Citation Nr: 21077013 Decision Date: 12/28/21 Archive Date: 12/28/21 DOCKET NO. 19-29 111A DATE: December 28, 2021 ORDER The claim of whether new and material evidence has been submitted to reopen the previously denied claim of entitlement to service connection for a vasectomy has been withdrawn. The claim of entitlement to an effective date earl1ier than April 12, 2018, for the grant of an increased rating of 40 percent for bilateral open-angle glaucoma has been withdrawn. The claim of entitlement to an effective date earlier than April 12, 2018, for the grant of an increased rating of 30 percent for a scar on the bridge of the nose has been withdrawn. The petition to reopen the previously denied claim of entitlement to service connection for bilateral eustachian tube dysfunction is granted. The petition to reopen the previously denied claim of entitlement to service connection for prostate cancer is granted. The petition to reopen the previously denied claim of entitlement to service connection for sleep apnea is granted. The petition to reopen the previously denied claim of entitlement to service connection for a right hand keloid scar is granted. The petition to reopen the previously denied claim of entitlement to service connection for gum disease is granted. The petition to reopen the previously denied claim of entitlement to service connection for athlete's foot is granted. Entitlement to service connection for a right hand keloid scar is granted. Entitlement to service connection for athlete's foot is granted. Entitlement to a compensable disability rating for a left shoulder keloid scar is granted. REMANDED Entitlement to service connection for gum disease is remanded. Entitlement to service connection for prostate cancer is remanded. Entitlement to a disability rating in excess of 40 percent for bilateral open-angle glaucoma since April 12, 2018, is remanded. Entitlement to a compensable disability rating for hypertension is remanded. Entitlement to a disability rating in excess of 30 percent for a scar on the bridge of the nose since April 12, 2018, is remanded. Entitlement to service connection for bilateral eustachian tube dysfunction is remanded. Entitlement to service connection for a sleep disorder, to include sleep apnea, is remanded. Entitlement to a compensable disability rating for left scrotal cyst is remanded. FINDINGS OF FACT 1. At the June 2021 Board of Veterans' Appeals (Board) hearing, prior to the promulgation of a decision in the appeal, the Board received notification from the Veteran that a withdrawal of the appeal of whether new and material evidence has been submitted to reopen the previously denied claim of entitlement to service connection for a vasectomy is requested. 2. At the June 2021 Board hearing, prior to the promulgation of a decision in the appeal, the Board received notification from the Veteran that a withdrawal of the appeal of entitlement to an effective date earlier than April 12, 2018, for the grant of an increased rating of 40 percent for bilateral open-angle glaucoma is requested. 3. At the June 2021 Board hearing, prior to the promulgation of a decision in the appeal, the Board received notification from the Veteran that a withdrawal of the appeal of entitlement to an effective date earlier than April 12, 2018, for the grant of an increased rating of 30 percent for a scar on the bridge of the nose is requested. 4. An unappealed April 2008 rating decision denied service connection for bilateral eustachian tube dysfunction. 5. The evidence pertaining to the Veteran's bilateral eustachian tube dysfunction submitted subsequent to the April 2008 rating decision was not previously submitted, relates to an unestablished fact necessary to substantiate the claim, and raises a reasonable possibility of substantiating the claim. 6. An unappealed March 2016 rating decision denied service connection for prostate cancer. 7. The evidence pertaining to the Veteran's prostate cancer submitted subsequent to the March 2016 rating decision was not previously submitted, relates to an unestablished fact necessary to substantiate the claim, and raises a reasonable possibility of substantiating the claim. 8. An unappealed July 2010 rating decision denied service connection for sleep apnea. 9. The evidence pertaining to the Veteran's sleep apnea submitted subsequent to the July 2010 rating decision was not previously submitted, relates to an unestablished fact necessary to substantiate the claim, and raises a reasonable possibility of substantiating the claim. 10. An unappealed April 2008 rating decision denied service connection for a right hand keloid scar. 11. The evidence pertaining to the Veteran's right hand keloid scar submitted subsequent to the April 2008 rating decision was not previously submitted, relates to an unestablished fact necessary to substantiate the claim, and raises a reasonable possibility of substantiating the claim. 12. An unappealed March 2016 rating decision denied service connection for gum disease. 13. The evidence pertaining to the Veteran's gum disease submitted subsequent to the March 2016 rating decision was not previously submitted, relates to an unestablished fact necessary to substantiate the claim, and raises a reasonable possibility of substantiating the claim. 14. An unappealed March 2016 rating decision denied service connection for athlete's foot. 15. The evidence pertaining to the Veteran's athlete's foot submitted subsequent to the March 2016 rating decision was not previously submitted, relates to an unestablished fact necessary to substantiate the claim, and raises a reasonable possibility of substantiating the claim. 16. The Veteran's right hand keloid scar began during active service. 17. The Veteran's athlete's foot began during active service. 18. Throughout the entire appeal period, the left shoulder keloid scar has been manifested by pain, itchiness, and sensitivity. CONCLUSIONS OF LAW 1. The criteria for withdrawal of the claim of whether new and material evidence has been submitted to reopen the previously denied claim of entitlement to service connection for a vasectomy by the Veteran have been met. 38 U.S.C. § 7105; 38 C.F.R. § 19.55. 2. The criteria for withdrawal of the claim of entitlement to an effective date earlier than April 12, 2018, for the grant of an increased rating of 40 percent for bilateral open-angle glaucoma by the Veteran have been met. 38 U.S.C. § 7105; 38 C.F.R. § 19.55. 3. The criteria for withdrawal of the claim of entitlement to an effective date earlier than April 12, 2018, for the grant of an increased rating of 30 percent for a scar on the bridge of the nose by the Veteran have been met. 38 U.S.C. § 7105; 38 C.F.R. § 19.55. 4. The April 2008 rating decision denying service connection for bilateral eustachian tube dysfunction is final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. 5. New and material evidence has been submitted to reopen the Veteran's claim of entitlement to service connection for bilateral eustachian tube dysfunction. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 6. The March 2016 rating decision denying service connection for prostate cancer is final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. 7. New and material evidence has been submitted to reopen the Veteran's claim of entitlement to service connection for prostate cancer. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 8. The July 2010 rating decision denying service connection for sleep apnea is final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. 9. New and material evidence has been submitted to reopen the Veteran's claim of entitlement to service connection for sleep apnea. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 10. The April 2008 rating decision denying service connection for right hand keloid scar is final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. 11. New and material evidence has been submitted to reopen the Veteran's claim of entitlement to service connection for right hand keloid scar. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 12. The March 2016 rating decision denying service connection for gum disease is final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. 13. New and material evidence has been submitted to reopen the Veteran's claim of entitlement to service connection for gum disease. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 14. The March 2016 rating decision denying service connection for athlete's foot is final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. 15. New and material evidence has been submitted to reopen the Veteran's claim of entitlement to service connection for athlete's foot. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 16. The criteria for service connection for a right hand keloid scar are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 17. The criteria for service connection for athlete's foot are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 18. The criteria for a 10 percent disability rating, but no higher, for the Veteran's left shoulder keloid scar are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, ¬¬¬¬¬¬¬¬¬4.118, Diagnostic Codes 7819-7804. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active military service from August 1980 to January 1989 and from October 1992 to August 2007. These issues are on appeal from September 2018 and September 2019 rating decisions. In June 2021, the Veteran testified before the undersigned Veterans Law Judge at a Board of Veterans' Appeals (Board) hearing. Withdrawals 1. Whether new and material evidence has been submitted to reopen the previously denied claim of entitlement to service connection for a vasectomy. 2. Entitlement to an effective date earlier than April 12, 2018, for the grant of an increased rating of 40 percent for bilateral open-angle glaucoma. 3. Entitlement to an effective date earlier than April 12, 2018, for the grant of an increased rating of 30 percent for a scar on the bridge of the nose. The Board may dismiss any appeal which fails to allege specific error of fact or law in the determination being appealed. 38 U.S.C. § 7105. An appeal may be withdrawn as to any or all issues involved in the appeal at any time before the Board promulgates a decision. 38 C.F.R. § 19.55. Withdrawal may be made by the appellant or by his or her authorized representative. Id. In the present case, the Veteran has withdrawn the specific issues of (1) whether new and material evidence has been submitted to reopen the previously denied claim of entitlement to service connection for a vasectomy, (2) entitlement to an effective date earlier than April 12, 2018, for the grant of an increased rating of 40 percent for bilateral open-angle glaucoma, and (3) entitlement to an effective date earlier than April 12, 2018, for the grant of an increased rating of 30 percent for a scar on the bridge of the nose. Hence, there remain no allegations of errors of fact or law for appellate consideration regarding these issues. The Board notes that the Veteran's withdrawals were oral and made at his Board hearing. In this regard, an oral withdrawal of an appeal, such as one made at a hearing, must be (1) explicit, (2) unambiguous, and (3) done with a full understanding of the consequences of such action on the part of the claimant. DeLisio v. Shinseki, 25 Vet. App. 45, 57 (2011); see Acree v. O'Rourke, 891 F.3d 1009, 1014 (Fed. Cir. 2018) (the Board must address all three prongs of the DeLisio standard when it applies). Specifically, at the Board hearing, the Veteran stated that he wanted the issue of "entitlement to an earlier effective date than April 12, 2018 for that same issue [bilateral open-angle glaucoma discussed in the sentence prior]" withdrawn. In response, the Veterans Law Judge stated she would not be issuing a decision on that particular issue. The Veteran responded with "Yes, ma'am." See Board hearing transcript, page 2. Regarding the issue of entitlement to an effective date earlier than April 12, 2018, for the grant of an increased rating of 30 percent for a scar on the bridge of the nose, the Veteran's representative at the Board hearing stated that, "as far as the increased rating for the bridge nose scar, the earlier effective date is the only part of that issue that we want to discontinue." The Veterans Law Judge responded, "you don't want to address that particular issue. Is that correct?" The Veteran's representative answered, "That is correct, Judge." See Board hearing transcript, page 3. Finally, at the Board hearing, the Veteran's representative stated that the Veteran "would like to withdraw the issue of service connection for vasectomy." The Veterans Law Judge replied, "So is that your choice? You want to withdraw this issue?" The Veteran responded, "Yes, Your Honor." See Board hearing Transcript, page 69. The Board finds that the withdrawals made at the Board hearing meet the requisite criterion as described by the recent caselaw. Accordingly, the Board does not have jurisdiction to review these appeals and they are dismissed. New and Material Claims 4. Whether new and material evidence has been submitted to reopen the previously denied claim of entitlement to service connection for bilateral eustachian tube dysfunction. 5. Whether new and material evidence has been submitted to reopen the previously denied claim of entitlement to service connection for prostate cancer. 6. Whether new and material evidence has been submitted to reopen the previously denied claim of entitlement to service connection for sleep apnea. 7. Whether new and material evidence has been submitted to reopen the previously denied claim of entitlement to service connection for a right hand keloid scar. 8. Whether new and material evidence has been submitted to reopen the previously denied claim of entitlement to service connection for gum disease. 9. Whether new and material evidence has been submitted to reopen the previously denied claim of entitlement to service connection for athlete's foot. The Veteran seeks to reopen his previously denied claims of entitlement to service connection for bilateral eustachian tube dysfunction, prostate cancer, sleep apnea, right hand keloid scar, gum disease, and athlete's foot based on the submission of new and material evidence. The Agency of Original Jurisdiction (AOJ), by a decision entered in April 2008, denied the Veteran's claims for service connection for bilateral eustachian tube dysfunction and right hand keloid scar. The AOJ notified the Veteran of its decision and of his appellate rights in a letter dated in May 2008, but he did not initiate an appeal of the AOJ's decision within one year. New and material evidence was also not received within a year of the decision. 38 C.F.R. § 3.156(b). As a result, the AOJ's April 2008 decision became final. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.156, 20.200, 20.201, 20.302, 20.1103. The AOJ, by a decision entered in July 2010, denied the Veteran's claim for service connection for sleep apnea. The AOJ notified the Veteran of its decision and of his appellate rights in a letter dated in July 2010, but he did not initiate an appeal of the AOJ's decision within one year. New and material evidence was also not received within a year of the decision. 38 C.F.R. § 3.156(b). As a result, the AOJ's July 2010 decision became final. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.156, 20.200, 20.201, 20.302, 20.1103. The AOJ, by a decision entered in March 2016, denied the Veteran's claims for service connection for prostate cancer, gum disease, and athlete's foot. The AOJ notified the Veteran of its decision and of his appellate rights in a letter dated in March 2016, but he did not initiate an appeal of the AOJ's decision within one year. New and material evidence was also not received within a year of the decision. 38 C.F.R. § 3.156(b). As a result, the AOJ's March 2016decision became final. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.156, 20.200, 20.201, 20.302, 20.1103. Accordingly, the claims may now be considered on the merits only if new and material evidence has been received since the time of the prior adjudication. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a); Jackson v. Principi, 265 F.3d 1366 (Fed. Cir. 2001). Evidence is considered "new" if it was not previously submitted to agency decision makers. "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 prior 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 the April 2008 rating decision, service connection for bilateral eustachian tube dysfunction was denied because there was no permanent residual or chronic disability, and the VA examiner found that there was no pathology to render a diagnosis. In the April 2008 rating decision, service connection for a right hand keloid scar was denied because the VA examiner found that there was no pathology to render a diagnosis. The evidence received since the AOJ's April 2008 rating decision includes the Board hearing transcript, Department of Defense and Walter Reed National Military Medical Center treatment records, VA examinations, and lay statements from the Veteran and his representative. This evidence was not before adjudicators when the Veteran's claims were last denied in April 2008, and it is not cumulative or redundant of the evidence of record at the time of that decision. It also relates to an unestablished fact necessary to substantiate the claims for service connection for bilateral eustachian tube dysfunction and right hand keloid scar, and raises a reasonable possibility of substantiating the claims. Specifically, at the Board hearing, the Veteran competently testified that he has bilateral eustachian tube dysfunction that has been persistent since service. See Board hearing transcript, pages 34, 39. He reported that his ears stop up frequently, he cannot equalize the pressure in his ears, and he experiences pain and ringing in his ears. Id. at 40. The Veteran also testified that he has a painful right hand keloid scar. Id. at 63. This competent hearing testimony provides a suggestion that the Veteran has current diagnoses of bilateral eustachian tube dysfunction and a right hand keloid scar the reasons for the prior denials of the claims. In the July 2010 rating decision, service connection for sleep apnea was denied because there was no evidence that the claimed condition exists and because a review of the Veteran's service treatment records was negative for a diagnosis or, or treatment for, sleep apnea or complaints of snoring while he was on active duty. The evidence received since the AOJ's July 2010 rating decision includes the Board hearing transcript, Department of Defense and Walter Reed National Military Medical Center treatment records, VA examinations, and lay statements from the Veteran and his representative. This evidence was not before adjudicators when the Veteran's claim was last denied in July 2010, and it is not cumulative or redundant of the evidence of record at the time of that decision. It also relates to an unestablished fact necessary to substantiate the claim for service connection for sleep apnea, and raises a reasonable possibility of substantiating the claim. Specifically, at his Board hearing, the Veteran competently testified that his sleep disorder started in service and that he currently has a sleep problem. See Board hearing transcript, page 61. This competent hearing testimony provides a suggestion that the Veteran has a current sleep problem and had a sleep problem in service the reasons for the prior denial of the claim. In the March 2016 rating decision, service connection for prostate cancer and gum disease was denied because the conditions were neither occurred in nor was caused by service. In the March 2016 rating decision, service connection for athlete's foot was denied because the evidence did not show a current diagnosed disability and because there was no continuity of symptoms from service to the present. The evidence received since the AOJ's March 2016 rating decision includes the Board hearing transcript, Department of Defense and Walter Reed National Military Medical Center treatment records, VA examinations, and lay statements from the Veteran and his representative. This evidence was not before adjudicators when the Veteran's claims were last denied in March 2016, and it is not cumulative or redundant of the evidence of record at the time of that decision. It also relates to an unestablished fact necessary to substantiate the claims for service connection for prostate cancer, gum disease, and athlete's foot, and raises a reasonable possibility of substantiating the claims. Specifically, at his Board hearing, the Veteran testified that there was a radiation leak onboard his submarine during service, and he was exposed to this radiation for an hour. He argued that this radiation exposure caused his prostate cancer and gum disease. See Board hearing transcript, pages 48, 50, 55. The Veteran also testified that he experienced gum disease in service. Id. at 56. This competent hearing testimony provides a suggestion of in-service incurrences the reason for the prior denials of the prostate cancer and gum disease claims. Also, at his Board hearing, the Veteran testified that he currently has athlete's foot and has experienced these symptoms since service. Id. at 32-33. This competent hearing testimony provides a suggestion of a current diagnosis the reason for the prior denial of the athlete's foot claim. In determining whether evidence is new and material, the "credibility of the evidence is to be presumed." Justus v. Principi, 3 Vet. App. 510, 513 (1992). Accordingly, new and material evidence is demonstrated, and the claims of entitlement to service connection for bilateral eustachian tube dysfunction, prostate cancer, sleep apnea, right hand keloid scar, gum disease, and athlete's foot are reopened. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). 10. Entitlement to service connection for a right hand keloid scar. The Veteran contends that that he currently has a right hand keloid scar that was noted in his service treatment records (STRs) as a second degree linear burn that caused a keloid. See Board hearing transcript, page 63-65. The Board concludes that the Veteran has a current disability that began during his active service. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). The Veteran testified that he currently has a painful right hand keloid scar. See Board hearing transcript, page 63. The Board finds that the Veteran is competent and credible to describe this current diagnosis. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005). At his Board hearing, the Veteran testified that during service, he was cut while he was mess cooking and sought medical treatment because it was bleeding. See Board hearing transcript, pages 64-65. He received six or seven stitches in service in the right hand. Id. at 68-69. The STRs document that in November 1983, the Veteran was seen for treatment of a second degree linear burn to the long portion of his right hand. Also, an August 2004 military examination documents a keloid on the hand. There are no nexus opinions of record; however, the Board finds that a VA examination and opinion are not necessary to decide this claim. Instead, the Board finds the lay and medical evidence supports that the Veteran's current right hand keloid scar arose in service. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for a right hand keloid scar is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 11. Entitlement to service connection for athlete's foot. The Veteran asserts that he currently has painful athlete's foot between his baby toe and the next toe. See Board hearing transcript, page 32. The Veteran's representative stated that atophic dermatitis of the feet was noted on several occasions in service. Id. at 33. The Veteran testified that he has "always had it, but I had it for a significant amount of time while I was in the service." Id. at 34. The Veteran reported that he has had the athlete's foot off and on for 27 years. Id. The Board concludes that the Veteran has a current disability that began during his active service. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(a). The Veteran testified he has painful athlete's foot between his baby toe and the next toe. See Board hearing transcript, page 32. The Board finds that the Veteran is competent and credible to describe this current diagnosis. See Washington, 19 Vet. App. at 368. There are no pertinent complaints of athlete's foot documented in the Veteran's first period of service. Just prior to the Veteran's second period of service, he was seen in May 1991 for complaints of a tinea foot infection that the doctor described as "relatively chronic and ongoing." Prior to beginning his second period of active duty in October 1992, the Veteran was given an entry examination in May 1992. The May 1992 examination nor the initial April 1980 entry examination into the first period of service document athlete's foot. Thus, the presumption of soundness attaches to this matter. There is no medical opinion of record regarding whether there is clear and unmistakable evidence that the Veteran's athlete's foot preexisted either period of service. As such, the Board will address the Veteran's claim on a direct service connection basis. In this regard, during his second period of service, in April 2001, the Veteran was seen for treatment of his atophic dermatitis. Also, as stated above, the Veteran testified that he experienced athlete's foot continuously during and since his active military service. See Board hearing transcript, page 34. There are no nexus opinions of record; however, the Board finds that a VA examination and opinion are not necessary to decide this claim. The Board finds the lay and medical evidence supports that the Veteran's current athlete's foot arose in service. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for athlete's foot is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 12. Entitlement to a compensable disability rating for a left shoulder keloid scar. The Veteran seeks a compensable disability rating for his left shoulder keloid scar. He testified that his left shoulder scar is itchy and irritating. See Board hearing transcript, page 24. Disability evaluations are determined by the application of a schedule of ratings which is based on the average impairment of earning capacity in civil occupations. See 38 U.S.C. § 1155. Separate diagnostic codes identify the various disabilities. In considering the severity of a disability, it is essential to trace the medical history of the veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41. Consideration of the whole recorded history is necessary so that a rating may accurately reflect the elements of disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991). While the regulations require review of the recorded history of a disability by the adjudicator to ensure a more accurate evaluation, the regulations do not give past medical reports precedence over the current medical findings. Where an increase in the disability rating is at issue, the "present level" of the veteran's disability is the primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, where VA's adjudication of an increased rating claim is lengthy, a claimant may experience multiple distinct degrees of disability that would result in different levels of compensation from the time the increased rating claim was filed until a final decision on that claim is made. Thus, VA's determination of the "present level" of a disability may result in a conclusion that the disability has undergone varying and distinct levels of severity throughout the entire time period the increased rating claim has been pending. Hart v. Mansfield, 21 Vet. App. 505 (2007). The Veteran is in receipt of a 0 percent disability rating under 38 C.F.R. § 4.118, Diagnostic Codes 7819-7804 for his left shoulder keloid scar. The Board notes that VA amended the criteria for rating skin disabilities effective from August 13, 2018. However, pertinent to this appeal, Diagnostic Codes 7804 and 7819 were not changed by the August 13, 2018, amendments. Diagnostic Code 7819 provides that benign skin neoplasms are rated as disfigurement of the head, face, or neck (Diagnostic Code 7800), scars (Diagnostic Codes 7801-7805), or rated on impairment of function. 38 C.F.R. § 4.118. Here, Diagnostic Code 7800 does not apply since the scar is not located on the Veteran's head, face, or neck. 38 C.F.R. § 4.118. Under Diagnostic Code 7804, one or two scars that are unstable or painful scars warrant a 10 percent rating. Three or four scars that are unstable or painful scars warrant a 20 percent rating. Five or more scars that are unstable or painful warrant a 30 percent rating. Note 1 to Diagnostic Code 7804 instructs that an unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. 38 C.F.R. § 4.118. In particular, under Diagnostic Code 7804, one or two scars that are unstable or painful warrant a 10 percent rating. At the August 2018 VA examination, the Veteran reported that his left shoulder keloid scar is sensitive at times. At his Board hearing, the Veteran testified that his left shoulder keloid scar is itchy and irritating. See Board hearing transcript, page 24. This evidence supports the assignment of a disability rating of 10 percent for the left shoulder keloid scar throughout the entire appeal period. 38 C.F.R. § 4.118. The Board finds that the preponderance of the evidence is against the assignment of a disability rating in excess of 10 percent under Diagnostic Code 7804 because the Veteran's left shoulder keloid scar is not manifest by three or four scars that are unstable or painful. At the August 2018 VA examination, the examiner found that the Veteran only has one scar of the left shoulder. The Veteran does not assert, and the medical evidence does not support, that he has three or more scars of the left shoulder. 38 C.F.R. § 4.118. The Board has also considered the other Diagnostic Codes pertaining to scars. However, the Veteran's left shoulder keloid scar is not deep and nonlinear, and is not associated with underlying soft tissue damage. Although it is superficial and not associated with underlying soft tissue damage, it does not cover an area or areas of 144 square inches or greater. At the August 2018 VA examination, the left shoulder keloid scar measured 2 centimeters by 1 centimeter. Therefore, Diagnostic Codes 7801 and 7802, both prior to and from August 13, 2018, are inapplicable. 38 C.F.R. § 4.118. Diagnostic Code 7805, both prior to and from August 13, 2018, provides that any other scars (including linear scars) and other disabling effects of scars should be evaluated even if not considered in a rating provided under diagnostic codes 7800-04 under an appropriate diagnostic code. 38 C.F.R. § 4.118. The Board has considered whether any other relevant diagnostic codes may afford the Veteran a higher evaluation for his left shoulder keloid scar. However, given the clinical findings showing no current treatment and no current residual conditions or complications associated with the Veteran's left shoulder keloid scar, the Board finds that there are no other applicable diagnostic codes. 38 C.F.R. § 4.118. Also, the Board does not find that an additional or higher rating is warranted for impairment of function of the left shoulder caused by the left shoulder keloid scar. The August 2018 VA examiner did not find, and the Veteran does not assert, that the left shoulder keloid scar causes impairment of the left shoulder function. 38 C.F.R. § 4.118. The Board acknowledges that the Veteran believes that the disability on appeal has been more severe than the assigned disability rating reflects. Moreover, the Veteran is competent to report observable symptoms, to include pain and itchiness, and his reports are credible. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). However, he does not assert, and the medical records do not show, that the Veteran's left shoulder keloid scar is manifest by three or four scars that are unstable or painful. In conclusion, the Board finds that a disability rating of 10 percent, but no higher, is warranted for the left shoulder keloid scar for the entire appeal period. In denying a higher rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. Finally, neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Yancy v. McDonald, 27 Vet. App. 484, 495 (2016); Doucette v. Shulkin, 38 Vet. App. 366, 369-70 (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 1. Entitlement to service connection for gum disease is remanded. 2. Entitlement to service connection for prostate cancer is remanded. The record does not contain sufficient evidence regarding the Veteran's asserted radiation exposure. Medical records show the Veteran has been diagnosed with prostate cancer, which is a radiogenic disease under 38 C.F.R. § 3.311(b)(2). Also, while gum disease is not a radiogenic disease, the Veteran provided competent testimony at his Board hearing indicating that it could possibly be radiogenic in origin. Specifically, the Veteran testified that there was a radiation leak onboard the USS James Monroe in 1982 or 1983 during service, and he was exposed to this radiation for an hour. He argued that this radiation exposure caused his prostate cancer and gum disease. See Board hearing transcript, pages 48, 50, 55. Accordingly, VA should develop the Veteran's claim as directed under 38 C.F.R. § 3.311. In this regard, a remand is also necessary to obtain the complete set of deck logs for the USS James Monroe from 1982 to 1983 to determine whether the asserted in-service radiation exposure occurred. 3. Entitlement to a disability rating in excess of 40 percent for bilateral open-angle glaucoma since April 12, 2018, is remanded. 4. Entitlement to a compensable disability rating for hypertension is remanded. 5. Entitlement to a disability rating in excess of 30 percent for a scar on the bridge of the nose since April 12, 2018, is remanded. At his Board hearing, the Veteran reported treatment for his eyes and hypertension at the Walter Reed National Military Medical Center in Maryland and Fort Belvoir in Virginia. See Board hearing transcript, pages 8, 16. He stated he was scheduled for upcoming eye surgery. Id. at 13. These records are not currently contained in the Veteran's claims file, as the most recent treatment records from the Department of Defense (to include Walter Reed) are dated in August 2019. A remand is required to allow VA to request these outstanding and relevant treatment records. Also, at his Board hearing, the Veteran asserted that his glaucoma, hypertension, and scar on the bridge of his nose have increased in severity since the Veteran was last examined by VA in August 2018. See Board hearing transcript, pages 6, 9, 17, 29. The Veteran should be provided an opportunity to report for VA examinations to ascertain the current severity and manifestations of these disabilities. Further, at his Board hearing, the Veteran reported experiencing headaches as a result of his service-connected bilateral open-angle glaucoma. To date, a VA secondary service connection medical opinion has not been obtained. Upon remand, a medical opinion must be obtained. 6. Entitlement to service connection for bilateral eustachian tube dysfunction is remanded. 7. Entitlement to service connection for a sleep disorder, to include sleep apnea, is remanded. The Board cannot make a fully-informed decision on the bilateral eustachian tube dysfunction and sleep disorder issues because no VA examiner has opined whether the Veteran's current bilateral eustachian tube dysfunction and sleep disorder are related to his active military service. At the Board hearing, the Veteran competently testified that he currently has bilateral eustachian tube dysfunction that has been persistent since service. See Board hearing transcript, pages 34, 39. He reported that his ears stop up frequently, he cannot equalize the pressure in his ears, and he experiences pain and ringing in his ears. Id. at 40. Also, at his Board hearing, the Veteran competently testified that his sleep disorder started in service and that he currently has a sleep problem. Id. at 61. The STRs document chronic eustachian tube dysfunction in December 1980, and otitis media and the ears stopping up on two occasions in December 1985. Upon remand, VA examinations to ascertain current diagnoses and medical nexus opinions must be obtained. 8. Entitlement to a compensable disability rating for left scrotal cyst is remanded. At his Board hearing, the Veteran asserted that the left scrotal cyst has increased in severity (specifically, larger) since the Veteran was last examined by VA in August 2018. See Board hearing transcript, page 23. The Veteran should be provided an opportunity to report for a VA examination to ascertain the current severity and manifestations of the disability. Also, at the Board hearing, the Veteran testified that he experiences a weak urine flow that he associated with his cyst. See Board hearing transcript, page 20. To date, a VA examiner has not addressed whether this urinary symptom is attributable to the service-connected left scrotal cyst. Upon remand, a VA medical opinion must be obtained. The matters are REMANDED for the following actions: 1. Obtain deck logs for the USS James Monroe (hull # SSBN622) from 1982 to 1983. 2. Develop the Veteran's assertion that he was exposed to radiation from the USS James Monroe (hull # SSBN622) from 1982 to 1983. If evidence of possible exposure to radiation or ionizing radiation is found, obtain a dose assessment and an opinion. If more details are needed, contact the Veteran to request the information. 3. Obtain the Veteran's records from the Department of Defense, to include the Walter Reed National Military Medical Center in Maryland and Fort Belvoir in Virginia, since August 2019, for the treatment of his hypertension and bilateral open-angle glaucoma. Document all requests for information as well as all responses in the claims file. 4. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected bilateral open-angle glaucoma. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria. 5. Schedule the Veteran for a VA examination for his claimed headaches. The examiner must review the claims file. If a diagnosis cannot be provided but the Veteran's condition manifests in symptoms that cause functional impairment, then the examiner should consider them a "disability" for the purpose of providing the requested opinions below. The examiner is asked to provide a response to the following: Are the headaches at least as likely as not proximately due to the service-connected bilateral open-angle glaucoma? Are the headaches at least as likely as not aggravated, i.e., worsened beyond its natural progression, by the service-connected bilateral open-angle glaucoma? Provide a rationale to support the opinions. 6. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected hypertension. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria. 7. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected scar on the bridge of the nose. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria. 8. Schedule the Veteran for a VA examination for his claimed bilateral eustachian tube dysfunction. The examiner must review the claims file. If a diagnosis cannot be provided but the Veteran's condition manifests in symptoms that cause functional impairment, then the examiner should consider them a "disability" for the purpose of providing the requested opinion below. The examiner is asked to provide a response to the following: Is the bilateral eustachian tube dysfunction at least as likely as not related to service, including the pertinent treatment and diagnoses in December 1980 and December 1985? Provide a rationale to support the opinion. In providing the requested opinion, consider the Veteran's description of his in-service injury and symptoms as well as his post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran's reported injury and symptoms in service and thereafter represented the onset of his current disability, this should be noted. Stated another way, do the Veteran's reports about his symptoms align with how the currently diagnosed disability is known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible? 9. Schedule the Veteran for a VA examination for his claimed sleep disorder, to include sleep apnea. The examiner must review the claims file. If a diagnosis cannot be provided but the Veteran's condition manifests in symptoms that cause functional impairment, then the examiner should consider them a "disability" for the purpose of providing the requested opinion below. The examiner is asked to provide a response to the following: Is the sleep disorder, to include sleep apnea, at least as likely as not related to service? Provide a rationale to support the opinion. In providing the requested opinion, consider the Veteran's description of his in-service injury and symptoms as well as his post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran's reported injury and symptoms in service and thereafter represented the onset of his current disability, this should be noted. Stated another way, do the Veteran's reports about his symptoms align with how the currently diagnosed disability is known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible? 10. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected left scrotal cyst. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria. The examiner is also asked to provide a response to the following: Are the Veteran's current urinary symptoms, to include a weak urine flow, at least as likely as not proximately due to the service-connected left scrotal cyst? Are the Veteran's current urinary symptoms, to include a weak urine flow, at least as likely as not aggravated, i.e., worsened beyond its natural progression, by the service-connected left scrotal cyst? Provide a rationale to support the opinions. 11. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal, to include consideration of whether the Veteran is entitled to a temporary total rating for convalescence following any surgery for his service-connected bilateral open-angle glaucoma and to include consideration of whether service connection is warranted for headaches secondary to the service-connected bilateral open-angle glaucoma. If the benefits sought are not granted to the Veteran's satisfaction, send the Veteran and his representative a Supplemental Statement of the Case and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. MARJORIE A. AUER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. M. Watkins, 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.