Citation Nr: 21008139 Decision Date: 02/11/21 Archive Date: 02/11/21 DOCKET NO. 20-15 844 DATE: February 11, 2021 ORDER An effective date of August 6, 2012 for service connection for generalized anxiety disorder (GAD) is granted. An effective date prior to January 6, 2017 for service connection for wrist scars is denied. An effective date of October 22, 2019 is granted for the increased 20 percent rating for wrist scars. An increased 70 percent rating for GAD prior to August 29, 2017 is granted. A rating in excess of 70 percent for GAD since August 29, 2017 is denied. An increased 10 percent rating for wrist scars prior to October 22, 2019 is granted. A rating in excess of 20 percent for wrist scars since October 22, 2019 is denied. A rating in excess of 10 percent for the residuals of right wrist open repair of posterior triangular fibrocartilage complex (TFCC) for the period prior to October 22, 2019 and the period since January 1, 2020 is denied. A rating in excess of 10 percent for the residuals of left wrist open repair of posterior TFCC is denied. Entitlement to a total disability rating based on individual unemployability (TDIU) is granted for the periods prior to October 22, 2019 and since January 1, 2020. Entitlement to TDIU for the period from October 22, 2019 to December 31, 2019, is dismissed as moot. REMANDED Service connection for diverticulitis is remanded. Service connection for a right knee disability is remanded. Service connection for a left knee disability is remanded. Service connection for a right ankle disability is remanded. Service connection for a left ankle disability is remanded. Service connection for a skin condition of the bilateral feet is remanded. Service connection for photophobia is remanded. Service connection for hyperhidrosis is remanded. FINDINGS OF FACT 1. The Veteran’s original claim for service connection for generalized anxiety disorder was received on August 6, 2012. 2. A December 2013 rating decision denying service connection for anxiety did not become final and his August 6, 2012 claim remained pending. 3. The Veteran’s claim for entitlement to service connection for bilateral wrist scars was received on January 6, 2017. 4. It is factually ascertainable that the Veteran’s wrist scars increased in severity on October 22, 2019. 5. Prior to August 29, 2017 the severity, frequency, and duration of the Veteran’s symptoms of GAD more closely approximated occupational and social impairment with deficiencies in most areas. 6. Since August 29, 2017, the severity, frequency, and duration of the Veteran’s symptoms of GAD did not more closely approximate total occupational and social impairment. 7. Prior to October 22, 2019 the Veteran had at least one painful wrist scar. 8. Since October 22, 2019 the Veteran has had three painful wrist scars. 9. The Veteran’s right wrist disability has not resulted in ankylosis in the period prior to October 22, 2019 or since January 1, 2020. 10. The Veteran’s left wrist disability has not resulted in ankylosis. 11. The Veteran’s service-connected disabilities precluded substantially gainful employment prior to October 22, 2019. 12. From October 22, 2019 to December 31, 2019, the issue of entitlement to TDIU was moot. 13. The Veteran’s service-connected disabilities have precluded substantially gainful employment since January 1, 2020. CONCLUSIONS OF LAW 1. An effective date of August 6, 2012, but no earlier, for the grant of service connection for GAD is warranted. 38 U.S.C. §§ 5101, 5107, 5110; 38 C.F.R. §§ 3.1, 3.114, 3.151, 3.155 (in effect prior to March 24, 2015), 3.400. 2. An effective date prior to January 6, 2017 for the grant of service connection for wrist scars is not warranted. 38 U.S.C. §§ 5101, 5107, 5110; 38 C.F.R. §§ 3.1, 3.114, 3.151, 3.155 (in effect prior to March 24, 2015), 3.400. 3. An effective date of October 22, 2019, but no earlier, for the grant of an increased is 20 percent rating for wrist scars is warranted. 38 U.S.C. § 5107, 5110; 38 C.F.R. §§ 3.102, 3.159, 3.400. 4. The criteria for a disability rating of 70 percent for GAD were met for the period prior to August 29, 2017. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9400. 5. Since August 29, 2017, the criteria for a disability rating in excess of 70 percent for GAD have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9400. 6. The criteria for a 10 percent disability rating for wrist scars were met for the period prior to October 22, 2019. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.118, Diagnostic Code 7804. 7. The criteria for a rating in excess of 20 percent for wrist scars have not been met since October 22, 2019. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.118, Diagnostic Code 7804. 8. For the period prior to October 22, 2019, the criteria for a rating in excess of 10 percent for a right wrist disability were not met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.40, 4.45, 4.71a, Diagnostic Code 5215. 9. For the period beginning January 1, 2020, the criteria for a rating in excess of 10 percent for a right wrist disability are not met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.40, 4.45, 4.71a, Diagnostic Code 5215. 10. The criteria for a rating in excess of 10 percent for a left wrist disability have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.40, 4.45, 4.71a, Diagnostic Code 5215. 11. Prior to October 22, 2019, the criteria for entitlement to TDIU were met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.16. 12. From October 22, 2019 to December 31, 2019, entitlement to TDIU was moot. 38 U.S.C. § 1155; 38 C.F.R. § 4.16. 13. Since January 1, 2020, the criteria for entitlement to TDIU have been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1999 to August 2004. In his January 2017 Fully Developed Claim form, the Veteran asserted service connection for “hypohydrosis” and “bilateral foot dermatitis.” But in a statement accompanying his claim, the Veteran described his conditions as hyperhidrosis and bilateral tinea pedis. The medical evidence of record includes diagnoses of hyperhidrosis and tinea pedis, but not “hypohydrosis” or “foot dermatitis” and the Board has therefore recharacterized the claims on appeal. The Veteran was granted temporary total 100 percent rating from October 22, 2019 to December 31, 2019 for his right wrist disability, which constitutes a full grant of the benefit sought for that period and it is not on appeal. Earlier Effective Dates 1. Service Connection for GAD The Veteran asserts that he is entitled to an effective date earlier than January 6, 2017 for service connection for generalized anxiety disorder. Except as otherwise provided, the effective date of an evaluation and award of pension, compensation or dependency and indemnity compensation based on an original claim, a claim reopened after final disallowance, or a claim for increase will be on the date of receipt of the claim or the date entitlement arose, whichever is the later. 38 U.S.C. § 5110 (a); 38 C.F.R. §§ 3.400, 3.400(b)(2). The Board notes that effective March 24, 2015, VA amended its adjudication regulations to require that all claims governed by VA's adjudication regulations be filed on standard forms prescribed by the Secretary. See 79 Fed. Reg. 57,660 (Sept. 25, 2014). This rulemaking eliminated the constructive receipt of VA reports of hospitalization or examination and other medical records as informal claims for increase and revised 38 C.F.R. § 3.400 (o)(2). VA received the Veteran’s original claim for service connection for an anxiety disorder on August 6, 2012. The agency of original jurisdiction (AOJ) denied the Veteran’s claim in a December 2013 rating decision. VA received the Veteran’s claim to reopen entitlement to service connection on January 6, 2017. The AOJ granted service connection in a May 2017 rating decision, assigning an effective date of January 6, 2017. However, while the Veteran neither disagreed with the initial December 2013 rating decision nor submitted a claim to reopen entitlement to service connection within one year of receiving the decision, the Veteran continued to receive treatment at a VA facility, and treatment records were created within one year of the initial denial. Those records were constructively before the AOJ, but the AOJ never determined whether the evidence was new and material. Therefore, the December 2013 rating decision did not become final and the Veteran’s August 2012 claim remained pending. 38C.F.R. §3.156 (b); Beraud v. McDonald, 766 F.3d 1402, 1406-07 (Fed. Cir. 2014); Lang v. Wilkie, 971 F.3d 1348, 1354-55 (Fed. Cir. 2020). The medical evidence of record documents treatment for a psychiatric condition as early as September 2012, when he was diagnosed with adjustment reaction, and an August 2012 Department of Defense treatment record indicates a history anxiety disorder. The Board therefore finds that an effective date of August 6, 2012, but no earlier, for service connection for GAD is warranted as that is the date VA first received the Veteran’s claim. 2. Service Connection for Wrist Scars The Veteran asserts that he is entitled to an effective date earlier than January 6, 2017, for service connection for wrist scars. The Veteran did not file a claim for entitlement for wrist scars. Instead, the AOJ granted service connection as a part of the Veteran’s claim for increased ratings for his service-connected wrist disabilities. Prior to January 6, 2017, the Veteran had never filed a service connection claim for scars. The Board has reviewed the remainder of the record and finds no instance where the Veteran or his representative submitted a statement which might be construed as a formal claim for service connection for wrist scars. 38 C.F.R. § 3.155 (a). Without an earlier received claim, the Board concludes that an earlier effective date for wrist scars is not warranted. 38 U.S.C. § 5110 (a); 38 C.F.R. § 3.400 (b)(2)(i). 3. Increased 20 Percent Rating for Wrist Scars The Veteran asserts he is entitled to an effective date prior to February 21, 2020 for the award of an increased 20 percent rating for wrist scars. The AOJ granted the 20 percent rating in a March 2020 rating decision, which was issued at the same time as the March 2020 statement of the case that is the basis of the Veteran’s appeal. The AOJ assigned an effective date of February 21, 2020, the date of a VA examination noting the presence of three wrist scars, two on the left wrist and one on the right. But the additional scars leading to the increased rating were the result of a right wrist surgery that occurred on October 22, 2019. It is therefore factually ascertainable that the Veteran’s disability increased on October 22, 2019, the date of the wrist surgery resulting in the additional scars. As such, an effective date of October 22, 2019 is warranted for the increased 20 percent rating. Increased Ratings 4. Generalized Anxiety Disorder The Veteran asserts the severity of his GAD entitles him to a rating in excess of 30 percent prior to August 29, 2017, and a rating in excess of 70 percent thereafter. The Board concludes the Veteran is entitled to a 70 percent rating prior to August 29, 2017 but his symptoms did not cause the level of impairment required for a disability rating of 100 percent at any point during the appeal period. Under the General Formula for Mental Disorders (General Formula), the Board must conduct a “holistic analysis” that considers all associated symptoms, regardless of whether they are listed as criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); 38 C.F.R. § 4.130. The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages. Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 2013). A 30 percent rating is assigned when symptoms such as depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, or mild memory loss (such as forgetting names, directions, or recent events), cause occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and normal conversation). A 50 percent rating is assigned when symptoms such as flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; or difficulty in establishing and maintaining effective work and social relationships cause occupational and social impairment with reduced reliability and productivity. A 70 percent rating is assigned when symptoms such as suicidal ideation; obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); or inability to establish and maintain effective relationships cause occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. A 100 percent rating is assigned for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; or memory loss for names of close relatives, own occupation or own name. The March 2017, August 2017, and February 2020 VA examination reports, the September 2020 disability benefits questionnaire and examination reported completed by K.G., Ph.D., and the Veteran’s lay statements show that the Veteran’s generalized anxiety disorder has been manifested by symptoms associated with a 70 percent rating, including intrusive thoughts of suicide, near continuous panic and depression, impaired impulse control, difficulty adapting to stressful circumstances, and an inability to establish and maintain effective relationships. The Board finds the severity, frequency, and duration of the Veteran’s unlisted symptoms more closely approximate the symptoms contemplated by a 70 percent rating, which are less severe, less frequent, and shorter in duration than those contemplated by a 100 percent rating. See 38 C.F.R. § 4.126. The Board notes that the Veteran expressed suicidal ideation, similar to persistent danger of self-harm, which is contemplated by the 100 percent criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 19 (2017). However, the severity, frequency, and duration of the Veteran’s suicidal ideation has not risen to the level contemplated by the 100 percent disability rating. The Veteran regularly denied thoughts, intent, or a plan involving self-harm in existing treatment records, and during the each of the VA examinations. As discussed below, the Board is granting the Veteran a total disability rating based on individual unemployability due to his service-connected disabilities, he is not totally socially impaired. While the Veteran has consistently reported that he has no friends and isolates at home most of the time, he has maintained a relationship with his children, albeit somewhat strained due to his psychiatric symptoms. Finally, the Board has assigned an earlier effective date of August 6, 2012 for service connection for GAD. The Veteran was not afforded a VA examination in conjunction with his initial claim and the Veteran received little psychiatric treatment during the appeal period. In her September 2020 evaluation, K.G. opined the Veteran’s current symptoms have been present since the date of his more recent January 2017 claim and, therefore, the Board will rely on the symptoms described in the later VA examinations and K.G.’s September 2020 evaluation in assigning the disability rating for the entire appeal period. In short, the preponderance of the evidence weighs in favor of assigning a 70 percent disability rating prior August 29, 2017, but weighs against finding that the severity, frequency, and duration of the Veteran’s symptoms resulted in the level of impairment required for a 100 percent rating at any point. The criteria for a 100 percent or higher rating are not met and the appeal must be denied for the period since August 29, 2017. 5. Wrist Scars The Veteran contends that he is entitled to a compensable rating for the scars resulting from the open repair posterior TFCC of the bilateral wrists for the period prior to October 22, 2019 and in excess of 20 percent thereafter. The Veteran’s wrist scars are rated under Diagnostic Code 7804 for unstable or painful scars. The Board notes that VA amended the criteria for rating skin disabilities effective from August 13, 2018. However, Diagnostic Code 7804 was not changed by the August 13, 2018, amendments. Under Diagnostic Code 7804, one or two scars that are unstable or painful scars warrants a 10 percent rating. Three or four scars that are unstable or painful scars warrants a 20 percent rating. Five or more scars that are unstable or painful warrants a 30 percent rating. 38 C.F.R. § 4.118. Note 1 to Diagnostic Code 7804 instructs that an unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. Id. Prior to October 22, 2019 The Board finds that a 10 percent rating under Diagnostic Code 7804 prior to October 22, 2019 is warranted. Prior to the right wrist surgery in October 2019, the Veteran had at least one scar that he has reported was painful. While a March 2017 VA examination report and a February 2020 VA examination are at odds as to whether the Veteran had one or two scars on his left wrist, there is no evidence indicating he had more than two scars. Likewise, the two VA examinations document differing accounts regarding the presence of pain. But, because the Veteran is competent to report pain, the Board affords him the benefit of the doubt and finds that he had at least one painful scar prior to October 22, 2019. However, there is no indication that the Veteran’s scars were unstable and an no additional award pursuant to Note 2 is warranted. The Board has also considered the other Diagnostic Codes pertaining to scars. However, the Veteran’s scars are not of the head, face, or neck, are not deep and nonlinear, and are not associated with underlying soft tissue damage. Although they are superficial and not associated with underlying soft tissue damage, they do not cover an area or areas of 144 square inches or greater. Therefore, Diagnostic Codes 7800 through 7802, both prior to and from August 13, 2018, are inapplicable. Finally, the evidence of record shows there are no other disabling effects not considered in a rating provided under Diagnostic Codes 7800-04 as contemplated under both pre- and post-August 13, 2018, Diagnostic Code 7805. In conclusion, the Board finds that the preponderance of the evidence is in favor of a 10 percent disability rating prior to October 22, 2019 for wrist scars, but no higher. Since October 22, 2019 The February 2020 VA examiner documented three scars on the Veteran’s bilateral wrists following his October 2019 right wrist surgery, all three of which were painful but not unstable. The Board therefore finds that the preponderance of the evidence is against the assignment of a rating in excess of 20 percent under Diagnostic Code 7804 since October 22, 2019. The Veteran does not have five or more scars that are unstable or painful. And there is no indication that his three scars are both painful and unstable. The Board has also considered the other Diagnostic Codes pertaining to scars. However, the Veteran’s scars are not of the head, face, or neck, are not deep and nonlinear, and are not associated with underlying soft tissue damage. Although they are superficial and not associated with underlying soft tissue damage, they do not cover an area or areas of 144 square inches or greater. Therefore, Diagnostic Codes 7800 through 7802, both prior to and from August 13, 2018, are inapplicable. Finally, the evidence of record shows there are no other disabling effects not considered in a rating provided under Diagnostic Codes 7800-04 as contemplated under both pre- and post-August 13, 2018, Diagnostic Code 7805. The Board acknowledges that the Veteran believes that the disability on appeal has been more severe than the assigned disability rating reflects. Moreover, the Veteran is competent to report observable symptoms, to include pain, and his reports are credible. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). However, he does not assert, and records do not show, that the Veteran’s has five or more scars that are unstable or painful. In conclusion, the Board finds that the preponderance of the evidence is against the Veteran’s claim for a disability rating in excess of 20 percent for his bilateral wrist scars. 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. 6. Status Post Open Repair of the Posterior TFCC of the Bilateral Wrists The Veteran’s right and left wrist disabilities are currently rated as 10 percent disabling, the maximum rating available based on limitation of motion. See 38 C.F.R. § 4.71a, Diagnostic Code 5215. The regulations provide for higher ratings for the wrist when there is ankylosis of the wrist pursuant to Diagnostic Code 5214. Here, neither the treatment records nor the VA examinations conducted in March 2017 or February 2020 document any evidence of ankylosis of the either wrist. Nor has the Veteran reported that he experienced pain that resulted in a functional loss that approximated ankylosis. 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca, 8 Vet. App. At 204-7. As such, a rating in excess of 10 percent is not warranted. 7. TDIU It is the established policy of VA that all veterans who are unable to secure and follow a substantially gainful occupation due to service-connected disabilities shall be rated totally disabled. 38 C.F.R. § 4.16.  A finding of total disability is appropriate “when there is present any impairment of mind or body which is sufficient to render it impossible for the average person to follow a substantially gainful occupation.” 38 C.F.R. §§ 3.340(a)(1), 4.15.  Specifically, if there is only one such disability, this disability shall be ratable at 60 percent or more; if there are two or more disabilities, there shall be at least one disability that is ratable at 40 percent or more and sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. §§ 3.340, 3.341, 4.16(a).  “Substantially gainful employment” is that employment “which is ordinarily followed by the nondisabled to earn their livelihood with earnings common to the particular occupation in the community where the veteran resides.” Moore v. Derwinski, 1 Vet. App. 356, 358 (1991). “Marginal employment shall not be considered substantially gainful employment.” 38 C.F.R. § 4.16(a) (2017).  The United States Court of Appeals for Veterans Claims (Court), in Ray v. Wilkie, 31 Vet. App. 58 (2019), interpreted the phrase “unable to secure and follow a substantially gainful occupation” under 38 C.F.R. § 4.16 (b). The Court defined the term to have two components: one economic and one noneconomic. The economic component means an occupation earning more than marginal income (outside of a protected environment) as determined by the U.S. Department of Commerce as the poverty threshold for one person. The non-economic component, which is pertinent in this case, includes consideration of: The Veteran’s history, education, skill, and training; whether the veteran has the physical ability to perform the type of activities required by the occupation at issue; and whether the veteran has the mental ability to perform the activities required by the occupation at issue.  The Veteran has met the schedular criteria for the entire appeal period. See 38 C.F.R. § 4.16(a). But the Board must still consider whether his service-connected disabilities have precluded him from securing and following substantially gainful employment for that period. See 38 C.F.R. §§ 3.341, 4.16(a); see also Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993).  For the Periods Prior to October 22, 2019 and Since January 1, 2020 In a September 2020 letter, Dr. M.B. opined that the combination of pain and the limitations of the Veteran’s service-connected disabilities would prevent him from being able to work. Likewise, in a September 2020 evaluation, K.G., Ph.D., opined that the Veteran had been fired from two nursing jobs and would be quick tempered at work due to his poor impulse control and poor judgment, would be confrontational or argumentative toward supervisors and coworkers. K.G. asserted the Veteran was triggered by routine stressors, would not seek help when it was needed, and would likely act out as a result. K.G. further stated the Veteran would be off task 80 to 85 percent of the time, which would be exacerbated by fatigue due to insomnia, and his memory problems could lead to safety issues on the job. Having considered the Veteran’s history, education, skill, and training along with the evidence of record, the Board finds that the Veteran has been rendered unable to obtain and maintain a substantially gainful occupation due to the physical and mental limitations resulting from his service-connected disabilities. For the Period from October 22, 2019 to December 29, 2019 From October 22, 2019 to December 29, 2019, the Veteran was assigned a temporary total schedular rating for his service-connected right wrist disability and special monthly compensation under 38 U.S.C. § 1114(s). Therefore, the Veteran’s benefits have maximized for this period. See Buie v. Shinseki, 24 Vet. App. 242, 250 (2011); Bradley v. Peake, 22 Vet. App. 280, 294 (2008). Under these circumstances, the claim for TDIU is moot for this period. REASONS FOR REMAND 1. Service Connection for Diverticulitis During a May 2017 VA examination, the Veteran reported he received treatment from a private gastroenterologist. No such records are in evidence. A remand is required to allow VA to obtain authorization and request these records. 2. Service Connection for Bilateral Knee and Ankle Disabilities A November 2004 VA examiner diagnosed bilateral knee and ankle arthralgia but did not give an etiological opinion. A May 2017 VA examiner opined the Veteran’s current bilateral knee and ankle disabilities were less likely than not related to his service because the medical records did not show a chronic condition since the Veteran left service. A medical opinion based solely on the absence of documentation in the record is inadequate. Dalton v. Peake, 21 Vet. App. 23 (2007). A remand for an additional opinion is necessary. 3. Service Connection for a Skin Condition of the Bilateral Feet October 2012 VA treatment records and November 2012 private treatment records include a diagnosis of tinea pedis and the Veteran has asserted he has experienced this condition since service. The Board cannot make a fully informed decision on the issue of a skin condition affecting the Veteran’s feet because no VA examiner has opined whether his condition is related to his active service. 4. Service Connection for Photophobia The Board cannot make a fully informed decision on the issue of service connection for photophobia because no VA examiner has opined whether the Veteran’s current symptoms are related to his in-service treatment for conjunctivitis with photophobia, documented in in July 2020 service treatment records. 5. Service Connection for Hyperhidrosis The Board cannot make a fully informed decision on the issue of service connection for hyperhidrosis because no VA examiner has opined whether the Veteran’s claimed disability is related to his active duty service or secondary to his service-connected GAD. The matters are REMANDED for the following action: 1. Ask the Veteran to complete a VA Form 21-4142 for his private gastroenterologist. Then make two requests for the authorized records from, unless it is clear after the first request that a second request would be futile. 2. Obtain an opinion from an appropriate clinician regarding whether the Veteran’s right or left knee disability is at least as likely as not related to service, to include his in-service treatment, documented in October 2002 service treatment records, January 2003 service treatment records, and a November 2004 VA examination report. 3. Obtain an opinion from an appropriate clinician regarding whether the Veteran’s right or left ankle disability is at least as likely as not related to service, to include his in-service treatment, documented in April 2000 service treatment records and a November 2004 VA examination report. 4. Schedule the Veteran for a VA examination for his claimed skin condition of the bilateral feet. The examiner must review the claims file. If a diagnosis cannot be provided but the Veteran’s condition manifests in symptoms that cause functional impairment, then the examiner should consider them a “disability” for the purpose of providing the requested opinions below. The examiner is asked to provide a response to the following: Is any skin condition of the feet, to include tinea pedis, at least as likely as not related to service, including the Veteran’s lay assertion that he suffered from symptoms of the condition during active duty? Provide a rationale to support the opinion. In providing the requested opinion, consider the Veteran’s description of his in-service symptoms as well as his post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran’s reported symptoms in service and thereafter represented the onset of his current disability, this should be noted. Stated another way, do the Veteran’s reports about his symptoms align with how the currently diagnosed disability is known to develop or are the Veteran’s reports generally inconsistent with medical knowledge or implausible? 5. Schedule the Veteran for a VA examination for his claimed photophobia. The examiner must review the claims file. If a diagnosis cannot be provided but the Veteran’s condition manifests in symptoms that cause functional impairment, then the examiner should consider them a “disability” for the purpose of providing the requested opinions below. The examiner is asked to provide a response to the following: Is the Veteran’s photophobia at least as likely as not related to service, including the treatment for conjunctivitis with photophobia documented in July 2000 service treatment records? Provide a rationale to support the opinion. In providing the requested opinion, consider the Veteran’s description of his in-service symptoms as well as his post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran’s reported symptoms in service and thereafter represented the onset of his current disability, this should be noted. Stated another way, do the Veteran’s reports about his symptoms align with how the currently diagnosed disability is known to develop or are the Veteran’s reports generally inconsistent with medical knowledge or implausible? 6. Schedule the Veteran for a VA examination for his claimed hyperhidrosis. The examiner must review the claims file. If a diagnosis cannot be provided but the Veteran’s condition manifests in symptoms that cause functional impairment, then the examiner should consider them a “disability” for the purpose of providing the requested opinions below. The examiner is asked to provide a response to the following: Is the Veteran’s hyperhidrosis at least as likely as not related to service, including the Veteran’s lay assertion that he suffered from the condition during active duty? Is hyperhidrosis at least as likely as not proximately due to the Veteran’s generalized anxiety disorder? Is hyperhidrosis at least as likely as not aggravated, i.e., worsened beyond its natural progression, by the Veteran’s service-connected generalized anxiety disorder? (Continued on the next page)   In providing the requested opinion, consider the Veteran’s description of his in-service symptoms as well as his post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran’s reported symptoms in service and thereafter represented the onset of his current disability, this should be noted. Stated another way, do the Veteran’s reports about his symptoms align with how the currently diagnosed disability is known to develop or are the Veteran’s reports generally inconsistent with medical knowledge or implausible? 7. Then readjudicate the claim. If any benefit sought is not granted, the Veteran and his representative should be furnished an SSOC and given the requisite opportunity to respond before the case is returned to the Board. DONNIE R. HACHEY Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Mine 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.