Citation Nr: 21006142 Decision Date: 02/03/21 Archive Date: 02/03/21 DOCKET NO. 14-41 565 DATE: February 3, 2021 ORDER Entitlement to a 20 percent rating, but no higher, prior to November 21, 2019 for lumbar strain with degenerative joint disease is granted. From November 21, 2019, a rating in excess of 20 percent for lumbar strain with degenerative joint disease is denied. Entitlement to a 20 percent rating, but no higher, prior to November 21, 2019 for cervical spine degenerative joint disease is granted. From November 21, 2019, a rating in excess of 20 percent for cervical strain with degenerative joint disease is denied. Entitlement to a 20 percent rating, but no higher, prior to September 27, 2019 for degenerative joint disease of the AC joint of the right shoulder is granted. From September 27, 2019, a rating in excess of 20 percent for degenerative joint disease of the AC joint of the right shoulder is denied. Entitlement to service connection for hearing loss is denied. REMANDED Entitlement to service connection for a left shoulder disability is remanded. Entitlement to a rating in excess of 10 percent for patellofemoral syndrome of the left knee with degenerative arthritis is remanded. FINDINGS OF FACT 1. During the appeal period, lumbar strain with degenerative joint disease has been manifested with flexion to 60 degrees, at worst, with consideration of functional loss and without unfavorable ankylosis of the thoracolumbar spine or incapacitating episodes having a total duration of at least four weeks during any 12-month period. 2. During the appeal period, cervical strain with degenerative joint disease has been manifested by guarding muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis; by flexion limited to 40 degrees; and without ankylosis of the cervical spine. 3. During the appeal period, degenerative joint disease of the AC joint of the right shoulder is manifested by painful motion of the right shoulder, external rotation to 80 degrees and without ankylosis of the scapulohumeral articulation or impairment of the humerus. 4. During the appeal period, the Veteran has not had a bilateral hearing loss disability, as defined by VA regulation. CONCLUSIONS OF LAW 1. Prior to November 21, 2019, the criteria for a 20 percent rating, but no higher, for lumbar strain with degenerative joint disease have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 3.321(b), 4.1, 4.2, 4.7, 4.10, 4.40, 4.45, 4.71(a), Diagnostic Code (DC) 5242. 2. From November 21, 2019, the criteria for a rating in excess of 20 percent for lumbar strain have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 3.321(b), 4.1, 4.2, 4.7, 4.10, 4.40, 4.45, 4.71(a), Diagnostic Code (DC) 5242. 3. Prior to November 21, 2019, the criteria for a 20 percent rating, but no higher, for cervical strain with degenerative disc disease have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 3.321(b), 4.1, 4.2, 4.7, 4.10, 4.40, 4.45, 4.71(a), Diagnostic Code (DC) 5237. 4. From November 21, 2019, the criteria for a rating in excess of 20 percent for cervical strain with degenerative joint disease have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 3.321(b), 4.1, 4.2, 4.7, 4.10, 4.40, 4.45, 4.71(a), Diagnostic Code (DC) 5237. 5. Prior to September 27, 2019, the criteria for a 20 percent rating, but no higher, for degenerative joint disease of the AC joint of the right shoulder have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 3.321(b), 4.1, 4.2, 4.7, 4.10, 4.40, 4.45, 4.71(a), Diagnostic Code (DC) 5201. 6. From September 27, 2019, the criteria for a rating in excess of 20 percent for right acromioclavicular joint arthritis have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 3.321(b), 4.1, 4.2, 4.7, 4.10, 4.40, 4.45, 4.71(a), Diagnostic Code (DC) 5201. 7. The criteria for service connection for hearing loss have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.385. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from March 1986 to March 1990 and from January 1991 to March 1991. In July 2018, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of the hearing has been reviewed. The case was previously remanded for additional development in March 2019. The remanded claims included service connection for an acquired psychiatric disorder. A September 2020 rating decision granted service connection for PTSD. That represents a full grant with respect to the claim for service connection for an acquired psychiatric disorder. Increased Rating Disability ratings are determined by applying the criteria set forth in the VA's Schedule for Rating Disabilities ("Rating Schedule"), which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The basis of disability evaluations is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. See 38 C.F.R. § 4.10. If there is a question as to which evaluation to apply to the Veteran's disability, 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. See 38 C.F.R. § 4.7. When reasonable doubt arises as to the degree of disability, such doubt will be resolved in the Veteran's favor. See 38 C.F.R. § 4.3. Pertinent regulations do not require that all cases show all findings specified by the Rating Schedule, but that findings sufficiently characteristic to identify the disease and the resulting disability and coordination of rating with impairment of function. See 38 C.F.R. § 4.21. Therefore, the Board has considered the potential application of various other provisions of the regulations governing VA benefits as well as the entire history of his disabilities in reaching its decision. Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). 1. Increased rating for lumbar spine disability A February 2013 rating decision granted service connection for lumbar spine degenerative joint disease and assigned a 10 percent rating from August 2011. A claim for an increased rating was received in June 2015. A July 2020 rating decision granted a 20 percent rating from November 21, 2019. The Veteran contends that he has daily back pain and muscle spasms which affect his ability to do lifting and standing and walk long distances. The Veteran’s lumbar spine degenerative joint disease is rated under 38 C.F.R. § 4.71a, Diagnostic Code 5237. Under the General Rating Formula for Diseases and Injuries of the Spine, a 10 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. A 20 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent rating is warranted for forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent evaluation is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine. Any associated objective neurological abnormalities, including, but not limited to, bowel or bladder impairment, are to be evaluated separately under an appropriate diagnostic code. Id. at Note 1. Ankylosis is defined as “immobility and consolidation of a joint due to disease, injury, or surgical procedure.” Dorland’s Illustrated Medical Dictionary, 94 (32nd ed. 2012). Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. Id. at Note 5. When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) (“[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran’s disability, after which a rating is determined based on the § 4.71a criteria.”). Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011). In Correia v. McDonald, 28 Vet. App. 158 (2016), the Court held that the final sentence of 38 C.F.R. § 4.59 requires that the examiner record the results of range of motion testing “for pain on both active and passive motion [and] in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint.” The spine has no opposite joint. In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that VA examiners must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from the veterans themselves, when a flare-up is not observable at the time of examination. The Board finds that a 20 percent rating, but no higher, is warranted for lumbar spine degenerative joint disease prior to November 21, 2019, based on limitation of motion of the lumbar spine approximating forward flexion greater than 60 degrees but not greater than 85 degrees. An August 2015 VA examination showed forward flexion of the lumbar spine to 75 degrees, 20 degrees extension, bilateral lateral flexion to 25 degrees, and bilateral lateral rotation to 30 degrees. The examination indicated that his forward flexion with functional loss was limited to 70 degrees with repetitive use and on repeated use over time. The examiner noted additional factors contributed to disability, including disturbance of locomotion, interference with sitting, interference with standing, and antalgic gait. The Veteran reported flare-ups of sharp pain that were a 10/10 in severity and indicated that he had trouble sleeping, getting in and out of bed, taking a shower, and bending over during a flare-up. Considering his functional loss which limited his back motion to 70 degrees and the additional limiting factors of disability, the Board finds that the criteria for a 20 percent rating are met for the period prior to November 21, 2019. At a November 2019 VA examination, the Veteran reported flare-ups occurring every 3 months that lasted about a week. He indicated that he could hardly bend over when he had flare-ups, but denied limitation with normal activities between flares at work or at home. Range of motion testing showed 60 degrees flexion, and 30 degrees extension, bilateral flexion, and bilateral rotation. There was pain noted on bilateral rotation, but it did not result in or cause functional loss. Repetitive use testing revealed no additional functional loss or loss of motion. The examination was noted as being conducted during a flare-up, and the examiner noted that a 10 degree decrease in flexion or extension was predicted with the lifting of over 30 pounds or repeated bending or stooping of over 5 minutes. The Board finds that the preponderance of the evidence is against a rating in excess of 20 percent for lumbar spine degenerative joint disease for the entire appeal period. The Board acknowledges the Veteran’s lay reports of symptoms and that there was functional loss due to flare-ups of back pain. However, even considering the Veteran’s lay reports of symptoms and noted functional loss, the degree of additional limitation would not result in limitation of motion more nearly approximating forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. Consideration has also been given to assigning a rating under the Formula for Rating Intervertebral Disc Syndrome (IVDS) Based on Incapacitating Episodes. However, the Veteran does not have IVDS that required physician prescribed bedrest. See 38 C.F.R. § 4.71a, Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. Accordingly, a higher rating is not warranted based on incapacitating episodes of intervertebral disc syndrome. Regarding neurological impairment, the Veteran has already been granted service connection for radiculopathy of the lower extremities and the lay and medical evidence of record is against a finding that the Veteran has any other neurological abnormality associated with his spine disability. Based on the foregoing, a 20 percent rating is warranted for lumbar spine degenerative joint disease throughout the appeal period. The preponderance of the evidence is against the Veteran’s claim for a rating in excess of 20 percent for lumbar spine degenerative joint disease. In denying such a 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. 2. Increased rating for degenerative joint disease of the AC joint of the right shoulder A February 2013 rating decision granted service connection for degenerative joint disease of the AC joint of the right shoulder. A 10 percent rating was assigned from August 2011. A claim for an increased rating was received in June 2015. A July 2020 rating decision granted a 20 percent rating from September 27, 2019 based on painful motion of the right shoulder warranting the minimum compensable rating for the shoulder joint. The Veteran contends that he is entitled to a higher rating based on loss of use and loss of motion of the right shoulder. The Veteran is left-hand dominant; therefore, the criteria for the minor joint are applicable for his shoulder disability. The Veteran’s right shoulder degenerative joint disease is rated under 38 C.F.R. § 4.71a, Diagnostic Code 5201, for limitation of motion of the arm. Under Diagnostic Code 5201, limitation of motion of the arm at shoulder level warrants a 20 percent rating for both the major and minor extremity. Limitation of motion of the arm midway between side and shoulder warrants a 20 percent rating for the minor extremity and a 30 percent rating for the major extremity. Limitation of motion of the arm to 25 degrees from side warrants a maximum 30 percent rating for the minor joint and a maximum 40 percent rating for the major joint. 38 C.F.R. § 4.71a, Diagnostic Code 5201. Diagnostic Code 5201 “does not provide separate ratings for limitation of motion in the flexion and abduction planes, but rather is addressed generically to limitation of motion of the arm.” Yonek v. Shinseki, 722 F.3d 1355, 1358 (Fed. Cir. 2013). Upon VA examination in August 2015, the Veteran reported daily pain in the right shoulder with activity, but he reported no flare-ups of the shoulder or arm. Examination showed flexion to 160 degrees, abduction to 150 degrees, and external and internal rotation to 80 degrees. Pain was noted with flexion and abduction. There was no additional functional loss or loss of range of motion after repetitive use testing. The Veteran is entitled to the minimum compensable rating for his right shoulder disability based on painful and limited motion of the shoulder. Therefore, a 20 percent rating, but no higher, is warranted for his right shoulder disability during the period prior to September 27, 2019. On VA examination in September 2019, the Veteran did not report any flare-ups of the shoulder or arm. He indicated that he had functional loss in the form of being unable to lift heavy objects or perform overhead activities. Range of motion testing showed 150 degrees flexion, 150 degrees abduction, 70 degrees external rotation, and 70 degrees internal rotation. Pain was noted on flexion and abduction and caused functional loss. There was no additional functional loss or loss of range of motion after repetitive use testing. At a November 2019 VA examination, the Veteran did not report any flare-ups of the shoulder or arm. He indicated functional loss in the form of only being able to move his arm up so far with difficulty reaching off a top shelf. Range of motion testing showed 130 degrees flexion, 130 degrees abduction, 40 degrees external rotation, and 70 degrees internal rotation. Pain was noted with external rotation, but it did not result in or cause functional loss. Repetitive use testing and repeated use over time showed 100 degrees flexion, 120 degrees abduction, 40 degrees external rotation, and 60 degrees internal rotation. The Board finds that the preponderance of the evidence is against a rating in excess of 20 percent for right shoulder degenerative joint disease for the entire appeal period. The evidence of record shows that the Veteran is left-handed. The Board acknowledges the Veteran’s lay reports of symptoms and that there was functional loss due to pain with activity and being unable to lift objects. However, even considering the Veteran’s lay reports of symptoms and noted functional loss, the degree of additional limitation reflected by the statements about his shoulder pain and problems lifting would not result in symptoms more nearly approximating limitation of motion of the arm midway between side and shoulder level of the major extremity or limitation of motion of the arm to 25 degrees from the side of the major or minor extremity. The Board has considered whether any other Diagnostic Codes related to disabilities of the shoulder would provide for a higher disability rating. However, the evidence does not reflect that the symptoms would warrant a higher rating under a different Diagnostic Code. See 38 C.F.R. § 4.71a. The Veteran does not have ankylosis of the scapulohumeral articulation or impairment of the humerus. Accordingly, a higher rating may not be assigned based on DC 5200 or 5202. Based on the foregoing, a 20 percent rating is warranted for right shoulder degenerative joint disease throughout the appeal period. The preponderance of the evidence is against the Veteran’s appeal for a rating in excess of 20 percent for right shoulder degenerative joint disease. In denying such a 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. 3. Increased rating for cervical strain with degenerative disc disease A February 2013 rating decision granted service connection for cervical strain and assigned a 10 percent rating from August 2011. A claim for an increased rating was received in June 2015. A July 2020 rating decision granted a 20 percent rating from November 21, 2019. The Veteran contends that a higher rating is warranted. He contends that he has limited motion, pain, and stiffness. He asserts that his flexion is worse than shown on the VA examination in 2015. The Veteran’s cervical strain is rated under 38 C.F.R. § 4.71a, Diagnostic Code 5237. Under the General Rating Formula for Diseases and Injuries of the Spine, a 10 percent rating is warranted for forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degrees; or, combined range of motion of the cervical spine greater than 170 degrees but not greater than 335 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. A 20 percent rating is warranted for forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; or, the combined range of motion of the cervical spine not greater than 170 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 30 percent rating is warranted for forward flexion of the cervical spine to 15 degrees or less; or favorable ankylosis of the entire cervical spine. A 40 percent rating is warranted for unfavorable ankylosis of the entire cervical spine. A 100 percent rating is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine. The VA examination in August 2015 reflects that the Veteran reported decreased range of motion with right and left motion of his neck. The Veteran had forward flexion to 40 degrees and extension to 0 degrees. The combined range of motion of the cervical spine was 305 degrees. The Veteran had guarding and muscle spasm, but it did not result in abnormal gait or abnormal spinal contour. The examiner opined that there was pain on examination that did not result in functional loss. A VA examination dated in November 2019 noted forward flexion to 40 degrees and flexion to 0 degrees. The examiner estimated that there was an additional 10 degree loss of extension due to repeated overhead reaching. With consideration of the reduced extension, the combined range of motion of the cervical spine was 215 degrees. The examination noted that there was guarding and muscle spasm severe enough to result in abnormal gait or abnormal spinal contour. The examiner noted “upper c-spine spasm with straightening of the lordotic curve.” Resolving reasonable doubt in the Veteran’s favor, the Board finds that a 20 percent rating, but no higher, is warranted prior to November 21, 2019 based on guarding and muscle spasm resulting in abnormal curvature. A 2012 examination of the cervical spine noted that the Veteran had flattening of the lordotic curve shown by x-rays of his cervical spine. Although the relationship between the abnormal spinal contour and cervical spasms was initially shown on examination in 2019, the criteria for a higher rating are met based on the evidence indicating that an abnormal spinal contour was present throughout the appeal period. Accordingly, the criteria for a 20 percent are met for the period prior to November 21, 2019. The Board finds that the preponderance of the evidence is against a rating in excess of 20 percent for degenerative joint disease of the cervical spine for the entire appeal period. The Board acknowledges the Veteran’s lay reports of symptoms and that there was functional loss due to pain and stiffness. However, even considering the Veteran’s lay reports of symptoms and noted functional loss, the degree of additional limitation would not result in limitation of motion more nearly approximating forward flexion of the cervical spine to 15 degrees or less; or favorable ankylosis of the entire cervical spine. Consideration has also been given to assigning a rating under the Formula for Rating Intervertebral Disc Syndrome (IVDS) Based on Incapacitating Episodes. However, the Veteran does not have IVDS that required prescribed bed rest by a physician for a duration that meets the criteria for a higher rating. See 38 C.F.R. § 4.71a, Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. Regarding neurological impairment, the Veteran has already been granted service connection for radiculopathy of the upper extremities, and the lay and medical evidence of record is against a finding that the Veteran has any other neurological abnormality associated with his spine disability. For the foregoing reasons, the Board finds that a 20 percent rating is warranted for cervical spine disability throughout the appeal period. The preponderance of the evidence is against the Veteran’s claim for a rating in excess of 20 percent for cervical strain with degenerative disc disease. In denying such a 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. Service Connection Entitlement to service connection for hearing loss Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C. §§ 1110; 1131; 38 C.F.R. § 3.303 (a). Establishing service connection generally requires competent evidence of three things: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. Holton v. Shinseki, 557 F. 3d 1362, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303 (a). Pursuant to 38 C.F.R. § 3.303(b), where a chronic disease is shown as such in service, subsequent manifestations of the same chronic disease are generally service-connected. A sensorineural hearing loss may be presumed to have been incurred in service if it was compensably disabling within a year of a Veteran's separation from active duty. 38 C.F.R. §§ 3.307, 3.309(a). For the purposes of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies at 500, 1000, 2000, 3000, or 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies at 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. Even though a disabling hearing loss was not demonstrated at separation, a Veteran may, nevertheless, establish service connection for a current hearing disability by submitting evidence that a current disability is related to service. Hensley v. Brown, 5 Vet. App. 155 (1993). A retention audiogram during service in September 1989 showed 30 decibels at 6000 Hertz. The other audiometric thresholds were lower than 26 decibels. The post-service evidence does not show hearing loss as defined by 3.385. A September 2019 VA examination reflects that the puretone thresholds for the right ear were 15 at 500 Hertz (Hz), 25 at 1000 Hz, 20 at 2000 Hz, 25 at 3000 Hz, and 30 at 4000 Hz. Puretone thresholds for the left ear were 15 at 500 Hz, 20 at 1000 Hz, 20 at 2000 Hz, 25 at 3000 Hz, and 25 at 4000 Hz. Speech discrimination was 100 percent in both ears. The Board finds the record does not demonstrate that the Veteran has a current hearing loss disability, pursuant to 38 C.F.R. § 3.385, at any time during the current appeal period. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). While the Veteran is competent to report difficulty with hearing, he is not competent to diagnose hearing loss for VA purposes. The threshold element of a service connection claim (a current disability) has not been met. Thus, service connection for hearing loss is denied. Brammer v. Derwinski, 3 Vet. App. 223 (1992). REASONS FOR REMAND 1. Entitlement to service connection for a left shoulder disability is remanded. The Veteran contends that his left shoulder was injured in service. At the Board hearing, he testified that he injured his shoulder using and carrying a 0.50-caliber machine gun that weighed about 70 pounds, and he had dislocations of his shoulder in service. A September 2019 VA examiner opined that the Veteran’s left shoulder disability is less likely than not related to service. The examiner indicated that there were no service records about the left shoulder. The examiner opined that the condition was acute during service. The examiner did not address the post-service VA evidence about the left shoulder, including diagnoses of left shoulder strain and arthropathy. The case is being remanded for an addendum opinion that addresses his current left shoulder disability. 2. Entitlement to an increased rating for patellofemoral syndrome of the left knee with degenerative arthritis is remanded. A July 2013 MRI report for the left knee dated in July 2013 noted mild thinning of the medial articular cartilage and a tiny defect in the medial femoral articular cartilage. A November 2019 VA examination of the left knee did not show any cartilage conditions. Recurrent effusion and swelling of the left knee were noted. A medical opinion is necessary to determine whether there is a meniscal condition of the left knee. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s left shoulder disability is at least as likely as not related to service. The examiner must opine whether it is at least as likely as not related to an in-service event, injury, or disease, including firing weapons in service. (a) The examiner must consider the Veteran’s statements about the shoulder symptoms he experienced in service. (b) The examiner should consider the VA treatment records showing a current diagnosis of left shoulder arthropathy. 2. Schedule the Veteran for an examination to determine the current nature of any left knee meniscal impairment. Specifically, the examiner is asked to determine if the left knee meniscus is torn, or the semilunar cartilage is otherwise shown to be dislocated, with frequent episodes of "locking," pain, and effusion into the joint. JENNIFER HWA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Catherine Cykowski 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.