Citation Nr: 21074301 Decision Date: 12/14/21 Archive Date: 12/14/21 DOCKET NO. 18-21 929 DATE: December 14, 2021 ORDER Entitlement to service connection for a bilateral shoulder disability is denied. Entitlement to service connection for bilateral ankle disability is denied. Entitlement to service connection for a bilateral elbow disability is denied. Entitlement to service connection for a bilateral wrist disability is denied. Entitlement to service connection for a cervical spine disability is denied. Entitlement to service connection for a bilateral hip disability is denied. Entitlement to service connection for a bilateral hearing loss disability is denied. Entitlement to service connection for tinnitus is denied. REMANDED Entitlement to a service connection for a bilateral foot disability other than plantar fasciitis is remanded. Entitlement to service connection for hypertension is remanded. Entitlement to service connection for a prostate disability is remanded. Entitlement to service connection for a thyroid disability is remanded. Entitlement to service connection for low back disability is remanded. Entitlement to service connection for an acquired psychiatric disability, to include general anxiety disorder, insomnia, and posttraumatic stress disorder (PTSD), is remanded. FINDINGS OF FACT 1. The preponderance of the credible evidence is against the finding that the Veteran's claimed bilateral shoulder, bilateral ankle, bilateral elbow, bilateral wrist, neck, and tinnitus disabilities were incurred in service, and were otherwise related to any aspect of his active service. 2. The preponderance of the credible evidence is against the finding that the Veteran has a current bilateral hearing loss disability for VA compensation purposes or a bilateral hip disability. CONCLUSIONS OF LAW 1. The criteria to establish entitlement to service connection for a bilateral shoulder disability, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.303(d), 3.307(a)(6)(iii). 2. The criteria to establish entitlement to service connection for a bilateral ankle disability, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.303(d), 3.307(a)(6)(iii). 3. The criteria to establish entitlement to service connection for a bilateral elbow disability, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.303(d), 3.307(a)(6)(iii). 4. The criteria to establish entitlement to service connection for a bilateral wrist disability, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.303(d), 3.307(a)(6)(iii). 5. The criteria to establish entitlement to service connection for a neck disability, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.303(d), 3.307(a)(6)(iii). 6. The criteria for entitlement to service connection for a bilateral hip disability, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304. 7. The criteria for service connection for hearing loss have not been met. 38 U.S.C. §§ 1110, 1112, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.385. 8. The criteria for service connection for tinnitus have not been met. 38 U.S.C. §§ 1110, 1112, 1131, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.310, 3.385. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served as a member of the Air National Guard of the Commonwealth of Puerto Rico from January 1984 to August 1992, to include a period of active duty from May 1984 to November 1984, and from July 1991 to August 1992. SERVICE CONNECTION Service connection is established if it is shown the Veteran has a disability resulting from an injury sustained or a disease contracted in the line of duty during active service, or for aggravation during service of a pre-existing condition beyond the natural progression of the disorder. 38 U.S.C. §§ 1110, 1131, 1153; 38 C.F.R. §§ 3.303, 3.306. Evidence of continuity of symptomatology from the time of service until the present is required where the chronicity of a chronic condition manifested during service either has not been established or might reasonably be questioned. 38 C.F.R. § 3.303(b). Only disabilities listed as chronic diseases in 38 C.F.R. § 3.309 (a) may be considered for service connection under 38 C.F.R. § 3.303(b). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Other disabilities initially diagnosed after service also may be service connected if the evidence, including that pertinent to service, shows the disability was incurred in service. 38 C.F.R. § 3.303(d). Hypertension is a chronic disability. 38 C.F.R. § 3.309(a). To establish service connection, there must be: (1) competent and credible evidence confirming the Veteran has the claimed disability or at least has since filing the claim; (2) competent and credible evidence of in-service incurrence or aggravation of a relevant disease or injury; and (3) competent and credible evidence of a nexus or link between the in-service injury or disease and the current disability. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Service connection may be established on a secondary basis for a disability that is shown to be proximately due to or the result of a service-connected disease or injury. Establishing service connection on a secondary basis requires evidence sufficient to show that a current disability exists and that the current disability was either caused or aggravated by a service-connected disability. 38 C.F.R. § 3.310(a); Allen v. Brown, 7 Vet. App. 439 (1995). In determining whether service connection is warranted for a disability, VA must determine whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The Board must assess the credibility and probative value of evidence, and the Board may favor one medical opinion over another if an adequate statement of reasons or bases is provided. Owens v. Brown, 7 Vet. App. 429 (1995); Wood v. Derwinski, 1 Vet. App. 190 (1991). While the Board cannot ignore the opinion of a treating physician, the Board may discount the credibility of a physician's statement. Guerrieri v. Brown, 4 Vet. App. 467 (1993); Sanden v. Derwinski, 2 Vet. App. 97 (1992). 1. Entitlement to service connection for a bilateral shoulder disability 2. Entitlement to service connection for bilateral ankle disability 3. Entitlement to service connection for a bilateral elbow disability 4. Entitlement to service connection for a bilateral wrist disability 5. Entitlement to service connection for a cervical spine disability The Veteran generally maintains that he suffers from disabilities of the neck, bilateral shoulders, ankles, elbows, and wrists, due to his time on active service. The Board finds that, while the record does demonstrate that the Veteran suffers from disabilities of the shoulders, ankles, elbows, wrists, and neck, the medical evidence, to include VA examinations, show that none of such condition are due any aspect of his active service. Therefore, as the preponderance of evidence is against the finding that the Veteran's disabilities are due to his active service, the Board must find that service connection is not warranted, and the Veteran's claims must be denied. As an initial matter, with respect to a current disability, the evidence of record does establish that the Veteran has current disabilities of his neck, shoulders, ankles, elbows, and wrists. VA and private treatment records, to include a November 2015 private opinion letter and an August 2020 VA examination reflect a diagnosis for his various claimed conditions, to include degenerative arthritis of the neck, shoulders and ankles, bilateral elbow tendonitis, and bilateral wrist strain. As such, the Board finds that a current disability is present and demonstrated by the evidence of record. Moving to the second element of service connection, an in-service injury or incurrence, the Board finds that such element is absent from the evidence. Initially, the Board notes that a close review of the Veteran's service treatment records (STRs) reveal no evidence of any complaint, treatment, and/or diagnosis for any condition/injury related to his neck, shoulders, ankles, elbows, and/or wrists. To this end, upon both entry and separation from active service, examinations reveal no findings of an injury or complaint of any condition related to his claimed disabilities; such include his report of medical history, which is void of any indication of injury related to his neck, shoulders, ankles, elbows, and wrists. Moreover, the Board notes that a review of the entire claims file reveals the Veteran has not provided even lay assertions regarding any in-service injury/incurrence regarding these claimed disabilities. Instead, much of the Veteran's submission have been generalized assertions simply that these conditions are due to his active service, without providing any specific explanation or citing any specific incident, or injuries. To this end, the Board notes that even in his November 2019 VA examination interviews, the Veteran was noted to explicitly deny any specific injury or incurrence of these condition during his active service. Specifically, during his November 2019 VA examinations, the VA examiner noted that for his bilateral elbow disability, the Veteran explicitly denied any specific in-service injury or incident but noted that he started experiencing elbow pain during his active service. With regards to his shoulders and his neck, the Veteran explicitly noted to the examiner that he did not experience any issue with either condition, to include pain, until 2006, a decade after service. Likewise, with regards to his wrists, the Veteran noted that he started having issues with such condition until "two-to-three years" prior. Finally, with regards to the Veteran's ankles the examiner noted that treatment did not start until 2008. As such, the Board must find that the preponderance of evidence is against the finding of any in-service injury or incurrence of any of the Veteran's claimed physiological disabilities. Here, not only does the evidence not show any in-service treatment or complaint regarding any of his claimed disabilities, the Veteran, himself, have not even asserted any specific in-service incident or injury in which can link his claimed disabilities to his active service. In making such finding, the Board does acknowledge that the Veteran has submitted a November 2015 private opinion letter, which ostensibly concluded a blanket finding that all the Veteran's claimed conditions, to include his musculoskeletal disabilities, were etiologically related to the Veteran's active service. The Board, however, finds that such opinion is of little probative weight, as such opinion not only fails to provide any rationale regarding such findings, but also is void of any specific in-service incident, injury, or incurrence in which such conditions are etiologically related; the private examiner's conclusion simply notes that any "neurological, cardiovascular, metabolic, and musculoskeletal" disabilities were due to his "military service performance". The Board finds such overly generalized blanket nexus findings to be of little or no probative weight, and here, fail to establish the requisite in-service element for service connection. However, even if the November 2015 private opinion was accepted as sufficient to overcome the inservice element for service connection, in arguendo, which the Board does not concede, the Veteran's claim would still fail to overcome the final nexus element for service connection. Here, as noted already, the November 2015 private opinion is considered wholly inadequate with regards to establishing an etiological nexus to service, as it fails to provide any rationale or basis for such findings, either medically or evidentiary. The Board finds that simple conclusory statements that all of the Veteran's diagnosed disabilities are related to his "military experience" is and inadequate rationale and carries little probative weight. On the other hand, the Board notes that the Veteran was afforded several VA examinations in November 2019, to assess the nature and etiology of his claimed disabilities related to his neck, shoulders, elbows, ankles, and wrists. A close review of these examination results and opinions reveals ostensibly the same findings, to include a diagnosis of a current and chronic disability for each claimed condition. With regards to the etiology of these conditions, the VA examiner found that for all his musculoskeletal conditions, that such disabilities were less likely than not related to any aspect of the Veteran's active duty, and that they were mostly related to the natural process of aging. To this end, the examiner noted that the STRs from the Veteran's relatively short period of active service showed no reports, complaints, or treatment for any injury or trauma to his claimed neck, shoulders, elbows, wrists, and/or ankles, to include upon separation from service. The examiner also pointed out that post-service treatment records, both, private and VA, show no treatment for any of the claimed conditions until a decade after the Veteran's separation from service. Finally, the VA examiner noted extensive review of the Veteran's claims file and medical history, to include the November 2015 private opinion. To this end, for all the claimed conditions, the VA examiner found the private opinion from the November 2015 private examiner to be inadequate, as it provided conclusory findings without any medical rationale or evidence. Specifically, the examiner noted that the private opinion ostensibly concluded, incorrectly, degenerative conditions for all the Veteran's musculoskeletal conditions without any radiological evidence or analysis, and provided such opinions without analysis of the available medical evidence of record. The Board finds that with regards to the Veteran's claim for a neck, wrist, shoulder, elbow, and ankle disabilities, that the November 2019 VA examination opinions are the most probative evidence of record, and as such, the preponderance of evidence is against the Veteran's claim for service connection. The Board finds the VA examiner's opinions to be well-reasoned and thorough, having considered the entire record, including STRs, the Veteran's historical accounts, and relevant private treatment records, to include reconciling such opinion with the November 2015 private opinion or record. These November 2019 opinions therefore warrants significant probative weight. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (explaining that "most of the probative value of a medical opinion comes from its reasoning" and that "[n]either a VA medical examination report nor a private medical opinion is entitled to any weight in a service-connection or rating context if it contains only data and conclusions"). In deciding these claims, the Board also considered the Veteran's statements asserting a nexus between his claimed disabilities, to include for his neck, shoulders, elbows, wrists, and ankles, and his active service. However, the current medical evidence of record, to include the November 2019 VA examinations do not suggest that the Veteran's musculoskeletal conditions are due to or arose during his active service. Further, as a lay person, the Veteran does not have the requisite medical knowledge, training, or experience to be able to render a competent medical opinion regarding the cause of the medically complex disorder of arthritis. See Kahana v. Shinseki, 24 Vet. App. 428, 437 (2011). Orthopedic disorders, to include arthritis, are complex disorders because of their multiple possible etiologies (such as age), require specialized testing to diagnose, and manifest symptomatology that may overlap with other disorders. Accordingly, the Board finds that the preponderance of the evidence is against the Veteran's claims for service connection for a neck, shoulder, elbow, wrist, and ankle disabilities. Therefore, the claims must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 6. Entitlement to service connection for a bilateral hip disability The Veteran contends that he has a bilateral hip disability that is related to his service. A close review of the Veteran's STRs, to include his separation examination, reveals no evidence of any complaints, treatment, or diagnosis for a hip disability during his active service. Similarly, post-service, VA and private treatment records are void of any diagnosed hip disabilities, to include notes on any complaints or treatment for the Veteran's bilateral hips. In November 2019 the Veteran was afforded a VA examination to determine the nature and etiology of any claimed hip disability. During the examination, the VA examiner identified no evidence of in-service or post-service treatment or diagnosis for a hip disability on either side. To this end, when interviewing the Veteran, the examiner noted that when demonstrating where he felt pain the Veteran pointed to his lumbar (back) region, and not his hips. The examiner also noted that when specifically asked about the Veteran's hips, the Veteran "denied" any pain or loss or range of motion of the hip joint; such was corroborated by the physical testing of the Veteran's hips, which showed normal range of motion. The examiner ultimately found no evidence of a current or previous hip disability. As the evidence does not show diagnosis of, or disability related to the bilateral hips, service connection is denied. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); see also McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); Romanowsky v. Shinseki, 26 Vet. App. 289, 293 (2013); Saunders v. Wilkie, 886 F.3d 1356, 1364-65 (Fed. Cir. 2018). To the extent that the Veteran has complained of pain in his bilateral hips, there is no indication that any subjective complaints result in functional impairment of either joint; and in fact, as noted in the November 2019 examination report, such pain is referring to the Veteran's lower lumbar region, and not his hip joints. Consequently, the Board finds that, at no time during the pendency of the claims does the Veteran have a current diagnosis of any hip disability and the record does not contain a recent diagnosis of disability prior to the Veteran's filing of the claims. Therefore, service connection is not warranted. 7. Entitlement to service connection for a bilateral hearing loss disability The Veteran claims that he currently has hearing loss in both ears as result of active service. A review of the evidence of record, to include VA medical records, VA examinations, and lay statements shows that the preponderance of the evidence is against a finding that the Veteran currently has a hearing loss disability, as defined by VA regulation. Therefore, the claim for service connection must be denied. Impaired hearing is considered to be a disability for VA purposes if the auditory threshold for any of the frequencies of 500, 1000, 2000, 3000, and 4000 hertz is 40 decibels or greater; the auditory thresholds for at least three of these frequencies are 26 decibels or greater; or speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. To establish service connection for hearing loss, the requirements for hearing loss to constitute a disability as defined in 38 C.F.R. § 3.385 need not be shown by the results of audiometric testing during active service. 38 C.F.R. § 3.385; Ledford v. Derwinski, 3 Vet. App. 87 (1992). Therefore, the threshold question that must be addressed is whether the Veteran's claimed hearing loss qualifies as a disability, as defined by VA. In the absence of proof of a present disability, there is no valid claim for service connection. Brammer v. Derwinski, 3 Vet. App. 223 (1992). After a thorough review of the Veteran's service medicals records, post-service VA treatment records, and a VA audiological examination, the Board finds that the Veteran's hearing does not meet the regulatory definition to constitute a hearing loss disability. While the Veteran has complained of loss of hearing, there is no objective evidence of loss of hearing that constitutes a disability. 38 C.F.R. § 3.385. The Board notes that while the Veteran's service treatment records (STRs) show several audiological examinations during his active service, a close review of these objective results shows no instance in which the Veteran's hearing loss rose to a level that would constitute hearing loss disability under VA regulations. The Board notes that since the Veteran's separation from service, post-service medical records also do not demonstrate any objective audiological examinations that show audiometric tests that show a hearing loss severe enough to be considered a hearing disability under VA regulation. During the claims period, the Veteran was afforded two separate VA audiological examinations to assess the nature and etiology of his claimed hearing loss in March 2016 and August 2020. During his initial examination in March 2016, the VA examiner noted that objective hearing test were not possible as the Veteran was noted to be uncooperative and refused to respond to the audio stimuli for testing. No objective audiometric scores were reported, however, the VA examiner noted that the Veteran could conversate with the examiner on a normal conversation level, and as such, the examiner found that the Veteran's condition was normal. At an August 2020 VA audiological examination, pure-tone thresholds, in decibels, were: HERTZ 500 1000 2000 3000 4000 RIGHT 10 10 10 15 15 LEFT 15 15 10 15 15 Speech audiometry results using the Maryland CNC were 96 percent bilaterally. The Board finds that the objective results from the hearing examination does not show the requisite levels of pure-tone thresholds or speech discriminations to constitute a current disability. Hearing loss is considered a disability only when any of those above noted categories reach 40 decibels or higher, or at least three of those categories reach 26 decibels or greater. 38 C.F.R. § 3.385. The Veteran's audiogram examinations results represent the most severe results from any hearing test of record, to include the separation examination from service. The Veteran's hearing acuity in both ears remains below the criteria for a diagnosis of hearing loss. The speech discrimination remains above the threshold to be considered a disability. Therefore, the Board finds that without a current disability of hearing loss, the claim for service connection cannot prevail. Brammer v. Derwinski, 3 Vet. App. 223 (1992). The Board realizes that the Veteran has asserted that he has a hearing loss disability. The Board notes that competent medical evidence of record includes an opinion that he has loss of hearing in both ears which is related to service. Hensley v. Brown, 5 Vet. App. 155 (1993). While the Board acknowledges that the Veteran may be competent to speak to the fact that his hearing is less than it was before, or as it was prior to service, he is not competent to speak to the specific level or severity of any hearing loss as it relates to achieving audiometric guidelines. For the purposes of applying the laws and regulations administrated by VA, the level of impairment is determined by a mechanical application of the objective criteria of VA regulations. Here, the objective criteria are not met by the Veteran's hearing acuity, and therefore, the Veteran's hearing loss cannot be considered a disability for which service connection may be granted. Therefore, the Board finds the evidence from the VA audiological examinations to be most probative in determining the proper diagnosis regarding the Veteran's claimed hearing loss. Consequently, as the preponderance of evidence is against the finding of a current disability of hearing loss for VA purposes, and the Veteran's claim of service connection for hearing loss must be denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 8. Entitlement to service connection for bilateral tinnitus With regards to the Veteran's claim for tinnitus, the Veteran's claims that he suffers from recurrent tinnitus due to noise exposure during his active service. To this end, the Board finds that the competent medical evidence of record, to include VA examinations, reveals that the Veteran's claimed tinnitus is not the result of any aspect of the Veteran's active service, or arose during such service. As such, the Board must find that the Veteran's claimed tinnitus does not warrant service connection. As a preliminary matter, the Board finds that a current disability has been established by the record, as the Veteran is competent to report the symptoms of tinnitus. Here, as the Veteran has reported such symptoms of tinnitus, to include during his November 2019 VA examination, the Board find that a disability has been established for the purpose of service connection. With regards to the second element of service connection, the Board also finds that such element to be fulfilled. Here, the Veteran has noted complaints of noise exposure from doing maintenance inspections and operating power generators systems during this active service. The Board finds that such inservice noise trauma is conceded as such matched his military occupation specialty (MOS) of electrical power production, Therefore, moving to the final element of an etiological nexus between the Veteran's noise exposure during service, and his currently claimed tinnitus. In this regard, the Veteran was afforded two separate VA audiological examinations in March 2016 and November 2019 to assess the nature and etiology of his claimed tinnitus. The VA audiology examination report dated in March 2016 indicates that the Veteran denied tinnitus symptoms when questioned by the examiner, and he indicated that he did not experience tinnitus. Based on the examination, the examiner concluded that the Veteran did not have recurrent tinnitus. In an August 2020 VA audiological examination, the VA examiner noted that the Veteran did in fact report recurrent and intermittent tinnitus. However, when questioned, the Veteran noted that such condition only began in 2013, nearly two decades after his separation from active service. Upon a noted review of the Veteran's service and medical history, the VA examiner concluded that the Veteran's tinnitus was not due to his active service. In arriving at this finding, the VA examiner noting that while "prolonged" exposure to noise trauma could cause tinnitus, the Veteran's active service of only a year was too short of a duration for exposure to have caused tinnitus. Additionally, the examiner rejected any theory of late-onset tinnitus, and found that such tinnitus was more likely due to the Veteran's post-service occupation and recreational noise exposure. The Board finds that the August 2020 VA examiner's opinion to be the most probative in speaking to the etiology of the Veteran's claimed tinnitus. While the Board recognizes that the Veteran claims that such condition is due to his active service, the Veteran is not competent to speak to such complex medical matters such as the etiology of a disability. Here, as an opinion regarding a medical nexus has been provided by a medical profession, the Board finds that such opinion to be the most probative evidence regarding the finding of a medical nexus; and as the preponderance of evidence is against the claim, the Board must find that the Veteran's claim for service connection must be denied. The Board additionally finds that service connection has also not been established on a presumptive basis. Here, the Board notes that the preponderance of evidence is against the finding that the Veteran's tinnitus arose during his active service and proceeded until the present. To this end, a close review of the Veteran's STRs reveal silence on any complaints, diagnosis, or treatment for tinnitus. Post-service medical records likewise are absent any complaints, diagnosis, or treatment for tinnitus. Additionally, by the Veteran's own admission at the November 2019 examination, he did not experience such tinnitus until 2013, decades after separation from service. Finally, the Board notes that close review of the Veteran's lay statements reveals no statements where the Veteran asserts tinnitus symptoms existed since his active service, until the present. Consequently, as the preponderance of the evidence is against the finding of both an etiological nexus to service or continuity of tinnitus symptoms since his service, the Board must find that the Veteran's claim for service connection must be denied. REASONS FOR REMAND 1. Entitlement to a service connection for a bilateral foot disability 2. Entitlement to service connection for hypertension 3. Entitlement to service connection for a prostate disability 4. Entitlement to service connection for a thyroid disability 5. Entitlement to service connection for low back disability is remanded. With regard to the Veteran's claims for service connection for a bilateral foot disability, hypertension, a prostate disability, a thyroid disability, and a back disability, the Board finds that the opinions obtained by the RO on the last remand are inadequate, and remand is required to obtain an addendum opinion for the VA to fulfill the duty to assist the Veteran. The Board notes that the VA's statutory duty to assist the Veteran includes the duty to conduct a thorough and contemporaneous examination so that the evaluation of the claimed disability will be a fully informed one. Green v. Derwinski, 1 Vet. App. 121 (1991); Snuffer v. Gober, 10 Vet. App. 400 (1997). Assistance by VA includes providing a medical examination or obtaining a medical opinion when such an examination or opinion is necessary to make a decision on a claim. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79 (2006). When the medical evidence is inadequate, as it is here, VA must supplement the record by seeking an advisory opinion or ordering another medical examination. Colvin v. Derwinski, 1 Vet. App. 171 (1991); Hatlestad v. Derwinski, 3 Vet. App. 213 (1992). With regards to the Veteran's claim for a bilateral foot disability, hypertension, a prostate disability, and hypothyroidism, the VA acquired a VA examination and opinion for these conditions in May 2021, to assess the nature and etiology of these claimed conditions. After a thorough review of the VA examination reports, the Board finds that the negative nexus opinions rendered to be incomplete. Specifically, while the VA examiner found that the Veteran's claimed prostate, thyroid, foot, and hypertension disabilities, were not related to service, the examiner's rationale failed to address the November 2015 private opinion letter which found that such conditions were all related to service. Here, while the VA finds the private opinion to be inadequate to be dispositive of the claim, such opinion still must be reconciled by the VA examiner in addressing these conditions. Therefore, as the May 2021 VA examiner's rationale was silent on speaking to the countervailing private opinion, the Board must find such opinion to be inadequate. Likewise, with regards to the Veteran's back disability, the VA afforded the Veteran a VA examination in November 2019. Here, again, the Board finds that the negative nexus opinion provided by this examiner to be also inadequate. Specifically, the VA examiner's rationale for finding against the Veteran's claim ostensibly relies on the finding that there was no evidence of inservice back injury; this is not based on the evidence. A close review of the Veteran's STRs reveals one incident of a complaint of back pain during the Veteran's initial active service for training during boot camp. The Board finds that such incident renders the VA examiner's opinion inadequate as the rationale is not based on the evidence of record, and therefore, remand is against required for the VA to fulfill its duty. 6. Entitlement to service connection for an acquired psychiatric disability is remanded. The Board also finds that the July 2020 VA examination afforded to the Veteran to assess the nature and etiology of his claimed psychiatric disability to be inadequate. Here, the July 2020 examiner only diagnosed the Veteran with insomnia, noting that while the Veteran was previously (May 2019) diagnosed with anxiety, that currently, the Veteran's array of symptoms no longer fulfilled the criteria for a diagnosis of anxiety. As such, the examiner only provided a negative nexus opinion regarding the Veteran's diagnosed insomnia, finding that such condition was not due to any aspect of the Veteran's active service. The Board finds that such opinion to be inadequate. Specifically, the Board notes that the medical evidence of record shows that the Veteran was diagnosed and treated for anxiety as recently as May 2019, in other words, during the claims period. As such, any opinion must speak to not only the disability in which the examiner diagnoses at that time, but also any diagnosed disability during the course of the claims period. The Board notes that a claim for service connection encompasses all current disabilities identified concurrent to the claims period. As such, the Board finds the July 2020 VA examiner's silence on assessing the etiology of the previously diagnosed anxiety to render the opinion inadequate. Accordingly, remand is required. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination with an appropriate medical professional to determine the nature and etiology of the Veteran's bilateral foot disability. The Veteran's claims file and any other information deemed pertinent must be provided and reviewed by the examiner in conjunction with the examination. All necessary testing and evaluation should be performed, and all findings set forth in detail. For any bilateral foot disability, the examiner is asked to opine as to whether it is at least as likely as not (a 50 percent or greater probability) that such foot disability is related to his active service. In answering the above question, the examiner must explicitly address and reconcile all findings with the November 2015 private opinion letter. The examiner must provide the rationale for all opinions provided. 2. Schedule the Veteran for a VA examination with an appropriate medical professional to determine the nature and etiology of the Veteran's hypertension. The Veteran's claims file and any other information deemed pertinent must be provided and reviewed by the examiner in conjunction with the examination. All necessary testing and evaluation should be performed, and all findings set forth in detail. The examiner is asked to opine as to whether it is at least as likely as not (a 50 percent or greater probability) that the hypertension is related to his active service. In answering the above question, the examiner must explicitly address and reconcile all findings with the November 2015 private opinion letter. The examiner must provide the rationale for all opinions provided. 3. Schedule the Veteran for a VA examination with an appropriate medical professional to determine the nature and etiology of the Veteran's prostate disability. The Veteran's claims file and any other information deemed pertinent must be provided and reviewed by the examiner in conjunction with the examination. All necessary testing and evaluation should be performed, and all findings set forth in detail. The examiner is asked to opine as to whether it is at least as likely as not (a 50 percent or greater probability) that the prostate disability is related to his active service. In answering the above question, the examiner must explicitly address and reconcile all findings with the November 2015 private opinion letter. The examiner must provide the rationale for all opinions provided. 4. Schedule the Veteran for a VA examination with an appropriate medical professional to determine the nature and etiology of the Veteran's thyroid disability. The Veteran's claims file and any other information deemed pertinent must be provided and reviewed by the examiner in conjunction with the examination. All necessary testing and evaluation should be performed, and all findings set forth in detail. The examiner is asked to opine as to whether it is at least as likely as not (a 50 percent or greater probability) that the thyroid disability is related to his active service. In answering the above question, the examiner must explicitly address and reconcile all findings with the November 2015 private opinion letter. The examiner must provide the rationale for all opinions provided. 5. Schedule the Veteran for a VA examination with an appropriate medical professional to determine the nature and etiology of the Veteran's claimed back disability. The Veteran's claims file and any other information deemed pertinent must be provided and reviewed by the examiner in conjunction with the examination. All necessary testing and evaluation should be performed, and all findings set forth in detail. The examiner is asked to opine as to whether it is at least as likely as not (a 50 percent or greater probability) that the back disability is related to his active service. In answering the above question, the examiner must explicitly address and reconcile all findings with the November 2015 private opinion letter, and explicitly speak to the inservice STRs notation of back pain during service. The examiner must provide the rationale for all opinions provided. 6. Schedule the Veteran for a VA psychiatric examination for the purpose of determining the current nature and etiology of the Veteran's claimed psychiatric disability, to include anxiety. The examiner must review the claims file and should note that review in the report. The examiner should provide the following: (a) The examiner should opine whether it is at least as likely as not (50 percent or greater probability) that any psychiatric disability is causally related to active service or any event, injury, or disease during service. The examiner should discuss the November 2015 private physician's statement. (b) The examiner should opine whether it is at least as likely as not (50 percent or greater probability) that any psychiatric disability is proximately due to or caused by any service-connected disability. (c) The examiner should opine whether it is at least as likely as not (50 percent or greater probability) that any psychiatric disability has been aggravated (permanently increased in severity beyond the natural progress of the disorder) by any service-connected disability. The examiner must provide the rationale for all opinions provided. DELYVONNE M. WHITEHEAD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Ziheng Zhu, 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.