Citation Nr: 21010716 Decision Date: 02/25/21 Archive Date: 02/25/21 DOCKET NO. 17-17 327 DATE: February 25, 2021 ORDER Entitlement to service connection for arthritis of the knees and legs is denied. Entitlement to service connection for tendonitis of the knees is denied. Entitlement to service connection for a right foot disability is denied. Entitlement to service connection for a left foot disability is denied. Entitlement to service connection for residuals of a cold weather injury, to include frostbite, is denied. Entitlement to service connection for acquired psychiatric disorder is granted. REMANDED Entitlement to service connection for a skin disability, to include eczema, is remanded. FINDINGS OF FACT 1. The Veteran has a diagnosis of right and left knee arthritis. 2. The weight of the competent and credible evidence is against finding that the Veteran’s right and left knee arthritis manifested in service or within one year of service; and is not etiologically caused by an in-service injury, event or disease. 3. The weight of the competent and credible evidence is against finding that the Veteran’s right foot hallux valgus manifested in service and is not etiologically caused by an in-service, injury or disease. 4. The weight of the competent and credible evidence is against finding that the Veteran has or has had at any time during the appeal a left foot disability. 5. The weight of the competent and credible evidence is against finding that the Veteran has or has had at any time during the appeal a cold weather injury, to include frostbite. 6. Resolving reasonable doubt in the Veteran’s favor his major depressive disorder is caused by service to include in service stressors. CONCLUSIONS OF LAW 1. The criteria for service connection for arthritis of the knees and legs have not been met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.309 (2019). 2. The criteria for service connection for tendonitis of the knees has not been met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.309 (2019). 3. The criteria for service connection for a right foot disability have not been met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.309 (2019). 4. The criteria for service connection for a left foot disability have not been met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.309 (2019). 5. The criteria for service connection for residuals of a cold weather injury, to include frostbite have not been met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.309 (2019). 6. The criteria for service connection for major depressive disorder have been met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.309 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S. Army from July 1984 to October 1991. These matters come before the Board of Veterans’ Appeals (Board) from an August 2013 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a Board video conference hearing before the undersigned Veterans’ Law Judge in September 2017. A transcript of the hearing has been associated with the claims file. Previously the claims were remanded for additional development in January 2019. The prior remand directives have been completed, in part, and will be discussed in greater detail below, and as such, the Board finds there has been substantial compliance with the prior remand directives, except as to the Veteran’s claim for service connection for a skin disability discussed in the remand section, and the claims are again before the Board. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Service Connection A veteran is entitled to VA disability compensation if there is a disability resulting from personal injury suffered or disease contracted in line of duty in active service, or for aggravation of a preexisting injury suffered or disease contracted in line of duty in active service. 38 U.S.C. §§ 1110, 1131. To establish a right to compensation for a present disability, a Veteran must show: “(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service” - the so-called “nexus” requirement. Shedden v. Principi, 381 F.3d 1163, 1167 Fed. Cir. (2004). For the showing of chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word “Chronic.” When the disease identity is established (leprosy, tuberculosis, multiple sclerosis, etc.), there is no requirement of evidentiary showing of continuity. Continuity of symptomatology is required only where the condition noted during service (or in the presumptive period) is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. 38 C.F.R. § 3.303(b). Service connection for a recognized chronic disease can also be established through continuity of symptomatology. Walker v. Shinseki, 708 F.3d 1331 (2013); 38 C.F.R. §§ 3.303 (b), 3.309. Service Connection 1. Entitlement to service connection for arthritis of the knees and legs 2. Entitlement to service connection for tendonitis of the knees The Veteran contends that service connection is warranted for arthritis of his knees and legs. In addition, the Veteran contends that service connection is warranted for tendonitis of the knees. The Veteran reports that his ongoing leg and knee symptoms are related to his in-service exposure to cold weather in Germany. The Veteran reports ongoing symptomology associated with his knees and legs. For the sake of brevity, the Board will discuss the claim for service connection for arthritis of the knees and legs and service connection for tendonitis of the knees together. The Board will broadly consider the Veteran’s symptomology of his knees and legs as discussed in greater detail below. The Veteran is competent to describe his current symptoms, in-service events, and the occurrence of ongoing symptoms, and to this extent, these statements are credible. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The question for the Board is whether the Veteran has arthritis of the knees and legs or tendonitis of the knees that began during service, manifested during the applicable presumptive period, or is at least as likely as not caused by an in service, injury or disease. The Veteran has a diagnosis of bilateral degenerative arthritis of the knees status post-surgical repair. The Board concludes that the Veteran does not have a current diagnosis of tendonitis of the knees or any additional diagnosis of the knee or legs and has not had one at any time during the pendency of the claim or recent to the filing of the claim. See 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); McKinney v. McDonald, 28 Vet. App. 15 (2016); 38 C.F.R. § 3.303(a), (d). Under 38 U.S.C. § 1110, there must be a disability due to an identified personal injury suffered or disease or injury, contracted in-service. Where pain alone results in functional impairment, even if there is no identified underlying diagnosis, it can constitute a disability. However, subjective pain in and of itself will not establish a current disability. Consideration should be given to the impact, or lack thereof, from pain, focusing on evidence of functional limitation caused by pain. Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir., 2018). Herein, even if the Board considered the Veteran’s reports of general knee pain and associated symptomology to broadly encompass general reports of pain, these are already contemplated by his current right and left knee arthritis. Here there is no functional limitation, beyond what has already been contemplated by the Veteran’s right and left knee arthritis, which are discussed in greater detail below. Further, not all pain results in a disability, as in here, or rises to the level of impairment of working ability. The Veteran’s service treatment records (STRs) have been associated with the claims file. August 1986 STRs note the Veteran was seen for reports of knee pain for approximately 2 weeks. Examination was negative for trauma and the Veteran reported pain in knee when pressure is applied while standing. The Veteran reported locking of the knee, negative McMurray’s testing was noted, with tenderness. A diagnosis of right knee strain was noted. In September 1989 on a report of medical examination clinical evaluation of the lower extremities and musculoskeletal system was normal. In a September 1989 report of medical history the Veteran denied swollen or painful joints, arthritis, bone, joint or other deformity and a “trick” or locked knee. In preparation for separation in August 1991 the Veteran requested a physical and review of the Veteran’s records found that a medical examination was not required for separation. In light of the Veteran’s statements and review of service treatment records the Board finds an in-service injury broadly relating to the Veteran’s knees limited to a one-time episode of knee strain in 1986 that was followed by a normal examination in 1989. The Veteran was afforded a VA examination in December 2019. The Veteran reported knee pain with prolonged walking. The examiner noted a diagnosis of degenerative arthritis status post-surgical repair. Physical examination noted a diagnosis of degenerative arthritis status post-surgical repair based on objective imaging studies. The examiner noted that no other diagnosis was warranted. The examiner noted that the Veteran was involved in a motor vehicle accident in 1996 which caused torn ligaments in both knees and resulted in surgery. Imaging noted mild to moderate bilateral tibiofemoral joint space narrowing with prominent marginal osteophytes. No flare ups or functional loss or functional impairment was noted. Range of motion testing of the right knee and left knee noted flexion to 140 degrees and extension to 0 degrees. No evidence of pain or localized tenderness was noted. Repetitive use testing did not result in any additional loss of range of motion. Muscle strength testing was 5/5 bilaterally with no muscle atrophy. There was no objective evidence of pain on weight bearing. Passive range of motion testing was the same as active range of motion. No ankylosis was noted. Joint stability testing noted no recurrent subluxation, no lateral instability and no recurrent effusion. The Veteran underwent a meniscectomy ACL repair in 1996. Imaging noted mild to moderate bilateral tibiofemoral joint space narrowing. The examiner noted that the Veteran’s bilateral knee disability does not impact his ability to perform any type of occupational task. The examiner found that it is less likely than not that the Veteran’s current bilateral knee disability was incurred in or caused by an in service injury, event or illness, including a cold weather injury. The examiner noted that the only diagnosis regarding the Veteran’s knee is bilateral degenerative arthritis status post-surgical repair. The Veteran’s arthritis is status post-surgery which was necessitated by a motor vehicle accident in 1996 and are unrelated to a cold weather injury. The Veteran left active duty in 1991. As such the examiner found that it is less likely than not that the Veteran’s current knee arthritis was incurred in or caused by service. VA and private treatment records have been associated with the claims file. Private treatment records in November 1999 note follow up for a knee reconstruction after a motor vehicle accident. A review of these records shows that the Veteran’s earliest self-reporting of knee symptomology began in 1999. These treatment records do not contradict the VA examination and are absent indications between the Veteran’s current knee disability and an in service disease of injury. After consideration of all the evidence of record the Board finds that the evidence is against finding that service connection for the Veteran’s right and left knee arthritis is warranted. The Board concludes that service connection for right and left knee arthritis is not warranted on a direct basis as the Veteran’s knee disability was not caused by service. The Veteran’s reports of the onset of his arthritis in-service warrant low credible and probative weight as they are not consistent with the STRs which noted no ongoing knee symptomology. While the Veteran reports that his current right and left knee arthritis is related to service the record does not reflect that he has the requisite training or expertise to offer a medical opinion linking a current disability to service decades earlier and as such the Veteran is not competent to provide a nexus opinion in this case. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). The Board finds that the medical evidence is more probative and credible than the lay opinions of record. The competent medical evidence of record including the VA examination in December 2019 is entitled to significant probative weight. The VA examiner noted a diagnosis of degenerative arthritis status post-surgical repair. The examiner found that it is less likely than not that the Veteran’s current bilateral knee disability was incurred in or caused by an in service injury, event or illness, including a cold weather injury. The examiner noted that the only diagnosis regarding the Veteran’s knee is bilateral degenerative arthritis status post-surgical repair. The Veteran’s arthritis is status pos- surgery which was necessitated by a motor vehicle accident post-service and are unrelated to a cold weather injury. The Veteran left active duty in 1991. The Board finds the opinion is entitled to significant probative weight as it was based on adequate rationale and is not contradicted by other opinions. The Board finds that direct service connection is not warranted as the Veteran’s current right and left knee arthritis is not caused by service. The STRs note an instance of knee pain and a diagnosis of a right knee strain in August 1986 however a report of medical examination in September 1989 noted normal clinical evaluation of the lower extremities and musculoskeletal system. The Board has thoroughly considered the Veteran’s lay statements and testimony however, the Board gives more probative weight to the VA examination. As such the Board finds the Veteran’s current right and left knee arthritis is less likely than not related to active service. As to presumptive service connection the Veteran’s right and left knee arthritis did not manifest until many years post-service. The Board concludes that while the Veteran has arthritis, which falls within a chronic disease under 38 U.S.C. § 1101 (3)/38 C.F.R. § 3.309(a), however such was not chronic in service nor did these manifest to a compensable degree in service or within the presumptive period, and continuity of symptomatology is not established. The Veteran’s arthritis was not noted during service or within one year of separation. See Walker, 708 F.3d 1331. Service records do not support an onset of the Veteran’s arthritis in active service. Based on the probative evidence of record the Board finds that the Veteran’s arthritis did not manifest within the one-year period after service and service connection is not warranted on a presumptive basis. Private treatment records note surgery in 1999 after a motor vehicle accident, which was 8 years after separation from service, and the subsequent development of arthritis attributable to such. In addition, in weighing the evidence of record the Board finds the competent and credible evidence of record is against finding continuity of symptomatology. As a result, service connection based on continuity of symptomology is not warranted. In conclusion, the Board finds that the preponderance of the evidence is against the Veteran’s claims for service connection for knee and leg arthritis and service connection for tendonitis of the knee. Since the preponderance of the evidence is against the claims, and the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107 (b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 5557 (1990); 38 C.F.R. § 3.102. For these reasons, the claims are denied. 3. Entitlement to service connection for a right foot disability 4. Entitlement to service connection for a left foot disability The Veteran contends that service connection is warranted for a right foot disability. In addition, the Veteran contends that service connection is warranted for a left foot disability. The Veteran reports that in service he was exposed to cold weather and has a cold weather injury from serving in Germany and performing guard duty. The Veteran is competent to describe his current symptoms, in-service events, and the occurrence of ongoing symptoms, and to this extent, these statements are credible. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The question for the Board is whether the Veteran has a right and left foot disability that began during service or is at least as likely as not caused by an in service injury, event or disease. The Veteran has a diagnosis of right foot hallux valgus. The Board concludes that the Veteran does not have a current left foot disability and has not had one at any time during the pendency of the claim or recent to the filing of the claim. See 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); McKinney v. McDonald, 28 Vet. App. 15 (2016); 38 C.F.R. § 3.303(a), (d). Under 38 U.S.C. § 1110, there must be a disability due to an identified personal injury suffered or disease or injury, contracted in-service. Where pain alone results in functional impairment, even if there is no identified underlying diagnosis, it can constitute a disability. However, subjective pain in and of itself will not establish a current disability. Consideration should be given to the impact, or lack thereof, from pain, focusing on evidence of functional limitation caused by pain. Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir., 2018). Herein, even if the Board considered the Veteran’s subjective reports of generalized left foot pain, there is no functional limitation. Further, not all pain results in a disability, as in here, or rises to the level of impairment of working ability. The Veteran’s STRs and personnel records have been associated with the claims file. The Veteran served in Germany from June 1988 to June 1990. In September 1989 on the report of medical examination clinical evaluation of the lower extremities, feet and musculoskeletal system was normal. In a September 1989 report of medical history the Veteran denied swollen or painful joints, arthritis, bone, joint or other deformity and foot trouble. In preparation for separation in August 1991 the Veteran requested a physical and review of the Veteran’s records found that a medical examination was not required for separation. In light of the Veteran’s statements and review of service treatment records the Board finds an in-service injury broadly relating to the Veteran’s feet. The Veteran was afforded a VA foot examination in December 2019. The Veteran reported that in April 1981 he burned his feet on boiling water and was treated with skin grafts. The Veteran reports pain with prolonged walking and in cold weather ever since. The examiner noted right foot hallux valgus. The examiner noted no objective evidence to support a musculoskeletal condition of the left foot. Pain of the left foot was noted with a deep aching. No flare ups which impact the function of his foot were not noted. No pain was noted with manipulation of the feet and no swelling was noted. The examiner noted asymptomatic right hallux valgus diagnosed via X-ray imaging. The examiner noted no right or left foot pain on manipulation. No functional loss was noted or attributed to the right or left lower extremity. Imagining noted right foot hallux valgus and a medial sesamoid of the left foot which is bipartite in appearance. The VA examiner noted that the Veteran’s medial sesamoid of the left foot is a normal variant and does not warrant a diagnosis. Further, the examiner noted that such is not attributable to a cold weather injury. The examiner noted that the Veteran had burns to his right foot as a child requiring skin grafts. Currently the Veteran reports bilateral foot pain, which is unlikely due to musculoskeletal condition or residuals of the burn injury. The examiner noted that etiology of the reported pain is unknown, as to the Veteran’s pain is subjective. The examiner noted no evidence to support a musculoskeletal foot condition of the Veteran’s left foot. Further examination noted no pain on manipulation of feet. Examination and imagining noted no evidence of a cold weather injury or residuals of a cold weather injury. The examiner found that it is less likely than not that the Veteran’s current foot disability was incurred in or caused by an in service injury, event or illness. The examiner noted the Veteran had burns to his right foot from boiling water as a child requiring skin grafts. Examination noted no musculoskeletal residuals. The Veteran reports bilateral pain and such reported pain is unlikely due to residuals of the burn injury. The examiner noted that the Veteran’s pain is subjective and etiology unknown. The Veteran has a diagnosis of right foot hallus valgus which is asymptomatic, and the pain described by the Veteran is not consistent with this condition. Based on examination there is no evidence to support a musculoskeletal foot condition for the Veteran’s left foot. The examiner noted that was no evidence of pain on manipulation or evidence of a cold weather injury. VA and private treatment records have been associated with the claims file. A review of these records shows that the Veteran’s earliest self-reported symptomology began in 2010 with ongoing reports of foot pain at times. These treatment records do not contradict the VA examination and are absent indications between that the Veteran’s current right foot hallux valgus and in-service disease or injury. After consideration of all the evidence of record the Board finds that the evidence is against finding that service connection for the Veteran’s right foot disability is warranted. The Board concludes that service connection for right foot hallux valgus is not warranted on a direct basis as the Veteran’s right foot disability is not caused by service. The Veteran’s reported onset of foot pain in-service warrants low credible and probative weight as they are not consistent with the STRs. While the Veteran reports that his right foot hallux valgus is related to service the record does not reflect that he has the requisite training or expertise to offer a medical opinion linking a current disability to service decades earlier and as such the Veteran is not competent to provide a nexus opinion in this case. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). The Board finds that the medical evidence is more probative and credible than the lay opinions of record. The competent medical evidence of record includes the VA examination in December 2019 which is entitled to significant probative weight. The VA examiner noted right foot hallux valgus. The examiner found that it is less likely than not that the Veteran’s current foot disability was incurred in or caused by an in service injury, event or illness. The examiner noted the Veteran had burns to his right foot from boiling water as a child requiring skin grafts. Examination noted no musculoskeletal residuals. The Veteran reports bilateral pain and such reported pain is unlikely due to residuals of the burn injury. The Veteran has a diagnosis of right foot hallus valgus which is asymptomatic, and the pain described by the Veteran is not consistent with this condition. The examiner noted that was no evidence of pain on manipulation or evidence of a cold weather injury. The Board finds that the opinion is entitled to probative weight as the opinion was based on an adequate rationale and is not contradicted by other opinions. The Board finds that service connection is not warranted as the Veteran’s current right foot hallux valgus is not related to service. The Board notes that STRs note in September 1989 on the report of medical examination clinical evaluation of the lower extremities, feet and musculoskeletal system was normal. In a September 1989 report of medical history the Veteran denied swollen or painful joints, arthritis, bone, joint or other deformity and feet trouble. The Board has thoroughly considered the Veteran’s lay statements however, the Board gives more probative weight to the competent medical evidence. Further, the Board gives significant probative weight to the December 2019 VA examination. As such the Board finds that the Veteran’s current right foot hallux valgus is less likely than not related to active service. As to the Veteran’s left foot the weight of the competent and credible evidence is against the Veteran’s claim for service connection for a left foot disability. While the Veteran believes that his symptoms and in-service exposures are indicative of an ongoing left foot disability and related to his service, he is not competent to provide a nexus opinion in this case. The record does not reflect that he has the requisite training ot expertise to offer a medical opinion diagnosing a left foot disability, and linking current symptoms, if any, to an in-service injury or exposure, and as such he is competent to provide an opinion in this case. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The Board finds that the medical evidence is more probative and more credible than the lay opinions of record as to the Veteran’s left foot. As to the Veteran’s general contentions of ongoing left foot pain and associated symptoms and manifestations the Veteran is competent to report his ongoing symptomology. However, the Board assigns low credible weight to the Veteran’s reports because the Veteran had opportunities to report these symptoms at numerous times during his ongoing VA primary care, follow-up and treatment but no continuing left foot symptoms were reported. The December 2019 VA examination noted an extensive review of the Veteran’s claims file and noted that the Veteran does not have a current left foot disability. The examiner noted on examination no pain was noted with manipulation of the feet or swelling. The examiner noted no right or left foot pain on manipulation. No functional loss was noted attributed to the right or left lower extremity. Imagining noted right foot hallux valgus and a medial sesamoid of the left foot is bipartite in appearance. The VA examiner noted that the Veteran’s medial sesamoid of the left foot is a normal variant and does not warrant a diagnosis. Further, no functional impact relating to the Veteran’s left foot was noted. Thus, the more probative evidence of record indicates that the Veteran does not have a current left foot disability and as such service connection for a left foot disability is not warranted. In conclusion, the Board finds that the preponderance of the evidence is against the Veteran’s claims for service connection for a right foot disability and service connection for a left foot disability. Since the preponderance of the evidence is against the claims, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107 (b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 5557 (1990); 38 C.F.R. § 3.102. For these reasons, the claims are denied. 5. Entitlement to service connection for residuals of a cold weather injury, to include frostbite The Veteran contends that service connection is warranted for residuals of a cold weather injury to include frostbite. The Veteran reports while serving in Germany he was exposed to cold weather during guard duty and such resulted in an ongoing cold weather injury of his feet and lower extremities. The Veteran is competent to describe his current symptoms, in-service events, and the occurrence of ongoing symptoms, and to this extent, these statements are credible. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The question for the Board is whether the Veteran has current residuals of a cold weather injury, to include frostbite that began during service or is at least as likely as not caused by an in service, injury, or disease. The Board concludes that the Veteran does not have current residuals of a cold weather injury and has not had one at any time during the pendency of the claim or recent to the filing of the claim. See 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); McKinney v. McDonald, 28 Vet. App. 15 (2016); 38 C.F.R. § 3.303(a), (d). Under 38 U.S.C. § 1110, there must be a disability due to an identified personal injury suffered or disease or injury, contracted in-service. Where pain alone results in functional impairment, even if there is no identified underlying diagnosis, it can constitute a disability. However, subjective pain in and of itself will not establish a current disability. Consideration should be given to the impact, or lack thereof, from pain, focusing on evidence of functional limitation caused by pain. Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir., 2018). Herein, even if the Board considered the Veteran’s general reports of foot pain and knee pain to broadly encompass general reports of pain, these are already contemplated by his right and left knee arthritis and have been addressed in greater detail above. Here there is no functional limitation relating to a cold weather injury of the Veteran’s right and left feet. Further, not all pain results in a disability, as in here, or rises to the level of impairment of working ability. The Veteran’s STRs and personnel records have been associated with the claims file. The Veteran served in Germany from June 1988 to June 1990. In September 1989 on the report of medical examination clinical evaluation of the lower extremities, feet and musculoskeletal system was normal. In a September 1989 report of medical history the Veteran denied swollen or painful joints, arthritis, bone, joint or other deformity and foot trouble. In preparation for separation in August 1991 the Veteran requested a physical and review of the Veteran’s records found that a medical examination was not required for separation. In light of the Veteran’s statements and review of service treatment records and testimony regarding in service duties the Board finds an in-service injury broadly relating to the Veteran’s feet. The question for the Board is whether the Veteran has a current cold weather injury, then if so, if such is related to an in-service event, injury or illness. The Veteran was afforded a VA foot examination in December 2019. The Veteran reported that in April 1981 he burned his feet on boiling water and was treated with skin grafts. Since he has had pain with prolonged walking and in cold weather ever since. The examiner noted right foot hallux valgus. The examiner noted no objective evidence to support a musculoskeletal condition of the left foot. Pain of the left foot was noted with a deep aching. No flare ups which impact the function of his foot were not noted. No pain was noted with manipulation of the feet or swelling was noted. The examiner noted asymptomatic right hallux valgus diagnosed via X-ray imaging. The examiner noted no right or left foot pain on manipulation. No functional loss was noted attributed to the right or left lower extremity. Imagining noted right foot hallux valgus and a medial sesamoid of the left foot which is bipartite in appearance. The VA examiner noted that the Veteran’s medial sesamoid of the left foot is a normal variant and does not warrant a diagnosis. Further, the examiner noted that such is not attributable to a cold weather injury. The examiner noted that the Veteran had burns to his right foot as a child requiring skin grafts. Currently the Veteran reports bilateral foot pain, which is unlikely due to musculoskeletal condition or residual of the burn injury. Etiology of the reported pain is unknown, as the Veteran’s pain is subjective. The examiner noted no evidence to support a musculoskeletal condition of the Veteran’s left foot. Further examination noted no pain on manipulation of feet. Examination and imagining noted no evidence of a cold weather injury or residuals of a cold weather injury. The examiner found that it is less likely than not that the Veteran’s current foot disability was incurred in or caused by an in service injury, event or illness. The examiner noted the Veteran had burns to his right foot from boiling water as a child requiring skin grafts. Examination noted no musculoskeletal residuals. The Veteran reports bilateral pain and such reported pain is unlikely due to residuals of the burn injury. The examiner noted that the Veteran’s pain is subjective and etiology unknown. The Veteran has a diagnosis of right foot hallus valgus which is asymptomatic, and the pain described by the Veteran is not consistent with this condition. Based on examination there is no evidence to support a musculoskeletal foot condition for the Veteran’s left foot. The examiner noted that was no evidence of pain on manipulation or evidence of a cold weather injury. VA and private treatment records have been associated with the claims file. VA treatment records note reports of foot pain at times but are absent indications of ongoing symptomology associated with a cold weather injury. These treatment record do not contradict the VA examination and are absent indications between the Veteran’s current feet symptomology and an in-service disease or injury, to include a cold weather injury. The weight of the competent and credible evidence is against the Veteran’s claim for service connection for residuals of a cold weather injury. While the Veteran believes his symptoms and in-service exposure are indicative of an ongoing cold weather injury and related to service, he is not competent to provide a nexus opinion in this case. The record does not reflect that he has the requisite training or expertise to offer a medical opinion diagnosing a cold weather injury, and linking current symptoms, if any to an in-service injury or exposure and as such he is not competent to provide a medical opinion in this case. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The Board finds that the medical evidence is more probative and more credible than the lay opinions of record. As to the Veteran’s general contentions of ongoing symptoms and manifestations the Veteran is competent to report his ongoing symptomology. However, the Board assigns low credible weight to the Veteran’s reports because the Veteran had opportunities to report these symptoms at numerous times during his ongoing VA primary care, follow-up and treatment. The December 2019 VA examination noted no evidence of a cold weather injury or residuals of a cold weather injury. The examiner found that it is less likely than not that the Veteran’s current foot disability was incurred in or caused by an in service injury, event or illness. Examination noted no musculoskeletal residuals. The Veteran reports bilateral pain and such reported pain is unlikely due to residuals of the burn injury. The examiner noted that was no evidence of pain on manipulation or evidence of a cold weather injury. Thus, the more probative evidence of record indicates the Veteran does not have a current cold weather injury and as such service connection is not warranted. As such, the Board finds that service connection for a cold weather injury is not warranted. Since the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107(b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990); 38 C.F.R. § 3.102. For these reasons, the claim for entitlement to service connection for a cold weather injury is denied. 5. Entitlement to service connection for an acquired psychiatric disorder anxiety disorder The Veteran contends that service connection is warranted for an acquired psychiatric disorder to include PTSD. The Veteran testified to ongoing symptoms of anxiety, depression, nightmares, difficulty sleeping, flashbacks and irritability which he attributes to in-service events. Service personnel records show that the Veteran was awarded an Army Commendation Medal for his work as a supply clerk for an infantry regiment from March 1985 to May 1988 that included deployment as part of a multinational force and observer in the Sinai, Egypt. The Veteran has a current diagnosis of major depressive disorder conforming to the to the DSM-V. The Veteran’s STRs have been associated with the claims file. On a September 1989 report of medical examination, a clinical psychiatric evaluation was normal. On a September 1989 report of medical history, the Veteran denied frequent trouble sleeping, depressive or excessive worry and nervous trouble of any sort. VA and Vet Center treatment records have been associated with the claims file and note ongoing symptoms of anxiety, nightmares and depression. The Veteran continues to undergo medication management and therapeutic treatment. The Veteran was afforded a VA examination in January 2020. The examiner noted that the Veteran does not have a diagnosis of PTSD that conforms to the DSM-V. The Veteran had a diagnosis of major depressive disorder, moderate and alcohol use disorder, moderate in sustained remission conforming to the DSM-V. The Veteran reported minimal social interactions outside of his family and ongoing sadness and depression. The Veteran reported ongoing difficulty driving especially on the highway due to an incident in service. The examiner noted that the Veteran’s symptoms are associated with his diagnosis of depression at this time as his alcohol use disorder is in remission. The examiner noted that the Veteran’s alcohol use disorder was more likely than not a coping mechanism for his mental health issues. The Veteran’s major depressive disorder results in occupational and social impairment with occasional decreases in work efficiency and intermittent ability to perform occupational tasks. The examiner note that clinical records note a diagnosis of PTSD. The Veteran reported stressors including in-service while serving as a truck driver at Fort Campbell, Kentucky, he hit a Volkswagen bug at night while raining and saved the other driver but there was blood everywhere. The examiner noted that this stressor does not meet the Criterion for a diagnosis of PTSD. A second stressor the Veteran reported was while stationed in Egypt he was involved in a firefight which did not meet the stressor requirements to support a diagnosis of PTSD. The Veteran reported symptoms including depressed mood, anxiety, panic attacks, chronic sleep impairment, disturbances of motivation and mood and difficulty establishing and maintaining effective work and social relationships. A mental status exam noted that the Veteran arrived on time and was appropriately dressed and groomed, he reported a sad mood and denied suicidal thinking. The Veteran is competent to manage his financial affairs. The VA examiner noted that it is at least as likely as not that the Veteran’s current major depressive disorder was incurred in or caused by the claim in service injury event or illness. The examiner noted that the Veteran reports distressing memories associated with stressors from service and such started soon after these events. The Veteran’s symptoms are severe enough that the Veteran sought out and continues to engage in psychotherapy and medication management. The examiner noted that over time the Veteran reports decreased socialization and a loss of interest in the hobbies he use to enjoy. The Veteran reports ongoing symptoms of depressed mood, anxiety, difficulty sleeping nightmares and isolating behaviors at times which are related to in-service stressors and events. The Veteran reports that his mental health symptomology began soon after service and has worsened over time. The Board finds the Veteran’s lay statements and associated testimony as to the account of the in-service events is credible. The Veteran is competent to describe his ongoing symptoms since service, and his statements are credible. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). In light of the VA opinion, treatment records and Veteran’s consistent statements the Board concludes that the evidence is at least in relative equipoise as to whether the Veteran’s current major depressive disorder is related to service and in-service events. The Board notes that there is both favorable and unfavorable evidence regarding the Veteran’s diagnosis of major depressive disorder but finds the Veteran’s reports of his ongoing symptoms and ongoing treatment records to be credible. Resolving reasonable doubt in the Veteran’s favor the Board finds that service connection is warranted for major depressive disorder as it is at least as likely as not that the Veteran’s current diagnosis of major depressive disorder is related to in-service events. As such the Board finds that service connection for major depressive disorder is granted. REASONS FOR REMAND 1. Entitlement to service connection for a skin disability to include eczema. The Veteran contends that service connection is warranted for a skin disability, to include eczema. The Veteran reports ongoing symptoms of eczema that began during service and flare ups when he is exposed to hot weather. Regrettably, another remand is warranted to comply with the prior remand directives. A remand by the Board confers upon the Veteran, as a matter of law, the right to compliance with the remand instructions, and imposes upon VA a concomitant duty to ensure compliance with the terms of the remand. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Where the remand orders of the Board are not complied with, the Board errs as a matter of law when it fails to ensure compliance. As such, another remand is warranted for a supplemental clarifying opinion. The Board cannot make a fully-informed decision on the issue of entitlement to service connection for a skin disability, to include eczema because no VA examiner has fully opined as to direct service connection. The Veteran was afforded a VA examination in December 2019. The Veteran reported an intermittent rash on his back that comes and goes. The examiner noted that that it is less likely than not that the Veteran’s eczema was incurred in or caused by the claimed in-service injury, event, or illness. However, the examiner failed provide a reasoned rationale for the conclusions reached and to fully address the Veteran’s lay statements. The Veteran testified that his symptoms of eczema began during service and have continued since with flare ups during warm weather. As such a remand is warranted for a supplemental opinion. The matter is REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding the Veteran’s eczema and whether: (a.) Is it at least as likely as not (a 50 percent probability of greater) that the Veteran’s eczema was caused by an in-service injury, event or disease? Review of the entire claims file is required. The examiner must provide a complete rationale for all findings and opinions, and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Attention is invited to the VA examination in December 2019. The Veteran reported an intermittent rash on his back that comes and foes. The examiner noted that that it is less likely than not that the Veteran’s eczema was incurred in or caused by the claimed in-service injury, event, or illness. Further, the Veteran testified to ongoing symptoms of eczema that began during service when exposed to hot weather and have continued since with ongoing seasonal flare ups. J.W. FRANCIS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K.R. Kardian, 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.