Citation Nr: 21006992 Decision Date: 02/08/21 Archive Date: 02/08/21 DOCKET NO. 18-46 263A DATE: February 8, 2021 ORDER An effective date prior to March 3, 2016, for the award of service connection for neuropathy of the right upper extremity is denied. An effective date prior to March 3, 2016, for the award of service connection for neuropathy of the left upper extremity is denied. An effective date prior to March 3, 2016, for the award of service connection for left shoulder strain and acromioclavicular joint osteoarthritis is denied. An effective date prior to March 3, 2016, for the award of service connection for cervical strain, degenerative arthritis, and intervertebral disc syndrome (IVDS) is denied. An initial rating in excess of 20 percent prior to November 21, 2018, and in excess of 40 percent thereafter for neuropathy of the right upper extremity is denied. An initial rating in excess of 20 percent prior to November 21, 2018, and in excess of 30 percent thereafter for neuropathy of the left upper extremity is denied. An initial rating in excess of 20 percent for left shoulder strain and acromio-clavicular joint osteoarthritis is denied. An initial rating in excess of 20 percent for cervical strain, degenerative arthritis, and IVDS is denied. New and material evidence having not been received, the application to reopen the claim of entitlement to service connection for a low back disorder is denied. New and material evidence having not been received, the application to reopen the claim of entitlement to service connection for vertigo is denied. New and material evidence having not been received, the application to reopen the claim of entitlement to service connection for a headache disorder is denied. New and material evidence having not been received, the application to reopen the claim of entitlement to service connection for peripheral neuropathy of the left lower extremity is denied. New and material evidence having not been received, the application to reopen the claim of entitlement to service connection for peripheral neuropathy of the right lower extremity is denied. Service connection for unspecified depressive disorder is granted. REMANDED Entitlement to service connection for a right shoulder disorder, to include as secondary to service-connected cervical strain, degenerative arthritis, and IVDS, is remanded. Entitlement to service connection for a respiratory disorder, to include as secondary to service-connected disability, is remanded. Entitlement to service connection for a right hip disorder, to include as secondary to service-connected disability, is remanded. Entitlement to service connection for a left hip disorder, to include as secondary to service-connected disability, is remanded. Entitlement to service connection for a sleep disorder, to include as secondary to service-connected disability, is remanded. Entitlement to service connection for hypertension, to include as secondary to service-connected disability, is remanded. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) prior to November 21, 2018, is remanded. FINDINGS OF FACT 1. In a final decision issued in July 2014, the Agency of Original Jurisdiction (AOJ) denied the application to reopen claim of entitlement to service connection for a low back disorder, characterized as degenerative arthritis low back, and denied service connection for vertigo, a headache disorder, characterized as headaches/migraines, and neuropathy of the bilateral upper and lower extremities, characterized as neuropathy of the bilateral hands and feet. 2. Following the issuance of the final July 2014 rating decision, the Veteran did not file a formal or informal claim for service connection for neuropathy of the right upper extremity prior to the receipt of his formal claim on March 3, 2016. 3. Following the issuance of the final July 2014 rating decision, the Veteran did not file a formal or informal claim for service connection for neuropathy of the left upper extremity prior to the receipt of his formal claim on March 3, 2016. 4. The Veteran did not file a formal or informal claim for service connection for a left shoulder disorder prior to the receipt of his formal claim on March 3, 2016. 5. The Veteran did not file a formal or informal claim for service connection for a cervical spine disorder prior to the receipt of his formal claim on March 3, 2016. 6. The Veteran is right hand dominant. 7. The Veteran’s neuropathy of the right upper extremity resulted in no more than mild incomplete paralysis of the lower radicular group prior to November 21, 2018, and no more than moderate incomplete paralysis of the lower radicular group thereafter. 8. The Veteran’s neuropathy of the left upper extremity resulted in no more than mild incomplete paralysis of the lower radicular group prior to November 21, 2018, and no more than moderate incomplete paralysis of the lower radicular group thereafter. 9. For the entire appeal period, the Veteran’s left shoulder strain and acromio-clavicular joint osteoarthritis is manifested by symptoms of pain, stiffness, and popping with arm motion limited to, at most, midway between the arm and shoulder level, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups, without malunion of the humerus, recurrent dislocation of the humerus at the scapulohumeral joint, or ankylosis of the scapulohumeral articulation. 10. For the entire appeal period, the Veteran’s cervical strain, degenerative arthritis and IVDS was manifested by forward flexion limited to, at most, 25 degrees, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups, without ankylosis, IVDS with incapacitating episodes having a total duration of at least 4 weeks, or associated objective neurologic abnormalities other than neuropathy of the right and left upper extremities. 11. Evidence associated with the record since the final denial in June 2014 is cumulative or redundant of the evidence of record at the time of the decision and does not raise a reasonable possibility of substantiating the claim of entitlement to service connection for a low back disorder. 12. Evidence associated with the record since the final denial in June 2014 is cumulative or redundant of the evidence of record at the time of the decision and does not raise a reasonable possibility of substantiating the claim of entitlement to service connection for vertigo. 13. Evidence associated with the record since the final denial in June 2014 is cumulative or redundant of the evidence of record at the time of the decision and does not raise a reasonable possibility of substantiating the claim of entitlement to service connection for a headache disorder. 14. Evidence associated with the record since the final denial in June 2014 is cumulative or redundant of the evidence of record at the time of the decision and does not raise a reasonable possibility of substantiating the claim of entitlement to service connection for peripheral neuropathy of the left lower extremity. 15. Evidence associated with the record since the final denial in June 2014 is cumulative or redundant of the evidence of record at the time of the decision and does not raise a reasonable possibility of substantiating the claim of entitlement to service connection for peripheral neuropathy of the right lower extremity. 16. Resolving all doubt in the Veteran’s favor, his currently diagnosed unspecified depressive disorder is proximately due to his service-connected disabilities. CONCLUSIONS OF LAW 1. The July 2014 rating decision that denied the application to reopen the claim of entitlement to service connection for low back disorder, characterized as degenerative arthritis low back, and denied service connection for vertigo, a headache disorder, characterized as headaches/migraines, and neuropathy of the bilateral upper and lower extremities, characterized as neuropathy of the bilateral hands and feet, is final. 38 U.S.C. § 7105(c) (West 2012) [(2012)]; 38 C.F.R. §§ 3.104, 3.156, 20.302, 20.1103 (2014) [(2020)]. 2. The criteria for an effective date prior to March 3, 2016, for the award of service connection for neuropathy of the right upper extremity have not been met. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. 3. The criteria for an effective date prior to March 3, 2016, for the award of service connection for neuropathy of the left upper extremity have not been met. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. 4. The criteria for an effective date prior to March 3, 2016, for the award of service connection for left shoulder strain and acromioclavicular joint osteoarthritis have not been met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. § 3.400. 5. The criteria for an effective date prior to March 3, 2016, for the award of service connection for cervical strain, degenerative arthritis, and IVDS have not been met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. § 3.400. 6. The criteria for an initial rating in excess of 20 percent prior to November 21, 2018, and in excess of 40 percent thereafter for neuropathy of the right upper extremity have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.120, 4.124a, Diagnostic Code 8512. 7. The criteria for an initial rating in excess of 20 percent prior to November 21, 2018, and in excess of 30 percent thereafter for neuropathy of the left upper extremity have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.120, 4.124a, Diagnostic Code 8512. 8. The criteria for an initial rating in excess of 20 percent for left shoulder strain and acromioclavicular joint osteoarthritis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5201. 9. The criteria for an initial rating in excess of 20 percent for cervical strain, degenerative arthritis, and IVDS have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5237. 10. New and material evidence has not been received to reopen a claim of entitlement to service connection for a low back disorder. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 11. New and material evidence has not been received to reopen a claim of entitlement to service connection for vertigo. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 12. New and material evidence has not been received to reopen a claim of entitlement to service connection for a headache disorder. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 13. New and material evidence has not been received to reopen a claim of entitlement to service connection for peripheral neuropathy of the left lower extremity. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 14. New and material evidence has not been received to reopen a claim of entitlement to service connection for peripheral neuropathy of the right lower extremity. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 15. The criteria for service connection for unspecified depressive disorder have been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1979 to October 1983. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a rating decision issued in August 2016 by a Department of Veterans Affairs (VA) Regional Office, which denied applications to reopen claims of entitlement to service connection for a low back disorder, vertigo, a headache disorder, and neuropathy of the bilateral lower extremities, denied service connection for bilateral hip disorders, a right shoulder disorder, sleep apnea, a respiratory disorder, hypertension, and an acquired psychiatric disorder, and awarded service connection for cervical strain, degenerative arthritis and IVDS, neuropathy of the right upper extremity, neuropathy of the left upper extremity, and left shoulder strain and acromioclavicular joint osteoarthritis. In November 2016, the Veteran submitted a timely notice of disagreement with all aspects of each issue decided in the August 2016 rating decision, and the AOJ issued a statement of the case addressing such claims in March 2018. Upon receipt of the Veteran’s substantive appeal in October 2018, the AOJ initially notified him in November 2018 that such was untimely. As a result, the Veteran submitted a VA 21-526b, Veteran Supplemental Claim, that same month repeating his assertions from his November 2016 notice of disagreement, and the AOJ issued a rating decision in January 2019 addressing the issues. In February 2019, the Veteran submitted a notice of disagreement as to the January 2019 rating decision, the AOJ issued a statement of the case in January 2020, and the Veteran filed a substantive appeal in March 2020. Nevertheless, as a review of the record indicated the Veteran had not received the March 2018 statement of the case, the AOJ subsequently notified him in a March 2020 letter that his October 2018 substantive appeal would be considered timely. Thus, the Board finds the current appeal stems from the August 2016 rating decision and has characterized the issues accordingly. In regard to the Veteran’s TDIU claim, the Board notes that a December 2019 rating decision awarded such as of November 21, 2018. However, the Veteran’s claims for higher initial ratings for his service-connected disabilities on appeal stem from the March 3, 2016, date of service connection. Thus, the Board finds that, despite the absence of a formal notice of disagreement, the issue of entitlement to a TDIU prior to November 21, 2018, remains on appeal. Rice v. Shinseki, 22 Vet. App. 447 (2009); Harper v. Wilkie, 30 Vet. App. 345 (2018). Effective Dates The assignment of an effective date for an award is generally governed by 38 U.S.C. § 5110 and 38 C.F.R. § 3.400. Unless specifically provided otherwise, the effective date of an award based on a claim for service connection or for an increase of compensation “shall be fixed in accordance with the facts found, but shall not be earlier than the date of receipt of application therefore.” 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400. The effective date for an award of service connection is the day after separation from service or day entitlement arose, if a claim is received within one year of separation from service, otherwise the date of receipt of claim, or the day entitlement arose, whichever is later. 38 U.S.C. § 5110(b)(1); 38 C.F.R. § 3.400(b)(2)(i). The effective date based on new and material evidence other than service department records received after the final disallowance is the date of receipt of the new claim or the date entitlement arose, whichever is later. 38 C.F.R. § 3.400(q)(1)(ii). Under 38 C.F.R. § 3.400(r), the effective date based on a reopened claim is the date of receipt of the claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110. A claim for VA benefits, whether formal or informal, must be in writing and must identify the benefit sought. 38 U.S.C. § 5101; 38 C.F.R. §§ 3.1(p), 3.151, 3.155; Rodriguez v. West, 189 F.3d 1351 (Fed. Cir. 1999); Lalonde v. West, 12 Vet. App. 377 (1999). Prior to March 24, 2015, any communication or action indicating intent to apply for one or more benefits under the laws administered by VA, was considered an informal claim. Such informal claim must identify the benefit sought. Upon receipt of an informal claim, if a formal claim has not been filed, an application form will be forwarded to the claimant for execution. 38 C.F.R. § 3.155(a). While the VA should broadly interpret submissions from a veteran, it is not required to conjure up claims not specifically raised. Brannon v. West, 12 Vet. App. 32 (1998); Talbert v. Brown, 7 Vet. App. 352, 356-57 (1995). 1. Entitlement to an effective date prior to March 3, 2016, for the award of service connection for neuropathy of the right upper extremity. 2. Entitlement to an effective date prior to March 3, 2016, for the award of service connection for neuropathy of the left upper extremity. By way of background, VA received the Veteran’s original claim for service connection for neuropathy of the bilateral upper extremities in January 2014. Thereafter, in a rating decision issued in June 2014, the AOJ denied service connection for neuropathy of the right and left upper extremity, characterized as neuropathy of the bilateral hands. In July 2014, the Veteran was advised of the decision and of his appellate rights, but he did not enter a notice of disagreement with such decision. Additionally, no new and material evidence was physically or constructively associated with the record within one year of the issuance of such decision, and no relevant service department records have since been received. Therefore, the July 2014 rating decision is final. 38 U.S.C. § 7105(c) (West 2012); 38 C.F.R. §§ 3.104, 3.156, 20.302, 20.1103 (2014). VA received the Veteran’s application to reopen the claim of entitlement to service connection for neuropathy of the bilateral upper extremities on March 3, 2016, and in a rating decision issued in August 2016, the AOJ granted service connection for neuropathy of the right and left upper extremities with an effective date of March 3, 2016, the date of receipt of his application to reopen such claims. The Veteran disagreed with the propriety of the assigned effective dates, but has not offered any specific argument as to why he believes earlier effective dates for such awards are warranted. Upon review, the Board finds that there is no document of record that can be construed as a formal or informal claim for service connection for neuropathy right or upper extremity that was received after the issuance of the July 2014 rating decision and prior to the receipt of the Veteran’s application to reopen on March 3, 2016. In particular, although the Veteran submitted a written statement in October 2014, such only requested a copy of his claims file. Later that month, VA received a VA 21-526EZ, Application for Disability Compensation and Related Compensation Benefits, in which the Veteran applied to reopen his claim for service connection for lower back pain. Thus, absent at least a general description of neuropathy of the bilateral upper extremities, such earlier filings may not be construed as a claim for service connection for such disorders. Sellers v. Wilkie, 965 F.3d 1328 (Fed. Cir. 2020) (holding that “a veteran’s formal claim is required to identify the sickness, disease, or injuries for which compensation is sought, at least at a high level of generality”). Furthermore, upon review of the Veteran’s earlier filings, the Board finds that such did not identify specific medical records that contained a reasonably ascertainable diagnosis of neuropathy of the bilateral upper extremities so that such submission may constitute an informal claim for benefits under the pre-March 24, 2015, regulations. Shea v. Wilkie, 926 F.3d 1362 (Fed. Cir. 2019). Consequently, the Board finds an effective date prior to March 3, 2016, for the award of service connection for neuropathy of the right and left upper extremities is not warranted. See 38 U.S.C. § 5110; 38 C.F.R. § 3.400. 3. Entitlement to an effective date prior to March 3, 2016, for the award of service connection for left shoulder strain and acromioclavicular joint osteoarthritis. 4. Entitlement to an effective date prior to March 3, 2016, for the award of service connection for cervical strain, degenerative arthritis, and IVDS. In the August 2016 rating decision, the AOJ awarded service connection for the Veteran’s left shoulder and cervical spine disabilities as of March 3, 2016, the date of receipt of his original claim for such benefits. The Veteran disagreed with the propriety of the assigned effective dates, but has not offered any specific argument as to why he believes earlier effective dates for such awards are warranted. Upon review of the record, there is no formal or informal claim for service connection for a left shoulder or cervical spine disorder prior to the receipt of the Veteran’s formal claim on March 3, 2016. In this regard, in June 2009, VA received a VA Form 21-526, Veteran’s Application for Compensation and/or Pension, in which the Veteran filed claims for service connection for tinnitus and a back disorder and, in February 2011, VA received his informal application to reopen such previously denied claims. Additionally, in January 2014, VA received a VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits, in which the Veteran filed claims for service connection for neuropathy of the bilateral hands and feet, a back disorder, vertigo, and a headache disorder and, as noted previously, in October 2014, VA received another VA 21-526EZ, Application for Disability Compensation and Related Compensation Benefits, in which the Veteran applied to reopen his claim for service connection for lower back pain. Thus, absent at least a general description of neuropathy of the bilateral upper extremities, such earlier filings may not be construed as a claim for service connection for such disorders. Sellers, supra. Furthermore, upon review of the Veteran’s earlier filings, the Board finds that such did not identify specific medical records that contained a reasonably ascertainable diagnosis of a left shoulder or cervical spine disorder so that such submission may constitute an informal claim for benefits under the pre-March 24, 2015, regulations. Shea, supra. Consequently, the Board finds an effective date prior to March 3, 2016, for the award of service connection for the Veteran’s left shoulder and cervical spine disabilities is not warranted. See 38 U.S.C. § 5110; 38 C.F.R. § 3.400. Increased Ratings Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R., Part 4. Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the veteran working or seeking work. 38 C.F.R. § 4.2. All reasonable doubt will be resolved in the claimant’s favor. 38 C.F.R. § 4.3. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7. Separate ratings can be assigned for separate periods based on the facts found - a practice known as “staged” ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Staged ratings are appropriate whenever the factual findings show distinct periods where the service-connected disability exhibits symptoms that would warrant different ratings. Id. The basis of disability evaluation 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. 38 C.F.R. § 4.10. Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance. Functional loss may be due to the absence or deformity of structures or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior in undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40. In Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011), the United States Court of Appeals for Veterans Claims (Court) held that, although pain may cause a functional loss, “pain itself does not rise to the level of functional loss as contemplated by VA regulations applicable to the musculoskeletal system.” Rather, pain may result in functional loss, but only if it limits the ability “to perform the normal working movements of the body with normal excursion, strength, speed, coordination, or endurance.” Id., quoting 38 C.F.R. § 4.40. With respect to joints, in particular, the factors of disability reside in reductions of normal excursion of movements in different planes. Inquiry will be directed to more or less than normal movement, weakened movement, excess fatigability, incoordination, pain on movement, swelling, deformity or atrophy of disuse. 38 C.F.R. § 4.45; DeLuca v. Brown, 8 Vet. App. 202 (1995). The intent of the Rating Schedule is to recognize actually painful, unstable or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint, even in the absence of arthritis. 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1, 5 (2011). In this regard, 38 C.F.R. § 4.59 requires that “[t]he joints involved should be tested for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint.” Correia v. McDonald, 28 Vet. App. 158 (2016). Further, 38 C.F.R. § 4.59 is applicable to the evaluation of musculoskeletal disabilities involving actually painful, unstable or malaligned joints or periarticular regions, regardless of whether the Diagnostic Code under which the disability is evaluated is predicated on range of motion measurements. Southall-Norman v. McDonald, 28 Vet. App. 346 (2016). The appeal period before the Board begins on March 3, 2016, the date service connection for the Veteran’s neuropathy of the right and upper extremities, left shoulder disability, and cervical spine disability was established. 5. Entitlement to an initial rating in excess of 20 percent prior to November 21, 2018, and in excess of 40 percent thereafter for neuropathy of the right upper extremity. 6. Entitlement to an initial rating in excess of 20 percent prior to November 21, 2018, and in excess of 30 percent thereafter for neuropathy of the left upper extremity. The Veteran’s neuropathy of the right and left upper extremities are rated pursuant to 38 C.F.R. § 4.124a, Diagnostic Code 8512, which addresses paralysis of the lower radicular group. For the major extremity, Diagnostic Code 8512 provides a 20 percent rating for mild incomplete paralysis, a 40 percent rating for moderate incomplete paralysis, and a 50 percent rating for severe incomplete paralysis. A 70 percent rating is assigned for the major extremity when there is complete paralysis with all intrinsic muscles of the hand and some or all of the flexors of the wrist and fingers paralyzed (substantial loss of use of hand). For the minor extremity, Diagnostic Code 8512 provides a 20 percent rating for mild incomplete paralysis, a 30 percent rating for moderate incomplete paralysis, and a 40 percent rating for severe incomplete paralysis. A 60 percent rating is assigned for the minor extremity when there is complete paralysis with all intrinsic muscles of the hand and some or all of the flexors of the wrist and fingers paralyzed (substantial loss of use of hand). Although the words “mild,” “moderate,” and “severe” are not defined in the VA rating schedule, the Board must evaluate all the evidence in order to render a decision that is “equitable and just.” 38 C.F.R. § 4.6. However, regulations specifically state that when the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. 38 C.F.R. § 4.124a. Prior to November 21, 2018, the Veteran’s neuropathy of the right upper extremity, which is his major extremity as he is right hand dominant, and his neuropathy of the left upper extremity are rated as 20 percent disabling. In this regard, at an April 2016 VA examination, the Veteran reported mild constant pain, intermittent pain, paresthesias and/or dysesthesias, and numbness in the right upper extremity, and moderate constant pain, intermittent pain, paresthesias and/or dysesthesias, and numbness in the left upper extremity. He had hypoactive deep tendon reflexes in the bilateral biceps, bilateral brachioradialis, and left triceps, without muscle atrophy, and decreased sensation to light touch in the bilateral shoulder area, inner/outer forearms, and hand/fingers. Ultimately, the VA examiner found that the Veteran had neuropathy of the bilateral upper extremities that resulted in mild impairment of the middle radicular groups (however, as noted below a November 2018 VA examination clarified that the Veteran’s bilateral upper extremity neuropathy affected the lower radicular group, rather than middle radicular group). Furthermore, a May 2017 VA treatment record shows the Veteran denied radiculopathy, and a February 2018 VA treatment record indicates sensation in his bilateral upper extremities was intact. The remaining VA treatment records pertinent to the appeal period prior to November 21, 2018, do not reflect complaints related to the Veteran’s neuropathy of the bilateral upper extremities. Based on the above, the Board finds the Veteran’s neuropathy of the right and left upper extremities resulted in no more than mild incomplete paralysis of the lower radicular groups prior to November 21, 2018. Consequently, ratings in excess of 20 percent prior to November 21, 2018, are not warranted. As of November 21, 2018, the Veteran’s neuropathy right upper extremity is rated as 40 percent disabling, while his neuropathy left upper extremity is rated as 30 percent disabling. According to a December 2018 VA examination report, the Veteran experienced moderate constant pain, paresthesias and/or dysesthesias, and numbness in the bilateral upper extremities without intermittent pain. He had hypoactive deep tendon reflexes in the bilateral biceps, triceps, and brachioradialis and decreased sensation to light touch in the bilateral inner/outer forearms and hand/fingers, but normal sensation to light touch in the shoulder area. The Veteran did not have muscle atrophy or trophic changes. Overall, the VA examiner found the Veteran’s neuropathy of the bilateral upper extremities resulted in moderate incomplete paralysis of the lower radicular groups. Similarly, upon VA examination in September 2019, the Veteran reported moderate constant pain, paresthesias and/or dysesthesias, and numbness, and severe intermittent pain in the bilateral upper extremities. However, muscle strength testing was normal at 5/5, reflexes were normal at 2+, and the Veteran had normal sensation in the bilateral upper extremities. Rather, as Phalen’s and Tinel’s tests were positive, the examiner found that the Veteran had moderate incomplete paralysis of the median nerves bilaterally. However, as the ratings assigned for the lower radicular groups result in higher ratings than those pertinent to the median nerves, and contemplates the same manifestations, the Board will not change the Diagnostic Code under which the Veteran’s neuropathy of the bilateral upper extremities is rated. Based on this evidence, the Board finds the manifestations of the Veteran’s neuropathy of the right and left upper extremities resulted in no more than moderate incomplete paralysis of the lower radicular groups as of November 21, 2018. Thus, ratings in excess of 40 percent and 30 percent are not warranted for neuropathy of the right and left upper extremities, respectively, as of such date. In reaching such determinations, the Board relies upon the competent medical evidence with regard to the specialized evaluations of functional impairment, symptom severity, and details of clinical features of the Veteran’s service-connected neuropathy of the right and left upper extremities. Specifically, such disabilities resulted in no more than mild incomplete paralysis of the lower radicular groups prior to November 21, 2018, and moderate incomplete paralysis of the lower radicular groups thereafter, as determined by medical professionals who considered the Veteran’s subjective symptomatology and objective findings pertinent to muscle strength, reflex, and sensory testing. Therefore, the criteria for an initial rating in excess of 20 percent prior to November 21, 2018, and in excess of 40 percent thereafter for neuropathy of the right upper extremity have not been met. Likewise, the criteria for an initial rating in excess of 20 percent prior to November 21, 2018, and in excess of 30 percent thereafter for neuropathy of the left upper extremity have not been met. 7. Entitlement to an initial rating in excess of 20 percent for left shoulder strain and acromio-clavicular joint osteoarthritis. Throughout the appeal period, the Veteran’s service-connected left shoulder disability is rated as 20 percent disabling pursuant to 38 C.F.R. § 4.71a, Diagnostic Code 5201. Under Diagnostic Code 5201, arm motion that is limited to shoulder level warrants a 20 percent rating in the major and minor extremities. Arm motion that is limited midway between the side and shoulder level warrants a 20 percent rating in the minor extremity and a 30 percent rating in the major extremity. Arm motion limited to 25 degrees from the side warrants a 30 percent rating in the minor extremity and a 40 percent rating in the major extremity. Normal range of motion in the shoulder is from zero to 180 degrees of forward elevation (flexion) and zero to 180 degrees of shoulder abduction. See 38 C.F.R. § 4.71a, Plate I. As noted above, the Veteran is right hand dominant, and therefore, the evidence must demonstrate limitation of arm motion to 25 degrees from the side to warrant a higher rating under Diagnostic Code 5201. On VA examination in April 2016, the Veteran’s left shoulder flexion was to 120 degrees, abduction was to 90 degrees, and both external and internal rotation were to 60 degrees upon initial testing. There was no additional loss of function or range of motion after three repetitions. With respect to the Veteran’s report of flare-ups, which he described as pain with movement and freezing of the shoulder, the VA examiner estimated that pain, fatigue, weakness, lack of endurance, and incoordination would significantly limit functional ability during such and result in flexion limited to 90 degrees, abduction to 70 degrees, and external and internal rotation each limited to 50 degrees. The VA examiner further found the Veteran had less movement than normal and weakened movement with swelling and disturbance of locomotion. Muscle strength was reduced to 4/5 and 3/5 on forward flexion and abduction, respectively, but there was no evidence of muscle atrophy. A February 2018 VA treatment record indicates the Veteran had full range of motion and full strength in both shoulders. In December 2018, VA examination of the Veteran’s left shoulder revealed flexion limited to 130 degrees, abduction limited to 110 degrees, and both external and internal rotation limited to 90 degrees following repetitive-use testing. The Veteran described flare-ups that involved an increased intensity of shoulder pain that made it difficult to lift and carry heavy objects, which the VA examiner estimated would result in flexion limited to 120 degrees, abduction limited to 100 degrees, and external and internal rotation each limited to 90 degrees due to pain and weakness. The Veteran had reduced muscle strength of 4/5 with forward flexion and abduction but no muscle atrophy. Here, the objective medical evidence does not reflect arm motion of the minor extremity limited to 25 degrees from the side at any time during the pendency of the appeal, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, and incoordination. Therefore, even with consideration of the Veteran’s complaints of pain, stiffness, popping, flare-ups, and lost motion, the criteria for a rating in excess of the 20 percent assigned is not warranted under Diagnostic Code 5201. Additionally, the competent evidence does not demonstrate ankylosis of the scapulohumeral articulation, impairment of the humerus, or impairment of the clavicle or scapula to warrant a higher and/or separate rating under Diagnostic Codes 5200, 5202, or 5203. Id. Accordingly, the Board finds the preponderance of the evidence shows the Veteran’s left shoulder disability does not meet the criteria for a rating in excess of 20 percent under any applicable rating criteria at any time during the pendency of the appeal. 8. Entitlement to an initial rating in excess of 20 percent for cervical strain, degenerative arthritis and IVDS. Throughout the appeal period, the Veteran’s cervical spine disability is rated as 20 percent disabling under Diagnostic Code 5237 for lumbosacral or cervical strain. 38 C.F.R. § 4.71a. In this regard, disabilities of the spine may be evaluated under the General Rating Formula for Diseases and Injuries of the Spine (General Rating Formula) or under the Formula for Rating IVDS Based on Incapacitating Episodes (IVDS Rating Formula), whichever method results in the higher evaluation when all disabilities are combined. See 38 C.F.R. § 4.25 (combined ratings table). In pertinent part, the General Rating Formula for Diseases and Injuries of the Spine provides, with or without symptoms such as pain, stiffness, or aching in the area of the spine, a 20 percent rating 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 assigned when there is forward flexion of the cervical spine 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, and a 100 percent rating is provided for unfavorable ankylosis of the entire spine. Note (1) to the rating formula specifies that any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, should be separately evaluated under an appropriate diagnostic code. Note (2): (See also Plate V.) For VA compensation purposes, normal forward flexion of the cervical spine is zero to 45 degrees, extension is zero to 45 degrees, left and right lateral flexion are zero to 45 degrees, and left and right lateral rotation are zero to 80 degrees. Normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the cervical spine is 340 degrees and of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion. Note (3): In exceptional cases, an examiner may state that because of age, body habitus, neurologic disease, or other factors not the result of disease or injury of the spine, the range of motion of the spine in a particular individual should be considered normal for that individual, even though it does not conform to the normal range of motion stated in Note (2). Provided that the examiner supplies an explanation, the examiner’s assessment that the range of motion is normal for that individual will be accepted. Note (4): Round each range of motion measurement to the nearest five degrees. Note (5): For VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. Note (6): Separately evaluate disability of the thoracolumbar and cervical spine segments, except when there is unfavorable ankylosis of both segments, which will be rated as a single disability. In pertinent part, the IVDS Rating Formula provides that a 20 percent rating is warranted when there are incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months. A 40 percent rating is assigned when there are incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months, and a 60 percent rating is provided when there are incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. Note (1) provides that an incapacitating episode is a period of acute signs and symptoms due to IVDS that requires bed rest prescribed by a physician and treatment by a physician. Turning to the evidence of record, on VA examination in April 2016, forward flexion of the cervical spine was limited to 30 degrees and the overall combined range of motion of the cervical spine was 245 degrees, with no additional loss of function or range of motion after three repetitions. According to the examination report, the Veteran was experiencing a flare-up at that time, and the VA examiner recorded forward flexion limited to 25 degrees and an overall combined range of motion of 180 degrees due to pain, fatigue, weakness, lack of endurance, and incoordination. The Veteran did not have localized tenderness, guarding, or muscle spasm of the cervical spine, but he did experience less movement than normal and weakened movement due to his service-connected cervical spine disability. There was no ankylosis of the spine, and there were no associated neurologic abnormalities related to the cervical spine disability, aside from the Veteran’s service-connected neuropathy of the bilateral upper extremities. Also, it was noted that he had incapacitating episodes over the past 12 months with a total duration of less than one week. According to a December 2018 VA examination report, forward flexion of the cervical spine was limited to 35 degrees. The VA examiner estimated forward flexion would be limited to 30 degrees following repetitive-use and 25 degrees during a flare-up. The VA examiner also estimated the overall combined range of motion to be limited to, at most, 180 degrees during a flare-up, and the Veteran did not have guarding or muscle spasm of the cervical spine. There was no ankylosis of the spine, and there were no associated neurologic abnormalities related to the cervical spine disability, aside from the Veteran’s service-connected neuropathy of the bilateral upper extremities. Further, although the Veteran did have IVDS of the cervical spine, the VA examiner reported he had no episodes of acute signs and symptoms due to IVDS that required bed rest prescribed by a physician in the past 12 months. To warrant a higher disability rating under the General Rating Formula, the evidence must demonstrate forward flexion of the cervical spine limited to 15 degrees or less, or favorable ankylosis of the entire cervical spine. In this regard, the Board notes that, with respect to functional impairment, the Veteran reported that his cervical spine disability prevented him from moving swiftly in April 2016, and he could not turn his head or neck frequently over his shoulders in December 2018. However, even in consideration of such reports, the evidence of record as described herein does not contain range of motion findings that meet the criteria necessary for a higher rating at any time during the pendency of the appeal. Rather, forward flexion of the cervical spine was estimated by medical professionals to be limited to, at most 25 degrees, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups, and there is no evidence of ankylosis. Thus, an initial rating in excess of 20 percent for the Veteran’s cervical spine disability is not warranted under the General Rating Formula. Additionally, the evidence fails to show objective neurological abnormalities associated with the Veteran’s cervical spine disability apart from his already-service-connected neuropathy of the bilateral upper extremities so as to warrant additional separate ratings, pursuant to Note (1) of the General Rating Formula. Further, the evidence does not reflect IVDS with incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during a 12-month period to warrant a higher rating under the IVDS Formula at any time during the pendency of the appeal. Thus, an initial rating in excess of 20 percent under such criteria is not warranted at any point pertinent to the appeal period. Other Considerations The Board has also considered whether additional staged ratings under Fenderson, supra, are appropriate for the Veteran’s service-connected disabilities; however, the Board finds that his symptomatology has been stable throughout each period on appeal. Thus, assigning additional staged ratings for such disabilities is not warranted. Furthermore, neither the Veteran nor his representative have raised any other issues, nor have any other issues been reasonably raised by the record, with regard to the initial rating claims adjudicated herein. Doucette v. Shulkin, 28 Vet. App. 366 (2017). In reaching such determinations, the Board has considered the applicability of the benefit of the doubt doctrine; however, the preponderance of the evidence is against the Veteran’s initial rating claims. Thus, the benefit of the doubt doctrine is not applicable in such regard and such claims must be denied. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. Application to Reopen Service Connection Claims Generally, a claim which has been denied in an unappealed Board decision or an unappealed AOJ decision may not thereafter be reopened and allowed. 38 U.S.C. §§ 7104(b), 7105(c). The exception to this rule is 38 U.S.C. § 5108, which provides that if new and material evidence is presented or secured with respect to a claim which has been disallowed, the Secretary shall reopen the claim and review the former disposition of the claim. New evidence means existing evidence not previously submitted to agency decisionmakers. Material evidence means 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). New evidence would raise a reasonable possibility of substantiating the claim if, when considered with the old evidence, it would at least trigger the Secretary’s duty to assist by providing a medical opinion. Shade v. Shinseki, 24 Vet. App. 110 (2010). For the purpose of establishing whether new and material evidence has been submitted, the credibility of the evidence is to be presumed. Justus v. Principi, 3 Vet. App. 510, 513 (1992). 9. Whether new and material evidence has been received to reopen the claim of entitlement to service connection for a low back disorder. 10. Whether new and material evidence has been received to reopen the claim of entitlement to service connection for vertigo. 11. Whether new and material evidence has been received to reopen the claim of entitlement to service connection for a headache disorder. 12. Whether new and material evidence has been received to reopen the claim of entitlement to service connection for peripheral neuropathy of the left lower extremity. 13. Whether new and material evidence has been received to reopen the claim of entitlement to service connection for peripheral neuropathy of the right lower extremity. By way of background, the AOJ denied the Veteran’s original claim for service connection for a low back disorder in a September 2009 rating decision. In this regard, the AOJ considered the Veteran’s service treatment records and post-service VA treatment records, and found that, while he was treated for back complaints in service and had a current disability, the evidence did not show a relationship between such current disability and his military service. In February 2011, VA received the Veteran’s informal application to reopen his claim for service connection for a low back disorder. In a June 2012 rating decision, the AOJ considered the Veteran’s service treatment records, post-service VA treatment records, and a May 2012 VA examination, in which the examiner found that his current back disability was unrelated to his military service as his back spasms in 1979 were self-limiting and resolved without residuals. Thus, the AOJ found the newly received evidence did not indicate that the Veteran’s current back disorder was related to his military service. In January 2014, the Veteran filed a formal application to reopen his claim for service connection for a low back disorder, and original claims for service connection for vertigo, a headache disorder, and peripheral neuropathy of the bilateral lower extremities. In a June 2014 rating decision, the AOJ considered the entirety of the evidence of record, to include the Veteran’s service treatment records, post-service VA treatment records, and May 2012 VA examination. In regard to the Veteran’s low back disorder, the AOJ found that new and material evidence had not been received in order to reopen such claim as the newly received evidence consisting of VA treatment records did not relate to an unestablished fact necessary to substantiate the claim and does not a reasonable possibility of substantiating the claim. With respect to the other claims, while the Board notes that the evidence showed diagnoses of diabetic neuropathy and sciatic nerve radiculopathy, and the Veteran’s reports of dizziness, headaches, and numbness and tingling in his feet and toes; however, the found that, as the evidence did not show a link between a currently diagnosed disability and the Veteran’s military service, the AOJ denied service connection for such disorders. In July 2014, the Veteran was advised of the decision and his appellate rights; however, he did not enter a notice of disagreement. Furthermore, no new and material evidence was physically or constructively received within one year of the issuance of such decision, and no relevant service department records have since been received. Therefore, the July 2014 rating decision is final. 38 U.S.C. § 7105(c) (2012); 38 C.F.R. §§ 3.104, 3.156, 20.302, 20.1103 (2014). Since the issuance of the most recent rating decision in July 2014, evidence consisting of VA treatment records, private treatment records, lay statements, VA examination reports, and records from the Social Security Administration (SSA) has been associated with the record. However, such do not reflect any opinions relating a current back disorder, vertigo, headaches, and/or peripheral neuropathy of the bilateral lower extremities, or symptomatology associated with such claimed disorders, to any instance of the Veteran’s military service, or a service-connected disability. Further, the Veteran himself has not provided any additional information, to include lay statements, specifically in support of his claims independent of his formal application to reopen, notice of disagreement, and substantive appeal, which only repeat his basic requests for service connection. Therefore, as the Veteran’s claims for service connection for a low back disorder, vertigo, a headache disorder, and neuropathy of the bilateral lower extremities were previously denied based on the lack of a nexus or relationship to his military service and the newly received evidence likewise fails to address such missing element, the Board finds the evidence added to the record since the final July 2014 denial is cumulative or redundant of the evidence of record at the time of the decision and does not raise a reasonable possibility of substantiating the Veteran’s claims. Therefore, as new and material evidence has not been received, his applications to reopen such claims must be denied. Service Connection 14. Entitlement to service connection for acquired psychiatric disorder, to include as secondary to service-connected disabilities. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Service connection may also be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). Further, service connection may not be awarded on the basis of aggravation without establishing a pre-aggravation baseline level of disability and comparing it to the current level of disability. 38 C.F.R. § 3.310(b). A June 2020 mental disorders disability benefits questionnaire (DBQ) reflects a diagnosis of unspecified depressive disorder. In an associated report, the private psychologist who evaluated the Veteran and completed the DBQ opined that such disorder is more likely than not caused by his service-connected disabilities, as well as non-service-connected diabetes. In this regard, she indicated that it is not possible to determine the extent of which the Veteran’s medical problems impact his depressive symptoms due to the complex relationship between his medical concerns. The private psychologist further explained that the Veteran suffers from high irritability, anger, depressed mood, and poor sleep due to chronic pain from his service-connected disabilities as well as complications of his diabetes. Upon review, the Board finds that private psychologist’s favorable opinion linking the Veteran’s unspecified depressive disorder to his service-connected disabilities probative as she provided an unequivocal opinion with a stated rationale. Further, there is no medical opinion to the contrary of record. Thus, the Board resolves all doubt in favor of the Veteran and finds that his currently diagnosed unspecified depressive disorder is proximately due to his service-connected disabilities. Therefore, service connection for unspecified depressive disorder is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. REASONS FOR REMAND 15. Entitlement to service connection for right shoulder disorder, to include as secondary to service-connected cervical strain, degenerative arthritis, and IVDS. The Veteran contends he has a right shoulder disorder related to service or, in the alternative, as secondary to his service-connected cervical spine disability. VA treatment records reflect the Veteran’s reports of chronic right shoulder pain. Although he underwent VA examination of the shoulders and arms in April 2016 and December 2018, VA examiners did not detail clear diagnoses of a right shoulder disorder and, therefore, did not provide opinions addressing the etiology of the Veteran’s complaints. Nevertheless, given the Veteran’s competent reports of right shoulder pain, relevant complaints in his service treatment records, i.e., in November 1979, he reported pain in the bilateral trapezius muscles and in March and June 1983, he complained of shoulder pain and bruising of the right arm, and the fact that he is service-connected for a cervical spine disability, the Board finds a remand for an additional examination and a medical opinion is necessary to determine whether a current right shoulder disorder is related to service or, alternatively, caused or aggravated by his cervical spine disability. 16. Entitlement to service connection for a respiratory disorder, to include as secondary to service-connected disabilities. 17. Entitlement to service connection for a right hip disorder, to include as secondary to service-connected disabilities. 18. Entitlement to service connection for a left hip disorder, to include as secondary to service-connected disabilities. 19. Entitlement to service connection for a sleep disorder, to include as secondary to service-connected disabilities. 20. Entitlement to service connection for hypertension, to include as secondary to service-connected disabilities. The Veteran contends he has a respiratory disorder, bilateral hip disorder, sleep disorder, and hypertension related to service. Additionally, the Board finds the record raises the theory of entitlement to service connection on a secondary basis. Here, the medical evidence reflects diagnoses of pulmonary sarcoidosis, atypical pneumonia, chronic obstructive pulmonary disease, a sleep disorder, and hypertension, as well as the Veteran’s reports of bilateral hip pain. However, he was not afforded a VA examination in connection with his claims. Based on the medical evidence, the Veteran’s competent report of symptoms, and the theories of entitlement raised, the Board finds a remand is warranted to afford the Veteran VA examinations to determine the nature and etiology of his claimed disorders. 21. Entitlement to a TDIU prior to November 21, 2018. The Veteran asserts that his service-connected disabilities, to include his unspecified depressive disorder, have prevented him from securing and following a substantially gainful occupation since March 2016. Thus, the Board finds the implementation of the award of service connection for unspecified depressive disorder, as well as the development and adjudication of the service connection claims remanded herein, could impact the Veteran’s entitlement to a TDIU prior to November 21, 2018. See Tyrues v. Shinseki, 23 Vet. App. 166, 177 (2009) (en banc) (explaining that claims are inextricably intertwined where the adjudication of one claim could have a significant impact on the adjudication of another claim); Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). Therefore, the Veteran’s claim for a TDIU prior to November 21, 2018, is inextricably intertwined with the remanded claims and award of service connection, and adjudication of the former issue must be deferred pending the outcome of the latter issues. The matters are REMANDED for the following action: Afford the Veteran appropriate VA examination(s) to determine the nature and etiology of his claimed right shoulder disorder, respiratory disorder, right hip disorder, left hip disorder, sleep disorder, and hypertension. Following a review of the record and any necessary testing, the examiner(s) should address the following inquiries: (A) Identify all current right shoulder, respiratory, right hip, left hip, sleep, and hypertension disorders and address all diagnoses found in the treatment records, to include pulmonary sarcoidosis, atypical pneumonia, chronic obstructive pulmonary disease, a sleep disorder, and hypertension. If no disorder related to the Veteran’s subjective complaints is diagnosed, the examiner should offer an opinion as to whether such results in functional impairment of earning capacity. If so, the examiner is advised that he or she should accept that the Veteran has such a disability for the purpose of rendering the opinions requested below. (B) For each disability, offer an opinion as to whether it is at least as likely as not (i.e. 50 percent or greater probability) that such had its onset in, or is otherwise related to, the Veteran’s military service. In offering such opinion, the examiner should address the service treatment records dated in November 1979, March 1983, and June 1983 reflecting findings of bilateral trapezius pain, shoulder pain, and bruising of the right arm, respectively. (C) For each disability, offer an opinion as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that such is caused or aggravated by a service-connected disability, to include neuropathy of the bilateral upper extremities, left shoulder disability, cervical spine disability, tinnitus, and unspecified depressive disorder. For any aggravation found, the examiner should state, to the best of his/her ability, the baseline of symptomatology and the amount, quantified if possible, of aggravation beyond the baseline symptomatology. In offering any opinion, the examiner should consider the Veteran’s statements regarding the onset and continuity of symptomatology. A rationale for any opinion offered should be provided. A. JAEGER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. M. Celli, 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.