Citation Nr: 21076706 Decision Date: 12/27/21 Archive Date: 12/27/21 DOCKET NO. 17-59 066 DATE: December 27, 2021 ORDER A rating in excess of 10 percent for right ankle osteoarthritis is denied. A rating in excess of 10 percent for lumbar spine degenerative joint disease (DJD) with degenerative disc disease (DDD) is denied. A rating in excess of 10 percent for right elbow injury is denied. Service connection for right knee disorder is granted. Service connection for right foot plantar fasciitis is granted. Service connection for varicose veins is denied. Service connection for rhinitis is denied. REMANDED Service connection for bilateral hearing loss. Service connection for a left shoulder disorder. FINDINGS OF FACT 1. The Veteran served on active duty from June 1989 to December 1996, January 2012 to February 2013, and March to September 2020. 2. Right ankle osteoarthritis has been manifested by subjective complaints of pain; objective findings included no more than moderate limitation of motion. 3. A low back disability has been manifested by pain; objective findings include forward flexion to 80 degrees at worst, a combined range of motion of 210 degrees at worst, and no muscle spasms, guarding, or incapacitating episodes of IVDS. 4. A right elbow disability has been manifested by pain; objective findings include flexion to 105 degrees at worst and extension to 30 degrees at worst. 5. A right knee disorder, diagnosed as arthritis, was shown in November 2013, with complaints beginning in May 2013. 6. Right foot plantar fasciitis is causally or etiologically related to service. 7. Varicose veins and rhinitis were not shown in service and are not causally or etiologically related to service. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 10 percent for right ankle osteoarthritis have not been met. 38 U.S.C. §§ 1155, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.6, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code (DC) 5271 (2021). 2. The criteria for a rating in excess of 10 percent for lumbar spine DJD with DDD have not been met. 38 U.S.C. §§ 1155, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.6, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, DC 5242 (2021). 3. The criteria for a rating in excess of 10 percent for right elbow injury have not been met. 38 U.S.C. §§ 1155, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.6, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, DCs 5003-5206, 5207, 5208 (2021). 4. A right knee disorder was incurred in service. 38 U.S.C. §§ 1110, 1112, 1131, 5103, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309, 3.310 (2021). 5. Right foot plantar fasciitis was incurred in service. 38 U.S.C. §§ 1110, 1131, 5103, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.303 (2021). 6. Varicose veins were not incurred in service. 38 U.S.C. §§ 1110, 1131, 5103, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.303 (2021). 7. Rhinitis was not incurred in service. 38 U.S.C. §§ 1110, 1131, 5103, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.303 (2021). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS In February 2021, the Veteran testified at a hearing held before the undersigned Veterans Law Judge. A transcript of that hearing is of record. Increased Rating Claims Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Right Ankle Osteoarthritis In order to warrant a higher rating, the evidence must show "marked" limitation of motion under DC 5271. The terms "marked" is not further defined within the schedular criteria. Normal range of motion of the ankle joint includes dorsiflexion from 0 to 20 degrees and plantar flexion from 0 to 45 degrees. 38 C.F.R. § 4.71, Plate II. Turning to the medical evidence, a December 2014 VA ankle examiner diagnosed right ankle osteoarthritis. The Veteran denied flare-ups. Range of motion testing revealed normal range of motion for the right ankle. Ranges of motion remained the same following repetitive use testing. The examiner was unable to say whether pain, weakness, fatigability, or incoordination significantly limited functional ability with repeated use over time. There was no ankylosis, no astraglectomy and no joint instability. Strength testing was normal (5/5) and there was no atrophy. The Veteran did not use any assistive device. It was noted that he was an avid runner and had been running marathons the past two years. He had been experiencing increasing ankle pain with running. Imaging studies revealed DJD. A September 2017 VA examiner noted that the Veteran denied flare-ups and functional loss of the ankle. Range of motion testing revealed normal range of motion (dorsiflexion to 20 degrees and plantar flexion to 45 degrees). No pain was noted on examination. There was objective evidence of tenderness or pain on palpation of the lateral malleolus. There was no objective evidence of crepitus or pain with weight bearing. The examiner was unable to say without resort to speculation whether pain, weakness, fatigability, or incoordination would significantly limit functional ability after repeated use over time. Muscle strength testing was full and there was no ankylosis. Joint stability tests were normal. No assistive devices were used. A March 2018 private clinician noted hypertrophy of the lateral malleolus, consistent with the old fracture. There was crepitation on movement of the right ankle. Range of motion testing was 30 degrees of plantar flexion, 15 degrees of dorsiflexion, 10 degrees inversion, and 10 degrees of eversion. A July 2019 VA examiner noted the Veteran's report that his right ankle aches that came and went. Pain increased with weather changes and he took Ibuprofen 800 mg twice a day as needed. He denied flare-ups and functional loss. Range of motion of the right ankle was normal. Pain was noted on examination but it did not result in functional loss. There was mild to moderate tenderness to palpation of the lateral aspect, including lateral malleolus. There was evidence of crepitus, pain with weightbearing, and pain on passive range of motion. Repetitive use testing was performed and there was no change in range of motion after three repetitions. The examiner opined that pain, weakness, fatigability, and incoordination did not significantly limit functional ability after repeated used over time. Muscle strength was full. There was no atrophy or ankylosis. Joint stability tests were normal. It was noted that the Veteran occasionally used an ankle brace. Based on the above, the medical evidence does not support a higher rating. The VA examinations all reflected normal right ankle range of motion and according to the March 2018 private examination report, dorsiflexion (at worst) was 15 degrees, versus a normal finding to 20 degrees, and plantar flexion was 30 degrees, versus a normal finding to 45 degrees. On VA examination, the Veteran was found to have normal and complete strength testing. Further, no private or VA medical records during the appeal period have shown that the Veteran has had restricted range of motion sufficient to warrant a higher rating under DC 5271. Importantly, the medical evidence does not indicate marked limitation of motion and while at the Board hearing the Veteran testified that his right ankle symptoms had worsened, an August 2018 VA treatment record specifically indicated that the Veteran reported no longer having significant ankle problems. In sum, while limitation of both dorsiflexion and plantar flexion of the right ankle was noted on a single occasion during the appeal period, this evidence represents the most severe limitation noted and it shows that he retained approximately half of normal ranges of motion for both dorsiflexion and plantar flexion. Thus, limitation of motion is closer to moderate than marked. The Board has also considered whether a higher rating is warranted under other diagnostic criteria. Because ankylosis of the ankle or subastragalar or tarsal joints, malunion of the os calcis or astragalus, and an astragalectomy are not shown, a rating in excess of 10 percent is not warranted. Further, as malunion or nonunion of the tibia or fibula is not shown, a higher rating under DC 5262 is not warranted. As such, the medical evidence does not support a higher rating under any other DC. Lumbar Spine The Veteran's low back disability is rated at 10 percent under DC 5242. A rating in excess of 10 percent will be assigned when the objective medical evidence shows the following: forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees (20 percent); combined range of motion of the thoracolumbar spine not greater than 120 degrees (20 percent); muscle spasms or guarding that is severe enough to result in an abnormal gait or abnormal spinal contour, such as scoliosis, reversed lordosis, or abnormal kyphosis (20 percent); incapacitating episodes of IVDS having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months (20 percent); or, in the absence of limitation of motion, degenerative arthritis with x-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups with occasional incapacitating exacerbations (20 percent). Turning to the medical evidence, a December 2014 VA examination report noted that the Veteran denied flare-ups and functional impairment of the thoracolumbar spine. Range of motion was full flexion to 90 degrees, extension to 0 degrees, right and left lateral flexion to 30 degrees, and right and left lateral rotation to 30 degrees. There was pain on motion at the endpoints. There was pain after repetitive motion but there was no additional functional loss or range of motion loss after repetitive motion. There was no evidence of pain with weightbearing and no localized pain or tenderness to palpation of the spine. There was no muscle spasm or guarding. Muscle strength testing was normal. There was no atrophy. Sensory examination was normal and straight leg raising test was negative. There were no objective signs or symptoms of radiculopathy. There was no ankylosis or neurological abnormalities. The examiner opined that the Veteran did not have IVDS. A September 2017 VA examiner noted that the Veteran reported low back flare-ups approximately once every three to four months. He described increased pain which resulted in decreased ability to perform activities of daily living for four days to one week. He did not report functional loss or functional impairment. Range of motion was forward flexion to 80 degrees, extension to 25 degrees, right and left lateral flexion to 30 degrees, and right and left lateral rotation were to 30 degrees. Pain was noted on examination and it caused functional loss. There was no objective evidence of localized tenderness or pain on palpation of the joints or associated soft tissue of the thoracolumbar spine. Repetitive use testing was performed and range of motion did not change after three repetitions. The examiner was unable to say whether pain, weakness, fatigability, or incoordination could significantly limit functional ability after repeated use over time or during flare-ups because the Veteran was not being examined under those circumstances. Muscle strength testing was normal, as were deep tendon reflexes and sensory examination. Straight leg raising test was negative and there were no other signs or symptoms of radiculopathy. It was noted that the Veteran did not use assistive devices. A March 2018 private clinician noted a normal lordotic curve, tenderness of the iliolumbar and sacroiliac ligaments, decreased sensation to light touch and pinprick of the S1 nerve, and weakness in plantar flexion of the right foot. Range of motion was 58 degrees of forward flexion, 16 degrees of extension, 14 degrees of right lateral flexion, 12 degrees of left lateral flexion, 15 degrees of right lateral rotation, and 14 degrees of left lateral rotation. A July 2019 VA examiner noted that the Veteran reported squeezing type pain in the low back with flare-ups which caused him to need bed rest for a week. Then it would be another week before he could stand up straight. These flare-ups occurred once or twice a year. He denied functional loss. Range of motion was forward flexion to 90 degrees, extension to 20 degrees, right and left lateral flexion to 20 degrees, and right and left lateral rotation to 30 degrees. Pain was noted on examination (all excursions of motion except left lateral rotation and left lateral flexion). There was objective evidence of pain with weightbearing. There was mild tenderness to palpation of the lower lumbar spine and paraspinal muscles. Repetitive use testing was accomplished and range of motion did not change after three repetitions. The examiner opined that pain, weakness, fatigability, and incoordination did not significantly limit functional ability with repeated use over time or during a flare-up. There was no guarding or muscle spasm of the thoracolumbar spine. Sensory examination was normal. There was no ankylosis, no IVDS, and no neurological abnormalities. It was noted that the Veteran occasionally used a brace. Passive range of motion testing was not performed because it was not feasible. Based on the above, the medical evidence does not support a rating in excess of 10 percent. While the March 2018 private clinician noted forward flexion to 58 degrees, there are no other VA or private treatment records or VA examination report evidence showing such decreased range of motion. In this regard, all of the VA examinations both prior to and since the March 2018 private examination showed flexion to no worse than 80 degrees. Moreover, an August 2018 VA treatment record (just five months after the March 2018 private examination was conducted) specifically noted the Veteran's statement that he was no longer having significant back problems. The examiners further found that he did not have muscle spasms or guarding of the lumbar spine or IVDS. In addition, a November 2019 VA treatment record noted that the Veteran only had "mild back pain." As such, the single finding of flexion to 58 degrees is not indicative of the overall disability picture during the period of the claim and does not warrant a higher rating. Accordingly, the medical evidence does not support a rating in excess of 10 percent. Right Elbow The Veteran's right elbow injury is rated at 10 percent pursuant to DC 5003-5206 for arthritis and limitation of flexion of the forearm. The record reflects that the Veteran is left hand dominant, so the right elbow is his non-dominant (minor) arm. Under DC 5003, degenerative arthritis is rated based on limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. If the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate codes, an evaluation of 10 percent is applied for each major joint or group of minor joints affected by limitation of motion. 38 C.F.R. § 4.71a, DC 5003. In the absence of limitation of motion, with X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups, with occasional incapacitating exacerbations, a 20 percent rating is assigned; with X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups, a 10 percent rating is assigned. Under DC 5206, a 10 percent rating is warranted with flexion of the minor arm limited to 100 degrees, a 20 percent rating is warranted with flexion limited to 90 or 70 degrees, a 30 percent rating is warranted with flexion limited to 55 degrees, and a 40 percent rating is warranted with flexion is limited to 45 degrees. Under DC 5207, limitation of forearm extension to 45 degrees or to 60 degrees warrants a 10 percent rating for a minor arm, limitation of extension to 75 degrees or to 90 degrees warrants a 20 percent rating, limitation of extension to 100 degrees warrants a 30 percent rating, and limitation of extension to 110 degrees warrants a 40 percent rating. Under DC 5208, a 20 percent rating contemplates a combination of flexion limited to 100 degrees and extension to 45 degrees in either forearm. Turning to the medical evidence, a December 2014 VA examiner diagnosed degenerative arthritis of the right elbow. The Veteran was noted to be left hand dominant. He denied flare-ups and functional impairment of the right elbow. Range of motion testing was normal for the right elbow with flexion to 145 degrees, extension to zero degrees, forearm supination to 85 degrees, and forearm pronation to 80 degrees. There was no evidence of pain with weightbearing. There was objective evidence of localized pain or tenderness on palpation of the olecranon process. Repetitive use testing was accomplished and range of motion did not change after three repetitions. The examiner stated that the Veteran was being examined after repetitive use over time but was unable to state whether pain, weakness, fatigability, or incoordination significantly limited functional ability with repeated use over time. Muscle strength testing was full. The examiner noted that the right bicep was slightly smaller than the left, which could be normal because the Veteran was left handed. There was no flail joint, joint fracture, ununited fracture, malaligned fracture, or impairment of supination or pronation. The Veteran did not use any assistive device. There was no evidence of crepitus. The examiner noted that the olecranon bursa was tender, there was no cystic swelling, and no thickening, inflammation or erythema present. A March 2015 VA treatment record noted that right elbow extension was to 30 degrees and flexion was to 105 degrees. There was no pain on motion. The elbow was stable and not tender. A September 2017 VA examiner noted that the Veteran was left hand dominant. He denied flare-ups and functional loss involving the right elbow. Range of motion testing of the right elbow was normal (flexion to 145, extension to 0 degrees, forearm supination to 85 degrees, and forearm pronation to 85 degrees). Pain was noted on the examination (flexion only) but it did not cause functional loss. There was pain with weightbearing and there was objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue (there was tenderness at the lateral and medial epicondyle). Repetitive use testing was accomplished and range of motion did not change after three repetitions. The examiner was unable to say whether pain, weakness, fatigability, or incoordination significantly limit functional ability after repeated use over time. Muscle strength testing was full; there was no atrophy. There was no flail joint, joint fracture, ununited fracture, malaligned fracture, or impairment of supination or pronation. A March 2018 private medical examination report noted that examination of the right elbow revealed tenderness of the medial epicondyle. Range of motion testing of the right elbow revealed 124 degrees of flexion, full extension, 68 degrees of pronation, and 58 degrees of supination. A December 2019 VA examination report noted that the right elbow range of motion was normal. No pain was noted on examination and there was no objective evidence of crepitus or localized tenderness/pain on palpation of the joint or associated soft tissue. Repetitive use testing was accomplished and range of motion did not change after three repetitions. Muscle strength testing was full. There was no ankylosis. There was no evidence of flail joint, joint fracture, ununited fracture, malaligned fracture, or impairment of supination or pronation. There was no evidence of pain on passive motion or with weightbearing and non-weightbearing. Based on the above, the medical evidence does not support an increased rating. To that end, the VA examinations all noted normal range of motion of the right elbow. At worst, flexion of the left elbow was limited to 105 degrees, which does not meet the criteria for a higher, 20 percent rating under DC 5206. At no time was flexion of the elbow limited to 70 or 90 degrees so as to warrant the assignment of a 20 percent rating under DC 5206. Next, a separate or higher rating is not warranted for the right elbow disability under DC 5207 or 5208. At worst, extension of the left elbow was limited to 30 degrees. At no time was extension of the elbow limited to 45 or 60 degrees so as to warrant a separate 10 percent rating under DC 5207 nor was extension limited to 75 or 90 degrees so as to warrant the assignment of a higher 20 percent rating under DC 5207. Similarly, at no time did the evidence reflect a combination of flexion limited to 100 degrees and extension to 45 degrees in the left forearm so as to warrant a 20 percent rating under DC 5208. As noted above, at worst flexion of the left elbow was limited to 105 degrees, and extension was limited to 30 degrees. A rating in excess of 10 percent is not warranted under any other diagnostic code. In this regard, there is no flail joint, impairment of ulna or radius. Further, there is no evidence of limitation of pronation such that motion is lost beyond the last quarter of arc. In sum, the medical evidence does not support a rating in excess of 10 percent for right elbow injury. As to all the increased rating claims, the Board has considered the Veteran's lay statements that his disabilities are worse. While he is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses, he is not competent to identify a specific level of disability of these disorders according to the appropriate diagnostic codes. Such competent evidence concerning the nature and extent of the Veteran's disabilities has been provided by the medical personnel who have examined him during the current appeal and who have rendered pertinent opinions in conjunction with the evaluations. The medical findings (as provided in the examination reports and other clinical evidence) directly address the criteria under which the disabilities are is evaluated. Moreover, as the examiners have the requisite medical expertise to render medical opinions regarding the degree of impairment caused by the disabilities and had sufficient facts and data on which to base the conclusions, the Board affords the medical opinions great probative value. As such, these records are more probative than the Veteran's subjective complaints of increased symptomatology. In sum, after a careful review of the evidence of record, the benefit of the doubt rule is not applicable and the appeals are denied. Service Connection Claims Turning to the relevant laws and regulations, service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). Service connection may be granted on a secondary basis for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury under 38 C.F.R. § 3.310. Allen v. Brown, 7 Vet. App. 439 (1995). In order to establish service connection on a secondary basis, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical evidence establishing a link between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). Service connection may be granted on a presumptive basis for diseases listed in 38 C.F.R. § 3.309 under the following circumstances: (1) where a chronic disease or injury is shown in service and subsequent manifestations of the same disease or injury are shown at a later date unless clearly attributable to an intercurrent cause; or (2) where there is continuity of symptomatology since service; or (3) by showing that the disorder manifested itself to a degree of 10 percent or more within one year from the date of separation from service. See 38 C.F.R. § 3.307. Right Knee The Veteran claims that service connection is warranted for right knee arthritis because it began in service and has continued ever since. In the alternative, he has argued that it is secondary to his service-connected right ankle injury. The record reflects a diagnosis of right knee arthritis in a November 2013 VA X-ray study. As such, the first element of service connection has been met. While the service treatment records (STRs) do not reflect any right knee injury, findings or diagnoses, including at service separation, and the Veteran denied knee problems on the January 2013 Report of Medical History, he did note on a January 2013 post-deployment assessment that he was "bothered a little" by pain in the arms, legs, hips, knees. The record reflects that the Veteran was discharged from service in February 2013 and May and June 2013 VA treatment records noted that he was seen for right knee complaints. Moreover, a November 2013 VA X-ray study reflected mild osteoarthritis of the right knee. As arthritis of the right knee was shown within one year of service discharge in February 2013, service connection is warranted on a presumptive basis. The Board notes that although a March 2008 private treatment record reflected that the Veteran presented with right knee pain which began in December 2007 after running a couple of 5K races, March 2008 X-ray studies of the right knee were normal and MRI was also essentially normal at that time. As such, the preponderance of the evidence reflects that arthritis of the right knee manifested within one year of service discharge in February 2013. The appeal is granted. Right Foot Plantar Fasciitis The Veteran claims that service connection is warranted for right foot plantar fasciitis because it began during service and continued ever since. The medical evidence reflects a current diagnosis of right foot plantar fasciitis. As such, the first element of service connection has been met. The STRs noted complaints of foot pain, right heel pain, and a sore right foot at a post-deployment assessment and the service separation examination in January 2013. As such, the second element of service connection has been met. VA treatment records dated in May 2013, August 2013 and November 2013 noted complaints of right heel pain and diagnoses of plantar fasciitis. The May 2013 VA treatment record indicated that the Veteran reported right heel pain ongoing for one year. A December 2014 VA examination report noted that there was no objective evidence of plantar fasciitis on examination. The Veteran reported that he had been experiencing right foot pain upon running. He related that he had been an avid runner all his life and was not able to run as much as he used to. A September 2017 VA examination report noted that the Veteran indicated his right foot plantar fasciitis was diagnosed during service and he was given inserts. The examiner opined that the right foot plantar fasciitis was not caused or aggravated by his service-connected right ankle arthritis. The examiner noted that repetitive stretching and tearing from tension on the plantar fascia could cause the plantar fascia to become inflamed and irritated. The examiner related that in many cases, the cause of plantar fasciitis was not clear. Factors that increase the risk of plantar fasciitis include age (most common between 40 and 60 years of age), activities and exercise that puts a lot of stress on the heel and attached tissue (including long distance running), being flat-footed/foot mechanics, obesity, and occupations putting you on your feet. A March 2018 private medical opinion report noted that the Veteran developed right foot plantar fasciitis in 2012 in service and by the time he left service, he was having a lot of pain, especially in the bottom of the right foot. It was opined that he developed plantar fasciitis in service wearing combat boots and being on his feet a lot as an intelligence specialist. Based on the above, the medical evidence is at least in equipoise with respect to whether the Veteran's right foot plantar fasciitis is etiologically related to service and/or whether it began during service and continued ever since. In this regard, the March 2018 private clinician reflected that plantar fasciitis began in service and had been ongoing. While the September 2017 VA examiner intimated that the Veteran's post-service running may have caused right foot plantar fasciitis, there is no medical opinion against the claim on a direct service incurrence basis. Moreover, the Veteran complained of heel pain at service separation in 2013 and was seen months later at the VA Medical Center with ongoing complaints of right heel pain and a diagnosis of plantar fasciitis. As such, and in giving the Veteran the benefit of the doubt, service connection for right foot plantar fasciitis is warranted; the appeal is granted. Varicose Veins The Veteran claims that service connection is warranted for varicose veins because they began during service in 2012 and continued ever since. In addition, he testified that he felt varicose veins were due to wearing combat boots and carrying a heavy rucksack in service. A December 2014 VA examination report noted a diagnosis of varicose veins. As such, the first element of service connection has been met. As to an in-service incurrence, the STRs are negative for varicose veins. The January 2013 post-deployment assessment and separation examination report do not note any varicose veins or related complaints despite complaints of other unrelated symptoms and problems at the time. As such, the second element of service connection has not been met. VA treatment records dated in August 2013, November 2013 and January 2015 VA treatment record noted that there were no varicosities and there is no medical opinion in favor of the claim. The March 2018 private examination and opinion report did not even reference any complaints or findings regarding varicose veins. As such, the medical evidence weighs against the claim. Rhinitis The Veteran claims that service connection is warranted for rhinitis. At the hearing he testified that he was unsure why he was claiming service connection for rhinitis. A December 2014 VA examination report noted a diagnosis of allergic rhinitis, which was diagnosed at the examination. The Veteran reported that he had had nasal drainage since his deployment to Afghanistan. He reported that he took over the counter allergy medication. As such, the first element of service connection has been met. The STRs do not reflect any complaints or findings with respect to rhinitis. Notably, the January 2013 post-deployment health assessment did not reflect any sinus problems including rhinitis. The January 2013 separation examination report also noted no sinus problems or rhinitis and the Veteran denied sinus problems on the separation report of medical history. As such, the second element of service connection an inservice incurrence has not been met. As to a medical nexus, there is no evidence of any connection between service and the December 2014 diagnosis of rhinitis. In this regard, VA treatment records dated in June 2017, January 2018, August 2018, March 2019, and November 2019 indicated that the Veteran had no sinus problems. The March 2018 private clinician did not note any sinus problems or rhinitis. As such, the medical evidence weighs against the claim. The Board has considered the Veteran's lay statements that his varicose veins and rhinitis were caused by service. He is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses. However, he is not competent to offer an opinion as to the etiology of his current disorders due to the medical complexity of the matters involved. Such competent evidence has been provided by the service records, clinical evidence, and examinations obtained and associated with the claims file. Here, the Board attaches greater probative weight to the clinical findings than to his statements. In light of the above, the preponderance of the evidence is against the claims for service connection and there is no doubt to be otherwise resolved. As such, the appeal for these issues is denied. The Board notes that the STRs from the Veteran's second period of active duty are not available. As such, there is a heightened obligation to explain findings and to consider the benefit of the doubt rule. O'Hare v. Derwinski, 1 Vet. App. 365, 367 (1991). However, as noted above, the January 2013 post-deployment health assessment, January 2013 separation examination report and report of medical history are of record and the Board finds that the lack of complaints and findings in those reports, as well as the direct denial of some specific symptoms at separation and the remaining medical evidence of record as explained above, satisfy this heightened obligation. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). REASONS FOR REMAND Bilateral hearing loss. For VA purposes, impaired hearing will be considered a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz (Hz) is 40 decibels (dB) or greater, the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, and 4000 Hz are 26 dB or greater, or speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. Additionally, the Court has held that "the threshold for normal hearing is from 0 to 20 dBs, and higher threshold levels indicate some degree of hearing loss." See Hensley v. Brown, 5 Vet. App. 155, 157 (1993). The Veteran has claimed entitlement to service connection for bilateral hearing loss. Although a VA opinion was obtained in August 2017, an audiological examination was not provided and there is no medical evidence of record showing whether the Veteran has been diagnosed with bilateral hearing loss disability that meets the VA regulatory criteria at 38 C.F.R. § 3.385. Under the circumstances, the Board finds that a remand is required to schedule the Veteran for a VA audiology examination. Left Shoulder. The Veteran claims that service connection is warranted for a left shoulder disorder because he injured his left shoulder in service at the same time that he injured his back in December 2012 and has had problems ever since. The record reflects a current diagnosis of left shoulder impingement syndrome, partial thickness tear of the infraspinatus, and tendonitis of the supraspinatus and some mild arthritic findings. While the STRs (including the January 2013 post-deployment health assessment and January 2013 separation examination and report of medical history) do not reflect any complaints or findings with respect to the left shoulder, a March 2018 private clinician noted that the Veteran injured his left shoulder in service slipping on ice, began having increased pain in his left shoulder due to carrying body armor and ruck sack, and that the current left shoulder disorder was due to the fall in service. A July 2018 VA examiner opined that the Veteran's current left shoulder disorder was not related to service because there was nothing in the STRs about the left shoulder and he separated from service in 1996 but first noted left shoulder problems in 2017. As the Veteran claims that he injured his shoulder in 2012 and separated from his second period of service in 2013, and because a May 2014 VA treatment record reflected that he was seen for concerns about his left shoulder (he reported that he experienced pain when throwing a ball with his kids) and a December 2014 MRI reflected high grade partial intra-articular tear of the distal infraspinatus tendon with no complete full thickness tear, mild distal supraspinatus tendinopathy and mild subacromial subdeltoid bursitis, and mild thickening of the middle glenohumeral ligament, a remand is required for another medical opinion with an adequate rationale. The matters are REMANDED for the following actions: 1. Schedule the Veteran for a VA audiology examination in order to determine the nature and etiology of any current hearing loss. The entire claims file and a copy of this remand must be made available to the examiner for review, and the examiner must specifically acknowledge receipt and review of these materials in any reports generated. First, the examiner must provide all findings, to include bilateral audiometric testing results. Second, if the criteria for a bilateral hearing loss disability for VA purposes has been met (pursuant to the criteria under 38 C.F.R. § 3.385), then provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the disability began during active service, is related to an incident of service (to include conceded military noise exposure), or began within one year after discharge from active service. The examiner must provide all findings, along with a complete rationale for his or her opinion(s) in the examination report. 2. Direct the claims file, to include a copy of this remand, to a clinician in order to obtain an addendum medical opinion regarding the etiology of the Veteran's current left shoulder disorder. After review of the record, the clinician is asked to provide an opinion as to whether it is at least as likely as not (i.e. probability of 50 percent or greater) that the currently-diagnosed left shoulder disorder is causally or etiologically related to active duty, to include a claimed 2012 slip and fall injury or repeated overhead work as an aircraft mechanic. A complete rationale for any opinion expressed should be provided in a report. The Veteran is competent to report ongoing symptoms and treatment, and his reports must be taken into account, along with the other evidence of record. The clinician is asked to address May 2014 VA treatment record which reflected that the Veteran was seen for concerns about his left shoulder (he reported that he experienced pain when throwing a ball with his kids). If the clinician feels that another examination is warranted in order to provide the above requested opinions, one should be scheduled. L. HOWELL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Redman, 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.