Citation Nr: 21013845 Decision Date: 03/10/21 Archive Date: 03/10/21 DOCKET NO. 10-47 891 DATE: March 10, 2021 ORDER Entitlement to a rating higher than 10 percent for status-post comminuted fracture of the left distal radius (left wrist) is denied. Prior to March 26, 2019, entitlement to a rating higher than 10 percent for status-post fracture of the left distal fibula (left ankle) is denied. As of March 26, 2019, a 20 percent rating is granted. New and material evidence having been received, the application to reopen the previously denied claim of entitlement to service connection for a left knee disability is granted. New and material evidence having been received, the application to reopen the previously denied claim of entitlement to service connection for a low back disability is granted. Entitlement to service connection for a cervical spine disability is denied. Entitlement to service connection for diabetes mellitus, type II, is denied. Entitlement to service connection for bilateral upper extremity peripheral neuropathy is denied. Entitlement to service connection for bilateral lower extremity peripheral neuropathy is denied. Entitlement to service connection for hypertension is denied. Entitlement to service connection for sinusitis is denied. Entitlement to service connection for bronchitis is denied. Entitlement to service connection for asthma is denied. Entitlement to service connection for arthritis is denied. Entitlement to service connection for joint pain is denied. REMANDED Entitlement to service connection for a left knee disability is remanded. Entitlement to service connection for a low back disability is remanded. FINDINGS OF FACT 1. Throughout the appeal period, the Veteran’s left non-dominant wrist disability has manifested by decreased range of motion, pain, weakness, and stiffness. No ankylosis of the left wrist has been demonstrated at any point during the appeal. 2. Prior to March 26, 2019, the Veteran’s left ankle disability picture manifested by “moderate” limitation of motion. Since March 26, 2019, it is factually ascertainable that, when considering flare-ups, the Veteran’s left ankle disability picture more closely approximates “marked” limitation of motion. At no point during the appeal period has the Veteran demonstrated, or contended that he experiences, ankylosis of any kind in his left ankle. 3. A May 1988 rating decision originally denied the Veteran’s claim for service connection for a left knee disability. He did not appeal that decision and it therefore became final. 4. Evidence received since the May 1988 related to the Veteran’s claim for service connection for a left knee disability is new and it is also material as it relates to an unestablished fact necessary to substantiate the claim. 5. A March 2002 rating decision last denied the Veteran’s claim for service connection for a low back disability. He did not appeal that decision and it therefore became final. 6. The evidence received since the March 2002 rating decision related to the Veteran’s claim for service connection for a low back disability is new and it is material as it relates to an unestablished fact necessary to substantiate the claim. 7. The Veteran’s cervical spine disability is less likely than not related to service, to include as a result of wear and tear. It is not shown to have manifested in service or within one year of service; it manifested several years after service. 8. Diabetes mellitus is not shown to have manifested in service or for years thereafter and the medical evidence of record weighs against the claim. 9. The Veteran’s bilateral upper extremity radiculopathy is not shown to have manifested in service or for years thereafter and the medical evidence of record weighs against the claim. 10. The Veteran’s bilateral lower extremity neuropathy is not shown to have manifested in service or for years thereafter and the medical evidence of record weighs against the claim. 11. The Veteran’s hypertension is not shown to have manifested in service or for years thereafter and the medical evidence of record weighs against the claim. 12. Sinusitis is not shown to have manifested in service or for years thereafter. The only medical opinion of record addressing the etiology of the Veteran’s respiratory disabilities weighs against the claim. 13. Asthma is not shown to have manifested in service or for years thereafter. The only medical opinion of record addressing the etiology of the Veteran’s respiratory disabilities weighs against the claim. 14. Bronchitis is not shown to have manifested in service or for years thereafter. The only medical opinion of record addressing the etiology of the Veteran’s respiratory disabilities weighs against the claim. 15. Arthritis is not shown to have manifested in service or for years thereafter. The only medical opinion of record addressing the etiology of the Veteran’s arthritis and the medical evidence of record weigh against the claim. 16. Joint pain is not shown to have manifested in service or for years thereafter. The only medical opinion of record addressing the etiology of the Veteran’s joint pain and the medical evidence of record weigh against the claim. CONCLUSIONS OF LAW 1. The criteria for entitlement to a rating higher than 10 percent for status-post comminuted fracture of the left distal radius have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1-4.14, 4.20, 4.21, 4.30, 4.40, 4.45, 4.59, 4.69, 4.71a, Diagnostic Code 5215. 2. Prior to March 26, 2019, the criteria for entitlement to a rating higher than 10 percent for status-post fracture of the left distal fibula have not been met. Since March 26, 2019, the criteria for entitlement to a higher 20 percent rating have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5003, 5014, 5262, 5270, 5271. 3. The May 1988 rating decision denying the Veteran’s claim for entitlement to service connection for a left knee disability is final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1100. 4. Evidence received since the May 1988 rating decision related to the Veteran’s claim for service connection for a left knee disability is new and material. The criteria for reopening the claim for entitlement to service connection for a left knee disability have been met. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 5. The March 2002 rating decision denying the Veteran’s claim for entitlement to service connection for a low back disability is final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1100. 6. Evidence received since the March 2002 rating decision related to the Veteran’s claim for service connection for a low back disability is new and material. The criteria for reopening the claim for entitlement to service connection for a low back disability have been met. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 7. The criteria for entitlement to service connection for a cervical spine disability have not been met. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. § 3.102, 3.303, 3.304, 3.307, 3.309. 8. The criteria for entitlement to service connection for diabetes mellitus, type II, have not been met. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. § 3.102, 3.303, 3.304, 3.307, 3.309. 9. The criteria for entitlement to service connection for bilateral upper extremity peripheral neuropathy have not been met. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. § 3.102, 3.303, 3.304, 3.307, 3.309. 10. The criteria for entitlement to service connection for bilateral lower extremity peripheral neuropathy have not been met. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. § 3.102, 3.303, 3.304, 3.307, 3.309. 11. The criteria for entitlement to service connection for hypertension have not been met. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. § 3.102, 3.303, 3.304, 3.307, 3.309. 12. The criteria for entitlement to service connection for sinusitis have not been met. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. § 3.102, 3.303, 3.304, 3.307, 3.309. 13. The criteria for entitlement to service connection for asthma have not been met. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. § 3.102, 3.303, 3.304, 3.307, 3.309. 14. The criteria for entitlement to service connection for bronchitis have not been met. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. § 3.102, 3.303, 3.304, 3.307, 3.309. 15. The criteria for entitlement to service connection for arthritis, to include arthritis of the feet, have not been met. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. § 3.102, 3.303, 3.304, 3.307, 3.309. 16. The criteria for entitlement to service connection for joint pain have not been met. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. § 3.102, 3.303, 3.304, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty service from January 1980 to April 1980 and again from July 1980 to July 1983. In January 2014, he testified at a hearing before a Decision Review Officer (DRO). A transcript of the hearing is of record. As previously noted, in June 2018, the Board denied some of the issues listed above and remanded the remaining issues for further development. The Veteran then appealed that decision and in April 2019, the parties submitted a Joint Motion for Remand, requesting that the issues be vacated and remanded. The Court of Appeals for Veterans Claims (the Court) granted the motion in a May 2019 Order, and the case was returned to the Board. In September 2019, the Board remanded the claims for further development. The development included: (1) sending the Veteran a VCAA-compliant notice; (2) obtaining outstanding service personnel records; (3) obtaining all relevant outstanding VA and private treatment records; (4) obtaining specific VA treatment records scanned into VISTA; and (5) obtaining a VA addendum opinion addressing the nature and etiology of the Veteran’s cervical spine disability. A review of the record shows that the RO sent the Veteran a VCAA-compliant letter in July 2020, obtained all relevant VA treatment records as well as a VA addendum opinion, and requested a complete copy of the Veteran’s service medical records file as well as his entire personnel file from NPRC in October 2020. As such, there has been substantial compliance with the Board’s remand directives. See Stegall v. West, 11 Vet. App. 268 (1998). Increased Rating Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4. The rating schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. 1. Entitlement to a rating higher than 10 percent for status-post comminuted fracture of the left distal radius. The Veteran’s status-post comminuted fracture of the left distal radius (left wrist) is currently rated as 10 percent disabling under Diagnostic Code 5215 for the entire appeal period. Normal range of motion for the wrist is 70 degrees of dorsiflexion (extension) and 80 degrees of palmar flexion. 38 C.F.R. § 4.71, Plate I. Normal ulnar deviation is 45 degrees, while normal radiation deviation is 20 degrees. Id. Diagnostic Code 5215 provides for a maximum rating of 10 percent for limitation of motion of the wrist for either the dominant or non-dominant hand when dorsiflexion is less than 15 degrees or when palmer flexion is limited in line with the forearm. 38 C.F.R. § 4.71a. A 10 percent rating is the maximum rating available under Diagnostic Code 5215. Because the Veteran is currently in receipt of the maximum available rating, further consideration under Diagnostic Code 5215 could not afford the Veteran a higher rating. Diagnostic Code 5214 pertains to ankylosis of the wrist. In the minor extremity, this is evaluated as follows: unfavorable ankylosis in any degree of palmar flexion or with ulnar or radial deviation (40 percent); unfavorable ankylosis in any other position (30 percent); or favorable ankylosis, defined as in 20 to 30 degrees of dorsiflexion (20 percent). 38 C.F.R. § 4.71a, Diagnostic Code 5214. Effective February 7, 2021, VA revised the criteria for evaluating musculoskeletal disorders. See Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76453, 76464 (Nov. 30, 2020); Correction, 86 Fed. Reg. 8142, 8143 (Feb. 4, 2021) (changing new diagnostic code applicable to plantar fasciitis from 5285 to 5269). However, Diagnostic Codes 5215 and 5214 were not amended and remain the same both prior to February 7, 2021, and thereafter. 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, including the March 2019 VA examination report, the Veteran is right-handed, and as such, a wrist disability rating for his non-dominant left hand is applicable here. See 38 C.F.R. § 4.69. 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). However, a higher rating based on functional loss may not exceed the highest rating available under the applicable diagnostic code pertaining to range of motion. See Johnston v. Brown, 10 Vet. App. 80, 85 (1997). In this instance, as noted above, the Veteran is already in receipt of the highest rating available based on range of motion. To warrant a higher rating, the evidence would have to demonstrate some level of ankylosis. The Veteran was afforded a VA examination for his left wrist in October 2009. On examination, it was noted that the course of the Veteran’s disability was stable. He had a fair response to treatment. Pain, stiffness, weakness, incoordination, and decreased speed of joint motion was noted on examination. The Veteran endorsed flare-ups after “picking up something heavy or twisting the wrist.” Pain was alleviated by Tylenol, Neurontin (taken for his non-service-connected peripheral neuropathy) and discontinuing the motion that caused the pain. Decreased strength of 3/5 was noted on examination. There was objective evidence of pain on active motion. The Veteran demonstrated dorsiflexion to 35 degrees; palmar flexion to 30 degrees; left radial deviation to 20 degrees; and ulnar deviation to 10 degrees. There was objective evidence of pain following repetitive use. However, there was no additional loss of motion. VA treatment records from January 2011 document complaints of left wrist pain. A VA EMG consult from May 2013 showed evidence of median mononeuropathy across the wrist bilaterally affecting both sensory and motor fibers. The findings were consistent with moderate carpal tunnel syndrome. There was also evidence of a mild polyneuropathy with slowing of conduction velocities in several nerves examined which suggested a diffuse process of mild demyelination. The findings were thought to be consistent with an early diabetic polyneuropathy, for which the Veteran is not service-connected. VA treatment records from June 2013 indicate that the Veteran was measured, fit, and issued wrist splints following the recommendations made post-EMG. At his January 2014 DRO hearing, the Veteran reported wearing a brace and gloves. He endorsed pain, stiffness, swelling, and limited movement in his left wrist. On VA examination in February 2014, the Veteran reported having limited mobility in his left wrist. He denied experiencing flare-ups and had palmar flexion to 55 degrees with no objective evidence of painful motion; and dorsiflexion to 55 degrees with no objective evidence of painful motion. There was no additional loss of motion on repetitive use. Muscle strength testing was normal and there was no ankylosis of either wrist. A VA examination report dated in August 2017 notes normal muscle strength in wrist flexion and extension. The Veteran endorsed flare-ups of the wrist and stated when his wrist flares, he tries to use it as little as possible. The Veteran was afforded an additional VA examination for his left wrist disability in March 2019. At the time of examination, he reported a worsening in the course of his condition as he experienced increased pain, tingling, swelling, stiffness, and weakness. Regarding flare-ups, the Veteran reported increased pain, stiffness, and weakness. According to the Veteran’s statements, the loss of range of motion during a flare is variable, depending on how strenuously the joint is used. On range of motion testing, the Veteran had palmar flexion to 40 degrees; dorsiflexion to 40 degrees; ulnar deviation to 25 degrees; and radial deviation to 20 degrees. Pain was noted on examination and found to cause functional loss in all ranges of motion. There was pain on palpation of the left wrist joint. The Veteran was unable to perform repetitive use testing with at least three repetitions as a result of 8/10 pain and increased stiffness. No level of ankylosis of the wrist was found. Specifically, the examiner found that the Veteran did not experience favorable ankylosis in 20 to 30 degrees dorsiflexion; extremely unfavorable ankylosis; or unfavorable ankylosis of any kind. The Veteran’s range of motion was the same on passive motion. Following a thorough review of the evidence, the Board finds that a disability rating higher than 10 percent for the Veteran’s left wrist is not warranted at any point during the appeal period. As noted above, under Diagnostic Code 5215, a 10 percent rating is warranted when palmar flexion is limited in line with the forearm or dorsiflexion is less than 15 degrees. The Veteran is currently in receipt of a 10 percent rating under this Diagnostic Code. Higher ratings are not provided under Diagnostic Code 5215. Thus, a higher schedular rating for the wrist is only warranted when there is evidence of ankylosis, rated under 38 C.F.R. § 4.71a, Diagnostic Code 5214. However, the Veteran has not claimed, and the objective medical evidence does not demonstrate that his left wrist has been ankylosed at any time during the pendency of the claim. No other diagnostic codes are appropriate for rating the Veteran’s left wrist disability. As the Veteran has been assigned the maximum schedular rating under 38 C.F.R. § 4.71a, Diagnostic Code 5215, and does not qualify for a schedular rating under 38 C.F.R. § 4.71a, Diagnostic Code 5214 for ankylosis, the Veteran’s claim must be denied. 2. Entitlement to a rating higher than 10 percent for status-post fracture of the left distal fibula. The Veteran’s status-post fracture of the left distal fibula (left ankle) is currently rated as 10 percent disabling, for the entire appeal period, under Diagnostic Code 5262. This Diagnostic Code contemplates tibia and fibula impairment. However, a review of the evidence shows that the Veteran’s impairment is in his ankle specifically. Therefore, he is more appropriately rated under Diagnostic Code 5271. As noted above, effective February 7, 2021, VA revised the criteria for evaluating musculoskeletal disorders. See Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76453, 76464 (Nov. 30, 2020); Correction, 86 Fed. Reg. 8142, 8143 (Feb. 4, 2021) (changing new diagnostic code applicable to plantar fasciitis from 5285 to 5269). VA’s General Counsel has held that where a law or regulation changes during the pendency of a claim for a higher rating, the Board must first determine whether the revised version is more favorable to the veteran. In so doing, it may be necessary for the Board to apply both the old and new versions of the regulation. If the revised version of the regulation is more favorable, the retroactive reach of that regulation under 38 U.S.C. § 5110(g) can be no earlier than the effective date of that change. The Board must generally apply both the former and the revised versions of the regulation for the period prior and subsequent to the regulatory change, but an effective date based on the revised criteria may be no earlier than the date of the change. VA thus must consider the claim for a higher rating pursuant to the former and revised regulations during the latter part of this appeal. See VAOPGCPREC 3 2000, 65 Fed. Reg. 33,422 (2000); DeSousa v. Gober, 10 Vet. App. 461, 467 (1997). Therefore, the Board will consider the Veteran’s claim under the old criteria prior to February 7, 2021 and both the old and new rating criteria from February 7, 2021. The criteria that is more favorable to the Veteran will be applied. As of February 7, 2021, Diagnostic Code 5262 now states malunion of the tibia and fibula should be evaluated under diagnostic codes 5256, 5257, 5260, or 5261 for the knee, or 5270 or 5271 for the ankle, whichever results in the highest evaluation. The new rating criteria also discuss shin splints. However, in this instance, the evidence of record does not support that the Veteran experiences shin splints. See e.g. March 2019 VA Examination Report. In addition, the Veteran’s status-post fracture of the left distal fibula has not resulted in nonunion with loose motion requiring a brace. Prior to February 7, 2021, under DC 5262, a 10 percent rating was assigned for malunion of the tibia and fibula with slight knee or ankle disability. A 20 percent rating was assigned for malunion of the tibia and fibula with moderate knee or ankle disability, a 30 percent rating was assigned for malunion of the tibia and fibula with marked knee or ankle disability, and a 40 percent rating was assigned for nonunion of the tibia and fibula, with loose motion, requiring a brace. Under Diagnostic Code 5270, ankylosis (total loss of motion) of the ankle is rated at 40, 30, or 20 percent, depending on the position in which the ankle is frozen. Under Diagnostic Code 5271, limitation of motion of the ankle is rated at 20 percent if marked and 10 percent if moderate. On VA examination in October 2009, the Veteran reported pain in the left lower leg/ankle. There was no fracture or history of deformity. No assistive devices were needed for walking. The Veteran’s left ankle fracture was noted to affect motion of the joint. The Veteran endorsed flare-ups of the ankle in the form of pain which occurred daily, lasted hours, and were severe. On examination, his gait was normal. There was no deformity, giving way, or instability. Pain, stiffness, weakness, incoordination, and decreased speed of joint motion was noted. The Veteran reported having a cane but not using it for his left ankle. On range of motion testing, he had dorsiflexion to 10 degrees and plantar flexion to 20 degrees. There was objective evidence of pain with active motion on the left side. There was objective evidence of pain following repetitive motion but no additional limitations after three repetitions of range of motion. No joint ankylosis was found. VA treatment records from December 2010 and January 2011 note left ankle pain. It was noted that prolonged ambulation, walking, and strenuous activities increased pain. The Veteran had full range of motion in the ankle. The remainder of the Veteran’s VA treatment records document ankle pain. See e.g. May 2020 VA Treatment Records (noting the Veteran has limited movement in his left ankle with pain in the back of his ankle). On VA examination in February 2014, the Veteran reported wearing an ankle brace when he slept. He took meloxicam for ankle pain and thought he had arthritis in his ankle. He denied flare-ups. On range of motion testing, he had left ankle plantar flexion to 30 degrees with no objective evidence of painful motion; and left ankle plantar dorsiflexion to 15 degrees with no objective evidence of painful motion. He was able to perform repetitive use testing with no additional loss of motion. Muscle strength testing revealed normal strength in the left ankle. Anterior drawer and talar tilt testing did not reveal any laxity compared to the opposite side. There was no ankylosis. There had not been a total ankle joint replacement. Nor had there been any arthroscopic or other ankle surgery. The Veteran did not use any assistive devices as a normal mode of locomotion. Diagnostic testing did not reveal any abnormal findings. The Veteran was afforded additional VA examination for his left ankle in March 2019. A diagnosis of status-post fracture left distal fibula was noted; arthritis was not diagnosed. The Veteran reported daily pain, weakness, and stiffness. He reported that his condition affected his left hip. He is separately service connected for impairment of the left hip (osteoarthritis, limitation of extension, and limitation of flexion). See December 2020 Rating Decision. The propriety of these ratings is not currently before the Board. Instead, the Board must focus on the functional loss caused by the Veteran’s left ankle in determining the appropriate rating. On examination, the Veteran endorsed symptoms of daily pain, stiffness, and weakness that is unrelieved by pain meds. Regarding flare-ups, he reported increased pain and stiffness that limits his ability to walk. He reported difficulty with standing and walking for long periods. On range of motion testing, he had dorsiflexion to 15 degrees and plantar flexion to 25 degrees. Pain was noted on examination during both ranges of motion. There was objective evidence of localized tenderness or pain on palpation of the joint as well as pain with weight bearing and crepitus. The Veteran was able to perform repetitive use testing; however, he had additional loss of motion. He demonstrated plantar flexion to 20 degrees (0-45) and dorsiflexion to 10 degrees (0-20). Pain and weakness were noted. Regarding flares and on repetitive use over time, the examiner noted that the Veteran’s range of motion is variable, depending on how strenuously the joint is used. He stated that, at worst, he cannot move his ankle at all due to pain and weakness, but there are other times where his range of motion loss is minimal. An antalgic gait on the left side was noted. Muscle strength testing revealed 4/5 strength (active movement against some resistance). There was no muscle atrophy and no ankylosis of any kind was demonstrated or observed. Ankle instability or dislocation was not suspected. The Veteran did not have shin splints. Constant use of a cane and regular use of a brace was noted. The Veteran’s passive range of motion was the same as active. Having considered all of the evidence of record, the Board finds that prior to March 26, 2019, the evidence shows that the Veteran’s left ankle disability manifested by moderate limitation of motion, such that a rating higher than 10 percent is not warranted. However, as of March 26, 2019, it is factually ascertainable that the Veteran’s left ankle disability picture more nearly approximated “marked” limitation of motion, such that a higher 20 percent rating is warranted as of that date. At no point during the appeal period has the Veteran demonstrated any ankylosis of the left ankle such that a rating under DC 5270 is warranted. Because the Board is rating the Veteran’s ankle disability under Diagnostic Codes 5270 and 5271, the new and old rating criteria are essentially the same. Prior to March 26, 2019, the evidence shows that, at worst, the Veteran had left ankle plantar flexion to 30 degrees with no objective evidence of painful motion and left ankle plantar dorsiflexion to 15 degrees with no objective evidence of painful motion. Normal endpoint for plantar flexion is 45 degrees and normal endpoint for dorsiflexion is 20 degrees. Thus, the evidence shows that prior to March 26, 2019, the Veteran retained more than half of his range of motion in the left ankle. He did not have any additional loss of motion of the ankle following repetitive use testing. Further, the Veteran reported that he did not experience flare-ups that impacted the function of his left ankle. Therefore, the Board finds that his disability picture more nearly approximated moderate limitation of motion, such that the currently assigned 10 percent rating is appropriate. However, as of March 26, 2019, the date the Veteran was afforded a VA examination for his left ankle, the Board finds that the Veteran’s left ankle disability more nearly approximated “marked” limitation of motion, such that a higher 20 percent rating is warranted. On VA examination in April 2019, the Veteran reported his left ankle impacting his ability to stand and walk for long periods of time. He demonstrated plantar flexion to 20 degrees and dorsiflexion to 10 degrees, which is less than of the normal range of motion. Furthermore, he reported that during flares, he is unable to move his left ankle at all. He conceded that his left ankle disability did not manifest by ankylosis as he reported that sometimes during flares his loss of motion was minimal. The Board has considered the Veteran’s lay statements regarding his left ankle disability. Indeed, the VA examination reports of record are based on the Veteran’s lay reports regarding his symptoms. To the extent, however, the Veteran feels that higher ratings are warranted, the Board affords more probative weight to the medical evidence of record. The Board does not dispute that the Veteran is competent to report symptoms such as pain and weakness. However, the VA examination reports are the most probative as they document the Veteran’s lay reports and also provide objective testing results as it applies to the rating criteria. In sum, the Board finds that prior to March 26, 2019, a rating higher than 10 percent for the Veteran’s left ankle disability is not warranted. However, as of March 26, 2019, a higher 20 percent rating is warranted. This is the highest rating available based on loss of motion and the Veteran has not demonstrated any level of ankylosis at any point during the appeal period. The Board has considered the new regulations implemented effective February 7, 2021 in rendering a decision. However, the new and old regulations are the same and would not afford the Veteran a higher rating at any point during the appeal period. 3. Whether new and material evidence has been received to reopen the previously denied claim of entitlement to service connection for a left knee disability. New evidence is evidence not previously submitted to agency decision makers. Material evidence is 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 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). In determining whether new and material evidence has been received, VA must initially decide whether evidence associated with the claims file since the prior final denial is new. That analysis is undertaken by comparing newly received evidence with the evidence previously of record. After evidence is determined to be new, the next question is whether it is material. The Board must review all evidence submitted by or on behalf of a claimant since the last final denial on any basis to determine whether a claim must be reopened. Evans v. Brown, 9 Vet. App. 273 (1996). For purposes of determining whether new evidence is material, the credibility of the new evidence is presumed. Justus v. Principi, 3 Vet. App. 510 (1992). New and material evidence is not required as to each previously unproven element of a claim. Shade v. Shinseki, 24 Vet. App. 110 (2010). Entitlement to service connection for a left knee disability was previously denied by a May 1988 rating decision. The Veteran did not appeal that decision and therefore it became final. Thus, in order for VA to consider this claim on the merits, new and material evidence must be submitted. The Board directed the RO to send the Veteran notice regarding the requirements for new and material evidence that complied with the VCAA in connection with his left knee disability claim. As noted above, the Veteran has been provided with such notice. The May 1988 rating decision noted an in-service injury and denied the Veteran’s claim on the basis that he did not have a currently diagnosed disability. Specifically, the RO stated: In October 1981, he complained of pain in the left knee after playing football. There were no further complaints during service and VA exam shows no residual disability of the sprain. Since the May 1988 rating decision, a voluminous amount of records, including VA treatment records, have been added to the claims file. These records show left knee pain with potential functional loss (though with full range of motion) related to the Veteran’s left hip and left ankle. The VA treatment records show that he experiences pain with radiation from hip to foot. This evidence raises a new theory of entitlement, secondary service-connection, and also raises doubt as to whether or not the Veteran has a currently diagnosed left knee disability. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). As such, it is both new and it is also material as it relates to an unestablished fact necessary to substantiate the Veteran’s claim. Therefore, the claim for service connection for a left knee disability is reopened. To this extent only, the appeal is granted. 4. Whether new and material evidence has been received to reopen the previously denied claim of entitlement to service connection for a low back disability. A May 1988 rating decision original denied the Veteran’s claim for service connection for low back strain on the basis that there was no diagnosis for such a condition in service, within a year of service, and that no such condition had been linked to service. However, the RO conceded that there was a diagnosis of low back strain at the time of the rating decision. In April 2000, the Veteran sought to reopen his claim for service connection for a low back disability. A March 2002 rating decision declined to reopen the Veteran’s claim for a low back disability for a lack of the introduction of new and material evidence. The Veteran did not appeal that decision and it is now final. 38 U.S.C. § 7104. In December 2009, the Veteran sought to reopen his claim for entitlement to service connection for a low back disability. At that time, he also provided a statement in which he described jumping from planes which had put “tremendous wear and tear” on him and that he believed his back disability was caused by the physical demands required by his military service. Additional evidence added to the record since the final March 2002 RO decision includes additional statements from the Veteran, medical records from a correctional facility, VA treatment records, a VA examination, the Veteran’s DRO hearing testimony, and previously submitted copies of the Veteran’s service treatment and military personnel records. An April 2012 VAMC record indicated the Veteran did not have any complaints of back pain. In January 2014, the Veteran testified before a DRO. He stated that he believed the weight of his parachute pack caused his back disability. The Veteran was afforded a VA examination for his low back in April 2014. The examiner did not find that the Veteran had a low back disability. The Veteran denied that he had a diagnosed low back disability but stated that he had chronic low back pain. He stated he believed his low back pain was due to his carrying heavy loads in the military. X-rays did not indicate that the Veteran had arthritis on the Veteran had full range of motion on examination. There was no evidence of functional loss due to the Veteran’s low back pain. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). The examiner stated that there was no pathology upon which to offer an opinion as the Veteran did not have a diagnosable low back disability. However, it is worth noting that VA treatment records from February 2019 document “significant lumbar osteoarthritis.” In the June 2019 JMR, the parties agreed that remand was warranted for the Board to consider Shade, supra, as it applies to the Veteran’s statements regarding an in-service injury to the low back. In this instance, since the March 2002 rating decision, the Veteran has submitted evidence indicative of an in-service injury, which is an unestablished fact. This fact triggered VA’s duty to provide a medical examination. Indeed, as noted above, the Veteran was afforded a VA examination April 2014 to address the etiology of his low back disability. An opinion was not rendered because the evidence did not show a diagnosed low back disability. However, the evidence of record now establishes that the Veteran does in fact have significant osteoarthritis of the low back. As such, the evidence is new, and it is also material. Therefore, the claim for service connection for a low back disability is reopened. To this extent only, the appeal is granted. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated during service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. That determination requires a finding of current disability that is related to an injury or disease in service. Watson v. Brown, 4 Vet. App. 309 (1993); Rabideau v. Derwinski, 2 Vet. App. 141 (1992). Service connection may be granted for a disability diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability is due to disease or injury that was incurred or aggravated in service. 38 C.F.R. § 3.303(d). Service connection may be presumed for certain chronic diseases which develop to a compensable degree within one year after discharge from service, even though there is no evidence of such disease during the period of service. That presumption is rebuttable by probative evidence to the contrary. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. § 3.307, 3.309(a). Where the evidence shows that the Veteran had a chronic condition in service or during an applicable presumption period and still has that chronic disability, service connection can be granted. That does not mean that any manifestations in service will permit service connection. To show 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 entity is established, there is no requirement of evidentiary showing of continuity. 38 C.F.R. § 3.303(b). If there is no evidence of a chronic condition during service or an applicable presumptive period, then a showing of continuity of symptoms after service may serve as an alternative method of establishing service connection. 38 C.F.R. § 3.303(b). Continuity of symptoms may be established if a claimant can demonstrate (1) that a condition was noted during service; (2) evidence of post- service continuity of the same symptomatology and (3) medical or, in certain circumstances, lay evidence of a nexus between the present disability and the post-service symptomatology. If service connection is established by continuity of symptomatology, there must be medical evidence that relates a current condition to that symptomatology. Continuity of symptoms applies only to those conditions explicitly recognized as chronic. 38 C.F.R. § 3.309(a); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). 5. Entitlement to service connection for a cervical spine disability. An October 2017 VA examination report confirms a diagnosis of cervical spine degenerative joint disease. In addition, the Veteran’s service treatment records show that in June 1981, he “fell directly on head while carrying neck stack.” He complained of a headache and neck pain at the time. On his later June 1983 Report of Medical History, he specifically denied experiencing any swollen or painful joints, frequent or severe headaches, and head injury. He did endorse other symptoms unrelated to his cervical spine and on his discharge examination, his neck was found to be clinically normal. Regardless, the first and second element of service connection have been met. The question before the Board is therefore whether there is a so-called “nexus” between the Veteran’s current cervical spine disability and service. The Veteran was afforded VA examinations for his cervical spine in February 2014 and August 2017 and a VA addendum opinion was obtained in November 2020. The VA examiners found that the Veteran’s cervical spine disability was less likely than not incurred in or caused by his active duty service, including his June 1981 in-service neck injury. In February 2014, in support of his opinion, the examiner explained that the Veteran’s separation examination did not show any neck complaints or abnormality. He stated that there is no evidence of an injury to the neck during active duty service that was significant enough to expect any long-term consequences. In November 2015, the Board remanded the Veteran’s claim for further opinion. Specifically, the Board found the February 2014 VA medical opinion was incomplete as the examiner did not discuss the Veteran’s lay assertions of sustaining a neck disability as a result of physical training and paratrooper activity. As a result, the Veteran was afforded additional VA examination in August 2017. After performing a thorough in-person examination and considering the Veteran’s entire claims file, including his lay statements, the examiner again opined that the Veteran’s cervical spine disability was less likely than not related to service. As rationale, the examiner stated: Veteran suffered an acute cervical strain [on] June 4, 1981 after a fall. [He] was treated conservatively and no follow up notes or other neck complaint is noted in STR or within one year of discharge. The vast majority of strains heal well without residuals in young healthy people as this Veteran was at the time of injury which is well documented in the medical literature. This is further supported by the fact that this individual was able to continue in a physically strenuous rate for the completion of his enlistment 2 years after neck injury per his statements this date. There is no objective evidence of chronic neck injury due to service. As noted by the Board in its September 2019 decision, the JMR determined that the Board failed to ensure substantial compliance with its prior remand directives and a remand was warranted to obtain a medical opinion that complied with the November 2015 Board remand. It notes that the August 2017 VA examination report “did not offer an opinion as to whether Appellant’s cervical spine condition was at least as likely as not related to his physical training and/or paratrooper training while in service.” Because the August 2017 VA examination report did discuss the Veteran’s acute injury in June 1981, the Board sought a VA addendum opinion specifically addressing whether the Veteran has a current neck disability that is related to wear and tear from physical training and paratrooper training. In November 2020, a VA medical opinion was obtained. The examiner opined that the Veteran’s cervical spine disability was less likely than not related to service. In support of his opinion, the examiner explained that: The Veteran was diagnosed with degenerative arthritis of cervical spine in 2014, about 31 years after he left active service. During service, the condition of cervical sprain/strain was acute only. There is insufficient medical documentation and no evidence of chronicity of care. A nexus has not been established. Based on this examiner’s review of current peer-reviewed literature along with a Cochrane Database Systemic Review, this examiner could not find any literature that reports any objective evidence that any neck sprain/strain leads to cervical spine degenerative arthritis. According to literature reviews, advanced age is one of the strongest risk factors associated with degenerative osteoarthritis. It is more likely the cervical spine degenerative arthritis is related to the natural aging process with wear and tear of day-to-day life. Therefore, [it is] less likely than not that any current neck disability had its onset during any period of service, or is otherwise related to such periods of service, to include any physical training and/or paratrooper training. When taken together, the Board finds the February 2014, August 2017, and November 2020 VA medical opinions highly probative. The examiners considered the Veteran’s entire medical history and provided clear conclusions with supporting rationale. The examiners considered whether the Veteran’s in-service injury as well as any potential wear and tear caused his current cervical spine degenerative joint disease. Significantly, the Veteran has not presented or identified any contrary medical opinion that supports the claim for service connection. The only medical opinions of record show that the Veteran’s cervical spine disability is not related to his active duty service. The Board has considered the Veteran’s lay statements, including his January 2014 hearing testimony. Although he is competent to describe the observable symptoms of his cervical spine disability, including pain, he is not competent to opine as to its etiology. He has not been shown to possess the requisite training or credentials needed to render a competent opinion as to medical diagnosis or causation. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). As such, his lay opinion does not constitute competent medical evidence and lacks probative value. In sum, the claims file does not contain competent and credible evidence that the Veteran’s cervical spine disability is related to service. As the preponderance of the evidence is against the claim for service connection, the benefit-of-the-doubt rule is not for application, and the claim must be denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 6. Entitlement to service connection for diabetes mellitus, type II; entitlement to service connection for bilateral lower extremity peripheral neuropathy; and Entitlement to service connection for bilateral upper extremity peripheral neuropathy; and entitlement to service connection for hypertension. The Veteran’s VA treatment records document diagnoses of diabetes mellitus, type II, diabetic bilateral upper and lower extremity peripheral neuropathy, and hypertension. Therefore, the first element of service connection has been met. However, the Board finds that there is no evidence of record linking the Veteran’s diabetes, bilateral upper and lower extremity neuropathy, and hypertension to his active duty service. As admitted by the Veteran and supported by the evidence of record, he did not have any issues or complaints regarding diabetes, neuropathy of any extremity, or high blood pressure while in-service. No such conditions or symptomology of such conditions were noted or found during his June 1983 separation examination. Indeed, on his Report of Medical History on separation, the Veteran specifically denied high or low blood pressure, as well as frequent urination, or sugar in urine, which can be indicative of diabetes. Instead, the first documented complaints regarding these conditions are found in his correctional medical record, almost 20 years after his separation from service. The passage of many years between discharge from active service and the documentation of a claimed disability is a factor that tends to weigh against a claim for service connection. Maxson v. Gober, 230 F. 3d 1330 (Fed. Cir. 2000). Additionally, there is no evidence of record, including the Veteran’s own statements, that he was experiencing any continuity of symptomology for diabetes or diabetes-like symptoms, or any complaints or pain of his extremities, or vascular system since his separation from service. It is clear from the evidence of record that no demonstrated condition of diabetes, hypertension, or bilateral upper and lower extremity neuropathy was noted during service and no continuity of such symptomology was evident post-service. Additionally, the Board notes that the Veteran has not identified, and no such record has been indicated to be in evidence, which purports to link the Veteran’s diabetes, bilateral upper and lower extremity neuropathy, or hypertension to his active duty service. None of the numerous medical providers who have treated the Veteran related these disabilities to his active duty service. The Board has considered the Veteran’s lay statements, including his January 2014 hearing testimony. Although he is competent to describe the observable symptoms of his diabetes, bilateral upper and lower extremity neuropathy, and hypertension, he is not competent to opine as to their etiology, as he has not been shown to possess the requisite training or credentials needed to render a competent opinion as to medical diagnosis or causation. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Further, as noted, the Veteran himself has not identified any in-service injury of which these disabilities may be related to. As such, his lay opinion does not constitute competent medical evidence and lacks probative value. In sum, the claims file does not contain competent and credible evidence that the Veteran’s diabetes, bilateral upper and lower extremity neuropathy, and hypertension are related to service. Accordingly, as the preponderance of the evidence is against the claims for service connection, the benefit-of-the-doubt rule is not for application, and the claims must be denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 7. Entitlement to service connection for bronchitis; entitlement to service connection for sinusitis; and entitlement to service connection for asthma. Regarding the Veteran’s sinusitis, asthma, and bronchitis, the Board also finds no such link between the Veteran’s active service and these conditions is supported by the record. The Veteran’s VA treatment records document a diagnosis of asthma. In addition, VA treatment records from April 2015 document that the Veteran had sinus symptoms and a cough for a week. The Veteran reported having seasonal allergies. See also April 2012 VA Treatment Records (noting a “previous diagnosis” of sinusitis). He has been prescribed sodium chloride 0.9% to irrigate his sinuses twice a day. Further, VA treatment records from March 2020 document “mild bronchial wall thickening.” Therefore, the first element of service connection has been met. Regarding the second, “in-service injury” element, the Board acknowledges that the Veteran had an in-service diagnosis and was treated for irritative bronchitis, which is, by definition, acute in nature. There is no indication that this condition was persistent in nature and that he had continued symptomology which did not resolve. The Veteran did not make continued complaints of bronchitis symptoms and did not indicate on his June 1983 separation examination that he either had such symptoms or was continuing to suffer from such complaints. Indeed, on his Report of Medical History on separation, he specifically denied sinusitis, hay fever, asthma, shortness of breath, chronic cough, and pain or pressure in chest. Additionally, all of the Veteran’s in-service chest X-rays were normal, including one in August 1982, after his treatment for irritative bronchitis. There is no indication in the Veteran’s service treatment records that he had any complaints of or diagnosis of either asthma or sinusitis. Furthermore, there is no indication that he suffered from any respiratory symptomology in the year after his service. In a May 2000 VA treatment record he denied asthma or sinus infection and reported bronchitis by history, not as a current medical concern. His first report of asthma was in January 2005, over twenty years after his active service. The first diagnosis of sinusitis contained in the record also occurred over twenty years after his active service and the August 2017 VA examiner reported that the Veteran did not have a current diagnosis of bronchitis. Once again, the passage of many years between discharge from active service and the documentation of a claimed disability is a factor that tends to weigh against a claim for service connection. Maxson, 230 F. 3d 1333. It is clear from the evidence of record, then, that no demonstrated respiratory disability including sinusitis, asthma, or bronchitis was diagnosed during service and there was no evidence of post-service continuity of any respiratory symptomatology. The Board notes that the August 2017 VA examiner found that that it was less likely than not that the Veteran’s claimed conditions were incurred in or caused by his active duty service, including his February 1981 in-service diagnosis of irritative bronchitis. The Board finds the August 2017 examiner’s medical opinion highly probative to the issue of whether the Veteran’s respiratory disabilities including sinusitis, asthma, and bronchitis were related to his active duty service. The examiner possessed the necessary education, training, and expertise to provide the requested opinion. Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). The opinion was based on a review of the claims file and examination of the Veteran. The examiner’s review of the Veteran’s claims file consisted of his service treatment records and post-service medical evidence, and his contentions, upon which the examiner relied upon in giving the opinion. It is clear that the examiner took into consideration all relevant factors in giving their opinion. Significantly, the April 2019 JMR did not state that the August 2017 VA examination report was inadequate. The Veteran has not presented or identified any contrary medical opinion that supports the claims for service connection for any respiratory disability. None of the numerous medical providers who have treated the Veteran related his conditions to his active duty service. The Board finds that the only medical opinion of record shows that the Veteran’s sinusitis, asthma, and bronchitis are not related to his active duty service. The Board has considered the Veteran’s lay statements, including his January 2014 hearing testimony. Although he is competent to describe the observable symptoms of his respiratory disabilities, he is not competent to opine as to its etiology. He has not been shown to possess the requisite training or credentials needed to render a competent opinion as to medical diagnosis or causation. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). As such, his lay opinion does not constitute competent medical evidence and lacks probative value. In sum, the claims file does not contain competent and credible evidence that the Veteran’s respiratory disabilities including sinusitis, asthma, and/or bronchitis are related to service. Accordingly, as the preponderance of the evidence is against the claim for service connection, the benefit-of-the-doubt rule is not for application, and the claim must be denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 8. Entitlement to service connection for arthritis, to include arthritis of the feet; and entitlement to service connection for joint pain. Finally, regarding the Veteran’s claim for joint pain and arthritis, the Board again finds that no such link between the Veteran’s active service and these conditions is supported by the record. Although the evidence of record shows that the Veteran currently has a diagnosis of joint pain and arthritis, there is no indication that the Veteran had any injury or complaint of such pain or symptomology regarding all the major joints in his body or arthritis during service. His June 1983 separation examination did not report such complaints or make any findings of such conditions being present. Furthermore, the Veteran did not make continued complaints of joint and/or arthritic pain within a year of his separation from service. The first reports of any joint pain or foot pain or arthritis occurred over 20 years after the Veteran’s separation from service. Once again, the passage of many years between discharge from active service and the documentation of a claimed disability is a factor that tends to weigh against a claim for service connection. Maxson, 230 F. 3d 1333. It is clear from the evidence of record, then, that no demonstrated joint or arthritic disability was diagnosed during service and there was no evidence of post-service continuity of any such symptomatology. The Board notes that the August 2017 VA examiner found that that it was less likely than not that the Veteran’s arthritis was incurred in or caused by his active duty service. The examiner identified numerous other potential causes for the Veteran’s arthritic complaints and did not find any link to his service. The Board finds the August 2017 examiner’s medical opinion highly probative to the issue of whether the Veteran’s arthritic complaints and joint pain were related to his active duty service. The examiner possessed the necessary education, training, and expertise to provide the requested opinion. The examiner took into consideration all relevant factors in giving their opinion. Significantly, the April 2019 JMR did not state that the August 2017 VA examination report was inadequate. Instead, in the April 2019 JMR, the parties agreed that the Board had not previously provided sufficient reasons and bases for its decision. Specifically, the JMR states: Upon remand, the Board must address Appellant’s argument that his arthritis and joint pain are secondary to his service-connected fracture of the left distal radius. (December 2012 written statement noting that he “would like to add the fact that my claim for service connection for both arthritis and joint pain is secondary to my []fracture left distal radius”). VA is obliged to provide an examination when the record contains competent evidence that the claimant has a current disability or signs and symptoms of a current disability, the record indicates that the disability or signs and symptoms of disability may be associated with active service [or a service-connected disability]; and the record does not contain sufficient information to make a decision on the claim. 38 U.S.C. § 5103A(d); McLendon v. Nicholson, 20 Vet. App. 79 (2006). Although the threshold for finding a link between a current disability and service is low, there is still a threshold. Locklear v. Nicholson, 20 Vet. App. 410 (2006). If a veteran’s mere contentions, standing alone, were enough to satisfy the “indication of an association” threshold, then that element of 38 U.S.C. § 5103A is meaningless. An interpretation of a statute that renders part of the statutory language superfluous is to be avoided. See Splane v. West, 216 F.3d 1058, 1068-69 (Fed. Cir. 2000) (holding that canons of construction require us to give effect to the clear language of statute and avoid rendering any portions meaningless or superfluous). It is clear to the Board that more than a mere contention is required. Despite the Veteran’s contentions, the evidence of record does not otherwise support a potential relationship between the Veteran’s general joint pain and arthritis, and his left distal fracture. Significantly, the Board is remanding the Veteran’s claim for a left knee disability because the medical evidence of record supports a possible relationship between his knee and left distal fracture. However, the low threshold in McLendon, suggesting a link between the Veteran’s general joint pain and arthritis and his service-connected left ankle disability has not been met. Put differently, there is no medical evidence that the Veteran’s general joint pain and arthritis was caused or potentially aggravated by his left ankle disability. Instead, the Veteran has advanced such theory by his own lay statements. These statements are not competent as they involve a complex medical question. As such, VA is not obligated to obtain a VA medical opinion as to that theory of entitlement. Significantly, the Veteran has not presented or identified any contrary medical opinion that supports the claims for service connection for either joint pain or arthritis. None of the numerous medical providers who have treated the Veteran related his conditions to his active duty service. The Board finds that the only medical opinion of record showed that the Veteran’s arthritis and joint pain were not related to his active duty service. The Board has considered the Veteran’s lay statements, including his January 2014 hearing testimony. Although the Veteran is competent to describe the observable symptoms of any arthritis, such as pain, he is not competent to opine as to such a condition’s etiology, as he has not been shown to possess the requisite training or credentials needed to render a competent opinion as to medical diagnosis or causation. As such, his lay opinion does not constitute competent medical evidence and lacks probative value. In sum, the claims file does not contain competent and credible evidence that the Veteran’s arthritis and/or general joint pain are related to service or a service-connected disability. As the preponderance of the evidence is against the claims for service connection, the benefit-of-the-doubt rule is not for application, and the claims must be denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990).   REASONS FOR REMAND 1. Entitlement to service connection for a left knee disability. As noted above, the Board has reopened the Veteran’s claim for a left knee disability. VA treatment records suggest a potential relationship between the Veteran’s now service-connected left hip disability, his service-connected left ankle disability, and his left knee pain with functional loss. Therefore, remand is warranted to afford the Veteran a VA examination to determine the etiology of any diagnosed left knee disability. 2. Entitlement to service connection for a low back disability. As noted above, the Veteran’s VA treatment records document a diagnosis of severe low back osteoarthritis. The Veteran contends that his low back disability was caused by the wear and tear of parachuting and his military duties generally. He was afforded a VA examination for his low back in February 2014. The examiner found that an opinion could not be rendered as the Veteran did not have a diagnosable low back disability. Given the evidence of a current low back disability, remand is warranted for further VA medical opinion. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination with an appropriate clinician to determine the etiology of any diagnosed left knee disability. The examiner must review the claims file. If a diagnosis cannot be provided but the Veteran’s condition manifests in symptoms that cause functional impairment, then the examiner should consider them a “disability” for the purpose of providing the requested opinion(s) below. The examiner is asked to provide a response to the following: (a) Whether the Veteran’s left knee disability is at least as likely as not directly related to service. In so opining, the examiner must consider the October 1981 complaint of pain in the left knee after playing football. (b) Whether the Veteran’s left knee disability was at least as likely as not caused by his service-connected left ankle disability; (c) Whether the Veteran’s left knee disability was at least as likely as not aggravated by his service-connected left ankle disability; (d) Whether the Veteran’s left knee disability was at least as likely as not caused by his service-connected left hip disabilities; (e) Whether the Veteran’s left knee disability was at least as likely as not aggravated by his service-connected left hip disabilities. A complete rationale for any medical opinion rendered must be provided. 2. Obtain a VA medical opinion from an appropriate clinician addressing the etiology of the Veteran’s severe low back osteoarthritis. The need for an in-person examination is left to the discretion of the examiner. The examiner is advised that he or she may contact the Veteran via telephone to elicit any additional information regarding his low back disability. The examiner must review the claims file and is asked to opine: (a.) Whether the Veteran’s low back disability is at least as likely as not related to his active duty service. The examiner must address the Veteran’s contentions regarding the wear and tear on his back from parachuting and general military duties and address the likelihood that wear and tear caused the low back osteoarthritis. A complete rationale for any medical opinion rendered must be provided. H.M. WALKER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Martha R. Luboch, 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.