Citation Nr: 21023680 Decision Date: 04/21/21 Archive Date: 04/21/21 DOCKET NO. 16-63 066 DATE: April 21, 2021 ORDER 1. Entitlement to service connection for a bilateral eye disability is denied. 2. New and material evidence having been received, the application to reopen the claim for service connection for pseudofolliculitis is granted. The appeal is granted to this extent only. REMANDED 3. Entitlement to service connection for pseudofolliculitis is remanded. 4. Entitlement to compensable disability rating for right inguinal hernia repair is remanded. 5. Entitlement to a disability rating in excess of 10 percent for right knee strain is remanded. 6. Entitlement to service connection for a psychiatric disorder, to include depression and generalized anxiety disorder, is remanded. 7. Entitlement to service connection for a left third digit finger disability is remanded. 8. Entitlement to service connection for digestive problems is remanded. 9. Entitlement to service connection for obstructive sleep apnea (OSA) is remanded 10. Entitlement to service connection for bronchial spasm is remanded. 11. Entitlement to service connection for sinusitis is remanded. 12. Entitlement to service connection for a cervical spine disability is remanded. 13. Entitlement to service connection for a lumbar spine disability is remanded. FINDINGS OF FACT 1. The Veteran’s defective visual acuity is not a disability for VA compensation purposes. 2. The Veteran did not incur vision loss (other than due to a refractive error) during activity duty and any current vision loss (other than refractive error) is not otherwise related to active duty. 3. The Veteran did not appeal a March 2009 rating decision that denied service connection for pseudofolliculitis based on a finding of no evidence of a current disability, and no new and material evidence was received during the one year appeal period. 4. Evidence received since the March 2009 rating decision that denied service connection for pseudofolliculitis, when considered by itself or in connection with evidence previously assembled, relates to an unestablished fact necessary to substantiate the claim for service connection and raises a reasonable possibility of substantiating the claim. CONCLUSIONS OF LAW 1. The criteria for service connection for a bilateral eye disability have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 4.9. 2. The March 2009 rating decision denying service connection for pseudofolliculitis is final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. 3. As evidence received since the March 2009 rating decision is new and material, the criteria for reopening the claim of entitlement to service connection for pseudofolliculitis are met. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from May 1983 to March 1990. In February 2020, the Veteran provided testimony at a video conference hearing before the undersigned Veterans Law Judge (VLJ). A copy of the hearing transcript is associated with the claims file. 1. Entitlement to service connection for a bilateral eye disability. The Veteran contends that a bilateral eye disability is warranted because it is related to service. Specifically, during the February 2020 Board video conference hearing, the Veteran testified that while in Turkey out in the flight line, he had to wear safety glasses and experienced a lot of glare on the flight line but was not allowed to wear sunglasses. He reported that he had eye issues in service including redness and irritation for which he went to medical and indicated that the extent of treatment was eye drops. Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may also 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). Establishing service connection generally requires evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with a veteran prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. VA regulations provide that refractive error does not constitute a “disease” or injury” for in the meaning of applicable legislation for VA compensation purposes. See 38 C.F.R. § 3.303(c), 4.9; Terry v. Principi, 340 F.3d 1378 (Fed. Cir. 2003). Therefore, service connection may not be allowed for refractive error of the eyes. See VAOPGCPREC 82-90 (July 18, 1990). Service connection could be granted for superimposed disease or injury. The Board has reviewed the record and finds that the preponderance of the evidence is against a finding that the Veteran has an eye disability other than refractive error that was incurred in service or otherwise related to service. During the February 2020 Board hearing, the Veteran reported that he needed glasses for distance and did not report any other eye disability. The preponderance of the evidence is also against a finding that a refractive error had been subject to a superimposed disease or injury in service. A review of the service treatment records indicates that clinical evaluations revealed normal “eyes-general;” “ophthalmoscopic;” “pupils;” and “ocular motility” within the November 1984 and December 1989 Reports of Medical Examination. The Veteran’s defective visual acuity, near and distant vision, is noted on the Reports of Medical Examinations, however, these are refractive errors of the eyes and no other eye disabilities are documented. Further, in the corresponding Reports of Medical History accompanying the examinations, the Veteran denied a history of “eye trouble.” Post service treatment records do not document a diagnosis of an eye disability. Therefore, service connection may not be granted for the Veteran’s vision problems due to refractive error. In summary, the Veteran’s current vision problems are refractive errors which do not constitute a “disease” or “injury” for VA compensation purposes and have not been shown to have been subject to superimposed disease or injury in service; the Veteran has not shown that any eye condition other than a refractive error was incurred in or otherwise related to active duty, therefore service connection for vision loss is not warranted. The Veteran was not afforded a VA examination in connection with the claim for service connection for a bilateral eye disability. VA must provide a medical examination or opinion when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) evidence establishing that an event, injury, or disease occurred in service, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran’s service, but (4) there is insufficient competent medical evidence on file for the Secretary to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79 (2006). As laid out above, the Board finds as fact that the record does not show that the Veteran has a current disability other than refractive error, which is not a disability for VA purposes. For a VA examination to be warranted, all the criteria have to be met, and at least one criteria is not met. For all the reasons discussed above, the Board finds the preponderance of the evidence is against the claim of service connection for vision loss. The benefit-of-the-doubt doctrine is not for application, and the claim is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102, 4.3; Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). 2. Whether new and material evidence has been received to reopen the previously denied claim for service connection for pseudofolliculitis. Prior unappealed decisions of the Regional Office (RO) are final. 38 U.S.C. §§ 7105 (c); 38 C.F.R. §§ 3.160(d), 20.302(a), 20.1103. The Board does not have jurisdiction to consider a claim that has become final before it determines that new and material evidence has been presented, irrespective of what the regional office may have determined with respect to new and material evidence. Barnett v. Brown, 83 F.3d 1380, 1383 (Fed. Cir. 1996). If, however, new and material evidence is presented or secured with respect to a claim which has been disallowed, VA shall reopen the claim and review the former disposition of the claim. New evidence means existing evidence not previously submitted to agency decision makers. 38 C.F.R. § 3.156(a). Material evidence means existing evidence that, by itself or considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened and must raise a reasonable possibility of substantiating the claim. Id. New and material evidence need not be received as to each previously unproven element of a claim in order to justify reopening thereof; the threshold for determining whether new and material evidence raises a reasonable possibility of substantiating a claim is “low.” Shade v. Shinseki, 24 Vet. App. 110, 117 (2010). Entitlement to service connection for pseudofolliculitis was denied in a March 2009 rating decision. The Veteran was notified of the denial and of his appellate rights. In the one-year appeal period that followed, the Veteran submitted neither a notice of disagreement nor any new and material evidence. This rating decision is final. 38 U.S.C. § 7105; 38 C.F.R. §§ 20.302, 20.1103. The March 2009 rating decision denied service connection for pseudofolliculitis on the basis that there was no evidence of a current diagnosis/disability. Since the March 2009 rating decision, the Veteran has submitted an “independent medical examination,” which the private physician noted that the Veteran “has to let his beard grow out, he cannot shave” and included a medical opinion for the Veteran’s pseudofolliculitis. Given that the threshold for substantiating a claim to reopen is low, this evidence, when considered by itself or in connection with evidence previously assembled, relates to an unestablished fact necessary to substantiate the claim for service connection for pseudofolliculitis and raises a reasonable possibility of substantiating the claim. The Board finds that this new evidence is also material. Thus, the claim of entitlement to service connection for pseudofolliculitis is reopened. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. REASONS FOR REMAND 3. Entitlement to service connection for pseudofolliculitis is remanded. The Board has reopened the claim for service connection for pseudofolliculitis, herein. However, the record shows that the Agency of Original Jurisdiction (AOJ) has not considered the merits of the service-connection claim with all of the new and material evidence that justified the reopening of the claim. When the Board reopens a claim after the RO has denied reopening that same claim, the matter generally must be returned to the RO for consideration of the merits. 4. Entitlement to compensable disability rating for right inguinal hernia repair is remanded. The Veteran was last afforded a VA examination (contracted Disability Benefits Questionnaire (DBQ)) in September 2016 in order to establish the severity of the right inguinal hernia repair related symptoms. During the February 2020 Board video conference hearing, the Veteran testified that his hernia incision would “from time to time, bulge out” and that it would be sore. The Veteran reported that VA was supposed to be providing him a belt that helps provide support. The Board finds that in light of the Veteran’s statements and reported current treatment at VA, which is suggestive of a worsening of the disability, Board finds that a remand is necessary to afford the Veteran an opportunity to undergo a VA examination to assess the current nature, extent and severity of his right inguinal hernia repair disability. 5. Entitlement to a disability rating in excess of 10 percent for right knee strain is remanded. The Veteran was last afforded a VA examination (contracted DBQ) in September 2016 in order to establish the severity of the right knee strain related symptoms. During the February 2020 Board video conference hearing, the Veteran testified that his disability was “trying to get worse” and reported that he had a knee brace on order with VA and that x-ray imaging of the knee was “degenerative.” Subsequently, the Veteran submitted VA medical records from February 2020 which indicated that he has degenerative arthritis of the knee and lumbar spine and his chronic pain interferes with activities. The VA medical records also include a diagnosis of chronic degenerative, traumatic arthritis, a right knee brace was ordered, and the Veteran would keep his TENS unit and would self-refer to physical therapy. Thus, the Board finds that a remand is necessary to afford the Veteran an opportunity to undergo a VA examination to assess the current nature, extent and severity of his right knee disability. Duty to Assist The Board finds that remand is warranted to fully assist the Veteran with the development of his claims. After a review of the claims file, the Board finds that there are outstanding medical records that are relevant to the issues on appeal. Specifically, during the February 2020 Board video conference hearing, the Veteran testified that there were diagnoses of his claimed disabilities in primary care records that he was planning to submit. The undersigned VLJ informed the Veteran that VA had private medical records from January 2013 to October 2015 and confirmed with the Veteran that he planned to submit private medical records from 2010 and more recent records after 2016. The Veteran stated that he started with the private primary care provider in 2009 and was trying to get all of these records. The Veteran also indicated that he was in the emergency room around 2013 for stomach issues (claimed digestive problems). The record includes private medical records from a chiropractor from September 2015 to October 2015; a primary care practice, Dubois Medial Clinic with providers Dr. Steven Ditto and Dr. Patrick Martin from January 2013 to April 2016; and a gastroenterologist, Dr. Sikandar Mesiya from September 2013 to January 2014. The primary care records indicate that the Veteran was seen after a transition of care from the emergency department at St. Anthony’s in November 2013. VA medical records from January 2004 to October 2013 are also of record. Since the February 2020 Board hearing, the Veteran has proffered additional private medical records from Dubois Medical Clinic from November 2013 to October 2016 and piecemeal VA medical records from February 2020. Given the indication that relevant private treatment records may be outstanding, the Veteran should be provided an opportunity to identify any additional outstanding relevant private medical records on remand. An effort must be made to locate and associate any outstanding private medical records with the Veteran’s claims file and outstanding VA medical records should be obtained. VA’s duty to assist also includes providing a medical examination and/or obtaining a medical opinion when necessary to make a decision on the claim, as defined by law. See 38 U.S.C. § 5103A; 38 C.F.R. §§ 3.159(c)(4), 3.326(a); McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). VA will provide a medical examination or obtain a medical opinion if the evidence indicates the existence of a current disability or persistent or recurrent symptoms of a disability that may be associated with an event, injury, or disease in service, and there is insufficient medical evidence of record to decide the claim. 38 U.S.C. § 5103A(d)(2); 38C.F.R. § 3.159(c)(4)(i); McLendon, 20 Vet. App. at 79. When VA undertakes to obtain an examination, it must ensure that the examination and opinion therein is adequate. Barr v. Nicholson, 21 Vet. App. 303 (2007). In review of the VA examinations and opinions (contracted Disability Benefits Questionnaire (DBQ)) provided in September 2016 for the claimed left third digit finger disability, cervical spine disability, lumbar spine disability, sleep apnea, and sinusitis, the Board finds the opinions to be inadequate for adjudication purposes. The examiner’s only rationale is that there are no medical records showing diagnoses and treatment for the claimed disabilities while the Veteran was in service. When the “sole premise” of a medical conclusion is the “lack of notation or treatment” of claimed injuries or symptoms, it is inadequate for rating purposes. Dalton v. Nicholson, 21 Vet. App. 23, 39 (2007). The Veteran has proffered an “independent medical examination,” dated June 2020, with opinions by a private physician for the claimed disabilities on appeal except for his psychiatric disorder, including lumbar spine, cervical spine, asthma, sleep apnea, irritable bowel syndrome (IBS), and left third finger. The Board finds that the probative value of the opinions to be diminished as they are not supported by a well-reasoned rationale. The opinions provided rely mainly on the subjective reports provided by the Veteran, call for speculation, and did not consider all the relevant evidence that the Board has found to be credible. See Reonal v. Brown, 5 Vet. App. 458, 460-61 (1993) (holding that medical opinions based on incomplete or inaccurate factual premises are not probative); Dalton v. Nicholson, 21 Vet. App. 23 (2007); Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (noting that “a medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two). Therefore, the Board finds that VA examinations and medical opinions are necessary to adjudicate the claimed disabilities below. See 38 C.F.R. § 3.159(c)(4) (holding a medical examination or opinion is necessary if the information and evidence of record does not contain sufficient medical evidence to decide the claim). 6. Entitlement to service connection for a psychiatric disorder, to include depression and generalized anxiety disorder, is remanded. The Veteran has proffered a February 2020 VA medical record, which reflects that the Veteran was seeking mental health treatment as he had recently realized some experience in his past likely led to significant anxiety over the years. The Veteran reported that he only recently “connected” the events to his anxiety over the years and reported a 1988 domestic incident with his wife on a military base. A diagnostic impression of anxiety disorder was noted. As indicated above, outstanding VA medical records will be obtained, however, it appears that the Veteran is currently seeking treatment for a possible psychiatric disorder and the Veteran’s in-service domestic incident is documented in service treatment records. Under these circumstances, the Board finds that the threshold of the McLendon standard has been met, and the Veteran should be afforded a VA examination to determine the nature and etiology of his claimed psychiatric disorder. See McLendon, 20 Vet. App. at 81. 7. Entitlement to service connection for a left third digit finger disability is remanded. 8. Entitlement to service connection for digestive disorder is remanded. 9. Entitlement to service connection for obstructive sleep apnea (OSA) is remanded. 10. Entitlement to service connection for bronchial spasm is remanded. 11. Entitlement to service connection for sinusitis is remanded. 12. Entitlement to service connection for a cervical spine disability is remanded. 13. Entitlement to service connection for a lumbar spine disability is remanded. The matters are REMANDED for the following action: 1. Ask the Veteran to identify any relevant outstanding private treatment records related to the claimed disabilities on appeal, to specifically include, but not limited to records from the following medical professionals: • a chiropractor; • a primary care practice, Dubois Medial Clinic with providers Dr. Steven Ditto and Dr. Patrick Martin, particularly from, but not limited to, after 2009 and since 2016; • a gastroenterologist, Dr. Sikandar Mesiya; • the emergency department at St. Anthony’s in approximately November 2013; and • any other private medical professional whose records would be relevant to the issues on appeal. After obtaining any necessary authorization forms from the Veteran, obtain any pertinent records identified, and associate them with the claims file. Any negative responses should be in writing and should be associated with the claims file. 2. Obtain outstanding VA treatment records beginning in September 2010 and associate them with the claims file. 3. The AOJ should review the evidence and take any additional development as deemed necessary for the reopened claim for service connection for pseudofolliculitis and should readjudicate the claim on the merits. 4. Schedule the Veteran for a VA examination to evaluate the current severity of his service-connected right inguinal hernia repair. 5. Schedule the Veteran for a VA examination to evaluate the current severity of his service-connected right knee strain. 6. Schedule the Veteran for a VA examination to evaluate the current nature and etiology of his claimed psychiatric disorder. A copy of the below facts should be provided to the VA examiner. The examiner is asked to review the record. Any indicated evaluations, studies, and tests deemed to be necessary by the examiner should be performed. To assist in a review of the claims file, the examiner is informed of the following facts with citations in the record, where applicable: • The Veteran served on active duty from May 1983 to March 1990 with a military occupational specialty (MOS) of aerospace ground equipment specialist. • The Veteran contends that he has a psychiatric disorder that had an onset in service or was otherwise caused by service. • The Veteran testified to an alcohol-related incident where his wife pulled knives on him and he had to defend himself in service. He reported that his wife received a letter of reprimand and to his understanding was later diagnosed with PTSD from that incident. See VBMS entry with document type, “Hearing Transcript,” receipt date 02/28/2020, pages 6-10. • The Veteran claimed that the incident created anxiety and that he was in fear, “very, very fearful about being in crowds….” He stated he started to self-medicate for his anxiety with marijuana in service and that his problems resulted in his discharge from service. Id. • Of record is a November 1984 Report of Medical Examination which reflects a normal clinical evaluation of the Veteran’s psychiatric state. See VBMS entry with document type, “STR – Medical,” receipt date 06/08/2016, with “#1” in the subject field, pages 110-111 (item 42). • A May 1988 service treatment record shows that the Veteran was involved in an alleged incident involving domestic violence. See VBMS entry with document type, “STR – Medical,” receipt date 06/08/2016, with “#1” in the subject field, pages 10-11. • A February 1989 service treatment record reflects that the Veteran was separated from his wife since May 1988 due to a domestic incident. See VBMS entry with document type, “STR – Medical,” receipt date 06/08/2016, with “#1” in the subject field, page 76. • Of record are military personnel records related to August 1989 and September 1989 charges of wrongful use of marijuana and a January 1989 arrest for driving under the influence of alcohol. See VBMS entries with document type, “Military Personnel Record” and “Correspondence,” receipt date 08/20/2020. • A December 1989 Report of Medical Examination reflects a normal clinical evaluation of the Veteran’s psychiatric state. See VBMS entry with document type, “STR – Medical,” receipt date 07/14/2016, with “#1” in the subject field, pages 1-2. • In the accompanying December 1989 Report of Medical History, the Veteran documented that he was in “good health” and was taking “no medication.” He denied that he ever “attempted suicide” or had or ever had “depression or excessive worry.” The Veteran documented a positive history of “nervous trouble of any sort,” and the examiner noted that the Veteran had nervous trouble off and on due to his job and that he bit his fingernails. The examiner indicated that such finding was “NCNS” or no complications, no sequelae. See VBMS entry with document type, “STR – Medical,” with “#1” in the subject field, receipt date 07/14/2016, pages 3-4. • In a January 2004 VA medical record, an addiction therapist noted that that the Veteran was known from previous contact and information was given on various programs to include substance abuse treatment center and mental health. See VBMS entry with document type, “CAPRI,” receipt date 08/10/2016, page 15. • A September 2010 VA medical record shows the Veteran was provided with depression and PTSD screens, which were both negative. See VBMS entry with document type, “CAPRI,” receipt date 8/10/2016, page 13. • A September 2010 VA medical record shows that when the examiner performed a history and physical examination, the Veteran denied psychiatric complaints. See VBMS entry with document type, “CAPRI,” receipt date 08/10/2016, page 8. • A private January 2013 medical record includes a review of systems of the Veteran’s psychiatric state, which was negative for depression and sleep disturbance. Mental health history was also negative in September 2013; November 2013; July 2014; October 2014, and April 2016. See VBMS entry with document type, “Medical Treatment Record - Non-Government Facility,” receipt date 05/13/2016, with “#2” in the subject field, page 27 (January 2013); 22 (September 2013); 18 (November 2013); 9 (July 2014); 6 (October 2014); 31 (April 2016). • In November 2013 and January 2014, when performing a review of systems, the examiner documented that the Veteran denied anxiety and depression. See VBMS entry with document type, “Medical Treatment Record - Non-Government Facility,” receipt date 05/13/2016, with “#3” in the subject field, pages 10 (November 2013) & 1 (January 2014). • A September 2016 private medical record shows a negative mental health history. See VBMS entry with document type, “Medical Treatment Record - Non-Government Facility,” receipt date 08/20/2020, with “#4” in the subject field, page 34. • February 2020 VA medical records reflect that the Veteran was seeking mental health treatment, as he had recently realized some experienced in his past likely led to significant anxiety over the years. The Veteran reported that he only recently “connected” the events to his anxiety over the years and reported a 1988 domestic incident with his wife on a military base. A diagnostic impression of anxiety disorder was noted. The Veteran also reported that he had anxiety related to active duty, was never given treatment, self-treated with marijuana, and eventually was discharged because of it. See VBMS entry with document type, “Medical Treatment Record - Government Facility,” receipt date 08/20/2020, with “#5” in the subject field. • The examiner’s review of the record is NOT restricted to the evidence listed above. Additional evidence sought above may have been associated with the claims file. This list is provided in an effort to assist the examiner in locating potentially relevant evidence. While the Board has provided some of the relevant facts above, the examiner is to review the entire record, and then answer the following questions: a) What, if any, psychiatric diagnosis(es) does the Veteran have? b) For each psychiatric diagnosis offered, it at least as likely as not (50 percent or greater likelihood) that it was incurred during service from May 1983 to March 1990, or otherwise related to service? Please discuss the December 1988 in-service domestic incident (location above). Please explain your answers by citing to supporting clinical data and/or medical literature, as deemed appropriate. A full rationale must be provided for all medical opinions given. If the examiner is unable to provide an opinion without resorting to mere speculation, he or she should explain why this is so. The examiner shall then explain whether the inability to provide a more definitive opinion is the result of a need for more information and indicate what additional evidence is necessary, or whether he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). 7. Schedule the Veteran for a VA examination for the claimed left third digit finger disability, to determine the nature, extent, and etiology of the claimed disability. A copy of this remand should be provided to the VA examiner. The examiner is asked to review the record. Any indicated evaluations, studies, and tests deemed to be necessary by the examiner should be performed. To assist in a review of the claims file, the examiner is informed of the following facts with citations in the record, where applicable: • The Veteran served on active duty from May 1983 to March 1990 with a military occupational specialty (MOS) of aerospace ground equipment specialist. • The Veteran contends that he injured his left third digit finger on active duty hooking up equipment to the back of a tow truck to take out to the flight line. He reported that he was putting on the tow hitch and his finger was caught. Specifically, he states that his gloves got caught underneath where the cup on the equipment goes down on the ball and it pinched his finger and hand down between the tow hitch. See VBMS entry with document type, “Hearing Transcript,” receipt date 02/28/2020, pages 14-16. • September 1986 service treatment records show a direct blow to the left third digit finger when it was hit between 25 and 35 pound dumbbells, which he Veteran reported had persistent pain and swelling. X-ray imaging of the left third digit finger showed no fracture or joint abnormality. There was a small smoothly marginated ossific density that projected along the palmar aspect of the PIP joint, which was old in appearance and did not constitute an acute fracture. The Veteran was not symptomatic at that point. See VBMS entry with document type, “STR – Medical,” receipt date 06/08/2016, with “#1” in the subject field, pages 60, 29 (x-ray). • A December 1989 Report of Medical Examination shows a normal clinical evaluation of the upper extremities. See VBMS entry with document type, “STR – Medical,” receipt date 07/14/2016, with “#1” in the subject field, pages 1-2. • In the accompanying December 1989 Report of Medical History, the Veteran documented that he was in “good health” and was taking “no medication.” He denied that he had or ever had “arthritis, rheumatism, or bursitis;” “bone, joint, or other deformity;” “lameness;” and “loss of finger or toe.” See VBMS entry with document type, “STR – Medical,” with “#1” in the subject field, receipt date 07/14/2016, pages 3-4. • A September 2010 VA medical record shows that when the examiner performed a history and physical examination, the Veteran denied musculoskeletal complaints. See VBMS entry with document type, “CAPRI,” receipt date 08/10/2016, page 8. • A September 2016 VA examination report (contracted Disability Benefits Questionnaire (DBQ)) for the claimed left third digit finger disability shows the Veteran reported that the date of onset of symptoms was 1983 in Turkey, when he was working in the shop and one of the parts fell on his hand. See VBMS entry with document type, “C&P Exam,” receipt date 09/08/2016, with “#6” in the subject field. • The September 2016 examiner provided the opinion that the claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event or illness. She provided the rationale that there are no medical records showing diagnosis, treatment for the finger condition while the Veteran was in service. See VBMS entry with document type, “C&P Exam,” receipt date 09/08/2016, with “#7” in the subject field. • The finding by the September 2016 examiner of no in-service medical records showing a finger condition is inaccurate. • In a June 2020 opinion, Dr. John Ellis documented that the Veteran smashed his left middle left finger while stationed in England, still had decreased range of motion of the finger, had pain and decreased grip strength in the dominant hand, and could even feel weather change in the left middle finger, his back and somewhat his neck and right knee. The physician opined that it is more likely than not, that the injury the Veteran sustained while stationed in England to his left middle finger caused soft tissue swelling, which then caused erosion of the joints, which caused arthritis of the finger. See VBMS entry with document type, “Medical Treatment Record - Non-Government Facility,” receipt date 08/20/2020, with “#4” in the subject field, page 6. • The examiner’s review of the record is NOT restricted to the evidence listed above. Additional evidence sought above may have been associated with the claims file. This list is provided in an effort to assist the examiner in locating potentially relevant evidence. While the Board has provided some of the relevant facts above, the examiner is to review the entire record, and then answer the following questions: a) Does the Veteran have a current left third digit finger disability, or any functional impairment due to finger pain? b) For each left third digit finger disability (or functional impairment due to finger pain) offered, the examiner is asked to address whether it is at least as likely as not (50 percent probability or more) that such disability had its onset in service from May 1983 to March 1990, or is otherwise related to service, to specially include but not limited to, the documented September 1986 record that shows a direct blow to the left third digit finger when it was hit between 25 and 35 pound dumbbells (locations above). Please also address the private June 2020 medical opinion (location above). Please explain your answers by citing to supporting clinical data and/or medical literature, as deemed appropriate. A full rationale must be provided for all medical opinions given. If the examiner is unable to provide an opinion without resorting to mere speculation, he or she should explain why this is so. The examiner shall then explain whether the inability to provide a more definitive opinion is the result of a need for more information and indicate what additional evidence is necessary, or whether he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). 8. Schedule the Veteran for a VA examination for the claimed digestive problems, to determine the nature, extent, and etiology of the claimed disability. A copy of this remand should be provided to the VA examiner. The examiner is asked to review the record. Any indicated evaluations, studies, and tests deemed to be necessary by the examiner should be performed. To assist in a review of the claims file, the examiner is informed of the following facts with citations in the record, where applicable: • The Veteran served on active duty from May 1983 to March 1990 with a military occupational specialty (MOS) of aerospace ground equipment specialist. • The Veteran contends that his digestive problems were incurred in or otherwise related to service, to include acute gastroenteritis in 1985, and subsequent issues in December 1987 and 1989. See VBMS entry with document type, “Hearing Transcript,” receipt date 02/28/2020, pages 35-37. • January 1984 service treatment records reflect the Veteran’s complaint of stomachache and headache with an assessment of AGE, acute gastroenteritis. See VBMS entry with document type, “STR – Medical,” receipt date 06/08/2016, with “#1” in the subject field, page 45. See also VBMS entry with document type, “STR – Medical,” receipt date 06/08/2016, with “#2” in the subject field, pages 9-10. • An October 1985 service treatment record shows the Veteran’s complaint of two days of headaches and diarrhea with an assessment of acute gastroenteritis (GE). See VBMS entry with document type, “STR – Medical,” receipt date 06/08/2016, with “#1” in the subject field, page 57. • A December 1987 service treatment record reflects the Veteran’s complaint of “flu,” sore throat, nausea, vomiting and stiff neck. No diarrhea was noted. It appears an assessment of “AGG” or “AGE” was made, possibly acute gastroenteritis (GE). See VBMS entry with document type, “STR – Medical,” receipt date 06/08/2016, with “#1” in the subject field, page 65. • A subsequent December 1987 service treatment record, the following day, documents that the Veteran was referred back because of persistent cold and no change. It was noted that the Veteran had no vomiting or diarrhea. An assessment of viral syndrome was made and the plan was for the Veteran to return to duty. See VBMS entry with document type, “STR – Medical,” receipt date 06/08/2016, with “#1” in the subject field, page 66. • A December 1989 Report of Medical Examination reflects a normal clinical evaluation of the abdomen and viscera. See VBMS entry with document type, “STR – Medical,” receipt date 07/14/2016, with “#1” in the subject field, pages 1-2. • In the accompanying December 1989 Report of Medical History, the Veteran documented that he was in “good health” and was taking “no medication.” He denied that he had or ever had “frequent indigestion” and “stomach, liver, or intestinal trouble.” See VBMS entry with document type, “STR – Medical,” with “#1” in the subject field, receipt date 07/14/2016, pages 3-4. • A September 2010 VA medical record shows that when the examiner performed a history and physical examination, the Veteran denied gastroenterology complaints. See VBMS entry with document type, “CAPRI,” receipt date 08/10/2016, page 8. • In review of systems, the Veteran’s gastrointestinal was negative in private medical records in January 2013, October 2014 and March 2015. See VBMS entry with document type, “Medical Treatment Record - Non-Government Facility,” receipt date 05/13/2016, with “#2” in the subject field, pages 27 (January 2013), 5 (October 2014), & 2 (March 2015). • In November 2013 private treatment records, the Veteran complained of loss of appetite, first noticed three months prior. There was a 35 pound weight loss and associated symptoms included center abdominal pain. It was noted that the Veteran’s pertinent past medical history was unremarkable. The Veteran had come as a follow-up from the emergency department at St. Anthony’s with abdominal pain. He was positive for acid reflux symptoms and abdominal bloating but negative for abdominal pain, diarrhea, nausea, and vomiting. The Veteran was referred to a gastroenterologist. See VBMS entry with document type, “Medical Treatment Record - Non-Government Facility,” receipt date 05/13/2016, with “#2” in the subject field, pages 17-20. • In November 2013, the gastroenterologist stated that he was not sure of the etiology of the abdominal pain at the time. See VBMS entry with document type, “Medical Treatment Record - Non-Government Facility,” receipt date 05/13/2016, with “#3” in the subject field, page 12. • December 2013 records document that the Veteran’s esophagogastroduodenoscopy and biopsies were negative. The Veteran had some mild gastritis and his gastrointestinal symptoms and appetite had significantly improved. The Veteran was taking Nexium which helped him. See VBMS entry with document type, “Medical Treatment Record - Non-Government Facility,” receipt date 05/13/2016, with “#2” in the subject field, pages 14-16. • In a January 2014 private medical record, the Veteran denied ongoing concerns or recurrent complaints and had felt well for one month. The resolution of prior symptoms was attributed to change of diet or lifestyle. The Veteran specifically denied abdominal pain, nausea and/or vomiting, diarrhea, constipation, heartburn, and weight loss. He stopped taking Nexium and had one episode of reflux in the preceding month. See VBMS entry with document type, “Medical Treatment Record - Non-Government Facility,” receipt date 05/13/2016, with “#2” in the subject field, page 34. • A July 2014 private medical record notes that the Veteran was seen several times in the preceding year for unexplained weight loss, bloating, nausea, intermittent diarrhea. The Veteran stated that he found out on his own by process of elimination that his symptoms were caused by excessive whey protein intake. Since stopping them and going back to a more natural diet, his symptoms had completely resolved, he felt great, and had gained 15 of the 30 pounds that he had lost. See VBMS entry with document type, “Medical Treatment Record - Non-Government Facility,” receipt date 05/13/2016, with “#2” in the subject field, pages 8-10. • A July 2016 private medical record includes a note of concerning cholelithiasis and that the Veteran describes the pain as aching, which began 3 weeks prior. Associated symptoms included bloating and diarrhea. See VBMS entry with document type, “Medical Treatment Record - Non-Government Facility,” receipt date 08/20/2020, with “#4” in the subject field, pages 37-38. • In a June 2020 opinion, Dr. John Ellis diagnosed irritable bowel syndrome (IBS). The physician opined that it is more likely than not, that the Veteran developed a change in the microbial biome in his abdomen while in Turkey and that the change caused irritation of the gastrointestinal tract, causing severe IBS, which continued after the service wherein he lost 60 to 70 pounds. See VBMS entry with document type, “Medical Treatment Record - Non-Government Facility,” receipt date 08/20/2020, with “#4” in the subject field, pages 5-6. • The examiner’s review of the record is NOT restricted to the evidence listed above. Additional evidence sought above may have been associated with the claims file. This list is provided in an effort to assist the examiner in locating potentially relevant evidence. While the Board has provided some of the relevant facts above, the examiner is to review the entire record, and then answer the following questions: a) Does the Veteran have a current diagnosis of gastrointestinal and/or digestive disorder? b) For each gastrointestinal and/or digestive disorder offered, the examiner is asked to address whether it is at least as likely as not (50 percent probability or more) that such disability had its onset in service from May 1983 to March 1990, or is otherwise related to service, to specially include but not limited to, the documented January 1984, October 1985 and December 1987 records of acute gastroenteritis (locations above). Please also address the private June 2020 medical opinion (location above). Please explain your answers by citing to supporting clinical data and/or medical literature, as deemed appropriate. A full rationale must be provided for all medical opinions given. If the examiner is unable to provide an opinion without resorting to mere speculation, he or she should explain why this is so. The examiner shall then explain whether the inability to provide a more definitive opinion is the result of a need for more information and indicate what additional evidence is necessary, or whether he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). 9. Schedule the Veteran for a VA examination for the claimed obstructive sleep apnea (OSA), to determine the nature, extent, and etiology of the claimed disability. A copy of this remand should be provided to the VA examiner. The examiner is asked to review the record. Any indicated evaluations, studies, and tests deemed to be necessary by the examiner should be performed. To assist in a review of the claims file, the examiner is informed of the following facts with citations in the record, where applicable: • The Veteran served on active duty from May 1983 to March 1990 with a military occupational specialty (MOS) of aerospace ground equipment specialist. • The Veteran contends that his OSA had its onset in or otherwise related to service, to include change of sleep habits due to his hours of duty. He testified that his wife at the time mentioned his snoring and would bump him at times to wake him up to change positions. The Veteran reported that he was diagnosed with sleep apnea in 2009 following a sleep study. See VBMS entry with document type, “Hearing Transcript,” receipt date 02/28/2020, pages 6, 21-24. • A May 1984 service treatment record includes the Veteran’s complaint of difficulty breathing, especially at night with chest tightness and wheezing. See VBMS entry with document type, “STR – Medical,” receipt date 06/08/2016, with “#1” in the subject field, page 50. • A May 1984 chest x-ray showed no significant radiographic abnormalities following a history of wheezing. See VBMS entry with document type, “STR – Medical,” receipt date 06/08/2016, with “#1” in the subject field, page 30. • A November 1984 Report of Medical Examination reflects a normal clinical evaluation of the lungs and chest. See VBMS entry with document type, “STR – Medical,” receipt date 06/08/2016, with “#1” in the subject field, pages 110-111. • In the accompanying November 1984 Report of Medical History, the Veteran documented that he was in “good health” and was taking “no medication.” He denied that he had ever “been a sleepwalker,” and that he had or ever had “frequent trouble sleeping.” See VBMS entry with document type, “STR – Medical,” with “#2” in the subject field, receipt date 06/08/2016, pages 1-2. • An August 1987 service treatment record shows the Veteran’s complaint of difficulty breathing for two years that was increased at night and previously decreased on Primatene mist. An assessment of bronchospasm was made. See VBMS entry with document type, “STR – Medical,” receipt date 06/08/2016, with “#1” in the subject field, page 63. • A December 1989 Report of Medical Examination reflects a normal clinical evaluation of the lungs and chest. See VBMS entry with document type, “STR – Medical,” receipt date 07/14/2016, with “#1” in the subject field, pages 1-2. • In the accompanying December 1989 Report of Medical History, the Veteran documented that he was in “good health” and was taking “no medication.” He denied that he had ever “been a sleepwalker,” and that he had or ever had “frequent trouble sleeping.” See VBMS entry with document type, “STR – Medical,” with “#1” in the subject field, receipt date 07/14/2016, pages 3-4. • A September 2010 VA medical record shows the Veteran reported that he was not sleeping well since 1990 (out of military) and that the problem was late awakening, snores heavily, and daytime drowsiness. See VBMS entry with document type, “CAPRI,” receipt date 8/10/2016, page 8. • A December 2010 VA sleep study report shows a conclusion that the overnight diagnostic portable sleep test demonstrated mild obstructive sleep apnea/ hypopnea syndrome. See VBMS entry with document type, “CAPRI,” receipt date 8/10/2016, pages 4-6, generally. • A September 2016 VA examination report (contracted Disability Benefits Questionnaire (DBQ)) for sleep apnea shows the Veteran reported that the condition began in 1983. He reported that he was having sinus issues and the doctor asked if he wanted to do a sleep study (VA Hospital in Oklahoma City). He stated that he was diagnosed with sleep apnea in 2012 and reported current symptoms of fatigue, sleepy during the day, and lack of concentration. See VBMS entry with document type, “C&P Exam,” receipt date 09/08/2016, with “#9” in the subject field. • The September 2016 examiner provided the opinion that the claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event or illness. She provided the rationale that there are no medical records showing diagnosis, treatment for any sleep condition while the Veteran was in service. See VBMS entry with document type, “C&P Exam,” receipt date 09/08/2016, with “#10” in the subject field. • In a June 2020 opinion, Dr. John Ellis wrote that while stationed in Turkey, the Veteran was snoring and had great difficulty snoring, would have sinusitis and rhinitis and would cough. He began waking up in the morning very tired. The physician opined that it is more likely than not, that the Veteran developed sleep apnea symptomatology in the service. He also opined that it is more likely than not that the Veteran’s upper and lower respiratory tract conditions have contributed to, aggravated, and accelerated his sleep apnea. See VBMS entry with document type, “Medical Treatment Record - Non-Government Facility,” receipt date 08/20/2020, with “#4” in the subject field, pages 5. • The examiner’s review of the record is NOT restricted to the evidence listed above. Additional evidence sought above may have been associated with the claims file. This list is provided in an effort to assist the examiner in locating potentially relevant evidence. While the Board has provided some of the relevant facts above, the examiner is to review the entire record, and then answer the following question: Is at least as likely as not (50 percent probability or more) that the Veteran’s OSA had its onset in service from May 1983 to March 1990, or is otherwise related to service, to specially include but not limited to, the documented May 1984 and August 1987 records of difficulty breathing (location above). Please also address the private June 2020 medical opinion (location above). Please explain your answers by citing to supporting clinical data and/or medical literature, as deemed appropriate. A full rationale must be provided for all medical opinions given. If the examiner is unable to provide an opinion without resorting to mere speculation, he or she should explain why this is so. The examiner shall then explain whether the inability to provide a more definitive opinion is the result of a need for more information and indicate what additional evidence is necessary, or whether he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). 10. Schedule the Veteran for a VA examination(s) for the claimed bronchial spasm (respiratory disability) and sinusitis (sinus disability), to determine the nature, extent, and etiology of the claimed disabilities. A copy of this remand should be provided to the VA examiner. The examiner is asked to review the record. Any indicated evaluations, studies, and tests deemed to be necessary by the examiner should be performed. To assist in a review of the claims file, the examiner is informed of the following facts with citations in the record, where applicable: • The Veteran served on active duty from May 1983 to March 1990 with a military occupational specialty (MOS) of aerospace ground equipment specialist. • The Veteran contends that his respiratory (bronchitis) and sinus issues were incurred in or otherwise related to service. The Veteran testified that he had sinus issues with all of the jet fumes / dust and whatever was in the air that came off the flight line and had a lot of breathing issues including bronchitis and wheezing. See VBMS entry with document type, “Hearing Transcript,” receipt date 02/28/2020, pages 5, 16-19. • A May 1984 service treatment record includes the Veteran’s complaint of difficulty breathing, especially at night with chest tightness and wheezing. See VBMS entry with document type, “STR – Medical,” receipt date 06/08/2016, with “#1” in the subject field, page 50. • A May 1984 chest x-ray which showed no significant radiographic abnormalities following a history of wheezing. See VBMS entry with document type, “STR – Medical,” receipt date 06/08/2016, with “#1” in the subject field, page 30. • A November 1984 Report of Medical Examination reflects a normal clinical evaluation of the lungs and chest. See VBMS entry with document type, “STR – Medical,” receipt date 06/08/2016, with “#1” in the subject field, pages 110-111. • In the accompanying November 1984 Report of Medical History, the Veteran documented that he was in “good health” and was taking “no medication.” The Veteran denied that he had ever “coughed up blood,” and that he had or ever had “ear, nose, or throat trouble;” “chronic or frequent colds;” “sinusitis;” “asthma;” “shortness of breath;” “pain or pressure in chest;” and “chronic cough.” See VBMS entry with document type, “STR – Medical,” with “#2” in the subject field, receipt date 06/08/2016, pages 1-2. • December 1986 service treatment records reflect the Veteran’s complaint of persistent sinus congestion. An assessment of chronic sinusitis; probably allergic was made. See VBMS entry with document type, “STR – Medical,” receipt date 06/08/2016, with “#1” in the subject field, pages 61-62. • An August 1987 service treatment record shows the Veteran’s complaint of difficulty breathing for two years that was increased at night and previously decreased on Primatene mist. An assessment of bronchospasm was made. See VBMS entry with document type, “STR – Medical,” receipt date 06/08/2016, with “#1” in the subject field, page 63. • An October 1987 service treatment record shows the Veteran’s complaint of sinus with objective findings of nasal congestion. An assessment of upper respiratory infection was made. See VBMS entry with document type, “STR – Medical,” receipt date 06/08/2016, with “#1” in the subject field, page 64. • An April 1988 service treatment record reflects the Veteran’s complaint of chest congestions and pains. There were no upper respiratory infection symptoms. The Veteran’s chest was clear to auscultation and an assessment of viral conditions, probable was made. See VBMS entry with document type, “STR – Medical,” receipt date 06/08/2016, with “#1” in the subject field, page 69. • A May 1988 service treatment record reflects the Veteran’s complaint of cold and an assessment of upper respiratory infection was made. See VBMS entry with document type, “STR – Medical,” receipt date 06/08/2016, with “#1” in the subject field, page 59. • A December 1989 Report of Medical Examination reflects a normal clinical evaluation of the lungs and chest. See VBMS entry with document type, “STR – Medical,” receipt date 07/14/2016, with “#1” in the subject field, pages 1-2. • In the accompanying December 1989 Report of Medical History, the Veteran documented that he was in “good health” and was taking “no medication.” The Veteran denied that he had ever “coughed up blood,” and that he had or ever had “ear, nose, or throat trouble;” “chronic or frequent colds;” “sinusitis;” “asthma;” “shortness of breath;” “pain or pressure in chest;” and “chronic cough.” See VBMS entry with document type, “STR – Medical,” with “#1” in the subject field, receipt date 07/14/2016, pages 3-4. • A September 2010 VA medical record shows that when the examiner performed a history and physical examination, the Veteran denied ear, nose, throat or respiratory complaints. See VBMS entry with document type, “CAPRI,” receipt date 08/10/2016, page 8. • In November 2013 and January 2014 private medical record review of symptoms, the Veteran denied allergic immunologic symptoms including sinus allergy symptoms and frequent illness. He also denied respiratory symptoms including shortness of breath and wheezing. See VBMS entry with document type, “Medical Treatment Record - Non-Government Facility,” receipt date 05/13/2016, with “#3” in the subject field, pages 10 (November 2013) & 1 (January 2014). • A July 2016 private medical record includes a diagnosis of allergies which started one to two weeks prior. His symptom complex included post-nasal drip, nasal congestion, and “scratchy” throat, which were better with over-the-counter antihistamines. See VBMS entry with document type, “Medical Treatment Record - Non-Government Facility,” receipt date 08/20/2020, with “#4” in the subject field, page 37. • A September 2016 private medical record notes concerning sinusitis, which had been a problem for the preceding two months. See VBMS entry with document type, “Medical Treatment Record - Non-Government Facility,” receipt date 08/20/2020, with “#4” in the subject field, page 33. • A September 2016 VA examination report (contracted Disability Benefits Questionnaire (DBQ)) for sinusitis/rhinitis and other conditions of the nose, throat, larynx and pharynx shows a diagnosis of allergic rhinitis. The Veteran reported that condition began in basic training in Lackland, San Antonio, Texas in May 1983. He reported that there was a weird odor in the dorm and his sinuses started swelling and giving him headaches. He had sinus headache and drainage often. See VBMS entry with document type, “C&P Exam,” receipt date 09/08/2016, with “#11” in the subject field. • The September 2016 examiner provided the opinion that the claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event or illness. She provided the rationale that there are no medical records showing diagnosis, treatment for the allergic rhinitis condition while the Veteran was in service. See VBMS entry with document type, “C&P Exam,” receipt date 09/08/2016, with “#12” in the subject field. • In a June 2020 opinion, Dr. John Ellis entered a diagnosis of asthma and several bronchial diagnoses. The physician noted that while in Turkey, the Veteran was around a lot of dust and the cities were very smoggy. He opined that it is more likely than not, that the Veteran’s environmental exposures in Turkey caused irritation of the mucous membranes of the upper and lower respiratory tract which caused sensitization of the membranes, which caused rhinitis, which caused closing of the ostia (openings) of the sinuses, which caused multiple episodes of acute chronic sinusitis, when then changed to chronic sinusitis. See VBMS entry with document type, “Medical Treatment Record - Non-Government Facility,” receipt date 08/20/2020, with “#4” in the subject field, pages 4-5. • Dr. Ellis also opined that it is more likely than not that the Veteran’s exposure to the environment in Turkey caused sensitization of the bronchial tract, causing bronchitis and asthma. The bronchitis is a chronic cough that the Veteran has and the sputum that he brings up. The asthma is the wheezing for which he has to use inhalers. See VBMS entry with document type, “Medical Treatment Record - Non-Government Facility,” receipt date 08/20/2020, with “#4” in the subject field, pages 4-5. • The examiner’s review of the record is NOT restricted to the evidence listed above. Additional evidence sought above may have been associated with the claims file. This list is provided in an effort to assist the examiner in locating potentially relevant evidence. While the Board has provided some of the relevant facts above, the examiner is to review the entire record, and then answer the following questions: a) Does the Veteran have a current diagnosis(es) of bronchial spasm (or other respiratory disability, or functional impairment)? b) For each diagnosis, to include bronchial spasm (or other respiratory disability, or functional impairment) offered, the examiner is asked to address whether it is at least as likely as not (50 percent probability or more) that such disability had its onset in service from May 1983 to March 1990, or is otherwise related to service, to specially include but not limited to, the documented events in service above. Please also address the private June 2020 medical opinion (location above). c) Does the Veteran have a current diagnosis(es) of sinusitis or other sinus disability? d) For each diagnosis, to include sinusitis (or other sinus disability or functional impairment) offered, the examiner is asked to address whether it is at least as likely as not (50 percent probability or more) that such disability had its onset in service from May 1983 to March 1990, or is otherwise related to service, to specially include but not limited to, the documented events in service above. Please also address the private June 2020 medical opinion (location above). Please explain your answers by citing to supporting clinical data and/or medical literature, as deemed appropriate. A full rationale must be provided for all medical opinions given. If the examiner is unable to provide an opinion without resorting to mere speculation, he or she should explain why this is so. The examiner shall then explain whether the inability to provide a more definitive opinion is the result of a need for more information and indicate what additional evidence is necessary, or whether he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). 11. Schedule the Veteran for a VA examination for the claimed cervical spine (neck) disability, to determine the nature, extent, and etiology of the claimed disability. A copy of this remand should be provided to the VA examiner. The examiner is asked to review the record. Any indicated evaluations, studies, and tests deemed to be necessary by the examiner should be performed. To assist in a review of the claims file, the examiner is informed of the following facts with citations in the record, where applicable: • The Veteran served on active duty from May 1983 to March 1990 with a military occupational specialty (MOS) of aerospace ground equipment specialist. • The Veteran contends that he injured his neck on active duty moving equipment. The Veteran testified to being in the back of a van when his head was jammed against a piece of equipment pushed by a person in front of him. The Veteran stated that he did seek medical treatment for the incident, however, the Veteran’s representative responded that he could not find the medical report. See VBMS entry with document type, “Hearing Transcript,” receipt date 02/28/2020, pages 4, 8-9, 13-14. • A September 1983 service treatment record includes the Veteran’s complaint of pain in the neck for two months with no known trauma. The Veteran’s neck had full range of motion, no stiffness, or spasm. An assessment of cervical sprain was made. See VBMS entry with document type, “STR – Medical,” receipt date 06/08/2016, with “#1” in the subject field, page 42. • A November 1984 Report of Medical Examination reflects a normal clinical evaluation of the “head, face, neck and scalp;” “upper extremities;” and “spine, other musculoskeletal.” See VBMS entry with document type, “STR – Medical,” receipt date 06/08/2016, with “#1” in the subject field, pages 110-111. • In the accompanying November 1984 Report of Medical History, the Veteran documented that he was in “good health” and was taking “no medication.” The Veteran denied that he had or ever had “swollen or painful joints;” “head injury;” “arthritis, rheumatism, or bursitis;” “bone, joint or other deformity;” “lameness:” and “painful or ‘trick’ shoulder or elbow.” See VBMS entry with document type, “STR – Medical,” with “#2” in the subject field, receipt date 06/08/2016, pages 1-2. • A December 1989 Report of Medical Examination reflects a normal clinical evaluation of the “head, face, neck and scalp;” “upper extremities;” and “spine, other musculoskeletal.”. See VBMS entry with document type, “STR – Medical,” receipt date 07/14/2016, with “#1” in the subject field, pages 1-2. • In the accompanying December 1989 Report of Medical History, the Veteran documented that he was in “good health” and was taking “no medication.” The Veteran denied that he had or ever had “swollen or painful joints;” “head injury;” “arthritis, rheumatism, or bursitis;” “bone, joint or other deformity;” and “lameness.” See VBMS entry with document type, “STR – Medical,” with “#1” in the subject field, receipt date 07/14/2016, pages 3-4. • A September 2010 VA medical record shows that when the examiner performed a history and physical examination, the Veteran denied musculoskeletal complaints. See VBMS entry with document type, “CAPRI,” receipt date 08/10/2016, page 8. • Private chiropractor records from September and October 2015 document the Veteran’s complaints of neck pain after he fell at work. See VBMS entry with document type, “Medical Treatment Record - Non-Government Facility,” receipt date 05/13/2016, with “#1” in the subject field. • The September 2016 VA examination report (contracted Disability Benefits Questionnaire (DBQ)) for the claimed neck (cervical spine) disability shows a diagnosis of cervical strain. The Veteran reported that the onset of symptoms was 1985 and began in Lakenherath, England. He reported that while moving a unit inside a van, his head hit the side of the van and hyperextended and popped. See VBMS entry with document type, “C&P Exam,” receipt date 09/08/2016, with “#14” in the subject field. • The September 2016 examiner provided the opinion that the claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event or illness. She provided the rationale that there are no medical records showing diagnosis, treatment for the cervical spine condition while the Veteran was in service. See VBMS entry with document type, “C&P Exam,” receipt date 09/08/2016, with “#15” in the subject field. • In the June 2020 opinion, Dr. John Ellis wrote that while in Turkey, the Veteran was lifting equipment in a van and had a sudden pain between his shoulders, base of the neck and upper back. The physician opined that it is more likely than not, that the initial straining of the muscles and ligaments was a straining of the muscles and ligaments in the cervical, thoracic and shoulder girdle areas, which caused instability in the neck and upper back. He added that the straining of these muscles and ligaments were so severe that it caused him to keep restraining his neck and back muscles and ligaments as it the Veteran would lift and do the heavy work in the Air Force. See VBMS entry with document type, “Medical Treatment Record - Non-Government Facility,” receipt date 08/20/2020, with “#4” in the subject field, page 3-4. • Dr. Ellis also opined that it is more likely than not that the tight muscles and ligaments in the Veteran’s neck and shoulders were impinging the brachial plexus of the nerves down both arms. He added that he did not find any cervical spine disc disease and that it was a peripheral brachial plexus impingement. See VBMS entry with document type, “Medical Treatment Record - Non-Government Facility,” receipt date 08/20/2020, with “#4” in the subject field, page 3-4. • A February 2020 VA medical record includes a cervical spine x-ray report, which indicates that there is straightening of the normal cervical lordosis. The vertebral body heights and alignments were preserved. Disc spaces were grossly maintained with scattered small marginal osteophytes. The lateral masses were symmetric and the dens was intact. Prevertebral soft tissues were within normal limits. See VBMS entry with document type, “CAPRI,” receipt date 08/10/2016, page 3. • The examiner’s review of the record is NOT restricted to the evidence listed above. Additional evidence sought above may have been associated with the claims file. This list is provided in an effort to assist the examiner in locating potentially relevant evidence. While the Board has provided some of the relevant facts above, the examiner is to review the entire record, and then answer the following questions: a) Does the Veteran have a current cervical spine, or any functional impairment due to cervical spine pain? b) For each cervical spine disability (or functional impairment due to cervical spine pain) offered, the examiner is asked to address whether it is at least as likely as not (50 percent probability or more) that such disability had its onset in service from May 1983 to March 1990, or is otherwise related to service, to specially include but not limited to, the documented September 1983 complaint of neck pain (locations above). Please also address the private June 2020 medical opinion (location above). Please explain your answers by citing to supporting clinical data and/or medical literature, as deemed appropriate. A full rationale must be provided for all medical opinions given. If the examiner is unable to provide an opinion without resorting to mere speculation, he or she should explain why this is so. The examiner shall then explain whether the inability to provide a more definitive opinion is the result of a need for more information and indicate what additional evidence is necessary, or whether he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). 12. Schedule the Veteran for a VA examination for the claimed lumbar spine (back) disability, to determine the nature, extent, and etiology of the claimed disability. A copy of this remand should be provided to the VA examiner. The examiner is asked to review the record. Any indicated evaluations, studies, and tests deemed to be necessary by the examiner should be performed. To assist in a review of the claims file, the examiner is informed of the following facts with citations in the record, where applicable: • The Veteran served on active duty from May 1983 to March 1990 with a military occupational specialty (MOS) of aerospace ground equipment specialist. • The Veteran contends that he injured his back on active duty. The Veteran testified that he had a back injury sustained at a swimming pool. See VBMS entry with document type, “Hearing Transcript,” receipt date 02/28/2020, pages 5, 12-13. • July 1983 service treatment records show the Veteran’s complaint of lower back pain. It was noted that he strained the area while diving off a diving board at the pool. The Veteran landed on his back but there was no numbness, tingling, or radiation. A physical therapy consultation after the incident is also of record. X-ray report of the lumbar spine reflects tenderness over the mid lumbar. See VBMS entry with document type, “STR – Medical,” receipt date 06/08/2016, with “#1” in the subject field, pages 39, 99-100, and 31 (x-ray). • A March 1984 service treatments record include the Veteran’s complaint of a back strain and knee problem. The back was noted to have full range of motion. See VBMS entry with document type, “STR – Medical,” receipt date 06/08/2016, with “#1” in the subject field, page 47. • In an April 1984 service treatment record, the Veteran stated that medications were not helping his pain. An assessment of low back strain was provided. See VBMS entry with document type, “STR – Medical,” receipt date 06/08/2016, with “#1” in the subject field, page 48. • A November 1984 Report of Medical Examination reflects a normal clinical evaluation of the “lower extremities;” and “spine, other musculoskeletal.” See VBMS entry with document type, “STR – Medical,” receipt date 06/08/2016, with “#1” in the subject field, pages 110-111. • In the accompanying November 1984 Report of Medical History, the Veteran documented that he was in “good health” and was taking “no medication.” The Veteran denied that he had or ever had “swollen or painful joints;” “head injury;” “arthritis, rheumatism, or bursitis;” “bone, joint or other deformity;” “lameness” and “recurrent back pain.” See VBMS entry with document type, “STR – Medical,” with “#2” in the subject field, receipt date 06/08/2016, pages 1-2. • A December 1989 Report of Medical Examination reflects a normal clinical evaluation of the “head, face, neck and scalp;” “lower extremities;” and “spine, other musculoskeletal.”. See VBMS entry with document type, “STR – Medical,” receipt date 07/14/2016, with “#1” in the subject field, pages 1-2. • In the accompanying December 1989 Report of Medical History, the Veteran documented that he was in “good health” and was taking “no medication.” The Veteran denied that he had or ever had “swollen or painful joints;” “head injury;” “arthritis, rheumatism, or bursitis;” “bone, joint or other deformity;” “lameness” and “recurrent back pain.” See VBMS entry with document type, “STR – Medical,” with “#1” in the subject field, receipt date 07/14/2016, pages 3-4. • A September 2010 VA medical record shows that when the examiner performed a history and physical examination, the Veteran denied musculoskeletal complaints. See VBMS entry with document type, “CAPRI,” receipt date 08/10/2016, page 8. • Of record are private chiropractor records from September and October 2015 for the Veteran’s complaints of neck pain after he fell at work. See VBMS entry with document type, “Medical Treatment Record - Non-Government Facility,” receipt date 05/13/2016, with “#1” in the subject field. • A September 2016 VA examination report (contracted Disability Benefits Questionnaire (DBQ)) for the claimed back disability shows a diagnosis of lumbar strain. The Veteran reported that the onset of symptoms was 1984. He reported that he injured himself in a swimming pool with a diving accident while on active duty. See VBMS entry with document type, “C&P Exam,” receipt date 09/08/2016, with “#16” in the subject field. • The September 2016 examiner provided the opinion that the claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event or illness. She provided the rationale that there are no medical records showing diagnosis, treatment for the lumbar spine condition while the Veteran was in service. See VBMS entry with document type, “C&P Exam,” receipt date 09/08/2016, with “#17” in the subject field. • In a June 2020 opinion, Dr. John Ellis wrote that while in Turkey, the Veteran was going to dive into the pool and the “board broke or something happened” and the Veteran fell into the pool. He had immediate pain between in his shoulders and low back. The physician opined that it is more likely than not, that the Veteran had an acute strain of his back in a pool accident and the jerking of his back and abnormal positioning caused straining of the muscles and ligaments of the lower lumbar area, especially into the iliolumbar and the L5 and S1 intervertebral discs and supporting structures. See VBMS entry with document type, “Medical Treatment Record - Non-Government Facility,” receipt date 08/20/2020, with “#4” in the subject field, page 2-3. • Dr. Ellis also opined that it is more likely than not that it caused instability in his back, which caused the lower vertebrae L4, L5, and S1 to rub on each other abnormally, causing traumatic arthritis and subsequent deranged discs, which then caused impingement of the S1 spinal nerves down both legs. See VBMS entry with document type, “Medical Treatment Record - Non-Government Facility,” receipt date 08/20/2020, with “#4” in the subject field, page 2-3. • A February 2020 VA medical record includes the Veteran’s complaint of lower back pain and x-rays of the lumbar spine. Degenerative arthritis of the lumbar spine was noted. Disc space narrowing and osteophyte formation at L4-5 and L5-S1 was noted to be compatible with degenerative disc disease. See VBMS entry with document type, “Medical Treatment Record - Government Facility,” receipt date 08/20/2020, with “#18” in the subject field, on pages 1, 4-7, 14. • The examiner’s review of the record is NOT restricted to the evidence listed above. Additional evidence sought above may have been associated with the claims file. This list is provided in an effort to assist the examiner in locating potentially relevant evidence. While the Board has provided some of the relevant facts above, the examiner is to review the entire record, and then answer the following questions: a) Please lists the Veteran’s current lumbar spine disability(ies), or any functional impairment due to lumbar spine pain? b) For each lumbar spine disability (or functional impairment due to lumbar spine pain) offered, the examiner is asked to address whether it is at least as likely as not (50 percent probability or more) that such disability had its onset in service from May 1983 to March 1990, or is otherwise related to service, to specially include but not limited to, the documented July 1983 swimming pool fall and March/April 1984 complaints of back pain (locations above). Please also address the private June 2020 medical opinion (location above). Please explain your answers by citing to supporting clinical data and/or medical literature, as deemed appropriate. A full rationale must be provided for all medical opinions given. If the examiner is unable to provide an opinion without resorting to mere speculation, he or she should explain why this is so. The examiner shall then explain whether the inability to provide a more definitive opinion is the result of a need for more information and indicate what additional evidence is necessary, or whether he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). 13. After all available evidence has been associated with the record, review the evidence and determine if further development is warranted. The AOJ should take any additional development as deemed necessary. A. P. SIMPSON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Cheng, 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.