Citation Nr: 21022735 Decision Date: 04/19/21 Archive Date: 04/19/21 DOCKET NO. 16-50 002A DATE: April 19, 2021 ORDER Prior to November 17, 2020, an initial compensable rating for bilateral hearing loss is denied. Beginning November 17, 2020, a rating in excess of 10 percent for bilateral hearing loss is denied. An initial compensable rating for status post ganglionectomy on the left wrist is denied. Service connection for a right wrist disability is denied. Service connection for a perforated right ear drum is denied. Service connection for a left shoulder disability is denied. Service connection for a cervical spine disability is denied. REMANDED The claim for service connection for sinusitis is remanded. The claim for service connection for a respiratory disability, including asthma and bronchitis, is remanded. The claim for service connection for gastroesophageal reflux disease (GERD) is remanded. FINDINGS OF FACT 1. Prior to November 17, 2020, the Veteran’s bilateral hearing loss has been manifested by no more than Level III hearing acuity in the right ear and Level II hearing acuity in the left ear. 2. Beginning November 17, 2020, the Veteran’s bilateral hearing loss has been manifested by no more than Level V hearing acuity in the right ear and Level III hearing acuity in the left ear. 3. Throughout the period on appeal, the Veteran’s service-connected status post ganglionectomy on the left wrist has been manifested by full range of motion with no evidence of pain, functional loss, or ankylosis. 4. The preponderance of the evidence is against a finding that a current right wrist disability was incurred in or caused by service. 5. The preponderance of the evidence is against a finding that a perforated right ear drum was incurred in or caused by service. 6. The preponderance of the evidence is against a finding that a current left shoulder disability was incurred in or caused by service. 7. The preponderance of the evidence is against a finding that a current cervical spine disability was incurred in or caused by service. CONCLUSIONS OF LAW 1. Prior to November 17, 2020, the criteria for an initial compensable rating for bilateral hearing loss have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. § 4.85 Diagnostic Code 6100 (2020). 2. From November 17, 2020, the criteria for a rating in excess of 10 percent for bilateral hearing loss have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. § 4.85, Diagnostic Code 6100 (2020). 3. The criteria for an initial compensable rating for status post ganglionectomy on the left wrist have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. § 4.71a, Diagnostic Code 5215 (2020). 4. The criteria for establishing entitlement to service connection for a right wrist disability have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107 38 C.F.R. §§ 3.303, 3.307, 3.309 (2020). 5. The criteria for establishing entitlement to service connection for perforated right eardrum have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303 (2020). 6. The criteria for establishing entitlement to service connection for a left shoulder disability have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107 38 C.F.R. §§ 3.303, 3.307, 3.309 (2020). 7. The criteria for establishing entitlement to service connection for a cervical spine disability have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107 38 C.F.R. §§ 3.303, 3.307, 3.309 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1962 to November 1982. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2014 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Board notes that on the Veteran’s December 2013 application for benefits, he indicated that he was seeking service connection for a left shoulder disability. However, during the course of the claim, the Veteran indicated that he intended to file a claim for service connection for a right shoulder disability, not the left. As a claim for service connection for a right shoulder disability has not been adjudicated by the agency of original jurisdiction (AOJ), the Board does not have jurisdiction over such claim. The Veteran is advised that if he wishes to file a claim for service connection for a right shoulder disability, he must do so on the application form prescribed by the Secretary. Disability Ratings Disability ratings are determined by applying the criteria set forth in the VA Schedule of Rating Disabilities (Rating Schedule) and are intended to represent the average impairment of earning capacity resulting from disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1 (2020). Disability of the musculoskeletal system is primarily the inability, due to damage or inflammation in parts of the system, to perform normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. The functional loss may be due to absence of part or all of the necessary bones, joints and muscles, or associated structures, or to deformity, adhesions, defective innervation, or other pathology, or may be due to pain, supported by adequate pathology and evidenced by visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part which becomes painful on use must be regarded as disabled. See DeLuca v. Brown, 8 Vet. App. 202 (1995); 38 C.F.R. § 4.40; see also 38 C.F.R. §§ 4.45, 4.59. Although pain may be a cause or manifestation of functional loss, limitation of motion due to pain is not necessarily rated at the same level as functional loss where motion is impeded. See Mitchell v. Shinseki, 25 Vet. App. 32 (2011). Additionally, the intent of the Rating Schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. When a disability demonstrates actually painful, unstable, or malaligned joints due to healed injury, it is entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59. 1. Entitlement to a higher initial rating for bilateral hearing loss, rated as 0 percent disabling prior to November 17, 2020, and 10 percent thereafter Disability ratings for hearing loss range from noncompensable to 100 percent based on organic impairment of hearing acuity as measured by the results of controlled speech discrimination tests (Maryland CNC) combined with the average hearing threshold levels as measured by puretone audiometry tests in the frequencies 1000, 2000, 3000, and 4000 Hertz. 38 C.F.R. § 4.85, Diagnostic Code 6100. To evaluate the degree of disability for service-connected hearing loss, the Rating Schedule contains eleven auditory acuity levels, designated from Level I through Level XI. 38 C.F.R. § 4.85(h), Tables VI, VIA (2020). The results of the puretone audiometry tests and speech discrimination tests are charted on Table VI, or on Table VIA for exceptional cases described in 38 C.F.R. § 4.86 or if the examiner certifies that the use of speech discrimination testing is not appropriate. 38 C.F.R. § 4.85(c). Table VII prescribes the disability rating based on the relationship between the values for each ear derived from Table VI. See 38 C.F.R. § 4.85. The evaluations derived from the Rating Schedule are intended to make proper allowance for improvement by hearing aids. The rating criteria also provides for rating exceptional patterns of hearing impairment when the puretone threshold at each of the four specified frequencies of 1000, 2000, 3000, and 4000 Hertz are 55 decibels or more, or when the puretone threshold is 30 decibels or less at 1000 Hertz and 70 decibels or more at 2000 Hertz. 38 C.F.R. § 4.86. In such cases, each ear is evaluated separately, and the Roman numeral designation for the ear with an exceptional pattern of hearing impairment is derived from Table VI or VIA, whichever results in the higher numeral. Id. When the puretone threshold is 30 decibels or less at 1000 Hertz and 70 decibels or more at 2000 Hertz, the assigned numeral is elevated to the next higher Roman numeral. Id. Prior to November 17, 2020 Upon review of the record, the Board finds that an initial compensable rating for bilateral hearing loss is not warranted at any time prior to November 17, 2020. The Veteran underwent a VA audiological examination in May 2014, at which time audiometric testing revealed puretone thresholds, in decibels, as follows: HERTZ 1000 2000 3000 4000 RIGHT 15 40 45 45 LEFT 20 35 30 30 The puretone threshold average was 36.25 decibels in the right ear and 28.75 decibels in the left ear. Speech recognition testing using the Maryland CNC word list revealed scores of 80 percent in the right ear and 90 percent in the left ear. Under Table VI of the Rating Schedule, the results of the May 2014 audiometric testing correspond with a numeric designation of Level III for the right ear and Level II for the left ear. Applying those numeric designations to Table VII warrants a rating of 0 percent for bilateral hearing loss. See 38 C.F.R. § 4.85. The Veteran did not report any functional impact of his hearing loss. See Martinak v. Nicholson, 21 Vet. App. 447, 454-56 (2007). However, even considering any claimed subjective functional impact, disability ratings for hearing impairment are derived by a mechanical application of the Rating Schedule to the numeric designations assigned after audiometric evaluations are rendered. Lendenman v. Principi, 3 Vet. App. 345, 349 (1992). As the evidence of record does not show audiometric testing results that warrant a higher rating at any time prior to November 17, 2020, an initial compensable rating for bilateral hearing loss prior to November 17, 2020, is denied.   Beginning November 17, 2020 Upon review of the record, the Board finds that a rating in excess of 10 percent for bilateral hearing loss is not warranted at any time on or after November 17, 2020. The Veteran underwent a VA audiological examination in November 2020, at which time audiometric testing revealed puretone thresholds, in decibels, as follows: HERTZ 1000 2000 3000 4000 RIGHT 35 50 65 95 LEFT 35 50 50 55 The puretone threshold average was 61 decibels in the right ear and 48 decibels in the left ear. Speech recognition testing using the Maryland CNC word list revealed scores of 72 percent in the right ear and 76 percent in the left ear. Under Table VI of the Rating Schedule, the results of the November 2020 audiometric testing correspond with a numeric designation of Level V for the right ear and Level III for the left ear. Applying those numeric designations to Table VII warrants a rating of 10 percent for bilateral hearing loss. See 38 C.F.R. § 4.85. The Board has reviewed and considered the Veteran’s assertions with respect to the functional impairment caused by his hearing loss, including difficulty hearing conversational speech, having to ask people to repeat themselves, and holding the telephone to his left ear only. See Martinak, 21 Vet. App. at 454-56. However, disability ratings for hearing impairment are derived by a mechanical application of the Rating Schedule to the numeric designations assigned after audiometric evaluations are rendered. Lendenman, 3 Vet. App. at 349. Even considering the Veteran’s subjective complaints, the evidence of record does not show audiometric testing results that warrant a higher rating at any time on or after November 17, 2020. Accordingly, a rating in excess of 10 percent for bilateral hearing loss is not warranted at any time on after November 17, 2020. 2. Entitlement to an initial compensable rating for status post ganglionectomy on the left wrist The Veteran’s service-connected left wrist disability has been evaluated under Diagnostic Code 5215, relating to limitation of motion of the wrist. Pursuant to Diagnostic Code 5215, a 10 percent rating is warranted where palmar flexion of either extremity is limited in line with the forearm (zero degrees), or where dorsiflexion (extension) of either extremity is less than 15 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5215. Full wrist motion is to 70 degrees of dorsiflexion (extension), 80 degrees of palmar flexion, 45 degrees of ulnar deviation, and 20 degrees of radial deviation. 38 C.F.R. § 4.71. Ten percent is the maximum schedular rating available based on limitation of motion of the wrist under this diagnostic code. A higher rating is only warranted when there is evidence of ankylosis. 38 C.F.R. § 4.71a, Diagnostic Code 5214. As opposed to limitation of motion, ankylosis is a distinct disability defined as the “immobility and consolidation of a joint due to disease, injury, or surgical procedure.” Shipwash v. Brown, 8 Vet. App. 218, 221 (1995). Pursuant to Diagnostic Code 5214, a 30 percent rating is warranted for favorable ankylosis of the major wrist in 20 to 30 degrees of dorsiflexion. 38 C.F.R. § 4.71a, Diagnostic Code 5214. A 40 percent rating is warranted for ankylosis of the major wrist in any other position, except favorable. Id. A maximum 50 percent rating is warranted for unfavorable ankylosis of the major wrist in any degree of palmar flexion, or with ulnar or radial deviation. Id. Upon review of the record, the Board finds that a compensable rating for status post ganglionectomy on the left wrist is not warranted at any time during the period under review. The Veteran underwent a VA examination in May 2014, during which he reported having a ganglion cyst removed from his left wrist during service. Range of motion testing of the left wrist revealed palmar flexion to 80 degrees or greater, dorsiflexion (extension) to 70 degrees or greater, ulnar deviation to 45 degrees, and radial deviation to 20 degrees, with no additional limitation upon repetition. There was no evidence of ankylosis, pain, or functional loss, and the left wrist exhibited full muscle strength. The Veteran underwent another VA examination in December 2020, during which he reported that he was actually seeking compensation for a right wrist disability, not the left. The Veteran did not report any symptoms related to his service-connected left wrist disability. Range of motion testing of the left wrist revealed palmar flexion to 80 degrees, dorsiflexion (extension) to 70 degrees, ulnar deviation to 45 degrees, and radial deviation to 20 degrees, with no additional limitation upon repetition. There was no evidence of ankylosis, pain, or functional loss, and the left wrist exhibited full muscle strength. As there is no evidence of left wrist pain, limitation of motion, or functional loss, the Board finds that a compensable rating is not warranted for status post ganglionectomy on the left wrist at any time during the period under review. See 38 C.F.R. §§ 4.59, 4.71a, Diagnostic Code 5215. Service Connection Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Generally, to prove service connection, there must be competent, credible evidence of (1) a current disability, (2) 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). Where a veteran served continuously for 90 days or more during a period of war, or during peacetime service after December 31, 1946, and arthritis becomes manifest to a degree of 10 percent within one year from date of termination of such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. 3. Entitlement to service connection for a right wrist disability The Veteran seeks service connection for residuals of a cyst on the right wrist. Upon review of the record, the Board finds that the preponderance of the evidence is against a finding that a current right wrist disability was incurred in or caused by service. To the extent that the Veteran claims to have had right wrist symptoms since service, the Board finds that such assertions are not consistent with the evidence of record. Service treatment records show that the Veteran was treated for a ganglion cyst on the left wrist in 1977 and 1981. However, the record shows no complaints of or treatment for a right wrist condition during service. A November 1982 report of medical examination shows that the Veteran’s upper extremities were normal upon his discharge from active duty, and he denied any swollen or painful joints, arthritis, rheumatism, or bursitis on an accompanying report of medical history. The record shows no complaints of or treatment for right wrist symptoms until approximately May 2012, when the Veteran reported a lump on his right wrist for the past four to five months, and he was diagnosed with a ganglion cyst on the right wrist. Around August 2013, he was diagnosed with arthritis of the right wrist and underwent a ganglion cyst removal. The Board finds the contemporaneous medical evidence to be significantly more credible and probative than statements made to VA for purposes of seeking compensation. See Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991); see also Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006). The Veteran underwent a VA examination in May 2014, during which he was diagnosed with status post ganglionectomy of both wrists. The Veteran reported the date of onset of his symptoms was 1977. It was noted that service treatment records showed that the Veteran had a ganglion cyst removed from the left wrist in 1977, which recurred and was again removed in 1981. The examiner opined that it was less likely than not a current right wrist disability was incurred in or caused by service. In support of this, the examiner explained that service treatment records showed no evidence of a right wrist condition during service. The Board finds the opinion of the VA examiner to be highly probative and persuasive, as it is supported by a reasoned explanation based on a review of the evidence of record. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008). To the extent that the Veteran believes that a current right wrist disability is related to service, as a lay person, he has not shown that he has specialized training enough to render such an opinion. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). In this regard, the diagnosis and etiology of a wrist condition that had its onset many years after service are matters not capable of lay observation and require medical expertise to determine. Thus, the opinion of the Veteran regarding the etiology of a current right wrist disability is not competent medical evidence. 4. Entitlement to service connection for a perforated right ear drum As an initial matter, the Board notes that service connection has been granted for other disabilities relating to the ear, including bilateral hearing loss, tinnitus, and residuals of a traumatic brain injury (TBI) with vertigo. Therefore, this decision will only address the diagnosis of a perforated right eardrum. Upon review of the record, the Board finds that the preponderance of the evidence is against a finding that a perforated right eardrum was incurred in or caused by service. Although the Veteran claims to have sustained a perforated right eardrum during service, his assertions are not consistent with the evidence of record. Service treatment records show several complaints of right ear pain, drainage, and hearing loss between 1969 and 1981 and diagnoses of otitis media, swimmer’s ear, fungus in the ear, and contact dermatitis of the right ear. During an examination of the right ear in November 1974, it was noted that the right tympanic membrane was intact. In August 1975, the Veteran was physically assaulted and hit in the head with an object, and he subsequently sought treatment for dizziness, headaches, and neck pain. However, the record does not show that he suffered a perforated eardrum during the assault. In May 1981, an examination of the right ear revealed some fluid behind the tympanic membrane, but the canal was within normal limits. A November 1982 report of medical history shows that the Veteran’s ears and eardrums were normal upon his discharge from active duty, and he denied any ear trouble on an accompanying report of medical history. Post-service treatment records show that the Veteran underwent tympanic membrane graft surgery in 1990. The Board finds the contemporaneous medical evidence to be significantly more credible and probative than statements made to VA for purposes of seeking compensation. See Cartright, 2 Vet. App. at 25; see also Buchanan, 451 F.3d at 1337. The Veteran underwent a VA audiological examination in May 2014, during which he reported sustaining a perforated eardrum around 1975. The Veteran also underwent a VA ear examination pursuant to his claim for service connection for vertigo in May 2014, and that examination report indicates that the Veteran sustained a perforated right tympanic membrane in 1984. A physical examination of the right ear revealed evidence of a healed tympanic membrane perforation. The Veteran underwent another VA ear examination in December 2020, during which he reported sustaining a perforated right eardrum during service and undergoing graft surgery. He reported intermittent right ear pain and hearing loss ever since. A physical examination of the right ear revealed scar tissue in the tympanic membrane. The examiner opined that it was less likely than not that the Veteran’s right eardrum perforation was incurred in or caused by service. In support of this, the examiner explained that treatment records show the Veteran sustained a perforated eardrum and underwent a tympanic membrane graft in 1990, eight years after his discharge from service. The examiner further explained that the Veteran suffered ear infections and otitis media during service; however, those conditions are unrelated to his subsequent perforated eardrum. The Board finds the opinion of the December 2020 VA examiner to be highly probative and persuasive, as it is supported by a reasoned explanation based on a review of the evidence of record. See Nieves-Rodriguez, 22 Vet. App. at 301. To the extent that the Veteran believes that his perforated right eardrum is related to service, as a lay person, he has not shown that he has specialized training enough to render such an opinion. See Jandreau, 492 F.3d at 1377. In this regard, the diagnosis and etiology of a perforated eardrum that occurred several years after service are matters not capable of lay observation and require medical expertise to determine. Thus, the opinion of the Veteran regarding the etiology of his perforated right eardrum is not competent medical evidence. 5. Entitlement to service connection for a left shoulder disability Upon review of the record, the Board finds that the preponderance of the evidence is against a finding that a current left shoulder disability was incurred in or caused by service. To the extent that the Veteran claims to have had continued left shoulder pain since service, the Board finds that such assertions are not consistent with the evidence of record. Service treatment records show that after the August 1975 assault, the Veteran’s left shoulder exhibited supraclavicular ecchymosis and edema, but had full passive range of motion and no clicks or rubs. Subsequent service treatment records show no complaints of or treatment for left shoulder symptoms. A November 1982 report of medical examination shows that the Veteran’s upper extremities were normal upon his discharge from active duty, and he denied any swollen or painful joints, arthritis, rheumatism, or bursitis on an accompanying report of medical history. Thereafter, despite seeking treatment for various other conditions, post-service treatment records show no complaints of or treatment for a left shoulder condition until the Veteran filed a claim for service connection in December 2013. However, when the Veteran underwent a VA shoulder examination in May 2014, he indicated that he intended to file a claim for service connection for a right shoulder disability, not the left. Treatment records show that the Veteran first complained of left shoulder pain in April 2015, at which time he was diagnosed with arthritis of the left shoulder. The Board finds the contemporaneous medical evidence to be significantly more credible and probative than statements made to VA for purposes of seeking compensation. See Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991); see also Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006). As previously noted, the Veteran initially underwent a VA shoulder examination in May 2014, during which he did not report any left shoulder symptoms. The left shoulder exhibited full range of motion, and there was no evidence of pain or functional loss. The examiner opined that it was less likely than not that the claimed condition was incurred in or caused by service, as the record did not show that the Veteran had a left shoulder condition, and no left shoulder condition was noted upon the Veteran’s discharge from active duty. The Veteran underwent another VA shoulder examination in December 2020, during which he reported left shoulder pain after loading heavy items aboard a ship during service, which has gotten worse over the years. The examiner indicated that the Veteran was diagnosed with degenerative arthritis of the left shoulder in 2015 and opined that it was less likely than not incurred in or caused by service. In support of this, the examiner explained that evidence of record shows that the Veteran’s in-service left shoulder supraclavicular ecchymosis with edema was an acute injury that resolved, and his current arthritis was not diagnosed for over 30 years after the Veteran’s discharge from service. The Board finds the opinion of the December 2020 VA examiner to be highly probative and persuasive, as it is supported by a reasoned explanation based on a review of the evidence of record. See Nieves-Rodriguez, 22 Vet. App. at 301. To the extent that the Veteran believes that a current left shoulder disability is related to service, as a lay person, he has not shown that he has specialized training enough to render such an opinion. See Jandreau, 492 F.3d at 1377. In this regard, the diagnosis and etiology of a left shoulder disability are matters not capable of lay observation and require medical expertise to determine. Thus, the opinion of the Veteran regarding the etiology of arthritis of the left shoulder is not competent medical evidence. 6. Entitlement to service connection for a cervical spine disability Upon review of the record, the Board finds that the preponderance of the evidence is against a finding that a current cervical spine disability was incurred in or caused by service. To the extent that the Veteran claims to have experienced continued neck pain since service, the Board finds that such assertions are not consistent with the evidence of record. As previously noted, service treatment records also show that the Veteran was physically assaulted and hit in the head with an object in August 1975, and he subsequently sought treatment for dizziness, headaches, and neck pain. Cervical spine x-rays performed in September 1975 revealed no fracture, and it was noted that the Veteran may have sustained a cervical muscle strain. Another September 1975 service treatment record shows that the Veteran reported that his neck pain was better, but he was advised to continue wearing a cervical collar. In November 1975, the Veteran reported that his cervical vertigo had resolved. Subsequent service treatment records show no addition complaints of neck pain. In April 1976, the Veteran sought treatment for lower back pain after moving heavy objects; however, there was no mention of neck pain. A November 1982 report of medical examination shows that the Veteran’s neck, spine, and other musculoskeletal systems were normal upon his discharge from active duty, and he denied any swollen or painful joints, arthritis, rheumatism, or bursitis on an accompanying report of medical history. Thereafter, despite seeking treatment for various other conditions, post-service treatment records show no complaints of or treatment for neck pain until approximately November 2010. See AZ v. Shinseki, 731 F.3d 1303, 1315 (Fed. Cir. 2013) (recognizing the widely held view that the absence of an entry in a record may be considered evidence that the fact did not occur if it appears that the fact would have been recorded if present). The Board finds the contemporaneous medical evidence to be significantly more credible and probative than statements made to VA for purposes of seeking compensation. See Cartright, 2 Vet. App. at 25; see also Buchanan, 451 F.3d at 1337. The Veteran underwent a VA examination in May 2014, during which he reported gradual onset of neck symptoms in the late 1970’s, around the same time that his lower back pain began. X-rays revealed spurs and/or narrowing of the neural foramina at C3-6. The examiner diagnosed the Veteran with cervical osteoarthritis with spurs and narrowed neuroforamina and opined that it was less likely than not incurred in or caused by service. In support of this, the examiner explained that service treatment records showed treatment for neck spasms in 1975; however, x-rays of the cervical spine were negative at that time, and there was no additional documentation of a neck condition during service. The Board finds the opinion of the VA examiner to be highly probative and persuasive, as it is supported by a reasoned explanation based on a review of the evidence of record. See Nieves-Rodriguez, 22 Vet. App. at 302-04. To the extent that the Veteran believes that a current neck disability is related to service, as a lay person, he has not shown that he has specialized training enough to render such an opinion. See Jandreau, 492 F.3d at 1377. In this regard, the diagnosis and etiology of cervical spine disabilities are matters not capable of lay observation and require medical expertise to determine. Thus, the opinion of the Veteran regarding the etiology of his current arthritis of the cervical spine is not competent medical evidence. The Board finds the opinion of the VA examiner to be significantly more probative than the Veteran’s lay assertions. In reaching the above conclusions, the Board has considered the doctrine of reasonable doubt; however, as the preponderance of the evidence is the claims, the doctrine is not for application. See Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). REASONS FOR REMAND 7. The claim for service connection for sinusitis is remanded. 8. The claim for service connection for a respiratory disability, including asthma and bronchitis, is remanded. Service treatment records show numerous complaints of cough, sore throat, nasal congestion, and sinus pressure between 1967 and 1981 and diagnoses of acute bronchitis, chronic bronchitis, sinusitis, upper respiratory infection, chronic congestion, chronic cough, flu, viral syndrome, and rule out asthma. Post-service treatment records dated 2000 through 2016 likewise show many complaints of cough, sore throat, nasal congestion, and sinus pressure and diagnoses of sinusitis in April 2000, August 2004, December 2004, November 2005, November 2006, March 2007, August 2007, and April 2009 and diagnoses of bronchitis in December 2001, November 2005, November 2006, August 2007, October 2011, and January 2014. The Veteran underwent VA respiratory and sinus examinations in December 2020, at which time the examiner indicated that the Veteran was diagnosed with asthma in 2009. The examiner opined that the Veteran’s asthma was less likely than not incurred in or caused by service, as the Veteran was apparently diagnosed with asthma in 2009, 27 years after his discharge from active duty. With respect to the Veteran’s claimed chronic sinusitis and chronic bronchitis, the examiner indicated that no diagnosis was warranted, as the Veteran was diagnosed with acute sinusitis in 2009 and acute bronchitis in 2012, both of which resolved. Because the VA examiner’s opinion appears to suggest that the Veteran was only diagnosed with sinusitis and bronchitis on one occasion after service, the Board finds that a remand is necessary in order to obtain a new medical opinion that considers the numerous diagnoses of sinusitis and bronchitis over the years. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (holding that “[a]n opinion based on an inaccurate factual premise has no probative value”). Additionally, in August 2014, the Veteran submitted a letter from a private physician who indicated that he has treated the Veteran for allergic rhinitis since 1988, and the Veteran’s complications include sinusitis and asthma. As those records may be relevant to the Veteran’s claims for service connection for a sinus and/or respiratory disability, the Veteran should be asked to submit or request that VA obtain those records of treatment. Furthermore, a VA medical opinion should also be obtained as to whether a claimed sinus or respiratory disability was caused or aggravated by the Veteran’s service-connected allergic rhinitis. See 38 C.F.R. § 3.310(b); Allen v. Brown, 7 Vet. App. 439, 448-49 (1995). 9. The claim for service connection for GERD is remanded. Service treatment records show that in May 1982, the Veteran reported epigastric pain for the past three to four days. The impression was rule out peptic ulcer disease, rule out pancreatitis, and rule out gastroesophageal reflux. During a physical examination conducted upon the Veteran’s discharge from active duty, he reported “don’t know” when asked if he had a history of stomach, liver, or intestinal trouble. Based on the foregoing, the Board finds that the Veteran should be provided with a VA examination to determine whether he has a current diagnosis of GERD, and if so, whether it is related to service. The matters are REMANDED for the following action: 1. Ask the Veteran to submit or request that VA obtain treatment records from his private allergist, Dr. Radin. After securing any necessary releases, request any relevant records identified. If any requested records are unavailable, the Veteran should be notified of such. 2. After the above has been completed and available records have been associated with the claims file, provide the claims file to an appropriate VA examiner to obtain an opinion with respect to the Veteran’s claims for service connection for sinusitis, bronchitis, and asthma. Do not schedule the Veteran for another examination unless it is deemed necessary to respond the questions presented. After a review of the claims file, the practitioner should answer the following: (a.) Is it at least as likely as not (50 percent probability or greater) that a current sinus or respiratory disability (including sinusitis, bronchitis, and/or asthma) was incurred in or caused by service? Please explain why or why not. (b.) If not related to service, is it at least as likely as not (50 percent probability or greater) that a current sinus or respiratory disability (including sinusitis, bronchitis, and/or asthma) was caused by the Veteran’s service-connected allergic rhinitis? Please explain why or why not. (c.) If not, is it at least as likely as not (50 percent probability or greater) that a current sinus or respiratory disability (including sinusitis, bronchitis, and/or asthma) was aggravated by the Veteran’s service-connected allergic rhinitis? Please explain why or why not. (d.) If the practitioner finds that a current sinus or respiratory disability was aggravated by the Veteran’s allergic rhinitis, the practitioner should attempt to quantify the degree of worsening beyond the baseline level. A complete rationale for all opinions must be provided. The practitioner’s opinion must reflect consideration of the following evidence: • Service treatment records showing numerous complaints of cough, sore throat, nasal congestion, and sinus pressure between 1967 and 1981 and diagnoses of acute bronchitis, chronic bronchitis, sinusitis, upper respiratory infection, chronic congestion, chronic cough, flu, viral syndrome, and rule out asthma. • Post-service treatment records dated 2000 through 2016 showing many complaints of cough, sore throat, nasal congestion, and sinus pressure and diagnoses of sinusitis, bronchitis, and allergies versus asthma. 3. Schedule the Veteran for a VA examination pursuant to his claim for service connection for GERD. After examination and review of the claims file, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that any current gastroesophageal disability is a continuation of or otherwise related to the Veteran’s in-service treatment for gastroesophageal reflux in May 1982. Please explain why or why not. 4. If the claims remain denied, issue a supplemental statement of the case. K. A. BANFIELD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Banister, 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.