Citation Nr: 21022685 Decision Date: 04/19/21 Archive Date: 04/19/21 DOCKET NO. 16-61 893 DATE: April 19, 2021 ORDER The claim for service connection for right foot arthritis is denied. The claim for service connection for left foot arthritis is denied. The claim for a disability rating in excess of 30 percent prior to August 17, 2020, for bilateral flat foot/pes planus (herein pes planus) is denied. The claim for a disability rating in excess of 50 percent beginning August 17, 2020, for bilateral pes planus is denied. The claim for a higher disability rating in excess of 40 percent for lumbar spondylosis at L5-S1 (herein lumbar spine disability) is denied. The claim for a higher disability rating in excess of 20 percent for right lower extremity radiculopathy is denied. The claim for an increased disability rating in excess of 20 percent for left lower extremity radiculopathy is denied. An effective date of May 14, 2018, but no earlier is granted for the grant of service connection for right lower extremity radiculopathy. An effective date of May 14, 2018, but no earlier is granted for the grant of service connection for left lower extremity radiculopathy. REMANDED The claim for service connection for residuals, left ankle fracture, is remanded FINDINGS OF FACT 1. The preponderance of the evidence of record is against finding that the Veteran has had right foot arthritis at any time during or approximate to the pendency of the claim. 2. The preponderance of the evidence of record is against finding that the Veteran has had left foot arthritis at any time during or approximate to the pendency of the claim. 3. Prior to August 17, 2020, the Veteran’s pes planus manifested by marked pronation without extreme tenderness of the plantar surfaces of the feet, pain, or extreme tenderness on manipulation, or marked inward displacement with severe spasm of the Achilles tendon on manipulation. 4. Beginning August 17, 2020, the Veteran is in receipt of the maximum disability rating provided for bilateral flat foot/pes planus and his symptoms are fully contemplated by that rating. 5. The Veteran’s lumbar spine disability is not manifest by favorable or unfavorable ankylosis at any time during the appeal. 6. The Veteran’s right lower extremity radiculopathy is manifest by no more than moderate, incomplete paralysis of the sciatic nerve. 7. The Veteran’s left lower extremity radiculopathy is manifest by no more than moderate, incomplete paralysis of the sciatic nerve. 8. May 14, 2018, the date of the examination where it first became factually ascertainable that the Veteran had right lower extremity radiculopathy, is the correct effective date for service connection for that disability. 9. May 14, 2018, the date of the examination where it first became factually ascertainable that the Veteran had left lower extremity radiculopathy, is the correct effective date for service connection for that disability. CONCLUSIONS OF LAW 1. The criteria for service connection for right foot arthritis are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for left foot arthritis are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for a rating in excess of 30 percent prior to August 17, 2020, for flat feet/pes planus are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.59, 4.71a, Diagnostic Code 5276. 4. The criteria for a rating in excess of 50 percent beginning August 17, 2020, for flat feet/pes planus are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.59, 4.71a, Diagnostic Code 5276. 5. The criteria for a rating in excess of 40 percent for lumbar spine disability are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5239. 6. The criteria for a disability rating in excess of 20 percent for right lower extremity radiculopathy are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8520. 7. The criteria for a disability rating in excess of 20 percent for left lower extremity radiculopathy are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8520. 8. The criteria for an effective date of May 14, 2018, but no earlier, for the grant of service connection for right lower extremity radiculopathy are met. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. 9. The criteria for an effective date of May 14, 2018, but no earlier, for the grant of service connection for right lower extremity radiculopathy are met. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1981 to July 2001. The issues regarding bilateral pes planus, residuals of a left ankle fracture, and arthritis of the right and left foot were remanded by the Board in March 2019 and have been returned now for further appellate action. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). 1. Entitlement to service connection for right foot arthritis 2. Entitlement to service connection for left foot arthritis The Veteran that he incurred right and left foot arthritis during or as a result of military service. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the Veteran does not have a current diagnosis of right or left foot arthritis and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). Arthritis has not been found upon diagnostic testing during VA treatment or VA examination. The most recent VA examination in August 2020 specifically notes that arthritis has not been found upon examination. While the Veteran certainly believes that he has a current diagnosis of arthritis in both feet, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education and the ability to interpret complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. Given the lack of medical evidence in support of the claim, the evidence is against a finding of a current right or left foot arthritis disability. Accordingly, the Board must conclude that the preponderance of the evidence is against the claim, and it is, therefore, denied. In arriving at the decision to deny the claim, the Board has considered the applicability of the benefit-of-the-doubt rule enunciated in 38 U.S.C. § 5107(b). However, as there is not an approximate balance of evidence, that rule is not applicable in this case. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990); Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001). Increased Rating 3. Entitlement to a higher disability rating in excess of 30 percent prior to August 17, 2020, for bilateral pes planus The Veteran contends that she is entitled to a higher for her bilateral pes planus. The Veteran’s pes planus is rated under 38 C.F.R. § 4.71a, Diagnostic Code 5276, for acquired flatfoot. Under Diagnostic Code 5276, a maximum 50 percent rating is warranted for bilateral acquired flatfoot when there is marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo-Achillis on manipulation, which are not improved by orthopedic shoes or appliances. 38 C.F.R. § 4.71a, Diagnostic Code 5276. The Board finds that the preponderance of the evidence is against a rating in excess of 30 percent for bilateral pes planus prior to August 17, 2020. The Board acknowledges the Veteran’s lay reports of symptoms and that there was functional loss due to pain, weakened movement, excess fatigability, repetitive use, pain during flare-ups, and pain during repetitive use over time. However, even considering the Veteran’s lay reports of symptoms, such as marked pronation causing pain and swelling, and functional loss, the degree of additional limitation reflected by the statements such statements would not result in symptoms more nearly approximating pronounced bilateral acquired flatfoot. VA examiners in January 2014 and July 2016 did not report evidence of a pronounced pes planus disability upon examination. Although marked pronation was demonstrated during each examination, the 2014 examiner found that it was improved by his use of orthotics. Neither VA examiner found upon examination extreme tenderness of the plantar surfaces of the feet, pain, or extreme tenderness on manipulation, or marked inward displacement with severe spasm of the Achilles tendon on manipulation. The Board notes that the VA treatment records during this period also do not demonstrate symptoms which more likely approximate those required for a maximum 50 percent disability rating. The Board has also considered the other Diagnostic Codes pertaining to the foot. Other disability ratings may be assigned only if the symptomatology for a disability is not duplicative or overlapping with the symptomatology of any other disability. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994); see also Lyles v. Shulkin, 29 Vet. App. 107 (2017). In Scott v. Wilkie, the Federal Circuit expressly adopted the Court’s holding that disabilities specifically listed in the rating schedule may only be rated under Diagnostic Codes which specifically pertain to them. Scott v. Wilkie, 920 F.3d 1375 (Fed. Cir. 2019) (citing Copeland v. McDonald, 27 Vet. App. 333, 336 (2015)). Finally, the Federal Circuit concluded that the Board must also consider assigning separate ratings under analogous Diagnostic Codes, when rating an unlisted service-connected foot disability exhibiting distinct manifestations, even when service connection has also been granted for one of the eight conditions listed in the rating schedule. Id. Here, the Veteran’s disability is specifically listed under the rating schedule and, therefore, cannot be rated under a different Diagnostic Code. Additionally, the evidence of record does not reflect that the Veteran has any other service-connected foot disabilities that would warrant a separate rating under a different Diagnostic Code other than those already rated and not currently on appeal. Based on the foregoing, the Board finds that the preponderance of the evidence is a rating in excess of 30 percent for bilateral pes planus prior to August 17, 2020. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 4. Entitlement to a higher disability rating in excess of 50 percent beginning August 17, 2020, for bilateral pes planus The Veteran contends that he is entitled to a higher rating for his bilateral pes planus beginning August 17, 2020. As noted above, the Veteran’s pes planus is rated under 38 C.F.R. § 4.71a, Diagnostic Code 5276, where the maximum schedular rating provided is the currently assigned 50 percent rating. 38 C.F.R. § 4.71a, Diagnostic Code 5276. As the Veteran is in receipt of the highest schedular rating for acquired flat foot/pes planus, there is no basis to award a higher rating. The Board has also considered the other Diagnostic Codes pertaining to the foot. Other disability ratings may be assigned only if the symptomatology for a disability is not duplicative or overlapping with the symptomatology of any other disability. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994); see also Lyles v. Shulkin, 29 Vet. App. 107 (2017). In Scott v. Wilkie, the Federal Circuit expressly adopted the Court’s holding that disabilities specifically listed in the rating schedule may only be rated under Diagnostic Codes which specifically pertain to them. Scott v. Wilkie, 920 F.3d 1375 (Fed. Cir. 2019) (citing Copeland v. McDonald, 27 Vet. App. 333, 336 (2015)). The Federal Circuit also expressly adopted the Court’s holding that unlisted conditions may be rated by analogy to Diagnostic Codes that may not describe the unlisted disability but addresses disabilities that may be productive of similar symptoms. Scott, 920 F.3d 1375 (citing Yancy v. McDonald, 27 Vet. App. 484, 493 (2016). Finally, the Federal Circuit concluded that the Board must also consider assigning separate ratings under analogous Diagnostic Codes, when rating an unlisted service-connected foot disability exhibiting distinct manifestations, even when service connection has also been granted for one of the eight conditions listed in the rating schedule. Id. Here, the Veteran’s disability is specifically listed under the rating schedule and therefore cannot be rated under a different Diagnostic Code. The Board notes that the Veteran has other service-connected foot disabilities. However, the evidence of record is against a finding that the disabilities have distinct manifestations from those that are already being compensated. See 38 C.F.R. § 4.14. The current rating assigned fully encompasses the Veteran’s complete set of symptoms and specifically contemplates symptoms such as pain, stiffness, swelling, marked deformity, tenderness, pain, or spasm on manipulation. As the Veteran already has the maximum schedular disability rating and all symptoms are contemplated by that rating, the appeal is denied. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 5. Entitlement to a higher disability rating in excess of 40 percent for lumbar spine disability The Veteran contends that he is entitled to a higher disability rating for lumbar spine disability. Unfortunately, the evidence does not demonstrate that a higher rating is warranted. The Veteran’s lumbar spine disability is rated under 38 C.F.R. § 4.71a, Diagnostic Code 5239. Under the General Rating Formula for Diseases and Injuries of the Spine, a 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent evaluation is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine. Any associated objective neurological abnormalities, including, but not limited to, bowel or bladder impairment, are to be evaluated separately under an appropriate diagnostic code. Id. at Note 1. Unfavorable ankylosis is defined as “a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching.” Id. at Note 5. Additionally, fixation of a spinal segment in neutral position (zero degrees) is “always” considered favorable ankylosis. Id. Under the formula for IVDS based on incapacitating episodes, 38 C.F.R. § 4.71a, Diagnostic Code 5243, the next highest disability rating, a 60 percent rating, contemplates incapacitating episodes having a total duration of at least six weeks during the past twelve months. These criteria are an alternative to rating on the basis of orthopedic and neurologic manifestations under the General Formula for Diseases and Injuries of the Spine, and a rating is assigned on the basis of whichever method results in the higher rating. 38 C.F.R. § 4.71a, Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, Note (2). In order to be awarded a disability rating in excess of 40 percent, the evidence must demonstrate ankylosis, either favorable or unfavorable, of the entire thoracolumbar spine or doctor prescribed bedrest for incapacitating episodes having a total duration of at least six weeks during the past twelve months. Other symptoms, such as limitation of motions other than flexion, muscle spasm, and abnormal spinal contour, are fully contemplated by the assigned 40 percent evaluation and do not warrant further discussion with regard to the question of whether an increased evaluation is warranted. The Board notes that throughout two VA examinations, in July 2016 and May 2018, and hundreds of pages of VA treatment records, ankylosis has never been demonstrated. In fact, each VA examiner found that there was no ankylosis and found that the Veteran was able to bend his back in all ways. Indeed, throughout this period, the Veteran has demonstrated an ability to move the spine in all directions. The evidence, including the lay evidence, shows no indication whatsoever that the spine has been fixed in extension or flexion at any time during this appeal, thus demonstrating the absence of ankylosis. Therefore, an increased rating in excess of 40 percent is not warranted under Diagnostic Code 5239 or the general rating formula for spin disorders. Similarly, the evidence does not demonstrate that the Veteran has ever been prescribed six weeks or more of bedrest by a doctor. The Veteran has not described any period of such bedrest lasting six weeks of any year. As such, a rating in excess of 40 percent is not warranted under the rating criteria for IVDS. The Board notes that all possibly relevant diagnostic codes have been considered but finds that no other codes are applicable. In considering the appropriate disability ratings, the Board has also considered the Veteran's statements that his back disability is worse than the rating he currently receives. In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency of evidence differs from weight and credibility. While the Veteran is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses, he is not competent to identify a specific level of disability of his disabilities according to the appropriate diagnostic codes. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) ("although interest may affect the credibility of testimony, it does not affect competency to testify"). On the other hand, such competent evidence concerning the nature and extent of the Veteran's disability has been provided by the medical personnel who have examined him during the current appeal and who have rendered pertinent opinions in conjunction with the evaluations. The medical findings (as provided in the examination reports) directly address the criteria under which this disability is evaluated. The Board acknowledges the Veteran’s lay reports of symptoms and that there was functional loss due to pain, excess fatigability, incoordination, repetitive use, pain during flare-ups, and pain during repetitive use over time. However, even considering the Veteran’s lay reports of symptoms and noted functional loss, the degree of additional limitation reflected by the statements would not result in symptoms more nearly approximating unfavorable ankylosis of the entire thoracolumbar spine. Again, the Veteran has not reported, nor does the evidence suggest or demonstrate, that he experiences symptoms that more nearly approximate ankylosis of any kind, as he has been shown to bend his spine in all directions, regardless of additional functional factors such as pain and flare-ups. The issues involving neurological impairment due to the lumbar spine disability are discussed below. Therefore, there is no basis on which to grant an increased schedular rating in excess of 40 percent for the service-connected back disability. 38 C.F.R. §§ 4.3, 4.7. For the foregoing reasons, the preponderance of the evidence is against the Veteran’s claim for a rating in excess of 40 percent for lumbar spine disability. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 6. Entitlement to a higher disability rating in excess of 20 percent for right lower extremity sciatic radiculopathy 7. Entitlement to a higher disability rating in excess of 20 percent for left lower extremity sciatic radiculopathy The Veteran contends that he is entitled to an increased disability rating for right and left lower extremity radiculopathy. Paralysis of the sciatic nerve is evaluated in accordance with the criteria set forth in 38 C.F.R. § 4.124a, Diagnostic Code 8520. Under these criteria, the next highest rating, a 40 percent rating, is awarded for moderately severe incomplete paralysis. Severe incomplete paralysis, with marked muscular atrophy is rated as 60 percent disabling. Complete paralysis, with the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost is rated as 80 percent disabling. 38 C.F.R. § 4.124a. The words “mild,” “moderate,” and “severe” as used in the various Diagnostic Codes are not defined in the Rating Schedule. Regulations provide that ratings for peripheral neurological disorders are to be assigned based the relative impairment of motor function, trophic changes, or sensory disturbance. 38 C.F.R. § 4.120. Consideration is also given for loss of reflexes, pain, and muscle atrophy. See 38 C.F.R. §§ 4.123, 4.124. The term “incomplete paralysis” indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating is for the mild, or at most, the moderate degree. The disability ratings for the peripheral nerves are for unilateral involvement; when bilateral, the ratings combine with application of the bilateral factor. 38 C.F.R. § 4.124a, Note at “Diseases of the Peripheral Nerves.” The Note to 38 C.F.R. § 4.124a establishes a maximum disability rating for conditions that are wholly sensory, as opposed to a minimum disability rating for conditions that are more than wholly sensory. See Miller v. Shulkin, 28 Vet. App. 376 (2017). The maximum rating which may be assigned for neuritis not characterized by organic changes will be moderately severe incomplete paralysis for sciatic nerve involvement. See 38 C.F.R. § 4.123. The Board finds that a higher initial rating for right and left lower extremity radiculopathy is not warranted in this claim as moderately severe incomplete paralysis has not been demonstrated. Throughout two VA examinations in July 2016 and May 2018, and hundreds of VA treatment records, the Veteran’s right and left motor functions have been, at worst, a 4/5, demonstrating active movement against some resistance, as found for the first time in the 2018 examination. The 2016 sensory examination findings were normal as were the 2018 examination findings, with the exception of decreased sensation in the right and left feet and toes. The evidence does not demonstrate any trophic changes, muscle atrophy, impairment of reflexes, or complete paralysis. Although the Veteran has reported intermittent pain, the 2016 VA examiner found no evidence of radicular pain or any other signs or symptoms of radiculopathy. Further, while the Veteran reported during the 2018 examination severe radicular pain on a scale of 8 out of 10 on average and 10/10 during flare ups, the VA examiner concluded that there was a moderate amount of tenderness upon palpation. The examiner also noted that the examination was medically consistent with the Veteran’s statements describing functional loss with repetitive use over time. The examiner also noted radicular symptoms at the moderate severity to include constant pain in the right lower extremity, no intermittent pain (usually dull) bilaterally, and paresthesias and numbness of the right and left lower extremities. Finally, the examiner indicated nerve root involvement of the sciatic nerve with a moderate level of severity. The remaining medical evidence documents the Veteran’s complaints of pain radiating down one or both legs but does not document the severity of his pain at that time. Based on the above, the Board finds that the disability is primarily manifest by, at worst, moderate sensory disturbance, motor functions impairment, and pain without trophic changes, muscle atrophy, impairment of reflexes, or complete paralysis. The Board also finds that the most probative evidence of record is against a finding that the disability is manifest by moderately severe impairment of motor functions, trophic changes, sensory disturbance, loss of reflexes, pain, muscle atrophy, or complete paralysis. Although the Veteran reported severe pain during the 2018 VA examination, the treatment records do not document such pain upon examination, and the VA examiner found moderate tenderness to palpation despite the Veteran’s reports. The Board thus finds that the level of impairment is most analogous to moderate incomplete paralysis. The Board acknowledges the lay assertions of impairment of motor functions, sensory disturbance, and pain and finds that the Veteran is competent to report such lay-observable symptoms. However, the Board finds the medical evidence of record to be more probative because the Veteran has not been shown to possess the medical expertise required to evaluate the severity of his symptoms. The Board has considered all other potentially applicable Diagnostic Codes, but there is no evidence showing the Veteran has neurological impairment associated with any other peripheral nerves that have not already been service-connected. Therefore, a separate or higher rating under a different Diagnostic Code is not warranted. In conclusion, the Board finds that the preponderance of the evidence is against the Veteran’s claim for an initial rating in excess of 20 percent for right or left lower extremity radiculopathy. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 8. Entitlement to an effective date earlier than May 18, 2018, for the grant of service connection for right lower extremity radiculopathy 9. Entitlement to an effective date earlier than May 18, 2018, for the grant of service connection for left lower extremity radiculopathy The Veteran contends that he is entitlement to an effective date earlier than May 18, 2018, for the grant of service connection for the right and left lower extremity radiculopathy because he had radicular symptoms prior to that date. The Board concludes that the evidence does not support such a finding. Although not specifically claimed, your right and left lower extremity sciatic radiculopathy was inferred as a sympathetically related residual to your lumbar spine condition. Therefore, the condition is considered within the scope of your lumbar spine claim filed in April 2010. The proper effective date in this claim, May 14, 2018, is the earliest date that the diagnoses of sciatic radiculopathy in each extremity is factually ascertainable based on findings from your VA examination that confirmed your diagnosis. (38 CFR 3.155(d)(2), 38 CFR 3.400. The acknowledges that the Veteran reported radicular symptoms potentially related to the current diagnosis of sciatic radiculopathy prior to May 14, 2018, a diagnosis for such disability was supported until that date, as found upon the VA examination that day. We acknowledge and considered your medical evidence to include prior VA examinations which discusses the symptoms of occasional pain radiating down your right leg. However, the medical evidence of record, including a July 2010 and a July 2016 VA examination, does not demonstrate anything more than some radicular symptoms which were not determined to be radiculopathy until May 14, 2018. The 2010 VA examination revealed normal reflexes, normal sensory findings, and normal muscle strength of the lower extremities and the examiner stated that the Veteran did not have radiculopathy. The 2016 VA examiner found normal muscle strength testing, normal reflexes, negative straight leg testing and normal results for sensation to light touch testing. The examiner again indicated that there were no signs or symptoms due to radiculopathy at that time. The Board acknowledges that the Veteran is competent to report the lay-observable symptoms he experienced, such as radiating pain; however, lay evidence may not be used to establish an effective date. This conclusion is reserved for VA regulations and policy based on the evidence of record. Moreover, the Veteran is not shown to possess the medical expertise required to diagnose a disability based on those symptoms. Such an opinion requires knowledge of the interaction of multiple body symptoms and ability to conduct and/or interpret complicated diagnostic testing, knowledge or experience which the Veteran does not have. Therefore, the Board concludes that the VA examiners’ opinions are more probative in this claim, as they are based on such medical expertise and review of the complete medical record. The Board notes that the regional office (RO) originally assigned May 18, 2018, as the effective date for the grant of service connection or a separate rating for right and left lower extremity radiculopathy. However, the record clearly demonstrates that the diagnosis occurred on May 14, 2018, the correct date of the VA examination where the disabilities were diagnosed. Therefore, the Board finds that the correct and proper effective date for the right and left extremity radiculopathy disabilities is May 14, 2018. REASONS FOR REMAND 1. Entitlement to service connection for residuals, left ankle fracture The Veteran contends that he fell and incurred the left ankle fracture as a result of his service-connected bilateral pes planus and hallux valgus. An August 2020 VA examiner stated that an opinion could not be provided as to a proximate connection between the fall and his service-connected disabilities as medical evidence before the fall in question demonstrated. Regarding the fall itself, the examiner merely noted the Veteran’s reports of “taking a bad step” and rolling his ankle. The Board finds that it is entirely unclear from the examination report what exactly happened before the fall and is left with the impression that the examination of the Veteran was incomplete. Additional questions could clarify what caused the fall, including whether any of his service-connected symptoms led to the incident as he descended the stairs. The need for such clarification is further supported by VA treatment records which note that the Veteran’s hallux valgus causes alteration of the weight bearing line. As such, the Board requires an opinion based on a complete and accurate factual history and, therefore, must request a new VA examination to be obtained. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s residuals, left ankle fracture, disability is at least as likely as not proximately due to service-connected disability or aggravated beyond its natural progression by service-connected disability, including service-connected pes planus or hallux valgus. Cynthia M. Bruce Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. B., 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.