Citation Nr: 21006393 Decision Date: 02/04/21 Archive Date: 02/04/21 DOCKET NO. 14-31 343A DATE: February 4, 2021 ORDER Entitlement to service connection for patellofemoral syndrome of the left knee is granted. Entitlement to service connection for right elbow epicondylitis is granted. Entitlement to service connection for bilateral hearing loss is denied. Entitlement to an initial rating in excess of 20 percent for degenerative changes of the lumbar spine is denied. Entitlement to an initial rating in excess of 10 percent for right achilles tendonitis with spurs and arthritis is denied. REMANDED Entitlement to service connection for bronchitis is remanded. Entitlement to service connection for chronic sinusitis is remanded. FINDINGS OF FACT 1. The Veteran’s patellofemoral syndrome of the left knee had its onset during his active service. 2. The Veteran’s right elbow epicondylitis had its onset during his active service. 3. The preponderance of the evidence of record is against finding that the Veteran has had a hearing loss disability of either ear at any time during or proximate to the pendency of the claim. 4. The Veteran’s degenerative changes of the lumbar spine is not manifested by forward flexion of the thoracolumbar spine of 30 degrees or less or by ankylosis of the thoracolumbar spine. 5. The Veteran’s right achilles tendonitis with spurs and arthritis is manifested by no more than moderate limited motion of the ankle. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for patellofemoral syndrome of the left knee have been met. 38 U.S.C. §§ 1110, 1131, 5103, 5107A; 38 C.F.R. §§ 3.102, 3.159, 3.303. 2. The criteria for entitlement to service connection for right elbow epicondylitis have been met. 38 U.S.C. §§ 1110, 1131, 5103, 5107A; 38 C.F.R. §§ 3.102, 3.159, 3.303. 3. The criteria for entitlement to service connection for bilateral hearing loss have not been met. 38 U.S.C. §§ 1110, 1131, 5103, 5107A; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.385. 4. The criteria for entitlement to an initial rating in excess of 20 percent for degenerative changes of the lumbar spine have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.400, 4.3, 4.7, 4.14, 4.21, 4.71a, Diagnostic Code 5242. 5. The criteria for entitlement to an initial rating in excess of 10 percent for right achilles tendonitis with spurs and arthritis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.400, 4.3, 4.7, 4.14, 4.21, 4.71a, Diagnostic Code 5010-5271. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from January 1989 to July 2011. In his substantive appeal, the Veteran requested a Board hearing in Washington, D.C. However, in December 2016 the Veteran indicated that he wished to withdraw his hearing request. Therefore, the hearing request has been withdrawn, and the Board will proceed with appellate review. See 38 C.F.R. § 20.704(e). The Board remanded this case in October 2018. Relevant to the issues denied in this decision, that remand directed the Agency of Original Jurisdiction (AOJ) to obtain a copy of the Veteran’s DD Form 214 and provide the Veteran examinations as to the claims for entitlement to service connection for bilateral hearing loss and entitlement to higher initial ratings for the service-connected lumbar spine and right ankle disabilities. Pursuant to the remand, the AOJ obtained the Veteran’s service personnel records, which include a copy of his DD Form 214, and provided the Veteran’s the requested examinations in November 2019 and January 2020. The examinations were responsive to the remand directives and provide the information necessary to render a decision as to the issues. Accordingly, the Board finds that VA at least substantially complied with the October 2018 remand. See 38 U.S.C. § 5103A(b); Stegall v. West, 11 Vet. App. 268, 271 (1998); D’Aries v. Peake, 22 Vet. App. 97, 105 (2008). Neither the Veteran nor his representative has raised any issues with regard to the duty to notify or duty to assist as they pertain to the issues denied in this decision. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board . . . to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). The analysis in this decision focuses on the most relevant evidence and on what the evidence shows or does not show with respect to the issues denied in this decision. The Veteran should not assume that evidence that is not explicitly discussed in the decision has been overlooked. See Timberlake v. Gober, 14 Vet. App. 122 (2000) (noting that the law requires only that reasons for rejecting evidence favorable to the claimant be addressed). Service Connection 1. Entitlement to service connection for patellofemoral syndrome of the left knee The Veteran seeks entitlement to service connection for patellofemoral syndrome of the left knee, which he contends had its onset during his active service. 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). The Veteran’s service treatment records show that he was diagnosed with bilateral patellofemoral syndrome during his active service, to include in the months leading up to his July 2011 separation from active service. His post-service medical treatment records show that he continued to complain of bilateral knee pain. A January 2020 VA examiner diagnosed the Veteran with left knee patellofemoral pain syndrome. Thus, the question becomes whether the current disability is related to service. On this question there are probative opinions in favor of and against the claim. The evidence against the claim includes the January 2020 VA examiner’s opinion that the Veteran’s current left knee disability was less likely than not incurred during active service or was caused by an in-service injury, event, or illness. As a rationale for that opinion, he explained, “Veteran has had an injury to his left knee since time of service. Due to additional injury I am unable at this time to establish if the original injury from time of service is the sole cause for his knee pain or if more recent injuries such as documented on 4/23/2015 are the cause of his pain.” The evidence in favor of the claim includes a November 2020 VA examiner’s opinion that it is at least as likely that the Veteran’s right knee condition in service had its nexus in the chronic events of service. In support of that opinion, the examiner noted the in-service complaints of bilateral knee pain that was diagnosed as patellofemoral syndrome. He also noted a post-service diagnosis of bilateral knee degenerative joint disease in 2013, which “implies continuity.” He therefore concluded, “Clearly, the condition arose while in service and had continuity throughout the remainder of service”. The examiner further explained that the January 2020 VA examiner referenced a 2015 injury, but that an opinion could be provided based on the development of arthritis as early as 2013 and “A chronic, inflammatory knee condition such [patellofemoral syndrome] can predispose to [degenerative joint disease].” The Board finds that although the November 2020 opinion pertains to the Veteran’s right knee, it can also be applied to his left knee because the examiner discusses the bilateral knees in his rationale for that opinion. In assessing the relative probative value of the two opinions discussed above, the Board notes that it is not clear from the record that the Veteran actually suffered an injury to the left knee in April 2015, as stated by the January 2020 VA examiner. The VA treatment records show that in April 2015 the Veteran complained of left knee pain and swelling for the prior week. He explained that he had refereed a soccer game the prior Wednesday and the knee felt fine that night. The following day his left knee was painful or swollen. However, the Veteran did not report any specific injury to the left knee. Because the January 2020 VA examiner based his negative opinion on the premise that the Veteran had an intercurrent left knee injury between his active service and the date of the examination, but the record does not clearly show such an injury, the Board finds that the January 2020 VA examiner’s opinion is due less probative value than the November 2020 VA examiner’s opinion. Upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran’s current patellofemoral syndrome of the left knee had its onset during his active service. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for patellofemoral syndrome of the left knee is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 2. Entitlement to service connection for right elbow epicondylitis The Veteran seeks entitlement to service connection for right elbow epicondylitis, which he contends had its onset during his active service. The service treatment records show that he was treated for right elbow pain, diagnosed as epicondylitis of the right elbow, from 2009 to 2011. He was last treated for the condition at the end of March 2011, just over one month before he submitted his pre-discharge claim for VA compensation in May 2011 and approximately 4 months prior to his separation from active service at the end of July 2011. At a January 2020 VA examination, the Veteran reported that he began having pain in his right elbow in 2009 to 2010 after he hyperextended the elbow while exercising with a punching bag. He further reported that the pain had been stable since its onset and currently occurs daily at a severity of 2 out of 10. The examiner diagnosed him with right elbow lateral epicondylitis and opined that the disability was less likely than not incurred during his active service or caused by an in-service injury, event, or illness. As a rationale for that opinion, the examiner explained that although the service treatment records show episodes of right elbow lateral epicondylitis, “there is no evidence/documentation of chronic nature to show that there has been an ongoing issue or need of care. Veteran has been out of service from 2011 making it a 9 year gap of time without sufficient documentation of a need for chronic care of his right elbow.” The Board finds that the service treatment records showing treatment for right elbow epicondylitis during the latter months of the Veteran’s active service, the Veteran’s reports of continued right elbow pain since that time, and the VA examiner’s diagnosis of right elbow lateral epicondylitis based on those same symptoms of right elbow pain to be sufficient evidence to determine that the current right elbow epicondylitis is the same disability that had its onset during the Veteran’s active service. The Board has considered the VA examiner’s negative opinion, and finds that it does not outweigh the other evidence of record because it treats the Veteran’s competent reports of continuous right elbow pain since service as not credible solely based on a lack of contemporaneous medical evidence. See Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006). The Board finds no reason to doubt the Veteran’s reports in that regard. Moreover, the examiner’s opinion suggests that if there were an indication of a chronic nature in the Veteran’s right elbow symptoms, then a positive opinion would have been provided. The Veteran’s competent and credible statements attesting to a continuity in his right elbow pain since service provides such an indication. Upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran’s current right elbow epicondylitis had its onset during his active service. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for right elbow epicondylitis is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 3. Entitlement to service connection for bilateral hearing loss The Veteran seeks entitlement to service connection for bilateral hearing loss. At a November 2019 VA examination, he reported that during his active service he was exposed to noise from gunfire and from aircraft engines and that he believed his hearing loss had its onset during his active service in 1996 or 1997. 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 500, 1000, 2000, 3000, or 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hz are 26 dB or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. In this case, the record does not show that the Veteran had a bilateral hearing loss disability for VA purposes, as defined by 38 C.F.R. § 3.385, at any time during the appeal period or in proximity to the claim for service connection. See McClain v. Nicholson, 21 Vet. App. 319 (2007); Romanowsky v. Shinseki, 26 Vet. App. 289 (2013). Specifically, the Veteran’s service treatment records show that he underwent a hearing test in September 2010 in preparation for his upcoming separation from active service. At that visit, he reported that he had noise exposure early in his active service while serving on the flight line and that his current hearing difficulties cause problems with communication, particularly when there is background noise. However, testing revealed normal hearing bilaterally. The results of audiological testing at the November 2019 VA examination were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 15 10 10 10 20 LEFT 10 15 15 20 15 Speech audiometry revealed speech recognition scores of 100 percent in the right ear and 100 percent in the left ear. Such audiometric and speech recognition findings do not reflect a hearing loss disability for VA purposes, as defined in 38 C.F.R. § 3.385. Accordingly, the evidence of record, to include the September 2010 in-service testing just prior to the claim period and the November 2019 VA examination, does not reveal a right or left ear hearing loss disability for VA purposes, as defined by 38 C.F.R. § 3.385. As such, the evidence does not show that the Veteran has been diagnosed with a bilateral hearing loss disability for VA purposes. The Board acknowledges the Veteran’s contention that he has bilateral hearing loss that is etiologically attributable to in-service noise exposure. The Veteran, as a lay person, is competent to report that he has difficulty hearing; however, he is not competent to diagnose a hearing loss disability for VA compensation purposes. See Layno v. Brown, 6 Vet. App. 465, 469 (1994); Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011); Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (2006). Diagnosing a hearing loss disability for VA purposes requires specialized diagnostic testing. The Veteran has not been shown to possess the medical expertise or knowledge to diagnose a hearing loss disability. Therefore, his contentions do not constitute competent evidence of a current bilateral hearing loss disability for VA purposes, and do not weigh against the probative value of the relevant objective audiological test results of record. In the absence of proof of a current disability, there can be no valid claim for service connection. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Accordingly, without evidence of a current bilateral hearing loss disability for VA purposes, the Board need not address the other elements of service connection for a bilateral hearing loss disability. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. Increased Rating 4. Entitlement to an initial rating in excess of 20 percent for degenerative changes of the lumbar spine The Veteran seeks a higher initial rating for degenerative changes of the lumbar spine. The applicable rating period is from August 1, 2011, the effective date for the award of service connection for that disability, through the present. See 38 C.F.R. § 3.400. Disability ratings are determined by the application of VA’s Schedule for Rating Disabilities (Schedule), which is based on the average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Pertinent regulations do not require that all cases show all findings specified by the Schedule, but that findings sufficient to identify the disease and the resulting disability and, above all, coordination of the rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21; see also Mauerhan v. Principi, 16 Vet. App. 436 (2002). When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant. 38 C.F.R. § 4.3. Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. 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,” in all claims for increased ratings. Fenderson v. West, 12 Vet. App. 119, 126-27 (1999). The Veteran’s degenerative changes of the lumbar spine is rated under 38 C.F.R. § 4.71a, Diagnostic Code 5242, and the General Rating Formula for Diseases and Injuries of the Spine (General Formula). Under the General Formula, 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). The Board finds that the preponderance of the evidence is against a rating in excess of 20 percent for degenerative changes of the lumbar spine. The Board acknowledges the Veteran’s lay reports of symptoms and that there was functional loss due to daily back pain that travels down both legs with prolonged sitting and standing. However, even considering the Veteran’s lay reports of symptoms and noted functional loss, the degree of additional limitation reflected by the statements 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. In February 2011, months before the start of the relevant rating period, the Veteran presented with bilateral knee pain. A physical examination revealed, among other things, lumbar spine active range of motion that was within normal limits and pain in the low back with flexion. The Veteran’s medical treatment records show complaints of low back pain, but do not include range of motion measurements showing forward flexion of 30 degrees or less and do not indicate that the Veteran has had favorable ankylosis of the thoracolumbar spine. At a January 2020 VA examination, the Veteran had forward flexion to 50 degrees with pain. He also had forward to flexion to 50 degrees following repetitive-use testing, and the examiner opined that the Veteran would have forward flexion to 50 degrees on repetitive use over time and during flareups. The examiner further indicated that passive range of motion testing could not be performed for the lumbar spine because it is not feasible to do so in a safe and reasonable manner. In addition, there was no evidence of pain when the spine was in a nonweight-bearing position at rest. The Veteran did not have ankylosing of the thoracolumbar spine. Accordingly, the medical evidence of record does not indicate that the Veteran had forward flexion of 30 degrees or less or that the Veteran has had favorable ankylosis of the thoracolumbar spine at any time during or proximate to the relevant rating period such that an initial rating in excess of 20 percent is warranted under the General Formula. Consideration has also been given to assigning a rating under the Formula for Rating Intervertebral Disc Syndrome (IVDS) Based on Incapacitating Episodes. The January 2020 VA examiner indicated that the Veteran has IVDS, but that he has not been prescribed bed rest by a physician for a duration that meets the criteria for a higher rating. The other evidence of record also does not show that the Veteran has had incapacitating episodes due to IVDS that meet the criteria for a higher rating. See 38 C.F.R. § 4.71a, Formula for Rating IVDS Based on Incapacitating Episodes. Regarding neurological impairment, the Veteran has already been granted service connection for radiculopathy of the right and left lower extremities associated with his degenerative changes of the lumbar spine and the lay and medical evidence of record is against a finding that the Veteran has any other neurological abnormality associated with his service-connected lumbar spine disability. Neither the Veteran nor his representative has raised any other issues with regard to the rating for degenerative changes of the lumbar spine, nor have any other such 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). Based on the foregoing, the preponderance of the evidence is against the Veteran’s appeal for an initial rating in excess of 20 percent for degenerative changes of the lumbar spine. 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. 5. Entitlement to an initial rating in excess of 10 percent for right achilles tendonitis with spurs and arthritis The Veteran seeks a higher initial rating for right achilles tendonitis with spurs and arthritis. The applicable rating period is from August 1, 2011, the effective date for the award of service connection for that disability, through the present. See 38 C.F.R. § 3.400. The Veteran’s right achilles tendonitis with spurs and arthritis is rated under 38 C.F.R. § 4.71a, Diagnostic Code 5010-5271. A hyphenated diagnostic code is used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the rating assigned. The additional diagnostic code is shown after the hyphen. In this case, rating the Veteran’s service-connected left ankle disability under Diagnostic Code 5010, which pertains to traumatic arthritis, requires the use of Diagnostic Code 5271, which pertains to limitation of motion of the ankle. Under Diagnostic Code 5010, traumatic arthritis established by X-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. Under Diagnostic Code 5271, a 10 percent rating is warranted for moderate limited motion of the ankle. A maximum 20 percent rating is warranted for marked limited motion of the ankle. Normal range of motion of the ankle is 20 degrees of dorsiflexion and 45 degrees of plantar flexion. 38 C.F.R. § 4.71a, Plate II. Although the Schedule does not provide a definition for “moderate” or “marked” limitation of ankle motion, changes to Diagnostic Code 5271 that will become effective from February 7, 2021, provide that moderate limitation of ankle motion is present when there is less than 15 degrees dorsiflexion or less than 30 degrees plantar flexion, and marked limitation of ankle motion is present when there is less than 5 degrees dorsiflexion or less than 10 degrees plantar flexion. See 85 FR 76464. In the proposed rule for those changes, VA noted that, “[a]s VA currently uses these standards to define marked and moderate, this change is intended as a clarification of current policy and would ensure consistent application of these criteria among rating personnel.” 82 FR 35723. As the changes that will become effective from February 7, 2021, merely implement previous VA policy, for purposes of rating the Veteran’s service-connected right ankle disability, the Board defines “moderate” limited ankle motion as less than 15 degrees of dorsiflexion or less than 30 degrees of plantar flexion, and “marked” limited ankle motion as less than 5 degrees of dorsiflexion or less than 10 degrees of plantar flexion. The Board finds that the preponderance of the evidence is against a rating in excess of 10 percent for right achilles tendonitis with spurs and arthritis. The Board acknowledges the Veteran’s lay reports of symptoms and that there was functional loss due to daily pain and tightness in the back of his right ankle that causes difficulty with running, walking quickly, or walking on uneven ground. However, even considering the Veteran’s lay reports of symptoms and functional loss, the degree of additional limitation reflected by the statements that would not result in symptoms more nearly approximating marked limited motion. At a January 2020 VA examination, the Veteran had right ankle dorsiflexion to 10 degrees and plantar flexion to 45 degrees with pain on initial range of motion testing, He did not have additional loss of motion following repetitive-use testing, The examiner opined that the Veteran would have right ankle dorsiflexion to 5 degrees and plantar flexion to 40 degrees on repeated use over time and during flareups. The examiner indicated that there was no objective evidence of pain on passive motion or on nonweight-bearing in the right ankle. Accordingly, the medical evidence of record does not indicate that the Veteran had right ankle dorsiflexion of less than 5 degrees or plantar flexion of less than 10 degrees during or proximate to the relevant rating period such that the service-connected right ankle disability manifested in marked limited motion warranting a higher initial rating of 20 percent under Diagnostic Code 5271. The Board has considered whether any other diagnostic codes for disabilities of the ankle would provide a higher disability rating. However, the evidence does not reflect that the service-connected right ankle disability has manifested in ankylosis or in malunion of the os calcis or astragalus, or required an astragalectomy such that a rating under the other diagnostic codes pertaining to the ankle is warranted. See 38 C.F.R. § 4.71a, Diagnostic Codes 5270, 5272, 5273, and 5274. Neither the Veteran nor his representative has raised any other issues with regard to the rating for the service-connected right achilles tendonitis with spurs and arthritis, nor have any other such issues been reasonably raised by the record. See Yancy, 27 Vet. App. at 495; Doucette, 38 Vet. App. at 369-70. In conclusion, the Board finds that the preponderance of the evidence is against the Veteran’s appeal for a rating in excess of 10 percent for right achilles tendonitis with spurs and arthritis. 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. REASONS FOR REMAND 1. Entitlement to service connection for bronchitis is remanded. The VA treatment records show that the Veteran underwent a pulmonary diagnostic study in June 2011 and that the results for that study have been scanned into VistA Imaging. The evidence scanned into VistA Imaging must be associated with the claims file. 2. Entitlement to service connection for chronic sinusitis is remanded. The Veteran seeks entitlement to service connection for chronic sinusitis. The service treatment records show that he was treated for sinus symptoms and sinusitis on multiple dates. At a January 2020 VA examination, he told the examiner that he began having facial pressure and persistent drainage sporadically in the early 1990s and that he currently has sporadic episodes of nasal drainage and congestion. The examiner diagnosed the Veteran with acute sinusitis and opined that the disability was less likely than not incurred in service or caused by an in-service injury, event, or illness because, “During service, condition was acute only. There is no evidence of chronicity of care. Veteran also had documented issues with his sinuses marked on his entrance exam prior to military service showing that it was a pre-existing condition upon entry into service”. The Board finds the examiner’s opinion inadequate for decision-making purposes because it treats the Veteran’s competent reports of sporadic episodes of nasal drainage and congestion since service as not credible solely based on a lack of contemporaneous medical evidence. See Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006). It is also based on the inaccurate factual premise that the Veteran had sinus problems at the time of his medical examination for entrance into active service. Although the Veteran’s August 1988 report of medical history for enlistment shows that he endorsed current or past sinusitis, his August 1988 report of medical examination for enlistment shows that he had normal clinical evaluations of the sinuses, nose, mouth, and throat. Therefore, he did not have sinus problems at the time of the enlistment examination, and he is presumed sound upon entry as to sinusitis. The issue must be remanded so that an addendum opinion may be obtained. The matters are REMANDED for the following action: 1. Obtain the documents referenced in the VA treatment records as having been scanned into VistA Imaging, to include the June 2011 pulmonary diagnostic study. Efforts to obtain those records must continue until it is concluded that the records sought do not exist or that further efforts to obtain those records would be futile. Any inability to obtain the records must be documented in the record and the Veteran should be notified of that inability in a manner consistent with 38 C.F.R. § 3.159(e). 2. Obtain an addendum opinion from an appropriate clinician regarding whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s current sinusitis had its onset during his active service or is otherwise related to the in-service sinusitis and/or sinus symptoms. The examiner must note that the Veteran had normal clinical evaluations of the sinuses, nose, mouth, and throat at his August 1988 medical examination for enlistment. Therefore, he is presumed sound upon entry as to sinusitis despite any information contained on the August 1988 report of medical history for enlistment. As such, the examiner must not find that the Veteran had a pre-existing sinus disability at the time of enlistment. The examiner must also note that lack of contemporaneous medical evidence does not, in and of itself, render lay evidence not credible. Therefore, the examiner must not treat the Veteran’s competent reports of sporadic episodes of nasal drainage and congestion since service as not credible solely based on a lack of contemporaneous medical evidence documenting treatment since his separation from active service. MICHAEL MARTIN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. J. Anthony, 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.