Citation Nr: 21008948 Decision Date: 02/18/21 Archive Date: 02/18/21 DOCKET NO. 10-00 463 DATE: February 18, 2021 ORDER The application to reopen a claim of service connection for back disability is granted. The application to reopen a claim of service connection for gastrointestinal disability is granted. The application to reopen a claim of service connection for diabetes mellitus is granted. The application to reopen a claim of service connection for respiratory disability is granted. Entitlement to service connection for bipolar disorder, schizophrenia, mood disorder, and psychotic disorder is granted. Entitlement to service connection for lumbosacral strain, lumbago, degenerative disc and joint disease of the lumbar spine, lumbar spondylosis, and scoliosis is granted. Entitlement to service connection for asthma and chronic obstructive pulmonary disease (COPD) is granted. Entitlement to a rating in excess of 10 percent for condylectomy medial aspect distal phalanx right great toe and hammertoe right little toe, postoperative proximal phalangectomy and condylectomy, with tender callous lateral aspect right little toe, is denied. Entitlement to a rating in excess of 10 percent for condylectomy medial aspect of distal phalanx left great toe with plantar calluses left foot is denied. REMANDED Entitlement to service connection for diabetes mellitus is remanded. Entitlement to service connection for gastrointestinal disability, to include irritable colon syndrome, is remanded. Entitlement to a rating in excess of 10 percent for dermatophytosis of both feet with pseudofolliculitis barbae and multiple scars of bilateral cheeks is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities is remanded. FINDINGS OF FACT 1. The Veteran’s claim of service connection for back disability was originally denied on the merits in a November 1977 rating decision on the basis that there was no medical evidence of any such disability that was related to service; the Veteran did not appeal this decision within one year of its issuance and new and material evidence was not received within that year. 2. The Veteran’s claims of service connection for gastrointestinal disability and respiratory disability were denied in a March 1991 Board decision; the claim of service connection for gastrointestinal disability was denied on the basis that there was no medical evidence of any such disability that was related to service; the claim of service connection for respiratory disability was denied on the basis that the disability was not incurred in or aggravated by service. 3. Applications to reopen the claims of service connection for back disability, gastrointestinal disability (characterized as duodenitis), and respiratory disability (characterized as respiratory condition/asthma) were denied in June 1991 and May 2001 decisions on the basis that new and material evidence had not been submitted; the Veteran did not appeal these decisions within one year of their issuance and new and material evidence was not received within those years. 4. The Veteran’s claim of service connection for diabetes mellitus was denied in a May 2004 Board decision on the basis that the disability did not have its onset in service and was not otherwise related to service. 5. An application to reopen the claim of service connection for diabetes mellitus was denied in a September 2006 rating decision on the basis that new and material evidence had not been submitted; the Veteran did not appeal this decision within one year of its issuance and new and material evidence was not received within that year. 6. Evidence received since the May 2001 and September 2006 agency of original jurisdiction (AOJ) decisions includes information that was not previously considered and which relates to unestablished facts necessary to substantiate the claims of service connection for back disability, gastrointestinal disability, diabetes mellitus, and respiratory disability, the absence of which was the basis of the previous denials. 7. The evidence is at least evenly balanced as to whether the Veteran’s bipolar disorder, schizophrenia, mood disorder, and psychotic disorder began during service. 8. The evidence is at least evenly balanced as to whether the Veteran’s lumbosacral strain, lumbago, degenerative disc and joint disease of the lumbar spine, lumbar spondylosis, and scoliosis began during service. 9. The evidence is at least evenly balanced as to whether the Veteran’s asthma and COPD began during service. 10. The Veteran’s condylectomy medial aspect distal phalanx right great toe and hammertoe right little toe, postoperative proximal phalangectomy and condylectomy, with tender callous lateral aspect right little toe is manifested by right foot pain, tenderness, and limited motion. 11. The Veteran’s condylectomy medial aspect of distal phalanx left great toe with plantar calluses left foot is manifested by left foot pain, tenderness, and limited motion. CONCLUSIONS OF LAW 1. The November 1977, March 1991, June 1991, May 2001, May 2004, and September 2006 AOJ and Board decisions which denied the claims of service connection for back disability, gastrointestinal disability, diabetes mellitus, and respiratory disability are final. 38 U.S.C. §§ 7104, 7105; 38 C.F.R. §§ 3.104, 3.156(a)-(b), 19.52, 20.1100, 20.1103. 2. The evidence received since the May 2001 and September 2006 AOJ decisions is new and material and reopening of the claims of service connection for back disability, gastrointestinal disability, diabetes mellitus, and respiratory disability is therefore warranted. 38 U.S.C. § 5108; 38 C.F.R. § 3.156 (a). 3. With reasonable doubt resolved in favor of the Veteran, the criteria for service connection for bipolar disorder, schizophrenia, mood disorder, and psychotic disorder are met. 38 U.S.C. §§ 1110, 1111, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. With reasonable doubt resolved in favor of the Veteran, the criteria for service connection for lumbosacral strain, lumbago, degenerative disc and joint disease of the lumbar spine, lumbar spondylosis, and scoliosis are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 5. With reasonable doubt resolved in favor of the Veteran, the criteria for service connection for asthma and COPD are met. 38 U.S.C. §§ 1110, 1111, 5107; 38 C.F.R. §§ 3.102, 3.303. 6. The criteria for a rating in excess of 10 percent for condylectomy medial aspect distal phalanx right great toe and hammertoe right little toe, postoperative proximal phalangectomy and condylectomy, with tender callous lateral aspect right little toe are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.10, 4.20, 4.21, 4.71A, Diagnostic Codes (DC) 5276-5284. 7. The criteria for a rating in excess of 10 percent for condylectomy medial aspect of distal phalanx left great toe with plantar calluses left foot are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.10, 4.20, 4.21, 4.71A, Diagnostic Codes (DC) 5276-5284. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from February 1969 to October 1973. These matters initially came before the Board of Veterans’ Appeals (Board) from a February 2009 rating decision. In November 2014, the Board granted the Veteran’s application to reopen a claim of service connection for psychiatric disability. The Board remanded the underlying claim, as well as the other matters on appeal, for further development and issuance of a statement of the case (SOC) pertaining to the applications to reopen claims of service connection for asthma and diabetes mellitus and the issue of entitlement to service connection for irritable colon syndrome. See Manlincon v. West, 12 Vet. App. 238 (1999). In January 2019, the Board remanded all matters on appeal for readjudication and issuance of a supplemental statement of the case (SSOC). In April 2019, a Decision Review Officer (DRO) awarded service connection for pseudofolliculitis barbae with multiple scars of bilateral cheeks. This disability was rated together with the already service-connected dermatophytosis of both feet and the rating for the service-connected skin disability remained at 10 percent. As for characterization of the issues on appeal, the evidence reflects that the Veteran has been unemployed during the claim period and that he has been unable to work due to now service-connected disabilities. Entitlement to a TDIU may be an element of an increased rating claim. Rice v. Shinseki, 22 Vet. App. 447 (2009). Entitlement to a TDIU is raised where a veteran: (1) submits evidence of a medical disability; (2) makes a claim for the highest rating possible; and (3) submits evidence of unemployability. Roberson v. Principi, 251 F.3d 1378 (Fed. Cir. 2001); Rice v. Shinseki, 22 Vet. App. 447, 453 (2009). Given the evidence of current disabilities, the Veteran’s claims for the highest ratings possible for his service-connected foot and skin disabilities, and the evidence of unemployability, the issue of entitlement to a TDIU is properly before the Board as part and parcel of the Veteran’s claims for increased ratings for his service-connected foot and skin disabilities. Moreover, in the November 2014 and January 2019 remands, the Board instructed the AOJ to, among other things, obtain the Veteran’s relevant outstanding Social Security Administration (SSA) records, readjudicate all matters on appeal, and issue an SSOC. Pursuant to the Board’s remands, the AOJ contacted the SSA in June 2015 and requested the Veteran’s relevant records. The SSA responded later that same month that the Veteran’s records did not exist and that further efforts to obtain them would be futile because the medical records had been destroyed. In a September 2015 statement (VA Form 21-4138), the Veteran acknowledged that his SSA records had been destroyed and he submitted a letter from the SSA that he had in his possession. Also, the AOJ re-adjudicated all matters on appeal and an SSOC was most recently issued in March 2020. Therefore, the AOJ substantially complied with the Board’s pertinent remand directives. Stegall v. West, 11 Vet. App. 268, 271 (1998). Lastly, the Board notes that the issue of entitlement to a clothing allowance pursuant to 38 U.S.C. § 1162 and 38 C.F.R. § 3.810 will be the subject of a separate Board decision. I. Applications to Reopen Generally, a claim which has been denied in a Board decision and an AOJ decision denying a claim which has become final may not thereafter be readjudicated 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. 38 U.S.C. § 5108. New evidence is defined as existing evidence not previously submitted to VA, and material evidence is defined as 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). The newly presented evidence is presumed to be credible for purposes of determining whether it is new and material. Justus v. Principi, 3 Vet. App. 510, 512-513 (1992). When evaluating the materiality of newly submitted evidence, the focus must not be solely on whether the evidence remedies the principal reason for denial in the last prior decision; rather the determination of materiality should focus on whether the evidence, taken together, could at least trigger the duty to assist or consideration of a new theory of entitlement. See Shade v. Shinseki, 24 Vet. App. 110, 117 (2010). For the purpose of determining whether new and material evidence has been presented to reopen a claim, the evidence for consideration is that which has been presented or secured since the last time the claim was finally disallowed on any basis. Evans v. Brown, 9 Vet. App. 273, 285 (1996). The applications to reopen claims of service connection for back disability, gastrointestinal disability, diabetes mellitus, and respiratory disability The Veteran’s claim of service connection for back disability was originally denied on the merits in a November 1977 rating decision on the basis that there was no medical evidence of any such disability that was related to service. The Veteran was notified of the AOJ’s November 1977 decision, he did not appeal the decision within one year of its issuance, and new and material evidence was not received within that year. Therefore, the November 1977 decision became final. See 38 U.S.C. § 7105 (c); Bond v. Shinseki, 659 F.3d 1362 (Fed. Cir. 2011); 38 C.F.R. §§ 3.104, 3.156(a)-(b), 19.52(a), 20.1103. The Veteran’s claims of service connection for gastrointestinal disability and respiratory disability were denied in a March 1991 Board decision. The claim of service connection for gastrointestinal disability was denied on the basis that there was no medical evidence of any such disability that was related to service. The claim of service connection for respiratory disability was denied on the basis that the disability was not incurred in or aggravated by service. The Board’s March 1991 decision was final when issued. See 38 U.S.C. § 7104 (b); 38 C.F.R. § 20.1100 (a) (a Board decision is final on the date stamped on the face of the decision). Applications to reopen the claims of service connection for back disability, gastrointestinal disability (characterized as duodenitis) and respiratory disability (characterized as respiratory condition/asthma) were denied in June 1991 and May 2001 decisions on the basis that new and material evidence had not been submitted. The Veteran was notified of the AOJ’s June 1991 and May 2001 decisions, he did not appeal either decision within one year of their issuance, and new and material evidence was not received within those years. Therefore, the June 1991 and May 2001 decisions became final. See 38 U.S.C. § 7105 (c); Bond, 659 F.3d at 1362; 38 C.F.R. §§ 3.104, 3.156(a)-(b), 19.52(a), 20.1103. The Veteran’s claim of service connection for diabetes mellitus was denied in a May 2004 Board decision on the basis that the disability did not have its onset in service and was not otherwise related to service. The Board’s decision was final when issued. See 38 U.S.C. § 7104 (b); 38 C.F.R. § 20.1100 (a). An application to reopen the claim of service connection for diabetes mellitus was denied in a September 2006 rating decision on the basis that new and material evidence had not been submitted. The Veteran was notified of the AOJ’s September 2006 decision, he did not appeal the decision within one year of its issuance, and new and material evidence was not received within that year. Therefore, the September 2006 decision became final. See 38 U.S.C. § 7105 (c); Bond, 659 F.3d at 1362; 38 C.F.R. §§ 3.104, 3.156(a)-(b), 19.52(a), 20.1103. The pertinent new evidence received since the May 2001 and September 2006 denials of service connection for back disability, gastrointestinal disability, diabetes mellitus, and respiratory disability includes a May 2009 VA treatment record, the report of a February 2017 VA back examination, a September 2017 VA primary care physician note, a July 2018 VA addendum note, and medical literature submitted by the Veteran’s representative in October 2012. This additional evidence reflects that the Veteran has been diagnosed as having lumbosacral strain, degenerative disc and joint disease of the lumbar spine, gastroesophageal reflux disease (GERD), and helicobacter pylori gastritis, that there is a potential association between psychiatric disability and gastrointestinal disability and diabetes mellitus, and that common side effects of one of the Veteran’s psychiatric medications include trouble breathing, stomach pain, and cough. As explained in more detail below, the Board is awarding service connection for psychiatric disability and the Veteran has experienced continuous back and respiratory symptoms in the years since service. Therefore, the additional evidence pertains to elements of the claims of service connection for back disability, gastrointestinal disability, diabetes mellitus, and respiratory disability that were previously found to be lacking and raises a reasonable possibility of substantiating the claims by indicating that the Veteran’s claimed disabilities may be related to service or now service-connected psychiatric disability. The evidence is, therefore, new and material, and the claims of service connection for back disability, gastrointestinal disability, diabetes mellitus, and respiratory disability are reopened. II. Service Connection Service connection will be granted if the evidence demonstrates that current disability resulted from an injury suffered or disease contracted in active military, naval, or air service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) current disability; (2) in-service injury or disease; and (3) a relationship between the two. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). Consistent with this framework, service connection is warranted for a disease first diagnosed after service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Pursuant to 38 C.F.R. § 3.303(b), where a chronic disease is shown as such in service, subsequent manifestations of the same chronic disease are generally service connected; if a chronic disease is noted in service but chronicity in service is not adequately supported, a showing of continuity of symptomatology after separation is required. Entitlement to service connection based on chronicity or continuity of symptomatology pursuant to 38 C.F.R. § 3.303(b) applies only when the disability for which the Veteran is claiming compensation is due to a disease enumerated on the list of chronic diseases in 38 U.S.C. § 1101(3) or 38 C.F.R. § 3.309(a) (e.g., arthritis and psychoses). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). In addition, such chronic diseases are presumed to have been incurred in service if they manifested to a compensable degree within one year of separation from service. 38 U.S.C. §§ 1101(3), 1112(a)(1), 1113; 38 C.F.R. §§ 3.307(a), 3.309(a). Although entitlement to service connection on any of the presumptive bases noted above may not be established, a veteran is not precluded from establishing service connection on a direct basis. See 38 U.S.C. § 1113 (b); 38 C.F.R. § 3.303 (d) (the availability of service connection on a presumptive basis does not preclude consideration of service connection on a direct basis). Entitlement to service connection for psychiatric disability (bipolar disorder, schizophrenia, mood disorder, and psychotic disorder), back disability (lumbosacral strain, lumbago, degenerative disc and joint disease of the lumbar spine, lumbar spondylosis, and scoliosis), and respiratory disability (asthma and COPD) The Veteran contends that he has current psychiatric disability, back disability, and respiratory disability, and that these disabilities had their onset in service. The Board finds, for the following reasons, that the Veteran has current diagnoses of bipolar disorder, schizophrenia, mood disorder, psychotic disorder, lumbosacral strain, lumbago, degenerative disc and joint disease of the lumbar spine, lumbar spondylosis, scoliosis, asthma, and COPD, and that the evidence is at least evenly balanced as to whether all of these disabilities began during active service. As an initial matter, the Board notes that the Veteran reported on a December 1968 report of medical history form completed for purposes of entrance into service that he experienced a history of shortness of breath, cough, frequent trouble sleeping, and frequent or terrifying nightmares prior to service. The Board points out, however, that a veteran will be considered to have been in sound condition when examined, accepted and enrolled for service, except as to defects, infirmities, or disorders noted at entrance into service, or where clear and unmistakable (obvious or manifest) evidence demonstrates that an injury or disease existed prior thereto and was not aggravated. 38 U.S.C. § 1111; 38 C.F.R. § 3.304 (b). The term “noted,” in 38 U.S.C. § 1111, refers to “[o]nly such conditions as are recorded in examination reports.” 38 C.F.R. § 3.304 (b). A “[h]istory of preservice existence of conditions recorded at the time of examination does not constitute a notation of such conditions.” 38 C.F.R. § 3.304 (b)(1); see also Crowe v. Brown, 7 Vet. App. 238, 245 (1994). In this case, although the Veteran is certainly competent to report a history of potential psychiatric and respiratory problems prior to service, a veteran’s report of history, even when related by a medical professional, without an independent basis in the record, is insufficient to rebut the presumption of soundness. Miller v. West, 11 Vet. App. 345 (1998). There is no other evidence of any pre-existing psychiatric or respiratory disability prior to service and the Veteran’s December 1968 entrance examination did not reflect any psychiatric or respiratory abnormalities. Therefore, the Board finds that the evidence is not clear and unmistakable that any psychiatric or respiratory disability pre-existed service and was not aggravated in service and the Veteran is presumed sound at service entrance. 38 U.S.C. § 1111. Medical records, including a February 2011 VA mental health attending note, an August 2011 VA mental health note, a January 2013 VA mental health resident outpatient note, the report of an April 2013 VA back examination, a February 2017 VA back examination report, a February 2017 VA respiratory examination report, and a July 2018 VA mental health outpatient note, show the Veteran has current diagnoses of bipolar disorder, schizophrenia, mood disorder, psychotic disorder, lumbosacral strain, lumbago, degenerative disc and joint disease of the lumbar spine, lumbar spondylosis, scoliosis, asthma, and COPD. Thus, current psychiatric, back, and respiratory disabilities have been demonstrated. There is also evidence of psychiatric, back, and respiratory problems during service and evidence of continuous symptoms in the years since service. In this regard, the Veteran has reported that he began to experience nervousness, nightmares, depression, and exercise-induced shortness of breath during service, and that he began to experience back pain in service after he fell off a telephone pole and landed on his back during advanced individual training. His service treatment records confirm that he was referred for a mental evaluation in June 1973 because of frequent behavioral problems, including uncooperativeness, inattentiveness, resentfulness, insubordination, poor motivation, and frequent rule infractions. He was treated for back pain, tenderness, and soreness in August 1970, November 1971, and September 1972, and was diagnosed as having a back strain. He was treated for a viral upper respiratory infection and a cough with sputum in March 1969 and December 1970. He reported on a September 1973 report of medical history form completed for purposes of separation from service that he experienced frequent trouble sleeping, depression or excessive worry, nervous trouble, recurrent back pain, shortness of breath while running, and a chronic cough. Also, a fellow service member (G.J.) reported in a July 2009 statement that he witnessed the Veteran experience psychiatric symptoms in service (including difficulty sleeping, crying, talking to himself, nightmares, paranoia, and violent outbursts). Moreover, the Veteran’s post-service medical records and lay statements indicate that his psychiatric, back, and respiratory symptoms have continued in the years since service. The Veteran is competent to report continuous psychiatric, back, and respiratory symptoms in the years since service and G.J. is competent to report his observations of the Veteran’s psychiatric symptoms in service. Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006). Also, there no evidence that explicitly contradicts these lay reports and they are generally consistent with the evidence of record. Therefore, the Board concludes that the reports of continuous back, psychiatric, and respiratory symptoms in the years since service are credible. A March 2002 VA mental health attending note includes an opinion that since the Veteran experienced some psychiatric problems in service and the usual onset of bipolar disorder is late teens and early twenties, it was likely that the Veteran’s symptoms in service were the “prodrome of his current illness.” A December 2009 VA back examination report includes an opinion that the Veteran’s lumbar strain was not likely (“less likely than not”) related his back complaints in service in 1969 and 1973. There was no further explanation or rationale provided for this opinion. The examiner who conducted an April 2013 VA respiratory examination opined that the Veteran’s claimed respiratory disability was not likely (“less likely than not”/“less than 50 percent probability”) incurred in or caused by service. The examiner reasoned that there was no evidence of any evaluation or treatment for COPD in the Veteran’s service treatment records, and that it was likely (“more likely than not”) that his COPD was due to his 16 pack year smoking history. A review of medical literature revealed that the primary cause of COPD is exposure to tobacco smoke and that tobacco smoking accounts for as much as 90 percent of COPD risk. Cigarette smoking induces macrophages to release neutrophil chemotactic factors and elastases, which lead to tissue destruction. Clinically significant COPD develops in 15 percent of cigarette smokers, although this number is believed to be an underestimate. The age of initiation of smoking, total pack years, and current smoking status predict COPD mortality. People who smoke have an increased annual decline in FEV1. The physiologic normal decline in FEV1 is estimated to be 20 to 30 ml per year, but the rate of decline in COPD patients is generally 60 ml per year or greater. Moreover, secondhand smoke, or environmental tobacco smoke, increases the risk of respiratory infections, augments asthma symptoms, and causes a measurable reduction in pulmonary function. A study revealed that lung function deviation and lung structural changes are present in people who smoke cigarettes before the clinical signs of airway obstruction reveal them. These changes can be detected by body plethysmography and diffusing capacity measurement with routine spirometry. The examiner who conducted an April 2013 VA back examination opined that the Veteran’s claimed back disability was not likely (“less likely than not”/“less than 50 percent probability”) incurred in or caused by service. The examiner reasoned that it was likely (“more likely than not”) that the Veteran’s back disability was due to chronic degenerative changes associated with aging. The physician who conducted the February 2017 VA back examination opined that it was not likely (“less likely as not”) that the Veteran’s current back disability was proximately due to or caused by service. He reasoned that while the Veteran’s service treatment records contain documentation of recurrent lower back problems through the time of his separation examination in 1973, there was then a significant gap of chronic lower back complaints until 1990, when a VA examination was performed and lower back x-rays were normal. There was then an additional gap until the next mention of lumbago in 2009. The current clinical findings were consistent with lumbar degenerative disc and joint disease which was likely (“more than likely”) due to normal aging of the spine. Therefore, there was no establishment of chronicity for the lower back. The physician who conducted the February 2017 VA respiratory examination opined that it was not likely (“less likely as not”) that the Veteran’s current asthma and COPD were proximately due to or caused by service. The examiner reasoned that the Veteran’s service treatment records only noted shortness of breath with running/exertion during his 1973 separation examination. There was no actual treatment for these conditions during service and the first mention of asthma/COPD was not until the early 1990s. The December 2009 and April 2013 back opinions are of little, if any probative value because they are not accompanied by any specific explanations or rationales. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (most of the probative value of a medical opinion comes from its reasoning; threshold considerations are whether the person opining is suitably qualified and sufficiently informed). The April 2013 respiratory opinion and the February 2017 opinions are also all of minimal probative value because they are largely based on the absence of evidence of treatment for respiratory and back problems for many years after service and they do not take into account the Veteran’s competent and credible reports of continuous back and respiratory symptoms in the years since service. In this regard, a medical opinion is inadequate if it is based solely on the absence of documentation in the record and does not take into account the Veteran’s reports of symptoms and history (even if recorded in the course of the examination). Dalton v. Peake, 21 Vet. App. 23 (2007). The March 2002 psychiatric opinion, by contrast, is based upon treatment of the Veteran and consideration of his reported history, and it is accompanied by a rationale that is consistent with the evidence of record. Therefore, this opinion is entitled to substantial probative weight. See Nieves-Rodriguez, 22 Vet. App. at 304. In sum, the evidence reflects that the Veteran experienced psychiatric, back, and respiratory symptoms in service and that there have been continuous symptoms in the years since service. He has also been diagnosed as having current bipolar disorder, schizophrenia, mood disorder, psychotic disorder, lumbosacral strain, lumbago, degenerative disc and joint disease of the lumbar spine, lumbar spondylosis, scoliosis, asthma, and COPD, and there is a probative medical opinion that the Veteran’s psychiatric disability had its onset in service. There is no adequate medical opinion contrary to a conclusion that the current bipolar disorder, schizophrenia, mood disorder, psychotic disorder, lumbosacral strain, lumbago, degenerative disc and joint disease of the lumbar spine, lumbar spondylosis, scoliosis, asthma, and COPD had their onset in service. Thus, the evidence is at least evenly balanced as to whether these disabilities had their onset in service. As the reasonable doubt created by this relative equipoise in the evidence must be resolved in favor of the Veteran, entitlement to service connection for bipolar disorder, schizophrenia, mood disorder, psychotic disorder, lumbosacral strain, lumbago, degenerative disc and joint disease of the lumbar spine, lumbar spondylosis, scoliosis, asthma, and COPD is warranted. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. See also Buchanan, 451 F.3d at 1335 (“[N]othing in the regulatory or statutory provisions [relating to evidence to be considered] require both medical and competent lay evidence; rather, they make clear that competent lay evidence can be sufficient in and of itself”). III. Increased Ratings Disability evaluations are determined by evaluating the extent to which a veteran’s service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing his symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. If two evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation; otherwise, the lower evaluation will be assigned. 38 C.F.R. § 4.7. In view of the number of atypical instances it is not expected, especially with the more fully described grades of disabilities, that all cases will show all the findings specified. Findings sufficiently characteristic to identify the disease and the disability therefrom, and above all, coordination of rating with impairment of function will, however, be expected in all instances. 38 C.F.R. § 4.21. In evaluating a disability, the Board considers the current examination reports in light of the whole recorded history to ensure that the current rating accurately reflects the severity of the condition. The Board has a duty to acknowledge and consider all regulations that are potentially applicable. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). The medical as well as industrial history is to be considered, and a full description of the effects of the disability upon ordinary activity is also required. 38 C.F.R. §§ 4.1, 4.2, 4.10. Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Although a rating specialist is directed to review the recorded history of a disability in order to make a more accurate evaluation, see 38 C.F.R. § 4.2, the regulations do not give past medical reports precedence over current findings. Francisco v. Brown, 7 Vet. App. 55 (1994). Staged ratings are, however, appropriate for an increased rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. The relevant focus for adjudicating an increased rating claim is on the evidence concerning the state of the disability from the time period one year before the claim was filed until VA makes a final decision on the claim. Hart v. Mansfield, 21 Vet. App. 505 (2007). Entitlement to ratings in excess of 10 percent for service-connected right foot disability (condylectomy medial aspect distal phalanx right great toe and hammertoe right little toe, postoperative proximal phalangectomy and condylectomy, with tender callous lateral aspect right little toe) and left foot disability (condylectomy medial aspect of distal phalanx left great toe with plantar calluses left foot) The Veteran’s service-connected right and left foot disabilities are rated under 38 C.F.R. § 4.71A, DCs 5299-5284. Hyphenated diagnostic codes are used when a rating under one code requires use of an additional diagnostic code to identify the basis for the rating assigned. 38 C.F.R. § 4.27. Here, the use of DCs 5299-5284 reflects that there is no diagnostic code specifically applicable to the Veteran’s service-connected foot disabilities, and that these disabilities have been rated by analogy to foot injury under DC 5284. See 38 C.F.R. § 4.20 (allowing for rating of unlisted condition by analogy to closely related disease or injury). Under DC 5284, a 10 percent rating is warranted for a moderate foot injury, a 20 percent rating is warranted for a moderately severe foot injury, and a 30 percent rating is warranted for a severe foot injury. A note to DC 5284 provides that a 40 percent disability rating will be assigned for actual loss of use of the foot. 38 C.F.R. § 4.71A, DC 5284. Considering the pertinent evidence in light of the applicable rating criteria and considerations, the Board finds, for the following reasons, that the Veteran’s service-connected right and left foot disabilities have not met or approximated the criteria for a rating in excess of 10 percent at any time during the claim period. At the outset, the Board acknowledges that the Veteran was most recently afforded a VA examination to assess the severity of his service-connected right and left foot disabilities in January 2018. The January 2018 examination provided the findings necessary to properly rate the Veteran’s disabilities based upon an in-person examination, he has not reported any changes in his foot disabilities since that time, and the record does not otherwise suggest any changes. Palczewski v. Nicholson, 21 Vet. App. 174 (2007) (mere passage of time does not trigger need for a new VA examination, absent evidence of a change in the disability). Thus, a new VA examination for his foot disabilities need not be conducted merely due to the passage of time since the last examination. The Veteran’s claim for increased ratings for his service-connected right and left foot disabilities was received on January 17, 2007. The Veteran reported during a June 2006 VA foot examination that he experienced right fifth toe pain and numbness and that he was unable to move the toe. He took amitriptyline for pain (probably for diabetic neuropathy), did not wear any special shoes, had not undergone any surgery since service, and did not experience any flare ups of foot symptoms. His daily activities were affected in that it was difficult for him to walk. Examination of the right great toe revealed that there was tinea unguium of the toenail, but that there was no corn and the skin was smooth. There was normal flexion and extension of the toe, without indication of any pain or tenderness. There was no indication of any pain, weakness, or fatigue with repeat flexion and extension. The Veteran was diagnosed as having normal right fifth toe without corn. The report of an August 2009 VA foot examination indicates that the Veteran experienced constant pain on the tops, bottoms, and sides of both feet every day. The pain was sharp and throbbing in nature, was 9/10 in intensity, and was aggravated by walking 75 yards or more, standing for 20 minutes or more, and using stairs. There was no additional limitation with flare ups. He did not take any medication for pain, but wore special diabetic shoes due to numbness and tingling associated with diabetes. His foot symptoms interfered with daily activities in that it primarily caused problems with walking and standing for prolonged periods of time. There were calluses on both sides of the great toes and hard calluses on both heels. He did not use any assistive devices other than special shoes and possibly a cane. Examination revealed a shortened right little toe and poor foot hygiene. There was no pes planus or ulcerations and Achilles tendon alignment was normal bilaterally. There was some pain with palpation on the sides of both feet and great toes. The Veteran had normal standing, walking, and weightbearing, active range of motion did not produce any weakness, fatigue, or incoordination, and there was no additional loss of range of motion with 3 repetitions of movement. There was no flexion of the right little toe and full extension without pain. There was full extension of both great toes and flexion of 0 to 5 degrees with pain. Diagnoses of condylectomy medial aspect distal phalanx left and right great toes with no residuals, and postoperative proximal phalangectomy and condylectomy right little toe without any complaints were provided. The Veteran reported during an April 2013 VA foot examination that he experienced daily moderate to severe bilateral foot plantar and first metatarsophalangeal joint mechanical pain. His disability was treated conservatively and symptomatically as an outpatient only, and he had not undergone any invasive treatment or hospitalization. There were hammer toes at the third and second toes bilaterally and there were mild or moderate symptoms of hallux valgus bilaterally, but the Veteran had not undergone any surgery for hallux valgus. Also, there was no Morton’s neuroma, metatarsalgia, hallux rigidus, acquired claw foot (pes cavus), malunion or nonunion of the tarsal or metatarsal bones, bilateral weak foot, or any other foot injuries. There were scars related to the Veteran’s foot disability, but none of the scars were painful or unstable and the total area of all related scars was not greater than 39 square centimeters (6 square inches). There were no other pertinent physical findings, complications, conditions, signs, or symptoms. The Veteran occasionally used a back brace, knee brace, and cane for back and knee pain and constantly used diabetic shoes for diabetes. There was no functional impairment of an extremity such that no effective function remained other than that which would have been equally well served by an amputation with prosthesis. The Veteran was diagnosed as having hammer toes, hallux valgus, and status post bilateral great toe condylectomies for treatment of painful corns. These disabilities did not impact his ability to work. The Veteran reported during a January 2018 VA foot examination that his “whole feet [were] sore from diabetes,” that there was soreness and burning from diabetes, and that there was a sore spot on his lateral heels. He did not allow anyone to trim his calluses because they hurt for 3 months after trimming. He did not have any flare ups of foot symptoms and there was no functional loss/impairment of the feet. Examination revealed that there were no symptoms associated with flatfoot (including pain on use or manipulation of the feet, swelling on use, characteristic callosities, extreme tenderness of plantar surfaces, decreased longitudinal arch height, objective evidence of marked deformity, marked pronation, or weight-bearing line falling over or medial to the great toe), lower extremity deformity other than pes planus causing alteration of the weight-bearing line, inward bowing of the Achilles tendon, or marked inward displacement and severe spasm of the Achilles tendon (rigid hindfoot) on manipulation of one or both feet. Moreover, there was a hammertoe at the second left toe, but no hammertoes on the right. The Veteran did not have any symptoms due to hallux valgus, had not undergone surgery due to hallux valgus, and did not have any other foot injuries or conditions. He had a history of right and left foot surgeries, but there were no residual signs or symptoms due to arthroscopic or other foot surgery. There was tenderness to palpation at the lateral heels due to hyperkeratosis bilaterally, but the pain did not contribute to functional loss. There was no functional loss of either lower extremity, there was no pain, weakness, fatigability, or incoordination that significantly limited functional ability during flare ups or when the feet were used repeatedly over a period of time, and there was no other functional loss during flare ups or when the feet were used repeatedly over a period of time. There were no scars related to the Veteran’s foot disabilities and there were no other pertinent physical findings, complications, conditions, signs, or symptoms. He regularly used a cane for “diabetic feet” when he went outside of his home, but there was no functional impairment of an extremity such that no effective function remained other than that which would have been equally well served by an amputation with prosthesis. X-rays revealed moderate degenerative joint disease of both feet, the arthritis was not related to the Veteran’s foot surgeries (condylectomies) and there were no other significant diagnostic test findings or results. Diagnoses of bilateral hammertoes, bilateral hallux valgus, status post condylectomies of phalanges of right and left great toes, and condylectomy and phalangectomy right 5th hammer toe were provided. These disabilities did not impact the Veteran’s ability to perform occupational tasks. Also, the examiner noted that there was no evidence of pain on passive range of motion testing or when the feet were used in non weight-bearing. The above evidence reflects that the Veteran has been diagnosed as having hammer toes, hallux valgus, and arthritis during the claim period, in addition to his service-connected bilateral foot surgeries. In this regard, distinct, diagnosed foot conditions not explicitly listed in the rating schedule may be rated by analogy under DC 5284. Yancy v. McDonald, 27 Vet. App. 484, 493 (2016). However, “when a condition is specifically listed in the Schedule, it may not be rated by analogy.” Copeland v. McDonald, 27 Vet. App. 333, 337 (2015). Thus, “[u]nder Copeland and Yancy, the Board is obligated to consider analogous DCs, including DC 5284, when rating unlisted conditions, despite the presence of listed conditions.” Scott v. Wilkie, 920 F.3d 1375, 1379 (Fed. Cir. 2019). Furthermore, application of DC 5284 is appropriate here as the ratings assigned for the Veteran’s bilateral foot disabilities are related to the results of surgeries to his feet. Yancy, 27 Vet. App. at 491 (the plain meaning of the word “injury” limits the application of DC 5284 to disabilities resulting from actual injuries to the foot, as opposed to disabilities caused by, for example, degenerative conditions). With respect to the diagnosed hallux valgus and hammer toes, the Veteran is not service-connected for these disabilities and there is no indication that they are related to his service-connected foot disabilities. Regardless a compensable rating for hallux valgus is only warranted if there was operation with resection of the metatarsal head or if the disability is severe and equivalent to amputation of the great toe. Also, a compensable rating for hammer toes is only warranted if all toes of a foot are affected. See 38 C.F.R. § 4.71A, DCs 5280, 5282. In this case, the Veteran has not undergone any surgery for his hallux valgus, the examiner who conducted the April 2013 examination noted that the Veteran only had mild to moderate symptoms of hallux valgus, there were no symptoms of hallux valgus during the January 2018 examination, and the Veteran’s hammer toes have not affected all toes of a single foot. Therefore, no separate/higher rating(s) is/are warranted under DCs 5280 or 5282 on the basis of the diagnosed hallux valgus or hammer toes. The above evidence reflects that the Veteran experiences bilateral foot disability manifested by pain, tenderness, and limited toe motion. His foot symptoms somewhat limit his ability to stand and walk for prolonged periods, but he has not reported any flare ups of foot symptoms or significant functional impairments associated with his service-connected foot disabilities with repeated use over time. The majority of the Veteran’s foot symptoms and impairments have been attributed to his non service-connected diabetes, he has not exhibited an impaired gait due to his service-connected foot disabilities, and he has only used assistive devices/special shoes due to back disability, knee disability, and diabetes. In light of these reported and observed symptoms, the Board finds that the symptoms of the Veteran’s service-connected right and left foot disabilities have most closely approximated the criteria for a 10 percent rating under DC 5284 during the entire claim period. This contemplates moderate right and left foot injuries. Overall, the Board finds that the reported functional impairments have not been so severe, frequent, and/or prolonged to warrant a rating higher than 10 percent. In other words, even considering functional impairment due to pain and other factors, the Veteran’s symptoms have not been shown to be so disabling as to actually or effectively result in more than moderate limitation of foot function. 38 C.F.R. § 4.71A, DC 5284. The only other diagnostic codes under which a rating higher than 10 percent is available are DCs 5276 (acquired flat foot), 5278 (claw foot (pes cavus)), and 5283 (malunion or nonunion of the tarsal or metatarsal bones). There has been no evidence of any acquired flat foot, claw foot (pes cavus), or malunion/nonunion of the tarsal or metatarsal bones during the claim period. Moreover, the Veteran has not contended, and the evidence does not otherwise reflect, that he has completely lost all functional use of either foot, with no effective function remaining other than that which would be equally well served by an amputation stump with a suitable prosthetic appliance. This finding was specifically made during the April 2103 and January 2018 VA examinations and the Veteran has retained the ability to ambulate. Thus, a higher rating of 40 percent under DC 5284 for loss of use of the foot is also not warranted for either the left or right foot. Lastly, although the Veteran has been diagnosed as having bilateral foot arthritis during the claim period, both degenerative and traumatic arthritis are rated on the basis of limitation of motion under the appropriate diagnostic code for the specific joint involved. See 38 C.F.R. § 4.71a, DCs 5003, 5010. As the Veteran is in receipt of a 10 percent rating under DC 5284 and this rating contemplates limitation of motion/function of the feet due to pain, any separate rating(s) on the basis of foot arthritis would constitute prohibited pyramiding and is not warranted. 38 C.F.R. § 4.14. In sum, the Veteran’s service-connected right and left foot disabilities have resulted in impairments that most closely approximate the criteria for 10 percent, but no higher, ratings under DC 5284 for both the right and left foot during the entire claim period and ratings higher than 10 percent are not warranted at any time during the claim period. As a final point, the Board notes that in conjunction with the claims for increased ratings for the service-connected left and right foot disabilities, other than the issue of entitlement to a TDIU which is addressed below, neither the Veteran nor his representative have raised any other related issues, and no other such issues have been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 369-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). REASONS FOR REMAND 1. Entitlement to service connection for gastrointestinal disability (to include irritable colon syndrome) and diabetes mellitus are remanded. The Veteran contends that he has current gastrointestinal disability and diabetes mellitus that are either directly related to service or are associated with his now service-connected psychiatric disability. His medical records reflect that he has been diagnosed as having various upper and lower gastrointestinal disabilities and diabetes mellitus and his service treatment records reflect that he reported and/or was treated for gastrointestinal symptoms during service. Moreover, he has submitted medical literature which suggests that there is a possible association between gastrointestinal symptoms and psychiatric disability and that diabetes is more prevalent among those with schizophrenia. Also, a May 2009 VA treatment record indicates that gastrointestinal symptoms may be a side effect of one of the Veteran’s psychiatric medications. Overall, the Veteran has current gastrointestinal disability and diabetes mellitus, the record indicates that the disabilities may be associated with the Veteran’s now service-connected psychiatric disability, and the record does not contain sufficient information to make a decision on the claims. Therefore, the Veteran should be afforded appropriate examinations upon remand to assess the nature of his claimed gastrointestinal disability and diabetes and appropriate medical opinions should be obtained as to whether these disabilities are related to service or are caused or aggravated by now service-connected psychiatric disability. See 38 U.S.C. § 5103A (d); McLendon v. Nicholson, 20 Vet. App. 79 (2006). Also, the evidence indicates that there may be outstanding relevant VA treatment records. The most recent VA treatment records in the claims file are from the VA North Texas Health Care System (dated to August 2018) and the Central Texas Veterans Health Care System (dated to September 2006). Any VA treatment records are within VA’s constructive possession, and must be obtained regardless of their relevance as long as they are sufficiently identified. Sullivan v. McDonald, 815 F.3d 786, 793 (Fed. Cir. 2016) (VA has a duty to assist in obtaining sufficiently identified VA medical records regardless of their relevance). See also Jones v. Wilkie, 918 F.3d 922 (Fed. Cir. 2019) (confirming the holding in Sullivan). A remand is required to allow VA to obtain them. 2. Entitlement to a rating in excess of 10 percent for dermatophytosis of both feet with pseudofolliculitis barbae and multiple scars of bilateral cheeks is remanded. The Veteran’s claim for an increased rating for dermatophytosis of both feet with pseudofolliculitis barbae and multiple scars of bilateral cheeks was received in January 2007. His service-connected skin disability is rated under 38 C.F.R. § 4.118, DCs 7813-7806. The Veteran was afforded VA skin examinations during the claim period which reflect that he has used various creams for his skin disability, sometimes noted as being a topical corticosteroid on a constant or near-constant basis. In Johnson v. Shulkin, 862 F.3d 1351 (Fed. Cir. 2017), the United States Court of Appeals for the Federal Circuit held that a topical corticosteroid treatment can meet the definition of systemic therapy if it is administered on a large enough scale such that it affects the body as a whole, and the use of a topical corticosteroid can be considered either systemic therapy or topical therapy based on the factual circumstances of each case. In Warren v. McDonald, 28 Vet. App. 194, 197 (2016), the United States Court of Appeals for Veterans Claims (Court) held that the types of systemic treatment that are compensable under DC 7806 are not limited to “corticosteroids or other immunosuppressive drugs;” rather, compensation is available for “all systemic therapies that are like or similar to corticosteroids or other immunosuppressive drugs.” Finally, in Burton v. Wilkie, 30 Vet. App. 286, 291 (2018), the Court held that there are at least two other potential ways of showing that a topical corticosteroid is systemic: the method by which the treatment works and its side effects. In light of the date that the Veteran’s increased rating claim was received and the rating criteria that are applicable in this case, the Board finds that a new VA skin examination is necessary to ascertain the current severity and manifestations of his service-connected skin disability, to include consideration of the precise nature of any skin treatments throughout the claim period. In addition, the criteria for rating skin disabilities were amended following the most recent VA skin examination in January 2018. Also, all outstanding VA treatment records should be secured upon remand. 3. Entitlement to a TDIU due to service-connected disabilities is remanded. The issue of entitlement to a TDIU should be adjudicated in the first instance by the AOJ, to include appropriate notification and a request for the Veteran to submit a formal application for a TDIU (VA Form 21-8940). Also, since the AOJ’s implementation of the Board’s award of service connection for psychiatric disability, back disability, and respiratory disability, and a decision on the other remanded service connection and increased rating issues could significantly impact a decision on the issue of entitlement to a TDIU, the issues are inextricably intertwined. A remand of the claim for a TDIU is required. Lastly, all outstanding VA treatment records should be secured upon remand. The matters are REMANDED for the following action: 1. Send the Veteran a notice letter which provides him with notice as to the information and evidence that is required to substantiate his claim for a TDIU. A copy of this letter must be included in his claims file. 2. Ask the Veteran to complete a formal application for a TDIU (VA Form 21-8940) and to report his education and employment history and earnings. 3. Obtain the Veteran’s outstanding VA treatment records from the VA North Texas Health Care System for the period since August 2018; the Central Texas Veterans Health Care System for the period since September 2006; and all such relevant records from any other sufficiently identified VA facility. 4. After all efforts have been exhausted to obtain and associate with the claims file any additional treatment records, schedule the Veteran for an examination by an appropriate clinician (or telehealth interview, review of the record, etc., if an in-person examination is not feasible) to determine the nature and etiology of any current gastrointestinal disability. The clinician must opine whether any gastrointestinal disability experienced by the Veteran since approximately January 2007 (including, but not limited to, GERD, irritable colon syndrome, and any stomach disability) at least as likely as not (1) began during active service; (2) is related to an in-service injury or disease, including the stomach/gastrointestinal problems documented in his service treatment records; (3) is caused by service-connected bipolar disorder, schizophrenia, mood disorder, and psychotic disorder (to include any medications taken for these disabilities); OR (4) is aggravated by service-connected bipolar disorder, schizophrenia, mood disorder, and psychotic disorder (to include any medications taken for these disabilities). The clinician must provide reasons for each opinion given. In this regard, the clinician should acknowledge and comment on the medical literature submitted by the Veteran which suggests that some gastrointestinal symptoms may be associated with psychiatric disability and his psychiatric medications. 5. After all efforts have been exhausted to obtain and associate with the claims file any additional treatment records, schedule the Veteran for an examination by an appropriate clinician (or telehealth interview, review of the record, etc., if an in-person examination is not feasible) to determine the nature and etiology of his current diabetes mellitus. The clinician must opine whether any diabetes mellitus experienced by the Veteran since approximately January 2007 at least as likely as not (1) began during active service; (2) manifested within one year after discharge from service (3) is related to an in-service injury or disease; (4) is caused by service-connected bipolar disorder, schizophrenia, mood disorder, and psychotic disorder (to include any medications taken for these disabilities); OR (5) is aggravated by service-connected bipolar disorder, schizophrenia, mood disorder, and psychotic disorder (to include any medications taken for these disabilities). The clinician must provide reasons for each opinion given. In this regard, the clinician should acknowledge and comment on the medical literature submitted by the Veteran which suggests that diabetes is more prevalent among people with schizophrenia. 6. After all efforts have been exhausted to obtain and associate with the claims file any additional treatment records, schedule the Veteran for an examination by an appropriate clinician (or telehealth interview, review of the record, etc., if an in-person examination is not feasible) to determine the current severity of his service-connected dermatophytosis of both feet with pseudofolliculitis barbae and multiple scars of bilateral cheeks. The clinician should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. Specifically, the clinician should address whether the Veteran’s dermatophytosis of both feet with pseudofolliculitis barbae and multiple scars of bilateral cheeks has required systemic therapy at any time since January 2007, to include whether any topical therapy (such as skin cream) is systemic in its scale, method, or side effects. The clinician should also report the nature and severity of any scarring associated with the service-connected dermatophytosis of both feet with pseudofolliculitis barbae and multiple scars of bilateral cheeks, to include whether any scar causes any limited motion or loss of function. Each scar size (including BOTH scar length and width) and whether any scar is superficial, deep, associated with underlying soft tissue damage, nonlinear, unstable, or painful should also be noted. To the extent possible, the clinician should identify any symptoms and functional impairments due to the service-connected dermatophytosis of both feet with pseudofolliculitis barbae and multiple scars of bilateral cheeks alone and discuss the effect of the disability on any occupational functioning and activities of daily living. The clinician must provide reasons for any opinion given. Jonathan Hager Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Elwood, 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.