Citation Nr: 21024970 Decision Date: 04/27/21 Archive Date: 04/27/21 DOCKET NO. 17-07 957 DATE: April 27, 2021 ORDER Entitlement to service connection for conjunctivitis is dismissed. Entitlement to a compensable rating for bilateral hearing loss is dismissed. Entitlement to a rating in excess of 10 percent for left wrist tendonitis is dismissed. Entitlement to service connection for vertigo (claimed as ear infection) is granted. Entitlement to service connection for a gastrointestinal disability, to include enterocolitis, is granted. Entitlement to service connection for Dupuytren's contracture of the right wrist is granted. Entitlement to service connection for Dupuytren's contracture of the right hand is granted. Entitlement to service connection for Dupuytren's contracture of the left hand is granted. REMANDED Entitlement to a compensable rating for pseudofolliculitis barbae is remanded. Entitlement to service connection for a right shoulder disability is remanded. Entitlement to service connection for a left knee disability is remanded. FINDINGS OF FACT 1. At the February 2020 Board hearing, the Veteran withdrew the appeal of the issues of entitlement to service connection for conjunctivitis, entitlement to a compensable rating for bilateral hearing loss, and entitlement to a rating in excess of 10 percent for left wrist tendonitis. 2. The evidence is in relative equipoise as to whether the Veteran’s current vertigo is secondary to his service-connected bilateral hearing loss and tinnitus. 3. The evidence is in relative equipoise as to whether the Veteran’s current gastrointestinal disability is causally related to his active service. 4. The evidence is in relative equipoise as to whether the Veteran’s current Dupuytren's contracture of the right wrist is secondary to his service-connected left wrist disability. 5. The evidence is in relative equipoise as to whether the Veteran’s current Dupuytren’s contracture of the right hand is secondary to his service-connected left wrist disability. 6. The evidence is in relative equipoise as to whether the Veteran’s current Dupuytren’s contracture of the left hand is secondary to his service-connected left wrist disability. CONCLUSIONS OF LAW 1. The criteria for withdrawal of the appeal of the issues of entitlement to service connection for conjunctivitis, entitlement to a compensable rating for bilateral hearing loss, and entitlement to a rating in excess of 10 percent for left wrist tendonitis by the Veteran are met. 38 U.S.C. § 7105; 38 C.F.R. § 19.55. 2. The criteria for entitlement to service connection for vertigo have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.102, 3.303, 3.310. 3. The criteria for entitlement to service connection for a gastrointestinal disability have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.102, 3.303. 4. The criteria for entitlement to service connection for Dupuytren's contracture of the right wrist have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.102, 3.303, 3.307, 3.309, 3.310. 5. The criteria for entitlement to service connection for Dupuytren's contracture of the right hand have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.102, 3.303, 3.310. 6. The criteria for entitlement to service connection for Dupuytren's contracture of the left hand have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1971 to October 1975. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from February 2013 and January 2019 rating decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO), which, inter alia, denied service connection for conjunctivitis, an ear infection, enterocolitis, and a left knee disability, granted service connection for left wrist tendonitis and assigned a 10 percent evaluation, effective July 17, 2012, granted service connection for bilateral hearing loss and pseudofolliculitis and assigned a noncompensable rating, effective July 17, 2012, and denied service connection for Dupuytren’s contracture of the right wrist and bilateral hands and a right shoulder disability, respectively. In February 2020, the Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge. A transcript of the hearing is of record. In light of the Veteran’s clarifying hearing testimony, and at the request of his attorney, the Board has recharacterized the Veteran’s claim of service connection for an ear infection as a claim of service connection for vertigo. Additionally, the Board has recharacterized the Veteran’s claim of service connection for enterocolitis more broadly as a claim of service connection for a gastrointestinal disability, to include enterocolitis. In light of the decision below, no prejudice to the Veteran has resulted from the Board’s recharacterization of the issues. Bernard v. Brown, 4 Vet. App. 384 (1993) (holding that before the Board may address a matter that has not been addressed by the RO, it must consider whether the claimant has been given adequate notice of the need to submit evidence or argument, an opportunity to submit such evidence or argument, and an opportunity to address the question at a hearing, and whether the claimant has been prejudiced by any denials of those opportunities). 1. Entitlement to service connection for conjunctivitis is dismissed. 2. Entitlement to a compensable rating for bilateral hearing loss is dismissed. 3. Entitlement to a rating in excess of 10 percent for left wrist tendonitis is dismissed. Under applicable criteria, the Board may dismiss any appeal which fails to allege specific error of fact or law in the determination being appealed. 38 U.S.C. § 7105. An appeal may be withdrawn as to any or all issues involved in the appeal at any time before the Board promulgates a decision. 38 C.F.R. § 19.55. Withdrawal may be made by the appellant or by his or her authorized representative. 38 C.F.R. § 19.55(a). At the February 2020 Board hearing, the Veteran, with the assistance of his attorney, expressed his desire to withdraw the pending appeal of the issues of entitlement to service connection for conjunctivitis, entitlement to a compensable rating for bilateral hearing loss, and entitlement to a rating in excess of 10 percent for left wrist tendonitis. As reflected in the hearing transcript, the withdrawal was explicit and unambiguous. Moreover, the undersigned explained the consequences of the withdrawal and the Veteran indicated that he fully understood the consequences. DeLisio v. Shinseki, 25 Vet. App. 45, 57 (2011). Hence, no allegations of errors of fact or law remain for appellate consideration with respect to said claims. Accordingly, the Board does not have jurisdiction to review the appeal as to these matters, and they must be dismissed. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). In addition, certain chronic diseases, including arthritis, will be presumed related to service if they were shown as chronic (reliably diagnosed) in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service, with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013); Fountain v. McDonald, 27 Vet. App. 258 (2015); 38 C.F.R. §§ 3.303, 3.307, 3.309. Disability which is proximately due to or the result of a service-connected disease or injury shall also be service connected. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show: (1) that a current disability exists; and (2) that the current disability was either (a) caused or (b) aggravated by a service-connected disability. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439 (1995). The standard of proof to be applied in decisions on claims for VA benefits is set forth in 38 U.S.C. § 5107(b). Under that provision, VA shall consider all information and lay and medical evidence of record in a case before the Secretary with respect to benefits under laws administered by the Secretary. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b); see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 4. Entitlement to service connection for vertigo is granted. The Veteran contends that his vertigo is secondary to his service-connected bilateral hearing loss and tinnitus. See February 2020 Transcript of Hearing, pages 5-6. The Veteran’s service treatment records (STRs) are silent for complaints, observations, or treatment regarding dizziness or vertigo. The Veteran’s November 1974 separation examination noted that the Veteran had been treated for an ear infection in 1974 with no complications. The Veteran was afforded a VA examination in December 2012. The examiner determined that the Veteran had not been diagnosed with an ear or peripheral vestibular condition. However, the examiner noted that the Veteran experienced hearing impairment with vertigo and tinnitus. The Veteran reported a right ear infection while on active duty in 1974 but no current problems. After examination of the Veteran and review of the claims file, the examiner rendered a negative etiological opinion. The examiner opined, There is no pathology to render a diagnosis and no military records pertaining to “ear infection.” An August 2018 Disability Benefits Questionnaire (DBQ) completed by a private physician, Dr. K.M., noted a diagnosis of peripheral vestibular disorder. The physician noted the Veteran’s reports of symptoms related to benign paroxysmal positional vertigo over the last several years, which was confirmed on examination. The physician determined that the Veteran’s vertigo was secondary to his service-connected bilateral hearing loss and tinnitus, stating the following: Vertigo is a symptom of a more serious condition. Documented in medical studies show that hearing loss and tinnitus are a common denominator in patients suffering vertigo. It is my professional opinion that the veteran[’]s vertigo condition is more likely than not (>50%) secondary to and incurred as a result of his service connected hearing loss and tinnitus. See August 2018 DBQ received November 2018. In a September 2018 medical opinion, Dr. K.M. reiterated his determination that the Veteran’s vertigo was secondary to his service-connected bilateral hearing loss and tinnitus. See September 2018 medical opinion from Dr. K.M. received October 2018. At his February 2020 Board hearing, noted above, the Veteran testified that he began to experience symptoms of vertigo during active duty. He testified that he thought his symptoms, which included a spinning sensation, were food-related at the time, however, he currently believed that his vertigo was related to his service-connected bilateral hearing loss and tinnitus. See February 2020 Transcript of Hearing, pages 5-6. After a review of the evidence, the Board finds that service connection for vertigo as secondary to the Veteran’s service-connected bilateral hearing loss and tinnitus is warranted. As set forth above, disability which is proximately due to or the result of a service-connected disease or injury shall also be service connected. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show: (1) that a current disability exists; and (2) that the current disability was either (a) caused or (b) aggravated by a service-connected disability. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439 (1995). With regard to current disability, the Board finds sufficient clinical evidence to establish that the Veteran currently has vertigo. The December 2012 VA examination noted that the Veteran experienced hearing impairment with vertigo. Additionally, the August 2018 DBQ noted a diagnosis of benign paroxysmal positional vertigo. See August 2018 DBQ received November 2018. In addition, the record reflects that service connection is in effect for bilateral hearing loss and tinnitus. See e.g. February 2013 rating decision granting service connection for bilateral hearing loss and tinnitus. The remaining issue, therefore, is whether the Veteran’s current vertigo was caused or aggravated by his service-connected bilateral hearing loss and/or tinnitus. Affording the Veteran the benefit of the doubt, the Board finds that the evidence is in relative equipoise as to whether the Veteran’s vertigo was caused by his service-connected bilateral hearing loss and tinnitus. The Board finds the August and September 2018 positive nexus opinions from Dr. K.M. of great probative weight, as they were rendered after eliciting a detailed history from the Veteran and during the course of his continued treatment of the Veteran’s symptomatology. In addition, the physician explained the medical bases for the opinions offered. The Board also assigns great probative weight to the portion of the December 2012 VA examination noting that the Veteran experienced hearing impairment with vertigo. Additionally, the Board finds the Veteran’s February 2020 hearing testimony both competent and credible regarding the onset of his vertigo during active duty and his continuous symptoms since that time. Therefore, the Board also assigns great probative weight to the Veteran’s hearing testimony. Accordingly, the Board has weighed the evidence of record and finds that the evidence is at least in relative equipoise as to the Veteran’s vertigo and the causal relation between the Veteran’s disability and his service-connected bilateral hearing loss and tinnitus. The benefit-of-the-doubt rule is therefore for application. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. The Board will resolve the reasonable doubt in the Veteran’s favor and find that the evidence supports the grant of service connection for vertigo as secondary to the Veteran’s service-connected bilateral hearing loss and tinnitus. See 38 U.S.C. § 5107. 5. Entitlement to service connection for a gastrointestinal disability, to include enterocolitis, is granted. The Veteran contends that his gastrointestinal disability began during active duty and has continued since that time. See February 2020 Transcript of Hearing, pages 4-5. An April 1973 entry in the Veteran’s STRs noted that the Veteran was seen for complaints of gastric pain. The assessment was gastritis. A July 1973 entry noted the Veteran’s complaints of abdominal cramps, vomiting, and lower back pain for 2 days. The assessment was gastroenteritis. A November 1973 entry noted the Veteran’s complaints of abdominal pains off and on for 2 months. The assessment was gastroenteritis. An April 1974 entry noted the Veteran’s complaints of abdominal tightening and diarrhea since the previous night. The assessment was enterocolitis, probably viral. A September 1974 entry noted the Veteran’s complaints of sore throat and vomiting for 1 week and epigastric pain. The assessment was gastritis. The Veteran was afforded a VA examination in December 2012. The examiner noted a diagnosis of irritable bowel syndrome. The Veteran reported that his symptoms, which included a burning sensation and watery stool, began in 1974 and that he was diagnosed with enterocolitis. After examination of the Veteran and review of the claims file, the examiner offered a negative etiological opinion regarding the Veteran’s gastrointestinal disability. The examiner opined, The claimant’s irritable bowel syndrome is not due to service connected enterocolitis. The claimant was treated for enterocolitis, probable viral on November 11, 1973. These two conditions are different. In correspondence dated in December 2017, a fellow servicemember, C.W., indicated that the Veteran complained of stomach problems on several occasions during active duty, for which he visited the infirmary for treatment. See December 2017 statement from C.W. received January 2018. An August 2018 DBQ completed by a private physician, Dr. K.M., noted a diagnosis of hypertrophic gastritis. The physician opined that the Veteran’s gastrointestinal disability was more likely than not incurred during active service. See August 2018 DBQ received September 2018. In a September 2018 medical opinion, Dr. K.M. reiterated his determination that the Veteran’s gastrointestinal disability was more likely than not incurred during active service. The physician opined in pertinent part, Review of the veteran[’]s treatment records show evidence of long-term use of NSAIDs and medications for acid reflux and indigestion. It is widely known and accepted across the medical community that either of these medications when used individually are known as “High Risk Factors” in the cause of Chronic Gastritis. This veteran has used both to treat his service connected conditions far beyond the scope of traditional treatment periods. See September 2018 medical opinion from Dr. K.M. received October 2018. At the February 2020 Board hearing, noted above, the Veteran testified that he began experiencing gastrointestinal symptoms during active duty, for which he was prescribed medication. He testified that his symptoms have persisted continuously since that time and that he continues to take medication for such. See February 2020 Transcript of Hearing, pages 4-5. After a review of the evidence, the Board finds that service connection is warranted for a gastrointestinal disability. With regard to the first element of a service connection claim, the evidence shows that the Veteran has a current gastrointestinal disability. The August 2018 DBQ noted a diagnosis of hypertrophic gastritis. See August 2018 DBQ received September 2018. In addressing the second element, the evidence shows that the Veteran came to sickbay on multiple occasions with complaints of abdominal cramps, vomiting, and diarrhea. The evidence also shows that during active duty the Veteran was diagnosed with gastritis, gastroenteritis, and enterocolitis. With respect to the third element, the nexus requirement, the Board finds that the evidence is in relative equipoise as to whether the Veteran’s current gastrointestinal disability is causally related to the gastrointestinal symptomatology he experienced during active duty. The Board finds the August and September 2018 positive nexus opinions from Dr. K.M. of great probative weight, as the physician rendered his opinions after review of the Veteran’s STRs and post-service clinical records and during the course of continued treatment of the Veteran’s symptomatology. The Board also finds the Veteran’s statements both competent and credible regarding his in-service gastrointestinal symptomatology, as his statements are consistent throughout the course of the claim and are supported by his STRs. Therefore, the Board also assigns great probative weight to the Veteran’s statements. The Board affords less probative weight to the December 2012 VA examination, as the examiner did not find that the Veteran had a current diagnosis of gastritis and failed to note in-service diagnoses of gastritis. Accordingly, the Board has weighed the probative evidence of record and finds that the evidence is at least in relative equipoise as to the Veteran’s current gastrointestinal disability, diagnosed as hypertrophic gastritis, and the causal relation between the Veteran’s disability and his in-service gastrointestinal symptomatology. The benefit-of-the-doubt rule is therefore for application. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. The Board will resolve the reasonable doubt in the Veteran’s favor and find that the evidence supports the grant of service connection for a gastrointestinal disability. See 38 U.S.C. § 5107. 6. Entitlement to service connection for Dupuytren's contracture of the right wrist is granted. 7. Entitlement to service connection for Dupuytren's contracture of the right hand is granted. 8. Entitlement to service connection for Dupuytren's contracture of the left hand is granted. The Veteran contends that his Dupuytren’s contracture of his right wrist and right and left hands is secondary to his service-connected left wrist disability. The Veteran’s STRs are negative for complaints, observations, or treatment regarding disabilities of the right wrist or hands. An August 2018 DBQ completed by a private physician, Dr. K.M., noted, inter alia, a diagnosis of right wrist osteoarthritis. The Veteran reported painful motion in the right wrist. The physician opined that the Veteran’s right wrist disability was secondary to his service-connected left wrist disability, stating the following in pertinent part: Furthermore, it is my opinion that [the veteran’s] right wrist conditions are Secondary to and incurred as the result of over use and favoring of the service connected left wrist thereby increasing usage and wear upon the right wrist. See August 2018 DBQ received October 2018. The Veteran was afforded VA examinations for hand and peripheral nerve conditions in December 2018. The examiner noted a diagnosis of bilateral Dupuytren’s contracture. The Veteran reported that his condition began when he injured his left wrist and hand in 1973. He reported that he noticed pain after he fell and that the condition had become worse. After examination of the Veteran and review of the claims file, the examiner rendered a negative etiological opinion regarding the Veteran’s right and left hands. The examiner opined, Based on the provided medical records, the Veteran sustained an acute injury to his left wrist over 40 years ago and there is no documentation in the provided medical records of continuity of pathology of the wrist. On this exam he was found to have bilateral Dupuytren’s contracture which is not related etiologically to left wrist tendonitis. In a private medical opinion received in February 2020, Dr. K.M. noted that the Veteran experienced Dupuytren’s contracture in the palm of his hands, bilateral interphalangeal/metacarpophalangeal joints, and fingers (third to fifth digit). The physician determined that the Veteran’s right wrist and bilateral hand disabilities were secondary to his service-connected left wrist disability. The physician indicated that the Veteran’s service-connected left wrist disability caused his right wrist disability through “overuse, significant decrease ROM [range of motion], weakness, over compensation, altered gait of dominant hand.” Regarding the Veteran’s left hand, the physician opined, Veteran sustained in-service injuries on 08/14/1974 noted on STR of left wrist contusion and sprain, torn tendon, ulnar nerve injury and fracture of ring finger. His injuries cause significant impairment of his left hand and wrist, function loss, weakness and altered use of dominant hand that significantly caused over compensation. Due to improper treatment and care provided, his conditions continued to progress with recurrent injuries due to active duty service requirements. He had several noted PT waivers due to pain, over use, significant function loss and inability to perform full duty. The condition has worsened and may continue to progress with frozen hand and non-use of hands. Regarding the Veteran’s right hand, the physician opined in pertinent part, Due to overuse and limited use of left hand, [the Veteran] has over compensated with his right hand, loss of dominant hand function, decrease ROM, development of carpal tunnel with weakness and grip loss. See medical opinion from Dr. K.M. received February 2020. At the February 2020 Board hearing, noted above, the Veteran testified that he began using his right hand “a lot more” due to pain in his left wrist and as a result developed problems with his right hand and wrist. See February 2020 Transcript of Hearing, pages 6-8. After a review of the evidence, the Board finds that service connection for Dupuytren’s contracture of the right wrist and bilateral hands as secondary to the Veteran’s service-connected left wrist disability is warranted. As set forth above, disability which is proximately due to or the result of a service-connected disease or injury shall also be service connected. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show: (1) that a current disability exists; and (2) that the current disability was either (a) caused or (b) aggravated by a service-connected disability. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439 (1995). With regard to current disability, the Board finds sufficient clinical evidence to establish that the Veteran currently has right wrist and bilateral hand disabilities. The August 2018 DBQ noted a diagnosis of right wrist osteoarthritis. See August 2018 DBQ received October 2018. Additionally, the December 2018 VA examination and private medical opinion received in February 2020 noted a diagnosis of bilateral Dupuytren’s contracture. In addition, the record reflects that service connection is in effect for a left wrist disability. See e.g. February 2013 rating decision granting service connection for left wrist tendonitis. The remaining issue, therefore, is whether the Veteran’s Dupuytren’s contracture of the right wrist and bilateral hands was caused or aggravated by his service-connected left wrist disability. Affording the Veteran the benefit of the doubt, the Board finds that the evidence is in relative equipoise as to whether the Veteran’s Dupuytren’s contracture of the right wrist and bilateral hands was caused by his service-connected left wrist disability. The Board finds the August 2018 medical opinion, as well as the medical opinion received in February 2020, from Dr. K.M. of great probative weight, as they were rendered after a review of the Veteran’s STRs and post-service clinical records and during the course of his continued treatment of the Veteran’s symptomatology. In addition, the physician explained the medical bases for the opinions offered. Additionally, the Board finds the Veteran’s February 2020 hearing testimony both competent and credible regarding the circumstances surrounding the onset of his right wrist and hand problems. Therefore, the Board also assigns great probative weight to the Veteran’s hearing testimony. The Board affords less probative weight to the December 2018 VA examination, as the examiner failed to provide an adequate rationale or an opinion regarding aggravation. Accordingly, the Board has weighed the evidence of record and finds that the evidence is at least in relative equipoise as to the Veteran’s Dupuytren’s contracture of the right wrist and bilateral hands and the causal relation between the Veteran’s disabilities and his service-connected left wrist disability. The benefit-of-the-doubt rule is therefore for application. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. The Board will resolve the reasonable doubt in the Veteran’s favor and find that the evidence supports the grant of service connection for Dupuytren’s contracture of the right wrist and bilateral hands as secondary to the Veteran’s service-connected left wrist disability. See 38 U.S.C. § 5107. REASONS FOR REMAND 9. Entitlement to a compensable rating for pseudofolliculitis barbae is remanded. The Veteran contends that his pseudofolliculitis barbae is more severe than currently rated. The Veteran was most recently afforded a VA examination in February 2017. The examiner noted a diagnosis of pseudofolliculitis barbae. The Veteran reported itching and burning on the skin in his beard, as well as bumps. The examiner did not find that the Veteran’s pseudofolliculitis barbae caused scarring or disfigurement of the head, face, or neck. The examiner noted that the Veteran had not been treated with systemic corticosteroids or other immunosuppressive medications in the past 12 months. However, it was noted that the Veteran used topical medication daily. It was also noted that the total body area and exposed area covered by the Veteran’s pseudofolliculitis barbae was less than 5 percent. In support of his claim, the Veteran submitted a Pseudofolliculitis Barbae Questionnaire dated in September 2018 completed by a private physician, Dr. K.M., which indicated that the percentage of the affected area (facial neck/beard area) covered by the Veteran’s pseudofolliculitis barbae was between 20 and 39 percent. It was noted that the condition required constant systemic therapy during the past 12-month period. Symptoms were noted as follows: pain, 5 inches or more in length, 1/4 inches wide at widest part, hypo- or hyper-pigmented area exceeding six square inches, and skin texture abnormal in an area exceeding six square inches. See September 2018 Pseudofolliculitis Barbae Questionnaire received November 2018. At the February 2020 Board hearing, noted above, the Veteran reported additional symptoms since he was last examined for VA compensation purposes, to include painful scarring, severe burning, and peeling skin. Questions about the accuracy of the private questionnaire notwithstanding, as it appears that the Veteran’s disability may have worsened, the Veteran should be afforded a new VA examination to assess the current severity of his pseudofolliculitis barbae. See Snuffer v. Gober, 10 Vet. App. 400 (1997); Caffrey v. Brown, 6 Vet. App. 377 (1994). 10. Entitlement to service connection for a right shoulder disability is remanded. The Veteran contends that his right shoulder disability is secondary to his service-connected left wrist disability. The Veteran’s STRs are silent for complaints, observations, or treatment regarding a right shoulder disability. An August 2018 DBQ completed by a private physician, Dr. K.M., noted a diagnosis of right shoulder acromioclavicular joint osteoarthritis. The Veteran reported that he injured his right shoulder while on active duty. The physician rendered a positive etiological opinion regarding the Veteran’s right shoulder. See August 2018 DBQ received November 2018. In a private medical opinion received in February 2020, Dr. K.M. noted diagnoses of right shoulder post traumatic arthritis, rotator cuff impingement, tendon tears, tendonitis, and chronic pain. The physician opined that the Veteran’s service-connected left wrist disability aggravated his right shoulder disability. See medical opinion from Dr. K.M. received February 2020. The Board finds that although the August 2018 medical opinion of Dr. K.M. raises an indication that the Veteran’s right shoulder disability is related to service, the opinion is inadequate to support a grant of benefits sought, as the opinion is speculative and conclusory in nature and lacks an adequate rationale. The medical opinion from Dr. K.M. received in February 2020 is similarly inadequate to support a grant of benefits sought, as the opinion fails to establish an adequate baseline level of severity of the Veteran’s right shoulder prior to aggravation. Additionally, the Board notes that the Veteran has not been afforded a VA examination for his right shoulder. The VA has a duty to assist the Veteran in obtaining a medical examination or opinion in certain circumstances. 38 U.S.C. § 5103A (d); 38 C.F.R. § 3.159 (c)(4). A VA examination must be obtained in a disability compensation claim if there is competent evidence of a current disability or persistent or recurrent symptoms of a disability; establishment of an in-service event, injury, or disease; an indication that the current disability may be associated with an in-service event; and insufficient competent medical evidence to make a decision on the claim. McClendon v. Nicholson, 20 Vet. App. 79, 81-6 (2006). Because the Board cannot make a fully informed decision on the issue of the Veteran’s right shoulder without an examination, the Board concludes that a VA examination is warranted. 11. Entitlement to service connection for a left knee disability is remanded. The Veteran contends that he injured his left knee playing football during active duty and that his symptoms persisted and worsened since that time. See February 2020 Transcript of Hearing, page 9. Entries in the Veteran’s STRs dated in October 1972 noted that the Veteran was seen for a growth in the left leg which had been present for 4 months. The assessment was furuncle of the left popliteal area, which was incised and drained. See October 1972 Chronological Record of Medical Care. The Veteran was afforded a VA examination in December 2012. The examiner noted a diagnosis of left knee degenerative arthritis. The Veteran reported that the onset of his knee disability was in 1972 when he injured his knees during training. He reported that his condition had gotten worse since that time. After examination of the Veteran and review of the claims file, the examiner rendered a negative etiological opinion. The examiner opined, The claimant’s left knee degenerative arthritis is not service connected because there is no military medical record about left knee condition. An August 2018 DBQ completed by a private physician, Dr. K.M., noted diagnoses of left knee tendonitis, osteoarthritis, and infra/prepatellar bursitis. The physician opined that the Veteran’s left knee disability was more likely than not causally related to active duty. See August 2018 DBQ received September 2018. The Board finds that although the August 2018 medical opinion of Dr. K.M. raises an indication that the Veteran’s left knee disability is related to service, the opinion is inadequate to support a grant of benefits sought, as the opinion is conclusory in nature and lacks an adequate rationale. Additionally, the Board finds that the December 2012 VA examination is inadequate, as the examiner failed to consider an October 1972 entry in the Veteran’s STRs noting that a furuncle of the left popliteal area had been incised and drained. As such, the Board finds that remand is warranted for an addendum medical opinion. Accordingly, the matter is REMANDED for the following action: 1. Afford the Veteran a VA medical examination to determine the current severity of his service-connected pseudofolliculitis barbae. Access to the Veteran’s electronic claims file should be made available to the examiner for review in connection with the examination. The examiner should address the following: (a) Percentage of the entire body affected by the service-connected pseudofolliculitis barbae; (b) Percentage of the exposed areas affected; (c) Treatment for pseudofolliculitis barbae, to include topical treatment and/or systemic treatment (such as corticosteroids or immunosuppressive drugs) and the duration of such treatment; (d) Area in square inches (or square centimeters) of any darkened or hyper-pigmented skin, to include the skin under the chin and on the neck; and (e) Area in square inches (or square centimeters) of any abnormal skin texture (irregular, atrophic, shiny, scaly, etc.). 2. Afford the Veteran a VA medical examination regarding the nature and etiology of his right shoulder disability. Access to the Veteran’s electronic claims file should be made available to the examiner for review in connection with the examination. After examining the Veteran and reviewing the record, the examiner should provide an opinion, with supporting rationale, as to the following: (a) Is it at least as likely as not that the Veteran’s current right shoulder disability was incurred in or otherwise related to his active service? (b) If not, is it at least as likely as not that the Veteran’s current right shoulder disability is caused by his service-connected left wrist disability? (c) If not, is it at least as likely as not that the Veteran’s current right shoulder disability is aggravated by his service-connected left wrist disability? If aggravation is found, the examiner must attempt to establish a baseline level of severity of the disability, prior to aggravation. In providing the requested opinion, the examiner should reference any relevant evidence of record, to include the August 2018 DBQ and private medical opinion received in February 2020 from Dr. K.M. 3. Obtain an addendum medical opinion regarding the nature and etiology of the Veteran’s left knee disability. Access to the Veteran’s electronic claims file should be made available to the examiner for review in connection with the opinion. After reviewing the record, the examiner should provide an opinion, with supporting rationale, as to the following: Is it at least as likely as not that the Veteran’s current left knee disability was incurred in or otherwise related to his active service, to include in-service treatment for a furuncle of the left popliteal area, which was incised and drained in October 1972? In providing the requested opinion, the examiner should reference any relevant evidence of record, to include the Veteran’s service treatment records, VA and private treatment records, the August 2018 DBQ from Dr. K.M., and the Veteran’s February 2020 hearing testimony indicating that he injured his knee during active duty playing football. In providing the requested opinion, the clinician should consider the Veteran’s reported symptoms in service and thereafter, including the nature of his reported injury or injuries and the onset, progression and severity of the Veteran’s reported symptoms. If there is any medical reason to accept or reject the proposition that the Veteran’s reported symptoms in service and thereafter represented the onset of his current disabilities, this should be noted. Stated another way, do the appellant’s reports about his symptoms align with how the currently diagnosed disability is known to develop or are the Veteran’s reports generally inconsistent with medical knowledge or implausible? K. Conner Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Ruddy, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.