is also no post-service evidence of the disabilities until 2019, more than 20 years after service, when the Veteran filed his claims for service connection and a VA examination identified left hand and wrist arthritis and tinnitus. The absence of any clinical evidence of the Veteran's current left-hand arthritis, left wrist arthritis, or tinnitus in service or for years thereafter weighs the evidence against a finding that the disabilities were present in service, particularly as the Veteran has not alleged the onset of the conditions during service or for years thereafter. Maxson v. Gober, 230 F.3d 1330 (Fed. Cir. 2000). There is also no competent medical evidence supporting the claims for service connection. The only medical opinions of record addressing the etiology of the claimed hand, wrist, and tinnitus disabilities are those of the August 2019 and December 2019 VA examiners and their opinions weigh against service connection. The August 2019 VA examiner specifically considered the Veteran's reports of noise exposure during service, but also noted the Veteran's statements dating the onset of intermittent tinnitus to "several years ago" after his separation from active duty. Based on the Veteran's normal hearing at separation from service, his post-service noise exposure as an oil field worker, and the onset of the condition after service, the examiner concluded that it was less likely as not causally related to noise exposure during service. The December 2019 VA examiner also provided an opinion against service connection for arthritis of the hand and wrist. The examiner noted the presence of a single left-hand injury in October 1996, with no other treatment for injuries of the hand or wrist. The examiner further observed that while the Veteran was seen for psoriasis of the nails in October 1989, there was no evidence of joint involvement at that time or evidence in the orthopedic literature that injury to one joint would "spread" or have any significant impact on another joint in the absence of major muscle or nerve damage. As such, the Veteran's degenerative arthritis of the left hand and wrist was not related to active military service. The competent medical evidence of record is therefore against the claims for service connection. Service connection is also possible for certain chronic disabilities under 38 C.F.R. § 3.303(b) based on a continuity of symptomatology. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Arthritis is a chronic disease listed in 38 C.F.R. § 3.309(a) and tinnitus, with evidence of acoustic trauma, is considered an organic disease of the nervous system, also falling within the parameters of 38 C.F.R. § 3.309(a). Fountain v. McDonald, 27 Vet. App. 258, 259 (2015). However, the Veteran has not reported a history of continuous symptoms of joint pain or ringing in his ears since service. With respect to his general contentions linking his claimed arthritis and tinnitus to service, he is not competent to opine as to medical etiology or render medical opinions. Barr v. Nicholson, 21 Vet. App. 303 (2007); see Grover v. West, 12 Vet. App. 109, 112 (1999). The Board acknowledges that the appellant is competent to report observable symptoms but finds that his opinion as to the cause of the symptoms simply cannot be accepted as competent evidence. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-1377 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1131, 1336 (Fed. Cir. 2006). In sum, the post-service medical evidence of record shows that earliest evidence of the Veteran's disabilities was years after discharge from active service. In addition, there is no indication that the Veteran's tinnitus or arthritis of the left hands and wrist is etiologically related to an injury during service. The Veteran also claims service connection is warranted for arthritis of the left fingers, ankle, foot, and toes, to include psoriatic arthritis of all the joints, but the weight of the evidence establishes that these disabilities are not currently present. The preponderance of the evidence is therefore against the claims and they are denied. 38 U.S.C. § 5107(b). 10. Entitlement to service connection for pes planus. The Veteran contends that service connection is warranted for pes planus as the condition was incurred during service. During the August 2019 VA examination, the Veteran reported that his foot problems began during service after spraining his left ankle, wearing shoes with poor cushioning, and standing on a steel deck. The Board finds that service connection is not warranted for pes planus as the condition existed prior to service and was not aggravated therein. The January 2020 rating decision includes a favorable finding of a current disabilitythe Veteran was diagnosed with pes planus at the August 2019 VA examination. Regarding an in-service injury, the Board notes that pes planus was specifically noted on the March 1987 enlistment examination. A veteran who served during a period of war is presumed to be in sound condition when enrolled for service, except for any defects, infirmities, or disorders noted at the time of examination, acceptance, and enrollment. 38 U.S.C. § 1111. However, as the March 1987 examination clearly documents the presence of pes planus, the presumption of soundness is not for application in this case. See 38 U.S.C. §§ 1111, 1113; 38 C.F.R. § 3.304(b) The Board must therefore determine whether the Veteran's preexisting pes planus worsened in severity during service. Generally, a preexisting injury or disease is considered aggravated by active service where there is an increase in the disability during such service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease; however, aggravation may not be conceded where the disability underwent no increase in severity during service on the basis of all the evidence of record pertaining to the manifestations of the disability prior to, during and subsequent to service. 38 U.S.C. § 1153; 38 C.F.R. § 3.306; see also VAOPGCPREC 3-2003 (a preexisting injury or disease will be presumed to have been aggravated in service in cases where there was an increase in disability during service). The record does not establish that the Veteran's pes planus underwent an increase in severity during active duty. His pes planus was characterized as asymptomatic at the March 1987 enlistment examination and was not considered disabling. The Veteran was treated for foot pain on two occasions during service; first, in February 1989 for a painful left toe with a heloma durum (hard corn) secondary to shoe gear. Next, the Veteran complained of foot pain after a basketball injury in February 1995, but his condition was identified as a left ankle sprain and ligament injury. There are no other instances of treatment for foot problems during service and the Veteran's feet were normal upon physical examination for separation in May 1987. The Veteran reported a history of foot trouble on the May 1987 report of medical history, but did not provide any details regarding symptoms or impairment. Service records therefore document the presence of pes planus at enlistment, but are negative for further evidence of flat feet or an increase in the preexisting disability. The Veteran was seen on two occasions with complaints of foot pain, but these complaints were unrelated to pes planusthey were instead due to a left toe corn and a left ankle sprain. There are no complaints or treatment specific to pes planus, and while the Veteran reported a history of foot trouble on the separation report of medical history, the Veteran's feet were also physically normal at the May 1987 separation examination. The Board has considered the Veteran's statements that he experienced the onset of foot pain during service, and he is competent to report the symptoms he experiences, such as foot pain. See Jandreau, supra; Washington v. Nicholson, 21 Vet. App. 191, 195 (2007) (holding that, "[a]s a layperson, an appellant is competent to provide information regarding visible, or otherwise observable symptoms of disability). However, the Veteran is not competent to opine on the specific etiology of his symptoms. Barr, supra. In this case, while service records document some complaints of foot pain, the medical evidence clearly associates these complaints with conditions unrelated to the Veteran's pes planus. The Board finds that the medical evidence outweighs the Veteran's statements provided decades later during the August 2019 VA examination and concludes that the service records do not support a finding that the preexisting disability actually increased in severity during active service. The post-service medical evidence also weighs against the claim. In December 2019, a VA examiner found that the Veteran's pes planus existed prior to service and was not aggravated beyond its natural progression by an in-service injury, event, or illness. The examiner considered the Veteran's reports of foot pain, but noted that the August 2019 examination showed that the Veteran had never used orthotics, assistive decides, or required any procedures for the treatment of pes planus. The lack of treatment or intervention was consistent with the projected natural progression of the Veteran's pes planus disability and established that the condition was not aggravated during service. The Board finds that this medical opinion was rendered after review of the record and the relevant facts (to include the Veteran's current disability presentation at the August 2019 VA examination). It is therefore of significant probative value. See Bloom v. West, 12 Vet. App. 185, 187 (1999) (the probative value of a physician's statement is dependent, in part, upon the extent to which it reflects "clinical data or other rationale to support his opinion"). In contrast, while the record also contains an August 2019 medical opinion weighing in favor of service connection, the Board finds this opinion is of little probative value. The examiner did not consider the question of aggravation and applied the wrong legal standard. In addition, it is unclear whether the August 2019 examiner was rendering an opinion on the etiology of the Veteran's diagnosed pes planus, plantar fasciitis, or both. The August 2019 medical opinion is therefore clearly outweighed by the December 2019 medical opinion and the post-service medical evidence does not support a finding of aggravation. The Board has again considered the contentions of the Veteran that his pes planus was aggravated by military service. As noted above, lay witnesses are competent to opine as to some matters of diagnosis and etiology, and the Board must determine on a case by case basis whether a veteran's particular disability is the type of disability for which lay evidence is competent. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Kahana v. Shinseki, 24 Vet. App. 428, 433, n. 4 (2011). In this case, the Veteran's assertions as to aggravation of a preexisting disability concern an internal medical process, which extends beyond an immediately observable cause-and-effect relationship that is of the type that the courts have found to be beyond the competence of lay witnesses. Cf. Jandreau, 492 F.3d at 1376 (lay witness capable of diagnosing dislocated shoulder); Barr v. Nicholson, 21 Vet. App. 303, 308-9 (2007); Falzone v. Brown, 8 Vet. App. 398, 403 (1995) (lay person competent to testify to pain and visible flatness of his feet). In other words, while the Veteran is competent to describe his symptoms, he lacks the necessary expertise to state that those symptoms represent an aggravation of the underlying disability beyond its natural progression. In addition, the Veteran's contentions are contradicted by the December 2019 VA examiner. The Board therefore finds that the Veteran's statements are outweighed by the evidence establishing that the disability was not aggravated during service. The medical evidence, including the lack of complaints or treatment related to pes planus during service, the normal findings at separation, and the medical opinion of the December 2019 VA examiner, are all probative evidence weighing against aggravation. Therefore, the Board must conclude that the weight of the evidence is against a finding that the Veteran's preexisting pes planus was aggravated during active military service and service connection for this condition is denied. REASONS FOR REMAND 1. Entitlement to service connection for a left ankle disability other than psoriatic arthritis, to include a ligament sprain, is remanded. The issue of service connection for a left ankle disability is remanded to correct a duty to assist error that occurred prior to the November 2019 rating decision on appeal. As discussed above, the Board has determined that the Veteran's claim included service connection for a left ankle disability other than arthritis based on the findings of the August 2019 VA examination. This claim arose from the Veteran's claim for arthritis of the left lower extremity, specifically including the ankle. The August 2019 VA examiner diagnosed a lateral ligament strain of the left ankle. During the examination, the Veteran reported incurring multiple ankle strains during service. Service records document an inversion sprain of the left ankle in February 1995 that required treatment with "aggressive" physical therapy. Two months after the original injury, an April 1995 orthopedic examiner diagnosed a left ankle lateral ligament injury. Although the Veteran's left ankle was normal at the May 1997 separation examination, the Veteran reported a history of foot trouble on the accompanying report of medical history and specified that he experienced both foot and ankle problems. Despite this evidence, the examiner did not provide a medical opinion addressing the possibility of a link between the Veteran's current left ankle ligament strain and the Veteran's ankle ligament injury during service. A VA examination (or opinion) must be obtained in a disability compensation claim if there is competent evidence of a current disability or persistent or recurrent symptoms of a disability; establishment of an in-service event, injury, or disease; an indication that the current disability may be associated with an in-service event; and insufficient competent medical evidence to decide the claim. McClendon v. Nicholson, 20 Vet. App. 79, 81-6 (2006). In this case, the failure to obtain a medical opinion addressing the etiology of the Veteran's left ankle disability is a pre-decisional duty to assist error in accordance with McClendon, and a remand is required to correct the error. 2. Entitlement to service connection for bilateral plantar fasciitis. The Board also finds that a remand is necessary to correct a pre-decisional error of the duty to assist with respect to the claim for service connection for plantar fasciitis. Prior to the January 2020 rating decision on appeal, VA obtained medical opinions in August 2019 and December 2019 addressing a possible link between service and the claimed foot disability. The Board finds neither opinion is adequate to address the etiology of the plantar fasciitis. The Veteran contends that he incurred a bilateral foot disability during active service due to wearing uncomfortable shoes and standing on a steel deck. An August 2019 VA examiner diagnosed pes planus and plantar fasciitis and provided a medical opinion stating that a "claimed left foot condition" was incurred in or caused by active service. However, the examiner did not specify whether the foot condition in question referred to the diagnosed bilateral pes planus, plantar fasciitis, or both. The medical opinion is also unaccompanied by any rationale, frustrating the Board's attempt to determine the basis for the opinion linking a current foot condition to service. When assessing the probative value of a medical opinion, the access to claims files and the thoroughness and detail of the opinion must be considered. The opinion is considered probative if it is definitive and supported by detailed rationale. See Prejean v. West, 13 Vet. App. 444, 448-49 (2000). As the August 2019 VA opinion does not include a rationale to allow the Board to determine the basis for the opinion, it is not adequate. The duty to assist requires VA obtain an adequate VA opinion and a remand is therefore necessary. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's left ankle ligament strain is at least as likely as not related to the February 1995 in-service ankle sprain/ligament injury. The Veteran's left ankle was injured in February 1995 while playing basketball during service. He was diagnosed with an inversion sprain. Two months later, an orthopedist identified a left ankle lateral ligament injury and a grade II sprain. The Veteran was prescribed ice, elevation, crutches, and was expected to benefit from "aggressive" physical therapy. The service treatment records contain no further episodes of treatment for ankle pain during service, but the Veteran reported a history of "foot trouble [and] ankle problem" on the May 1997 report of medical history. During the August 2019 VA examination, the Veteran reported incurring multiple sprains of his ankle during service (though only one sprain is documented in the treatment records) requiring treatment with crutches, a walking boot, and physical therapy. Since that time, the Veteran reports that his left ankle condition has gotten worse with increased pain. 2. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's plantar fasciitis is at least as likely as not related to the complaints of foot pain during active service or the Veteran's reports that he wore uncomfortable shoes and stood on a steel deck. For the purposes of this opinion, the examiner should accept the Veteran's history regarding his shoes, standing on a steel deck, and foot pain as true. Service records include a finding of pes planus at the March 1987 enlistment examination. Plantar fasciitis was not identified during service, but the Veteran complained of foot pain on two occasions. First, in February 1989 when a corn was identified on the left toe due to shoe gear, and again in February 1995 due to a left ankle sprain. Physical examination of the feet was normal at the May 1997 separation examination, though the Veteran did report a history of foot trouble on the separation report of medical history. Plantar fasciitis was first identified at the August 2019 VA examination. The Veteran also reports the onset of foot pain during service after the February 1995 left ankle sprain. K. Conner Veterans Law Judge Board of Veterans' Appeals M. Riley, Attorney for the Board Department of Veterans Affairs 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.