Citation Nr: 21072008 Decision Date: 12/02/21 Archive Date: 12/02/21 DOCKET NO. 20-03 887 DATE: December 2, 2021 ORDER Entitlement to a compensable evaluation for residuals, fracture, ring finger, right hand previously evaluated as 4th metacarpal, right hand is denied. Entitlement to an initial compensable rating for scar, right ring finger s/p pinning and subsequent removal of pin with residual scar (claimed as right arm scar) is denied. Entitlement to service connection for tinnitus is denied. Entitlement to service connection for erectile dysfunction is denied. Entitlement to service connection for stroke is denied. Entitlement to service connection for bronchitis is denied. Entitlement to service connection for a right knee injury and numbness is denied. REMAND Entitlement to service connection for a back disorder is remanded. FINDINGS OF FACT 1. The Veteran's right residuals of a right fourth metacarpal fracture is assigned a noncompensable rating, which is the maximum rating possible under the diagnostic code that evaluates limitation of motion of the ring finger; there is no evidence of ankylosis or symptoms analogous to amputation. 2. The Veteran's right ring finger scar is not manifest by any disabling effects not considered under Diagnostic Codes 7800-04. His right ring finger scar measures 0.4 sq cm by 0.1 sq cm. 3. The preponderance of the evidence is against finding that tinnitus began during active service, or is otherwise related to an in-service injury or disease. 4. The preponderance of the evidence of record is against finding that the Veteran has had erectile dysfunction at any time during or approximate to the pendency of the claim. 5. The preponderance of the evidence is against finding that the Veteran's stroke began during active service, or is otherwise related to an in-service injury or disease. 6. The preponderance of the evidence of record is against finding that the Veteran has had bronchitis at any time during or approximate to the pendency of the claim. 7. The preponderance of the evidence of record is against finding that the Veteran has had a right knee injury and numbness at any time during or approximate to the pendency of the claim. CONCLUSIONS OF LAW 1. The criteria for a compensable evaluation for residuals of a right fourth metacarpal fracture are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71a, Diagnostic Code (DC) 5230. 2. The criteria for an initial compensable rating for a right ring finger residual scar are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.118, DC 7805. 3. The criteria for entitlement to service connection for tinnitus are not met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 4. The criteria for entitlement to service connection for erectile dysfunction are not met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 5. The criteria for entitlement to service connection for stroke are not met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 6. The criteria for entitlement to service connection for bronchitis are not met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 7. The criteria for entitlement to service connection for a right knee injury and numbness are not met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1976 to May 1982. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2018 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In the Veteran's December 2019 VA Form 9, he requested a videoconference hearing before the Board. In a January 2020 correspondence, VA informed the Veteran of his options regarding his hearing request, which included withdrawing the request. In February 2020, VA received the Veteran's response to its correspondence; the Veteran marked and initialed the option to withdraw his hearing request. As such, the Board will proceed with adjudication of the issues on appeal. Increased Rating Disability evaluations are determined by the application of the Schedule for Rating Disabilities, which assigns ratings based on the average impairment of earning capacity resulting from a service-connected disability. 38 U.S.C. § 1155. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3. In order to evaluate the level of disability and any changes in condition, it is necessary to consider the complete medical history of the Veteran's condition. Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991). Where, as here, entitlement to compensation already has been established and an increase in the disability rating is at issue, it is the current level of disability that is of primary concern, and VA must only address the evidence concerning the state of the disability from the time period one year before the claim for an increase was filed until VA makes a final decision on the claim. See Francisco v. Brown,7 Vet. App. 55, 58 (1994). When the factual findings show distinct time periods during which the veteran exhibits symptoms of the disability at issue, and such symptoms warrant different disability ratings, staged ratings may also be assigned. Hart v. Mansfield, 21 Vet. App. 505 (2007). When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and therefore, not be reflected on range of motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016). Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011). In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that VA examiners must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from the veterans themselves, when a flare-up is not observable at the time of examination. 1. Entitlement to a compensable evaluation for residuals of a right fourth metacarpal fracture is denied. The Veteran contends he is entitled to a compensable rating for his service-connected residuals, fracture, ring finger, right hand previously evaluated as 4th metacarpal, right hand (ring finger disability). The appeal period begins on October 26, 2016, one year prior to the date VA received the claim for an increased rating. See Gaston v. Shinseki, 605 F.3d 979, 982 (Fed. Cir. 2010). The Veteran's disability is currently rated as noncompensable under 38 C.F.R. § 4.71a, DC 5230. It was previously rated under DC 5227; the RO changed the diagnostic code in the rating decision on appeal. Under DC 5230, a limitation of motion of the ring or little finger is assigned a noncompensable rating. 38 C.F.R. § 4.71a. The rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a were amended effective February 7, 2021. 85 Fed. Reg. 230 (Nov. 30, 2020). These amendments revised select diagnostic codes "to ensure that this portion of the rating schedule uses current medical terminology and provides detailed and updated criteria for the evaluation of musculoskeletal disabilities." Id. While portions of the rating schedule addressing the musculoskeletal system were revised effective February 7, 2021, the diagnostic code in use here (5230) was not changed. Turning to the evidence of record, the Veteran was afforded a VA examination to determine the severity of his ring finger disability in March 2018. The examiner diagnosed right fourth finger boxer's fracture and noted the course of the condition since onset as healed. The Veteran reported occasional right ring finger pain when exposed to cold, performing manual labor for more than six to eight hours. The Veteran also reported flare-ups described as, "my hand sometimes gets numb when it is cold." Range of motion testing of the ring finger revealed maximum extension of the metacarpophalangeal joint to 0 degrees, proximal interphalangeal joint to 0 degrees, and the distal interphalangeal joint to 0 degrees. Range of motion testing of the ring finger revealed maximum flexion of the metacarpophalangeal joint to 90 degrees, proximal interphalangeal joint to 100 degrees, and the distal interphalangeal joint to 70 degrees. There was no gap between the thumb pad and the finger, no gap between the fingertip and the proximal transverse crease of the palm. Pain was not noted on examination. The Veteran was able to perform repetitive use testing with at least three repetitions without additional functional loss or range of motion. The examiner noted that neither pain, weakness, fatigability, or incoordination significantly limited functional ability with repeated use over a period of time or with flare-ups. The examiner did not find a reduction in muscle strength, muscle atrophy or ankylosis present. The examiner noted a 4cm x 0.1cm scar on the dorsal aspect right fourth finger and described it as "well healed no keloid formation or contracture." Generally, VA treatment records for the appeal period in question are silent regarding right ring finger pain. A VA treatment note from August 2019 shows some complaints of pain related to the right hand but is negative as to any complaints or treatment for the right fourth or ring finger. After a review of the evidentiary record, the Board finds that the preponderance of the evidence is against the assignment of a compensable evaluation under DC 5230 because any degree of limitation of motion of the ring finger disability warrants a noncompensable rating. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application and the claim must be denied. See 38 U.S.C. § 5107; 38 C.F.R. § 4.3. 2. Entitlement to an initial compensable rating for a right ring finger residual scar is denied. Service connection for a right ring finger residual scar was granted in the April 2018 rating decision on appeal. The RO assigned an initial noncompensable rating under 38 C.F.R. § DC 7805, effective October 26, 2017. The Veteran seeks an initial compensable rating for his service-connected right ring finger scar. VA amended the criteria for rating skin disabilities effective from August 13, 2018. These new regulations apply to all applications for benefits received by VA or that are pending before the agency of original jurisdiction on or after August 13, 2018. Claims pending prior to the effective date will be considered under both old and new rating criteria, and whatever criteria is more favorable to the veteran will be applied. The Board may not apply a current regulation prior to its effective date unless the regulation explicitly provides otherwise. Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). However, the Board is not precluded from applying prior versions of the applicable regulation to the period on or after the effective dates of the new regulation if the prior version was in effect during the pendency of the appeal. As this appeal was pending on August 13, 2018, the revised criteria are applicable, but only for the period beginning August 13, 2018. Former Rating Criteria DC 7802 provides a 10 percent rating for scars that are nonlinear, superficial, and not located on the head, face, or neck, that are of an area or areas of 144 square inches or greater. Note (1) to DC 7802 defines a superficial scar as one not associated with underlying soft tissue damage. Scars that are unstable or painful are rated pursuant to DC 7804. A 10 percent rating is warranted for one or two scars that are unstable or painful. Note (1) defines an unstable scar as one where there is frequent loss of covering of skin over the scar. Note (2) states that if one or more scars are both unstable and painful, add 10 percent to the evaluation that is based on the total number of unstable or painful scars. Note (3) states that scars evaluated under DCs 7800, 7801, 7802, or 7805 may also receive an evaluation under this DC when applicable. DC 7805 instructs that any disabling effect(s) not considered in a rating provided under diagnostic codes 7800-04 be evaluated under an appropriate diagnostic code. Revised Rating Criteria Effective August 13, 2018, DC 7802 is assigned to burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are not associated with underlying soft tissue damage. An assignment of a 10 percent disability rating is warranted where the scar covers an area or areas of 144 square inches (929 sq. cm.) or greater. 38 C.F.R. § 4.118. DCs 7804 and 7805 were not changed by the August 13, 2018, amendments. Analysis The preponderance of the evidence is against the assignment of a compensable rating for the Veteran's left leg residual surgical scar under DC 7805 as there are no other disabling effect(s) not considered in a rating provided under diagnostic codes 7800-04. As previously discussed, the Veteran was afforded a VA hand and finger examination in March 2018. One 4cm x 0.1cm scar located on the dorsal aspect right fourth finger was identified. The scar was not of the head, face, or neck; did not cover an area of at least 6 square inches (39 sq. cm) but less than 12 square inches (77 sq. cm.); did not cover an area of at least 144 square inches (929 sq. cm); and were not reported as painful or unstable. In addition to the hand and finger examination, the Veteran underwent a VA scars examination in March 2018. The examiner reported a diagnosis of right fourth finger fracture status post pinning and subsequent removal of pins with residual scar from 1978. The examiner noted the Veteran's complaint that he has "occasional right 4th finger pain when exposed to excessive cold performing manual labor for more than six to eight hours" and does not take pain medication for the right ring finger disability. On observation, the examiner indicated that the scar "to the dorsal aspect of the [Veteran's] right finger is healed and barely perceptible. No keloid formation of contracture is noted." The Veteran did not report a painful or unstable scar. A superficial non-linear scar was not found. The location and measurement of the scar were the same as the hand and finger examination report. In the examiner's remarks, it was noted that physical examination was normal, "ROM right hand full, neuoro sensation intact, [Veteran] able to grasp fine objects and lift 5lb weights." At the February 2019 VA examination for scars, two scars were reported, one on the right bicep area (not service-connected or on appeal) and the right ring finger (on appeal). In this examination report, the Veteran's complaint of "numbness to the scar but not painful" was recorded. The examiner noted that there was no painful or unstable scar present. The right ring finger scar measured 4cm x 1.5cm. The examiner provided the approximate combined total area in centimeters squared for the right upper extremity scars without underlying tissue damage, which included the right bicep area. Together, they measured 7 sq cm. The examiner's remarks indicated that the "claimed burn scar of the right bicep is not related to the service-connected status post pinning and subsequent removal of pin with residual scar. This is a new and separate condition." Based on the evidence of record, including VA treatment records and the Veteran's lay report, a compensable rating is not warranted under the former or revised diagnostic codes 7800-04. The Veteran's right ring finger scar is not of the head, face, or neck; does not cover an area of at least 6 square inches (39 sq. cm) but less than 12 square inches (77 sq. cm.); does not cover an area of at least 144 square inches (929 sq. cm); and is not reported as painful or unstable. Also, the Veteran's right ring finger scar was not described as deep and nonlinear, or associated with underlying soft tissue damage. Even if it were reported as superficial, it does not cover an area or areas of 144 square inches or greater. Moreover, the Veteran did not report that his scar was unstable or painful. Therefore, a compensable rating was not warranted under diagnostic codes 7800, 7801, 7802, and 7804 with consideration of either the former or revised diagnostic criteria. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. Therefore, the claim must be denied. See 38 U.S.C. § 5107; 38 C.F.R. § 4.3. 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). 3. Entitlement to service connection for tinnitus is denied. The Veteran asserts in a December 2019 correspondence that he developed tinnitus in service, and it has "never gone away." The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a current diagnosis of tinnitus, the preponderance of the evidence weighs against finding that the diagnosis of tinnitus began during service or is otherwise related to an in-service injury, event, or disease. Turning to the evidence of the record, the Veteran's service treatment records (STRs) do not contain any complaints or treatment of tinnitus. The Veteran's DD Form 214 shows military occupational specialties (MOS) of unit supply specialist and metal worker. Post-service VA treatment records from an initial May 2008 visit, show the Veteran had a prior medical history (PMH) for tinnitus. The Veteran was afforded a VA examination for hearing loss and tinnitus in February 2018. There, he reported that he had recurrent tinnitus that onset "2 years ago." The examiner noted the Veteran's report that the "bilateral intermittent tinnitus began 2 years ago" and that "ringing occurs daily and lasts 2-3 hours per occurrence." The examiner opined that the Veteran's tinnitus was less likely than not caused by or a result of military noise exposure. The examiner reasoned that although the Veteran had a military occupational specialty (MOS) of 44B and 76Y, a review of the medical records did not show evidence of hearing loss or permanent, significant changes in the Veteran's hearing sensitivity during service. Also, there were no reports of tinnitus during service or shortly after leaving service. The examiner's opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Tinnitus is a medical condition that is commonly self-diagnosed; therefore, veterans are considered competent to report symptoms such as ringing in the ears. Nevertheless, the credibility of a veteran's assertion must also be considered. Credibility is a factual determination as to whether a witness is worthy of belief. Generally, the credibility of a witness can be impeached by a showing of interest, bias, inconsistent statements, or, to a certain extent, bad character. Caluza v. Brown, 7 Vet. App. 498, 511 (1995), aff'd per curium, 78 F.3d 604 (Fed. Cir. 1996). The Veteran contends that he suffered from tinnitus in service; however, his STRs did not show complaints of or treatment for tinnitus. The Veteran's post-service VA treatment records also do not reflect a complaint of or treatment for tinnitus with onset during military service. While a May 2008 VA treatment note does reflect that he had a past medical history of tinnitus, the note does not indicate that the Veteran was currently suffering from or seeking treatment for tinnitus. In assessing the credibility of the Veteran's assertion that tinnitus onset in service and continued since then, the Board has considered, along with other evidence in the file, whether there is evidence of contemporaneous complaints of tinnitus symptoms after service. A review of the May 2008 treatment note shows the Veteran was establishing care with VA. For an appointment like this, it is reasonable to expect a patient to share current medical conditions and prior medical conditions, particularly if the prior condition is still a current problem. There is no report of such. To that end, the Board finds that tinnitus was not a condition the Veteran was experiencing at such time. Moreover, although tinnitus was listed in the May 2008 treatment note, it was not necessarily associated with the Veteran's military service. This is relevant because in the same note, the Veteran's right ring finger fracture was also listed (though mentioned as a prior surgical history (PSH)) and the Veteran did not complain about that listed condition either. Yet, when regarding the right ring finger, the note reflects that the fracture and repair of that finger was due to a fight in the 1970's, which relates back to the Veteran's military service. In contrast, there was no notation regarding the cause or onset for tinnitus. Following this treatment note and for the next few years, the Veteran continued to receive medical treatment at VA facilities and aside from the auto-generated list of conditions which included tinnitus, there were still no complaints of a chronic tinnitus condition -much less one having been present since service discharge. The contemporaneous VA treatment records coupled with the Veteran's February 2018 VA examination, suggest that although tinnitus was listed as a PMH, it resolved before 2016. The Veteran himself told the VA examiner that his tinnitus onset two years earlier, which would have been around 2016. It is notable that the Veteran did not also mention his 2008 PMH of tinnitus during the VA exam mainly because he contends a year later that his current symptoms began in service and continued thereafter. Because of the inconsistencies above, the Board does not find the Veteran's lay report from December 2019 regarding onset and continuous tinnitus since service probative because it is not credible. Caluza v. Brown, 7 Vet. App. 498, 511 (1995), aff'd per curium, 78 F.3d 604 (Fed. Cir. 1996). The Board acknowledges the Veteran's January 2020 submission of a VA article from the Journal of Rehabilitation Research and Development. This article which focuses on evaluating psychoacoustic measures for establishing the presence of tinnitus, discusses measures for testing tinnitus. As a reminder, the question is not whether the Veteran has tinnitus but rather, whether it is related to his military service. A VA examiner has already determined that it is not. The medical treatise the Veteran provides states, "patients reporting tinnitus are generally taken at their word because there would normally be no reason to dispute their complaint." In this case, the Veteran has offered conflicting reports of onset, one began in 2016 the other, over 30 years ago, in service. Thus, a determination must be made regarding which report is persuasive. The discrepancy however is that the Veteran stated before the denial of his claim that tinnitus onset around 2016. Since the unfavorable finding, he modified his statement to reflect 30 plus years. Although there is evidence of a PMH for tinnitus noted in 2008, there are no complaints of or treatment for a current tinnitus disability with a reported onset from service in the contemporaneous treatment records. Thus, making the veracity of the Veteran's recent lay report less persuasive. It is reasonable to expect disclosure of a long-standing condition at an exam for consideration of compensation. Also, noteworthy, the Veteran does not dispute the examiner's transcription of his self-report. In his December 2019 correspondence, the Veteran also asserts that according to VA, his MOS qualified as [noise] exposure that could impact his ear condition. In his January 2020 submission of evidence, a list of military specialties with noise exposure is included. The Veteran believes he currently has tinnitus as a result of his military service and in-service noise exposure caused by his MOS and day-to-day loud noises. However, as previously noted, the VA examiner has competently explained that despite the Veteran's MOS, his STRs do not show complaints of or treatment for tinnitus. Although tinnitus is a chronic disease, service connection is not warranted under 38 C.F.R. § 3.309 because there is no credible report of onset within one year of his discharge from service and according to the evidence and the Veteran's own statements, his symptoms began two years before his 2018 VA exam. Thus, there is no continuity of symptomatology. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. Service connection for tinnitus is denied. Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). 4. Entitlement to service connection for erectile dysfunction is denied. The Veteran contends he suffered from erectile dysfunction (ED). The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. After careful review of the evidence, the Board finds that service connection is not warranted. The Board concludes that the Veteran does not have a current diagnosis of ED and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). STRs are silent for complaints of or treatment for ED. Post-service VA treatment records do not indicate that the Veteran has a current diagnosis or is being treated for ED. Without a current diagnosis, service connection cannot be granted. See Brammer v. Derwinski, 3 Vet. App. 233, 225 (1992). The Veteran was afforded a VA examination in March 2018. There, he reported onset of ED as 1998 and denied having this disorder in service. The examiner noted that the Veteran was able to achieve and maintain erections sufficient for penetration and sexual relations without the use of medications. The examiner evaluated the Veteran and determined that the etiology of ED was situational and now resolved. The examiner opined that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner's rationale considered the Veteran's historical experience with ED as shared by the Veteran, and noted the Veteran's statements, "ED symptoms are now resolved." The examiner also noted that the Veteran reportedly had a new girlfriend and did not experience any difficulty achieving or maintaining erections without the use of medications or other devices. A September 2018 VA mental health note, affirmed this lack of diagnosis in the section for past/current medical history; sexual functioning was reported as "no concerns." The Board finds the March 2018 VA examination report, and the other objective medical evidence of record, probative regarding the lack of an ED disability. The VA examiner found no current pathology of ED from which to render a diagnosis. The examiner considered the Veteran's history, to include his military service, treatment records, and lay report. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302 (2008). Moreover, the examiner is qualified through education, training, and experience to offer medical diagnoses, statements, or opinions. The Board considered the Veteran's report of onset of ED; however, that was 15 years after his discharge from service and no longer present. Although the Veteran may have had a diagnosis of ED 20 years before his VA examination, and is competent to report symptoms of such, he also admits that the issue resolved and denies having any current symptoms of ED. Since the record presents no competent medical evidence to establish a current ED disability during the appeal, there can be no valid claim. Brammer, 3 Vet. App. 223, 225 (1992). As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. Thus, the claim of service connection for erectile dysfunction must be denied. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). 5. Entitlement to service connection for stroke is denied. The Veteran contends his stroke is related to military service. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a medical history of a stroke, the preponderance of the evidence weighs against finding that the stroke began during service or is otherwise related to an in-service injury, event, or disease. STRs do not contain any reference to a stroke or cerebrovascular accident. The Veteran filed his service connection claim in January 2018. Historically, VA treatment records reflect that in December 2016, the Veteran was admitted to ER on stroke protocol after showing symptoms of slurred speech and weakness to the left side. A computed tomography (CT) of his head revealed no acute abnormalities. A magnetic resonance imaging (MRI) of the brain revealed small acute infarct of the posterior limb of the right internal capsule with ischemic stroke, left-sided weakness, dysarthria. In January 2017 the Veteran called his VA primary care provider with a complaint of numbness of one hand. The clinician noted the Veteran's report of sudden numbness on the left hand and fingers for about 24 hrs. He indicated that his current symptoms were not similar to his recent December 2016 stroke and denied chest/abdominal pain, level of consciousness (LOC), difficulty speaking, diplopia, dysarthria, weakness, falling to one side, nausea or vomit. The Veteran was seen by VA neurology with a chief complaint of CVA in April 2017. The neurologist noted the Veteran's medical history and his treatment for acute CVA in December 2016. It was noted that the Veteran was placed on ASA and Lipitor, was "going through a divorce at the time and actively using amphetamines." The Veteran still had residual left-sided weakness, imbalance and dysarthria but improved. The neurologist also noted that the Veteran had no previous history of CVA and was being followed by psychiatric care for depression with psychosis and substance abuse. In June 2017 a VA cardiology technician note indicated that the Veteran was seen for an unscheduled visit regarding his non-service-connected hypertension. He subsequently underwent an echocardiogram for hypertension and cerebrovascular accident (CVA). A November 2019 VA primary care telephone encounter note from the Veteran's primary care physician reported the Veteran's CVA with mild left hemiplegia and dysarthria as "resolved" and improved speech. Upon careful review of the evidence, the Board finds service connection for the Veteran's stroke is not warranted. A stroke (or underlying pathology) was not manifested in service or within one-year of his separation from military service. Notably, he does not contend that it was manifested in service or in the first post-service year. Hence, service connection for this disability on the basis that it became manifest in service and has persisted, or on a presumptive basis (for cerebrovascular disability underlying a stroke, as a chronic disease under 38 U.S.C. § 1112) is not warranted. Instead, the Veteran asserts that his stroke is related to service. However, there is no competent evidence that shows or suggests that there may be such a nexus. The Veteran's STRs contain no mention of treatment for, or a diagnosis of, vascular disease. His post-service treatment records show that a stroke was diagnosed in 2016, approximately 34 years after his discharge from service. Whether or not a stroke may (in the absence of onset in service/continuity since) be related to an event in service that ended more than 30 years earlier is a medical question outside the scope of common knowledge. It requires medical expertise. See Jandreau v. Nicholson, 492 F. 3d 1372, 1377 (Fed. Cir. 2007). The Veteran is a layperson and has not presented any competent (medical opinion/treatise) evidence in support of his theory that stroke is somehow related to his service. His own opinion is not competent evidence in this matter. In this regard, the Board notes that a medical opinion has not been obtained; however, in this case, one is not required. There is no evidence demonstrating an in-service event, injury, or disease pertaining to stroke or CVA. Additionally, there is no indication that the Veteran's stroke may be associated with his military service or another service-connected disability. McLendon v. Nicholson, 20 Vet. App. 79 (2006). As there is no competent evidence that shows or suggests that the Veteran's stroke may be related to his service, the preponderance of the evidence is against this claim, and the claim must be denied. Gilbert, 1 Vet. App. 49, 55-56 (1990). 6. Entitlement to service connection for bronchitis is denied. The Veteran contends he has bronchitis and that it is related to his military service. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. After careful review of the evidence, the Board finds that service connection is not warranted. The Board concludes that the Veteran does not have a current diagnosis of bronchitis and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). Without a current diagnosis, service connection cannot be granted. See Brammer, 3 Vet. App. 233, 225 (1992). Indeed, STRs show a diagnosis of bronchitis in 1978 and 1982; however, it appears to have resolved as post-service treatment records do not show a current diagnosis for bronchitis. The Veteran filed his service connection claim in January 2018. Historically, a November 2008 VA treatment note shows the Veteran was positive for dyspnea, wheezing and morning cough, and negative for sputum, hemoptysis, and tuberculosis. A computed tomography arterial portography (CTAP) revealed normal breath sounds in all lung fields; there was no tactile fremitus. A March 2010 VA primary care note shows that results from the Veteran's 2008 pulmonary function tests (PFT) were normal, as was his chest x-ray. The Veteran was afforded a VA respiratory examination in March 2018. The examiner noted the Veteran's in-service diagnosis of bronchitis and marked that acute bronchitis was resolved. The Veteran reported that while in service he had a cough with yellow green mucus, fever, and wheezing. He was treated with antibiotics and the condition completely resolved. On current examination, the examiner determined that the Veteran did not have a pulmonary condition or a respiratory condition requiring medication. The examiner reported that a chest x-ray was performed in March 2018 and "no acute [or significant] pathology detected. No infiltrate of effusion seen. Heart size, lung volumes, and pulmonary vascularity are within normal limits." Results from PFT performed the same day as the chest x-ray were also normal. The VA examiner opined that the Veteran's claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. In providing a rationale, the examiner considered the Veteran's lay reports of symptoms, prior medical history, and diagnostic testing. The examiner noted that the Veteran's oxygen saturation level was 99 percent on room air during his examination and his lungs were clear to auscultation. There were no wheezes or rales. The examiner did not hear "E to A" changes for egophony. There was also no dullness to percussion or vocal or tactile fremitus. The Board finds the March 2018 VA examination report, and the other objective medical evidence of record, probative regarding the lack of bronchitis diagnosis. The VA examiner found no current pathology of bronchitis from which to render a diagnosis. The examiner considered the Veteran's history, to include his military service, treatment records, and lay report. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302 (2008). Moreover, the examiner is qualified through education, training, and experience to offer medical diagnoses, statements, or opinions. Also, VA treatment records since the exam remain silent for treatment or diagnosis of bronchitis. The Board acknowledges that the Veteran's STRs show two periods for which he was diagnosed with bronchitis, with the latter occurring in 1982. However, the record does not demonstrate that he continued to suffer from bronchitis post service. Rather, chest x-rays continue to show that he generally has normal lungs. While the Veteran believes he has a current diagnosis of bronchitis related to service, he is not competent to provide a diagnosis in this case because the issue is medically complex. It requires specialized medical education and the ability to interpret complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. Since the record presents no competent medical evidence to establish a current bronchitis disability during the appeal, there can be no valid claim. Brammer, 3 Vet. App. 223, 225 (1992). As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. Thus, the claim of service connection for bronchitis must be denied. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). 7. Entitlement to service connection for a right knee injury and numbness is denied. The Veteran asserts that while stationed in Panama, he suffered a right knee injury and the pain, which still exists, has been chronic. As a preliminary matter, the Board notes that the Veteran was originally denied service connection for a right knee injury with numbness in an unappealed December 2008 rating decision. At that time, the Veteran argued that he injured the knee during training and that the injury occurred while stationed in the Panama Canal, "on a 25-mile run with gear and weapons." The RO denied the claim because STRs did not show a complaint, treatment, or diagnosis of a right knee injury or numbness. Also, there was no link establishing nexus. The Veteran did not initiate an appeal of that decision and it became final. 38 U.S.C. §7105; 38 C.F.R. §§ 20.302, 20.1103. New and material evidence was not received within a year of notice of the decision. 38 C.F.R. § 3.156 (b). In January 2018, the Veteran filed an application to reopen service connection for a right knee injury with numbness. In the April 2018 rating decision on appeal, the RO determined new and material evidence was not received and declined to reopen the claim. However, the RO later reopened and readjudicated the matter on the merits in the December 2019 statement of the case. Nonetheless, the Board must address whether new and material evidence has been received to reopen the claim. See Jackson v. Principi, 265 F.3d 1366 (Fed. Cir. 2001). After reviewing the evidence of record at the time of the December 2008 rating decision, and the evidence since, to include the current VA examination report, the Board finds new and material evidence sufficient to reopen the claim. The Veteran submitted copies of correspondence from a private clinician dated in March 2010, which included reference to knee pain. The March 2018 VA examination is new as it was not previously of record. The examination report is also material because it relates to an element of service connection that was previously unestablished (i.e., a current disability). The examination report addresses whether a current right knee disability is present. As new and material evidence has been received, the claim is reopened. There is no prejudice for the Board to proceed to an adjudication on the merits, as the RO has already done so in the first instance. See Hickson v. Shinseki, 23 Vet. App. 394 (2010). The question before Board is whether the Veteran has a current right knee disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. Without a current diagnosis, service connection cannot be granted. See Brammer v. Derwinski, 3 Vet. App. 233, 225 (1992). After careful review of the evidence, the Board finds that service connection is not warranted. The Board concludes that the Veteran does not have a current right knee diagnosis and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). Regarding the Veteran's newly reported in-service injury, STRs show that the Veteran complained of pain in the back of his left knee, which was diagnosed as a severe left knee sprain in June 1978. Two months later, the Veteran fell off a bus while it was running and landed on his knee. The radiology report from this injury notes that the Veteran complained of pain in the posterior patella and indicates that an x-ray was requested for the left knee. The Veteran's post-service treatment records since the 2008 denial have not shown a diagnosis of or treatment for a right knee injury or numbness. At his March 2018 VA knees examination, the Veteran reported that while stationed in Panama and participating in a training exercise, he "fell off of a truck and had right knee pain." He explained that he "did not seek medical attention for several days" but was seen at the dispensary. The examiner noted the Veteran's report that he was "diagnosed with a right knee sprain, strain, treated with ice and ibuprofen and returned to ward." The examiner also noted that the discomfort completely resolved within a few days. Regarding his right knee condition post-service, the Veteran reported an employment history of 17 years in construction and iron work. The examiner noted the Veteran's self-report that in 2003, after several weeks or months of carrying approximately 70 pounds of steel and tools, he had right knee pain and occasional numbness to the lateral aspect of the right knee in a circular distribution (not in a dermatomal pattern). The Veteran reportedly sought treatment at a VA facility and results from an electromyogram (EMG) were normal. The examiner noted that the Veteran's symptoms "completely resolved since he stopped carrying heavy loads of steel and tools" and that his last flare up was over a year ago. On examination, the Veteran reported having flare-ups and it as right knee swelling. Notably, the Veteran indicated that that this occurred if he bended and worked a lot while working construction. The Veteran had normal range of motion for both flexion and extension. Pain was noted on exam or with weight bearing. There was no objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue. There was no objective evidence of crepitus. The Veteran was able to perform repetitive-use testing without any additional loss of function or range of motion after three repetitions. Neither pain, weakness, fatigability, or incoordination significantly limited the Veteran's functional ability with repeated use over a period of time. Results from the muscle strength and joint stability tests were normal. The examiner reported that the Veteran did not have a current diagnosis associated with a right knee injury. The Veteran was also afforded a VA examination for peripheral nerve conditions in March 2018. The VA examiner reported no diagnosis. The Veteran did not endorse any symptoms attributable to any peripheral nerve condition. Results from the muscle strength test, reflex and sensory exams were normal. The Veteran's gait was also marked as normal. An evaluation of the severity for lower extremity nerves rendered normal results bilaterally. The examiner remarked that the Veteran's complaint of occasional numbness in the lateral aspect of the right knee was due to carrying a combined 70 pounds of steel and tools while working construction. The symptoms reportedly resolved if he did not carry excessive weight for prolonged times and were resolved for over one year. The Veteran's physical exam was normal, and neuro-sensation was intact in the right knee. Thus, a diagnosis was not warranted. The examiner opined that the Veteran right knee condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness and explained that the Veteran's right knee pain from his in-service injury completely resolved. The examiner also explained that the Veteran's attributed his right knee pain and occasional numbness to lateral aspect of the right knee to carrying heavy steel and tools while working. The examiner noted the Veteran's denial of knee pain/numbness for over a year and lack of treatment. Lastly the examiner noted the Veteran's intact neuro-sensation in his bilateral lower extremities. The Board finds the March 2018 VA examination reports, and the other objective medical evidence of record, probative regarding the lack of diagnosis for a right knee injury or numbness. The VA examiner found no current pathology of a right knee injury or numbness from which to render a diagnosis. The examiner considered the Veteran's history, to include his military service, treatment records, and lay report. See Nieves-Rodriguez, 22 Vet. App. 295, 302 (2008). Moreover, the examiner is qualified through education, training, and experience to offer medical diagnoses, statements, or opinions. Also, VA treatment records since the examination remain silent for treatment or diagnosis of a right knee injury or numbness. The Board acknowledges that the Veteran's STRs show an in-service fall from a moving bus. However, the record does not demonstrate that the Veteran has had a right knee injury or numbness diagnosed post military service. Both the VA knee and peripheral neuropathy exams determined a current disability was not present. While the Veteran believes he has a current right knee disability, he is not competent to provide a diagnosis in this case because the issue is medically complex. It requires specialized medical education and the ability to interpret complicated diagnostic medical testing. Jandreau, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. Since the record presents no competent medical evidence to establish a current right knee disability during the appeal, there can be no valid claim. Brammer, 3 Vet. App. 223, 225 (1992). As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. Thus, the claim of service connection for a right knee injury or numbness must be denied. See 38 U.S.C. § 5107(b); Gilbert, 1 Vet. App. 49, 55-56 (1990). REASONS FOR REMAND 1. Entitlement to service connection for a back disorder is remanded. The Veteran asserts in a December 2019 correspondence that while stationed in the Panama Canal Zone, he suffered a back injury and still has chronic pain. The Veteran's service treatment records show a complaint of back pain in February 1981. The clinician's note reflects the Veteran's report of symptoms such as a non-constant aching in the lower area of his back. The clinician's diagnosis of the Veteran's back condition was a pulled muscle. VA treatment records show an October 2008 complaint from the Veteran reporting that he "sometimes has low back pain." The VA clinician's findings were a nontender back and negative results from the straight leg raise test. An x-ray of the Veteran's lumbar spine showed small osteophytes (bone spurs). A March 2009 VA treatment note mentions the Veteran's complaint of occasional low back pain that does not seem related to numbness. The note also mentions the 2008 x-ray findings of small osteophytes (bone spurs). At his March 2018 VA examination, the Veteran explains that he twisted his back during physical training and had low back pain without radiculopathy symptoms. The Veteran also explains that shortly after that incident, he was "forced to perform manual labor" which included picking up trash and shredding documents in a cold garage. The examiner's report includes the Veteran's self-report of symptoms and the progression of his back condition since onset. It also includes the examiner's statement that the Veteran's last x-rays, which were taken over 10 years ago were "allegedly normal. Not available for review." The examiner's conclusion is that the Veteran's back condition resolved and there is no current disability. However, consideration has not been given to the October 2018 x-ray of the Veteran's lumbar spine reveals degenerative changes or age-related changes. An addendum opinion is needed as it is unclear whether the findings from the 2018 x-ray are related to the Veteran's military service. The matter is REMANDED for the following action: Obtain an addendum opinion from an appropriate clinician. The need for an in-person examination is at the examiner's discretion. The examiner is asked to provide a response to the following: Are the current lumbar spine degenerative changes shown upon the October 2018 X-ray at least as likely as not related to service, including the pulled muscle diagnosed there, or the Veteran's assertion that he reportedly twisted his back and had to pick up trash and shred documents in a cold garage? Provide a rationale to support the opinion. In providing doing so, consider the Veteran's description of his in-service back injury and symptoms as well as his post-service back symptoms. If there is any medical reason to accept or reject the proposition that the Veteran's reported injury and symptoms in service and thereafter represented the onset of his current back disability (to include the lumbar spine degenerative changes shown on X-ray in October 2018), this should be noted. Stated another way, do the Veteran's reports about his symptoms align with how the currently diagnosed disability is known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible? D. JOHNSON Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Telamour, Associate Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.