Citation Nr: A21018656 Decision Date: 11/22/21 Archive Date: 11/22/21 DOCKET NO. 200603-91202 DATE: November 22, 2021 ORDER The Board having determined that new and relevant evidence has been received, concludes that readjudication of the claim of entitlement to service connection for an acquired psychiatric disorder, is granted. The Board having determined that new and relevant evidence has been received, concludes that readjudication of the claim of entitlement to service connection for bilateral pes planus, is granted. The Board having determined that new and relevant evidence has been received, concludes that readjudication of the claim of entitlement to service connection for lumbar spine disorder, is granted. The Board having determined that new and relevant evidence has been received, concludes that readjudication of the claim of entitlement to service connection for epididymitis, is granted. The Board having determined that new and relevant evidence has been received, concludes that readjudication of the claim of entitlement to service connection for right ankle disorder, to include as secondary to the service-connected bilateral pes planus disability (herein), is granted. The Board having determined that new and relevant evidence has been received, concludes that readjudication of the claim of entitlement to service connection for left ankle disorder, to include as secondary to the service-connected bilateral pes planus disability, is granted. The Board having determined that new and relevant evidence has been received, concludes that readjudication of the claim of entitlement to service connection for right knee disorder, to include as secondary to the service-connected bilateral pes planus disability, is granted. The Board having determined that new and relevant evidence has been received, concludes that readjudication of the claim of entitlement to service connection for left knee disorder, to include as secondary to the service-connected bilateral pes planus disability, is granted. The Board having determined that new and relevant evidence has not been received, concludes that readjudication of the claim of entitlement to service connection for streptococcus, is not warranted. The appeal as to the claim of entitlement to service connection for an acquired psychiatric disorder is granted. The appeal as to the claim of entitlement to service connection for bilateral pes planus is granted. The appeal as to the claim of entitlement to service connection for a lumbar spine disorder is granted. The appeal as to the claim of entitlement to service connection for epididymitis is granted. REMANDED The appeal as to the claim of entitlement to service connection for right ankle disorder, to include as secondary to service-connected disabilities, is remanded. The appeal as to the claim of entitlement to service connection for left ankle disorder, to include as secondary to service-connected disabilities, is remanded. The appeal as to the claim of entitlement to service connection for right knee disorder, to include as secondary to service-connected disabilities, is remanded. The appeal as to the claim of entitlement to service connection for left knee disorder, to include as secondary to service-connected bilateral disabilities, is remanded. FINDINGS OF FACT 1. In a December 2019 rating decision, the RO denied the Veteran's claims of entitlement to service connection for an acquired psychiatric disorder, bilateral pes planus, lumbar spine disorder, epididymitis, streptococcus, right ankle disorder, left ankle disorder, right knee disorder, and a left knee disorder; the Veteran did not appeal the decision and it is final. 2. Evidence has been received with the February 2020 Supplemental Claim (since the December 2019 rating decision) that is new and relevant to the claim of entitlement to service connection for an acquired psychiatric disorder, bilateral pes planus, lumbar spine disorder, epididymitis, right ankle disorder, left ankle disorder, right knee disorder, and a left knee disorder. 3. No new and relevant evidence has been submitted to readjudicate the claim of entitlement to service connection for streptococcus. 4. The Veteran's current depressive disorder is etiologically related to his active service. 5. The Veteran's current bilateral pes planus disorder is etiologically related to his active service. 6. The Veteran's current lumbar spine disorder is etiologically related to his active service. 7. The Veteran's current epididymitis disorder is etiologically related to his active service. CONCLUSIONS OF LAW 1. The criteria for readjudicating the claim of entitlement to service connection for an acquired psychiatric disorder have been met. 38 U.S.C. §§ 5103, 5108 (2012); 38 C.F.R. §§ 3.156 (d), 3.303 (2020). 2. The criteria for readjudicating the claim of entitlement to service connection for bilateral pes planus have been met. 38 U.S.C. §§ 5103, 5108 (2012); 38 C.F.R. §§ 3.156 (d), 3.303 (2020). 3. The criteria for readjudicating the claim of entitlement to service connection for lumbar spine disorder have been met. 38 U.S.C. §§ 5103, 5108 (2012); 38 C.F.R. §§ 3.156 (d), 3.303 (2020). 4. The criteria for readjudicating the claim of entitlement to service connection for epididymitis have been met. 38 U.S.C. §§ 5103, 5108 (2012); 38 C.F.R. §§ 3.156 (d), 3.303 (2020). 5. The criteria for readjudicating the claim of entitlement to service connection for right ankle disorder have been met. 38 U.S.C. §§ 5103, 5108 (2012); 38 C.F.R. §§ 3.156 (d), 3.303 (2020). 6. The criteria for readjudicating the claim of entitlement to service connection for left ankle disorder have been met. 38 U.S.C. §§ 5103, 5108 (2012); 38 C.F.R. §§ 3.156 (d), 3.303 (2020). 7. The criteria for readjudicating the claim of entitlement to service connection for right knee disorder have been met. 38 U.S.C. §§ 5103, 5108 (2012); 38 C.F.R. §§ 3.156 (d), 3.303 (2020). 8. The criteria for readjudicating the claim of entitlement to service connection for left knee disorder have been met. 38 U.S.C. §§ 5103, 5108 (2012); 38 C.F.R. §§ 3.156 (d), 3.303 (2020). 9. The criteria for readjudicating the claim of entitlement to service connection for streptococcus have not been met. 38 U.S.C. §§ 5103, 5108 (2012); 38 C.F.R. §§ 3.156 (d); 3.2501(a)(1) (2020). 10. The criteria for establishing entitlement to service connection for depressive disorder have been met. 38 U.S.C. §§ 1110, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020). 11. The criteria for establishing entitlement to service connection for bilateral pes planus disorder have been met. 38 U.S.C. §§ 1110, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020). 12. The criteria for establishing entitlement to service connection for a lumbar spine disorder have been met. 38 U.S.C. §§ 1110, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020). 13. The criteria for establishing entitlement to service connection for epididymitis have been met. 38 U.S.C. §§ 1110, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service in the United States Navy from February 1998 to February 2002. His service was under honorable conditions. The matters are on appeal from an April 2020 rating decision. On August 23, 2017, the President signed into law the Veterans Appeals Improvement and Modernization Act, Pub. L. No. 115-55 (to be codified as amended in scattered sections of 38 U.S.C.), 131 Stat. 1105 (2017), also known as the Appeals Modernization Act (AMA). This law creates a new framework for Veterans dissatisfied with VA's decision on their claim to seek review. The Veteran chose to participate in VA's test program "RAMP", the Rapid Appeals Modernization Program. This decision has been written consistent with the new AMA framework. The Veteran opted into RAMP on June 3, 2020, and selected the Hearing lane, indicating that he wanted a Board hearing and the opportunity to submit any additional evidence in support of the appeal within 90 days after the hearing. Thereafter, in correspondence, the Board accepted the Veteran's appeal and placed it on the Direct Review docket. In July 2021, the Veteran testified at a virtual hearing at the RO (Regional Office) before a Veterans Law Judge (VLJ). A transcript of this hearing has been prepared and associated with the evidence of record. The Veteran's claim has been developed and adjudicated as entitlement to service connection for posttraumatic stress disorder (PTSD). In addition, the evidence of record demonstrates the Veteran has a diagnosis of depressive disorder. See Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009). In light of Clemons, the issue has been recharacterized (as stated on the cover page) to encompass all psychiatric diagnoses. The Board has limited the discussion below to the relevant evidence required to support its finding of fact and conclusion of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016). New and Relevant Evidence VA will readjudicate a claim if new and relevant evidence is presented or secured. 38 C.F.R. § 3.156 (d). "Relevant evidence" is evidence that tends to prove or disprove a matter in issue. 38 C.F.R. § 3.2501 (a)(1). As the statutory definition of "relevant" does not require that the evidence relate to an unestablished fact necessary to substantiate the claim or raise a reasonable possibility of substantiating the claim; "new and relevant" evidence is a lower standard than the "new and material" evidence standard. 1. Whether new and relevant evidence has been received to readjudicate the claim of entitlement to service connection for an acquired psychiatric disorder. In the present matter, the Veteran asserted that his symptoms of depression and anxiety have progressively worsened since active service. In addition, a June 2021 private evaluation indicates a diagnosis of depression that is related to the Veteran's active service. Accordingly, as evidence has been submitted that is relevant to the matter in issue, the claim of entitlement to service connection for an acquired psychiatric disorder is reopened. 2. Whether new and relevant evidence has been received to readjudicate the claim of entitlement to service connection for bilateral pes planus. In this present matter, the Veteran testified that his symptoms of bilateral foot pain; specifically, the heel and arch, began during active service in approximately 1999. He further asserted that he received treatment for his bilateral foot condition during service. Moreover, the Veteran testified that his bilateral foot condition has progressively worsened since active service. He also asserted that he has continued to receive treatment from a private physician for his feet, to include injections to alleviate pain. In addition, a June 2021 private opinion notes a diagnosis of bilateral pes planus, that is related to the Veteran's active service. Accordingly, as evidence has been submitted that is relevant to the matter in issue, the claim of entitlement to service connection for bilateral pes planus is reopened. 3. Whether new and relevant evidence has been received to readjudicate the claim of entitlement to service connection for lumbar spine disorder. In the present matter, the Veteran asserted that his symptoms of low back pain and numbness have progressively worsened since active service. In addition, during a July 2021 hearing before the Board, the Veteran testified that he injured his low back twice during service, to include, lifting up a heavy box and coming down from a ladder, and his back gave out and he fell to the ground. He further asserted that he sought treatment during service following each injury. In addition, a June 2021 private evaluation indicates diagnoses of a lumbar spine strain and intervertebral disc syndrome, that are related to the Veteran's active service. Accordingly, as evidence has been submitted that is relevant to the matter in issue, the claim of entitlement to service connection for lumbar spine disorder is reopened. 4. Whether new and relevant evidence has been received to readjudicate the claim of entitlement to service connection for epididymitis. In the present matter, the Veteran asserted that his symptoms of testicular pain have progressively worsened since active service. In addition, a June 2021 private evaluation indicates a diagnosis of epididymitis that is related to the Veteran's active service. Accordingly, as evidence has been submitted that is relevant to the matter in issue, the claim of entitlement to service connection for epididymitis is reopened. 5. Whether new and relevant evidence has been received to readjudicate the claim of entitlement to service connection for right ankle disorder, to include as secondary to service-connected disabilities. See argument Below at 8 6. Whether new and relevant evidence has been received to readjudicate the claim of entitlement to service connection for left ankle disorder, to include as secondary to service-connected disabilities. See argument Below at 8 7. Whether new and relevant evidence has been received to readjudicate the claim of entitlement to service connection for right knee disorder, to include as secondary to service-connected disabilities. See argument Below at 8 8. Whether new and relevant evidence has been received to readjudicate the claim of entitlement to service connection for left knee disorder, to include as secondary to service-connected disabilities. In the present matter, the Veteran asserted that his symptoms of bilateral ankle and knee pain have progressively worsened since active service. In addition, a June 2021 private evaluation indicates diagnoses bilateral ankle and knee sprains that are related to the Veteran's active service. Accordingly, as evidence has been submitted that is relevant to the matters in issue, the claims of entitlement to service connection for right ankle, left ankle, right knee, and left knee, are reopened. 9. Whether new and relevant evidence has been received to readjudicate the claim of entitlement to service connection for streptococcus. As above, VA will readjudicate a claim if new and relevant evidence is presented or secured. 38 C.F.R. § 3.156 (d). "Relevant evidence" is evidence that tends to prove or disprove a matter in issue. 38 C.F.R. § 3.2501 (a)(1). The RO initially denied the claim of entitlement to service connection for streptococcus in a December 2019 rating decision. The RO determined there was no evidence of a current streptococcus disorder that was related to the Veteran's active service. In April 2020, the agency of original jurisdiction (AOJ) issued the supplemental claim decision, which found that new and relevant evidence had not been received to warrant readjudication of the claim of entitlement to service connection for streptococcus. Along with his February 2020 Supplemental Claim, the Veteran submitted VA outpatient treatment records dated in December 2019 that demonstrate treatment for the Veteran's feet, an article about the USS Enterprise, duplicate statements addressing unrelated health problems, private opinions dated in June 2021 addressing unrelated health problems, and the Veteran's July 2021 testimony before the Board reiterating his prior assertions of throat problems that began during active service and progressively worsened. Following a careful review of the record, the Board finds this evidence is not new to the Veteran's appeal, as it does not show any new information of a current diagnosis of streptococcus or any other throat condition. Furthermore, it does not suggest or indicate any new assertions in accordance with the Veteran's previously considered arguments. Therefore, none of the evidence received with the February 2020 Supplemental Claim tends to prove or disprove the diagnosis element of the claim and, as such, it is not relevant. 38 C.F.R. § 3.2501 (a)(1). Accordingly, the Board finds that the evidence received with the February 2020 Supplemental Claim is not new and relevant to the Veteran's claim of entitlement to service connection for streptococcus. Therefore, readjudication of the claim is not warranted. 38 C.F.R. §§ 3.156 (d); 3.2501(a)(1). Service Connection Legal Criteria Service connection is granted for disability resulting from disease or injury incurred in or aggravated by active duty. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303 (d). Lay evidence is competent to establish the presence of observable symptomatology and "may provide sufficient support for a claim of service connection." Layno v. Brown, 6 Vet. App. 465, 469 (1994). When a condition is capable of lay observation and may be diagnosed by its unique and readily identifiable features, the presence of the disorder is not a determination "medical in nature." Lay evidence, if competent and credible, may serve to establish a nexus in certain circumstances. See Davidson v. Shinseki, 581 F.3d 1313 (2009) (noting that lay evidence is not incompetent merely for lack of contemporaneous medical evidence). When considering whether lay evidence may be competent, the Board must determine, on a case by case basis, whether the Veteran's particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007) (holding that "[w]hether lay evidence is competent and sufficient in a particular case is a factual issue."). Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits under laws administered by the Secretary. The Secretary shall consider all information and lay and medical evidence of record in a case before the Secretary with respect to benefits under laws administered by the Secretary. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert, 1 Vet. App. at 54. 10. Entitlement to service connection for an acquired psychiatric disorder. The Veteran contends that his current acquired psychiatric disorder is related to service. Specifically, during a July 2021 hearing before the Board, the Veteran testified that his symptoms of anxiety, depression, moodiness, and irritability began during active service in 1998, when he witnessed his friends (soldiers), die in an explosion when two planes collided. He further asserted that while aboard the USS Enterprise, he was working on the catapult when a fellow soldier was getting ready to launch; however, the soldier ran out the wrong way and got sucked into the props of the plane and was chopped up. Service treatment records are negative for complaints of, treatment for, or a diagnosis of an acquired psychiatric disorder. Post-service records include the report of an October 2019 VA examination, during which, depression was assessed. The examiner found that the criteria for a diagnosis of PTSD were not met. Upon examination, the examiner determined that the Veteran's current depressive disorder was not related to his active service. In providing her opinion, the examiner noted a lack of complaints of, or treatment for, or a diagnosis of depression during service. During a July 2021 hearing before the Board, the Veteran asserted that he sought ongoing treatment for depression and PTSD at the VA Medical Center (VAMC) in Hampton for the past several years. Specifically, he reported that he saw a physician once a month who prescribed medication, and he met with a social worker every two weeks to talk about his symptoms. In June 2021, the Veteran underwent a private evaluation, and depression disorder was assessed. A.Q., Ph.D., provided an extensive review of the record, to include the Veteran's service treatment records, and found the Veteran's current depression disorder was related to his active service. In providing this opinion, A.Q. noted that the Veteran's current symptoms of anxiety, depression, moodiness, and irritability began during active service in 1998, when the Veteran witnessed an airplane crash into another airplane on the deck of the USS Enterprise, and he watched his friends burn in a "rolling ball of fire." A.Q. also described another incident in 1998 while serving on the USS Enterprise, in which the Veteran watched a fellow soldier prepare an airplane for launch, and his body was sucked through the plane propellers and he died. A.Q. noted that the aforementioned symptoms that began during active service continued to progressively worsen, as indicated by the Veteran's ongoing treatment for depression at VA, that includes continuous medication and therapy. The Board finds that the evidence of record supports a grant of service connection for depressive disorder. The clinical evidence of record establishes that the Veteran has a current diagnosis of depression in October 2019. Further, the Board finds the Veteran's testimony and statements concerning the nature of his symptoms during service, to be competent and credible. Moreover, the June 2021 private evaluation and opinion are presented as in support of the Veteran's claim. The Board acknowledges that the October 2019 VA opinion is presented as against the Veteran's claim. In this regard, the Board finds the opinion inadequate for adjudication of the claim. In crafting her opinion, the examiner failed to consider the Veteran's ongoing assertions of anxiety, depression, moodiness, and irritability, since active service. Moreover, the examiner in significant part, based her opinion that the Veteran's current PTSD was not related to active service, on a lack of a diagnosis in the service treatment records. Further, the examiner failed to offer an etiology for the Veteran's current depressive disorder. Accordingly, direct service connection for depressive disorder is warranted. As such, the benefit of the doubt must be resolved in the favor of the Veteran. Accordingly, entitlement to service connection for depressive disorder is warranted. 11. Entitlement to service connection for bilateral pes planus. The Veteran contends that his current bilateral pes planus disorder is related to service. In this regard, during the aforementioned hearing before the Board, he testified that his symptoms of bilateral foot pain began during active service and progressively worsened. Service treatment records include the report of a May 1996 induction examination, which is negative for complaints of, treatment for, or a diagnosis of a foot disorder. A March 1998 record notes the Veteran's report of pain in the ball of his feet for the past three days; contusion was noted. A June 2001 examination report notes the Veteran's report of bilateral foot pain; a diagnosis of bilateral pes planus was noted. The report of the December 2001 separation examination indicates a diagnosis of bilateral pes planus. Post-service records include the report of an August 2019 examination report that indicates diagnoses of bilateral pes planus and plantar fasciitis. Upon examination and review of the record, the examiner noted a March 1998 service treatment record that documents the Veteran's report of bilateral foot pain in the ball of his heel, and the December 2001 separation examination report that notes a diagnosis of bilateral pes planus. The examiner opined that the Veteran's current bilateral pes planus was not related to his active service because there was no continuity of care. VA outpatient treatment records dated in December 2019 note the Veteran's report of bilateral heel pain; bilateral pes planus, bilateral plantar fasciitis, and right foot fifth keratoma was assessed. In a June 2021 private opinion, M.S., M.D., noted the Veteran's in-service treatment for complaints of bilateral foot pain assessed as contusion in March 1998, and diagnoses of bilateral pes planus on examination in June 2001 and separation examination in December 2001. M.S. found that he Veteran's current bilateral pes planus was related to his active service. In providing this opinion, M.S. noted that the Veteran did not experience a trauma with respect to his feet, but was stationed on the flight deck of the USS Enterprise, and experienced Whole-body vibration (WBV). M.S. offered a detailed description of WBV, supported by medical literature and treatise; specifically, that vibrations result in increased occupational risk of spinal, hip, ankle, and foot traumas, and the persistent stress erodes the integrity of the soft tissues within these structures of those subjected to WBV. M.S. concluded that it was more likely that the Veteran's current bilateral pes planus was a direct result of the multiple microtraumas that he sustained while he was stationed on the flight deck of the USS Enterprise. The Board finds that the evidence of record supports a grant of service connection for bilateral pes planus disorder. The clinical evidence of record establishes that the Veteran has a current diagnosis of bilateral pes planus in August 2019. Further, the Board finds the Veteran's testimony and statements concerning the nature of his symptoms during service, to be competent and credible. In addition, the service treatment records note diagnoses of bilateral pes planus in June 2001 and on separation examination in December 2001. Moreover, the June 2021 private opinion is presented as in support of the Veteran's claim. The Board acknowledges that the August 2019 VA opinion is presented as against the Veteran's claim. In this regard, the Board finds the opinion inadequate for adjudication of the claim. In crafting her opinion, the examiner failed to consider the Veteran's ongoing assertions of bilateral foot pain since active service. Moreover, the examiner in significant part, based her opinion that the Veteran's current bilateral pes planus was not related to active service, on a lack of a diagnosis in the service treatment records; however, this finding in inaccurate, as the Veteran's service treatment records demonstrate diagnoses of bilateral pes planus in June 2001 and December 2001. Further, the examiner failed to offer an etiology for the Veteran's current bilateral pes planus disorder. Accordingly, direct service connection for bilateral pes planus disorder is warranted. As such, the benefit of the doubt must be resolved in the favor of the Veteran. Accordingly, entitlement to service connection for bilateral pes planus disorder is warranted. 12. Entitlement to service connection for a lumbar spine disorder. The Veteran contends that his current lumbar spine disorder had its onset during active service and progressively worsened. Service treatment records include a December 1998 record that notes the Veteran's report that his back gave out due to carrying a heavy rucksack. Examination revealed tenderness; the examiner diagnosed sciatica. A subsequent December 1998 record shows the Veteran underwent physical therapy for his back problem; acute lumbar impingement was diagnosed. A January 1999 record shows the Veteran sought treatment for extreme tenderness in his right lower back; musculoskeletal low back pain was assessed. An October 2000 record shows the Veteran sought treatment for severe low back pain and pain with weight-bearing when standing on his right leg; the assessment was musculoskeletal v. nephrolithiasis. A subsequent October 2000 record shows the Veteran sought treatment for low back pain. The examiner noted that the Veteran's pain was likely musculoskeletal. An October 2000 record demonstrates the Veteran sought treatment for low back pain. He was prescribed opioids, muscle relaxants, and was instructed to use a TENS unit and to limit his activities. The report of a December 2001 separation examination is negative for complaints of, or a diagnosis of a lumbar spine disorder. Post-service records include VA outpatient treatment records dated in November 2012 that note the Veteran's report of low back pain. VA outpatient treatment records dated in August 2019 note the Veteran's report of chronic low back pain. The report of an August 2019 VA examination indicates diagnoses of a lumbar spine strain and intervertebral disc syndrome (IVDS). The VA examiner opined that the Veteran's current lumbar spine strain and IVDS were not related to his active service. In providing this opinion, the examiner noted that the Veteran's back pain was chronic during service, but he found there was no continuity of symptoms or a diagnosed disability during service. In a June 2021 private opinion, M.S., M.D., noted the Veteran's in-service treatment for complaints of low back pain in December 1998, January 1999, and October 2000. M.S. further noted the Veteran's in-service complaints of extreme tenderness of his low back. He also noted that the Veteran was diagnosed with sciatica and lumbar impingement syndrome in December 1998, followed by multiple complaints of low back pain and treatment for such pain, to include, physical therapy and opioids. Finally, M.S. also noted the Veteran's consistent and ongoing assertions of low back pain since active service. M.S. concluded that the Veteran's current lumbar spine strain and IVDS are the direct result, and progression of, his in-service diagnoses. The Board finds that the evidence of record supports a grant of service connection for lumbar spine disorder, to include lumbar spine strain and IVDS. The clinical evidence of record establishes that the Veteran has current diagnoses of lumbar spine strain and IVDS in August 2019. Further, the Board finds the Veteran's testimony and statements concerning the nature of his symptoms during service, to be competent and credible. In addition, the service treatment records note diagnoses of sciatica and lumbar impingement syndrome, in December 1998. Moreover, the June 2021 private opinion is presented as in support of the Veteran's claim. The Board acknowledges that the August 2019 VA opinion is presented as against the Veteran's claim. In this regard, the Board finds the opinion inadequate for adjudication of the claim. In crafting her opinion, the examiner failed to consider the Veteran's ongoing assertions of low back pain since active service. Moreover, the examiner in significant part, based her opinion that the Veteran's current lumbar spine strain and IVDS were not related to active service, on a lack of a diagnoses in the service treatment records; however, this finding in inaccurate, as the Veteran's service treatment records demonstrate diagnoses of sciatica and lumbar impingement syndrome in December 1998. Further, the examiner failed to offer an etiology for the Veteran's current lumbar spine strain and IVDS disabilities. Accordingly, direct service connection for lumbar spine disorder is warranted. As such, the benefit of the doubt must be resolved in the favor of the Veteran. Accordingly, entitlement to service connection for lumbar spine disorder is warranted. 13. Entitlement to service connection for epididymitis. The Veteran contends that his current epididymitis and residual erectile dysfunction had their onset during active service. Specifically, he contends that his testicle was injured during service, in approximately 1998. Service treatment records include a February 1998 record that notes an undescended testicle. A February 2000 record shows the Veteran sought treatment for right testicular pain. At the time, the Veteran reported an acute onset of pain without any associated symptoms. The examiner assessed epididymitis versus torsion. Post-service records include the report of an August 2019 VA examination, during which, chronic epididymitis with residual erectile dysfunction was diagnosed. Upon examination and review of the record, the examiner found that the Veteran's current epididymitis with residual erectile dysfunction was not related to his active service. In providing this opinion, the examiner indicated that the service treatment records demonstrate the Veteran sought treatment once in February 2000, for an acute onset of right testicular pain associated with a finding of epididymitis. The report of a June 2021 private opinion notes that M.S., M.D., reviewed the record and interviewed the Veteran. M.S. opined that the Veteran's current epididymitis with residual erectile dysfunction are chronic conditions that began during active service, and have continued to the present. In providing this opinion, M.S. noted the August 2019 VA examination that indicates a current diagnosis of chronic epididymitis with residual erectile dysfunction. M.S. also noted the Veteran's consistent and ongoing assertions of testicular pain since active service. He further noted the Veteran's service treatment records that show treatment in February 1998 for an undescended testicle, and in February 2000 for right testicular pain associated with a finding of epididymitis. M.S. concluded that the Veteran's current epididymitis with residual erectile dysfunction is a direct result of a 1998 in-service testicular injury. The Board finds that the evidence of record supports a grant of service connection for epididymitis with residual erectile dysfunction. The clinical evidence of record establishes that the Veteran has a current diagnosis of epididymitis with residual erectile dysfunction in August 2019. Further, the Board finds the Veteran's testimony and statements concerning the nature of his symptoms during service to the present, to be competent and credible. In addition, the service treatment records note treatment for an undescended testicle in February 1998, and a diagnosis of epididymitis in February 2000. Moreover, the June 2021 private opinion is presented as in support of the Veteran's claim. The Board acknowledges that the August 2019 VA opinion is presented as against the Veteran's claim. In this regard, the Board finds the opinion inadequate for adjudication of the claim. In crafting her opinion, the examiner failed to consider the Veteran's ongoing assertions of testicle pain and erectile dysfunction since the documented in-service diagnosis of epididymitis. Further, the examiner failed to offer an etiology for the Veteran's current epididymitis with residual erectile dysfunction. Accordingly, direct service connection for epididymitis with residual erectile dysfunction is warranted. As such, the benefit of the doubt must be resolved in the favor of the Veteran. Accordingly, entitlement to service connection for epididymitis with residual erectile dysfunction disorder is warranted. REASONS FOR REMAND 1. Entitlement to service connection for a right ankle disorder, to include as secondary to service-connected disabilities. See argument Below at 4 2. Entitlement to service connection for a left ankle disorder, to include as secondary to service-connected disabilities. See argument Below at 4 3. Entitlement to service connection for a right knee disorder, to include as secondary to service-connected disabilities. See argument Below at 4 4. Entitlement to service connection for a left knee disorder, to include as secondary to service-connected disabilities. The Board finds that a remand is required to correct a duty to assist error that occurred prior to the Veteran's election to enter the RAMP program. Following a review of the evidence associated with the claims file prior to the Veteran electing to participate in the RAMP program, the Board finds that VA examinations and medical opinions are warranted. The Veteran contends that his current bilateral ankle and bilateral knee disorders are related to active service, and alternately, due to his service-connected bilateral pes planus and/or lumbar spine disability. A disability which is proximately due to or the result of a service-connected disease or injury shall be service connected. When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. 38 C.F.R. § 3.310(a) (2019). This includes any increase in severity of a nonservice-connected disease that is proximately due to or the result of a service-connected disability as set forth in 38 C.F.R. § 3.310(b). See also Allen v. Brown, 7 Vet. App. 439 (1995) (en banc). A claimant is also entitled to service connection on a secondary basis when it is shown that a service-connected disability aggravates a nonservice-connected disability. 38 C.F.R. § 3.310; Allen, 7 Vet. App. at 439. Service treatment records are negative for complaints of, treatment for, or a diagnosis of an ankle or knee disorder. Post-service treatment records include contemporaneous treatment records noting the Veteran's report of bilateral ankle and knee pain. The report of a June 2021 private opinion includes M.S., M.D.'s finding that the current bilateral ankle and knee strains are related to the Veteran's active service and/or his service-connected bilateral pes planus disability. In providing this opinion, the examiner indicated that to date, no extensive diagnostic testing of the Veteran's ankles or knees had been performed. The Board finds the private opinion of record inadequate to adjudicate the claim. In this regard, the Board notes the June 2021 private physician's finding, that the Veteran has current diagnoses of bilateral ankle and knee strains; however, M.S. indicated that no diagnostic testing was performed, as he only interviewed the Veteran and reviewed the record. Thus, clarification as to the Veteran's current ankle and knee disorders, is necessary. Accordingly, a VA examination and medical opinion regarding whether any current ankle or knee disorder is directly related to the Veteran's active service, or a service-connected disability, is necessary to make a determination in this case. 38 C.F.R. § 3.159(c)(4); see also McLendon v. Nicholson, 20 Vet. App. 79 (2006). Although further delay is regrettable, the Board finds that remand is necessary in this case to ensure that due process is followed. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination before an appropriate physician to determine the etiology of any current ankle disorder, present during the period on appeal. The examiner must review the record, to include service treatment records, VA and private treatment records, and the Veteran's assertions and testimony. The examiner must also consideration the Veteran's documented medical history, assertions, and reported symptoms. All necessary tests and studies should be completed, and all clinical findings reported in detail. The examiner must provide an opinion as to whether it is at least as likely as not (i.e., at least 50 percent probable) that any identified right or left ankle disorder(s), to include a strain, manifested during, or as a result of, active military service. If not, the physician should state a medical opinion as to whether it is at least as likely as not (i.e., at least 50 percent probable) that the right and/or left ankle disorder(s) was caused or permanently worsened by the service-connected bilateral pes planus and/or lumbar spine disorder(s). If the physician believes that a right or left ankle disorder was permanently worsened by a service-connected disorder(s), the physician should attempt to identify the baseline level of disability that existed prior to the onset of aggravation and the extent of disability that is attributable to aggravation. For purposes of the opinion, the examiner should assume that the Veteran is a credible historian to report on in-service and post-service symptomology he experienced. A complete rationale must be provided for all opinions offered. If an opinion cannot be offered without resort to mere speculation, the examiner must fully explain why this is the case and identify what additional evidence, if any, would allow for a more definitive opinion. 2. Schedule the Veteran for a VA examination before an appropriate physician to determine the etiology of any current knee disorder, present during the period on appeal. The examiner must review the record, to include service treatment records, VA and private treatment records, and the Veteran's assertions and testimony. The examiner must also consideration the Veteran's documented medical history, assertions, and reported symptoms. All necessary tests and studies should be completed, and all clinical findings reported in detail. The examiner must provide an opinion as to whether it is at least as likely as not (i.e., at least 50 percent probable) that any identified right or left knee disorder(s), to include a strain, manifested during, or as a result of, active military service. If not, the physician should state a medical opinion as to whether it is at least as likely as not (i.e., at least 50 percent probable) that the right and/or left knee disorder(s) was caused or permanently worsened by the service-connected bilateral pes planus and/or lumbar spine disorder(s). If the physician believes that a right or left knee disorder was permanently worsened by a service-connected disorder(s), the physician should attempt to identify the baseline level of disability that existed prior to the onset of aggravation and the extent of disability that is attributable to aggravation. For purposes of the opinion, the examiner should assume that the Veteran is a credible historian to report on in-service and post-service symptomology he experienced. A complete rationale must be provided for all opinions offered. If an opinion cannot be offered without resort to mere speculation, the examiner must fully explain why this is the case and identify what additional evidence, if any, would allow for a more definitive opinion. B. MULLINS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Sara Schinnerer, 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.