Citation Nr: 21032352 Decision Date: 05/26/21 Archive Date: 05/26/21 DOCKET NO. 13-32 456 DATE: May 26, 2021 ORDER Service connection for an acquired psychiatric disorder is denied. Service connection for a left knee disability is denied. Service connection for migraine headaches is denied. An initial rating in excess of 10 percent for right inguinal lymphadenopathy is denied. An initial rating in excess of 10 percent for left inguinal lymphadenopathy is denied. REMANDED A rating in excess of 10 percent for a right knee disability is remanded. FINDINGS OF FACT 1. The Veteran is currently diagnosed with major depressive disorder and an anxiety disorder; the current psychiatric disorder did not have its onset during service and is not otherwise causally related to service. 2. The Veteran's left knee disability is not due to his time in service or his service-connected right knee disability. 3. The Veteran's current headache disability did not manifest during service, is not due to an in-service event, injury, or disease; and is not secondary to a service-connected disability. 4. The Veteran's right inguinal lymphadenopathy was manifested by palpable lymph nodes on the inguinal groin region. 5. The Veteran's left inguinal lymphadenopathy was manifested by palpable lymph nodes on the inguinal groin region. CONCLUSIONS OF LAW 1. The criteria for service connection for an acquired psychiatric disorder, to include depression and anxiety disorders, have not been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. 2. The criteria for service connection for a left knee disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.159, 3.303. 3. The criteria for service connection for migraine headaches have not been met. 38 U.S.C.§§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(b), 3.310. 4. The criteria for an initial rating in excess of 10 percent for right inguinal lymphadenopathy have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. § 4.115b, Diagnostic Codes 7518-7338. 5. The criteria for an initial rating in excess of 10 percent for left inguinal lymphadenopathy have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. § 4.115b, Diagnostic Codes 7518-7338. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1978 to September 1981 and from February 1991 to April 1991. He had additional military reserve service. These matters come before the Board of Veterans' Appeals (Board) on appeal from September 2009, January 2012, and July 2014 rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO). The case was remanded for additional development in March 2016, May 2018, and July 2019. Service Connection Service connection will be granted for a disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.304. Service connection generally requires evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disease or injury. Hickson v. West, 12 Vet. App. 247 (1999). Service connection may also be granted for listed chronic diseases when the disease is manifested to a compensable degree within one year of separation from service. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. Under § 3.303(b), an alternative method of establishing the second and/or third elements of service connection for a listed chronic disease is through a demonstration of continuity of symptomatology. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013) (38 C.F.R. § 3.303(b) does not apply to any condition that has not been recognized as chronic under 38 C.F.R. § 3.309 (a)). In this regard, the Board notes that lay persons may provide evidence of diagnosis and nexus under 38 U.S.C. § 1154(a). See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Service connection may be established on a secondary basis for a disability that is 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. 38 C.F.R. § 3.310 (a), (b); Allen v. Brown, 7 Vet. App. 439 (1995). When there is an approximate balance in the evidence regarding the merits of an issue material to the determination of the matter, reasonable doubt will be resolved in each such issue in favor of the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. An appellant need only demonstrate that there is an approximate balance of positive and negative evidence in order to prevail. To deny a claim on its merits, the evidence must preponderate against the claim. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); Alemany v. Brown, 9 Vet. App. 518 (1996). 1. Service connection for an acquired psychiatric disorder The Veteran contends that he has an acquired psychiatric disorder that began on active duty. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a current diagnosis of major depressive disorder and has held diagnoses of anxiety disorder, not otherwise specified and adjustment disorder with depressed mood, and evidence shows that the Veteran at least indicated an issue with depression or excessive worry in service, the preponderance of the evidence weighs against finding that the Veteran's diagnosis of major depressive disorder began during service or is otherwise related to an in-service injury, event, or disease. In February 1993, letters from A.B.A. and T.C.C. show the Veteran was having marital problems for several months that required counseling and evaluation for depression. VA treatment records show the Veteran was not diagnosed with an acquired psychiatric disorder, specifically anxiety, not otherwise specified and an adjustment disorder with depressed mood, until March 2009, more than a decade after his separation from service and three decades after the Veteran contends his psychiatric disorder began. Further, the Veteran's depressed mood was noted to be secondary to separation from his wife. While the Veteran is competent to report having experienced symptoms of anger, outbursts, sadness, stress, and anxiety intermittently since service, he is not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of an acquired psychiatric disorder. The issue is medically complex, as it requires knowledge of interpretation of complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). The Veteran had a Decision Review Officer hearing with the RO in June 2012. At the hearing the Veteran testified that he believed his mental disorder started when he was discharged from the Reserves and noted it actually started with his marriage and some physical activities with his body. The Veteran testified that he was diagnosed on active duty with anxiety and depression. However, the record does not support this testimony as there is no diagnosis for an acquired psychiatric disorder of record during the Veteran's active duty service. Further, the July 2020 VA examiner opined that it was less likely than not that the Veteran had a diagnosis of posttraumatic stress disorder (PTSD) as the Veteran did not meet the diagnostic criteria. Further, the examiner opined that the diagnoses of anxiety disorder, NOS, depressive disorder, NOS, major depressive disorder, and depressive disorder secondary to comorbid general medical conditions are attributed to multiple psychological stressors to include marital problems, financial and housing issues, chronic pain, and medical conditions to include diabetes mellitus and Graves' disease. The examiner opined it was less likely than not that the claimed psychiatric conditions incurred in or were caused by the claimed in-service injury, event, or illness. The rationale was studies had shown there was an increased risk for depression and anxiety in individuals with diabetes and Graves' disease Further, the cause of auditory hallucinations and other psychotic symptoms could not be determined without resorting to speculation as hallucinations and psychotic symptoms could occur with hyperglycemia, hyperthyroidism due to Graves' disease, and also could be substance induced. The examiner's opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The Veteran believes his acquired psychiatric disorder is related to an in-service injury, event, or disease. The Veteran in this case is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of interpretation of complicated diagnostic medical testing. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the July 2020 VA examiner's opinion. In sum, the evidence in this case is against service connection for an acquired psychiatric disability, to include depression and anxiety. The benefit of the doubt is therefore not for application. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 2. Service connection for a left knee disability The Veteran contends his left knee disability is secondary to his service-connected right knee disability. The Veteran was service connected for his right knee disability as of a rating decision from September 2009. While the Veteran specifically raised entitlement due to secondary service connection, the Board must address all potential theories of entitlement. See Robinson v. Shinseki, 557 F.3d 1355, 1361 (Fed. Cir. 2009) ("where the claimant has raised an issue of service connection, the evidence in the record must be reviewed to determine the scope of that claim."); Szemraj v. Principi, 357 F.3d 1370, 1373 (Fed. Cir. 2004) (in adjudicating a claim the Board must consider all potential bases of entitlement). VA has a duty to address all arguments put forth by a claimant, including theories under which entitlement to benefits sought may be awarded. See also Robinson v. Peake, 21 Vet. App. 545, 552 (2008). The Veteran's service treatment records show the Veteran complained both knees were bothering him in February 1980. A February 1991 service treatment record shows the Veteran complained of knee and ankle pain following a basketball game. There was decreased flexion of both knees. The assessment was ligamental strain of both knee joints. However, the Veteran's March 1991 separation examination shows all systems as normal other than an identifying scar on the left knee. There is no evidence the Veteran sought medical attention for his left knee within a year after separation from active duty. In light of this, service connection on a presumptive basis under 38 C.F.R. § 3.307, 3.309 is not warranted as the evidence does not reflect a diagnosis during service or arthritis to a compensable degree within one year of service. The evidence also does not reflect continuity of symptomatology. In fact, the Veteran was afforded a VA examination for his right knee in September 2009 and an examination of his left knee was conducted at that time with results within normal limits. As the Veteran did not continue to complain of left knee issues following the February 1991 ligament strain, the September 2009 examination was normal, the amount of time that has passed since service, and because the Veteran neither contends nor is there evidence indicating continuous symptoms of degenerative arthritis of the left knee after service separation, the weight of the evidence is against finding that there were continuous symptoms of degenerative arthritis of the left knee since service. See also Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (the passage of many years between discharge from active service and complaint of a claimed disability is one factor to consider as evidence against a claim of service connection). Private treatment records from February 2009 to March 2011 show the Veteran complained of knee pain; however, there was only tenderness to palpation of the knee joint line without any other symptomatology. There was no gait disturbance. A March 2010 VA treatment record shows the Veteran reported bilateral knee pain had existed for five to six years. The physician noted that prior X-rays of the bilateral knee in April 2008 revealed bilateral medial compartment degenerative joint disease. Patellar crepitus was noted on knee flexion and extension. The Veteran had full range of motion and all other tests were normal. A July 2010 letter from Dr. O.M.O. provided the opinion that the Veteran's two years of joint pain which was chronic in nature was as likely caused by his military service as not. The Veteran was afforded a VA examination for his knees in May 2011. The examiner diagnosed degenerative joint disease of the left knee and left knee strain and chondromalacia. The examiner explains that since the Veteran contends that both knees were injured at the same time during a March 1980 training injury, the service-connected right knee disability could not have caused the left knee disability. The examiner further explains that there is a 28-year gap from service to the first medical records addressing the knees and opines that this does not establish a longitudinal trend of subjective complaints and objective findings. The examiner also pointed to annual examinations that showed the Veteran's systems as normal and where the Veteran did not indicate any issues with arthritis or his knees. Therefore, the examiner opined that a casual relationship could not be established. In July 2012, the Veteran underwent magnetic resonance imaging (MRI) that revealed left knee mild osteoarthritis, mild medial subluxation of the body of the medial meniscus, complex tear involving the anterior horn of the lateral meniscus, tricompartmental cartilaginous abnormalities, and a Baker's cyst. In a September 2013 VA treatment record, the Veteran was noted for the first time to have a slight antalgic gait without assistive devices. The Veteran was afforded another VA examination in October 2013. The examiner diagnosed degenerative joint disease of the left knee. The examiner opined that it was less likely than not that the left knee disability incurred proximately due to or the result of the Veteran's service-connected right knee disability. The rationale was the Veteran did not show a preexisting condition on the entrance examination in August 1978 and no claimed problem was noted on enlistment with the Reserves in November 1989. The examiner noted he was seen only once in service for a left knee problem. The examiner further noted the record had no medical records after service until 2011 for a left knee problem. The examiner opined there was no association in the medical records between right knee degenerative joint disease causing a left knee disability. The Veteran was afforded another VA examination in February 2019. The examiner diagnosed left knee meniscal tear and left knee degenerative arthritis. The examiner opined it was less likely than not that the Veteran's left knee disability was incurred while in service as reports of medical evaluations while in service were benign for any left knee related pathologies. The examiner also opined it was less likely than not that the Veteran's left knee disability was the result of his right knee disability as the record did not reveal supportive evidence to make such an association. The examiner further opined that it was less likely than not that the Veteran's left knee disability was aggravated beyond it natural progression by the Veteran's right knee as review of the medical records did not reveal supportive evidence to make such an association. The Veteran was afforded another VA examination in January 2020. The examiner found there was no diagnosis of the left knee because there were no findings, signs, or symptoms to support a diagnosis. Therefore, the examiner opined that as there was no left knee diagnosis, a nexus could not be established between the claimed left knee disability and service. Additionally, the examiner opined the claimed left knee disability was less likely than not proximately due to or the result of the Veteran's service-connected right knee disability because there was no current left knee disability. In an August 2020 addendum the examiner clarified that there was a diagnosis of left knee strain as noted in flexion. In a September 2020 addendum the examiner opined that it was less likely than not that the Veteran had a left knee disability that was directly related to active duty service. The examiner noted that the Veteran's enlistment examination was normal which indicated a presumption of soundness. There were two service treatment records that addressed both knees. The pertinent service treatment records that could include the left knee were about 11 years apart. Therefore, he opined this indicated that conditions were acute and transitory. In further support of an acute and transitory left knee condition is the subsequent pertinent separation examination was normal. There was no evidence the Veteran sought medical attention for his left knee within a year after separation from active duty. There was also no evidence the Veteran took any pertinent medication or used pertinent assistive devices for his left knee following active duty. The examiner noted that in 2008, approximately 17 years after separation from active duty in 1991, a knee X-ray showed degenerative changes; however, which knee was not identified. The examiner opined that in consideration of the presumption of soundness at the time of enlistment, acute and transitory in-service events, normal pertinent separation examination, no evidence the Veteran sought medical attention for his left knee within a year of separation from active duty, no evidence the Veteran took any pertinent medication or used pertinent assistive devices for his left knee, and temporal relationships, that chronicity and continuity could not be demonstrated and a nexus could not be established between left knee disability and in-service events. The examiner also opined in the September 2020 addendum that it was less likely than not that the Veteran's left knee was proximately due to his service-connected right knee disability or aggravated by his right knee disability. The rationale was that the Veteran had a longitudinal trend of normal gait analyses and the examiner opined that pathophysiologically it would be necessary to have abnormal gait due to the right knee for a prolonged period of time that would cause abnormal weight bearing for a prolonged time for the left knee to be adversely affected by the right knee. Therefore, without the prolonged abnormal gait or weight bearing, the examiner opined a nexus could not be established between the Veteran's left knee disability and his right knee disability. The Board notes that on occasion treatment records note a history of in-service injury as the origin of knee pain; however, this was based solely on the Veteran's report and not a review of the record. Further, there is no rationale provided to link the knee injury in service to the Veteran's current diagnosis. Therefore, this does not constitute a nexus to service. The July 2010 opinion provided by Dr O.M.O. does not specify that the joint pain referred to in the opinion includes the left knee, but even providing the Veteran the benefit of the doubt that Dr. O.M.O. was referencing the left knee, the opinion is inadequate as Dr. O.M.O. did not provide any rationale for the opinion. The VA medical opinions address all pertinent medical evidence and found that the Veteran's left knee disability is not secondary to the right knee disability. Therefore, the Board gives the VA examiners' opinions considerable probative weight. The Board finds that the claim is not in relative equipoise as the Veteran failed to provide adequate evidence of a medical nexus connecting the left knee disability to service or the Veteran's service-connected right knee disability. Accordingly, the Board finds that the preponderance of the evidence is against the claim for service connection and entitlement to service connection, to include secondary service connection of a left knee disability, is denied. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 3. Service connection for migraine headaches The Veteran generally contends that migraines are either the result of active service or are the result of the service-connected tinnitus. At the outset, the Board finds the Veteran is currently diagnosed with migraines. See January 2020 VA examination. After reviewing all the lay and medical evidence of record, the Board finds that there was no in-service head or other relevant injury, or migraine disease, or other relevant event during active duty service. Service treatment records do not reflect any report of injury, symptoms, or diagnosis of migraines. While a March 1991 service treatment record may reflect complaints of a headache, this same record diagnosed these symptoms as allergies and not as migraines. Post-service VA and private treatment records similarly do not show findings of migraines, rarely show complaints of headaches, and the Veteran was not diagnosed with migraines until the January 2020 VA examination. The Veteran was afforded a VA examination in January 2020 for his migraine headaches. The examiner diagnosed migraines. The examiner opined that the migraines were less likely than not incurred in or caused by service. The examiner noted the enlistment examination was normal which indicated a presumption of soundness. There were no pertinent service treatment records. The pertinent separation examination was negative. There was no evidence the Veteran sought medical attention for headaches within a year after separation from active duty. During the examination the Veteran reported that significant headaches had started about a year prior and occurred spontaneously over time. He also noted that he did not have significant headaches during active duty. The examiner opined that in consideration of the presumption of soundness at time of enlistment, no pertinent service treatment records, negative separation examination, no evidence the Veteran sought pertinent medical attention within a year after separation from active duty, and temporal relationships, a nexus could not be established between migraines and service. The examiner reiterated this opinion in February 2021. The Board finds that the VA medical opinions that migraines are less likely than not incurred in to or caused by service were premised on the Veteran's specific case, including medical history, and is based on accurate factual assumptions consistent with the evidence, as found by the Board. The weight of the evidence shows that the current migraines did not have their onset during service and are not otherwise casually related to service. The weight of the evidence shows that migraines had their onset after active service, with no diagnosis of migraines until January 2020. Regarding the theory of secondary service connection, the weight of the lay and medical evidence shows that the current migraines were not caused by or worsened beyond their normal progression by the service-connected tinnitus. In January 2020, the Veteran underwent a VA examination to help determine whether the migraine disorder was causally related to the service-connected tinnitus. While the examiner did diagnose migraines, in August 2020 the VA examiner opined that the migraines were less likely than not proximately due to the or the result of the service-connected tinnitus. The examiner explained that tinnitus does not cause migraine headaches as migraines are a vascular phenomenon and there is no physiologic or anatomic mechanism by which tinnitus could cause migraines. In February 2021, a VA examiner opined the Veteran's migraines were less likely than not proximately due to or the result of the Veteran's service-connected tinnitus. The examiner noted that the exact cause of migraines was unknown, but here were multifactorial triggers. It was acknowledged that there was a relationship between headaches and tinnitus; however, medical literature shows the relationship is not greater than 50 percent. Therefore, the examiner opined that migraines were less likely than not aggravated by the Veteran's service-connected tinnitus. The Board finds that the VA medical opinions that migraines are less likely than not proximately due to or the result of the Veteran's service-connected tinnitus was premised on the Veteran's specific case, including medical history, and is based on accurate factual assumptions consistent with the evidence, as found by the Board. Based on the foregoing, the Board finds that weight of the evidence demonstrates the current migraine disorder was not caused or worsened beyond a normal progression by the service-connected tinnitus. For these reasons, service connection for migraine, including as secondary to the service-connected tinnitus, must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.310. Increased Rating 4. An initial rating in excess of 10 percent for right inguinal lymphadenopathy 5. An initial rating in excess of 10 percent for left inguinal lymphadenopathy The Veteran contends he is entitled to a rating in excess of 10 percent for his right inguinal lymphadenopathy and in excess of 10 percent for his left inguinal lymphadenopathy. The Veteran's residuals of left and right inguinal lymphadenopathy are each rated 10 percent under 38 C.F.R. § 4.114, Diagnostic Codes 7518-7338 (hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the evaluation assigned, the additional code is shown after the hyphen). Under Diagnostic Code 7518, stricture of urethra should be rated as voiding dysfunction. The criteria for voiding dysfunction indicate that the particular condition should be rated as urine leakage, frequency, or obstructive voiding. The criteria for urine leakage provide that with continual urine leakage, post-surgical urinary diversion, urinary incontinence, or stress incontinence a 20 percent rating is assigned for urinary leakage requiring the wearing of absorbent materials which must be changed less than 2 times per day. A 40 percent rating is assigned for urinary leakage requiring the wearing of absorbent materials which must be changed 2 to 4 times per day. A 60 percent rating is assigned for urinary leakage requiring the use of an appliance or the wearing of absorbent materials which must be changed more than 4 times per day. The criteria for urinary frequency provide that a 10 percent rating is assigned for urinary frequency with daytime voiding interval between two and three hours, or; awakening to void two times per night. A 20 percent rating is assigned for urinary frequency with daytime voiding interval between one and two hours, or; awakening to void three to four times per night. A 40 percent rating is assigned for urinary frequency with daytime voiding interval less than one hour, or; awakening to void five or more times per night. As to obstructive urinary symptoms the applicable rating criteria provide that symptomatology with or without stricture disease requiring dilatation 1 to 2 times per year warrants a noncompensable rating. A 10 percent rating is assigned for obstructed voiding with marked obstructive symptomatology (hesitancy, slow or weak stream, decreased force of stream) with any one or combination of the following: (1) post void residuals greater than 150 cc; (2) uroflowmetry; markedly diminished peak flow rate (less than 10 cc/sec); (3) recurrent urinary tract infections secondary to obstruction; (4) stricture disease requiring periodic dilatation every 2 to 3 months. Obstructive voiding with urinary retention requiring intermittent or continuous catheterization warrants a 30 percent rating. Diagnostic Code 7338 provides ratings for inguinal hernia. Small inguinal hernia, reducible, or without true hernia protrusion, is rated noncompensable (zero percent). An inguinal hernia that is not operated, but is remediable, is rated noncompensable (zero percent) disabling. Postoperative recurrent inguinal hernia, readily reducible, well supported by truss or belt, is rated 10 percent disabling. Small inguinal hernia, postoperative recurrent, or unoperated irremediable, not well supported by truss, or not readily reducible, is rated 30 percent disabling. Large inguinal hernia, postoperative recurrent, not well supported under ordinary conditions and not readily reducible, when considered inoperable, is rated 60 percent disabling. A Note to Diagnostic Code 7338 provides that 10 percent is to be added for bilateral involvement, provided the second hernia is compensable. This means that the more severely disabling hernia is to be rated, and 10 percent, only, added for the second hernia, if the second hernia is of compensable degree. 38 C.F.R. § 4.114. The Veteran was afforded a VA examination in August 2011. The Veteran reported back pain, anorexia, fatigue, and weakness. He also reported dysuria, straining to urinate and urethral discharge. He did not have hesitancy or difficulty starting a stream, a weak or intermittent stream, hematuria, dribbling, frequency or nocturia. He reported he had constant urinary leakage or incontinence in which no pad or absorbent material was required. No appliance was required. He reported a history of urinary tract infections but had no infections within the last 12 months. He did not indicate a history of obstructive voiding. He denied a history of urinary tract stones. He reported a history of renal failure in which dialysis was not required. He denied a history of acute nephritis. He reported a history of hydronephrosis and experienced colic attacks with it, although he did not experience any colic attacks within the last 12 months. He reported experiencing erectile dysfunction. He indicated ejaculation was retrograde and attributed the most likely cause to pain in the genitals. On physical examination, there were palpable lymph nodes on the bilateral inguinal groin region. There were no findings of hepatomegaly, distension of the superficial veins, striae on the abdominal wall, abdominal tenderness to palpation, flank tenderness to palpation, an ostomy, ventral hernia, ascites, splenomegaly, and aortic aneurysm. The bladder was not palpable. The examiner diagnosed bilateral inguinal lymphadenopathy. The examiner opined the bilateral inguinal lymphadenopathy did not affect the Veteran's usual occupation of daily activities. The Veteran was afforded another VA examination in January 2020. The Veteran reported groin pain and erectile dysfunction. The examiner noted the Veteran's diagnosis was changed and was quiescent. There was no current lymphadenopathy. The examiner noted that the Veteran's bilateral inguinal lymphadenopathy did not impact his ability to work. There is no evidence that the VA examiners were not competent or credible, and as the examination reports were based on accurate facts and objective examinations of the Veteran, these are entitled to significant probative weight in determining the severity of the Veteran's bilateral inguinal lymphadenopathy during the period on appeal. Nieves-Rodriguez, 22 Vet. App. 295. Based on the lay and medical evidence of record the Board finds that a 10 percent rating for the right inguinal lymphadenopathy and a 10 percent rating for the left inguinal lymphadenopathy is warranted for the entire period on appeal. During the appeal the Veteran has stated that his right and left inguinal lymphadenopathy have been manifested by groin pain and erectile dysfunction. The Veteran is competent to testify to such lay observable symptomatology. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). However, such lay evidence, even when accepted as accurate, does not establish a level of disability contemplated by a higher evaluation. The Veteran's residuals of right and left inguinal lymphadenopathy have not been manifested by a recurrent inguinal hernia, not readily reducible, and not well supported by truss or belt. The evidence of record clearly demonstrates that the Veteran does not have active inguinal lymphadenopathy on either side. Additionally, the Veteran does not wear a supporting belt. The VA examinations and treatment records are absent reports of inguinal lymphadenopathy and use of a supporting belt or truss. As such, a rating in excess of 10 percent for either the right or left inguinal lymphadenopathy is not warranted. The Board finds that the Veteran's right and left inguinal lymphadenopathy residuals do not more closely approximate an increased 30 percent rating. A 10 percent rating is warranted for a postoperative recurrent inguinal hernia readily reducible and well supported by a truss or belt. The Veteran's hernia residuals have not even been manifested by a recurrent hernia that is readily reducible and well supported by a truss or belt. As such, a higher rating is not warranted. In conclusion, all potentially applicable diagnostic codes have been considered for this period, and there is no basis to assign an evaluation in excess of the rating assigned herein for the Veteran's bilateral inguinal lymphadenopathy. See Schafrath v. Derwinski, 1 Vet. App. 589, 593 (1991). The evidence of record reflects symptoms that best approximate a 10 percent rating. The evidence of record does not reflect that the Veteran suffers from symptoms warranting an increased 30 percent rating for right or left inguinal lymphadenopathy, and the claim is denied. 38 U.S.C. § 1155; 38 C.F.R. § 4.114, Diagnostic Code 7518-7338. REASONS FOR REMAND 1. A rating in excess of 10 percent for a right knee disability is remanded. A review of the record reflects the claims must be remanded for additional development prior to appellate consideration. Remand is required for an adequate VA examination. Where, as here, VA undertakes to provide an examination or obtain an opinion when developing a claim, even if not statutorily obligated to do so, it must provide an adequate one. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). An opinion based on an inaccurate factual premise should be discounted entirely. Monzingo v. Shinseki, 26 Vet. App. 97, 107 (2012). During the appeal period, VA afforded the Veteran several medical examinations for his right knee disability. Most recently, a VA examination was provided in January 2020. On physical examination, the examiner noted the Veteran did not have, nor did he ever have a meniscus condition. Here, it appears the January 2020 examiner's opinion may be based on an inaccurate factual premise. See Monzingo, 26 Vet. App. at 107. In particular, the examiner indicated that the Veteran does not have, nor has he ever had a meniscus condition. This is inconsistent with the evidence of record. For instance, VA medical records dated in September 2012 reflect imaging studies were performed in July 2012 and revealed a right knee complex tear throughout the medial meniscus. Further, the February 2019 VA examiner diagnosed a right knee meniscal tear. In light of the foregoing, the Board finds that a new VA examination is warranted. The matters are REMANDED for the following action: 1. Obtain updated VA treatment records. 2. After any additional records are associated with the claims file, schedule the Veteran for a VA examination by an appropriate medical professional to address the current nature and severity of the Veteran's right knee disability. The entire claims file must be made available to and be reviewed by the examiner. Any indicated tests and studies must be accomplished, and all clinical findings must be reported in detail and correlated to a specific diagnosis. An explanation for all opinions expressed must be provided. (a.) The examiner must test the range of motion and pain of the right knee in active motion, passive motion, weight-bearing, and non-weight-bearing. The examiner must also conduct the same testing on the left knee. If the examiner is unable to conduct the required testing or concludes that the required testing is not necessary, he or she should clearly explain why that is so. The examiner is also asked to indicate the point during range of motion testing that motion is limited by pain. (b.) The examiner must describe any functional limitation due to pain, weakened movement, excess fatigability, pain with use, or incoordination. Additional limitation of motion during flare-ups and following repetitive use due to limited motion, excess motion, fatigability, weakened motion, incoordination, or painful motion must also be noted. (c.) If the Veteran describes flare-ups of pain, the examiner must offer an opinion as to whether there would be additional limits on functional ability during flare-ups. All losses of function due to problems such as pain should be equated to additional degrees of limitation of flexion and extension beyond that shown clinically. If it is not feasible to offer such an opinion to any degree of medical certainty without resort to speculation, the examiner must provide a specific explanation for why this is so. If such an opinion is not procurable based on a lack of knowledge, then the inability to offer such an opinion must be based on a lack of knowledge among the "medical community at large," and not merely a lack of expertise, insufficient information, or unprocured testing on the part of the examiner. (d.) The examiner should describe any right knee symptoms due to meniscal problems and whether they can be clearly separated from the service-connected right knee degenerative joint disease. The examiner should consider and discuss as necessary July 2012 imaging studies revealing a right knee complex tear of the medial meniscus and VA medical records that reflect a diagnosis of a right knee complex tear of the medial meniscus. (e.) Lastly, the examiner should describe in detail all functional limitations due to the Veteran's service-connected right knee disabilities. The examiner must provide a rationale for all opinions provided. If an opinion cannot be made without resort to speculation, the examiner should provide an explanation as to why this is so and note what, if any, additional evidence would permit such an opinion to be made. MARJORIE A. AUER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Kelly A. Gastoukian 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.