Citation Nr: 21013228 Decision Date: 03/09/21 Archive Date: 03/09/21 DOCKET NO. 15-33 724 DATE: March 9, 2021 ORDER Entitlement to service connection for a left foot disability manifested by numbness and pain due to an undiagnosed illness is granted. Entitlement to an initial disability rating in excess of 10 percent for residuals of a left wrist fracture is denied. Entitlement to an initial compensable disability rating for anemia is denied. REMANDED Entitlement to service connection for a right ankle disability is remanded. Entitlement to service connection for a left calf disability is remanded. FINDINGS OF FACT 1. The evidence is at least evenly balanced as to whether the Veteran’s left foot numbness and pain are due to an undiagnosed illness and manifested to a compensable degree. 2. Throughout the period on appeal, the Veteran’s service-connected left wrist disability is assigned the maximum schedular disability rating for limitation of motion of the minor wrist, and ankylosis is not shown by the evidence of record. 3. Throughout the period on appeal, the Veteran’s service-connected anemia has been manifested by hemoglobin of no less than 12.5 gm/100ml with symptoms of fatigue and lightheadedness. CONCLUSIONS OF LAW 1. Resolving all reasonable doubt in favor of the Veteran, the criteria for entitlement to service connection for a left foot disability manifested by numbness and pain due to an undiagnosed illness have been met. 38 U.S.C. §§ 1110, 1117, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.317. 2. The criteria for an initial disability rating in excess of 10 percent for residuals of a left wrist fracture have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.7, 4.40, 4.45, 4.71a, Diagnostic Codes 5010, 5215. 3. The criteria for an initial compensable evaluation for anemia have not been met. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 4.1, 4.7, 4.119, Diagnostic Codes 7700, 7720-23. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 1979 to April 2001. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a January 2012 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). This case was previously before the Board in March 2019 when the Veteran’s claims for entitlement to service connection for a left foot disability and increased ratings for a left wrist disability and anemia were remanded for additional development. The claims for service connection for a right ankle strain and left calf strain were denied at that time. The Veteran appealed the decision to the United States Court of Appeals for Veterans Claims (Court) which, in a September 2020 Order, vacated and remanded the denied issues for action consistent with a Joint Motion for Partial Remand (Joint Motion). 1. Entitlement to service connection for a left foot disability manifested by numbness and pain due to an undiagnosed illness Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131. Generally, the evidence 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. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); Caluza v. Brown, 7 Vet. App. 498, 505 (1995). Service connection may also be warranted for a Persian Gulf Veteran who exhibits objective indications of a qualifying chronic disability that became manifest during active military, naval, or air service in the Southwest Asia theater of operations during the Persian Gulf War, or to a degree of 10 percent or more prior to December 31, 2021. 38 U.S.C. § 1117; 38 C.F.R. § 3.317. For purposes of section 3.317, there are three types of qualifying chronic disabilities: (1) an undiagnosed illness; (2) a medically unexplained chronic multi-symptom illness; and (3) a diagnosed illness that the Secretary determines in regulations prescribed under 38 U.S.C. § 1117(d) warrants a presumption of service connection. 38 C.F.R. § 3.317(a)(2). An “undiagnosed illness” is defined as a condition that by history, physical examination, and laboratory tests cannot be attributed to a known clinical diagnosis. In the case of claims based on undiagnosed illness, unlike those for direct service connection, there is no requirement that there be competent evidence of a nexus between the claimed illness and service. Further, lay persons are competent to report objective signs of illness. Gutierrez v. Principi, 19 Vet. App. 1, 8-9 (2004). The term “objective indications of a qualifying chronic disability” includes both signs, in a medical sense of objective evidence perceptible to an examining physician, and other, non-medical indicators that are capable of independent verification. 38 C.F.R. § 3.317(a)(3). Signs or symptoms that may be manifestations of an undiagnosed illness or a medically unexplained chronic multisymptom illness include, but are not limited to, the following: (1) fatigue; (2) signs or symptoms involving skin; (3) headache; (4) muscle pain; (5) joint pain; (6) neurologic signs or symptoms; (7) neuropsychological signs or symptoms; (8) signs or symptoms involving the respiratory system (upper or lower); (9) sleep disturbances; (10) gastrointestinal signs or symptoms; (11) cardiovascular signs or symptoms; (12) abnormal weight loss; and (13) menstrual disorders. 38 C.F.R. § 3.317(b). For purposes of Gulf War undiagnosed illness claims, disabilities that have existed for six months or more and disabilities that exhibit intermittent episodes of improvement and worsening over a six-month period will be considered chronic. The six-month period of chronicity will be measured from the earliest date on which the pertinent evidence establishes that the signs or symptoms of the disability first became manifest. 38 C.F.R. § 3.317(a)(2)(5). The Veteran’s Certificate of Release or Discharge from Active Duty, DD Form 214, indicates that the Veteran served in Southwest Asia. Accordingly, consideration of his claim pursuant to 38 U.S.C. § 1117 and 38 C.F.R. § 3.317 is warranted. The Veteran’s service treatment records dated in October 1999 note that the Veteran complained of a 3-month history of numbness in his left foot. An EMG study showed denervation of the left tibial and left peroneal nerve and the Veteran was diagnosed with nerve palsy. The Veteran was afforded a VA examination in May 2011. At that time, the Veteran reported great toe numbness which has been constant since serve. The examiner found no clinical evidence of a foot disability. After a December 2019 VA foot examination, the examiner diagnosed the Veteran with left lower extremity radiculopathy but found that the condition was less likely than not related to service and that the Veteran’s left foot pain was “most likely” sciatica related to back pain. Thereafter, during a March 2020 VA back examination, the examiner noted that the Veteran’s low back pain did not radiate to his foot. Accordingly, the Veteran was afforded a VA examination in August 2020 to assess his peripheral nerves. The examiner was unable to determine if the Veteran’s left foot symptoms were due to a known clinical diagnosis. The Board finds that entitlement to service connection for a left foot disability manifested by numbness and pain due to an undiagnosed illness is warranted. First, the Veteran has indicated that he continues to suffer from left foot numbness and pain which are specifically listed as signs or symptoms of undiagnosed illness. 38 C.F.R. § 3.317(b). In addition, the Veteran has indicated that the symptoms have persisted since service, therefore, the evidence of record has established that the Veteran’s left foot numbness and pain has persisted more than six months. Moreover, the evidence shows that the Veteran’s left foot numbness and pain has not been attributed to a known clinical diagnosis. Finally, the criterion of manifesting to a compensable disability rating has been met. Notably, mild incomplete paralysis of the peripheral nerves affecting the feet generally provide for a 10 percent disability rating for mild incomplete paralysis. Here, the Board finds the Veteran’s symptoms have been of at least mild severity. For the above reasons, the evidence is at least in equipoise as to whether the Veteran has a left foot disability manifested by numbness and pain due to an undiagnosed illness. Resolving all reasonable doubt in favor of the Veteran, entitlement to service connection for a left foot disability due to an undiagnosed illness is warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Increased Ratings A disability rating is determined by the application of VA’s Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Board will consider whether separate ratings may be assigned for separate periods of time based on facts found, a practice known as staged ratings. Fenderson v. West, 12 Vet. App. 119, 126-27 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) ([I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran’s disability, after which a rating is determined based on the § 4.71a criteria.). Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011). In Correia v. McDonald, 28 Vet. App. 158 (2016), the Court held that the final sentence of 38 C.F.R. § 4.59 requires that the examiner record the results of range of motion testing for pain on both active and passive motion [and] in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint. In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that VA examiners must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from the veterans themselves, when a flare-up is not observable at the time of examination. 2. Entitlement to an initial disability rating in excess of 10 percent for residuals of a left wrist fracture The Veteran seeks an increased rating for his service-connected residuals of a left wrist fracture. He is currently in receipt of an initial 10 percent disability rating under 38 C.F.R. § 4.71a, Diagnostic Codes 5010-5214. Hyphenated Diagnostic Codes are utilized when a rating under one Diagnostic Code requires use of an additional Diagnostic Code to identify the basis for the evaluation assigned; the additional code is shown after the hyphen. 38 C.F.R. § 4.27. In this particular case, the hyphenated diagnostic code indicates that the left wrist disorder is manifested as traumatic arthritis under 5010, to be rated as ankylosis of the left wrist pursuant to Diagnostic Code 5214. During the course of the appeal, on November 30, 2020, VA issued a final rule revising 38 C.F.R. § 4.71a, the portion of the VA Schedule for Rating Disabilities that addresses the musculoskeletal system, effective February 7, 2021. The rule clarified that Diagnostic Code 5010 for post-traumatic arthritis is to be rated as limitation of motion, dislocation, or other specified instability under the affected joint. If there are 2 or more joints affected, each rating shall be combined in accordance with 38 C.F.R. § 4.25. Prior to February 7, 2021, the VA Schedule for Rating Disabilities stated that Diagnostic Code 5010 for arthritis due to trauma was to be rated as arthritis, degenerative under Diagnostic Code 5003. Under Diagnostic Code 5003, where limitation of motion is noncompensable under the appropriate diagnostic code, a rating of 10 percent may be applied to each such major joint or group of minor joints affected by limitation of motion. The limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. Furthermore, a 20 percent rating is warranted for x-ray evidence of arthritis with evidence of involvement of 2 or more major joints or 2 or more minor joint groups, with occasional incapacitating exacerbations. 38 C.F.R. § 4.71a, Diagnostic Code 5003. The 20 percent and 10 percent ratings based on x-ray findings will not be combined with ratings based on limitation of motion. Id., Note 1. When a new regulation is issued while a claim is pending before VA, unless clearly specified otherwise, VA must apply the new provision to the claim from the effective date of the change as long as the application would not produce retroactive effects. See VAOPGCPREC 7-03. If application of an amended regulation has a retroactive effect, then the regulation cannot be applied. Rodriguez v. Peake, 511 F.3d 1147, 1153 (Fed. Cir. 2008). Even if the amended versions are more favorable, the amended versions may only be applied as of their effective date and, before that time, only the former version of the regulation may be applied. See VAOPGCPREC 3-00; 65 Fed. Reg. 33,422 (2000); see also Kuzma v. Principi, 341 F.3d 1327, 1328-29 (Fed. Cir. 2003). Diagnostic Codes 5214 and 5215 assign disability ratings based on limitation of motion of the wrist. Neither code was affected by the November 2020 revision of the rating criteria regarding the musculoskeletal system. Diagnostic Code 5214 provides a 20 percent disability rating for favorable ankylosis of the minor wrist in 20 degrees to 30 degrees of dorsiflexion. For ankylosis causing any other position except favorable, a 30 percent disability rating is warranted. A maximum 40 percent disability rating is warranted for unfavorable ankylosis of the minor wrist in any degree of palmar flexion, or with ulnar or radial deviation. A note following Diagnostic Code 5214 states that extremely unfavorable ankylosis will be rated as loss of use of hands under Diagnostic Code 5125. 38 C.F.R. § 4.71a, Diagnostic Code 5214. Under Diagnostic Code 5215, a 10 percent rating is warranted for limitation of motion of the wrist manifested by dorsiflexion limited to less than 15 degrees or by palmar flexion limited in line with the forearm. This is the maximum possible schedular rating under Diagnostic Code 5215. 38 C.F.R. § 4.71a, Diagnostic Code 5215. Normal range of motion of the wrist includes dorsiflexion (extension) from zero to 70 degrees, palmar flexion from zero to 80 degrees, ulnar deviation from zero to 45 degrees, and radial deviation from zero to 20 degrees. 38 C.F.R. § 4.71a, Plate I. Handedness for the purpose of a dominant rating will be determined by the evidence of record, or by testing on VA examination. Only one hand shall be considered dominant. As demonstrated by the medical evidence of record, the Veteran is right-handed, and as such, a disability rating for his minor, left wrist is applicable here. See 38 C.F.R. § 4.69. Based on a review of the relevant evidence and the applicable law and regulations, the Board finds that the evidence most nearly approximates the current assignment of a 10 percent rating, and no higher, for the Veteran’s left wrist disability for the entire period on appeal. The Veteran was afforded a VA examination in May 2011. The Veteran reported that he used a wrist brace but continued to have pain. Range of motion testing revealed dorsiflexion to 55 degrees, palmar flexion to 45 degrees, radial deviation to 20 degrees, and left ulnar deviation to 45 degrees. There was no objective evidence of pain following repetitive motion and no additional limitations after repetition. The Veteran was afforded an additional VA examination in December 2019. At that time, the Veteran denied flare-ups of the wrist but stated he had constant numbness and pain that diminished his strength in the left hand. Range of motion testing revealed palmar flexion to 20 degrees, dorsiflexion to 20 degrees, ulnar deviation to 15 degrees, and radial deviation to 10 degrees. The examiner noted that the Veteran showed pain during the examination on rest/non-movement. The Veteran was able to perform repetitive-use testing without additional loss of function or range of motion. There was reduced muscle strength, but no muscle atrophy noted. There was no evidence of ankylosis in the left wrist. Imaging of the left wrist documented traumatic arthritis. The Veteran’s post-service treatment records document complaints of chronic left wrist pain and radiographs from May 2011 and May 2020 indicate that the Veteran had degenerative joint disease in the wrist. The Veteran was also noted to use a brace on his left wrist. After review of the above, the Board does not find that the Veteran’s left wrist disability warrants a rating in excess of 10 percent at any point during the appeal period, under either the old or revised schedule. Prior to February 7, 2021, the Veteran’s 10 percent disability rating is warranted for painful range of motion with x-ray evidence of degenerative joint disease. Considering the revised Diagnostic Code 5010 beginning February 7, 2021, the Veteran’s limitation of motion of the wrist warrants a 10 percent disability rating under Diagnostic Code 5215. There is no evidence of ankylosis sufficient for an increased rating under Diagnostic Code 5214. The Board has further considered the Veteran’s lay statements. He is competent to report his own observations with regard to the symptoms of his left wrist disability. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). However, nothing in the Veteran’s lay statement indicates that he meets the schedular criteria for a rating in excess of 10 percent for his left wrist disability. In addition, the Board considered whether a higher rating is warranted under the regulations relating to additional functional loss due to pain, weakness, fatigability, incoordination, and other factors under DeLuca, 8 Vet. App. at 204-07; 38 C.F.R. §§ 4.40, 4.45. The evidence of record does not indicate that the Veteran’s functional impairment due to DeLuca factors is equivalent to the criteria for a rating greater than 10 percent for his left wrist disability at any point during the period on appeal. While the Veteran has reported experiencing left wrist pain throughout the appeal period, a higher rating is still not warranted, as this pain is already contemplated in the assignment of the 10 percent rating for limitation of motion under Diagnostic Code 5215. See Johnston v. Brown, 10 Vet. App. 80, 84-5 (1997). There is similarly no evidence that the Veteran experiences flare-ups of left wrist pain that would equate to an increase in limitation of motion or involvement of multiple joints, as would be necessary for an evaluation in excess of 10 percent. Sharp v. Shinseki, 29 Vet. App. 26 (2017); Correia v. McDonald, 28 Vet. App. 158 (2016). Finally, to the extent that the Veteran reports that he has carpal tunnel in the wrist and a potential nerve problem in the arm, the Board notes that the Veteran is separately service-connected for left upper extremity radiculopathy as secondary to the left wrist fracture. The rating assigned for that disability and/or service connection for another neurologic disorder such as carpal tunnel syndrome are not presently before the Board. In sum, the preponderance of the evidence is against the assignment of a disability rating in excess of 10 percent for the service-connected left wrist disability at any time during the appeal period. The benefit-of-the-doubt rule is not applicable, and the appeal for an increased rating is denied. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). 3. Entitlement to an initial compensable disability rating for anemia The Veteran’s normocytic anemia is currently rated as noncompensable under Diagnostic Code 7700 for anemia, hypochromic-microcytic and megaloblastic, such as iron-deficiency and pernicious anemia. At the time the Veteran filed the claim, anemia disabilities were evaluated under Diagnostic Code 7700. On October 29, 2018, VA issued a final rule revising 38 C.F.R. § 4.117, the portion of the VA Schedule for Rating Disabilities that addresses the hemic and lymphatic systems, effective December 9, 2018. The final rule updated medical terminology, added certain hematologic diseases, and provided detailed and updated criteria for evaluating conditions pertaining to the hematologic and lymphatic systems. The rule removed Diagnostic Code 7700 (Anemia, hypochromic-microcytic and megaloblastic, such as iron-deficiency and pernicious anemia) and added separate diagnostic codes (7720-7723) for the four major types of anemia that are neither hereditary nor secondary (addressed under the diagnostic code for the causative condition). Under the rating criteria in effect prior to December 9, 2018, Diagnostic Code 7700 (anemia) provided that a 10 percent rating was warranted for a hemoglobin level of 10gm/100ml or less with findings such as weakness, easy fatigability, or headaches. A 30 percent rating was warranted for a hemoglobin level of 8 gm/100ml or less, with findings such as weakness, easy fatigability, headaches, lightheadedness, or shortness of breath. A 70 percent rating was warranted for a hemoglobin level of 7 gm/100 ml or less, with findings such as dyspnea on mild exertion, cardiomegaly, tachycardia (100 to 120 beats per minute) or syncope (three episodes in the last six months). A 100 percent rating was warranted for a hemoglobin level of 5 gm/100 ml or less, with findings such as high output congestive heart failure or dyspnea at rest. 38 C.F.R. § 4.117 (2018). As of December 9, 2018, the VA Schedule for Rating Disabilities includes Diagnostic Codes 7720 (iron deficiency anemia), 7721 (folic acid deficiency), 7722 (pernicious anemia and Vitamin B12 deficiency anemia), and 7723 (acquired hemolytic anemia). Under Diagnostic Code 7720, asymptomatic iron deficiency anemia or requiring treatment only by dietary modification warrants a 10 percent rating. Iron deficiency anemia requiring intravenous iron infusions at least 1 time but less than 4 times in a 12-month period or requiring continuous treatment with oral supplementation provides a 10 percent rating. Iron deficiency anemia requiring intravenous iron infusions 4 or more times per 12-month period warrants a maximum 30 percent rating. Under Diagnostic Code 7721, a noncompensable rating is provided for asymptomatic folic acid deficiency anemia or requiring treatment only by dietary modification. Folic acid deficiency anemia requiring continuous treatment with high-dose oral supplementation warrants a maximum 10 percent rating. Under Diagnostic Code 7722, pernicious anemia and Vitamin B12 deficiency anemia requiring continuous treatment with Vitamin B12 injections, Vitamin B12 sublingual or high-dose oral tablets, or Vitamin B12 nasal spray or gel warrants a 10 percent rating. An initial diagnosis requiring transfusion due to severe anemia, or if there are signs or symptoms related to central nervous system impairment, such as encephalopathy, myelopathy, or severe peripheral neuropathy, requiring parenteral B12 therapy warrants a 100 percent rating. Under Diagnostic Code 7723, acquired hemolytic anemia requiring one course of immunosuppressive therapy per 12-month period warrants a 10 percent rating. Acquired hemolytic anemia requiring at least 2 but less than 4 courses of immunosuppressive therapy per 12-month period warrants a 30 percent rating. Acquired hemolytic anemia requiring immunosuppressive medication 4 or more times per 12-month period warrants a 60 percent rating. Acquired hemolytic anemia requiring a bone marrow transplant or continuous intravenous or immunosuppressive therapy warrants a 100 percent rating. 38 C.F.R. § 4.117. The Veteran’s treatment records do not include hemoglobin results. The Veteran was afforded a VA examination in May 2011. At that time, the Veteran was diagnosed with anemia but stated he had not had his blood checked for anemia in years and that he had not been evaluated for the condition since his release from active service. The Veteran denied lightheadedness, weakness, and headaches. His hemoglobin lab value was 12.5 g/dL. The examiner indicated that the Veteran’s anemia was mild and asymptomatic and would not have any effect on his usual occupation or daily activities. The Veteran was afforded an additional VA examination in December 2019. At that time, the Veteran’s hemoglobin was noted to be 13 g/dL. He was diagnosed with normocytic anemia and noted that he experienced fatigue and lightheadedness at times. He denied current treatment. The examiner indicated that the Veteran did not have leukemia, multiple myeloma, agranulocytosis, essential thrombocythemia, primary myelofibrosis, or myelodysplastic syndromes and did not have sickle cell anemia. The examiner further stated that the Veteran’s hematologic condition would not impact his ability to work. Based on a review of the record, the Board finds that a compensable disability rating is not warranted. Prior to December 9, 2018, the Veteran’s hemoglobin levels, as shown in VA examination reports, have not been shown to be 10 gm/100 ml (g/dL) or less at any time during the appeal period. The Veteran’s bloodwork showed hemoglobin levels to be no less than 12.5 gm/100 ml (g/dL) throughout the appeal period. Accordingly, the Board finds that the evidence does not more nearly approximate a compensable rating under the criteria for Diagnostic Code 7700. The revised criteria effective December 9, 2018 for Diagnostic Codes 7720, 7721, 7722, and 7723 similarly do not warrant a compensable disability rating, as there is no evidence that the Veteran requires intravenous iron infusions, high-dose oral supplementation, continuous B12 therapy, or immunosuppressive therapy. The Board has also considered the Veteran’s lay statement that his anemia warrants a higher disability rating because he believes it is causing chronic pain in the major joints on his left side. See Statement in Support of Claim dated July 26, 2020. While he is competent to report symptoms of pain, as such comes to him through his senses, Layno v. Brown, 6 Vet. App. 465, 470 (1994), he is not competent to comment on the etiology of that pain. Competent evidence concerning the nature and extent of his anemia has been provided by the medical personnel who have examined him during the current appeal. There is no competent evidence of his anemia causing joint pain. Further, the medical findings (as provided in the examination reports and other clinical evidence) directly address the criteria under which this disability is evaluated. All potentially applicable diagnostic codes have been considered, and there is no basis to assign an alternative evaluation for the Veteran’s anemia disability other than that discussed above. See Schafrath v. Derwinski, 1 Vet. App. 589, 593 (1991). In sum, after a careful review of the evidence of record, the Board finds that the preponderance of the evidence is against the assignment of an initial compensable rating for service-connected anemia. The benefit-of-the-doubt rule is not applicable, and the appeal for a compensable rating is denied. 38 U.S.C. § 5107(b); Gilbert, 1 Vet. App. at 54-56. REASONS FOR REMAND 1. Entitlement to service connection for a right ankle condition is remanded. 2. Entitlement to service connection for a left calf condition is remanded. The August 2020 Joint Motion indicated that the May 2011 VA examiner’s opinion was inadequate to adjudicate the right ankle and left calf claims. Specifically, the VA examiner should have addressed the Veteran’s competent reports of right ankle and left calf symptoms since discharge. Accordingly, the claims must be remanded to obtain adequate VA examinations and opinions regarding the nature and etiology of the Veteran’s claimed right ankle and left calf disabilities. The matters are REMANDED for the following action: Schedule the Veteran for a VA examination to assess the nature and etiology of his claimed right ankle and left calf disabilities. All indicated tests and studies should be performed. After a review of the claims file, to include a copy of this remand, the examiner is asked to respond to the following: (a.) Identify all right ankle and left calf disabilities diagnosed during the appeal period (from March 2010). (b.) For each right ankle disability, is it at least as likely as not (a 50 percent or greater probability) that the disability had its onset in or is otherwise related to the Veteran’s period of active service? The examiner should note the Veteran’s reported continuity of right ankle symptomatology since the in-service December 1997 right ankle inversion injury. (c.) For each left calf disability, is it at least as likely as not (a 50 percent or greater probability) that the disability had its onset in or is otherwise related to the Veteran’s period of active service? The examiner should note the Veteran’s reported continuity of left calf symptomatology since his in-service report of numbness and pain in the distal calf in July 1999. The examiner should note that the Veteran is considered competent to report the events that occurred during service, including what symptoms he experienced, when those symptoms began, and how long they have persisted. The Veteran’s lay statements must be considered and weighed in making the determination as to whether a nexus exists between the claimed disability and the Veteran’s military service. A rationale should be provided for all opinions offered. G. E. Wilkerson Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Connor, Lindsey 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.