Citation Nr: 21023639 Decision Date: 04/21/21 Archive Date: 04/21/21 DOCKET NO. 20-30 253 DATE: April 21, 2021 ORDER Service connection for a left arm disability (other than a left shoulder disability) is denied. Service connection for a left shoulder disability, including arthritis, is denied. Service connection for a left leg disability, including arthritis, is denied. Service connection for hypertension is denied. Service connection for sleep apnea is denied. Service connection for a respiratory disability (other than sleep apnea) is denied. Service connection for bilateral sensorineural hearing loss is granted. REMANDED Service connection for a left foot disability is remanded. Service connection for a left ankle disability is remanded. FINDINGS OF FACT 1. There was no left arm injury or disease during service, and there is no current left arm disability apart from the left shoulder disability. 2. There was no shoulder injury or disease during service, and chronic symptoms of left shoulder arthritis were not manifested during service; symptoms of left shoulder arthritis have not been continuous since service separation, and left shoulder arthritis did not manifest to a compensable degree in the year following separation from service; the left shoulder disability, including arthritis, was manifested many years after service and is not causally or etiologically related to service. 3. There was no left leg injury or disease during service, and chronic symptoms of left leg arthritis were not manifested during service; symptoms of left leg arthritis have not been continuous since service separation, and left leg arthritis did not manifest to a compensable degree in the year following separation from service; the left leg disability, including arthritis, was manifested many years after service and is not causally or etiologically related to service. 4. There was no vascular injury or disease during service, and chronic symptoms of hypertension were not manifested during service; symptoms of hypertension have not been continuous since service separation, and hypertension did not manifest to a compensable degree in the year following separation from service; hypertension was manifested many years after service and is not causally or etiologically related to service. 5. No relevant respiratory injury or disease or sleep apnea symptoms were manifested during service; sleep apnea was manifested many years after service and is not causally or etiologically related to service. 6. No relevant respiratory injury or disease, including symptoms, were manifested during service; the current bronchial asthma was first manifested many years after service, and is not causally or etiologically related to service. 7. The Veteran was exposed to loud noise during service; the Veteran currently has a bilateral sensorineural hearing loss disability for VA disability compensation purposes; and the current bilateral sensorineural hearing loss disability is causally related to in-service noise exposure. CONCLUSIONS OF LAW 1. The criteria for service connection for a left arm disability are not met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for a left shoulder disability, including arthritis, are not met. 38 U.S.C. §§ 1112, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 3. The criteria for service connection for a left leg disability, including arthritis, are not met. 38 U.S.C. §§ 1112, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 4. The criteria for service connection for hypertension are not met. 38 U.S.C. §§ 1112, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 5. The criteria for service connection for sleep apnea are not met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 6. The criteria for service connection for a respiratory disability other than sleep apnea are not met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.159, 3.303. 7. Resolving reasonable doubt in the Veteran's favor, the criteria for service connection for bilateral sensorineural hearing loss are met. 38 U.S.C. §§ 1112, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.385. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran, who is the appellant, had active service from September 1956 to November 1957. These matters are on appeal from March 1982, August 2011, January 2013, August 2015, and April 2017 rating decisions. In March 2018, the Board granted service connection for tinnitus and remanded the issues on appeal for any service treatment records and service personnel records in the Veteran’s possession, additional information and authorization from the Veteran regarding private treatment received for the claimed disabilities after service, additional VA treatment records, an additional VA examination for vitiligo, and issuance of a statement of the case (SOC) for the issues of service connection for the left arm and left leg disabilities. Collectively, in March 2018 and December 2018 letters, the Agency of Original Jurisdiction (AOJ) advised the Veteran that the service treatment records were unavailable, explained that he may furnish certain documents that can substitute for service treatment records, listed the types of documents that he may provide that relate to the disability during service, asked him to provide additional information, consent, and authorization for records for treatment from private medical providers, and asked him for statements from himself or any witnesses that can explain how the claimed disabilities are related to service and how the disabilities affect him. In April 2018, additional VA treatment records were obtained, the Veteran sent copies of certain VA treatment records and a service treatment record that he believed were relevant to the appeal and indicated that he had no other information or evidence to provide. In March 2019, a VA examination with a medical opinion for vitiligo was provided. In August 2020, the appeals were readjudicated (including issuance of a SOC for the issues of service connection for a left leg disability and left arm disability). For these reasons, the Board finds that there was compliance with the prior remand directives. As a result of the ordered development, service connection was established for vitiligo effective from June 29, 2015 in an August 2020 rating decision; therefore, that issue is no longer before the Board. After the August 2020 SOC was issued, the Veteran filed a timely substantive appeal for the issues of service connection for a left leg disability and left arm disability. In September 2020 and December 2020, the Board sent letters to the Veteran advising him that the appeal had previously been remanded and had been returned to the Board and he had 90 days from the date of the letter to request a change in representation or submit additional argument or evidence. In March 2021, the Board also asked the Veteran to clarify whether he wanted an optional Board hearing and advised the Veteran that the Board would assume that he did not want a hearing if he did not respond to the letter within 30 days. No response to the September 2020, December 2020, or March 2021 letters was received, so the Board will proceed with appellate review. Service Connection Legal Authority Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection may be established on a direct basis when there is competent, credible evidence of: (1) a current disability; (2) a disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. 38 C.F.R. § 3.303(a),(d). Service connection may be established on a presumptive basis for chronic diseases listed under 38 C.F.R. § 3.309(a) if chronic symptoms of the disease were shown in service; the disease was manifested to a compensable degree with a presumptive period, usually one year after service separation; or continuous symptoms of the disease were manifested since service. 38 U.S.C. §§ 1112, 1113; 38 C.F.R. §§ 3.33(b), 3.307, 3.309(a); see also Walker v. Shinseki, 708 F. 3d 1131 (Fed. Cir. 2013). Because the current diagnoses of left shoulder osteoarthritis and left leg osteoarthritis (i.e., arthritis), hypertension, and sensorineural hearing loss (as an organic disease of the nervous system) are listed as chronic diseases under 38 C.F.R. § 3.303(b), the presumptive service connection provisions are applicable to those diagnoses; however, bronchial asthma and sleep apnea are not chronic diseases under 38 C.F.R. § 3.303(b), so the presumptive service connection provisions are not applicable to those diagnoses. Service Connection Analysis 1. Service connection for a left arm disability is denied. 2. Service connection for a left shoulder disability, including arthritis, is denied. The Veteran contends that he has a current left arm disability and/or left shoulder disability causally related to service. He seeks service connection on this basis. After review of all the lay and medical evidence of record, the Board finds that the weight of the evidence is against finding that there was a left arm or shoulder injury or disease during service or that there were chronic symptoms of left shoulder arthritis during service. The service treatment records are fire-related and incomplete in this case. Available service treatment records show no complaint, report, diagnosis, or treatment for any left arm or shoulder problems during service. The earliest complaint of left arm problems is shown in 1982, approximately 25 years after service separation. Considered together with the evidence showing no left arm or shoulder injury, disease, or symptoms during service, the 25-year gap between service separation and the earliest left arm complaints is a factor that weighs against service incurrence. Because the weight of the evidence demonstrates no left arm or shoulder injury or disease, or "chronic" symptoms of left shoulder arthritis during service, the criteria for presumptive service connection under 38 C.F.R. § 3.303 (b) based on "chronic" symptoms in service are not met. 38 C.F.R. §§ 3.307, 3.309. Although the Veteran has asserted that the current left shoulder disability is causally related to service, he is a lay person and, under the specific facts of this case, does not have the requisite medical expertise to be able to diagnose left shoulder arthritis or render a competent medical opinion regarding its cause when the facts of this case show no in-service left arm or shoulder injury or disease, and no left shoulder arthritis symptoms until many years after service. Arthritis is complex and involves unseen systems processes and disease processes that are not observable by the five senses of a lay person, and includes various possible etiologies, only one of which involves trauma to a joint, and is diagnosable only by X-ray or similar specific specialized clinical testing; therefore, under the facts presented in this case, the Veteran is not competent to diagnose left shoulder arthritis or to opine as to its etiology. Thus, while the Veteran is competent to relate symptoms of left arm or shoulder pain that he experienced at any time, in the absence of credible evidence of in-service left arm or shoulder injury, disease, or symptoms as in this case, he is not competent to opine on whether there is a link between the left shoulder arthritis, which was manifested many years after service separation, and active service because such diagnosis and nexus require specific medical knowledge and training. King v. Shinseki, 700 F.3d 1339, 1345 (Fed. Cir. 2009) (holding that it was not erroneous for the Board to find that a lay veteran claiming service connection for a back disorder and his wife lacked the "requisite medical training, expertise, or credentials needed to render a diagnosis" and that their testimony "could not establish medical causation nor was it a competent opinion as to medical causation"); Clyburn v. West, 12 Vet. App. 296, 301 (1999) (holding that a veteran is not competent to relate currently diagnosed chondromalacia patellae or degenerative joint disease to the continuous post-service knee symptoms); Savage v. Gober, 10 Vet. App. 488, 496-97 (1997) (requiring that a veteran present medical nexus evidence relating currently diagnosed arthritis to in-service back injury). There is no medical opinion evidence linking the current left shoulder disability to service. For these reasons, the Veteran’s purported opinion that the current left shoulder disability is the result of service is of no probative value; thus, in consideration of the foregoing, the Board finds that a preponderance of the lay and medical evidence that is of record weighs against service connection for left shoulder disability, including arthritis, under any theory, including direct and presumptive as a chronic disease; therefore, the appeal must be denied. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. There is no current left arm diagnosis apart from a left shoulder disability. The Court has held that "Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability. In the absence of proof of a present disability there can be no valid claim." Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); see also Rabideau v. Derwinski, 2 Vet. App. 141, 143-44 (1992); McClain v. Nicholson, 21 Vet. App. 319 (2007) (recognizing the disability could arise at any time during the claim); Romanowsky v. Shinseki, 26 Vet. App. 289 (2013) (recognizing disabilities that occur immediately prior to filing of a claim). Because a current left arm disability apart from a left shoulder disability is not demonstrated in this case, disability benefits are not warranted for a left arm disability. 3. Service connection for a left leg disability is denied. The Veteran contends that the current left leg disability, which has been diagnosed as osteoarthritis, causally related to service. He seeks service connection on this basis. After review of all the lay and medical evidence of record, the Board finds that the weight of the evidence is against finding that there was a left leg injury or disease during service or that there were chronic symptoms of left leg arthritis during service. Available service treatment records show left foot pain in November 1956 with no complaint, report, diagnosis, or treatment for any left leg problems during service. On the February 1981 VA Form 21-4138, the Veteran reported that he sustained an-service left leg injury after falling during basic training; however, the earliest account of the alleged in-service left leg injury occurred many years after service separation when the memory is less reliable, and the June 1981 VA examination report shows that the left leg showed no residuals of trauma, so the Veteran’s account of an in-service left leg injury is not deemed credible and is of no probative value. The earliest complaint of left leg problems is shown in 1981, approximately 24 years after service separation. Considered together with the evidence showing no left leg injury, disease, or symptoms during service, the 24-year gap between service separation (or more) and the earliest left leg complaints is a factor that weighs against service incurrence. Because the weight of the evidence demonstrates no left leg injury or disease, or "chronic" symptoms of left leg arthritis during service, the criteria for presumptive service connection under 38 C.F.R. § 3.303 (b) based on "chronic" symptoms in service are not met. There is no competent medical opinion evidence of record linking the current left leg disability to service. In this case, a VA medical opinion was not obtained addressing whether any incident, event, or symptoms during service caused the current left leg disability because there were in fact no relevant in-service left leg injury, disease, or symptoms. Any such opinion elicited in this case, where the facts establish no in-service left leg injury, disease, or event including relevant symptoms, necessarily would be based on the inaccurate factual premise of a left leg injury, disease, or symptoms during service; therefore, such an opinion would be of no probative value. Although the Veteran has asserted that the current left leg disability is causally related to service, he is a lay person and, under the specific facts of this case, does not have the requisite medical expertise to be able to diagnose left leg arthritis or render a competent medical opinion regarding its cause when the facts of this case show no in-service left leg injury or disease, and no left leg arthritis symptoms until many years after service. Arthritis is complex and involves unseen systems processes and disease processes that are not observable by the five senses of a lay person, and includes various possible etiologies, only one of which involves trauma to a joint, and is diagnosable only by X-ray or similar specific specialized clinical testing; therefore, under the facts presented in this case, the Veteran is not competent to diagnose left leg arthritis or to opine as to its etiology. Thus, while the Veteran is competent to relate symptoms of left leg pain that he experienced at any time, in the absence of credible evidence of in-service left leg injury, disease, or symptoms as in this case, he is not competent to opine on whether there is a link between the left leg arthritis, which was manifested many years after service separation, and active service because such diagnosis and nexus require specific medical knowledge and training. For these reasons, the Veteran’s purported opinion that the current left leg disability is the result of service is of no probative value; thus, in consideration of the foregoing, the Board finds that a preponderance of the lay and medical evidence that is of record weighs against service connection for a left leg disability, including arthritis, under any theory, including direct and presumptive as a chronic disease; therefore, the appeals must be denied. 4. Service connection for hypertension is denied. The Veteran contends that hypertension had its onset during service or was otherwise causally or etiologically related to service. He seeks service connection on this basis. "Hypertension" refers to persistently high arterial blood pressure. Medical authorities have suggested various thresholds ranging from 140 mm Hg systolic and from 90 mm Hg diastolic to as high as 200 mm Hg systolic and 110 mm Hg diastolic as reflective of hypertension. See Dorland's Illustrated Medical Dictionary 909 (31st ed. 2007). Similarly, for VA rating purposes, the term hypertension means that the diastolic blood pressure is predominantly 90 mm or greater. The term "isolated systolic hypertension" means that the systolic blood pressure is predominantly 160 mm or greater with a diastolic blood pressure of less than 90 mm. See 38 C.F.R. § 4.104, Diagnostic Code 7101, Note 1. After review of the lay and medical evidence of record, the Board finds that the lay and medical evidence demonstrates that no vascular injury, disease, or chronic symptoms of hypertension occurred during service or were manifested during service. Available service treatment records show no symptoms, diagnosis, or treatment for hypertension, and the earliest evidence of hypertension included in the record is shown in 2001, approximately 44 years after service. Considered together with the evidence showing no vascular injury, disease, or symptoms during service, the 44-year gap between service separation and the onset of hypertension is a factor that weighs against service incurrence. As the weight of the evidence demonstrates no vascular injury or disease or "chronic" symptoms of hypertension during service, and no "continuous" symptoms of hypertension since service, including to a compensable degree within the first post-service year, the the criteria for presumptive service connection under 38 C.F.R. § 3.303 (b) based on "chronic" symptoms in service, "continuous" hypertension symptoms since service, or hypertension manifested to a degree of ten percent within one year of service separation are not met. There is no competent medical opinion evidence of record linking the current hypertension to service. A VA medical opinion was not obtained addressing whether any incident, event, or symptoms during service caused the current hypertension because there were in fact no in-service vascular injury, disease, or symptoms. Any such opinion elicited in this case, where the facts establish no in-service vascular injury, disease, or event including relevant symptoms, necessarily would be based on the inaccurate factual premise of a vascular injury, disease, or symptoms during service; therefore, such an opinion would be of no probative value. Although the Veteran has asserted his belief that hypertension was caused by service, he is a lay person and does not have the requisite medical expertise to render a competent medical opinion in this case regarding the etiology of hypertension, which was manifested many years after service. Such diagnoses and opinions as to relationship involve unseen systems processes and disease processes that are largely unobservable by the five senses of a lay person, involve an understanding of the cardiovascular system and the possible causes or etiologies of hypertension, and involve making findings based on medical knowledge and clinical testing results. Consequently, the Veteran's purported opinion relating hypertension to service is of no probative value. Thus, the weight of the evidence is against a finding that hypertension was incurred in or was otherwise caused by active service. In consideration of the foregoing, the Board finds that a preponderance of the lay and medical evidence that is of record weighs against service connection for hypertension, so the appeal must be denied. 5. Service connection for sleep apnea is denied. 6. Service connection for a respiratory disability is denied. The Veteran contends that the current sleep apnea and respiratory disability other than sleep apnea (i.e., bronchial asthma) had their onset during service or was otherwise causally or etiologically related to service. He seeks service connection on this basis. After review of all the lay and medical evidence of record, the Board finds that the weight of the lay and medical evidence is against finding that a respiratory injury or disease or sleep apnea symptoms were manifested during service. Available service treatment records are absent of complaints of, diagnoses of, or treatment for a respiratory disability, to include sleep apnea, or sleep apnea symptoms or for respiratory problems. The weight of the evidence is against finding that the current sleep apnea and respiratory disability other than sleep apnea is otherwise causally or etiologically related to service. The earliest indication of respiratory and/or sleep apnea symptoms was shown in 1980, approximately 23 years after service separation. See February 1981 private medical certificate (noting that the Veteran was treated in April 1980 and October 1980 for shortness of breath and difficulty breathing mostly at night and occasionally). At the 2014 VA examination, the Veteran reported that sleep apnea was first diagnosed in 2002, 45 years after service separation. A sleep study that confirmed a sleep apnea diagnosis was performed in 2008, 51 years after service separation. See March 2008 VA pulmonary note (noting that severe OSA was found on a recent sleep study done on fee-basis). The earliest diagnosis of bronchial asthma is shown in 2011, approximately 54 after service separation. See December 2011 VA primary care note (noting an assessment of bronchial asthma). Considered together with the lay and medical evidence contemporaneous to service showing no sleep apnea or respiratory symptoms, the approximate 23-year period between service separation in 1957 and the onset of respiratory symptoms approximately in 1981 is an additional factor that weighs against service incurrence. Additionally, there is no competent medical opinion evidence linking the current respiratory disability, including sleep apnea, to service. In this case, a VA medical opinion was not obtained addressing whether any incident, event, or symptoms during service caused the current sleep apnea and the respiratory disability other than sleep apnea (i.e., bronchial asthma) because there were in fact no relevant in-service injury, disease, or symptoms. Any such opinion elicited in this case, where the facts establish no in-service respiratory injury, disease, or event including relevant symptoms, necessarily would be based on the inaccurate factual premise of a respiratory injury or disease or bronchial asthma or sleep apnea symptoms during service; therefore, such an opinion would be of no probative value. Although the Veteran has asserted that sleep apnea and a respiratory disability other than sleep apnea are causally related to service, he is a lay person and, under the specific facts of this case that include no in-service symptoms and negative findings upon examination, and documented post-service onset of symptoms and diagnosis of respiratory disabilities, including sleep apnea, many years after service, does not have the requisite medical training or credentials to be able to render an opinion regarding the cause of sleep apnea and/or bronchial asthma. The etiology of bronchial asthma and sleep apnea are complex medical etiological questions dealing with the origin and progression of the respiratory system; sleep apnea and bronchial asthma are disorders diagnosed primarily on symptoms, clinical findings, and physiological testing; and would require knowledge of the origin and progression of the respiratory disabilities. While the Veteran is competent to report respiratory and/or sleep apnea symptoms that he experiences at any time, under the facts of this case, he is not competent to opine on whether there is a link between sleep apnea and/or a respiratory disability other than sleep apnea, symptoms of which were manifested many years after service, and active service because such opinions require specific medical knowledge and training. There are multiple potential risk factors or causative factors for sleep apnea, many of which the Veteran has that are unrelated to service, and which are shown by the facts of this case to have begun after service. See https://medlineplus.gov/sleepapnea.html (noting that a person has an increased risk for sleep apnea if overweight, male, has a family history for sleep apnea, or has small airways). For these reasons, the Veteran’s unsupported lay opinion is of no probative value. Thus, the weight of the evidence is against a finding that sleep apnea and a respiratory disability other than sleep apnea (i.e., bronchial asthma) had its onset during or was otherwise caused by active service. In consideration of the foregoing, the Board finds that a preponderance of the lay and medical evidence that is of record weighs against the appeal of service connection for sleep apnea and a respiratory disability other than sleep apnea; consequently, the appeals must be denied. 7. Service connection for bilateral hearing loss is granted. The Veteran contends that bilateral hearing loss is due to acoustic trauma sustained while performing duties related to his military occupational specialty of automobile mechanic and exposure to the firing of bazookas during service. He seeks service connection on this basis. For purposes of applying VA laws, impaired hearing is considered a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, and 4000 hertz (Hz) is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, and 4000 Hz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. VA regulations do not preclude service connection for a hearing loss which first met VA's definition of disability after service. Hensley v. Brown, 5 Vet. App. 155, 159 (1993). Where a current disability due to hearing loss is present, service connection can be granted for a hearing loss disability where the veteran can establish a nexus between his current hearing loss and a disability or injury he suffered while he was in military service. Godfrey v. Derwinski, 2 Vet. App. 352, 356 (1992). As a preliminary matter, the Board finds that the evidence shows a current bilateral hearing loss disability as defined by 38 C.F.R. § 3.385. The October 2016 audiogram performed as part of the October 2016 VA examination shows audiometric data depicted by graph, which reflects auditory thresholds (air conduction) greater than 40 decibels at each of the 2000, 3000, and 4000 Hz frequency levels in both ears; therefore, the Veteran has a current bilateral hearing loss disability as defined by VA regulatory criteria. After a review of all the lay and medical evidence of record, the Board finds that the Veteran sustained acoustic trauma (i.e., bilateral ear injury) during service. Because the Veteran served as an automobile mechanic during service, and exposure to the loud noise of automobile engines is consistent with the circumstances or conditions of his service, the lay account of exposure to loud noise (i.e., acoustic trauma) during service is deemed credible and of significant probative value. Chronic symptoms of bilateral sensorineural hearing loss were not manifested during service, and continuous symptoms of bilateral sensorineural hearing loss were not manifested since service, including to a compensable degree within one year of service separation. Available service treatment records show no report, complaint, diagnosis, or treatment for hearing loss during service, and the earliest evidence of hearing loss was shown in 2012, approximately 55 years after service separation; therefore, presumptive service connection for bilateral sensorineural hearing loss based on "chronic" in-service symptom criteria, "continuous" post-service symptom criteria, or symptoms manifested to a compensable degree within the first post-service year criteria have not been met. The evidence is in equipoise on the question of whether the current bilateral sensorineural hearing loss disability is otherwise causally related to service. After review of the record and interview and examination of the Veteran, to include the Veteran’s statements about military noise exposure, the November 2016 VA examiner opined that the Veteran had noise-induced high frequency hearing loss. Because the November 2016 VA examiner has expertise in auditory matters and provided adequate rationale for the medical opinion, it is of significant probative value. There is no competent medical opinion to the contrary of record. While the Veteran also has reported post-service occupational noise exposure, the Board notes that service connection has already been established for another hearing-related disability – i.e., tinnitus – primarily based on the Veteran’s report of in-service noise exposure. The grant of service connection for tinnitus based on in-service noise exposure is suggestive of nerve damage to the inner ear that occurred during service. In consideration of the foregoing, the Board finds that the evidence both for and against the question of whether the Veteran has bilateral sensorineural hearing loss due to in-service noise exposure during active service is in relative equipoise. Resolving reasonable doubt in the Veteran's favor, the Board finds that direct service connection for bilateral sensorineural hearing loss under 38 C.F.R. § 3.303(d) is warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. REASONS FOR REMAND 7. Service connection for the left foot disability is remanded. 8. Service connection for the left ankle disability is remanded. The issues of service connection for a left foot disability and a left ankle disability are remanded for a VA examination with a medical opinion. The available service treatment records show treatment for left foot pain in November 1956. Post-service treatment records show report of chronic left ankle pain in May 2011, diagnosis of left ankle osteoarthritis in December 2013 and October 2014, and treatment for left foot and ankle pain in November 2016. In consideration thereof, a remand for a VA examination with a medical opinion is warranted. The matters are REMANDED for the following action: Schedule the Veteran for a VA examination for the claimed left foot and left ankle disabilities. The examiner should review the record. If a diagnosis cannot be provided but the Veteran’s condition manifests in symptoms that cause functional impairment, then the examiner should consider them a “disability” for the purpose of providing the requested opinion(s) below. The examiner is asked to provide a response to the following: Is the current left ankle disability and/or left foot disability at least as likely as not related to service, including the in-service report of left foot pain in November 1956? Provide a rationale to support the opinion. If the Veteran is unable or unwilling to report for an examination, the examiner is asked to provide a medical opinion based on review of the record. J. PARKER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Palmer, 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.