Citation Nr: 21021576 Decision Date: 04/13/21 Archive Date: 04/13/21 DOCKET NO. 16-07 084 DATE: April 13, 2021 ORDER Withdrawal having been requested, the appeal to reopen entitlement to service connection for bilateral hearing loss is dismissed. Withdrawal having been requested, the appeal for entitlement to service connection for drug abuse is dismissed. New and material evidence has been received and the claim to reopen service connection for an acquired psychiatric disability, to include posttraumatic stress disorder (PTSD), depression, bipolar disorder, and other specified disorder, is granted. New and material evidence has not been received and the claim to reopen service connection for back disability is denied. New and material evidence has been received and the claim to reopen service connection for left hip disability is granted. New and material evidence has not been received and the claim to reopen service connection for right knee disability is denied. New and material evidence has not been received and the claim to reopen service connection for right foot pes planus is denied. Service connection for nodule, upper lobe, left lung is granted. REMANDED Service connection for an acquired psychiatric disability to include PTSD, depression, bipolar disorder, and other specified disorder, is remanded. Service connection for a left hip disability is remanded. FINDINGS OF FACT 1. During the Veteran’s November 2019 Board hearing, after certification of the appeal to the Board and prior to the issuance of a decision, the Veteran’s representative requested to withdraw from appeal the claim to reopen the Veteran’s claim for service connection for bilateral hearing loss. 2. During the Veteran’s November 2019 Board hearing, after certification of the appeal to the Board and prior to the issuance of a decision, the Veteran’s representative requested to withdraw from appeal the Veteran’s claim for service connection for drug abuse. 3. Since the most recent, final January 2017 rating decision, new and material evidence has been received that raises a reasonable possibility of substantiating the Veteran’s claim for service connection for an acquired psychiatric disability, to include PTSD, depression, bipolar disorder, and other specified disorder. 4. Since the most recent, final August 2015 rating decision, new evidence has been received, but the evidence is cumulative and redundant of the evidence of record and does not raise a reasonable possibility of substantiating the Veteran’s claim for service connection for a back disability. 5. Since the most recent, final January 2017 rating decision, new and material evidence has been received that raises a reasonable possibility of substantiating the Veteran’s claim for service connection for a left hip disability. 6. Since the most recent, final January 2017 rating decision new but not material evidence has been received, and the evidence is cumulative and redundant of evidence of record and does not raise a reasonable possibility of substantiating the Veteran’s claim for service connection. 7. Since the most recent, final August 2015 rating decision, no new and material evidence has been submitted to reopen the claim for service connection for right foot pes planus. 8. The Veteran’s nodule, upper lobe, left lung had its onset during active military service. CONCLUSIONS OF LAW 1. The criteria for withdrawal from appeal of the Veteran’s claim to reopen his claim for service connection for bilateral hearing loss by the Veteran’s authorized representative have been met. 38 U.S.C. § 7105; 38 C.F.R. § 19.55. 2. The criteria for withdrawal from appeal of the Veteran’s claim for service connection for drug abuse by the Veteran’s authorized representative have been met. 38 U.S.C. § 7105; 38 C.F.R. § 19.55. 3. Since the most recent, final January 2017 rating decision, the criteria to reopen the claim for service connection for an acquired psychiatric disability, to include PTSD, depression, bipolar disorder, and other specified disorder, have been met. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.156, 20.1103 4. Since the most recent, final August 2015 rating decision, the criteria to reopen the claim for service connection for a back disability have not been met. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.156, 20.1103. 5. Since the most recent, final January 2017 rating decision, the criteria to reopen the claim for service connection for a left hip disability have been met. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.156, 20.1103. 6. Since the most recent, final January 2017 rating decision, the criteria to reopen the claim for service connection for a right knee disability have not been met. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.156, 20.1103. 7. Since the most recent, final January 2017 rating decision, the criteria to reopen the claim for service connection for right foot pes planus have not been met. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.156, 20.1103. 8. The criteria for service connection for a nodule, upper lobe, left lung, are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Navy from July 1985 until his honorable discharge in December 1988, with previous service in the United States Air National Guard in 1983. This appeal has been advanced on the Board of Veterans’ Appeals’ (Board) docket pursuant to 38 U.S.C. § 7107(b) and 38 C.F.R. § 20.902(c). These matters come before the Board on appeal from the following: 1. An August 2015 decision by the Huntington, West Virginia, Regional Office (RO) of the United States Department of Veterans Affairs (VA), which denied reopening of the Veteran’s claim for service connection for nodule, upper lobe, left lung. 2. A September 2018 decision by the Huntington, West Virginia, RO of VA, which (a) denied service connection for drug abuse; (b) denied reopening of the Veteran’s claim for service connection for bilateral hearing loss; and (c) reopened and denied the Veteran’s claims for service connection for (i) back disability, (ii) left hip disability, (iii), right foot pes planus, and (iv) right knee disability. 3. An October 2018 decision by the Huntington, West Virginia, RO of VA, which denied reopening of the Veteran’s claims for service connection for (a) depression (previously denied as bipolar and other specified disorder) and (b) right foot pes planus. In November 2020, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge (VLJ). At this point, the Board notes that it has recharacterized the Veteran’s claim for service connection for depression (previously claimed as bipolar and other specified disorder) as a claim for service connection for an acquired psychiatric ability, to include posttraumatic stress disorder (PTSD), depression, bipolar disorder, and other specified disorder. See Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009) (finding that the scope of a claim may include any disorder that may reasonably be encompassed by the claimant’s description of the claim, reported symptoms, and other information of record). During a pre-hearing conference, the Veteran’s representative confirmed that the Veteran’s claim for service connection for drug abuse was to be encompassed, as a potential symptom, in his claim for service connection for an acquired psychiatric disability. November 2020 Board Hearing Transcript, at 2. During the hearing, the undersigned held the record open for 60 days to allow for the submission of additional evidence relating to the Veteran’s claim for service connection for an acquired psychiatric disability. The Veteran’s representative submitted a request on December 15, 2020, for an additional 60-day extension, which the Board granted from December 15, 2020; however, no additional evidence was submitted within the time period. Withdrawal of Appeals 1. Bilateral hearing loss 2. Drug abuse “Only an appellant, or an appellant’s authorized representative, may withdraw an appeal. An appeal may be withdrawn as to any or all issues involved in the appeal.” 38 C.F.R. §§ 19.55(a); see also 38 U.S.C. § 7105 (statutory authority). Section 19.55 speaks to the procedure for written withdrawals in Legacy appeals. It does not mention, nor prohibit, verbal withdrawals during a Board hearing. The prior version of section 19.55 was found in 38 C.F.R. § 20.204, which specifically acknowledged that issues on appeal could be withdrawn on the record during a Board hearing. Compare 38 C.F.R. § 20.204 (effective through February 18, 2019) with 38 C.F.R. § 19.55 (effective February 19, 2019). The Board finds no legal reason to read section 19.55 or 38 U.S.C. § 7105 as prohibiting an appellant or a representative from orally withdrawing an issue on appeal in a Legacy case during a Board hearing. See generally Christensen v. Harris Cty, 529 U.S. 576, 588 (2000) (an agency has discretion where conduct is not statutorily prohibited). Oral withdrawal of an appeal is only effective where the withdrawal is “explicit, unambiguous, and done with a full understanding of the consequences of such action on the part of the claimant.” DeLisio v. Shinseki, 25 Vet. App. 45, 57 (2011). When a representative withdraws an issue on appeal on behalf of an appellant, the Board must first find that the appellant understood the consequences of his representative’s actions before finding that a claim has been orally withdrawn. Acree v. O’Rourke, 891 F.3d 1009, 1013–15 (Fed. Cir. 2018) (adopting the DeLisio standard and requiring that the Board make findings as to whether the appellant understood the consequences of withdrawing claims, even if the alleged withdrawal was made by an appointed representative). Prior the start of November 2020 Board Hearing, the Veteran, his representative and the undersigned VLJ held a pre-hearing conference at which time it was determined the Veteran was withdrawing his appeal to reopen his claim for service connection for bilateral hearing loss and his appeal for service connection for drug abuse. November 2020 Board Hearing Transcript, at 2–3, 18. Specifically, it was understood the Veteran’s claim for service connection for drug abuse was to be considered as part of the symptomatology for his claim for service connection for an acquired psychiatric disability rather than a separate claim. Id. at 2. Based on the pre-hearing conference and the statements made on the record, the Board finds the Veteran understood the consequences of his representative’s actions. The withdrawal of these appeals was unambiguous, and the Veteran was fully informed of the consequences during the pre-hearing conference. Accordingly, the Board finds these issues on appeal are properly withdrawn. There remains no determination on these issues with which the Veteran disagrees. As such, those appeals are dismissed. New and Material Evidence To appeal a rating decision, the appellant must file a “notice of disagreement” “within one year from the date of the mailing of notice of the decision of the agency of original jurisdiction.” 38 U.S.C. § 7105(b)(1)(A); 38 C.F.R. § 19.2(c). A notice of disagreement must be submitted in writing and identify the specific determination with which the claimant disagrees. 38 U.S.C. § 7105(b)(2)(A). If no notice of disagreement is filed within the prescribed period, the action or decision of the agency of original jurisdiction becomes final from the date notice was mailed. 38 U.S.C. § 7105(c). For the purposes of reopening claims decided by the agency of original jurisdiction (AOJ) before February 19, 2019 (the effective date of the Veterans Appeals Improvement and Modernization Act of 2017), such claims are still considered “Legacy appeals” and are to be analyzed under VA’s traditional “Legacy” process. See 38 C.F.R. § 3.156(a); 38 C.F.R. § 3.2400(b). Under the Legacy process, a veteran “may reopen a finally adjudicated legacy claim by submitting new and material evidence.” 38 C.F.R. § 3.156(a). Here, the Veteran’s claims on appeal were finally adjudicated by the AOJ in August 2015, September 2018, and October 2018; thus, the “new and material evidence” standard applies. Regardless of the AOJ’s determination as to whether new and material evidence was received, the Board must address the issue in the first instance because it ultimately affects the Board’s jurisdiction to adjudicate the underlying claims. See Woehlaert v. Nicholson, 21 Vet. App. 456, 460‒61 (2007) (citation omitted). The Board must perform a two-step analysis when a veteran seeks to reopen a final decision based on new and material evidence. See Manio v. Derwinski, 1 Vet. App. 140, 145 (1991). First, it must determine whether the evidence presented or secured since the last final disallowance is “new and material.” Id. If it is, the Board must then reopen the claim and “evaluate the merits of the veteran’s claim in light of all the evidence, both new and old.” Id. “New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim and must raise a reasonable possibility of substantiating the claim.” 38 C.F.R. § 3.156(a). The language of section 3.156(a) “does not require new and material evidence as to each previously unproven element of a claim”; instead, it compels reopening whenever a claimant submits new and material evidence “as to an unestablished fact from the previously denied claim.” Shade v. Shinseki, 24 Vet. App. 110, 121 (2010). “New evidence” “is evidence not previously part of the actual record before agency adjudicators.” 38 C.F.R. § 3.156(a). “Material evidence” means “evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim.” 38 C.F.R. § 3.156(a). VA is required to presume the credibility of newly submitted evidence for the purposes of determining whether that evidence is material and sufficient to reopen a previously denied claim. Justus v. Principi, 3 Vet. App. 510, 513 (1992). In Shade, the Court held that the language of section 3.156(a), requiring the new evidence raise a reasonable possibility of substantiating the claim, is an analytical guide that creates a low threshold rather than a separate element. Id. at 117. In determining whether the low threshold inquiry is met, however, VA should consider whether the new and material evidence could, if the claim were reopened, reasonably substantiate the claim, to include triggering VA’s duty to assist or through consideration of an alternative theory of entitlement not previously established by the evidence, id. at 117‒19, but not including “presentation of new arguments based on evidence already of record at the time of the previous decision,” Untalan v. Nicholson, 20 Vet. App. 467, 470 (2006) (emphasis added). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b). The law requires the Board address its reasons for rejecting evidence favorable to the Veteran. Timberlake v. Gober, 14 Vet. App. 122, 128‒29 (2000). The Board must review the entire record but does not have to discuss each piece of evidence. Gonzales v. West, 218 F.3d 1378, 1381 (Fed. Cir. 2000). The analyses below focus on the most salient and relevant evidence within the relevant appeal periods and on what this evidence shows, or fails to show, on the claims. 3. Acquired psychiatric disability The Board first addresses what evidence was of record and what facts were established as of the January 2017 rating decision. Service connection for PTSD is governed by 38 C.F.R. § 3.304(f), which requires: (1) medical evidence diagnosing the condition in accordance with the DSM-5, 38 C.F.R. § 4.125(a); (2) credible supporting evidence that the claimed in-service stressor occurred, and (3) a link, established by the medical evidence, between current symptoms and an in-service stressor. The RO provided the Veteran two in-person VA examinations to address his acquired psychiatric disabilities. A June 2015 VA examiner diagnosed the Veteran with specified bipolar disorder and related disorder. A December 2016 VA examiner diagnosed the Veteran with alcohol use disorder, cocaine use disorder, and cannabis use disorder. Thus, the Veteran had a valid psychiatric diagnosis under the DSM-5. As to an in-service stressor, it appears that the Veteran did not identify a stressor prior to January 2017. Notably, each VA examiner opined that the Veteran’s acquired psychiatric disabilities were less likely than not caused by his active military service. Neither examiner discussed an in-service stressor. Instead, June 2015 VA examiner found the Veteran’s acquired psychiatric disabilities were due to his cocaine use. And the December 2016 VA examiner found his alcohol, cocaine, and cannabis use disorders were primary, meaning they developed on their own independent of his active service. Thus, the Board finds evidence of an in-service stressor was not established at the time of the January 2017 rating decision. Following the August 2019 statement of the case, the Veteran submitted a statement in which he said—for the first time—that he developed derepression because during his separation examination a spot/blemish was discovered on his left lung. He feared for his future because he was not sure what the spot/blemish would do following his service. He claimed that following his separation from service a VA physician misdiagnosed his spot/blemish as chronic bronchitis. He was informed by a VA pulmonologist that chronic bronchitis does not start as a spot/blemish on a lung. The spot grew in size and had to be removed surgically. He constantly thought of his premature death as a result of the misdiagnosis. During his November 2020 Board hearing, the Veteran testified—for the first time—that he believed he developed PTSD due to an incident while serving on the U.S.S. Brewton. He testified that he was almost pulled overboard during a refueling event. His life vest became entangled with a line. He feared for his life. He testified he currently received therapy for the event due to the nightmares he had. He also testified that while serving in the Philippines he was attacked at knife point; it is not clear if this was aside from his service or part of active combat. These events, he believes, have caused him to have PTSD. The Board presumes the evidence relating to his claimed in-service stressors is credible. The Board finds this evidence was not part of the record before the AOJ when it issued its October 2018 rating decision. Therefore, this evidence is “new.” 38 C.F.R. § 3.156(a). The Board also finds this evidence, individually and collectively, is material evidence. 38 C.F.R. § 3.156(a). The evidence relates to an unestablished fact of an in-service stressor. The Board finds the Veteran has submitted new and material evidence warranting reopening of his claim for service connection for an acquired psychiatric disability. The evidence raises a reasonably possibility of substantiating his claim. 38 C.F.R. § 3.156(a). Notably, no medical examination has been obtained addressing his claimed in-service stressors nor has verification of his stressors occurred. 4. Back disability When the Veteran filed his claim for service connection for a back disability in December 2014, he asserted that his back disability was secondary to his service-connected left foot pes planus with bone spurs. He was afforded an in-person VA examination in June 2015. At that time, the examiner documented that the Veteran experienced a gradual onset of back pain since 2012. The Veteran’s diagnosis was “malalignment” and his recommended treatment was “physical therapy.” The only symptom he reported at that time was pain for which he took Naproxen. The Veteran did not report flare-ups. His range-of-motion test results and strength test results were all within normal limits. The only effect on his occupational abilities was noted “pain.” The examiner concluded that there was no objective evidence of a back disability, only subjective complaints of pain. The Veteran’s VA medical records through August 2015 also revealed only subjective complaints of pain without functional impairment. The RO issued an August 2015 rating decision, which is final, denying service connection for a back disability because the Veteran did not have a diagnosed back disability. Thus, the only established fact as of the August 2015 rating decision was that the Veteran was service connected for left foot pes planus. The unestablished facts of consequence as of the August 2015 rating decision were: (1) that the Veteran had a current back disability; (2) an in-service event, injury, or illness related to a back disability; and (3) that any such back disability was caused by or aggravated by his service-connected left foot disability or was otherwise etiologically related to his active military service, i.e., a medical nexus. When the Veteran filed his claim to reopen in July 2018, he did not specify what theory of service connection he was relying on, nor did he provide or discuss any evidence on which he was relying. VA has associated multiple VA medical records with the Veteran’s claims file since August 2015. Of note, the Veteran’s VA medical records indicate between October 2015 and January 2016, he experienced on-and-off back pain. Compare October 2015 VA Emergency Dept Note (complaint of low back pain and tenderness); October 2015 VA Primary Care Physician Note (complaint of low back pain) with December 2015 VA Emergency Dept Note (no back tenderness); January 2016 VA Gastroenterology Consult (denied low back pain). He again experienced on-and-off back pain in 2017. Compare January 2017 VA Emergency Dept Note (complaint of left flank pain for four days); June 2017 VA Domiciliary Treatment Plan (complaint of low back pain) with May 2017 VA Domiciliary H & P Note (normal curvature and mobility of back; no pain or tenderness); August 2017 VA ED Initial Physician/PA Evaluation Note (no back pain). The same is true throughout 2018 and 2019. Compare June 2019 VA Nursing Domiciliary Note (complaint of low back pain); August 2019 VA Physician Assistant Domiciliary Note (same); November 2019 VA Nursing Note (same) with August 2018 VA Gastroenterology Consult (denied low back pain); June 2019 VA H & P Note (normal back curvature and mobility; no pain or tenderness). During his Board hearing, the Veteran did not provide any testimony about the extent to which his back pain limited his functional ability. He generally testified that he used walking apparatuses and his “back has suffered.” November 2019 Board Hearing Transcript, at 21. The Board is required to presume the foregoing evidence since the August 2015 rating decision is credible. The Board finds this evidence was not part of the record before the RO when it issued its August 2015 rating decision. Therefore, this evidence is “new.” 38 C.F.R. § 3.156(a). Nevertheless, the Board finds the evidence is cumulative and redundant and does not raise a reasonable possibility of substantiating the Veteran’s claim for service connection. Id. First, the evidence is cumulative and redundant of the evidence that was before the RO in August 2015. The Veteran’s low back pain was present prior to and at the time of the August 2015 rating decision, as documented in his VA medical records. The new VA medical evidence of record demonstrates that the Veteran continues to have low back pain. The RO considered similar evidence of back pain in its August 2015 rating decision. The fact that the Veteran’s pain has continued, without more, does not raise a reasonable possibility of substantiating his claim for service connection because his back pain has not changed in a material respect from the August 2015 rating decision based on the evidence of record. Furthermore, the evidence would not raise reasonable possibility of triggering VA’s duty to assist under 38 U.S.C. § 5103A. See McLendon v. Nicholson, 20 Vet. App. 79 (2006) (discussing elements to trigger VA’s duty to provide a VA examination). While the Veteran has reported continued pain since August 2015, the absence of evidence of functional impairment associated with his back pain, or any other material change in his back pain, does not reasonably indicate a possible disability. Thus, a VA examination would not be warranted. Accordingly, reopening of the Veteran’s claim for service connection for a back disability is not warranted. 5. Left hip disability When the Veteran filed his claim for service connection for a left hip disability in September 2016, he argued his left hip disability was secondary to his service-connected left knee disability. An August 2016 VA physician note documented that the Veteran reported a fall with left hip pain. The physician examined the Veteran and found no soft tissue injury, no bony tenderness, nor pain with weight bearing. His VA medical records documented complaints of left hip pain in January 2004 and in May through July 2007, but without any accompanying functional loss. He was afforded an in-person VA examination in December 2016. At that time, the examiner documented that the Veteran reported bilateral hip pain. He never reported issues with his hips, received care for his hips, nor was he diagnosed with a hip condition. The Veteran reported bilateral hip pain for about a year. The Veteran did not report flare-ups, but he did report stiffness intermittently. His range-of-motion test results and strength test results were all within normal limits. The examiner recorded no functional loss due to left hip pain or stiffness. The examiner concluded that the Veteran did not have a left hip disability (or a right hip disability). The RO issued a January 2017 rating decision, which is final, denying service connection for a left hip disability because the Veteran did not have a diagnosed disability, there was an absence of an in-service event, injury, or illness, and no medical nexus linking the Veteran’s left hip pain to his service-connected left knee disability or to his active military service. Thus, the only established fact as of the January 2017 rating decision was that the Veteran was service connected for a left knee disability. The unestablished facts of consequence as of the January 2017 rating decision were: (1) that the Veteran had a current left hip disability; (2) an in-service event, injury, or illness related to a left hip disability; and (3) that any such left hip disability was caused by or aggravated by his service-connected left knee disability or otherwise etiologically related to his active military service, i.e., a medical nexus. When the Veteran filed his claim to reopen in July 2018, he did not specify what theory of service connection he was relying on, nor did he provide or discuss any evidence on which he was relying. VA has associated multiple VA medical records with the Veteran’s claims file from January 2017 through the present. Pertinent to this analysis, a June 2019 VA nursing domiciliary note recorded that the Veteran reported he almost fell two times over the weekend and that he felt like his “hip was giving out.” He had experienced left hip pain for at least sixth months. He reported a decreased range of motion in his left hip. At his November 2019 Board hearing, the Veteran did not provide any testimony about his left hip pain. See generally November 2019 Board Hearing Transcript. His representative generally asserted that his left hip pain was now secondary to his secondary left foot condition, which was service connected prior to his left knee disability. Id. at 19. The Board is required to presume the foregoing evidence since the June 2017 rating decision is credible. The Board finds this evidence, to include his relevant VA medical records and new theory of secondary service connection, was not part of the record before the RO when it issued its January 2017 rating decision. Therefore, this evidence is “new.” 38 C.F.R. § 3.156(a). The Board also finds this evidence is “material.” 38 C.F.R. § 3.156(a). Collectively, the Veteran’s reports, that he subjectively believed his left hip had worsened, that the felt as if it was going to give out at one point in June 2019, and that he believed he experienced a loss of range of motion, relate to the unestablished fact of a current left hip disability. This evidence raises a reasonably possibility of functional loss due to his left hip pain, which could constitute a current disability. Saunders, 886 F.3d 1356. In addition, his new theory of secondary service connection based on his service-connected left foot pes planus, which was not previously considered by a prior RO rating decision, is also considered material to his claim for service connection. Overall, the Board finds the new and material evidence could reasonably substantiate the Veteran’s claim for service connection for his left hip pain. Accordingly, reopening of the Veteran’s claim for service connection for his claimed left hip disability is warranted. 6. Right knee disability The Veteran filed his initial claim for service connection for his right knee disability in January 1989. The RO obtained a VA examination in April 1990. The examiner diagnosed the Veteran with Osgood-Schlatter’s disease, which the examiner declared “old, resolved, with no local pain and normal function of the knee.” The RO denied service connection in a June 1990 rating decision finding that the Veteran’s right knee disability was a constitutional or developmental abnormality and not a disability under the law, and it had not progressed. The Veteran filed a claim to reopen his claim for service connection for his right knee disability in September 2014. He asserted his right knee disability was secondary to his right foot pes planus. Because VA associated relevant service treatment records with the Veteran’s claims file in August 2010, new and material evidence was not required to reopen the Veteran’s claim. 38 C.F.R. § 3.156(c) (2014). The RO denied service connection in a November 2014 rating decision because the Veteran was not service connected for right foot pes plans and the evidence did not otherwise indicate his right knee disability was incurred in or aggravated by his military service. The Veteran filed another claim for service connection for his right knee disability in December 2014, labeling it a claim to “reopen.” He asserted his right knee disability was secondary to non-PTSD trauma. In an August 2015 rating decision, the RO denied reopening the Veteran’s claim for service connection for his fight knee disability because he had not submitted new and material evidence. The RO stated that his right knee disability was a congenital or developmental defect, which was unrelated to military service and not aggravated by military service. Generally, when new and material evidence is submitted within one year of a rating decision under the Legacy appeal process, “reopening” of the claim is not possible because the claim has not become final at that time. 38 C.F.R. § 3.156(b); Turner, 29 Vet. App. at 211. Here, the rating decision was issued in November 2014. The Veteran submitted a new theory of entitlement in December 2014. The RO issued a rating decision in August 2015. Thus, November 2014 rating decision was not final at that time and there was nothing to “reopen.” The Veteran did not file new and material evidence within one year of the August 2015 rating decision, nor did he otherwise seek a timely appeal. Thus, the August 2015 rating decision became final. The Veteran then submitted a supplemental claim for service connection in September 2016. In his supplemental claim, the Veteran asserted his right knee disability was secondary to his service-connected left knee disability. He became service connected for his left knee disability via a June 2014 rating decision. The Veteran was afforded an in-person VA examination in December 2016. The examiner documented that the Veteran was diagnosed in September 2016 with a right knee meniscal tear and right knee osteoarthritis. The Veteran reported his knee was hurting “since the summer months.” The Veteran reported he suffered from lack of flexibility and instability while using stairs. The examiner documented normal range of motion, pain with weightbearing, no flare-ups, no loss of range of motion with repetitive use, normal muscle strength, normal stability, and that the Veteran was regularly using a brace for his knee. The examiner also provided a negative medical nexus opinion on secondary service connection. In a January 2017 rating decision, the RO reopened the Veteran’s claim for his right knee disability. The RO denied service connection because the evidence did not establish that the Veteran’s right knee disability was incurred in or aggravated by military service, was not chronic in service or within the presumptive period, nor was it secondary to his left knee disability. The RO observed the Veteran’s service treatment records (STRs) reflected knee pain complaints between 1986 and 1988, but a chronic right knee condition was not diagnosed in service. The Veteran’s VA medical records showed intermittent right knee pain as of 2005 through the present, which was not consistent with a chronic right knee condition. The Veteran did not submit additional new and material evidence within one year of the rating decision or otherwise appeal. Therefore, the January 2017 rating decision became final. Thus, the established facts as of the January 2017 rating decision were: (1) the Veteran had a right knee disability, to include a right knee meniscal tear and osteoarthritis; (2) he was previously diagnosed with Osgood-Schlatter’s disease in service, but it had resolved as of 1990; (3) his STRs indicated complaints of right knee pain while in service; and (4) he was service connected for left foot pes planus and a left knee disability as of January 2017. The unestablished facts as of the January 2017 rating decision were: (1) evidence of an in-service event, injury, or illness, other than those previously identified; (2) aggravation of an existing injury while in service; (3) a service-connected disability for an unidentified non-PTSD trauma; and (4) a medical nexus as to direct or secondary service connection. In July 2018, the Veteran filed a claim to reopen his claim for service connection for his right knee disability. He specifically labeled his claim, “right knee meniscal tear with osteoarthritis (previously denied as Osgood-Schlatter’s disease, right knee and right knee condition).” He did not specify on which theory, direct or secondary basis, he relied. Since January 2017, VA has associated numerous medical records with the Veteran’s claims file. Numerous VA medical records noted the Veteran’s subjective complaints of right knee pain from January 2017 through the present. VA medical records did not record any range-of-motion loss or strength loss associated with the Veteran’s consistent right knee pain. See, e.g., May 2017 VA Domiciliary Admission Evaluation Note (“musculoskeletal assessment: range of motion, moves all extremities well”); July 2019 VA Domiciliary Note (has full range of motion; no crepitus; no effusion; ambulates without obvious problems; stable); September 2019 VA Orthopedics Consult (“5 over 5 motor strength throughout”; “no instability”; “sensation intact to light touch”). At his November 2019 Board hearing, the Veteran generally testified that he wore a knee brace and used walking apparatuses because “his knees give out.” November 2019 Board Hearing Transcript, at 21. He generally associated his right knee disability as secondary to his left leg. Id. The Board notes that the RO denied service connection for a claimed left leg disability secondary to a claimed left hip disability in a February 2020 rating decision from which the Veteran as filed a notice of disagreement, and which is currently pending before the RO. As of now, the Veteran is not service connected for a left leg disability. The Board is required to presume the foregoing evidence since the January 2017 rating decision is credible. The Board finds this evidence was not part of the record before the RO when it issued its January 2017 rating decision. Therefore, this evidence is “new.” 38 C.F.R. § 3.156(a). The Board does not find this evidence is “material.” 38 C.F.R. § 3.156(a). First, The Veteran’s right knee pain was an established fact prior to the January 2017 rating decision, as was his current right knee disability, to include resolved Osgood-Schlatter’s disease, right knee meniscal tear, and right knee osteoarthritis. Neither the Veteran’s VA medical records nor his lay statements indicate a new diagnosis of a right knee disability or a reoccurrence of Osgood-Schlatter’s disease. The Veteran’s complaints of right knee pain were accounted for prior to and within the January 2017 rating decision. Thus, the evidence of the Veteran’s current right knee pain, which are similar in nature to his reports of right knee pain prior to January 2017, is cumulative and redundant of those prior reports of right knee pain. Second, pain alone is not a compensable disability without accompanying functional impairment. Saunders, 886 F.3d 1356. The evidence of record since the January 2017 rating decision does not reasonably show the Veteran suffers functional impairment associated with his right knee pain. While he has testified to using assistive devices and feeling as if his knee would give out, this evidence does not necessarily suggest he experiences functional impairment. See Id. The Board finds no such evidence in his VA medical records or in his lay statements or testimony. Rather, the Board interprets this evidence as an indication of right knee pain. On review of the numerous VA medical records, the Board is unable to locate a new diagnosis associated with the Veteran’s right knee pain that would constitute a new current disability. Third, the Veteran’s new evidence does not relate to the unestablished fact of a medical nexus, on either a direct or secondary basis. In the January 2017 rating decision, the RO considered the Veteran’s right knee osteoarthritis under the theory of presumptive service connection, 38 C.F.R. § 3.309(a). The RO discussed the Veteran’s in-service right knee complaints of pain, but it found no diagnosis of chronic condition based on the 1990 VA examination. The RO also considered whether the Veteran’s right knee pain evidenced continuity of symptomatology. The RO noted the Veteran’s right knee pain began in 2005, approximately 15 years following military service. No evidence linked his right knee osteoarthritis to his complaints of right knee pain in service. The RO also considered whether the Veterans’ right knee disability, to include his meniscal tear and osteoarthritis, were secondary to his service-connected left knee disability. Based on a VA examination and the relevant evidence of record at that time, the RO found the evidence did not show his right knee disability resulted from, or was aggravated by a service-connected left knee disability or was otherwise etiologically linked to his military service. Presently, the Veteran has only submitted new evidence that his right knee pain has continued and, perhaps, increased since the January 2017 rating decision. This evidence does not raise a reasonable possibility that his current pain is related to his pain in service. The RO already determined there was a lack of chronicity and continuity of symptomatology between the Veteran’s in-service right knee pain and right knee osteoarthritis in its January 2017 rating decision. The fact that the Veteran’s pain still exists, standing alone, does not raise a reasonable possibility of changing that determination based on the facts presented. Nor does the Veteran’s continued right knee pain raise a reasonable possibility that it is now related to his left knee disability. The Veteran has not provided any argument in connection with the new evidence that his right knee pain is due to his military service or any argument that the new evidence relates to a theory of secondary service connection that was not already considered by the RO prior to or in its January 2017 rating decision. Furthermore, for the same reasons, the evidence would not raise a reasonable possibility of triggering VA’s duty to assist under 38 U.S.C. § 5103A. See McLendon, 20 Vet. App. 79. While the Veteran reported continued right knee pain since January 2017, the absence of evidence of functional impairment associated with his right knee pain, or any other material change in his right knee pain, does not reasonably indicate a new disability, or a connection with his military service or his service-connected left knee disability that was not already considered by the RO. Thus, a VA examination would not be warranted. Overall, while the evidence may be new, it is not material to an unestablished fact, nor does the evidence raise a possibility of substantiating the Veteran’s claim for service connection for a right knee disability. Accordingly, reopening of the Veteran’s claim for service connection for a right knee disability, to include right knee meniscal tear with osteoarthritis (previously denied as Osgood-Schlatter’s disease, right knee and right knee condition), is not warranted. 7. Right foot pes planus When the Veteran filed his initial claim for service connection for right foot pes planus (flatfoot) in March 2010, he asserted that he entered the U.S. military with pre-existing flatfeet. He asserted his in-service running, marching, and physical training aggravated his flatfoot. While in service, he received orthotic inserts and special boots, but he stated they did not help his pain. He was afforded an in-person VA examination in May 2010. The examiner confirmed the Veteran’s prior diagnosis of bilateral flatfoot. His right foot revealed no localized tenderness, swelling, deformity, or instability. Nor did the examiner find pain on manipulation, midfoot malalignment, or callosity on the plantar aspect of the right foot. His range of motion was normal. In August 2010, the examiner opined that the Veteran’s right foot pes planus was not aggravated beyond normal progression of the disease due to the Veteran’s military service. Consequently, the RO issued a July 2011 rating decision denying the Veteran’s claim for service connection because, although the Veteran’s right foot pes planus existed prior to service based on his June 1982 entrance examination, the evidence did not establish that his condition was aggravated due to his military service. The July 2011 rating decision became final as the Veteran did not submit new and material evidence or otherwise appeal the decision within one year. In September 2014, the Veteran filed a claim to reopen his claim for service connection for right foot pes planus. He did not provide new and material evidence or a new theory of entitlement. Thus, the RO issued a November 2014 rating decision denying reopening of the Veteran’s claim. The Veteran then filed another claim to reopen in December 2014. Again, he did not submit evidence with his claim or assert a new theory. The Board points out that, in April 2015, service records were added to his claims file. Pursuant to 38 C.F.R. § 3.156(c)(1), if VA receives “relevant official service department records that existed and had not been associated with the claims file when VA first decided the claim, VA will reconsider the claim.” (Emphasis added). Although these service records were received after the prior rating decisions, the service records that were added were not relevant to the Veteran’s claim for service connection for right foot pes planus. The records contained no information pertaining to his condition. Thus, the Veteran was still required to submit new and material evidence to reopen his claim. The RO issued an August 2015 rating decision denying the Veteran’s claim to reopen because he did not submit new and material evidence relating to an unestablished fact for his claim for service connection. The Veteran did not submit new and material evidence or seek an appeal with one year of the decision. Thus, the August 2015 decision became final—this is the most recent final rating decision. In July 2018, the Veteran filed another claim to reopen his claim for service connection. Again, he did not submit the theory on which he relied for service connection nor did he submit evidence in connection with his claim to reopen. While his claim to reopen was still pending, in September 2018, the Veteran filed a second claim to reopen based on new VA medical records. Five days following the Veteran’s second claim to reopen, the RO issued a September 2018 rating decision reopening the Veteran’s claim for service connection for right foot pes planus, but ultimately denied service connection because evidence did not establish his condition was incurred in or aggravated by his military service. The RO then issued a second rating decision in October 2018. This time, the RO found the evidence submitted from the time of the Veteran September 2018 claim was not new and material and denied reopening of his claim. Thus, as of the August 2015 rating decision, the established facts were: (1) the Veteran has a current disability, right foot pes planus; (2) his right foot pes planus pre-existed his active military service; (3) he experienced running, marching, and physical training during active service (i.e., an in-service event); and (4) he received in-service orthotics for his right foot pes planus. The unestablished facts of consequence as of the August 2015 rating decision were: (1) an in-service incurrence or aggravation of the Veteran’s right foot pes planus beyond its normal progression; and (2) a medical nexus between the Veteran’s right foot pes planus and his military service or as secondary to a service-connected disability. Since the August 2015 rating decision, VA has associated numerous VA medical records with the Veteran’s claims file. On review of these medical records, the medical evidence only relates to the established fact of the Veteran’s current right foot pes planus. The VA medical records indicate he has flatfeet and experienced pain. There is no evidence related to his military service, a service-connected disability, or a medical nexus. At his November 2019 Board hearing, the Veteran generally testified about seeking service connection for both of his feet and how only his left foot was service connected as a result. November 2019 Board Hearing Transcript, at 21. He did not testify about an in-service event outside of what was documented in his STRs nor did he provide evidence about a medical nexus. The Board is required to presume the foregoing evidence is credible. The Board finds this evidence was not part of the record before the RO when it issued its August 2015 rating decision. Therefore, this evidence is “new.” 38 C.F.R. § 3.156(a). The Board does not find this evidence is “material.” 38 C.F.R. § 3.156(a). The new evidence only relates to the established fact of the Veteran’s current disability, his right foot pes planus. There is no evidence relating to any unestablished fact of consequence. The new medical evidence does not reasonably indicate a worsening of the Veteran’ right foot pes planus beyond normal progression. The Board points out that the RO granted the Veteran service connection in a November 2009 rating decision for his left foot pes planus because he developed a heel spur in connection with his military service, which was an aggravated condition beyond the normal course of his left foot pes planus. The Veteran did not experience a heel spur on his right foot, nor any other condition beyond pes planus. Thus, there was no aggravation beyond the normal course of the disease. Even if the evidence is considered new and material, it is cumulative and redundant of the evidence that was of record at the time of the August 2015 rating decision. While the Veteran’s new VA medical records demonstrate he experienced pain associated with his right foot pes planus, there is no evidence the pain progressed beyond the normal course of the disease, nor is there evidence the pain is materially different than the pain the Veteran experienced prior to August 2015. The RO considered the Veteran’s right foot pain as part of its rating decisions prior to and in the August 2015 rating decision. Therefore, this evidence is cumulative and redundant of the evidence that existed at the time of the August 2015 rating decision. Furthermore, for the same reasons, the evidence would not raise reasonable possibility of triggering VA’s duty to assist under 38 U.S.C. § 5103A. See McLendon v. Nicholson, 20 Vet. App. 79 (2006) (discussing elements to trigger VA’s duty to provide a VA examination). The Veteran’s current disability, right foot pes planus, is an established fact. In order to warrant a VA examination, the Veteran needs to offer evidence related to in-service aggravation of his right foot pes planus, which his submitted evidence does not do. Overall, while the evidence may be new, it is not material. And even if the evidence was new and material, it remains cumulative and redundant, and it does not raise a reasonable possibility of substantiating the Veteran’s claim for service connection for right foot pes planus. Accordingly, reopening of the Veterans’ claim for service connection for right foot pes planus is not warranted. Service Connection VA provides compensation for a disability resulting from disease or injury incurred in or aggravated by service. This is referred to as a “service connection.” 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Regulations also provide that service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d). Generally, in order to be entitled to service connection there must be competent, credible evidence of (1) a current disability, (2) an in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). When these elements are satisfied, service connection may be granted on a direct basis. In deciding claims, it is the Board’s responsibility to evaluate the entire record on appeal. VA is required to give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b). To deny a claim on its merits, the preponderance of the evidence must be against the claim. See Alemany v. Brown, 9 Vet. App. 518, 519 (1996). The law requires the Board address its reasons for rejecting evidence favorable to the Veteran. Timberlake, 14 Vet. App. at 128‒29. The Board must review the entire record but does not have to discuss each piece of evidence. Gonzales, 218 F.3d at 1381. The analyses below focus on the most salient and relevant evidence within the period on appeal and on what this evidence shows, or fails to show, on the claims. 8. Nodule, upper lobe, left lung The Board has not characterized this claim as one to reopen, contrary to the August 2015 rating decision from which the Veteran perfected his appeal. When a claimant submits new and material evidence during the appeal period before a RO decision becomes final, the claim remains pending until the Secretary determines whether such evidence is new and material. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(b); Turner, 29 Vet. App. at 211. The RO issued a January 2020 statement of the case (SOC) in which it confirmed an August 2015 rating decision that denied “reopening” of the Veteran’s claim for service connection for a nodule located on his upper lobe, left lung (left lobe nodule). The Board, however, finds the original rating decision, issued June 2014, never became final under 38 C.F.R. § 3.156(b). Thus, there is nothing to “reopen.” The Board provides the following analysis because it may affect the effective date of the Veteran’s award of service connection. The Veteran submitted a supplemental claim in July 2014, within one year of the June 2014 rating decision, which was accompanied by new and material evidence and the RO associated VA medical records with his file. The RO issued a rating decision in September 2014 continuing denial of service connection. The Veteran then submitted another supplemental claim for service connection for his left lobe nodule in December 2014, still within one year of the June 2014 rating decision, which was accompanied by new and material medical records from 1988. The RO also associated VA medical records with his file and obtained a VA examination. The RO then issued the August 2015 rating decision denying “reopening” of the claim for service connection from which the Veteran has currently appealed. Because the Veteran submitted new and material evidence within one year of the June 2014 rating decision, the June 2014 decision did not become final until adjudication of all of the new and material evidence. The adjudication occurred in August 2015. Therefore, the Veteran’s claim remained open until August 2015 and “reopening” was not required. 38 C.F.R. § 3.156(b). And since he has timely appealed that rating decision, the claim for service connection remains pending before the Board. The Board now turns to the merits of the Veteran’s claim for service connection. First, the Board observes that numerous VA medical records have been added to the Veteran’s claims file since the case was certified to the Board on March 28, 2016. Of particular importance is a March 2020 VA positive-nexus addendum medical opinion. Pursuant to 38 C.F.R. § 19.37(b), additional evidence received by the RO after the records have been transferred to the Board for appellate consideration will be forwarded to the Board if it has a bearing on the appellate issue or issues. The Board will then determine what action is required with respect to the additional evidence. Pursuant to 38 C.F.R. § 20.1305(c), pertinent evidence, that is evidence relating to the appellate issue, that is referred to the Board by the RO under section 19.37(b) must be referred to the RO for review in the first instance unless this procedural right is waived by the appellant or representative, or unless the Board determines that the benefit or benefits to which the evidence relates may be fully allowed on appeal without such referral. Because the Board is granting service connection, remand is not required for the RO to consider the evidence in the first instance. Seri v. Nicholson, 21 Vet. App. 441, 447 (2007) (the grant of a claim of service connection constitutes an award of full benefits sought on an appeal of the denial of a service connection claim). First element: A current disability As to the first element of service connection, a current disability, the Veteran’s medical records, past and present, establish he had a nodule in the upper lobe of his left lung, which was diagnosed as a hamartoma in 2014. “Hamartoma” is “a mass resembling a tumor that represents anomalous development of tissue natural to a part or organ rather than a true tumor.” Hamartoma, Merriam-Webster Dictionary Online, https://www.merriam-webster.com/medical/hamartoma, medical definition (last visited Mar. 30, 2021). In November 2019, he underwent a lobectomy to remove the hamartoma. The pathology report following his lobectomy confirmed chondroid hamartoma. While the Veteran’s left lobe nodule was removed as of November 2019, the nodule was present during pendency of this appeal. As such, the Veteran had a “current disability” for purposes of VA service connection. See McClain v. Nicholson, 21 Vet. App. 319, 321 (2007) (holding that an appellant satisfies the current disability requirement “when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim . . . even though the disability resolves prior to the Secretary’s adjudication of the claim”). Therefore, the first element is satisfied. Second element: An in-service event, injury, or illness, or aggravation thereof As to the second element of service connection, an in-service event, injury, or illness that occurred while on active duty, the evidence establishes an in-service illness and/or incurrence that relates to the Veterans left lobe nodule. In an April 1986 STR radiology report, the medical professional found “two small ill-defined infiltrates in the left upper lung.” An accompanying medical evaluation stated, “two 1-centimeter calcific densities” in the left upper chest, “possible scarring.” A November 1988 VA radiology record submitted by the Veteran noted “[a]n opacity . . . just lateral of the left hilum [in the left lung] . . . and measures about 1.5 centimeters in diameter.” Two December 1988 VA medical notes confirmed the presence of the nodule. The Veteran’s subsequent VA medical continuously recorded a left lobe nodule. Therefore, as the Veteran’s left lobe nodule was present to some extent while in service, the second element is satisfied. Third element: A causal link As to the third element of service connection, a causal link between the Veteran’s left lobe nodule and an in-service incurrence, the Board finds the evidence establishes such a link. In March 2020, a VA examiner provided a medical opinion after thorough review of the Veteran’s STRs, VA medical records, and military service records. He opined that the Veteran’s left lung hamartoma was at least as likely as not “the same lesion that was see on his [November 1988] chest x-ray while he was in the United States Navy.” The examiner explained that hamartomas are typically very slow growing masses. The Veteran’s continuous evaluations for years showed very slow progression of his left lung hamartoma until his lobectomy in November 2019. His rationale included a through recitation of the relevant evidence on which he relied. Absent evidence to the contrary, the Board finds the March 2020 examiner was competent to review the Veteran’s medical history, diagnose his left lobe nodule, and provide a medical opinion as to the left lobe nodule’s etiology. Cox v. Nicholson, 20 Vet. App. 563, 569 (2007) (the competence of VA examiners is presumed absent evidence to the contrary). The Board finds the examiner’s overall medical findings and medical opinion credible and probative. The examiner conducted a thorough review of the Veteran’s relevant medical record and overall medical and military history, relied on accurate facts, and provided a well-reasoned medical judgment that connected the facts to his ultimate conclusion. Therefore, the third element is satisfied. Accordingly, service connection for the Veteran’s nodule located in the upper lobe of his left lung is warranted. REASONS FOR REMAND Section 5103A of Title 38 of the United States Code, captioned “DUTY TO ASSIST,” mandates that a medical examination be provided in disability compensation claim cases when: (1) There is competent evidence that the claimant has a current disability, or persistent or recurrent symptoms of disability; (2) There is evidence establishing that an event, injury, or illness occurred in service or within an applicable presumptive period, or the Veteran has a service-connected disability; and (3) There is an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran’s service or with another service-connected disability, but (4) There is insufficient competent medical evidence on file for the Secretary to make a decision on the claim. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4); Waters v. Shinseki, 601 F.3d 1274, 1277 (Fed. Cir. 2010); McLendon, 20 Vet. App. 79. Each of the elements must be met. 1. Left hip disability The Veteran has submitted new and material evidence that he continues to suffer from left hip pain, but now his left hip pain is accompanied by loss of functional ability. He provided evidence that he fell twice, which he attributed to his hip condition. And he provided evidence of loss of range of motion. Jandreau v. Nicholson, 493 F.3d 1372, 1377 (Fed. Cir. 2007) (noting general competence of laypersons to testify as to symptoms but not medical diagnosis). The Veteran’s new and material evidence is competent evidence that he may have a current disability. See Saunders, 886 F.3d 1356. The Veteran has asserted a new theory of service connection, that being his left hip disability is secondary to his service-connected left foot pes planus with heel spur. This theory has not been developed by VA. As such, remand for a VA examination is necessary. The Board observes that the Veteran has not asserted, nor does the record reasonably raise an argument of, an in-service incurrence or aggravation associated with his left hip disability. Nonetheless, depending on the results of the medical examination, service connection on a direct basis could be warranted. Thus, the Board will also direct that a medical opinion be obtained on a theory of direct service connection. 2. Acquired psychiatric disability The Board finds the Veteran has credibly asserted three in-service stressors that have not been considered by the RO: (1) being misdiagnosed during his separation exam, which he claimed caused him to develop depression; (2) suffering a knife attack during active service in the Philippines, which he claimed caused him to develop PTSD; and (3) almost being pulled overboard during a refueling event aboard the U.S.S. Brewton, which he claimed has caused him to develop PTSD. As no development has occurred on these claims, to include in-service stressor verification and obtaining VA medical examinations, remand is necessary. Accordingly, the matters are REMANDED for the following actions: 1. Obtain any of the Veteran’s outstanding VA medical records and associate them with the claims file. 2. After any additional records are associated with the claims file, obtain a VA examination from an appropriate qualified clinician addressing the onset and etiology of the Veteran’s left hip disability. The entire claims file must be made available to and be reviewed by the examiner, including a copy of this REMAND order. The examiner is asked to provide an opinion regarding: (a.) Please identify the what, if any, left hip disability(-ies) the Veteran had during the pendency of his claim, as of July 31, 2018, through the present. (b.) For each identified disability, please opine whether it is at least as likely as not (50 percent probability or more) that the Veteran’s left hip disability had its onset in or is otherwise etiologically related to an in-service event, injury, or disease. (c.) For each identified disability, please opine whether it is at least as likely as not (50 percent probability or more) that the Veteran’s diagnosed left hip disability was caused by (proximately due to or as the result of) his service-connected left foot pes planus with heel spur. (d.) For each identified disability, please opine whether it is at least as likely as not (a 50 percent probability or more) that the Veteran’s diagnosed left hip disability was aggravated by his service-connected left foot pes planus. The examiner is advised “aggravation” means an increase in the severity of the underlying disability beyond its natural progression. The examiner is reminded to consider the Veteran’s lay statements regarding the nature and onset of his left hip disability, including any evidence concerning continuity of symptomatology. The examiner must not opine on the credibility of the Veteran. The examiner may, however, discuss whether there is any medical reason to accept or reject the Veteran’s assertion of a left hip disability in service or the assertion that the Veteran’s service-connected left foot pes planus led to a left hip disability. See Kahana v. Shinseki, 24 Vet. App. 428, 437 (2011). A clear and detailed rationale for the opinion(s), including a discussion of the facts and medical principles involved, should be provided as it will be of considerable assistance to the Board. Please do not simply list the facts on which you relied. If the examiner relies on medical treatises, the examiner must identify the treatises. If a requested opinion cannot be provided without resorting to speculation, the examiner should so state and explain why an opinion cannot be provided without resorting to speculation. In so doing, the medical professional shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to the particular question(s). 3. Send the Veteran a letter (i.e., stressor verification form) requesting any pertinent information to assist VA in attempting to verify any in-service stressors. Following receipt of any response, appropriate action should be taken to attempt to verify any reported stressors that are capable of verification, to include contacting Joint Services Record Retention Center (JSRRC) or any other appropriate sources. If the search for corroborating records leads to negative results, the RO must notify the Veteran and his representative of this fact, explaining the efforts taken, describing further action, if any, to be taken, and affording them the opportunity to respond. The RO should also follow up on any additional action suggested by each appropriate source contacted. 4. After any additional records are associated with the claims file, obtain a VA examination from an appropriately qualified clinician to provide an opinion addressing the onset and etiology of the Veteran’s claimed psychiatric disorders, to include depression, anxiety, and PTSD. The entire claims file must be made available to and be reviewed by the examiner, including a copy of this REMAND order. The examiner is asked to provide an opinion regarding the following: (a.) The examiner is asked to identify all current psychiatric disorders found during the examination. For any psychiatric disorder that is noted in the treatment records, but not found on current examination, the examiner should attempt to reconcile these findings. (b.) If the examiner determines that PTSD is present, then the examiner must specify the stressor supporting the diagnosis. (c.) If the Veteran meets the criteria for a diagnosis of PTSD and his reported stressors are verified, the examiner is asked to opine whether it is at least as likely as not (50 percent probability or more) that the disorder is etiologically related to the Veteran’s verified in-service stressor(s). (d.) With respect to each additional psychiatric disorder present during the period of this claim other than PTSD, the examiner is asked to opine whether it is at least as likely as not (50 percent or greater probability) that such disorder(s) had its onset in service or is otherwise etiologically related to service. The examiner is reminded to consider the Veteran’s lay statements regarding the nature and onset of his claimed disability, including any evidence concerning continuity of symptomatology. The examiner must not opine on the credibility of the Veteran. The examiner may, however, discuss whether there is any medical reason to accept or reject the Veteran’s assertion of a claimed disability in service or the assertion that an in-service event, injury, or illness led to his claimed disability. See Kahana v. Shinseki, 24 Vet. App. 428, 437 (2011). A clear and detailed rationale for the opinion(s), including a discussion of the facts and medical principles involved, should be provided as it will be of considerable assistance to the Board. Please do not simply list the facts on which you relied. If the examiner relies on medical treatises, the examiner should identify the treatises. If a requested opinion cannot be provided without resorting to speculation, the examiner should so state and explain why an opinion cannot be provided without resorting to speculation. In so doing, the medical professional shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to the particular question(s). M. Tenner Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. F. Sawka, Associate 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.