Citation Nr: 21029315 Decision Date: 05/13/21 Archive Date: 05/13/21 DOCKET NO. 16-33 719 DATE: May 13, 2021 ORDER New and material evidence has not been received to reopen a claim of entitlement to service connection for positive purified protein derivative (PPD) skin test (claimed as tuberculosis), and the claim remains denied. Service connection for hyperlipidemia is denied. Service connection for bilateral hearing loss is denied. Service connection for obstructive sleep apnea is denied. Service connection for bilateral foot osteoarthritis is denied. Service connection for bilateral hip osteoarthritis is denied Service connection for bilateral ankle osteoarthritis is denied. Service connection for right knee osteoarthritis is granted. An initial rating in excess of 10 percent for tinnitus is denied. A rating of 20 percent, but no greater, for right knee medial meniscal tear residuals from June 26, 2014, to December 7, 2014, is granted. A rating in excess of 10 percent for right knee medial meniscal tear residuals beginning February 1, 2015, is denied. A rating in excess of 20 percent for left shoulder dislocation residuals with degenerative joint disease and impingement syndrome is denied. A compensable rating for COPD prior to June 2, 2016, is denied. A rating of 10 percent, but no greater, for COPD beginning June 2, 2016, is granted. A rating in excess of 10 percent for COPD is denied. A compensable rating for a right knee scar is denied. A temporary total rating for right knee medial meniscal tear residuals under 38 C.F.R. § 4.29 for hospitalization in excess of 21 days is denied. Extension of the temporary total rating for convalescence for the right knee meniscal tear residuals under 38 C.F.R. § 4.30 beyond February 1, 2015, is denied. REMANDED Entitlement to service connection for a lumbar spine disorder, to include chronic myositis and degenerative disc disease, is remanded. Entitlement to service connection for a cervical spine disorder is remanded. Entitlement to service connection for right shoulder osteoarthritis is remanded. Entitlement to service connection for right elbow osteoarthritis is remanded. Entitlement to service connection for a left knee disorder, to include left knee strain, left patellofemoral degenerative osteoarthritis, and chondromalacia patellae is denied. Entitlement to service connection for bilateral upper extremity neurological disorder, to include carpal tunnel syndrome and peripheral neuropathy, is remanded. Entitlement to service connection for bilateral lower extremity peripheral neuropathy is remanded. Entitlement to service connection for hypertension is remanded. Entitlement to service connection for an acquired psychiatric disorder, to include anxiety disorder, major depressive disorder (MDD), and posttraumatic stress disorder (PTSD) is remanded. Entitlement to service connection for prostate cancer is remanded. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is remanded. Entitlement to special monthly compensation (SMC) based on the need for aid and attendance is remanded. Eligibility for financial assistance for automobile or other conveyance and adaptive equipment, or for adaptive equipment only, is remanded. FINDINGS OF FACT 1. A claim for service connection for positive PPD test claimed as tuberculosis were previously denied in a September 2010 rating decision, the Veteran did not appeal the decision, and no new evidence pertinent to the claims was received within one year from the date the Veteran was mailed notice of the decision; no additional evidence received since the final September 2010 decision raises a reasonable possibility of substantiating the claim. 2. The Veteran does not have any ascertainable disability manifested by hyperlipidemia or high cholesterol. 3. The Veteran did not have a hearing loss disability for VA service connection purposes at the time of his June 2014 claim for benefits and has not had one at any time since. 4. Sleep apnea did not begin during service and is not related to service in any other way. 5. No current foot disability began during service or is related to service in any other way. 6. No current ankle disability began during service or is related to service in any other way 7. No current hip disability began during service or is related to service in any other way. 8. The Veteran's right knee osteoarthritis is the result of his service-connected right knee meniscal tear disability. 9. The Veteran receives the maximum 10 percent schedular rating for tinnitus. 10. From June 26, 2014, to December 7, 2014, the Veteran's right knee medial meniscal tear residuals resulted in resulted in pain and episodes of locking. 11. Beginning February 1, 2015, the Veteran's right knee medial meniscal tear residuals most closely approximated removal of semilunar cartilage that is symptomatic. 12. The Veteran's left shoulder disability most closely approximates inability to move the arm above midway between the side and shoulder level (45 degrees) for the non-dominant arm. 13. Prior to June 2, 2016, pulmonary function tests showed post-bronchodilator FEV-1 of over 80 percent predicted and FEV-1/FVC over 80 percent. 14. Beginning June 2, 2016, post-bronchodilator FEV-1 was between 72 and 75 percent predicted. 15. PFTs have never shown post-bronchodilator FEV-1 of less than 70-percent predicted, or FEV-1/FVC of less than 70 percent. 16. The Veteran's right knee scar measures 1 cm by 0.1 cm, is not painful or unstable, and has no other disabling effects. 17. The Veteran's arthroscopic partial medial meniscectomy surgery for his service-connected right knee disability on December 8, 2014, did not result in hospital treatment for a period in excess of 21 days. 18. The Veteran's arthroscopic partial medial meniscectomy surgery for his service-connected right knee disability on December 8, 2014, did not result in a period of convalescence past January 2015. CONCLUSIONS OF LAW 1. The additional evidence presented since the September 2010 rating decision is not new and material, and the claim for service connection for positive PPD skin test (claimed as tuberculosis) is not reopened. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). 2. There is no legal basis for service connection for hyperlipidemia. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. 3. The criteria for service connection for bilateral hearing loss are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.303, 3.385. 4. The criteria for service connection for obstructive sleep apnea are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.303. 5. The criteria for service connection for bilateral foot osteoarthritis are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. 6. The criteria for service connection for bilateral ankle osteoarthritis are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. 7. The criteria for service connection for bilateral hip osteoarthritis are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. 8. The criteria for service connection for right knee osteoarthritis are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.303, 3.310. 9. There is no legal basis for a rating in excess of 10 percent for tinnitus. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.87, Diagnostic Code 6260. 10. The criteria for a rating 20 percent, but no greater, for right knee medial meniscal tear residuals from June 26, 2014, to December 7, 2014, are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5258. 11. The criteria for a rating in excess of 10 percent for right knee medial meniscal tear residuals beginning February 1, 2015, are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5259. 12. The criteria for a rating in excess of 20 percent for left shoulder dislocation residuals with degenerative joint disease and impingement syndrome are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Codes 5201, 5202. 13. The criteria for a compensable rating for COPD prior to June 2, 2016, are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.31, 4.96, 4.97, Diagnostic Code 6604. 14. The criteria for a rating of 10 percent, but no greater, for COPD beginning June 2, 2016, are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.96, 4.97, Diagnostic Code 6604. 15. The criteria for a rating in excess of 10 percent for COPD are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.96, 4.97, Diagnostic Code 6604. 16. The criteria for a compensable rating for a right knee scar are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.118, Diagnostic Codes 7801-7805. 17. The criteria for temporary total rating for right knee medial meniscal tear residuals under 38 C.F.R. § 4.29 for hospitalization in excess of 21 days are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.29. 18. The criteria for service connection for a temporary total rating for convalescence for the right knee meniscal tear residuals under 38 C.F.R. § 4.30 beyond February 1, 2015, are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.30. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1984 to January 1988, from May 1995 to June 1995, and from April 2003 to September 2003. This appeal is before the Board of Veterans' Appeals (Board) from rating decisions dated in April 2014, June 2015, March 2016, and January 2017. In July 2019, the Board remanded the matters on appeal. 1. New and material evidence has not been received to reopen a claim of entitlement to service connection for positive PPD skin test (claimed as tuberculosis), and the claim remains denied. Pertinent procedural regulations provide that "[n]othing in [38 U.S.C. § 5103A] shall be construed to require [VA] to reopen a claim that has been disallowed except when new and material evidence is presented or secured, as described in [38 U.S.C. § 5108]." 38 U.S.C. § 5103A(f). Reopening a claim for service connection which has been previously and finally disallowed requires that new and material evidence be presented or secured since the last final disallowance of the claim. 38 U.S.C. § 5108; Evans v. Brown, 9 Vet. App. 273, 285 (1996); see also Graves v. Brown, 8 Vet. App. 522, 524 (1996). New evidence means existing evidence not previously submitted to VA. Material evidence means existing evidence that, by itself or when 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. 38 C.F.R. § 3.156(a). The agency of original jurisdiction (AOJ) denied service connection for positive PPD test claimed as tuberculosis in a September 2010 rating decision. This decision was not appealed, and no new evidence pertinent to the claim was received by VA within one year from the date that the AOJ mailed notice of the decision to the Veteran. Furthermore, VA has not received or associated with the claims file any relevant official service department records that existed and had not been associated with the claims file at the time of that decision. Therefore, that decision is final. 38 U.S.C. § 7105; 38 C.F.R. §§ 38 C.F.R. §§ 3.104, 19.20, 19.52, 20.1103; see also 38 C.F.R. § 3.156(b), (c). The basis of the prior final denial was that while the Veteran had a positive PPD test in 2008, the medical evidence showed no active tuberculosis, and no clinical diagnosis of tuberculosis. Evidence obtained since the September 2010 rating decision does not contain findings or diagnoses indicating a current tuberculosis disability; it therefore does not relate to an unestablished fact necessary to substantiate the Veteran's claim, and does not raise a reasonable possibility of substantiating it. Accordingly, new and material evidence has not been submitted to reopen the Veteran's claim for service connection for a positive PPD test claimed as tuberculosis, and the claim remains denied. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection requires: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); see also Caluza v. Brown, 7 Vet. App. 498 (1995). In addition, for certain chronic diseases, such as arthritis, a presumption of service connection arises if the disease is manifested to a degree of 10 percent within one year following discharge from service. 38 C.F.R. §§ 3.307, 3.309(a). When a chronic disease is not shown within one year after service, under 38 C.F.R. § 3.303(b) for the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time. When the fact of chronicity in service is not adequately supported, a showing of continuity after discharge is required to support a claim for such diseases; however, such continuity of symptomatology may only support a claim for those chronic diseases listed under 38 C.F.R. § 3.309(a). 38 C.F.R. § 3.303(b); see Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Service connection may also be established on a secondary basis for a disability that is shown to be proximately due to or the result of a service-connected disease or injury. 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 by or (b) aggravated by a service-connected disability. Id. VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the claimant. 2. Service connection for hyperlipidemia is denied. In his June 2014 claim, the Veteran indicated that he was seeking service connection for hyperlipidemia. The record does not reflect, and the Veteran has not asserted, any ascertainable disability manifested by hyperlipidemia or high cholesterol. Hyperlipidemia and elevated cholesterol are considered to be laboratory results and not disabilities for VA compensation purposes. See 61 Fed. Reg. 20,440, 20,445 (May 7, 1996) (stating that diagnoses such as hyperlipidemia, elevated triglycerides, and elevated cholesterol are actually laboratory results and are not, in and of themselves, disabilities, and are not appropriate entities for the rating schedule). Accordingly, service connection for hyperlipidemia must be denied for lack of entitlement under the law. See Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). 3. Service connection for bilateral hearing loss is denied. For the purposes of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies of 500, 1,000, 2,000, 3,000 and 4,000 Hertz is 40 decibels or greater; or when the thresholds for at least three of these frequencies are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. See 38 C.F.R. § 3.385. The Veteran was given a VA audiological examination in May 2015. On examination, none of the auditory thresholds in any of the frequencies of 500, 1,000, 2,000, 3,000 and 4,000 Hertz for either ear was greater than 15 decibels, and speech recognition scores using the Maryland CNC Test were 100 percent for each ear. The record contains no further evidence reflecting impaired hearing for VA compensation purposes, and the Veteran has not identified any. As the evidence reflects that the Veteran did not have a hearing loss disability for VA service connection purposes at the time of his June 2014 claim for benefits and has not had one at any time since, there can be no valid service connection claim for such disability, and the claim must be denied. See Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); McClain v. Nicholson, 21 Vet. App. 319 (2007); Romanowsky v. Shinseki, 26 Vet. App. 289 (2013). 4. Service connection for obstructive sleep apnea is denied. A May 2016 VA treatment note reflects that the Veteran's record was reviewed to identify symptoms, signs and comorbidities suggestive of obstructive sleep apnea (snoring, witnessed apneas, excessive daytime sleepiness) or other conditions that may warrant asleep study, such as periodic leg movement disorder, parasomnias, narcolepsy or sleep-related seizures. The Epworth Sleepiness Scale and the Berlin Questionnaire results indicated that he had a high probability of having obstructive sleep apnea; it was noted that he had severe daytime sleepiness and would be scheduled for an urgent lab polysomnogram. A July 2016 private sleep study, submitted by the Veteran with his August 2016 service connection claim, reflects that he underwent nocturnal polysomnogram due to snoring, awakenings at night with lack of air, tiredness in the daytime, excessive daytime sleepiness, and suspicion of sleep apnea. The study resulted in a diagnosis of severe sleep apnea. However, service treatment records reflect no diagnoses, findings, or complaints relating to sleep apnea, and there is no indication in the record of how the Veteran's current sleep apnea might be related to his service, the last period of which ended more than 12 years before his sleep apnea was assessed. Furthermore, no potential basis for relating the Veteran's current sleep apnea to service or otherwise for service connection has been identified by Veteran. Therefore, the evidence weighs against a finding that sleep apnea began during service or is related to service in any other way. Accordingly, service connection for obstructive sleep apnea must be denied. 5. Service connection for bilateral foot osteoarthritis is denied. 6. Service connection for bilateral ankle osteoarthritis is denied. 7. Service connection for bilateral hip arthritis is denied. In April 1985, the Veteran was treated for right ankle pain that had begun one hour earlier when he was walking down a ladder and slipped. A first degree ankle sprain was assessed, and the Veteran was to use a wrap and ice for 24 hours, and then heat. However, the probative evidence in this case weighs against a finding of service connection for any foot, ankle, or hip disability. Service treatment records otherwise reflect no findings or complaints related to the feet, ankles, hips, or right elbow. Regular service examinations including in August 1989, July 1991, April 2000, and May 2005 all reflect no foot, ankle, hip, or right elbow problems, and the Veteran denying having or ever having had foot or right elbow problems, arthritis, or swollen or painful joints other than the right knee or left shoulder. On December 2008 post-deployment reassessment, the Veteran again reported muscle no aches or joint problems other than with the right knee. The Veteran submitted a June 2014 private examination report from Dr. C.E.M.Q., in which he diagnosed "osteoarthritis shoulders, arms, elbows," and "osteoarthritis hips, knee (left), ankles, feet." Dr. C.E.M.Q. further stated that, during his military service, the Veteran suffered multiple body traumas, and opined that the Veteran's musculoskeletal disorders were more probable than not secondary to his military service performance. On May 2015 VA examination, the Veteran "state[d] that since more than 10 years he developed multiple joint pain[s] described as deep and dull, worst during cold weather days that improve gradually after [30 minutes] of initial physical activities in the mornings." He stated that he did not recall a specific traumatic event as the trigger of pain. Following examination of the Veteran, including X-ray examination, and reviewing the record, the examiner diagnosed mild degenerative changes of the hip joints resulting in bilateral hip pain, and degenerative changes of the ankle joint resulting in ankle pain, and no bilateral foot condition found on examination; it was noted that foot examination was completely normal, and that the Veteran denied a foot condition other than one occasion of plantar foot pain in the past, the date of which he could not recall. The examiner opined that the Veteran's ankle and hip arthritis was not related to service, as it was related to degenerative changes due to the normal aging process. The examiner based the opinion largely on the imaging studies, which showed degenerative changes related to the normal aging process. The Board finds the May 2015 VA examiners report, diagnoses, and opinion far more probative than those of Dr. C.E.M.Q. in June 2014. The VA examiner detailed his examination findings, reviewed the record, and gave a clear and plausible explanation for his etiology opinion that the Veteran's arthritis, causing the Veteran's hip and ankle pain, was due to the normal aging process. Conversely, Dr. C.E.M.Q. provided no rationale or explanation for any opinion, did not describe what examination was performed or how the Veteran's diagnoses were determined, and did not note what, if any, records were reviewed or considered in formulating any opinion. To the extent that during the May 2014 VA examination the Veteran reported continuous joint pain since service, the Board finds the report not credible, as it contradicts the Veteran's contrary reports in the multiple service examinations noted above. Therefore, a preponderance of the evidence against a finding that any current foot, ankle, or hip disability began during service or is related to service in any other way. Accordingly, service connection for bilateral foot, ankle, and hip osteoarthritis must be denied. 8. Service connection for right knee osteoarthritis is granted. Pursuant to the Board's July 2019 remand instructions, the Veteran was given a VA examination of his knees in January 2020, at which time both right knee meniscal tear (first diagnosed in 2003) and right knee osteoarthritis (first diagnosed in 2008) were assessed. After reviewing the record and examining the Veteran, the examiner opined that the Veteran's right knee osteoarthritis was due to, or a progression of, his service-connected right knee meniscus disability. The examiner explained that medical records demonstrated a right knee MRI in 2003, noting joint effusion as well as meniscal tear, with follow-up X-rays in 2009 demonstrating degenerative arthritis in the right knee. The joint effusion was consistent with joint damage and subsequent development of osteoarthritis. There is no probative evidence contradicting the January 2020 VA opinion. Given this, resolving reasonable doubt in the Veteran's favor, the Board finds that right knee osteoarthritis is the result of the Veteran's service-connected right knee meniscal tear disability. Accordingly, service connection for right knee osteoarthritis must be granted. Increased Rating Disability ratings are determined by evaluating the extent to which a veteran's service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities. See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. If two ratings are potentially applicable, the higher rating will be assigned if the disability more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the veteran. See 38 C.F.R. § 4.3. Staged ratings are appropriate when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007); Fenderson v. West, 12 Vet. App. 119 (1999). Disability of the musculoskeletal system is primarily the inability, due to damage or infection of parts of the musculoskeletal system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. The functional loss may be due to absence of part, or all, of the necessary bones, joints, and muscles, or associated structures, or to deformity, adhesions, defective innervation, or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. See 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca v. Brown, 8 Vet. App. 202, 206-07 (1995). 9. An initial rating in excess of 10 percent for tinnitus is denied. The maximum schedular rating available for tinnitus is 10 percent. 38 C.F.R. § 4.87, DC 6260; see also Smith v. Nicholson, 451 F.3d 1344 (Fed. Cir. 2006). There is therefore no legal basis on which to award a higher schedular rating than 10 percent for bilateral tinnitus. The Veteran has submitted no evidence or argument establishing any basis on which to award any higher rating than 10 percent for his tinnitus. The claim must therefore be denied. See Sabonis, 6 Vet. App. 426. 10. A rating of 20 percent, but no greater, for right knee medial meniscal tear residuals from June 26, 2014, to December 7, 2014, is granted. 11. A rating in excess of 10 percent for right knee medial meniscal tear residuals beginning February 1, 2015, is denied. Meniscus, or semilunar cartilage, injuries are explicitly rated under 38 C.F.R. § 4.71a, DCs 5258 and 5259. DC 5258 provides a 20 percent rating for dislocated semilunar cartilage with frequent episodes of "locking," pain, and effusion into the joint. Diagnostic Code 5259 provides a 10 percent rating for removal of semilunar cartilage that is symptomatic. The Veteran filed a claim for an increased rating for his service-connected right knee medial meniscal tear on June 26, 2014. On March 2014 VA examination, joint stability tests were normal and there was noted to be no evidence or history of recurrent patellar subluxation/dislocation. He was noted to have a right meniscal tear, and used no assistive device to walk. November 2014 VA treatment records reflect that the Veteran had right knee tenderness to palpation and pain to varus and valgus testing. It was noted that his chronic right pain had been unresponsive to conservative management, and that he would have arthroscopic surgery. On December 8, 2014, the Veteran underwent arthroscopic partial medial meniscectomy surgery. In a June 2015 rating decision, the AOJ granted temporary rating of 100 percent effective December 8, 2014 based on surgical or other treatment necessitating convalescence, and a rating of 10 percent for that disability beginning February 1, 2015. On May 2015 VA examination, the Veteran reported right knee pain, which got worse during cold and raining days or after walking a long distance. The Veteran denied a knee locking sensation, and there was noted to be no episodes of locking. There was no joint instability on testing, but there was noted to be a meniscal tear, status post arthroscopic surgery, with frequent episodes of joint pain. The Veteran did not use any assistive device. On January 2020 VA examination, the Veteran reported that right knee symptoms had improved after his 2014 meniscal surgery, but that he experienced some discomfort in the right knee and prolonged walking, as well as on squatting and kneeling. He also reported using over-the-counter anti-inflammatories as needed and wearing a right knee brace regularly for knee pain. Stability testing was normal. Given the above, resolving reasonable doubt in the Veteran's favor, the Board finds that from June 26, 2014, to December 7, 2014, a rating of 20 percent, but no greater, for right knee medial meniscal tear residuals is warranted. During that time period, the Veteran had symptoms of a tear or dislocation of his right knee meniscus (semilunar cartilage) that resulted in pain and, as reflected in VA treatment records and examinations prior to 2015, episodes of locking. Therefore, a rating of 20 percent during that time period under DC 5258 is warranted. Beginning February 1, 2015, following the Veteran's December 2014 arthroscopic partial medial meniscectomy, the record reflects an improvement in symptoms, and episodes of locking were specifically noted not to occur on May 2015 VA examination. However, the Veteran's knee, post-meniscus removal, was still symptomatic, with pain and resulting functional impairment from the post-surgery meniscus residuals. Therefore, the Veteran's right knee meniscus disability has most closely approximated removal of semilunar cartilage that is symptomatic since that date, and thus warrants a 10 percent rating under DC 5258. The Board has considered 38 C.F.R. § 4.71a, DC 5257, but finds it inapplicable, as the Veteran's knee has consistently been noted to be without instability or subluxation. The Board has also considered the diagnostic codes that contemplate range of motion of the knee, and notes that the Veteran had been previously been rated under DC 5260 for limitation of flexion. However, in this decision, the Board is granting service connection separately for osteoarthritis of the right knee, which has yet to be rated in the first instance by the AOJ. The rating criteria for limitation of motion under 38 C.F.R. § 4.71a, DCs 5260 and 5261 are more appropriately considered for the Veteran's right knee arthritis disability granted herein, and yet to be rated in the first instance by the AOJ. See 38 C.F.R. § 4.71a, DC 5003 (establishing that degenerative arthritis is rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved). Therefore, the Veteran's separately rated meniscus disability is most appropriately rated pursuant to the specific diagnostic codes pertaining to meniscus injuries and surgery. Accordingly, a rating of 20 percent, but no greater, for right knee medial meniscal tear residuals from June 26, 2014, to December 7, 2014, must be granted, and a rating in excess of 10 percent for right knee medial meniscal tear residuals beginning February 1, 2015, must be denied. 12. A rating in excess of 20 percent for left shoulder dislocation residuals with degenerative joint disease and impingement syndrome is denied. The Veteran's left shoulder disability is rated as limitation of shoulder motion under Diagnostic Code (DC) 5201. Under DC 5201, for a minor (non-dominant) joint, motion limited to 25 degrees from the side warrants a maximum 30 percent rating, while motion limited to midway between side and shoulder level and motion limited to shoulder level both warrant a 20 percent rating. 38 C.F.R. § 4.71a, DC 5201 (2020). The Board notes that, effective February 7, 2021, the regulations were clarified to state that flexion and/or abduction limited to 25 degrees from side warrants the 30 percent rating; to midway between side and shoulder level (flexion and/or abduction limited to 45 degrees), and at shoulder level (flexion and/or abduction limited to 90 degrees), warrants a 20 percent rating for the minor joint. 85 Fed. Reg. 76453 (Nov. 30, 2020). On May 2015 VA examination, the Veteran reported left shoulder pain that got worse when doing overhead activities or when trying to lift heavy objects. It was noted that he was right-hand dominant, and reported no flare-ups of the shoulder or arm. On range of motion testing, left shoulder flexion was from 0 to 140 degrees, abduction was from 0 to 160 degrees, and external and internal rotation were to 80 degrees each. Pain was noted on examination, but without additional functional loss, and after repetition flexion was to 130 degrees and abduction to 145 degrees. Muscle strength was full. Hawkins' Impingement Test was positive, indicating possible rotator cuff tendinopathy or tear. There was no instability. On June 2016 VA examination, the Veteran reported inability to put a shirt on himself, and pain and limited range of motion. On range of motion testing, flexion was to 110 degrees, abduction was to 100 degrees, external rotation was to 55 degrees, and internal rotation was to 50 degrees. There was no loss of function after repetition. Muscle strength was reduced, 4/5, with no atrophy. Hawkins' Impingement Test was again positive, as was Empty-can Test, indicating possible rotator cuff pathology, including supraspinatus tendinopathy or tear. There was also guarding of movement at the left shoulder level. The examiner remarked, in terms of functional impairment, that function would be limited for overhead activities with the left upper extremity, including lifting, carrying, or occupational tasks. On January 2020 VA examination, the Veteran reported current left shoulder pain with lifting and reaching, is noticed significant decrease in range of motion of the shoulder is able to reach beyond mid chest level. It was noted that he had undergone arthroscopic evacuation of spinoglenoid cyst with superior labrum anterior and posterior (SLAP) repair in September 2019. On range of motion testing, flexion and abduction were to 50 degrees, and it was noted to be decreased range of motion limiting reaching to the mid chest level and impacting rotatory movements and repetitive movements of the shoulder, and similarly impacting lifting as well. Given the above, a rating in excess of 20 percent for left shoulder dislocation residuals with degenerative joint disease and impingement syndrome is not warranted. The Veteran's left shoulder disability has been shown to be productive of limitation of flexion and abduction of up to 50 degrees, at its worst, with pain and guarding with movement, occasional dislocation, and some loss of strength, and corresponding significant impairment in reaching, lifting, carrying, and other regular uses of the left arm and shoulder. However, such disability is adequately contemplated in the criteria for a 20 percent rating under DC 5201, which contemplates disability to the level of inability to move the arm above midway between the side and shoulder level (45 degrees) for the non-dominant arm. Even considering the totality of the Veteran's disability and functional impairment, it has not been shown to more closely approximate disability of the severity of arm motion limited to 25 degrees from the sidehalf of Veteran's worst range of motion measurement. Therefore, the Veteran's left shoulder warrants a 20 percent rating under DC 5201. The Board has also considered 38 C.F.R. § 4.71, DC 5202, which provides that recurrent dislocation of the humerus at the scapulohumeral joint warrants a 20 percent rating for the minor joint where there is either frequent episodes and guarding of all arm movements, or infrequent episodes and guarding of movement only at the shoulder level (flexion and/or abduction at 90 degrees). While the Veteran has been noted to have infrequent episodes of dislocation and guarding of arm movement, this diagnostic code does not provide any higher rating than the 20 percent the Veteran is already awarded. Also, as the symptomatology, including pain and impairment of arm movement, is contemplated in the Veteran's current rating under DC 5201, a separate rating under DC 5202 is not warranted for impairment of the humerus. See 38 C.F.R. § 4.14; see also Brady v. Brown, 4 Vet. App. 203, 206 (1993); Esteban v. Brown, 6 Vet. App. 259, 261 (1994). Accordingly, a rating in excess of 20 percent for left shoulder dislocation residuals with degenerative joint disease and impingement syndrome is denied. 13. A compensable rating for COPD prior to June 2, 2016, is denied. 14. A rating of 10 percent, but no greater, for COPD beginning June 2, 2016, is granted. 15. A rating in excess of 10 percent for COPD is denied. COPD is rated under DC 6604. Under DC 6604, a 100 percent rating is warranted for forced expiratory volume in one second (FEV-1) less than 40 percent of predicted value, or; the ratio of forced expiratory volume in one second to Forced Vital Capacity (FEV-1/FVC) less than 40 percent, or; diffusion capacity of the lung for carbon monoxide by the Single Breath Method (DLCO (SB)) less than 40-percent predicted, or; maximum exercise capacity less than 15 ml/kg/min oxygen consumption (with cardiac or respiratory limitation), or; cor pulmonale (right heart failure), or; right ventricular hypertrophy, or; pulmonary hypertension (shown by Echo or cardiac catheterization), or; episode(s) of acute respiratory failure, or; requires outpatient oxygen therapy. A 60 percent rating is warranted for FEV-1 of 40- to 55-percent predicted, or; FEV-1/FVC of 40 to 55 percent, or; DLCO (SB) of 40- to 55-percent predicted, or; maximum oxygen consumption of 15 to 20 ml/kg/min (with cardiorespiratory limit). A 30 percent rating is warranted for FEV-1 of 56- to 70-percent predicted, or; FEV-1/FVC of 56 to 70 percent, or; DLCO (SB) 56- to 65-percent predicted. A 10 percent rating is warranted for FEV-1 of 71- to 80-percent predicted, or; FEV-1/FVC of 71 to 80 percent, or; DLCO (SB) 66- to 80-percent predicted. 38 U.S.C. § 4.97. When evaluating based on pulmonary function tests (PFTs), post-bronchodilator results are used in applying the evaluation criteria in the rating schedule unless the post-bronchodilator results were poorer than the pre-bronchodilator results. In those cases, use the pre-bronchodilator values for rating purposes. 38 U.S.C. § 4.96(d)(5). When there is a disparity between the results of different PFT's FEV-1 (Forced Expiratory Volume in one second), FVC (Forced Vital Capacity), etc.), so that the level of evaluation would differ depending on which test result is used, use the test result that the examiner states most accurately reflects the level of disability. 38 U.S.C. § 4.96(d)(6). Where the schedular criteria does not provide for a noncompensable evaluation, such an evaluation shall be assigned when the requirements for a compensable evaluation are not met. 38 C.F.R. § 4.31. On May 2015 VA examination, the Veteran reported shortness of breath and chest tightness with exercise and dry cough in the mornings. Pre-bronchodilator PFTs were FVC of 75 percent predicted; FEV-1 of 65 percent predicted; FEV-1/FVC of 85 percent; and DLCO of 72 percent predicted. Post-bronchodilator PFTs were FVC of 82 percent predicted; FEV-1 of 87 percent predicted; FEV-1/FVC of 104 percent. The examiner noted that the test result that most accurately reflected the Veteran's level of disability based on the condition that was being evaluated for the report was FEV-1/FVC. The examiner further remarked that there was moderate obstructive ventilatory impairment responsive to bronchodilator therapy and mild reduction on gas transfer evaluated by corrected DLCO, and that arterial blood gases at room air showed no acid-base disturbance and normal oxygenation. On June 2, 2016, VA examination, the Veteran reported recurrent almost daily episodes of dry cough with associated dyspnea and shortness of breath, and episodes of chest tightness and shortness of breath that woke him from sleep. Pre-bronchodilator PFTs were FVC of 75 percent predicted; FEV-1 of 72 percent predicted; FEV-1/FVC of 95 percent; and DLCO of 59 percent predicted. Post-bronchodilator PFTs were FVC of 74 percent predicted; FEV-1 of 76 percent predicted; FEV-1/FVC of 103 percent. The examiner noted that the test result that most accurately reflected the Veteran's level of disability based on the condition that was being evaluated for the report was FEV-1. On January 2020 VA examination, the Veteran reported shortness of breath with prolonged walking, climbing stairs and running, that improved with rest. It was noted that he currently took no medications and underwent no treatment for his COPD. Pre-bronchodilator PFTs were FVC of 59 percent predicted; FEV-1 of 54 percent predicted; FEV-1/FVC of 71 percent predicted; and DLCO of 71 percent predicted. Post-bronchodilator PFTs were FVC of 67 percent predicted; FEV-1 of 75 percent predicted; FEV-1/FVC of 87 percent predicted. The examiner noted that the test result that most accurately reflected the Veteran's level of disability based on the condition that was being evaluated for the report was FEV-1 percent predicted. Given the above, pursuant to DC 6604, a compensable rating for COPD prior to June 2, 2016, is not warranted; a rating of 10 percent, but no greater, for COPD beginning June 2, 2016, is warranted; and a rating in excess of 10 percent for COPD is not warranted. Prior to June 2, 2016, post-bronchodilator FEV-1 was over 80 percent predicted and FEV-1/FVC over 80 percent. Beginning June 2, 2016, FEV-1the measurement determined by the examiners at those times to be the PFT that most accurately reflected the Veteran's level of disability based on the condition that was being evaluated for the reportwas 72 and 75 percent predicted. The Board notes the Veteran's DLCO scores, but that they were consistently assessed by the VA examiner's not to be the PFT that most accurately reflected the Veteran's level of disability based on his condition. See 38 U.S.C. § 4.96(d)(6). Accordingly, a compensable rating for COPD prior to June 2, 2016, must be denied; a rating of 10 percent, but no greater, for COPD beginning June 2, 2016, must be granted; and a rating in excess of 10 percent for COPD must be denied. 16. A compensable rating for a right knee scar is denied. Scars not of the head, face, or neck are rated under 38 C.F.R. § 4.118, DCs 7801 to 7805. Scar(s) not of the head, face, or neck, that are associated with underlying soft tissue damage, warrant at compensable 10 percent rating when in an area or areas of at least 6 square inches (39 sq. cm.) but less than 12 square inches (77 sq. cm.). 38 C.F.R. § 4.118, DC 7801. Scar(s) not of the head, face, or neck, that are not associated with underlying soft tissue damage, in an area or areas of 144 square inches (929 sq. cm.) or greater, warrant a 10 percent rating. 38 C.F.R. § 4.118, DC 7802. For scar(s) that are unstable or painful: five or more scars that are unstable or painful warrant a 30 percent rating; three or four scars that are unstable or painful warrant a 20 percent rating; one or two scars that are unstable or painful warrant a 10 percent rating. An unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. If one or more scars are both unstable and painful, add 10 percent to the evaluation that is based on the total number of unstable or painful scars. Scars evaluated under diagnostic codes 7800, 7801, 7802, or 7805 may also receive an evaluation under this diagnostic code, when applicable. 38 C.F.R. § 4.118, DC 7804. For other scars and other effects of scars evaluated under diagnostic codes 7800, 7801, 7802, and 7804, any disabling effect(s) not considered in a rating provided under diagnostic codes 7800-04 are to be evaluated under an appropriate diagnostic code. 38 C.F.R. § 4.118, DC 7805. A compensable rating for the Veteran's right knee scar is not warranted. On May 2015 VA examination, the Veteran's right knee scar was noted to measure 1 cm by 0.1 cm and not to be painful or unstable, and there was no indication of any other disabling effects of the scar. There is no evidence of record contradicting the May 2015 VA examination findings, and the Veteran has not identified any. Accordingly, a compensable rating for a right knee scar must be denied. 17. A temporary total evaluation for right knee medial meniscal tear residuals under 38 C.F.R. § 4.29 for hospitalization in excess of 21 days is denied. 18. Extension of the temporary total evaluation for convalescence for the right knee meniscal tear residuals under 38 C.F.R. § 4.30 beyond February 1, 2015, is denied. A total disability rating (100 percent) will be assigned without regard to other provisions of the rating schedule when it is established that a service-connected disability has required hospital treatment in a Department of Veterans Affairs or an approved hospital for a period in excess of 21 days or hospital observation at Department of Veterans Affairs expense for a service-connected disability for a period in excess of 21 days. 38 C.F.R. § 4.29. Without regard to other provisions on the rating schedule, a total disability rating (100 percent) will be assigned when it is established by report at hospital discharge (regular discharge or release to non-bed care) or outpatient release that entitlement is warranted, effective from the date of hospital admission or outpatient treatment and continuing for a period of one, two or three months from the first day of the month following such hospital discharge or outpatient release. In order to attain the temporary total disability rating, a veteran must demonstrate that his service connected disability resulted in: (1) surgery necessitating at least one month of convalescence; (2) surgery with severe postoperative residuals, such as incompletely healed surgical wounds, stumps of recent amputations, therapeutic immobilization of one major joint or more, application of a body cast, or the necessity for house confinement, or the necessity for continued use of a wheelchair or crutches (regular weight-bearing prohibited); or (3) immobilization by cast, without surgery, of one major joint or more. 38 C.F.R. § 4.30. The Veteran underwent arthroscopic partial medial meniscectomy surgery for his service-connected right knee disability on December 8, 2014. He was discharged the day of the surgery. In a June 2015 rating decision, the AOJ granted a temporary rating of 100 percent effective December 8, 2014, based on surgical or other treatment necessitating convalescence, and a rating of 10 percent for that disability beginning February 1, 2015. The record does not reflectand the Veteran has not identified any evidence showingeither hospital treatment for a period in excess of 21 days, or a period of convalescence past January 2015. A December 18, 2014, follow-up note to the Veteran's surgery indicates that the surgery had been performed 10 days ago and he had been doing well and had mild knee swelling and decreased strength and range of motion, and was ambulating with crutches. It was noted that a convalescence period would be extended 2 more weeks to allow swelling and pain to decrease. On January 29, 2015, treatment, it was noted that his right knee symptoms had improved since his surgery, but that the Veteran was now complaining of left knee pain. There are no further records indicating any necessary convalescence period for the Veteran's right knee surgery residuals, and he has not identified any. Accordingly, a temporary total rating beyond February 15, 2015, under 38 C.F.R. §§ 4.29 or 4.30 must denied. REASONS FOR REMAND 1. Entitlement to service connection for a lumbar spine disorder, to include chronic myositis and degenerative disc disease, is remanded. 2. Entitlement to service connection for a cervical spine disorder is remanded. 3. Entitlement to service connection for right shoulder osteoarthritis is remanded. 4. Entitlement to service connection for right elbow osteoarthritis is remanded. 5. Entitlement to service connection for a left knee disorder, to include left knee strain, left patellofemoral degenerative osteoarthritis, and chondromalacia patellae is remanded. 6. Entitlement to service connection for bilateral upper extremity neurological disorder, to include carpal tunnel syndrome and peripheral neuropathy, is remanded. 7. Entitlement to service connection for bilateral lower extremity peripheral neuropathy is remanded. 8. Entitlement to service connection for hypertension is remanded. In a June 2014 private examination report, Dr. C.E.M.Q. diagnosed hypertension, chronic cervical spine pain, chronic myositis of the para-lumbar spine muscles and lumbar spine degenerative disc disease, osteoarthritis of the shoulders, elbows and left knee, bilateral carpal tunnel syndrome, and peripheral neuropathy of the upper and lower limbs. Dr. C.E.M.Q. further stated that, during his military service, the Veteran suffered multiple body traumas, and opined that the Veteran's diagnosed disorders were more probable than not secondary to his military service performance. However, Dr. C.E.M.Q. provided no rationale or explanation for the opinion, and did not describe what examination was performed or how the Veteran's diagnoses were determined, and did not note what, if any, records were reviewed or considered in formulating the opinion. Service treatment records do contain an April 1987 treatment note for complaints of back pain, at which time the Veteran reported a history of previous back pain related to performance of strenuous activities. The pain was noted to be located below the shoulder blades, and overuse inflammation of the paraspinal muscles was assessed. Although the Veteran's claims were remanded by the Board in July 2019, the record does not contain any VA opinions regarding whether the above claimed disabilities are related to service. In light of Dr. C.E.M.Q.'s opinion diagnosing these disorders and linking them to the Veteran's service duties, VA should provide medical examinations and opinions to determine what, if any, such disorders are etiologically related to the Veteran's service. See 38 C.F.R. § 3.159(c)(4); see also McLendon v. Nicholson, 20 Vet. App. 79 (2006). 9. Entitlement to service connection for an acquired psychiatric disorder, to include anxiety disorder, MDD, and PTSD is remanded. The Veteran was given a VA examination for his claimed psychiatric disorder in May 2015. At that time, the examining psychiatrist determined that the Veteran did not have PTSD, but diagnosed anxiety disorder, with symptoms of nervousness, trouble sleeping with nightmares, and frustration over his physical conditions. The examiner further opined that the Veteran's anxiety disorder was not related to service, stating the following: Veteran sought psychiatric care in 2013, ten years after his military discharge, and the events that led to his military stressors. He was gainfully employed until two years ago when he was dismissed due to conflicts with management, after twenty two years of service. A temporal relationship between the neuropsychiatric disorder and the veteran's military service is not established. However, the Veteran's service and post-service medical records reflect that, in a December 2008 service post-deployment health re-assessment, the Veteran reported PTSD symptoms already under care. February 2009 VA treatment records further reflect that the Veteran was seen for mental health care reporting anxiety, insomnia, and poor impulse control, and he reported a past medical history that included depression. Also, while the examiner concluded that a temporal relationship between the Veteran's psychiatric disorder and service as not established, he did not directly address why his anxiety disorder was nonetheless unrelated to any in-service event. Furthermore, the examiner noted that the Veteran's anxiety symptoms included "frustration over his physical conditions." VA treatment records also reflect that in January 2014 the Veteran reported symptoms of feeling depressed, anxious, tired, a lack of energy, and overwhelmed and having trouble sleeping, which were noted to be associated with chronic pain, specifically of the left knee and shoulder. In August 2016 and November 2018, the Veteran also reported symptoms such as depression, anxiety, and irritability that he related to his prostate condition and other physical medical problems and limitations. However, the May 2015 examiner did not provide any opinion as to whether the Veteran's anxiety disorder might in any way be secondary to any service-connected disability or disabilities. Therefore, an addendum opinion should be obtained by the AOJ on remand addressing the Veteran's earlier complaints of mental health problems, whether his current psychiatric disorder is related to any in-service event, and whether such disorder was caused or aggravated by any service-connected disability. 10. Entitlement to service connection for prostate cancer is remanded. The Veteran's service connection claim for prostate cancer was remanded by the Board in July 2019, but the issue was not addressed in the AOJ's August 2020 supplemental statement of the case or otherwise readjudicated, as was required by the Board's remand. The issue must therefore be remanded for readjudication by the AOJ. 11. Entitlement to a TDIU is remanded. 12. Entitlement to SMC based on the need for aid and attendance is remanded. 13. Eligibility for financial assistance for automobile or other conveyance and adaptive equipment, or for adaptive equipment only, is remanded. Finally, because a decision on the remanded service connection issues of could significantly impact a decision on the issues of a TDIU, SMC based on the need for aid and attendence, and eligibility for financial assistance for automobile or other conveyance and adaptive equipment, or for adaptive equipment only, the issues are inextricably intertwined. A remand of these claims is therefore also required. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination with an appropriate examiner to determine the nature and etiology of any 1) lumbar spine disorder, to include chronic myositis and degenerative disc disease; 2) cervical spine disorder; 3) right shoulder osteoarthritis; 4) right elbow osteoarthritis; 5) left knee disorder, to include left knee strain, left patellofemoral degenerative osteoarthritis, and chondromalacia patellae; 6) bilateral upper extremity neurological disorder, to include carpal tunnel syndrome and peripheral neuropathy; 7) bilateral lower extremity peripheral neuropathy; and 8) hypertension. After reviewing the claims file, the examiner should determine: a) The nature and diagnoses, if any, of each of these claimed disabilities; and b) For any such diagnosed disorder, whether it is least as likely as not (i.e. a 50 percent probability or more) that such disorder began during, is the result of, or is otherwise related to service, to include physical trauma from his service duties. The examiner should specifically consider: a) The June 2014 private examination report of Dr. C.E.M.Q.; and b) The April 1987 service treatment record documenting complaints and a history of back pain, noted to be located below the shoulder blades, and assessed as overuse inflammation of the paraspinal muscles. All opinions are to be accompanied by a rationale consistent with the evidence of record. A discussion of the pertinent evidence, relevant medical treatises, and generally accepted medical principles is requested. If the examiner cannot provide an opinion without resorting to speculation, he or she shall provide complete explanations stating why this is so. In so doing, the examiner shall explain whether any inability to provide a more definitive opinion is the result of a need for additional information, or whether he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. 2. Forward the claims file to an appropriate VA examiner for an addendum opinion to the May 2015 VA psychiatric examination report. If the requested opinions cannot be provided without another examination of the Veteran, schedule him for a VA examination with an appropriate examiner. The claims file and a copy of this Remand must be reviewed by the examiner. After reviewing the claims file, the examiner should determine: a) Whether it is at least as likely as not (i.e. a 50 percent probability or more) that any psychiatric disorder, to include anxiety disorder, MDD, or PTSD, began during, is the result of, or is otherwise related to service. The examiner should specifically consider the December 2008 service post-deployment health re-assessment in which the Veteran reported PTSD symptoms already under care, and February 2009 VA treatment records reflecting that the Veteran was seen for mental health care reporting anxiety, insomnia, and poor impulse control, and he reported a past medical history that included depression. The examiner should also note that even if a temporal relationship between the Veteran's psychiatric disorder and service as not established, the examiner must still address whether a current disorder might nonetheless be related to any in-service event. b) If the answer to question (a) is negative, whether it is at least as likely as not (i.e. a 50 percent probability or more) that any psychiatric disorder, to include anxiety disorder, MDD, or PTSD, was caused or aggravated (i.e. worsened beyond its natural progression) by any service-connected disability. The examiner should note the May 2015 VA examination results, including the notation that the Veteran's anxiety symptoms included "frustration over his physical conditions"; January 2014 VA treatment records reflecting reported symptoms of feeling depressed, anxious, tired, a lack of energy, and overwhelmed and having trouble sleeping, noted to be associated with chronic pain, specifically of the left knee and shoulder; and August 2016 and November 2018 VA treatment records, reflecting reported symptoms of depression, anxiety, and irritability that the Veteran related to his prostate condition and other physical medical problems and limitations. All opinions are to be accompanied by a rationale consistent with the evidence of record. A discussion of the pertinent evidence, relevant medical treatises, and generally accepted medical principles is requested. If the examiner cannot provide an opinion without resorting to speculation, he or she shall provide complete explanations stating why this is so. In so doing, the examiner shall explain whether any inability to provide a more definitive opinion is the result of a need for additional information, or whether he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. 3. After completing the above and any other necessary development, readjudicate the issues remaining on appeal. If any benefit sought remains denied, provide a supplemental statement of the case to the Veteran. JONATHAN B. KRAMER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Andrew Mack, 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.