Citation Nr: 21040283 Decision Date: 07/03/21 Archive Date: 07/03/21 DOCKET NO. 17-36 609 DATE: July 3, 2021 ORDER The petition to reopen the claim of entitlement to service connection for right ear hearing loss is denied. The petition to reopen the claim of entitlement to service connection for left ear hearing loss is granted. The petition to reopen the claim of entitlement to service connection for residuals of a left knee strain is granted. Entitlement to service connection for tinnitus is granted. REMANDED Entitlement to service connection for left ear hearing loss is remanded. Entitlement to service connection for a lower back disability is remanded. Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), is remanded. Entitlement to service connection for a left shoulder disability is remanded. Entitlement to service connection for a right knee disability is remanded. Entitlement to service connection for sleep apnea is remanded. Entitlement to service connection for a left knee disability is remanded. Entitlement to service connection for cervical strain (claimed as neck pain) is remanded. Entitlement to service connection for a left ankle disability is remanded. Entitlement to service connection for a right shoulder disability, to include arthritis, is remanded. FINDINGS OF FACT 1. In an August 1995 rating decision, the Regional Office (RO) denied service connection for hearing loss and for residuals of a left knee strain. The Veteran did not timely appeal this decision, nor did he submit new and material evidence within one year of the decision. 2. Additional evidence has not been received since the August 1995 rating decision that relates to an unestablished fact necessary to substantiate the claim for service connection for right ear hearing loss. 3. Additional evidence has been received since the August 1995 rating decision that relates to unestablished facts necessary to substantiate the claims for service connection for left ear hearing loss and for residuals of a left knee strain and the claim is reopened; to this extent only the claim is granted. 4. Resolving reasonable doubt in the Veteran's favor, his tinnitus was incurred in service. CONCLUSIONS OF LAW 1. The August 1995 rating decision that denied service connection for hearing loss and residuals of a left knee strain is final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. 2. New and material evidence to reopen the claim for service connection for right ear hearing loss has not been received. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). 3. New and material evidence to reopen the claims for service connection for left ear hearing loss and for residuals of a left knee strain has been received. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). 4. The criteria for service connection for tinnitus have been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.303, 3.304. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from February 1987 to February 1990. This appeal arose to the Board of Veterans' Appeals (Board) from December 2014, August 2015, and January 2018 rating decisions issued by a Department of Veterans Affairs (VA) Regional Office (RO). In March 2021, the Veteran testified before the undersigned at a Board hearing. A transcript has been associated with the record. Pursuant to the Veterans Claims Assistance Act (VCAA), VA has duties to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C. §§ 5102, 5103, 5103A, 5107 (2012); 38 C.F.R. § 3.159 (2020). With respect to the application to reopen denied herein, neither the Veteran nor his representative have raised any issues with regard to the duties to notify or assist. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that "the Board's obligation to read filings in a liberal manner does not require the Board . . . to search the record and address procedural arguments when the veteran fails to raise them before the Board"); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). Moreover, as discussed below, the Veteran was afforded a VA audiological examination in October 2014 which confirmed he did not have a current right ear hearing loss disability, for VA purposes. Consequently, the Board finds VA's duties under the VCAA have been met. New and Material Evidence The Veteran seeks service connection for bilateral hearing loss and for a left knee disability. Implicit in these claims is the contention that new and material evidence has been received which is sufficient to reopen previously disallowed claims for these benefits. Generally, a claim that has been denied in a final unappealed rating decision may not thereafter be reopened and allowed. 38 U.S.C. § 7105(c). An exception to this rule is 38 U.S.C. § 5108, which provides that if new and material evidence is presented or secured with respect to a claim which has been disallowed, VA shall reopen the claim and review the former disposition of the claim. New evidence means existing evidence not previously submitted to agency decisionmakers. 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). An adjudicator must follow a two-step process in evaluating a previously denied claim. First, the adjudicator must determine whether the evidence added to the record since the last final denial is new and material. If new and material evidence is presented or secured with respect to a claim that has been finally denied, the claim will be reopened and decided upon the merits. Once it has been determined that a claimant has produced new and material evidence, the adjudicator must evaluate the merits of the claim in light of all the evidence, both new and old, after ensuring that the VA's statutory duty to assist the appellant in the development of his claim has been fulfilled. See 38 U.S.C. § 5108; Elkins v. West, 12 Vet. App. 209 (1999); Vargas-Gonzalez v. West, 12 Vet. App. 321, 328 (1999). The threshold for determining whether new and material evidence raises a reasonable possibility of substantiating a claim is "low." See Shade v. Shinseki, 24 Vet. App. 110, 117 (2010). Furthermore, in determining whether this low threshold is met, VA should not limit its consideration to whether the newly submitted evidence relates specifically to the reason why the claim was last denied, but instead should ask whether the evidence could reasonably substantiate the claim were the claim to be reopened, either by triggering the VA Secretary's duty to assist or through consideration of an alternative theory of entitlement. Id. at 118. Evidence is presumed to be credible for the purpose of determining whether the case should be reopened; once the case is reopened, the presumption as to the credibility no longer applies. Justus v. Principi, 3 Vet. App. 510, 513 (1992). The evidence must be both new and material; if the evidence is new, but not material, the inquiry ends and the claim cannot be reopened. Smith v. West, 12 Vet. App. 312 (1999). 1. Right ear hearing loss 2. Left ear hearing loss The Veteran previously filed claims for service connection for hearing loss. In an August 1995 rating decision, the RO denied the claim, finding the evidence did not show a current diagnosis of hearing loss, for VA purposes, in either ear. (This finding was based on an April 1995 VA audiological examination.) The Veteran was notified but did not appeal the decision. Accordingly, the rating decision is final. See 38 U.S.C. § 7105(c); 38 C.F.R. § 20.1103. Subsequently, the Veteran filed the instant application to reopen his claim. For the following reasons, the Board finds that new and material evidence has been received sufficient to reopen the claim for left ear hearing loss, but not for right ear hearing loss. At the time of the August 1995 rating decision, relevant evidence of record included the Veteran's service treatment records, contemporaneous medical records, and an April 1995 VA audiological examination report. Notably, the examination report included audiogram results showing the Veteran did not meet the threshold for a hearing loss "disability," under 38 C.F.R. § 3.385, in either ear. RO adjudicators determined that because there was no evidence a current hearing loss disability in either ear, the claim was not well-grounded. As a result, service connection was denied. The Veteran filed his application to reopen in January 2014. He was afforded a VA audiological examination in October 2014 which showed pure tone thresholds, in decibels, as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 5 10 10 15 15 LEFT 35 35 40 45 80 In addition, speech audiometry revealed speech recognition ability of 100 percent in both ears. The examiner noted the test results were valid. There is no subsequent evidence the Veteran's hearing loss has worsened since that examination. Based on the above audiogram, the Board finds there is evidence of a current left ear hearing loss disability, under 38 C.F.R. § 3.385, sufficient to reopen the claim as to that ear only. There is no evidence whatsoever that the Veteran has a current right ear hearing loss disability, under 38 C.F.R. § 3.385. As such, the claim as to the right ear cannot be reopened. The Board notes the Veteran has never alleged that he has a right ear hearing loss disability, for VA purposes, nor has he described being diagnosed with such a disability by a medical professional. The Veteran has simply indicated he believes his claimed disabilities, including hearing loss, were related to service; he has said nothing else regarding the origins or etiologies of these claims. As noted above, the RO previously denied the Veteran's claims because there was no evidence of current hearing loss disabilities in either ear, considering the Veteran's lay allegations but relying on the April 1995 VA audiological evaluation. The Veteran's general lay assertions of right ear hearing loss since then are cumulative. See Anglin v. West, 203 F.3d 1343, 1347 (2000) (evidence that is merely cumulative of other evidence in the record cannot be new and material even if that evidence had not been previously presented to the Board). Put another way, the RO had already weighedand rejectedthe Veteran's lay assertions. See 38 U.S.C. § 1131; 38 C.F.R. § 3.303 (establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a link between the claimed in-service disease or injury and the present disability). In sum, the record now includes credible evidence of a current left ear hearing loss disability but not of a current right ear hearing loss disability, for VA purposes. The claim for the left ear is reopened. The Veteran has not submitted any lay or medical evidence demonstrating that he has a current right ear hearing loss disability. As he has submitted no new and material evidence relating to a previously unestablished fact, the application to reopen the claim for the right ear must be denied. 3. Residuals of a left knee strain The Veteran previously filed a claim for service connection for residuals of a left knee strain. The claim was denied in an August 1995 rating decision. The decision noted that while there was documentation of a left knee injury in 1994 it was not established that this injury was incurred in the line of duty. The only pertinent evidence was the Veteran's general assertion of entitlement and medical records dating from late 1994 documenting treatment for a left knee patellar tendon injury due to a "misstep." The Veteran was notified but did not appeal the decision. Accordingly, the rating decision is final. See 38 U.S.C. § 7105(c); 38 C.F.R. § 20.1103. Subsequently, the Veteran filed the instant application to reopen his claim. As part and parcel of that application, the Veteran testified at his Board hearing that he believed this injury was incurred in the line of duty during a period of active duty for training (ACDUTRA). Although the Veteran did not provide objective documentation in support of these allegations, the Board must presume his assertions to be credible. Moreover, VA has not previously investigated the veracity of this claim, nor is there evidence in the record of the specific dates the Veteran was on ACDUTRA or INACDUTRA. (There is also a December 1994 treatment note stating the Veteran was "injured on AT," presumably "active training.") In this regard, the Veteran's allegations tend to support his contention of a nexus between service and his current left knee disability. The Board finds there is sufficient evidence of a previously unestablished element of the claim (in-service incurrence and a nexus between the claimed disability and service). Consequently, the claim will be reopened. Service Connection 4. Tinnitus The Veteran contends he has tinnitus, or ringing in the ears, which developed during service. For the following reasons, the Board finds service connection is warranted. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a link between the claimed in-service disease or injury and the present disability. Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d). In addition, for veterans who have served 90 days or more of active service after December 31, 1946, there is a presumption of service connection for certain chronic diseases if the disability is manifest to a compensable degree within one year of discharge from service. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. 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, as distinguished from merely isolated findings or a diagnosis including the word "chronic." Continuity of symptomatology after discharge is required where the condition noted during service is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. 38 C.F.R. § 3.303(b); see Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013) (the theory of continuity of symptomatology can be used only in cases involving those conditions explicitly recognized as chronic as per 38 C.F.R. § 3.309(a)). The record is consistent with exposure to harmful noises in service. As such, the Board accepts the Veteran's contentions of harmful noise exposure in service. See 38 U.S.C. § 1154(a). The record further shows the Veteran has been diagnosed with tinnitus. At his most recent VA C&P examination, in October 2014, the examiner noted the Veteran had complained of recurrent tinnitus since his period of active service. Thereafter, the Veteran has alleged, including in sworn testimony at his Board hearing, that he first experienced ringing in his ears during his service. In light of the Veteran's statements concerning continuity of symptomatology since his discharge from service the Board finds the evidence supports a finding that his diagnosed tinnitus originated in service. The Veteran's reports of harmful noise exposure are consistent with the circumstances of his service, and VA examination findings confirm the ringing in the ears observed by the Veteran was tinnitus. As the Veteran has asserted the ringing started during service, his credible assertions of ringing in his ears during and after active service establish chronicity of the condition which was later diagnosed as tinnitus. The Veteran is competent to establish all the elements of his service connection claim, and his contentions are supported by a VA examiner. As such, a nexus to service is shown. See 38 C.F.R. §§ 3.303(b), 3.309(a); see also Charles v. Principi, 16 Vet. App. 370, 374 (2002). Accordingly, by resolving all reasonable doubt in favor of the Veteran, service connection for tinnitus will be granted. REASONS FOR REMAND 5. Entitlement to service connection for left ear hearing loss is remanded. The Veteran contends his left ear hearing loss disability is related to in-service noise exposure. In October 2014, he received a VA audiological examination, following which the examiner opined the Veteran's left ear hearing loss was "most likely related to an [unspecified] medical condition and is not related to military noise exposure." On review, however, the Board finds this opinion to be suspect. Notably, the examiner stated the Veteran's hearing loss existed prior to service and that "there was improvement from induction to separation." The Veteran's service treatment records show, contrary to the examiner's opinion, that the Veteran's left ear hearing loss in fact did worsen from enlistment to separation. His February 1987 audiogram showed decibel levels at no worse than 5 at any threshold, while the January 1990 separation audiogram showed significantly worsened hearing at almost every threshold. The Board notes, however, that the April 1995 VA audiogram reflects no left ear hearing loss disability, for VA purposes, thus raising the question of whether the Veteran's current hearing loss is related to service. Given the uncertain nature of this evidence and the apparent inaccuracy of the October 2014 VA examiner's opinion, the Board finds an updated examination and opinion is warranted. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (when VA undertakes to provide a claimant with an examination or obtain a medical opinion, it must ensure the examination or opinion is adequate). 6. Entitlement to service connection for a lower back disability is remanded. The Veteran contends his current lower back disability is related to an in-service injury. Notably, there is a Reserve treatment note from July 1991 indicating his complaints of lower back pain shortly after separation from service. In addition, the Veteran's post-service VA treatment notes show he has complained of back pain for many years. To date, VA has not scheduled the Veteran for an examination to evaluate this disability. The Board finds such an examination is needed to ensure VA's duty to assist has been satisfied. See McClendon v. Nicholson, 20 Vet. App. 79 (2006) (discussing four-part determination of whether duty to assist requires VA to obtain medical examination or opinion). 7. Entitlement to service connection for an acquired psychiatric disorder, to include PTSD, is remanded. The Veteran contends his current acquired psychiatric disorder, which he characterizes as PTSD, is related to his exposure to traumatic events in service. He has specifically asserted being in fear of hostile military activity, for example in a March 2014 statement. The Board notes such experiences can form the basis of a PTSD diagnosis. See 38 C.F.R. § 3.304(f)(3). However, to date, VA has undertaken little meaningful development regarding his stressors nor has the Veteran been afforded a VA psychiatric examination. The Board finds the Veteran has put forth sufficient evidence to warrant this development. See McClendon, 20 Vet. App. 79. 8. Entitlement to service connection for a left shoulder disability is remanded. The Veteran contends his current left shoulder disability is related to an in-service injury. Notably, there is a service treatment note from April 1987 indicating treatment for left arm soreness. At his Board hearing, the Veteran suggested he had experienced shoulder pain since his service. However, to date, VA has not scheduled the Veteran for an examination to evaluate this disability. The Board finds such an examination is needed to ensure VA's duty to assist has been satisfied. See id. 9. Entitlement to service connection for a right knee disability is remanded. The Veteran contends his current right knee disability is related to service. Notably, a November 2013 VA treatment note shows his complaints of knee pain since service. In addition, the Veteran testified at his Board hearing that he had experienced knee pain since service. However, to date, VA has not scheduled the Veteran for an examination to evaluate this disability. The Board finds such an examination is needed to ensure VA's duty to assist has been satisfied. See id. 10. Entitlement to service connection for sleep apnea is remanded. The Veteran contends his current sleep apnea (diagnosed in 2014) began in active service. The Board notes there is no evidence of sleep apnea or sleep-related symptoms to be found in the Veteran's service treatment records. However, at his Board hearing, the Veteran testified he was told by a girlfriend that he had exhibited breathing problems while sleeping around the time he was service on active duty. To date, VA has not scheduled the Veteran for an examination to evaluate this disability. The Board finds such an examination is needed to ensure VA's duty to assist has been satisfied. See id. 11. Entitlement to service connection for a left knee disability is remanded. The Veteran contends his current left knee disability was incurred in active service, to include during a period of active duty for training (ACDUTRA) in late 1994. As discussed above, the Board reopened this claim based on the submission of new and material evidence. However, prior adjudicative actions by the RO have not considered the merits of the underlying claim, and other development, including possibly an updated VA examination, may now be warranted. Therefore, at this juncture, a decision on the claim would prejudice the Veteran as it would deprive him of initial RO review. See Hickson v. Shinseki, 23 Vet. App. 394 (2010). Thus, a remand is required for initial RO consideration, development, and adjudication of the claim on the merits. 12. Entitlement to service connection for a cervical strain (claimed as neck pain) is remanded. 13. Entitlement to service connection for a left ankle disability is remanded. 14. Entitlement to service connection for a right shoulder disability, to include arthritis, is remanded. The Veteran contends his current neck, left ankle, and right shoulder disabilities are related to in-service injuries. Specifically, he testified that he struck his neck and shoulder on a metal beam in service; this assertion is corroborated by service treatment notes reflecting treatment in September 1988 for a similar injury. Service treatment records also show the Veteran was seen in June 1987 for a left ankle basketball-related injury. The Veteran was afforded VA examinations for these disabilities in January 2018; thereafter, negative nexus opinions were provided with identical rationales, as follows: "During service, condition was acute only. There is no evidence of chronicity of care. A nexus has not been established." On review, however, the Board finds these opinions inadequate. In short, the rationales provided in the examination reports do not reflect meaningful engagement with either the in-service records or the Veteran's lay allegations. Accordingly, updated examinations and opinions are needed. See Barr, 21 Vet. App. at 311. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination by an examiner to determine the nature and etiology of the Veteran's left ear hearing loss. The examiner is asked to review the claims file and provide the following information: (a) State whether the criteria for a diagnosis are met. (b) Opine whether it is at least as likely as not (50 percent or greater probability) that the Veteran's left ear hearing loss was incurred in service or within one year of discharge from service. (c) If it is determined that there is another likely etiology for the Veteran's left ear hearing loss, that should be stated. (d) The examiner is specifically asked to comment on the chronology of the Veteran's hearing loss as reflected by his various in-service audiograms, to include those dated in February 1987, November 1987, and at separation in January 1990. Discuss the apparent worsening in left ear hearing from enlistment to separation. Also discuss the significance of any subsequent audiograms of record. In addition, the examiner should discuss the Veteran's testimony regarding this disability at his Board hearing. The examiner should set forth all examination findings, with a clear rationale for the conclusions reached. 2. Schedule the Veteran for a VA examination by an examiner to determine the nature and etiology of the Veteran's lower back disability. The examiner is asked to review the claims file and provide the following information: (a) Clarify whether the criteria for a current diagnosis are met. (b) Opine whether it is at least as likely as not (50 percent or greater probability) that this disability was incurred in service or developed within one year of separation of service. (c) If it is determined that there is another likely etiology for the disability, that should be stated. (d) The examiner is specifically asked to comment on a Reserve treatment note from July 1991 indicating the Veteran's complaints of lower back pain shortly after separation from service, and on the Veteran's post-service VA treatment notes showing he has complained of back pain for many years. The examiner should also discuss the Veteran's testimony regarding this disability at his Board hearing. The examiner should set forth all examination findings, with a clear rationale for the conclusions reached. 3. Conduct any development necessary to verify the Veteran's reported stressors in support of his PTSD claim, to include his reports of being in fear of hostile military activity. 4. Then, once directive (3) is accomplished, schedule the Veteran for a VA examination by an examiner to determine the nature and etiology of any acquired psychiatric disorder/s, to include PTSD. The examiner is asked to review the claims file and provide the following information: (a) State whether the criteria for a diagnosis of any acquired psychiatric disorder/s are met, to include PTSD. (b) Opine whether it is at least as likely as not (50 percent or greater probability) that any acquired psychiatric disorder/s were incurred in or otherwise related to his service. Specifically discuss the Veteran's statements describing fear of hostile military activity in service, as well as his Board hearing testimony. (c) With respect to PTSD, the RO should provide the examiner with a summary of any verified in-service stressors and the examiner must be instructed that only these events, or any stressor related to fear of hostile military or terrorist activity, may be considered for the purpose of determining whether exposure to an in-service stressor has resulted in PTSD. The examiner should determine whether the diagnostic criteria to support a diagnosis of PTSD have been satisfied. If a PTSD diagnosis is deemed appropriate, the examiner should then comment upon the link between the current symptomatology and any verified in-service stressor, including the fear of hostile military or terrorist activity. (d) The examiner should specifically discuss any pertinent lay statements provided by the Veteran in support of his claim, including statements given at his Board hearing. (e) If there is another etiology identified for the Veteran's disability, that should be noted. The examiner should set forth all examination findings, with a clear rationale for the conclusions reached. 5. Schedule the Veteran for a VA examination by an examiner to determine the nature and etiology of the Veteran's left shoulder disability. The examiner is asked to review the claims file and provide the following information: (a) Clarify whether the criteria for a current diagnosis are met. (b) Opine whether it is at least as likely as not (50 percent or greater probability) that this disability was incurred in service or developed within one year of separation of service. (c) If it is determined that there is another likely etiology for the disability, that should be stated. (d) The examiner is specifically asked to comment on the April 1987 service treatment note indicating left arm soreness. The examiner should also discuss the Veteran's testimony regarding this disability at his Board hearing. The examiner should set forth all examination findings, with a clear rationale for the conclusions reached. 6. Schedule the Veteran for a VA examination by an examiner to determine the nature and etiology of the Veteran's right knee disability. The examiner is asked to review the claims file and provide the following information: (a) Clarify whether the criteria for a current diagnosis are met. (b) Opine whether it is at least as likely as not (50 percent or greater probability) that this disability was incurred in service or developed within one year of separation of service. (c) If it is determined that there is another likely etiology for the disability, that should be stated. (d) The examiner is specifically asked to comment on the Veteran's post-service VA treatment notes showing he has complained of knee pain for many years. The examiner should also discuss the Veteran's testimony regarding this disability at his Board hearing. The examiner should set forth all examination findings, with a clear rationale for the conclusions reached. 7. Schedule the Veteran for a VA examination by an examiner to determine the nature and etiology of the Veteran's sleep apnea. The examiner is asked to review the claims file and provide the following information: (a) Clarify whether the criteria for a current diagnosis are met. (b) Opine whether it is at least as likely as not (50 percent or greater probability) that this disability was incurred in service or is otherwise related to service. (c) If it is determined that there is another likely etiology for the disability, that should be stated. (d) The examiner is specifically asked to comment on the Veteran's testimony regarding this disability at his Board hearing, to include his assertion that a former girlfriend told him he had breathing difficulties in his sleep around the time he was serving on active duty. The examiner should set forth all examination findings, with a clear rationale for the conclusions reached. 8. After undertaking any additional development deemed warranted, take adjudicatory action on the merits of the Veteran's reopened claim for service connection for a left knee disability. If the benefits sought remain denied, the Veteran should be issued a Supplemental Statement of the Case. An appropriate period of time should be allowed for response. 9. Schedule the Veteran for a VA examination by an examiner to determine the nature and etiology of the Veteran's cervical spine disability. The examiner is asked to review the claims file and provide the following information: (a) Clarify whether the criteria for a current diagnosis are met. (b) Opine whether it is at least as likely as not (50 percent or greater probability) that this disability was incurred in service or developed within one year of separation of service. (c) If it is determined that there is another likely etiology for the disability, that should be stated. (d) The examiner is specifically asked to comment on service treatment notes from late 1988 indicating the Veteran received treatment for injuries after being hit with a metal beam. The examiner should also discuss the Veteran's testimony regarding this disability at his Board hearing, including his assertion that his current neck symptoms stemmed from that in-service injury. The examiner should set forth all examination findings, with a clear rationale for the conclusions reached. 10. Schedule the Veteran for a VA examination by an examiner to determine the nature and etiology of the Veteran's left ankle disability. The examiner is asked to review the claims file and provide the following information: (a) Clarify whether the criteria for a current diagnosis are met. (b) Opine whether it is at least as likely as not (50 percent or greater probability) that this disability was incurred in service or developed within one year of separation of service. (c) If it is determined that there is another likely etiology for the disability, that should be stated. (d) The examiner is specifically asked to comment on service treatment notes from June 1987 indicating the Veteran received treatment for a left ankle injury while playing basketball. The examiner should also discuss the Veteran's testimony regarding this disability at his Board hearing. The examiner should set forth all examination findings, with a clear rationale for the conclusions reached. 11. Schedule the Veteran for a VA examination by an examiner to determine the nature and etiology of the Veteran's right shoulder disability, to include arthritis. The examiner is asked to review the claims file and provide the following information: (a) Clarify whether the criteria for a current diagnosis are met. (b) Opine whether it is at least as likely as not (50 percent or greater probability) that this disability was incurred in service or developed within one year of separation of service. (c) If it is determined that there is another likely etiology for the disability, that should be stated. (d) The examiner is specifically asked to comment on service treatment notes from late 1988 indicating the Veteran received treatment for injuries to his shoulder after being hit with a metal beam. The examiner should also discuss the Veteran's testimony regarding this disability at his Board hearing, including his assertion that his current symptoms stemmed from that in-service injury. The examiner should set forth all examination findings, with a clear rationale for the conclusions reached. LESLEY A. REIN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Ryan, Associate Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.