Citation Nr: 21029824 Decision Date: 05/17/21 Archive Date: 05/17/21 DOCKET NO. 15-10 128A DATE: May 17, 2021 ORDER Entitlement to a disability rating in excess of 70 percent for posttraumatic stress disorder (PTSD) is denied. Entitlement to service connection for right shoulder arthritis is granted. Entitlement to service connection for peripheral neuropathy of the left upper extremity is denied. REMANDED Entitlement to service connection for lumbar spine disability is remanded. Entitlement to service connection for peripheral neuropathy of the left lower extremity, to include as secondary to lumbar spine disability and in-service exposure to herbicides, is remanded. Entitlement to service connection for peripheral neuropathy of the right lower extremity, to include as secondary to lumbar spine disability and in-service exposure to herbicides, is remanded. Entitlement to service connection for radiculopathy of the right lower extremity, to include as secondary to lumbar spine disability and in-service exposure to herbicides, is remanded. Entitlement to service connection for right knee disability, to include as secondary to lumbar spine disability, is remanded. Entitlement to service connection for left knee disability, to include as secondary to lumbar spine disability, is remanded. FINDINGS OF FACT 1. PTSD does not result in total social and occupational impairment, nor does it alone render the Veteran unable to secure or follow substantially gainful employment. 2. The most probative evidence reflects that the Veteran has arthritis of the right shoulder related to an in-service combat injury; the evidence does not show joint arthritis other than the knee and back disabilities that are already on appeal 3. The most probative evidence does not reflect a neurological disability of the left upper extremity. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 70 percent for PTSD have not been met. 38 U.S.C. § § 1155, 5107(b); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.10, 4.130, Diagnostic Code 9411. 2. The criteria for service connection for right shoulder disability have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for service connection for peripheral neuropathy of the left upper extremity have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S. Marine Corps from July 1967 to September 1969. The Veteran received a Combat Action Ribbon and Purple Heart. These matters come before the Board of Veterans' Appeals (Board) from an April 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In May 2020, the Board, in part, denied entitlement to a rating in excess of 70 percent for PTSD. The Board also remanded the issues of service connection for osteoarthritis, peripheral neuropathy of the left upper extremity, lumbar spine disability, peripheral neuropathy of the left lower extremity, peripheral neuropathy of the right lower extremity, radiculopathy of the right lower extremity, right knee disability, and left knee disability, for additional development. The Veteran appealed the May 2020 Board decision to the U.S. Court of Appeals for Veterans Claims (Court). In December 2020, the Court granted the parties' joint motion for partial remand (JMPR) as to the denial of entitlement to an increased rating for PTSD, to include consideration of special monthly compensation, vacated the Board's decision concerning that issue, and dismissed the remaining issues. Thus, the issue of entitlement to an increased rating for PTSD, to include consideration of special monthly compensation, has been returned to the Board for review. The issues remanded by the Board in May 2020 have been returned to the Board for review. In May 2021, the Veteran's representative waived RO consideration of all evidence associated with the claims folder. Duty to Notify and Assist VA has a duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C. §§ 5100, 5102, 5103, 5103A, 5107, 5126; 38 C.F.R. §§ 3.102, 3.159, 3.326(a). These duties have been satisfied in this case. Appropriate notice was provided in January 2012, February 2012, and October 2012. The RO associated the Veteran's service and VA and private outpatient treatment records with the claims file. Updated VA treatment records have been associated with the claims folder in accord with prior Board remands. All released or submitted private treatment records have been associated with the claims file. The Veteran also submitted copies of medical records from the Campbell Clinic. No other relevant records have been identified and are outstanding. Appropriate and necessary examinations were afforded the Veteran, and are adequate for evaluation, as they include needed findings to permit application of the rating schedule and identification of current disability. The Board finds that the 2020 VA opinion concerning the left upper extremity substantially complies with the Board's remand. The examiner reviewed the evidence and determined that the Veteran did not have a left upper extremity disability. As such, VA has satisfied its duty to assist. Neither the Veteran nor his representative have raised any issues with the duty to notify or duty to assist. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016). Entitlement to a disability rating in excess of 70 percent for PTSD Disability evaluations are determined by comparing a veteran's present symptoms with the criteria set forth in the VA's Schedule for Rating Disabilities (rating schedule), which is based on average impairment in earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. When a question arises as to which of two ratings apply under a single diagnostic code, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating. 38 C.F.R. § 4.7. As such, the Board must consider all potentially applicable diagnostic codes when rating a Veteran's disability. However, evaluation of the same manifestation of the same disability under various diagnoses, otherwise known as "pyramiding" is to be avoided. 38 C.F.R. § 4.14; Esteban v. Brown, 6 Vet. App. 259, 261 (1994). Under the General Formula for Mental Disorders (General Formula), the Board must conduct a "holistic analysis" that considers all associated symptoms, regardless of whether they are listed as criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); 38 C.F.R. § 4.130. The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages. Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 2013). PTSD is rated at 38 C.F.R. § 4.130, Diagnostic Code 9411 under the General Formula. A 70 percent rating is assigned when symptoms such as suicidal ideation; obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); or inability to establish and maintain effective relationships cause occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. A 100 percent rating is assigned for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; or memory loss for names of close relatives, own occupation or own name. The claims folder contains VA outpatient records that date between 2009 and 2020. These records show that the Veteran is receiving medication management for PTSD and depression. He has had intermittent psychiatric therapy for PTSD as well as opioid and cocaine dependence. He was prescribed Sertraline and Bupropion for PTSD and related symptoms. A VA examination was conducted in January 2012. The Veteran reported that he has been married for 35 years, but characterized the relationship as increasingly distant. He conducted a lawn care business with his son and two of his son's friends, but had little involvement. He was last employed full time with the post office where he worked for 37 years. He struggled with cocaine addiction in the past and in the past year was diagnosed with opiod dependence. The examiner reported that the Veteran's symptoms caused clinically significant distress or impairment in social, occupational, or other important areas of functioning, and cited such symptoms as recurrent and distressing recollections, recurrent distressing dreams, acting or feeling as if the traumatic event were recurring, intense psychological distress at exposure to cues, physiological reactivity on exposure to internal or external cues, efforts to avoid thoughts, feelings, conversations associated with the trauma, markedly diminished interest or participation in significant events, feelings of detachment and estrangement from others, difficulty with sleep, difficulty concentrating, hypervigilance, and exaggerated startle response. The examiner reported symptoms of depressed mood, anxiety, sleep impairment, flattened affect, disturbance of motivation and mood, and difficulty in adapting to stressful circumstances including work and social relationships. At a VA examination in November 2012, the Veteran stated that he lived with his spouse and son. The Veteran reported that his marriage was not what it should be. There was little intimacy and over the last ten years they had grown distant from each other. He had started using cocaine which had a large effect. He felt depressed and no longer was interested in relationships. Occupationally, he closed his lawn care business due to apathy. He stated that he spent his time mostly gardening and reading. The Veteran was thinking about getting animals to keep him occupied. He preferred to be isolated. He took prescribed medications for his PTSD. The Veteran admitted to abusing his pain medication and sought treatment. Symptoms included sleep impairment, anxiety, feelings of claustrophobia, racing thoughts, intrusive thoughts, and depression which affected initiation of activities, energy levels, and the maintenance of relationships. His most significant symptom was sleep impairment. He denied homicidal or suicidal ideations. A private physician in an August 2017 statement reported the Veteran's various diagnoses and opined that he was unemployable as result of his PTSD and variously diagnosed mental disabilities. At a VA examination in October 2019, the examiner reported the Veteran's medical history noting that he participated in addiction therapy in 2014 on an outpatient basis. He has been followed by VA for medication management and occasional therapy. He is seen 3 times a year for medication management. Socially, he was still married. His children were no longer in the area but visited them on holidays. He had no friends except his brother-in law who served in Vietnam with him. He was active in the community church and assists in Sunday school. He did not go to store and rarely went out to eat. Occupationally, he last worked on his lawn service, but he had to let it go. He was in the process of selling the equipment. The Veteran reported similar symptoms of sleep impairment, suspiciousness, dissociative reactions, panic attacks, irritability, claustrophobia, uncomfortable in crowds, social isolation. He struggled to come up with something that gave him joy, satisfaction or peace. In recording the behavioral observations, the examiner noted that he was leisurely dressed and adequately groomed. He is oriented by four, cooperative, and easily engaged. He made fleeting attempts at eye contact. His speech was normal. His mood appeared depressed. His affect was flat. No perceptual disturbances were described or noted. His thought process content, and associations were generally coherent without spontaneity or unprompted elaborations. Suicidal and homicidal ideations were not endorsed or noted. His insight appeared to be fair/good; judgement, well articulated; abstracting, developmentally intact. There was no gross cognitive impairment or overt memory issues. The examiner noted symptoms that included dissociative reactions triggered by claustrophobic feelings that triggers panic attack; episodic anhedonia; and intermittent neglect of hygiene. The examiner further noted that the Veteran's depressive symptoms as well as his panic attacks are part and parcel of his PTSD. The Board finds that the evidence does not reflect the severity, frequency, and duration of the symptomatology associated with the criteria for total occupational and social impairment to warrant a higher rating of 100 percent. 38 C.F.R. § 4.130. While acknowledging his symptoms, to include his most recent examination reflecting some neglect of personal appearance and hygiene, limited social interaction, impaired impulse control, and mild memory loss, among other symptoms, the VA examination reports show that he has continued his marriage of over 40 years. He can still function and communicate with people, albeit with some limitations. He attends church meetings where he relates and helps in Sunday school, reads, and works in the yard. During his most recent VA examination, he stated that he had no friends outside of his family but described his brother in law as his best friend, demonstrating interaction with others. In addition, the Board finds highly probative that all of the VA examiners, who interviewed the Veteran, examined the Veteran, and reviewed the claims folder, determined that he did not experience total occupational and social impairment. The Board therefore finds that the Veteran's PTSD does not manifest in total occupational and social impairment. 38 C.F.R. § 4.130. A preponderance of the evidence is against the claim and a rating of 100 percent for PTSD is not warranted. Further, as noted by the Court, VA's duty to maximize a claimant's benefits includes consideration of whether disabilities establish entitlement to special monthly compensation (SMC) under 38 U.S.C. § 1114(s); Buie v. Shinseki, 24 Vet. App. 242 (2011). If a single disability forms the basis for the award of TDIU, that can qualify as a 100 percent rated disability, the Veteran's other disabilities would have to combine to 60 percent or higher to warrant SMC under 38 U.S.C. § 1114(s). The September 2018 Board decision that granted TDIU specifically noted a private opinion indicating that the Veteran was unemployable due to PTSD and other mental diagnoses, but also discussed impairment related to his paralysis of the right radial nerve. The Board found that TDIU was warranted based on his PTSD and his inability to perform fine motor skills due to his paralysis of the right radial nerve. Though the Veteran's PTSD has resulted in significant symptoms, it is both his mental symptoms and inability to perform fine motor skills, that prevent him from securing and following a substantially gainful occupation. Because the award of TDIU was based on the combined effect of his service-connected disabilities, for SMC purposes, the award of the TDIU does not satisfy the requirement of a "service-connected disability rated as total." SMC under 38 U.S.C. § 1114(s) is not warranted. Bradley v. Peake, 22 Vet. App. 280 (2008); Akles v. Derwinski, 1 Vet. App. 118 (1991). Service Connection Service connection will be granted if it is shown that the veteran suffers from a disability resulting from personal injury suffered or disease contracted in the line of duty, or for aggravation of a preexisting injury suffered or disease contracted in the line of duty, during active military service. 38 U.S.C. §§ 1110; 38 C.F.R. § 3.303. Disorders diagnosed after discharge will still be service connected if all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d); see also Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). In order to establish service connection on a direct basis, the record must contain competent evidence of: (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). Service connection for right shoulder arthritis In October 2012, the Veteran submitted a claim for service connection "as secondary to paralysis of the musculospiral nerve, osteoarthritis, back problems." The RO framed the issue on appeal as service connection for osteoarthritis without reference to a part or joint of the body. In June 2020, the Veteran was asked to identify what joint or part of the body was affected by osteoarthritis. He did not respond. Nonetheless, the October 2020 VA examiner commented on the findings of arthritis pertaining to the Veteran's back, knees, and right shoulder. The medical evidence of record contains no reference to osteoarthritis or arthritis of any joint other than the knees, back, and right shoulder. The claims for service connection for a bilateral knee disability and lumbar spine disability are being remanded for additional development and will not be discussed further in this decision as those claims include consideration of arthritis. Because the VA examiner addressed the right shoulder in relation to the Veteran's claim for osteoarthritis and the evidence shows a diagnosis of arthritis of the right shoulder, the Board will proceed with a claim for service connection for right shoulder disability, claimed as osteoarthritis, which is to the Veteran's benefit. The evidence reflects a current right shoulder disability. The medical evidence shows a diagnosis of degenerative changes and rotator cuff syndrome. As to an in-service injury or disease, the Veteran has reported that he injured his right shoulder during combat when he sustained a gunshot wound to the right shoulder. A July 1968 narrative summary shows that the Veteran was assessed with a shrapnel wound of the right shoulder and radial neuropathy. See also 38 U.S.C.§ 1154(b). Thus, an in-service injury has been demonstrated. The post-service medical evidence shows that the Veteran has complained of chronic right shoulder pain. A September 2014 MRI reveals an assessment of metal artifact from gunshot shrapnel and mild AC joint degenerative changes. An October 2014 private treatment record shows that the Veteran had a shrapnel metal injury to his right arm and reported issues with it since then, but recently had more pain in his shoulder. The assessment was rotator cuff syndrome. In October 2020, a VA examiner provided a negative etiology opinion regarding osteoarthritis. The examiner acknowledged the Veteran's back and knees when providing the opinion. However, the examiner then stated that the exception was the right shoulder injury at which it follows that previous injury leads to degenerative condition of that specific right shoulder. The examiner noted that the September 2014 MRI showed gunshot shrapnel with mild AC joint degenerative changes. The Board finds that service connection is warranted for right shoulder disability. Though the October 2020 VA examiner did not provide an opinion in terms of probability regarding the right shoulder disability, the examiner indicated that previous injury leads to degenerative condition of that specific right shoulder disability evidenced by the MRI that showed shrapnel in the right shoulder and degenerative changes. The Board will resolve the benefit of the doubt in favor of the Veteran and finds that the Veteran's right shoulder disability is related to service. 38 U.S.C. § 5107(b). Service connection for right shoulder arthritis is granted. Service connection for peripheral neuropathy of the left upper extremity The Veteran contends that he has a current neurological disability of the left upper extremity related to active service. The Board finds that the probative and competent medical evidence does not reflect a current left upper extremity disability. Thus, the first element of a service connection claim is not met. Shedden, 381 F.3d 1163. The Veteran is deemed competent and credible to describe observable symptoms. However, the Board must determine on a case by case basis whether a particular condition is the type of condition that is within the competence of a layperson to provide an opinion as to etiology. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Kahana v. Shinseki, 24 Vet. App. 428 (2011). The Veteran, in this case, is not competent to self-diagnose a left upper extremity neurological disability. Diagnosing such a disability involves an understanding of internal physical processes not observable to a layperson. The record does not show that he has the experience, skills, or medical training needed to self-diagnose the disability. Furthermore, there is no competent medical finding of record of the Veteran having a disability of the left upper extremity. A November 2012 VA examination report shows no reported symptoms regarding the left upper extremity, normal reflexes, and normal sensory examination. There was no diagnosis associated with the left upper extremity. Though a 2016 VA examination report included findings of absent and hypoactive deep tendon reflexes of the left triceps and brachioradialis, the report also shows that there was normal muscle strength testing, normal sensory testing, no reported symptoms regarding pain, paresthesias and/or dysesthesias, or numbness. The VA examiner found that there was no disability of the left upper extremity. In addition, the 2020 VA examiner acknowledged the 2016 examination findings, but noted that the 2016 examiner had only noted right radial nerve involvement and that the Veteran had normal left upper extremity nerves. The 2020 examiner stated that other examination reports of record showed normal reflexes and normal left upper extremity. Accordingly, the examiner determined that there were no consistent records to show active absent and hypoactive reflexes as those examination findings were isolated and an error. There was no underlying neuropathy of the left upper extremity at present. Thus, the VA examination reports and opinions are more probative than the Veteran's lay assertions. While medical diagnoses are not always necessary to establish a current disability for VA compensation purposes, there must be competent evidence indicating the Veteran's impairment affects his earning capacity. See Wait v. Wilkie, 33 Vet. App. 8 (2020) (holding there must be competent evidence specific to the claimant tending to show that his or her impairment rises to a level to affect earing capacity). A veteran must "show that his manifestations are of sufficient severity, duration, and frequency that they effect his ability to function under the ordinary conditions of daily life." Id. at 17. Accordingly, service connection for peripheral neuropathy of the left upper extremity is not warranted. A current disability is the cornerstone of a claim for VA disability compensation. Degmetich v. Brown, 104 F. 3d 1328 (Fed. Cir. 1997); Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998). In the absence of evidence of a current disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); McClain v. Nicholson, 21 Vet. App. 319 (2007). A preponderance of the evidence is against the claim and the claim is denied. REASONS FOR REMAND Lumbar spine disability, peripheral neuropathy/and or radiculopathy of the left and right lower extremities, and right and left knee disabilities The Veteran has reported that he was hospitalized for months during active service for combat injuries incurred in December 1967. He stated that he not only injured his right upper extremity as a result of combat, but also injured his right leg, allegedly limping for one month following his December 1967 combat injury, and experienced back pain. Service treatment records (STRs) contain a brief narrative summary regarding the Veteran's hospitalization from January to July 1968 at the U.S. Naval Hospital, Great Lakes. However, there are no other records pertaining to his hospitalization in the STRs. In-patient or hospitalization records are typically stored separately from individual STRs. Review of the claims file does not reveal a request for records from the Great Lakes U.S. Naval Hospital. Therefore, the Board finds that remand is warranted to obtain any available inpatient records. In October 2020, a VA examiner provided a negative etiology opinion concerning the Veteran's lumbar spine disability. The examiner acknowledged the Veteran's report of pain in the right leg and back due to a December 1967 explosion that caused his body to flip and be jarred which caused his pain. The examiner stated that STRs showed that the Veteran incurred a right radial nerve injury from a gunshot wound during service and had a right wrist drop as residuals of the right shoulder and arm injury. There was no complaint of concurrent back pain. The examiner noted that the July 1968 narrative summary did not show back pain or a bilateral lower leg injury. The post-service treatment records were silent for low back pain for 33 years. The examiner found that based on review of the medical records, there was limited medical objective evidence to show and support a low back injury from a bomb explosion or gunshot wound during service. The examiner stated that any lumbar spine injury or trauma in relation to the gunshot wound or bomb injury would demonstrate significant amount of pain and limitation of motion close to the date and time of exposure at which the Veteran did not have. The examiner stated that the amount of pain was less likely to be missed especially when attending the patient close to injury. The examiner stated that a muscle strain or any muscular trauma with no direct injury resolved over time and did not persist to become chronic. The Board finds that an addendum opinion is required. The Veteran has alleged that his back disability was incurred as a result of an injury sustained during combat. If a veteran engaged in combat with the enemy, and it is claimed that a disease or injury was incurred in such combat, VA shall accept as sufficient proof of service connection satisfactory lay or other evidence of service incurrence, if the lay or other evidence is consistent with the circumstances, conditions, or hardships of such service. 38 U.S.C. § 1154(b); 38 C.F.R. § 3.304(d). To establish service connection, however, there must be medical evidence of a nexus between the current disability and the combat injury. See Dalton v. Nicholson, 21 Vet. App. 23 (2007); but see Reeves v Shinseki, 682 F.3d 988 (Fed. Cir. 2012). Though the 2020 VA examiner acknowledged the Veteran's statements regarding a right leg and back injury during combat, the examiner also stated that there was limited medical objective evidence to show and support a low back injury from a bomb explosion or gunshot wound during service. Because the Veteran has asserted that his back injury incurred as a result of a combat injury, the examiner must be asked to presume that the Veteran experienced an injury to the back during combat and then to opine whether his current lumbar spine disability is related to that combat injury. The service connection claims related to the lower extremities are claimed as secondary to the Veteran's back disability and are inextricably intertwined with that issue. Harris v. Derwinski, 2 Vet. App. 180, 183 (1991) (issues are "inextricably intertwined" when a decision on one issue would have a "significant impact" on an appellant's claim for another issue). Additionally, given the Veteran's assertions regarding secondary service connection, allegations that his peripheral neuropathy of the lower extremities is related to in-service exposure to herbicides, and that his right leg/knee disabilities are combat-related injuries, the Board finds that addendum opinions are required. The matters are REMANDED for the following action: 1. Request the Veteran's inpatient clinical records from the Great Lakes U.S. Naval Hospital for hospitalization from January to July 1968. Any response must be documented. 2. Request an addendum opinion from the October 2020 VA examiner; or, if unavailable, another suitably qualified examiner, concerning the Veteran's claimed lumbar spine disability. The claims folder must be reviewed. The examiner must presume that the Veteran incurred a back injury as a result of combat. The examiner must then opine whether it is at least as likely as not (50 percent probability or higher) that the Veteran's current lumbar spine disability is related to his combat injury. A full and complete rationale must be provided. The examiner must address the Veteran's reports of chronic back pain and a 1970 VA examination report completed shortly after separation from service. 3. Request an addendum opinion from the October 2020 VA examiner; or, if unavailable, another suitably qualified examiner, concerning the Veteran's claimed peripheral neuropathy of the lower extremities and radiculopathy of the right lower extremity. The claims folder must be made available for review. The examiner must then address the following: (a.) As to any peripheral neuropathy of the lower extremities that has been documented during the appeal period, opine whether it is at least as likely as not (50 percent probability or higher) proximately due to or aggravated by the lumbar spine disability. (b.) As to any peripheral neuropathy of the lower extremities that has been documented during the appeal period, opine whether it is at least as likely as not (50 percent probability or higher) related to service, to include exposure to herbicides. (c.) As to the bilateral knee disability, opine whether it is at least as likely as not (50 percent probability or higher) proximately due to or aggravated by his lumbar spine disability. (d.) As to the bilateral knee disability, opine whether it is at least as likely as not (50 percent probability or higher) related to service, to include his combat injury. (e.) As to any radiculopathy of the right lower extremity, opine whether it is at least as likely as not (50 percent probability or higher) proximately due to or aggravated by the lumbar spine disability. (f.) As to any radiculopathy of the right lower extremity, opine whether it is at least as likely as not (50 percent probability or higher) related to the Veteran's service, to include combat injury and exposure to herbicides. A full and complete rationale must be provided for any opinion reached. The examiner must address the Veteran's lay statements. 4. Thereafter, readjudicate the remanded issues, and if still denied, return the matters to the Board for appellate review if otherwise in order. WILLIAM H. DONNELLY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Seay, 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.