Citation Nr: 21075609 Decision Date: 12/21/21 Archive Date: 12/21/21 DOCKET NO. 18-45 402 DATE: December 21, 2021 ORDER The application to reopen a claim for service connection for a low back disability is granted. Service connection for a low back disability, diagnosed as degenerative arthritis, is granted. Service connection for bilateral hearing loss is granted. Service connection for tinnitus is granted. REMANDED Entitlement to service connection for a psychiatric disorder, to include posttraumatic stress disorder (PTSD), is remanded. Entitlement to service connection for a right hip disability is remanded. Entitlement to service connection for a left hip disability is remanded. Entitlement to service connection for a right knee disability is remanded. Entitlement to service connection for a left knee disability is remanded. Entitlement to service connection for bilateral foot disabilities is remanded. Entitlement to service connection for hypertension is remanded. Entitlement to service connection for erectile dysfunction is remanded. FINDINGS OF FACT 1. The Veteran's low back disability, diagnosed as degenerative arthritis, had its onset in service. 2. The Veteran's bilateral hearing loss had its onset in service. 3. The Veteran's tinnitus had its onset in service. CONCLUSIONS OF LAW 1. The criteria for service connection for a low back disability, diagnosed as degenerative arthritis, have been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 1154(a), 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. 2. The criteria for service connection for bilateral hearing loss have been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 1154(a), 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.385. 3. The criteria for service connection for tinnitus have been met. 38 U.S.C. §§ 1110, 1131, 1154(a), 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the Army from August 1973 to September 1975. This matter is before the Board of Veterans' Appeals (Board) on appeal of a February 2016 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO), that determined that new and material evidence had not been received to reopen a claim for service connection for a low back disability. By this decision, the RO also denied service connection for a psychiatric disorder, to include PTSD. The Board finds that it is more appropriate to characterize the claim broadly as one of entitlement to service connection for a psychiatric disorder, to include PTSD. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). The RO further denied service connection for bilateral hearing loss; tinnitus; a right hip disability; a left hip disability; a right knee disability; a left knee disability; bilateral foot disabilities; hypertension; and for erectile dysfunction. In April 2021, the Veteran appeared at a Board hearing before the undersigned Veterans Law Judge. At the hearing the undersigned Veterans Law Judge agreed to hold the record open to afford the Veteran the opportunity to submit additional evidence in support of his appeal. That evidence will be considered by the Board in the adjudication of this appeal. The Board notes that the February 2016 RO decision determined that new and material evidence had not been received to reopen a claim for service connection for a low back disability. Service connection for a low back disability (listed as a back injury) was previously denied in final October 1986 and April 2003 RO decisions. Therefore, the Board must address whether new and material evidence has been received to reopen the Veteran's claim for service connection for a low back disability. See Jackson v. Principi, 265 F.3d 1366 (Fed. Cir. 2001). The Board finds, however, that new and material evidence has been received to reopen that claim pursuant to 38 C.F.R. § 3.156 (a). Therefore, this decision will address the merits of the underlying service connection claim for a low back disability. 1. Low Back Disability Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999); Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd per curiam, 78 F. 3d 604 (Fed. Cir. 1996) (table). Determinations as to service connection will be based on review of the entire evidence of record, to include all pertinent medical and lay evidence, with due consideration to VA's policy to administer the law under a broad and liberal interpretation consistent with the facts in each individual case. 38 U.S.C. § 1154(a); 38 C.F.R. § 3.303(a). Secondary service connection may be granted for a disability that is proximately due to, the result of, or aggravated by an established service-connected disability. 38 C.F.R. § 3.310; see also Allen v. Brown, 7 Vet. App. 439 (1995). In making all determinations, the Board must fully consider the lay assertions of record. A layperson is competent to report on the onset and recurrence of symptoms. See Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a Veteran is competent to report on that of which he or she has personal knowledge). Lay evidence can also be competent and sufficient evidence of a diagnosis or to establish etiology if (1) the layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). When considering whether lay evidence is 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 at 1377 (Fed. Cir. 2007) (holding that "[w]hether lay evidence is competent and sufficient in a particular case is a factual issue to be addressed by the Board"). The Board is charged with the duty to assess the credibility and weight given to evidence. Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997), cert. denied, 523 U.S. 1046 (1998); Wensch v. Principi, 15 Vet. App. 362, 367 (2001). Indeed, in Jefferson v. Principi, 271 F.3d 1072 (Fed. Cir. 2001), the United States Court of Appeals for the Federal Circuit (Federal Circuit), citing its decision in Madden, recognized that that Board had inherent fact-finding ability. Id. at 1076; see also 38 U.S.C. § 7104(a) (West 2002). Moreover, the United States Court of Appeals for Veterans Claims (Court) has declared that in adjudicating a claim, the Board has the responsibility to weigh and assess the evidence. Bryan v. West, 13 Vet. App. 482, 488-89 (2000); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992). As a finder of fact, when considering whether lay evidence is satisfactory, the Board may also properly consider internal inconsistency of the statements, facial plausibility, consistency with other evidence submitted on behalf of the Veteran, and the Veteran's demeanor when testifying at a hearing. See Dalton v. Nicholson, 21 Vet. App. 23, 38 (2007); Caluza v. Brown, 7 Vet. App. 498, 511 (1995), aff'd per curiam, 78 F.3d 604 (Fed. Cir. 1996). In determining the probative value to be assigned to a medical opinion, the Board must consider three factors. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The initial inquiry in determining probative value is to assess whether a medical expert was fully informed of the pertinent factual premises (i.e., medical history) of the case. A review of the claims file is not required, since a medical professional can also become aware of the relevant medical history by having treated a Veteran for a long period of time or through a factually accurate medical history reported by a Veteran. See Id. at 303-04. The second inquiry involves consideration of whether the medical expert provided a fully articulated opinion. See Id. A medical opinion that is equivocal in nature or expressed in speculative language does not provide the degree of certainty required for medical nexus evidence. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). The third and final factor in determining the probative value of an opinion involves consideration of whether the opinion is supported by a reasoned analysis. The most probative value of a medical opinion comes from its reasoning. Therefore, a medical opinion containing only data and conclusions is not entitled to any weight. In fact, a review of the claims file does not substitute for a lack of a reasoned analysis. See Nieves-Rodriguez, 22 Vet. App. at 304; see also Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A] medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions."). The Veteran contends that he has a low back disability that is related to service. He specifically maintains that he hurt his low back during service when an Army locker fell on him, and it pinned him against the wall. The Veteran states that when he got up, he could not feel anything below the waist. He indicates he was hospitalized, and that he received physical therapy, for his low back, at that time. The Veteran essentially asserts that he suffered from low back problems during service and since service. The Veteran served on active duty in the Army from August 1973 to September 1975. His DD Form 214 lists his occupational specialty as a tactical field wireman. The Veteran's service treatment records show that he reported that he had possible low back problems. On a medical history report at the time of an August 1975 separation examination, the Veteran checked that he had recurrent back pain. The reviewing examiner did not provide any notes or diagnoses. An August 1975 objective separation examination report includes a notation that the Veteran's spine and other musculoskeletal systems were normal. A September 1975 statement of medical condition notes that the Veteran underwent a separation examination more than three working days prior to his departure from his place of separation, and that he reported that his medical condition had changed. The Veteran stated that he suffered injuries to his back, twice, when he could not even bend down, or lift, or walk that well. Post-service VA treatment records, including a VA examination report, show treatment for variously diagnosed low back problems, including low back pain; chronic low back pain; myofascial pain syndrome; osteoarthritis; degenerative arthritis of the thoracolumbar spine; and age-related degeneration, mild. A November 2015 VA treatment entry notes that the Veteran had chronic low back pain; myofascial pain syndrome; osteoarthritis; and allergic rhinitis. The examiner stated that the Veteran "allegedly" had back pain since 1975, and that he was "allegedly" told that he had osteoarthritis while he was in prison. It was noted that the Veteran reported that he had a history of a motorcycle accident in July 2013. The examiner indicated that the Veteran maintained that he was told that x-rays show a mild fracture of the spine, 20 percent, but that he was told that the fracture had to be 50 percent or more to be significant. The assessment was as above. An August 2018 VA back conditions examination report includes a notation that the Veteran's claims file was reviewed. The examiner reported that the Veteran currently had a numb feeling in his legs, with prolonged sitting. The examiner stated that the numb feeling was not related to the spine, and that it was not radicular. The examiner maintained that the numb feeling was called meralgia paresthesia, and that such disorder was related to compression of the femoral nerve at the groin. It was noted that the Veteran had no back complaints and that he had not undergone surgery. The diagnoses were degenerative arthritis of the thoracolumbar spine and age-related degeneration, mild. The examiner indicated that the claimed condition was less likely than not (less than 50 percent probability) incurred in, or caused by, the claimed in-service injury, event, or illness. The examiner reported that there was no indication from the service treatment records of issues with the Veteran's back, other than at a separation examination. The examiner stated that there is a historical note in the separation examination about back pain. The related that there were no apparent mechanical issues during service that would lead to a future disability. The Board observes that the Veteran's service treatment indicate that he reported that he had possible back problems. On a medical history report at the time of an August 1975 separation examination, the Veteran checked that he had recurrent back pain. The reviewing examiner did not provide any notes or diagnoses, and an August 1975 objective separation examination report includes a notation that the Veteran's spine and other musculoskeletal systems were normal. A September 1975 statement of medical condition notes that the Veteran underwent a separation examination more than three working days prior to his departure from his place of separation, and that he reported that his medical condition had changed. The Veteran stated that he suffered injuries to his back, twice, when he could not even bend down, or lift, or walk that well. Additionally, post-service VA treatment records, including a VA examination report, show treatment for variously diagnosed low back problems, including low back pain; chronic low back pain; myofascial pain syndrome; osteoarthritis; degenerative arthritis of the thoracolumbar spine; and age-related degeneration, mild. The Board further notes that the Veteran has reported that he has suffered from low back problems during service and since that time. The Board also observes that the Veteran first filed a claim for service connection for a low back disability in September 1986. The Board observes that an August 2018 VA back conditions examination report relates diagnoses of degenerative arthritis of the thoracolumbar spine and age-related degeneration, mild. The examiner, following a review of the claims file, indicated that the claimed condition was less likely than not incurred in, or caused by, the claimed in-service injury, event, or illness. The examiner reported that there was no indication from the service treatment records of issues with the Veteran's back, other than at a separation examination. The examiner stated that there is a historical note in the separation examination about back pain. The related that there were no apparent mechanical issues during service that would lead to a future disability. The Board notes that although the examiner referred to the Veteran's report of recurrent back pain on a medical history report at the time of the August 1975 separation examination, the examiner did not address his later report, pursuant to a September 1975 statement of medical condition, that he suffered injuries to his back, twice, when he could not even bend down, or lift, or walk that well. Additionally, the Board observes that the examiner did not specifically address the Veteran's reports of low back problems during service and since service. The Veteran is competent to report low back problems during service and since service. See Davidson, 581 F.3d 1313 (Fed. Cir. 2009). Therefore, the Board finds that the examiner's opinions, pursuant to the August 2018 VA back conditions examination report, are not very probative in this matter. The Board observes that the Veteran is currently diagnosed with a low back disability, diagnosed as degenerative arthritis. The Board finds the Veteran's reports of low back problems during and since his period of service to be credible. See Jandreau v. Nicholson, 492 F.3d 1372 (2007) (holding that lay evidence can be competent and sufficient to establish a diagnosis of a condition when a lay person is competent to identify the medical condition, or reporting a contemporaneous medical diagnosis, or the lay testimony describing symptoms at the time supports a later diagnosis by a medical professional). Resolving any doubt in the Veteran's favor, the Board finds that the evidence is at least in equipoise as to whether the Veteran's low back disability, diagnosed degenerative arthritis, commenced during his period of service. In light of the evidence, the Board cannot conclude that the preponderance of the evidence is against granting service connection for a low back disability, diagnosed degenerative arthritis. Therefore, service connection for a low back disability, diagnosed as degenerative arthritis, is warranted. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. As the Board has granted direct service connection in this matter, it need not address other theories of service connection. 2. Bilateral Hearing Loss and Tinnitus Impaired hearing will be considered to be a disability for VA purposes when the thresholds for any of the frequencies of 500, 1000, 2000, 3000, and 4000 Hertz are 40 decibels or more; the thresholds for at least three of these frequencies are 26 decibels; or speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385 (2016). One requirement for service connection is the current existence of the claimed disability. With regard to hearing loss, 38 C.F.R. § 3.385 defines what constitutes the current existence of a hearing loss disability. For service connection, it is not required that a hearing loss disability by the standards of 38 C.F.R. § 3.385 be demonstrated during service, although a hearing loss disability by the standards of 38 C.F.R. § 3.385 must be currently present, and service connection is possible if such current hearing loss disability can be adequately linked to service. Ledford v. Derwinski, 3 Vet. App. 87 (1992). The Veteran contends that he has bilateral hearing loss and tinnitus that are related to service. He specifically maintains that he has bilateral hearing loss and tinnitus as a result of acoustic trauma while serving in communications during service. The Veteran reports that he was exposed to noise from artillery fire; mortar fire; tank and diesel engines; generators and airplanes; and to noise from grenade fire. He maintains that he was not provided with hearing protection for two and a half years. The Veteran essentially asserts that his bilateral hearing loss and ringing in the ears were first experienced during service and have continued since that time. The Veteran served on active duty in the Army from August 1973 to September 1975. His DD Form 214 lists his occupational specialty as a tactical field wireman. The Veteran's service treatment records do not show a hearing loss disability in either ear as defined by 38 C.F.R. § 3.385. Such records also do not show treatment for tinnitus. There is no specific evidence of hearing loss within the year after service as required for the presumption of service connection. A post-service private statement, with an audiological evaluation, show that the Veteran has bilateral hearing loss under the provisions of 38 C.F.R. § 3.385, and that he also has tinnitus. The evidence of record does show that the Veteran was exposed to in-service acoustic trauma and that he has been currently diagnosed with bilateral hearing loss, under the provisions of 38 C.F.R. § 3.385, and that he also has tinnitus. The Board notes that there are opinions of record, which address the etiology of the Veteran's claimed bilateral hearing loss and tinnitus, pursuant to a February 2016 VA audiological examination report, and a November 2018 statement from K. M., Aud., with an audiological evaluation. A November 2018 audiological evaluation report from K. M., Aud., relates results that were indicative of bilateral hearing loss as defined by 38 C.F.R. § 3.385. Tinnitus was also diagnosed at that time. In a November 2018 statement, K. M., Aud., notes that the Veteran was seen in her office, and that he reported that he had difficulty understanding normal conversation, and that he had experienced high-pitched tinnitus in both ears, since his military experience. It was noted that the Veteran served in the Army, that he reported that he served a combat tour in Vietnam, and that his occupational specialty was a 36K20-Field Wireman. Dr. K. M, reported that the Veteran fired weapons right-handed, and that he was exposed to all military weapons, including heavy artillery; mortars and grenades; fixed and rotary wing aircraft noise; noise from track and large wheel vehicles; and noise from generators, all without hearing protection. Dr. K. M., stated that the Veteran denied that he had any excessive noise exposure following his military career. It was noted that the Veteran related that he had to lip read a lot to understand conversations, and that his tinnitus interfered with concentration, communication, and sleep, and that it caused anxiety. Dr. K. M., discussed the results of the Veteran's audiological evaluation. Dr. K. M., indicated that with the length of time, and the extent of the Veteran's noise exposure and acoustic trauma, that he was exposed to, and the hearing loss, pursuant to the current audiological evaluation, his hearing loss and tinnitus in both ears were at least as likely as not related to military noise exposure and acoustic trauma. The Board observes that the Veteran is competent to report bilateral hearing problems and ringing in the ears during service and since that time. Moreover, the Board finds that his reports of noise exposure during service, and bilateral hearing problems and tinnitus, during and since service, are credible. See also Jandreau v. Nicholson, 492 F.3d 1372 (2007). The Board notes that the Veteran is diagnosed with bilateral hearing loss and tinnitus. In a November 2018 statement, Dr. K. M., indicated that with the length of time, and the extent of the Veteran's noise exposure and acoustic trauma, that he was exposed to, and the hearing loss, pursuant to the current audiological evaluation, his hearing loss and tinnitus in both ears were at least as likely as not related to military noise exposure and acoustic trauma. The Board observes that Dr. K. M., referred to the Veteran's report of combat tour in Vietnam. The Board notes that there is no indication that the Veteran served in the Republic of Vietnam. The Board observes, however, that the remainder of D. K. M.'s statement is consistent with the evidence of record. Therefore, the Board finds that the opinion provided by Dr. K. M., is the most probative of record. The opinion provided by Dr. K. M., supports the Veteran's claims. Resolving any doubt in the Veteran's favor, the Board finds that the evidence is at least in equipoise regarding whether his bilateral hearing loss and tinnitus, commenced during his period of service. In light of the evidence, the Board cannot conclude that the preponderance of the evidence is against granting service connection for bilateral hearing loss and for tinnitus. Accordingly, service connection for bilateral hearing loss, and for tinnitus, is warranted. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. As the Board has granted direct service connection in this matter, it need not address other theories of service connection. REASONS FOR REMAND The remaining issues on appeal are entitlement to service connection for a psychiatric disorder, to include PTSD; a right hip disability; a left hip disability; a right knee disability; a left knee disability; bilateral foot disabilities; hypertension; and for erectile dysfunction. As discussed above, the Board has granted service-connection for a low back disability, diagnosed as degenerative arthritis, and for bilateral hearing loss and tinnitus. Given this change in circumstances, and to accord the Veteran due process, the RO should readjudicate the issues of entitlement to service connection for a psychiatric disorder, to include PTSD; a right hip disability; a left hip disability; a right knee disability; a left knee disability; bilateral foot disabilities; hypertension; and for erectile dysfunction. The Veteran is now service-connected for a low back disability, diagnosed as degenerative arthritis. He is also presently service-connected for bilateral hearing loss and for tinnitus. The Veteran contends that he has a psychiatric disorder, to include PTSD; a right hip disability; a left hip disability; a right knee disability; a left knee disability; bilateral foot disabilities; hypertension; and erectile dysfunction, that are all related to service. The Veteran has reported various stressors in regard to his claim for service connection for a psychiatric disorder, to include PTSD, and that he began having psychiatric problems during service. He also has asserted that his claimed right hip disability; left hip disability; right knee disability; left knee disability; and bilateral foot disorders occurred at the time of his low back injury during service. The Veteran further maintains that those disabilities are secondary to his now service-connected low back disability, diagnosed as degenerative arthritis. The Veteran indicates that he was provided with hypertension pills during service, and that his erectile dysfunction is a result of his hypertension medication. The Veteran served on active duty in the Army from August 1973 to September 1975. His DD Form 214 lists his occupational specialty as a tactical field wireman. The Veteran's service personnel records indicate that he was involved in several disciplinary actions, and that he was discharged under honorable conditions. The Veteran's service treatment records indicate that he reported possible psychiatric problems and bilateral foot problems. Such records do not show treatment for right hip and/or left hip problems; right knee and/or left knee problems; hypertension or elevated blood pressure readings, and/or for erectile dysfunction. On a medical history report at the time of an August 1975 separation examination, the Veteran checked that he had foot trouble; loss of memory or amnesia; and nervous trouble. The reviewing examiner did not provide any notes or diagnoses. An August 1975 objective separation examination report includes notations that the Veteran's lower extremities and psychiatric evaluation were normal. The Veteran has not been afforded VA examinations, as to his claimed hypertension and erectile dysfunction. As to his claimed psychiatric disorder, to include PTSD, the Veteran was afforded a VA psychiatric examination in August 2018. There is a notation that the Veteran's claims file was reviewed. The examiner indicated that the Veteran's symptoms did not meet the DMS-5 criteria for PTSD, or for a mental disorder. The examiner reported that the Veteran did not report a Criterion A stressor consistent with PTSD, or a trauma and stressor-related disorder in the DSM-5 manual. The examiner stated that mood swings were not a psychiatric condition in the DSM-5 manual. The examiner indicated that the Veteran did not report symptoms consistent with other psychiatric conditions. It was noted that a review of the records, and the examination, were negative for evidence of a mental health diagnosis and treatment after the Veteran's discharge. The examiner stated that a review of PTSD screenings in November 2015, April 2017, June 2017, October 2017, and April 2018, were negative, and screenings in October 2016, April 2017, June 2017, October 2017, and April 2018, were negative for depression. The examiner maintained that it was less likely than not that the Veteran had PTSD, or any other psychiatric conditions, incurred or related to service, or caused by a complaint of mood swings. The Board observes that the examiner did not specifically address the Veteran's report of nervous trouble on a medical history form at the time of his August 1975 separation examination during service. Additionally, the Board notes that since the August 2018 VA psychiatric examination, the Veteran has been service-connected for a low back disability, diagnosed as degenerative arthritis, and for bilateral hearing loss and tinnitus. The Board notes that the examiner was not able to address if the Veteran's claimed psychiatric disorder, to include PTSD, was caused or aggravated by his now service-connected low back disability, diagnosed as degenerative arthritis; bilateral hearing loss; and tinnitus. In El-Amin v. Shinseki, 26 Vet. App. 136 (2013), a decision issued by the United States Court of Appeals for Veterans Claims (Court), the Court vacated a decision of the Board where a VA examiner did not specifically opine as to whether a disability was aggravated by a service-connected disability. As to the Veteran's claimed right hip disability and left hip disability, the Veteran was afforded a VA hip conditions examination in August 2018. There is a notation that the Veteran's claims file was reviewed. The examiner did not provide any diagnoses. An August 2018 VA knee and lower leg conditions examination report, by the same examiner who conducted the August 2018 VA hip conditions examination, includes a notation that the Veteran's claims file was reviewed. The diagnosis was left knee joint osteoarthritis. A right knee disability was not diagnosed at that time. The Veteran was also afforded a VA foot condition examination in August 2018, by the same examiner. There is a notation that the Veteran's claims file was reviewed. The diagnoses were hallux valgus of the right foot and hallux valgus of the left foot. As to the Veteran's claims for service connection for right and left hip disabilities and right and left knee disabilities, the examiner indicated that the claimed conditions were less likely than not (less than 50 percent probability) proximately due to, or the result of, the Veteran's service-connected condition. The examiner reported that there were no apparent mechanical issues during service that would lead to a future clinical disability. The examiner stated that the Veteran's current back and foot problems were not service-related, so the hips and knees could not be secondary. The examiner maintained that evidence-based medicine had shown that one extremity joint did not affect the spine, other extremity joints. It was noted that the spine did not affect extremity joints, and the examiner referred to a medical treatise. As to the Veteran's claim for service-connected for bilateral foot disabilities, the examiner indicated that the claimed condition was less likely than not (less than 50 percent probability) incurred in, or caused by, the claimed in-service injury, event, or illness. The examiner reported that the Veteran was never seen clinically for the claimed foot disabilities. The examiner stated that there was a historical note at the time of the separation examination about foot pain. The examiner maintained that the Veteran did have hallux valgus, but that he had no symptoms, and there was no evidence of such condition. It was noted that the Veteran had no current foot complaints. The Board observes that the examiner specifically indicated that the Veteran's current back and foot problems were not service-related, so the hips and knees could not be secondary. The Board notes, however, that the Veteran is now service-connected for a low back disability, diagnosed as degenerative arthritis. See El-Amin, 26 Vet. App. at 136. The Board also observes that the examiner did not address the Veteran's reports of right and left hip problems, right and left knee problems, and bilateral foot problems, during and since service. The Veteran is competent to report right and left hip problems; right and left knee problems; and bilateral foot problems, during service and since service. See Davidson, 581 F.3d at 1313. In light of the above, the Board finds that the Veteran must be afforded VA examinations, with the opportunity to obtain responsive etiological opinions, following a thorough review of the entire claims file, as to his claims for service connection for a psychiatric disorder, to include PTSD; a right hip disability; a left hip disability; a right knee disability; a left knee disability; bilateral foot disabilities; hypertension; and for erectile dysfunction. Such examinations must be accomplished on remand. 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79 (2006); Stefl v. Nicholson, 21 Vet. App. 120, 125 (2007). Finally, the Board notes that there are only approximately 30 pages of VA treatment reports of record dated from November 2015 to December 2015. The Board notes, however, that examination reports refer to additional VA treatment records. For example, the August 2018 VA psychiatric examination report refers to screenings for PTSD and depression as recently as April 2018. The Board observes that as there are possible further VA treatment records that may be pertinent to the Veteran's claims, they should be obtained on remand. See Bell v. Derwinski, 2 Vet. App. 611 (1992) (VA medical records are in constructive possession of the agency, and must be obtained if the material could be determinative of the claim); see also Sullivan v. McDonald, 815 F.3d 786 (Fed. Cir. 2016) (VA has a duty to assist in obtaining sufficiently identified VA medical records or records of examination or treatment at non-VA facilities authorized by VA, regardless of their relevance). The matters are REMANDED for the following action: 1. Obtain copies of the Veteran's VA treatment records, which are not already in the claims folder, concerning his claimed disabilities, since December 2016. 2. Ask the Veteran to identify all other medical providers who have treated him for a psychiatric disorder, to include PTSD; a right hip disability; a left hip disability; a right knee disability; a left knee disability; bilateral foot disabilities; hypertension; and erectile dysfunction, since December 2016. After receiving this information and any necessary releases, obtain copies of the related medical records which are not already in the claims folder. Document any unsuccessful efforts to obtain the records, inform the Veteran of such, and advise him that he may obtain and submit those records himself 3. Notify the Veteran that he may submit lay statements from himself and from other individuals who have first-hand knowledge, and/or were contemporaneously informed of his in-service and post-service symptomatology regarding his claimed psychiatric disorder, to include PTSD; right hip disability; left hip disability; right knee disability; left knee disability; bilateral foot disabilities; hypertension; and erectile dysfunction. The Veteran should be provided an appropriate amount of time to submit this lay evidence. 4. Schedule the Veteran for an appropriate VA examination (or telehealth interview, review of the record, etc., if an in-person examination is not feasible) to determine if he suffers from PTSD or from any other psychiatric disorders related to service. The claims file must be reviewed by the examiner. The examiner must identify each psychiatric disorder found to be present, and a diagnosis of PTSD must be ruled in or excluded. The examiner must opine as to whether it is at least as likely as not that any currently diagnosed psychiatric disorders are etiologically related to the Veteran's period of service. The examiner must specifically acknowledge and discuss the Veteran's report of nervous trouble on a medical history form at the time of his August 1975 separation examination, and any reports by the Veteran that he suffered from psychiatric problems during service and since service. The examiner must state whether it is at least as likely as not that any diagnosed psychiatric disorders, to include PTSD, are caused or aggravated by Veteran's service-connected low back disability, diagnosed as degenerative arthritis; bilateral hearing loss; and/or tinnitus. 5. Schedule the Veteran for an appropriate VA examination (or telehealth interview, review of the record, etc., if an in-person examination is not feasible) to determine the onset and/or etiology of his claimed right hip disability; left hip disability; right knee disability; left knee disability; and bilateral foot disabilities. The claims file must be reviewed by the examiner. The examiner must diagnose all current right hip disabilities; left hip disabilities; right knee disabilities; left hip disabilities; and bilateral foot disabilities. The examiner must then opine as to whether it is at least as likely as not that any currently diagnosed right hip disabilities; left hip disabilities; right knee disabilities; left knee disabilities; and bilateral foot disabilities, are related to, and/or had their onset during, the Veteran's period of service. The examiner must specifically acknowledge and discuss the Veteran's report of foot trouble on a medical history form at the time of an August 1975 separation examination, and any reports by the Veteran of treatment for right hip problems; left hip problems; right knee problems; left knee problems; right foot problems; and left foot problems, during service and since service. 6. The examiner must state whether it is at least as likely as not that any diagnosed right hip disabilities; left hip disabilities; right knee disabilities; left knee disabilities; and bilateral foot disabilities, are caused or aggravated by the Veteran's service-connected disabilities, to specifically include his service-connected low back disability, diagnosed as degenerative arthritis. 7. Schedule the Veteran for an appropriate VA examination(s) (or telehealth interview, review of the record, etc., if an in-person examination is not feasible) to determine the onset and/or etiology of his claimed hypertension and erectile dysfunction. The claims file must be reviewed by the examiner(s). The examiner(s) must specifically indicate if the Veteran has currently diagnosed hypertension and erectile dysfunction. The examiner(s) must then opine as to whether it is at least as likely as not that any currently diagnosed hypertension and erectile dysfunction, are related to, and/or had their onset during, the Veteran's period of service. The examiner(s) must specifically acknowledge and discuss any reports by the Veteran of erectile dysfunction during and since service, and symptoms he thought were due to hypertension during and since service. The examiner(s) must state whether it is at least as likely as not that any diagnosed hypertension and erectile dysfunction, are caused or aggravated by Veteran's service-connected low back disability, diagnosed as degenerative arthritis; bilateral hearing loss; and tinnitus. STEVEN D. REISS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. D. Regan, 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.