Citation Nr: 21076879 Decision Date: 12/28/21 Archive Date: 12/28/21 DOCKET NO. 16-58 477A DATE: December 28, 2021 ORDER New and material evidence having been received, the claim for service connection for traumatic arthrotomy of the right-hand index finger is reopened. To that extent, the appeal is granted. New and material evidence having been received, the claim for service connection for right foot plantar fasciitis and heel spur is reopened. To that extent, the appeal is granted. New and material evidence having been received, the claim for service connection for irritable bowel syndrome (IBS) is reopened. To that extent, the appeal is granted. New and material evidence having been received, the claim for service connection for gastroesophageal reflux disease (GERD) is reopened. To that extent, the appeal is granted. New and material evidence having been received, the claim for service connection for lumbar spine disabilities is reopened. To that extent, the appeal is granted. New and material evidence having been received, the claim for service connection for eye disabilities is reopened. To that extent only, the appeal is granted. New and material evidence having been received, the claim for service connection for bilateral hearing loss is reopened. To that extent only, the appeal is granted. Entitlement to service connection for traumatic arthrotomy of the right-hand index finger is granted. Entitlement to service connection for right foot plantar fasciitis and heel spur is granted. Entitlement to service connection for irritable bowel syndrome (IBS) is granted. Entitlement to service connection for gastroesophageal reflux disease (GERD) is granted. Entitlement to service connection for lumbar spine disabilities (to include L4-5 and L5-S1 degenerative disc, disc bulging, and foraminal stenosis) is granted. Entitlement to a 10 percent disability rating for residuals of surgical scar of the right-hand index finger is granted, subject to the law and regulations governing the payment of monetary benefits. REMANDED Entitlement to a disability rating in excess of 10 percent for residuals of surgical scar of the right-hand index finger is remanded. Entitlement to a compensable disability rating for eustachian tube dysfunction is remanded. Entitlement to a disability rating in excess of 10 percent for right knee patellofemoral pain syndrome and degenerative joint disease is remanded. Entitlement to service connection for left knee disabilities (to include knee strain, knee tendonitis, knee joint osteoarthritis, and meniscal tear) is remanded. Entitlement to service connection for eye disabilities (to include suspected glaucoma, iris cyst, and refractive error) is remanded. Entitlement to service connection for bilateral hearing loss is remanded. Entitlement to service connection for a left hip strain is remanded. Entitlement to service connection for a right hip strain is remanded. Entitlement to service connection for right ankle partial tear peroneus longus tendon is remanded. Entitlement to service connection for periodic limb movement disability is remanded. FINDINGS OF FACT 1. The evidence received since the January 2014 denial relates to an unestablished fact necessary to substantiate the claim for service connection for traumatic arthrotomy of the right-hand index finger and raises a reasonable possibility of substantiating the claim. 2. The evidence received since the January 2014 denial relates to an unestablished fact necessary to substantiate the claim for service connection for right foot disabilities and raises a reasonable possibility of substantiating the claim. 3. The evidence received since the January 2014 denial relates to an unestablished fact necessary to substantiate the claim for service connection for lumbar spine disabilities and raises a reasonable possibility of substantiating the claim. 4. The evidence received since the January 2014 denial relates to an unestablished fact necessary to substantiate the claim for service connection for IBS and raises a reasonable possibility of substantiating the claim. 5. The evidence received since the January 2014 denial relates to an unestablished fact necessary to substantiate the claim for service connection for GERD, claimed as heartburn, and raises a reasonable possibility of substantiating the claim. 6. The evidence received since the January 2014 denial relates to an unestablished fact necessary to substantiate the claim for service connection for eye disabilities and raises a reasonable possibility of substantiating the claim. 7. The evidence received since the November 2013 denial relates to an unestablished fact necessary to substantiate the claim for service connection for bilateral hearing loss and raises a reasonable possibility of substantiating the claim. 8. Resolving reasonable doubt in favor of the Veteran, his index finger disability had its onset in service. 9. Resolving reasonable doubt in favor of the Veteran, his chronic right foot disabilities had their onset in service. 10. Resolving reasonable doubt in favor of the Veteran, his IBS had its onset in service. 11. Giving the Veteran the benefit of the doubt, the Veteran's service-connected obstructive sleep apnea more likely than not caused or aggravated the Veteran's GERD. 12. Giving the Veteran the benefit of the doubt, the Veteran's service-connected right knee disability more likely than not caused or aggravated the Veteran's lumbar spine disabilities. 13. Giving the Veteran the benefit of the doubt, the residual scar in the right-hand index finger is painful. CONCLUSIONS OF LAW 1. New and material evidence has been received to reopen the previously denied claim for service connection for traumatic arthrotomy of the right-hand index finger. 38 U.S.C. § 5108; 38 C.F.R. §§ 3.156(a). 2. New and material evidence has been received to reopen the previously denied claim for service connection for right foot plantar fasciitis and heel spur. 38 U.S.C. § 5108; 38 C.F.R. §§ 3.156(a). 3. New and material evidence has been received to reopen the previously denied claim for service connection for IBS. 38 U.S.C. § 5108; 38 C.F.R. §§ 3.156(a). 4. New and material evidence has been received to reopen the previously denied claim for service connection for GERD. 38 U.S.C. § 5108; 38 C.F.R. §§ 3.156(a). 5. New and material evidence has been received to reopen the previously denied claim for service connection for lumbar spine disabilities. 38 U.S.C. § 5108; 38 C.F.R. §§ 3.156(a). 6. New and material evidence has been received to reopen the previously denied claim for service connection for eye disabilities. 38 U.S.C. § 5108; 38 C.F.R. §§ 3.156(a). 7. New and material evidence has been received to reopen the previously denied claim for service connection for bilateral hearing loss. 38 U.S.C. § 5108; 38 C.F.R. §§ 3.156(a). 8. The criteria for establishing service connection for traumatic arthrotomy of the right-hand index finger have been met. 38 U.S.C. §§ 1110, 1131, 1154(a), 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304. 9. The criteria for establishing service connection for right foot plantar fasciitis and heel spur have been met. 38 U.S.C. §§ 1110, 1131, 1154(a), 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304. 10. The criteria for establishing service connection for IBS have been met. 38 U.S.C. §§ 1110, 1131, 1154(a), 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304. 11. The criteria for entitlement to service connection on a secondary basis for GERD have been met. 38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303. 12. The criteria for entitlement to service connection on a secondary basis for lumbar spine disabilities have been met. 38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303. 13. The criteria for entitlement to a separate 10 percent rating for a painful scar in the right-hand index finger, as of January 15, 2015, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.7, 4.21, 4.118, Diagnostic Codes (DC) 7804. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from May 1993 to December 2001. These matters come before the Board of Veterans' Appeals (Board) on appeal from a November 2015 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Paul, Minnesota. The Board notes that in the August 2021 Appellate Brief, the Veteran and his representative attempted to raise the issues of an increased rating for his service-connected eustachian tubes, service connection for bilateral hearing loss, service connection for periodic limb movement disorder, service connection for a right ankle disability, service connection for a left hip disability, and service connection for a right hip disability. However, the Board notes that, while these issues were addressed in a December 2017 Statement of the Case (SOC), there was no timely VA Form 9 Appeal to the Board filing submitted within a year of the relevant SOC. Therefore, these issues are not currently before or under the jurisdiction of the Board. New and Material Evidence Generally, a final decision issued by the agency of original jurisdiction may not thereafter be reopened and allowed, and a claim based on the same factual basis may not be considered. 38 U.S.C. § 7105(c), (d). However, if new and material evidence is presented or secured with respect to a claim that has been disallowed, VA shall reopen the claim and review the former disposition of the claim. 38 U.S.C. § 5108. In a claim to reopen, VA must notify a claimant of the information and evidence necessary to reopen the claim and establish entitlement to the underlying claim for the benefit being sought. Kent v. Nicholson, 20 Vet. App. 1 (2006). To satisfy that requirement, VA is required to look at the bases for the denial in the prior decision and provide the claimant with a notice letter that describes what information and evidence would be necessary to substantiate those elements required to establish service connection that were found insufficient in the previous denial. "New evidence" is evidence that has not previously been reviewed by VA adjudicators. "Material evidence" is existing evidence, that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). In determining whether evidence is new and material, the credibility of the newly presented evidence is to be presumed. Justus v. Principi, 3 Vet. App. 510 (1992). The Board must review all of the evidence submitted since the last final disallowance of the claim on any basis in order to determine whether the claim may be reopened. Hickson v. West, 12 Vet. App. 247 (1999). The phrase "raise a reasonable possibility of substantiating the claim" does not create a third element for new and material evidence; rather, it provides guidance in determining whether submitted evidence meets the new and material requirements. Shade v. Shinseki, 24 Vet. App. 110, 117 (2010). 1. Whether new and material evidence has been received to reopen a claim for service connection for traumatic arthrotomy of the right-hand index finger The Veteran and his representative assert that the Veteran is entitled to service connection for traumatic arthrotomy of the right-hand index finger because he claims it originated due to his active-duty service. The claim for service connection for traumatic arthrotomy of the right-hand index finger was originally denied in a January 2014 rating decision. The claim was denied because, according to the rating decision, there was no diagnosis, there was no in-service event, disease, or injury, as the claimed in-service laceration was treated and did not involve the joint. There is also no indication that new and material evidence was received within the one year following that decision that would have been pertinent to the issue on appeal. 38 C.F.R. § 3.156(b). Thus, the decision became final. As new evidence was received, the claim was again adjudicated by the RO in November 2015, which is appealed in the current claim. The pertinent evidence received since the January 2014 denial includes a letter dated December 2013 from the Veteran's treating physician linking the Veteran's finger disability and scar to his in-service injury that was submitted in January 2015, and positive nexus opinion February 2013 that was submitted in April 2015. Additionally, the RO also reopened the claim in the November 2015 rating decision. Presuming the credibility of the evidence, the record now indicates that the Veteran has right-hand index finger disability, that may be related to service. The evidence is new, not cumulative, and relates to an unestablished fact necessary to substantiate the claim. Thus, as new and material evidence has been received, the claim for service connection for traumatic arthrotomy of the right-hand index finger is reopened. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). 2. Whether new and material evidence has been received to reopen a claim for service connection for right foot plantar fasciitis and heel spur The Veteran and his representative assert that the Veteran is entitled to service connection for right foot plantar fasciitis and heel spur because he claims it originated due to his active-duty service. The claim for service connection for right foot plantar fasciitis and heel spur was originally denied in a January 2014 rating decision. The claim was denied because, according to the rating decision, there was no in-service event, disease, or injury, and there was no link between the disability and the Veteran's active-duty service. There is also no indication that new and material evidence was received within the one year following that decision that would have been pertinent to the issue on appeal. 38 C.F.R. § 3.156(b). Thus, the decision became final. As new evidence was received, the claim was again adjudicated by the RO in November 2015, which is appealed in the current claim. The pertinent evidence received since the January 2014 denial includes treatment records which noted a link between the Veteran's bilateral foot pain and the Veteran's service dated January 2012, which were submitted in January 2015. Additionally, the RO also reopened the claim in the November 2015 rating decision. Presuming the credibility of the evidence, the record now indicates that the Veteran has a right foot disability, that may be related to service. The evidence is new, not cumulative, and relates to an unestablished fact necessary to substantiate the claim. Thus, as new and material evidence has been received, the claim for service connection for right foot plantar fasciitis and heel spur is reopened. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). 3. Whether new and material evidence has been received to reopen a claim for service connection for lumbar spine disabilities The Veteran and his representative assert that the Veteran is entitled to service connection for lumbar spine disabilities because he claims it originated due to his service-connected right knee disability. The claim for service connection for lumbar spine disabilities was originally denied in a January 2014 rating decision. The claim was denied because, according to the rating decision, there was no diagnosis of a lumbar spine disability. There is also no indication that new and material evidence was received within the one year following that decision that would have been pertinent to the issue on appeal. 38 C.F.R. § 3.156(b). Thus, the decision became final. As new evidence was received, the claim was again adjudicated by the RO in November 2015, which is appealed in the current claim. The pertinent evidence received since the January 2014 denial includes an MRI imaging interpretation from February 2015 which notes a diagnosis of spondylitic changes of the lumbar spine. There is also a nexus opinion dated June 2015 which linked the Veteran's lumbar spine disability to his service-connected knee due to his altered gait, the opinion was submitted in April 2016. Additionally, the RO also reopened the claim in the November 2015 rating decision. Presuming the credibility of the evidence, the record now indicates that the Veteran has a lumbar spine disability, that may be related to a service-connected disability. The evidence is new, not cumulative, and relates to an unestablished fact necessary to substantiate the claim. Thus, as new and material evidence has been received, the claim for service connection for lumbar spine disabilities is reopened. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). 4. Whether new and material evidence has been received to reopen a claim for service connection for irritable bowel syndrome (IBS) The Veteran and his representative assert that the Veteran is entitled to service connection for IBS because he claims it originated due to his service-connected obstructive sleep apnea. The claim for service connection for IBS was originally denied in a January 2014 rating decision. The claim was denied because, according to the rating decision, there was no clinical diagnosis of IBS. There is also no indication that new and material evidence was received within the one year following that decision that would have been pertinent to the issue on appeal. 38 C.F.R. § 3.156(b). Thus, the decision became final. As new evidence was received, the claim was again adjudicated by the RO in November 2015, which is appealed in the current claim. The pertinent evidence received since the January 2014 denial includes a Disability Benefits Questionnaire by a private physician confirming a diagnosis of IBS submitted in April 2015. There is also a nexus opinion dated December 2014 which linked the Veteran's IBS to his service, the opinion was submitted in April 2015. A letter from the Veteran's physician was obtained in June 2016, confirming the Veteran's IBS diagnosis. Additionally, the RO also reopened the claim in the November 2015 rating decision. Presuming the credibility of the evidence, the record now indicates that the Veteran has IBS, that may be related to service. The evidence is new, not cumulative, and relates to an unestablished fact necessary to substantiate the claim. Thus, as new and material evidence has been received, the claim for service connection for IBS is reopened. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). 5. Whether new and material evidence has been received to reopen a claim for service connection for gastroesophageal reflux disease (GERD) The Veteran and his representative assert that the Veteran is entitled to service connection for GERD because he claims it originated due to his service-connected obstructive sleep apnea. The claim for service connection for GERD was originally denied in a January 2014 rating decision. The claim was denied because, according to the rating decision, there was no diagnosis of a disability or an in-service disease or injury. There is also no indication that new and material evidence was received within the one year following that decision that would have been pertinent to the issue on appeal. 38 C.F.R. § 3.156(b). Thus, the decision became final. As new evidence was received, the claim was again adjudicated by the RO in November 2015, which is appealed in the current claim. The pertinent evidence received since the January 2014 denial includes a Disability Benefits Questionnaire dated December 2014 that confirmed a diagnosis of GERD that was submitted in April 2015. A letter dated December 2014, provided a private nexus opinion that linked the Veteran's GERD to his service-connected obstructive sleep apnea. Another letter dated in April 2015 from one of the Veteran's treating physicians, confirmed that the Veteran's GERD is partly due to his service-connected obstructive sleep apnea. Another letter from another one of the Veteran's physicians was obtained in June 2016, confirming the Veteran's diagnosis and noting that usage of a CPAP treatment for obstructive sleep apnea can exacerbate reflux symptoms. Additionally, the RO also reopened the claim in the November 2015 rating decision. Presuming the credibility of the evidence, the record now indicates that the Veteran has GERD, that may be related to a service-connected disability. The evidence is new, not cumulative, and relates to an unestablished fact necessary to substantiate the claim. Thus, as new and material evidence has been received, the claim for service connection for GERD is reopened. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). 6. Whether new and material evidence has been received to reopen a claim for service connection for eye disabilities The Veteran and his representative assert that the Veteran is entitled to service connection for various eye disabilities that originated due to his active-duty service, specifically exposure to asbestos. The claim for service connection for eye disabilities was originally denied in a January 2014 rating decision. The claim was denied because, according to the rating decision, there was no evidence to show the eye disabilities were incurred in or aggravated by his active-duty service. There is also no indication that new and material evidence was received within the one year following that decision that would have been pertinent to the issue on appeal. 38 C.F.R. § 3.156(b). Thus, the decision became final. As new evidence was received, the claim was again adjudicated by the RO in November 2015, which is appealed in the current claim. The pertinent evidence received since the January 2014 denial includes a lay statement from the February 2016 Notice of Disagreement asserting that his eye disabilities originated during his service and a VA nexus opinion from August 2016. Additionally, the RO also reopened the claim in the November 2015 rating decision. Presuming the credibility of the evidence, the record now indicates that the Veteran has an eye disability, that may be related to service. The evidence is new, not cumulative, and relates to an unestablished fact necessary to substantiate the claim. Thus, as new and material evidence has been received, the claim for service connection for an eye disability is reopened. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). 7. Whether new and material evidence has been received to reopen a claim for service connection for bilateral hearing loss The Veteran and his representative assert that the Veteran is entitled to service connection for bilateral hearing loss that originated due to his active-duty service, specifically exposure to acoustic trauma. The claim for service connection for bilateral hearing loss was originally denied in a November 2013 rating decision. The claim was denied because, according to the rating decision, there was no evidence to show a current bilateral hearing loss disability. There is also no indication that new and material evidence was received within the one year following that decision that would have been pertinent to the issue on appeal. 38 C.F.R. § 3.156(b). Thus, the decision became final. As new evidence was received, the claim was again adjudicated by the RO in May 2017, which is appealed in the current claim. The pertinent evidence received since the November 2013 denial includes treatment records from June 2016, noting a history of hearing loss. Presuming the credibility of the evidence, the record now indicates that the Veteran may have bilateral hearing loss, that may be related to service. The evidence is new, not cumulative, and relates to an unestablished fact necessary to substantiate the claim. Thus, as new and material evidence has been received, the claim for service connection for bilateral hearing loss is reopened. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. If a condition noted during service is not shown to be chronic, then generally a showing of continuity of symptomatology after service is required for service connection. 38 C.F.R. § 3.303(b), Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Service connection may also be granted for any disease diagnosed after discharge from service when all of the evidence, including lay evidence, establishes that the disability is due to disease or injury which was incurred in or aggravated by service. 38 C.F.R. § 3.303(d). In order to establish service connection for a claimed disability, the following three elements must be satisfied: (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship (nexus) between the present disability and the disease or injury incurred or aggravated during service. Hickson v. West, 12 Vet. App. 246 (1999). Service connection may be established on a secondary basis for a disability that is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310 (a). Establishing service connection on a secondary basis requires evidence to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. El-Amin v. Shinseki, 26 Vet. App. 136, 138 (2013); Allen v. Brown, 7 Vet. App. 439, 448 (1995). Service connection may also be granted where disability is proximately due to or the result of already service-connected disability. 38 C.F.R. § 3.310. The requirement of a current disability is satisfied when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim. McClain v. Nicholson, 21 Vet. App. 319 (2007). In evaluating the evidence in an appeal, it is the responsibility of the Board to weigh the evidence and decide where to give credit and where to withhold same and, in doing so, accept certain medical opinions over others. Schoolman v. West, 12 Vet. App. 307 (1999). In this regard, the Board has been charged with the duty to assess the credibility and weight given to the evidence. Jandreau v. Nicholson, 492 F.3d 1372 (2007). Competent medical evidence is the type of evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. It may also include statements conveying sound medical principles found in medical treatises and/or statements contained in authoritative writings, such as medical and scientific articles and research reports or analyses. 38 C.F.R. § 3.159(a)(1). Competent lay evidence is any kind of evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159(a)(2). This may include some medical matters, such as describing symptoms or relating a contemporaneous medical diagnosis. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). A medical examination is inadequate where the examiner impermissibly ignored the appellant's lay assertions regarding onset of symptoms or injury during service. Dalton v. Nicholson, 21 Vet. App. 23, 39-40 (2007). Furthermore, lay evidence concerning continuity of symptoms after service, if credible, can ultimately be considered competent, regardless of a lack of contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). The Veteran is competent to report his symptoms, as a layman; however, his opinion alone is not sufficient upon which to base a determination as to a relationship between service and current disability. Rather, the Board must weigh and assess the competence and credibility of all of the evidence of record. Espiritu v. Derwinski, 2 Vet. App. 492, 494- 95 (1992); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006); Washington v. Nicholson, 19 Vet. App. 362, 368-69 (2005); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Barr v. Nicholson, 21 Vet. App. 303 (2007). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 8. Entitlement to service connection for traumatic arthrotomy of the right-hand index finger The Veteran and his representative have asserted that his traumatic arthrotomy of the right-hand index finger originated due to an in-service injury. A condition precedent for establishing service connection is the presence of a current disability. The evidence of record also includes a VA examination from September 2012, confirming the current diagnosis of laceration of the right 2nd finger. Additionally, a Disability Benefits Questionnaire, dated February 2013, confirmed a diagnosis of traumatic arthrotomy of the right-hand index finger. The Board finds that the criteria for a current disability is satisfied. The second element to establish service connection is an in-service injury or event. A review of the service medical records confirms an in-service injury, during which the Veteran cut his hand during a fire drill and was evaluated by a corpsman. The Board finds that this evidence is sufficient to establish the second element for service connection. The remaining question is whether there is sufficient medical evidence of a nexus between the Veteran's in-service event and his current disability. As previously noted, the Veteran underwent a VA examination in September 2012. The September 2012 VA examiner opined that there is no relevant evidence Veteran had tendinitis or arthritis of his index finger, and that there was disability due to the laceration from service. The Veteran submitted a letter dated February 2013, from a private treating hand surgeon, opined that the Veteran's index finger disability was at least as likely as not incurred or caused by his in-service right index finger laceration during a fire drill. The private hand surgeon submitted another letter in December 2013, in which he explained that the cause of the Veteran's traumatic injury to the right index finger is clearly the in-service injury. A VA medical opinion was obtained in September 2015, during which the VA examiner opined that the Veteran's index finger injury had been resolved during service, and that the diagnosis of a traumatic arthrotomy of the right-hand index finger was inaccurate, as it was merely a skin laceration. The examiner also stated that pain and stiffness is not a diagnosis, opining that it is consistent with a natural aging progression. The medical opinions are probative because they are based on a review of the record and contain a clear conclusion with supporting data connected by a reasoned medical explanation. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 30102 (2008). The Board finds that the competent medical evidence of record is at least in equipoise. Therefore, the Board will resolve reasonable doubt in favor of the Veteran and find that entitlement to service connection for traumatic arthrotomy of the right-hand index finger is warranted. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 9. Entitlement to service connection for right foot plantar fasciitis and heel spur The Veteran and his representative have claimed that his right foot plantar fasciitis and heel spur originated during his active-duty service. A condition precedent for establishing service connection is the presence of a current disability. The evidence of record also includes a VA examination from September 2012, confirming the current diagnosis of right foot plantar fasciitis and heel spur. Additionally, a Disability Benefits Questionnaire, dated January 2013, confirmed a diagnosis of plantar fasciitis. The Board finds that the criteria for a current disability is satisfied. The second element to establish service connection is an in-service injury or event. A review of the service medical records confirms an in-service diagnosis of bilateral plantar fasciitis, but primarily in the left foot, and was treated with custom inserts in his shoes. The Board finds that this evidence is sufficient to establish the second element for service connection. The remaining question is whether there is sufficient medical evidence of a nexus between the Veteran's in-service event and his current disability. As previously noted, the Veteran underwent a VA examination in September 2012. The September 2012 VA examiner noted that the Veteran had been diagnosed with bilateral plantar fasciitis during his active-duty service and opined that the Veteran's right foot disability is less likely than not related to his service-connected right knee disability, while not addressing direct service connection. The Veteran submitted a treatment record dated January 2012, from a private treating physician, which linked the Veteran's bilateral foot pain to his active-duty service, as it originated during service. The medical opinions are probative because they are based on a review of the record and contain a clear conclusion with supporting data connected by a reasoned medical explanation. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 30102 (2008). The Board finds that the competent medical evidence of record is at least in equipoise. Therefore, the Board will resolve reasonable doubt in favor of the Veteran and find that entitlement to service connection for right foot plantar fasciitis and heel spur is warranted. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 10. Entitlement to service connection for irritable bowel syndrome (IBS) The Veteran and his representative have alleged that his IBS originated during his active-duty service. A condition precedent for establishing service connection is the presence of a current disability. The evidence of record also includes a Disability Benefits Questionnaire from an unclear date, confirming the current diagnosis of IBS. Additionally, a letter from his treating physician, dated February 2017, confirmed a diagnosis of IBS. While the Veteran was afforded a VA examination for intestinal conditions in September 2013, the examiner was not diagnosed with a disability during the examination. The Board finds that the criteria for a current disability is satisfied. The second element to establish service connection is an in-service injury or event. A review of the service medical records confirms multiple in-service complaints of diarrhea, nausea, and black stools. The Board finds that this evidence is sufficient to establish the second element for service connection. The remaining question is whether there is sufficient medical evidence of a nexus between the Veteran's in-service event and his current disability. However, the previously noted Disability Benefits Questionnaire, noted that the Veteran's service treatment records indicate multiple dates of diarrhea, nausea, and black stools, and that these symptoms have increase since the Veteran was on active-duty service until the present-day IBS. The Veteran submitted a letter dated December 2014, from a private treating physician, which linked the Veteran's IBS to his active-duty service. The private physician added that the Veteran's IBS has no cure, and the diagnosis was made based on the Veteran's symptoms of gastrointestinal symptoms, which are ongoing since active-duty service and worsening. The RO obtained a VA medical opinion in September 2015, which provided a negative nexus opinion. The examiner's opinion was based on a disagreement whether the Veteran was properly diagnosed with IBS, and whether the in-service symptoms were the etiological causes, as the examiner attributes these noted symptoms to acute illnesses. The medical opinions are probative because they are based on a review of the record and contain a clear conclusion with supporting data connected by a reasoned medical explanation. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 30102 (2008). The Board finds that the competent medical evidence of record is at least in equipoise. Therefore, the Board will resolve reasonable doubt in favor of the Veteran and find that entitlement to service connection for IBS is also warranted. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 11. Entitlement to service connection for gastroesophageal reflux disease (GERD) The Veteran and his representative contend that the Veteran is entitled to service connection for GERD as secondary to his service-connected obstructive sleep apnea (OSA). The first element for secondary service connection is satisfied in that the Veteran was diagnosed with GERD, as noted in a Disability Benefits Questionnaire from December 2014. The evidence relating to the final nexus element for secondary service connection is mixed. The Board notes that the Veteran was not afforded a VA examination, by his own request. The previously noted Disability Benefits Questionnaire from December 2014, noting provided medical literature, concluded that the Veteran's GERD was impacted by his service connected OSA. The physician added that OSA causes a high probability of GERD, and that its medications impact the Veteran's GERD. The Veteran submitted a letter dated April 2015, from a private treating sleep clinic physician, which linked the Veteran's GERD to his use of a CPAP due to his service connected OSA. The physician added that, due to negative intrathoracic pressure from sleep apnea, frequently patients suffer from GERD as a consequence. The RO obtained a VA medical opinion in September 2015, which provided a negative nexus opinion under a theory of secondary service connection. The examiner's opinion was based on a disagreement with whether the Veteran's GERD is proximately due to, the result of, or aggravated by, the Veteran's OSA. The examiner also disagreed with the provided medical literature linking GERD to OSA. The examiner added that, similar to OSA, the main causes of GERD are obesity and age. The Veteran submitted a letter dated June 2016, from a private treating physician, which implied a link between the Veteran's GERD to his service connected OSA, on a basis of aggravation. The physician added that, use of a CPAP is known to exacerbate reflux symptoms. The medical opinions are probative because they are based on a review of the record and contain a clear conclusion with supporting data connected by a reasoned medical explanation. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 30102 (2008). Giving every reasonable doubt to the Veteran with respect to this claim, the evidence contained in this opinion supports the existence of a nexus between the Veteran's GERD and the Veteran's service connected OSA. Therefore, the Board finds that the Veteran's service connected OSA at least as likely as not caused or aggravated the Veteran's GERD, and that service connection for GERD is therefore warranted. 12. Entitlement to service connection for lumbar spine disabilities (to include L4-5 and L5-S1 degenerative disc, disc bulging, and foraminal stenosis) The Veteran and his representative affirm that the Veteran is entitled to service connection for his lumbar spine disabilities as secondary to his service-connected right knee disability, to include due to his altered gait. The first element for secondary service connection is satisfied in that the Veteran was diagnosed with L4-5 and L5-S1 degenerative disc, disc bulging and foraminal stenosis, as noted in treatment records from June 2015. However, the Board notes that the Veteran was afforded a VA examination in September 2013, in which the examiner noted that the Veteran did not have a lumbar spine disability. The evidence relating to the final nexus element for secondary service connection is mixed. The previously noted VA examination from September 2013, provided a negative nexus opinion, primarily due to the lack of a lumbar spine disability. The previously noted treatment records from June 2015 provided a positive nexus opinion, linking the Veteran's lumbar spine disabilities to his service-connected right knee disability. The physician noted that the disabilities are directly related, due to the altered gait caused, in part, by the right knee disability. The RO obtained a VA medical opinion in September 2015, which provided a negative nexus opinion under a theory of secondary service connection. The examiner's opinion was based on a disagreement whether the Veteran's lumbar spine disabilities is proximately due to, the result of, or aggravated by, the Veteran's right knee disability. The examiner also disagreed with the assertion that the Veteran's altered gait, impacted the Veteran's lumbar spine. The examiner added that the likely main cause of the lumbar spine disabilities is age. The medical opinions are probative because they are based on a review of the record and contain a clear conclusion with supporting data connected by a reasoned medical explanation. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 30102 (2008). Giving every reasonable doubt to the Veteran with respect to this claim, the evidence contained in this opinion supports the existence of a nexus between the Veteran's lumbar spine disabilities and the Veteran's service-connected right knee disability. Therefore, the Board finds that the Veteran's service-connected right knee disability at least as likely as not caused or aggravated the Veteran's lumbar spine disabilities, and that service connection for lumbar spine disabilities is therefore also warranted. Increased Rating A disability rating is determined by the application of VA's Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. VA has a duty to acknowledge and consider all regulations that are potentially applicable through the assertions and issues raised in the record and to explain the reasons and bases for its conclusions. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The evaluation of the same disability under various diagnoses, known as pyramiding, is generally to be avoided. 38 C.F.R. § 4.14. The critical element in permitting the assignment of several ratings under various diagnostic codes is that none of the symptomatology for any one of the disabilities is duplicative or overlapping with the symptomatology of the other disability. Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). The Board will consider whether separate ratings may be assigned for separate periods of time based on facts found, a practice known as "staged ratings." Fenderson v. West, 12 Vet. App. 119, 126-27 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). In considering the evidence in any given appeal, it is the responsibility of the Board to weigh the evidence and decide where to give credit and where to withhold the same and, in so doing, accept certain medical opinions over others. Schoolman v. West, 12 Vet. App. 307, 310-11 (1999). In this regard, the Board has been charged with the duty to assess the credibility and weight given to evidence. Davidson v. Shinseki, 581 F. 3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F. 3d 1331 (Fed. Cir. 2006); Charles v. Principi, 16 Vet. App. 370 (2002); Klekar v. West, 12 Vet. App. 503, 507 (1999); Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). Indeed, the Court has declared that in adjudicating a claim, the Board has the responsibility to do so. Bryan v. West, 13 Vet. App. 482, 488-89 (2000); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992). In doing so, the Board is free to favor one medical opinion over another, provided it offers an adequate basis for doing so. Evans v. West, 12 Vet. App. 22, 30 (1998); Owens v. Brown, 7 Vet. App. 429, 433 (1995). When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. When all of the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a fair preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 13. Entitlement to a compensable disability rating for residuals of surgical scar of the right-hand index finger The Veteran and his representative assert that he is entitled to a compensable rating for his service-connected scar in his right-hand index finger. The Veteran's service-connected scar is currently rated under Diagnostic Code (DC) 7802. The Veteran was granted service connection for his right-hand index finger scar in a June 2013 rating decision, and reaffirmed in an August 2013 rating decision, which was not appealed. The Veteran filed a claim for an increased rating for the service-connected scar in January 2015. As the claim dates back to two different periods relating to the diagnostic criteria relating to scars, the Board will determine which criteria, if any, would provide the Veteran a higher disability rating. Subsequently, the Board will evaluate the evidence of record to determine the appropriate rating criteria and disability rating for the entire period on appeal. The Board will not only consider the criteria under the currently assigned DC, but also the criteria set forth in other potentially applicable DCs, such as DC 7804. In order to warrant a compensable rating under the rating criteria in effect from October 23, 2008, to August 13, 2018, a scar would need to involve the head, face or neck and have at least one characteristic of disfigurement (DC 7800); be deep and nonlinear and affect an area or areas exceeding at least 6 square inches (39 square centimeters) (DC 7801); be superficial and nonlinear and affect an area or areas of 144 square inches (929 square centimeters) or greater, and requires the scar be "not associated with underlying soft tissue damage" rather than be "superficial and nonlinear" (DC 7802); be unstable or painful (DC 7804); or have some other disabling effects (DC 7805). 38 C.F.R. § 4.118, DCs 7800, 7801, 7802, 7804, 7805. Note (1) defines six zones of the body as each extremity, anterior trunk, and posterior trunk; and states that the midaxillary line divides the anterior trunk from the posterior trunk. Note (2) states that a separate evaluation may be assigned for each affected zone of the body under this DC if there are multiple scars, or a single scar, affecting multiple zones of the body. Separate evaluations should be combined under 38 C.F.R. § 4.25. Alternatively, if a higher evaluation would result from adding the areas affected from multiple zones of the body, a single evaluation may also be assigned under the DC. Id. From October 23, 2008, to August 13, 2018, DC 7801 provides ratings for burns or other scars (not on the head, face, or neck) that are deep and nonlinear. Deep and nonlinear scars involving an area or areas of at least 6 square inches (39 sq. cm.) but less than 12 square inches (77 sq. cm.) are rated 10 percent. Scars in an area or areas of at least 12 square inches (77 sq. cm.) but less than 72 square inches (465 sq. cm.) are rated 20 percent. Scars in an area or areas of at least 72 square inches (465 sq. cm.) but less than 144 square inches (929 sq. cm.) are rated 30 percent. Scars in an area or areas of 144 square inches (929 sq. cm.) or greater are rated 40 percent. 38 C.F.R. § 4.118. Note (1) specifies that a deep scar is one associated with underlying soft tissue damage. 38 C.F.R. § 4.118, DC 7801. Note (2) specifies that if multiple qualifying scars are present, or if a single qualifying scar affects more than one extremity, or a single qualifying scar affects one or more extremities and either the anterior portion or posterior portion of the trunk, or both, or a single qualifying scar affects both the anterior portion and the posterior portion of the trunk, assign a separate evaluation for each affected extremity based on the total area of the qualifying scars that affect that extremity, assign a separate evaluation based on the total area of the qualifying scars that affect the anterior portion of the trunk, and assign a separate evaluation based on the total area of the qualifying scars that affect the posterior portion of the trunk. The midaxillary line on each side separates the anterior and posterior portions of the trunk. Combine the separate evaluations under § 4.25. Qualifying scars are scars that are nonlinear, superficial, and are not located on the head, face, or neck. 38 C.F.R. § 4.118, DC 7801. From October 23, 2008, to August 13, 2018, DC 7802 provides a maximum 10 percent rating for a burn or other scars that are superficial and nonlinear involving an area of 144 square inches (929 sq. cm.) or greater. Note (1) provides that a superficial scar is one note associated with underlying soft tissue damage. Note (2) specifies that if multiply qualifying scars are present, or if a single qualifying scar affects more than one extremity, or a single qualifying scar affects one or more extremities and either the anterior or posterior portion of the trunk, or both, or a single qualifying scar affects both the anterior portion and the posterior portion of the trunk, assign a separate evaluation for each affected extremity based on the total area of the qualifying scars that affect that extremity, assign a separate evaluation based on the total area of the qualifying scars that affect the anterior portion of the trunk, and assign a separate evaluation based on the total area of the qualifying scars that affect the posterior portion of the trunk. The midaxillary line on each side separates the anterior and posterior portions of the trunk. Combine the separate evaluations under § 4.25. Qualifying scars are scars that are nonlinear, superficial, and are not located on the head, face, or neck. 38 C.F.R. § 4.118, DC 7802. From October 23, 2008, to August 13, 2018, DC 7804 provides a 10 percent rating for one or two scars that are unstable or painful. A 20 percent rating is warranted for three or four scars that are unstable or painful. A 30 percent rating is warranted for five or more scars that are unstable or painful. Note (1) states that an unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. Note (2) notes that if one or more scars are both unstable and painful, 10 percent should be added to the rating that is based on the total number of unstable or painful scars. Note (3) states that scars evaluated under DCs 7800, 7801, 7802, or 7805 may also receive an evaluation under DC 7804, when applicable. From October 23, 2008, to August 13, 2018, DC 7805 provides that any disabling effects not considered in a rating provided under DCs 7800, 7801, 7802, 7804, 7805 can be considered under another appropriate DC. The rating criteria under DCs 7804 and 7805 were not changed in the August 2018 revisions (only the header of DC 7805 was revised). In order to warrant a compensable rating under the new rating criteria, in effect since August 13, 2018, a scar would need to involve the head, face or neck and have at least one characteristic of disfigurement (DC 7800); be associated with underlying soft tissue damage and affect an area or areas exceeding at least 6 square inches (39 square centimeters) (DC 7801); not be associated with underlying soft tissue damage, but affect an area or areas of 144 square inches (929 square centimeters) or greater (DC 7802); be unstable or painful (DC 7804); or have some other disabling effects (DC 7805). 38 C.F.R. § 4.118, DCs 7800, 7801, 7802, 7804, 7805. Under the amended criteria which became effective on August 13, 2018, DC 7801 now provides for burn scars or scars due to other causes, not of the head, face, or neck that are associated with underlying soft tissue damage. The rating criteria for this code remained the same. But Note (1) now reads as follows: For the purposes of DC 7801 and 7802, the six (6) zones of the body are defined as each extremity, anterior trunk, and posterior trunk. The midaxillary line divides the anterior trunk. Note (2) now reads as follows: A separate evaluation may be assigned for each affected zone of the body. Combine the separate evaluations under § 4.25. Alternatively, if a higher evaluation would result from adding the areas affected from multiple zones of the body, a single evaluation may also be assigned under this diagnostic code. 38 C.F.R. § 4.118, DC 7801. Under the amended criteria which became effective on August 13, 2018, DC 7802 now provides for burn scars or scars due to other causes, not of the head, face, or neck, that are not associated with underlying soft tissue damage. The rating criteria remained the same. But Note (1) now reads: For the purposes of DC 7801 and 7802, the six (6) zones of the body are defined as each extremity, anterior trunk, and posterior trunk. The midaxillary line divides the anterior trunk from the posterior trunk. Note (2) now reads: A separate evaluation may be assigned for each affected zone of the body. Combine the separate evaluations under § 4.25. Alternatively, if a higher evaluation would result from adding the areas affected from multiple zones of the body, a single evaluation may also be assigned under this diagnostic code. 3 8 C.F.R. § 4.118, DC 7802. DC 7805 was amended in that the parentheses which noted that linear scars were included was removed. The title now provides for scars, other; and other effects of scars evaluated under DC 7800, 7801, 7802, and 7804. The rating criteria remained the same. 38 C.F.R. § 4.118, DC 7805. For the relevant period on appeal, there is no new medical evidence of record, therefore the Board shall note review the medical evidence in the claims file prior to the period on appeal. The Veteran submitted a Disability Benefits Questionnaire from February 2013. The private physician diagnosed the Veteran with dorsum of right hand and 2nd degree burn to right hand. The physician noted that, while the in-service injury did not appear to involve the tendon, the joint was exposed in the injury. The physician also noted that the Veteran's scar was painful and reduced the Veteran's grip strength. The physician added that the Veteran's scar pain and weakness decreased his endurance, strength, dexterity, speed, and increased his fatigue. The physician concluded the evaluation by opining that, due to the in-service injury, the Veteran had permanent limitations, was unlikely to improve with therapy or further surgical intervention. The Veteran also underwent a VA examination in September 2013. The examiner did not diagnose the Veteran with a specific scar. The examiner noted the in-service injury, which resulted in a sustained 2nd degree burn on the Veteran's right palm. On examination, the examiner noted that there is no visible scar on the right palmar aspect of the hand, and that no pain was reported. The examiner concluded that this scar has been resolved. However, the Board notes that the VA examination did not address the scar located in the right-hand index finger. The lay statements of record include persistent reports of a tender and painful right-hand index finger scar. See February 2016 Notice of Disagreement. The Board notes that the Veteran is competent to report his symptoms, as pain and tenderness are readily identifiable by lay observation. Barr v. Nicholson, 21 Vet. App. 303, 309 (2007). Turning to DC 7804, the Board notes that, as outlined above for the entire period on appeal, in order to be entitled to a rating of 10 percent rating, the evidence must show that the Veteran has one or two scars that are unstable or painful; for a 20 percent rating, the evidence must show that the Veteran has three or four scars that are unstable or painful; and a 30 percent rating is warranted for five or more scars that are unstable or painful. See, 38 C.F.R. § 4.118, DC 7804. Notably, the Veteran filed a claim for an increased rating for his scar disability in January 2015, and pursuant to the rating criteria in effect as of October 2008, a separate compensable rating would be permissible for the same scar with a showing that it is painful. The Veteran has consistently asserted that his scar is painful, and the Board finds no reason to question the Veteran's credibility regarding this assertion. Giving the Veteran the benefit of the doubt, the Board finds that the Veteran's scar pain likely was one of the symptoms that caused him to file the claim for an increased rating. Therefore, the Board will grant a 10 percent rating for his painful scar with an effective date of January 15, 2015. The Board notes that the medical evidence of record does not support disability rating under DC 7800, as the scar is not located on the Veteran's head, face, or neck. While DCs 7801 and 7802 pertain to scars that are not of the head, face, or neck, those provisions are applicable, however, as there is no measurement available for the Veteran's service-connected scar. Therefore, a remand will be needed to address this rating criteria. See 38 C.F.R. § 4.118, DCs 7801, 7802. Additionally, there is some indication that there are other disabling effects that would warrant evaluation under an appropriate DC, such as reduced grip strength and weakness. 38 C.F.R. § 4.118, DC 7805. Thus, remand for further examination concerning this symptomatology is also warranted. However, as noted above, under the criteria of DC 7804 in effect from October 2008, the Board finds that as of January 15, 2015, the evidence of record supports the assignment of a 10 percent, but not higher, rating for a painful right-hand index finger scar. REASONS FOR REMAND 1. Entitlement to a disability rating in excess of 10 percent for residuals of surgical scar of the right-hand index finger is remanded. While the Board sincerely regrets further delay in this matter, additional development is required before the Veteran's claim may be adjudicated on the merits. As previously noted, there are no measurements for the Veteran's residual scar of right-hand index finger. In addition, while previous examination has determined that that there is loss of grip strength and weakness associated with this disorder, there are insufficient findings concerning this aspect of the disability. Therefore, to properly assess the severity of the Veteran's service-connected scar, a remand for further examination is necessary. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). 2. Entitlement to a compensable disability rating for eustachian tube dysfunction is remanded. While the Board sincerely regrets further delay in this matter, additional development is required before the Veteran's claim may be adjudicated on the merits. A new examination is required in light of the Veteran's claim of alleged worsening of symptomatology. The Veteran last received a VA examination for his eustachian tube dysfunction in December 2016, however in his August 2021 Appellate Brief, the Veteran indicated continued worsening of this disability. Given the claim of increased severity of symptomatology, the Board finds that a remand is required to afford the Veteran with a contemporaneous VA examination to assess the current severity of this service-connected disability. Snuffer v. Gober, 10 Vet. App. 400 (1997); Green v. Derwinski, 1 Vet. App. 121 (1991). 3. Entitlement to a disability rating in excess of 10 percent for right knee patellofemoral pain syndrome and degenerative joint disease is remanded. 4. Entitlement to service connection for left knee disabilities (to include knee strain, knee tendonitis, knee joint osteoarthritis, and meniscal tear) is remanded. While the Board sincerely regrets further delay in this matter, additional development is required before the Veteran's claim may be adjudicated on the merits. The Veteran was afforded VA examinations in May 2015 and December 2016. However, the Board notes that the examination has a deficiency which requires another remand. The Court's holding in Sharp v. Shulkin, 29 Vet. App. 26 (2017) requires that the claim be remanded. In Sharp, the Court noted that for a joint examination to be adequate, the examiner "must express an opinion on whether pain could significantly limit" a veteran's functional ability, and that determination "should, if feasible, be portrayed in terms of the degree of additional range of motion loss due to pain on use or during flare-ups." Furthermore, the Court stated that the examiner must "obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment [resulting from flare-ups] from the veterans themselves." Sharp, 29 Vet. App. at 34. The examiner must also "offer flare opinions based on estimates derived from information procured from relevant sources, including the lay statements of veterans," and the examiner's determination "should, if feasible, be portrayed in terms of the degree of additional range of motion loss due to pain on use or during flare-ups." Id. at 10. While flare-ups are not reported in any of the examinations, an opinion with respect to the extent of functional impairment is not present and therefore, a retroactive opinion is warranted in light of Sharp. Accordingly, a new examination with a retrospective opinion is required. With regard to the Veteran's service connection claim for his left knee disability, while the Veteran asserts that his disability originated during his active-duty service, he also raised the issue of secondary service connection and aggravation. Based on the medical treatment records finding that the Veteran has an altered gait partially due to his service-connected right knee disability, another opinion is needed to make a proper determination. Additionally, as an examination of the knees is already necessary for the increased rating claim, the Board finds that a remand is warranted because these claims are inextricably linked. Harris v. Derwinski, 1 Vet. App. 180 (1991) (issues are inextricably intertwined when a decision on one issue would have a significant impact on another issue). 5. Entitlement to service connection for eye disabilities (to include suspected glaucoma, iris cyst, and refractive error) is remanded. The Veteran and his representative assert that his eye disability originated during active-duty service, due to exposure to asbestos. While the Board sincerely regrets further delay in this matter, additional development is required before the Veteran's claim may be adjudicated on the merits. The Veteran was afforded a VA examination in September 2013. The examination confirmed a diagnosis of an iris cyst and ocular hypertension. The RO obtained a VA medical opinion in August 2016, which disagreed with the Veteran's claim, explaining that the eye disability did not originate due to asbestos exposure, and that the Veteran's eye disabilities are generally considered to be congenital or developmental. While this opinion addressed a theory of direct service connection, it did not address secondary service connection or aggravation, as the examiner did not adequately address whether the disability was congenital, just generally stating that it was, and not clearly addressing whether it would be a congenital disease or defect. Therefore, the Board finds that a remand with be necessary to afford the Veteran a new examination and medical opinion. 6. Entitlement to service connection for bilateral hearing loss is remanded. The Veteran and his representative assert that his claimed bilateral hearing loss disability originated during active-duty service, due to exposure to acoustic trauma. While the Board sincerely regrets further delay in this matter, additional development is required before the Veteran's claim may be adjudicated on the merits. The Veteran was afforded a VA examination in August 2013. At that time, the examination did not reveal a hearing loss disability in accordance with VA regulations. See 38 C.F.R. § 3.385. However, the Board notes that, according to June 2016 treatment records, the Veteran has a history of hearing loss. Therefore, the Board finds that a remand with be necessary to afford the Veteran a new examination to ascertain whether the Veteran's disability now meets the criteria established in 38 C.F.R. § 3.385. 7. Entitlement to service connection for a left hip strain is remanded. 8. Entitlement to service connection for a right hip strain is remanded. The Veteran and his representative assert that his bilateral hip disability originated due to his service-connected disabilities, notably his service-connected right knee disability. While the Board sincerely regrets further delay in this matter, additional development is required before the Veteran's claim may be adjudicated on the merits. The Veteran was afforded a VA examination in September 2012. The examination confirmed a diagnosis of a bilateral hip strain. There is currently no medical nexus opinion in the claims file. A medical examination or medical opinion is necessary in a claim for service connection when there is competent evidence of a current disability or persistent or recurrent symptoms of a disability, evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the Veteran's service or with another service-connected disability, but insufficient competent medical evidence on file for the Secretary to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79, 8186 (2006). See also 38 U.S.C. § 5103A(d)(2); 38 C.F.R. § 3.159(c)(4)(i). Therefore, the Board finds that a remand with be necessary to afford the Veteran a new VA examination and medical opinion. 9. Entitlement to service connection for right ankle partial tear peroneus longus tendon is remanded. The Veteran and his representative assert that his right ankle disability originated due to his service-connected disabilities. While the Board sincerely regrets further delay in this matter, additional development is required before the Veteran's claim may be adjudicated on the merits. The Veteran was afforded a VA examination in December 2016. The examination confirmed a diagnosis of a right ankle partial tear peroneus longus tendon. The RO also obtained a VA medical opinion during the same VA examination, which opined that the right ankle disability was not related to, caused or aggravated by the Veteran's right knee disability. While this opinion addressed a theory of secondary service connection with respect to the service-connected right knee disability, it did not address secondary service connection or aggravation by the Veteran's other service-connected disabilities, to include his newly service-connected right foot disability. Therefore, the Board finds that a remand with be necessary to afford the Veteran a new VA examination and etiological medical opinion. 10. Entitlement to service connection for periodic limb movement is remanded. The Veteran and his representative assert that his periodic limb movement disability originated due to his service-connected disabilities. While the Board sincerely regrets further delay in this matter, additional development is required before the Veteran's claim may be adjudicated on the merits. The Veteran was afforded a VA examination in December 2016. The examination confirmed a diagnosis of periodic limb movement. The RO also obtained a VA medical opinion during the same VA examination, which opined that the periodic limb movement disability was not related to, caused or aggravated by the Veteran's obstructive sleep apnea disability. While this opinion addressed a theory of secondary service connection with respect to the service-connected obstructive sleep apnea disability, it did not address secondary service connection or aggravation by the Veteran's other service-connected disabilities, to include his newly service-connected lumbar spine disability. Therefore, the Board finds that a remand with be necessary to afford the Veteran a new VA examination and medical opinion. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination to evaluate the current severity of the residual scar in the right-hand index finger, to include its measurements and other associated symptoms such as loss of grip strength and weakness. All indicated tests and studies should be performed and findings reported in detail. The claims folder must be made available to the examiner for review prior to examination. The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports must be specifically acknowledged and considered in formulating any opinions. If the examiner rejects the Veteran's reports, he or she must provide a reason for doing so. 2. Schedule the Veteran for a VA examination to evaluate the current severity of the Veteran's eustachian tube dysfunction. All indicated tests and studies should be performed and findings reported in detail. The claims folder must be made available to the examiner for review prior to examination. The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports must be specifically acknowledged and considered in formulating any opinions. If the examiner rejects the Veteran's reports, he or she must provide a reason for doing so. 3. Schedule the Veteran for a VA examination to evaluate the nature, etiology, and current severity of the Veteran's right knee disability and the nature and etiology of the Veteran's left knee disabilities. All indicated tests and studies should be performed and findings reported in detail. The claims folder must be made available to the examiner for review prior to examination. For the right knee, the examiner should conduct range of motion testing (expressed in degrees) in active motion, passive motion, weight-bearing, and nonweight-bearing. The examiner shall specifically provide the degree at which pain begins during range of motion testing, if any. The examiner shall also specify whether and to what extent there is any additional loss to range of motion (stated in degrees) due to any weakened movement, excess fatigability, incoordination, flare ups, and/or pain. The Board recognizes the difficulty in making such determinations but requests that the examiner provide his or her best estimate based on the examination findings and statements of the Veteran, as such is required by the law as interpreted by the Court. Following a complete review of the record and examination, the examiner is further asked to: a) Explain the nature and etiology of the Veteran's diagnosed left knee disability, and state specifically whether it is at least as likely as not (50 percent probability or greater) that the Veteran's left knee disability was caused by, or originated during, the Veteran's active-duty service, to include the basketball injury that led to his service-connected right knee disability. b) Explain the nature and etiology of the Veteran's diagnosed left knee disability, and state specifically whether it is at least as likely as not (50 percent probability or greater) that the Veteran's left knee disability was caused or aggravated by the Veteran's service-connected right knee disability, to include the noted altered gait. 4. Schedule the Veteran for a VA examination to evaluate the nature and etiology of the Veteran's right eye disability. All indicated tests and studies should be performed and findings reported in detail. The claims folder must be made available to the examiner for review prior to examination. Following a complete review of the record and examination, the examiner is asked to: a) Explain the nature and etiology of the Veteran's diagnosed eye disability, and state specifically whether it is at least as likely as not (50 percent probability or greater) that the Veteran's eye disability was caused by, or originated during, the Veteran's active-duty service, to include due to exposure to asbestos. In this regard, if the examiner should conclude that the Veteran's eye disability is congenital in nature, the examiner should further opine as to whether it is best described as a disease or defect, and if a defect, whether there is superimposed injury that resulted from service. b) Explain the nature and etiology of the Veteran's diagnosed eye disability, and state specifically whether it is at least as likely as not (50 percent probability or greater) that the Veteran's eye disability was caused or aggravated by the Veteran's service-connected disabilities. 5. Schedule the Veteran for a VA examination to evaluate the Veteran's claimed bilateral hearing loss disability. All indicated tests and studies should be performed and findings reported in detail. The claims folder must be made available to the examiner for review prior to examination. Following a complete review of the record and examination, the examiner is asked to determine if the Veteran's claimed hearing loss meets the criteria established in 38 C.F.R. § 3.385, and if so whether his hearing loss is at least as likely as not (50 percent probability or greater) related to active service. 6. Schedule the Veteran for a VA examination to evaluate the nature and etiology of the Veteran's bilateral hip disability. All indicated tests and studies should be performed and findings reported in detail. The claims folder must be made available to the examiner for review prior to examination. Following a complete review of the record and examination, the examiner is asked to explain the nature and etiology of the Veteran's diagnosed bilateral hip disability, and state specifically whether it is at least as likely as not (50 percent probability or greater) that the Veteran's bilateral hip disability was caused or aggravated by the Veteran's service-connected disabilities, notably the Veteran's service-connected right knee disability. 7. Schedule the Veteran for a VA examination to evaluate the nature and etiology of the Veteran's right ankle disability. All indicated tests and studies should be performed and findings reported in detail. The claims folder must be made available to the examiner for review prior to examination. Following a complete review of the record and examination, the examiner is asked to explain the nature and etiology of the Veteran's diagnosed right ankle disability, and state specifically whether it is at least as likely as not (50 percent probability or greater) that the Veteran's right ankle disability was caused or aggravated by the Veteran's service-connected disabilities, notably the Veteran's service-connected right foot disability. 8. Schedule the Veteran for a VA examination to evaluate the nature and etiology of the Veteran's periodic limb movement disability. All indicated tests and studies should be performed and findings reported in detail. The claims folder must be made available to the examiner for review prior to examination. Following a complete review of the record and examination, the examiner is asked to explain the nature and etiology of the Veteran's diagnosed periodic limb movement disability, and state specifically whether it is at least as likely as not (50 percent probability or greater) that the Veteran's periodic limb movement disability was caused or aggravated by the Veteran's service-connected disabilities, notably the Veteran's service-connected lumbar spine disability. 9. After completing the requested actions, and any additional notification and/or development deemed warranted, readjudicate the remaining claims on appeal. If any benefit sought on appeal remains denied, the Veteran and his representative should be provided a supplemental statement of the case (SSOC), and an appropriate period of time should be allowed for response. Michael J. Skaltsounis Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. R. Montalvo, Associate Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.