Citation Nr: 21042403 Decision Date: 07/13/21 Archive Date: 07/13/21 DOCKET NO. 17-38 775 DATE: July 13, 2021 ORDER Entitlement to service connection for Charcot-Marie-Tooth (CMT) disease is granted. Entitlement to service connection for axonal polyneuropathy and radiculopathy of the right lower extremity, to include as secondary to CMT disease is granted. Entitlement to service connection for axonal polyneuropathy and radiculopathy of the left lower extremity, to include as secondary to CMT disease is granted. Entitlement to an effective date earlier than January 6, 2012 for the grant of service connection for pes cavus with hallux valgus and metatarsalgia of both feet is denied. Entitlement to an effective date earlier than January 6, 2012 for the grant of service connection for degenerative arthritis of both feet is denied. Entitlement to an effective date earlier than January 6, 2012 for the grant of service connection for bilateral weak feet is denied. REMANDED Entitlement to service connection for left knee instability, to include as secondary to CMT disease, is remanded. Entitlement to service connection for residuals of lymphangitis and a parasitic infection of the right foot is remanded. Entitlement to service connection for scoliosis and ankylosis of the thoracolumbar spine, to include as secondary to CMT, is remanded. Entitlement to a total disability rating based upon individual unemployability due to service-connected disabilities (TDIU) is remanded. Entitlement to an initial rating greater than 30 percent for pes cavus with hallux valgus and metatarsalgia of both feet is remanded. Entitlement to an initial disability rating greater than 10 percent for bilateral weak feet is remanded. Entitlement to an initial disability rating greater than 10 percent for degenerative arthritis of both feet is remanded. FINDINGS OF FACT 1. Resolving reasonable doubt in the Veteran's favor, the evidence is at least in equipoise as to whether the Veteran has CMT which had its onset during active duty service. 2. The weight of the probative evidence of record shows that the Veteran's axonal polyneuropathy of the right lower extremity is etiologically related to his active duty service. 3. The weight of the probative evidence of record shows that the Veteran's axonal polyneuropathy of the left lower extremity is etiologically related to his active duty service. 4. On January 6, 2012, the Veteran filed a formal claim seeking service connection for bilateral foot disabilities. 5. The evidence of record does not show that a formal or informal claim for service connection for bilateral pes cavus, degenerative arthritis of the feet, or bilateral weak feet was received by VA prior to the January 6, 2012 claim. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for CMT have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. 2. The criteria for entitlement to service connection for axonal polyneuropathy of the right lower extremity have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. 3. The criteria for entitlement to service connection for axonal polyneuropathy of the left lower extremity have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. 4. The criteria for entitlement to an effective date earlier than January 6, 2012 for the award of service connection for bilateral pes cavus have not been met. 38 U.S.C. §§ 5110, 5107; 38 C.F.R. §§ 3.102, 3.400. 5. The criteria for entitlement to an effective date earlier than January 6, 2012 for the award of service connection for degenerative arthritis of the feet have not been met. 38 U.S.C. §§ 5110, 5107; 38 C.F.R. §§ 3.102, 3.400. 6. The criteria for entitlement to an effective date earlier than January 6, 2012 for the award of service connection for bilateral weak feet have not been met. 38 U.S.C. §§ 5110, 5107; 38 C.F.R. §§ 3.102, 3.400. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from February 1993 to April 1995. The Veteran testified at a virtual hearing before the undersigned Veterans Law Judge in December 2020. A transcript of that hearing is associated with the claims file. The Board has considered the Veteran's claims and decided entitlement based on the evidence or record. Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record, with respect to his claims. See Doucette v. Shulkin, 28 Vet. App. 366, 369-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). Service Connection Service connection may be established for a disability resulting from disease or injury which was clearly present in service or for a disease diagnosed after discharge from service, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 U.S.C. §§ 1110, 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) an 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 disability. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). 1. Entitlement to service connection for CMT disease After thorough consideration of the record, the Board concludes that the evidence supports a grant of service connection for CMT. First, the evidence is at least in equipoise as to whether the Veteran has a current diagnosis of CMT. In that regard, a June 2013 VA treatment record reported that the Veteran did not have a confirmed diagnosis of CMT, and that the diagnosis of CMT was "suspect" because the Veteran did not have a family history of hereditary polyneuropathy; genetic testing had not been completed to support a diagnosis of CMT; the Veteran's neurologic examination did not support a 20-year history of CMT; September 2012 electromyography (EMG) findings were non-specific; and pes cavus is not pathognomonic with a diagnosis of CMT. Genetic testing, conducted in June 2013, was negative for gene mutations indicative of CMT; however, the test results explain that the diagnosis of CMT "cannot be completely ruled out due to mutations not detected by these assays or mutations that may be present in other genes not tested." A June 2013 VA treatment record explained that, although the Veteran did not have the more common demyelinating form of CMT, he may have an axonal form. The physician noted that negative genetic testing would not absolutely exclude it as there is not testing available for all of the genetic markers of CMT, but that the negative genetic test results and lack of family history of polyneuropathy would make a diagnosis of CMT unlikely. However, an August 2012 VA examination reflects a diagnosis of CMT disease, with an onset date in 1993. Further, a June 2014 VA treatment record concluded that the Veteran had chronic axonal sensorimotor polyneuropathy, and that the polyneuropathy most likely represented an axonal form of CMT. The neurologist explained that this diagnosis was suggested by the early age of onset based upon June 1994 studies, the presence of pes cavus and hammer toes, the absence of other relevant neurologic or extra-neural manifestations, and the lack of a viable alternative diagnosis. The neurologist acknowledged, however, that a diagnosis of CMT could not be made with "absolute certainty" because there was no family history and genetic testing was negative. Nevertheless, the neurologist noted that negative genetic testing did not exclude CMT, since genetic testing does not detect all mutations causing CMT. The opinions in favor of a diagnosis of CMT and against a diagnosis of CMT are each probative, as they are based upon review of the pertinent evidence in the claims file, including EMG testing, nerve conduction studies, family history, clinical examination, and the results of genetic testing. Further, they provide adequate supporting rationales for their findings. Based on this evidence, and resolving reasonable doubt in the Veteran's favor, the evidence of record is at least in equipoise as to whether the Veteran has a current diagnosis of CMT. Accordingly, a current diagnosis is established. Second, there is evidence of an in-service event, disease, or injury, as the Veteran's service treatment records document diagnoses of generalized sensory motor polyneuropathy which, "[i]n the present clinical context" was "consistent with a diagnosis of Charcot-Marie-Tooth disease." This diagnosis was based upon the results of nerve conduction studies and EMG testing. The medical evaluation board also concluded that the Veteran had a diagnosis of pes cavus consistent with CMT. Last, the only medical evidence in the claims file discussing the etiology of the Veteran's CMT is the June 2014 VA treatment record, which states that the Veteran's polyneuropathy which represents CMT "dates back to at least 6/94," during the Veteran's active duty service. This evidence shows that the Veteran's CMT began during his active duty service, and has continued since that time. There is no evidence in the claims file that weighs against a finding that the Veteran's CMT had its onset during service. The Board therefore concludes that, with the benefit of the doubt resolved in the Veteran's favor, service connection for CMT is warranted. See Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990) ("[T]he 'benefit of the doubt' standard is similar to the rule deeply embedded in sandlot baseball folklore that 'the tie goes to the runner'. [I]f the play is close, i.e., 'there is an approximate balance of positive and negative evidence,' the veteran prevails by operation of [statute]."). 2. Entitlement to service connection for axonal polyneuropathy and radiculopathy of the right lower extremity, to include as secondary to CMT disease; and entitlement to service connection for axonal polyneuropathy and radiculopathy of the left lower extremity, to include as secondary to CMT disease After thorough consideration of the evidence of record, the Board concludes that service connection is warranted for axonal polyneuropathy of the right and left lower extremities. The first post-service medical evidence of record showing diagnoses of axonal polyneuropathy of the right and left lower extremities is demonstrated in an August 2012 VA examination. The Veteran underwent an EMG at that time which revealed moderately severe sensory-motor axonal polyneuropathy. These findings were confirmed in EMG testing conducted in September 2012 and August 2013. Accordingly, current diagnoses of axonal polyneuropathy of the right and left lower extremities is established. Additionally, the service treatment records reflect findings of generalized sensory motor polyneuropathy in EMG testing and nerve conduction studies performed in June 1994. Consequently, the evidence establishes in-service incurrence of polyneuropathy of the right and left lower extremities. The only medical evidence in the claims file which addresses the etiology of the Veteran's axonal polyneuropathy of the right and left lower extremities is a June 2014 VA treatment record in which the neurologist diagnosed chronic axonal sensorimotor polyneuropathy and reported that nerve conduction studies and EMG testing indicated that "the polyneuropathy was present during active duty and dates back to at least 6/94 . . . ." Because this evidence shows that the Veteran's current axonal polyneuropathy of the right and left lower extremities had its onset during service, the evidence establishes a nexus between the Veteran's current axonal polyneuropathy and his active duty service. Based on the evidence documenting axonal polyneuropathy of the right and left lower extremities during service, the evidence establishing a current diagnosis of axonal polyneuropathy, and the June 2014 VA opinion linking the current polyneuropathy to the Veteran's active duty service, entitlement to service connection for axonal polyneuropathy of the right and left lower extremities is warranted. Effective Date In general, the effective date of an award of disability compensation, in conjunction with a grant of entitlement to service connection, shall be the day following separation from active service or the date entitlement arose if the claim is received within one year of separation from service; otherwise, the effective date shall be the date of receipt of the claim, or the date entitlement arose, whichever is later. 38 U.S.C. § 5110; 38 C.F.R. § 3.400(b)(2)(i). This rule applies for both original claims for service connection and for claims reopened after final disallowance. VA amended its adjudication regulations on March 24, 2015 to require that all claims governed by VA's adjudication regulations be filed on standard forms prescribed by the Secretary, regardless of the type of claim or posture in which the claim arises. See 79 Fed. Reg. 57660 (Sept. 25, 2014). The amendments, however, are only effective for claims and appeals filed on or after March 24, 2015. As the Veteran's appeal was filed prior to that date, the amendments are not applicable in this instance and the regulations in effect prior to March 24, 2015 will be applied in this case. Under the old regulations, "claim" is defined broadly to include a formal or informal communication in writing requesting a determination of entitlement or evidencing a belief in entitlement to a benefit. 38 C.F.R. § 3.1(p); see also Brannon v. West, 12 Vet. App. 32, 34-35 (1998); Servello v. Derwinski, 3 Vet. App. 196, 199 (1992). Any communication or action indicating an intent to apply for one or more benefits under laws administered by the VA from a claimant may be considered an informal claim. Such an informal claim must identify the benefits sought. Upon receipt of an informal claim, if a formal claim has not been filed, an application form will be forwarded to the claimant for execution. 38 C.F.R. § 3.155(a). To determine when a claim was received, the Board must review all communications in the claims file that may be construed as an application or claim. See Quarles v. Derwinski, 3 Vet. App. 129, 134 (1992). There is no provision in the law for awarding an earlier effective date based simply on the presence of the disability. See Brannon, 12 Vet. App. at 35 (the mere presence of medical evidence of a condition does not establish an intent on the part of the veteran to seek service connection for the disability). 3. Entitlement to an effective date earlier than January 6, 2012 for the grant of service connection for pes cavus with hallux valgus and metatarsalgia of both feet; entitlement to an effective date earlier than January 6, 2012 for the grant of service connection for degenerative arthritis of both feet; and entitlement to an effective date earlier than January 6, 2012 for the grant of service connection for bilateral weak feet The Veteran contends that an effective date earlier than January 6, 2012 is warranted for the awards of service connection for bilateral pes cavus, degenerative arthritis of both feet, and bilateral weak feet. In a September 2013 Notice of Disagreement, the Veteran reported that he filed a VA Form 21-526 during active duty service while he was being medically discharged. After thorough consideration of the evidence of record, the Board concludes that an effective date earlier than January 6, 2012, is not warranted for the grant of service connection for bilateral pes cavus, degenerative arthritis of the feet, or bilateral weak feet. 38 C.F.R. § 3.400(r). The Veteran's initial claim for entitlement to service connection was received by VA on January 6, 2012. Service connection for bilateral pes cavus, degenerative arthritis of the feet, and bilateral weak feet was granted in a September 2013 rating decision, effective January 6, 2012. The evidence of record does not reveal that a formal or informal claim for service connection for bilateral pes cavus, degenerative arthritis of the feet, or bilateral weak feet was received by VA prior to January 6, 2012. See 38 C.F.R. § 3.155. Indeed, on his January 6, 2012 claim form, the Veteran reported that he had not previously filed a claim with VA. The earliest communication indicating an intent to apply for service connection for bilateral pes cavus, degenerative arthritis of the feet, or bilateral weak feet in the Veteran's claims file is the formal claim received by VA on January 6, 2012. The Board acknowledges the Veteran's contention that he initially filed a claim for VA benefits during his medical discharge from active duty service. In support of his claim, the Veteran submitted a copy of a VA Form 21-526 signed and dated by the Veteran in October 1999. However, review of the formal claim dated in October 1999 does not reveal a VA date stamp indicating that it was ever received by VA. The Veteran has not provided any contentions or evidence to show that the formal claim that he submitted was, in fact, received by VA. The Board notes that there is a presumption of regularity in the law that applies in this case. "The presumption of regularity supports the official acts of public officers and, in the absence of clear evidence to the contrary, courts presume that they have properly discharged their official duties." Clear evidence to the contrary is required to rebut the presumption of regularity. Ashley v. Derwinski, 2 Vet. App. 307 (1992), (quoting United States v. Chemical Foundation, 272 U.S. 1, 14-15 (1926)). While the Ashley case dealt with regularity in procedures at the Board, in Mindenhall v. Brown, 7 Vet. App. 271 (1994), the presumption of regularity was applied to procedures at the RO level, such as in the instant case. The Board finds the presumption of regularity has attached, and the Veteran must show by clear and convincing evidence that the presumption of regularity has been rebutted. However, the Veteran's contention that he did in fact file a formal application for benefits in 1999 is not sufficient to rebut the presumption of regularity in this case. There is also not sufficient evidence to establish the presumption of receipt under the common law mailbox rule. The Board finds that the VA Form 21-526 signed and dated by the Veteran in October 1999 is not sufficient to establish an earlier effective date for the grant of service connection for his claims. There is no date stamp on this document which would indicate the date of receipt by the RO. See Ashley, 2 Vet. App. at 308 (there is a presumption that government officials have properly discharged their official duties). Thus, the Board finds that there is not clear evidence to rebut the presumption of regularity. Additionally, the Board notes that the common mailbox rule's presumption of receipt is not invoked as the Veteran has provided no evidence of mailing this document. With consideration of the presumption of regularity of the official acts of public officers and without evidence to the contrary, the Board must conclude that any mail sent to the RO by the Veteran or his representative would have been received and associated with the claims file. Consequently, since the Veteran's initial application for benefits was not received by the RO until January 6, 2012, an earlier effective cannot be granted for these claims. The pertinent legal authority governing effective dates in this case is clear and specific, and the Board is bound by this authority. Pursuant to this authority, the Board finds that there is no legal basis by which an effective date earlier than January 6, 2012 can be assigned for the grants of service connection for bilateral pes planus, degenerative arthritis of the feet, or bilateral weak feet; hence, the claims for an earlier effective date must be denied. 38 C.F.R. § 3.400(b)(2)(i). REASONS FOR REMAND 1. Entitlement to service connection for left knee instability, to include as secondary to CMT disease, is remanded. Review of the evidence of record shows that additional development is required with regard to the Veteran's claim for entitlement to service connection for left knee instability. The Veteran underwent a VA examination in April 2014. At that time, the VA examiner found that the Veteran did not have instability of the left knee. As a result, the VA examiner did not provide an etiological opinion with regard to left knee instability. Based upon the April 2014 VA examination, the March 2015 rating decision denied service connection for left knee instability on the basis that the Veteran did not have a left knee instability disability. However, VA treatment records dated in August 2013 document findings of left knee instability. Because there is evidence of left knee instability during the appeal period and evidence of left knee symptomatology during service, a VA opinion is required to determine its etiology. 2. Entitlement to service connection for residuals of lymphangitis and a parasitic infection of the right foot is remanded. The Veteran contends that he has foot symptoms which are residuals of lymphangitis and a parasitic infection of the foot incurred during service. Initially, the Board notes that the Veteran clarified during his December 2020 hearing before the Board that his claim for service connection pertained to his left foot, and not his right foot. However, the Veteran's service treatment records consistently document diagnoses of and treatment for a parasitic infection of the right foot. Accordingly, the Agency of Original Jurisdiction (AOJ) should clarify with the Veteran whether his claim for residuals of an in-service foot infection pertain to his right foot or his left foot. Additionally, the Veteran should undergo a VA examination to determine the existence and etiology of his reported residuals of an in-service foot infection. Toward that end, the Veteran has testified that he experiences foot symptoms including persistent pain which he believes are related to the in-service foot infection. Given the in-service evidence of a right foot infection and the Veteran's testimony, a VA examination is warranted to determine the etiology of his current symptoms. 38 U.S.C. § 5103A(d)(2), 38 C.F.R. § 3.159(c)(4)(i); see also McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). 3. Entitlement to service connection for scoliosis and ankylosis of the thoracolumbar spine, to include as secondary to CMT is remanded. The Veteran underwent a VA examination in August 2017 with regard to his claim for service connection for a thoracolumbar spine disorder. The August 2017 VA examiner diagnosed lumbosacral strain and rotatory levocurvature and opined that the Veteran's current spine disorder was not related to service, in part, because the Veteran "was able to [play] a high physically demanding sport at a top level following his military service. A substantial back injury would not have allowed him to play NCAA Division I Football." However, during his December 2020 hearing before the Board, the Veteran clarified that this rationale is factually inaccurate, as he did not play football after service, as he was not academically eligible to play. Because the August 2017 VA opinion was based upon inaccurate facts, a new VA opinion is required. 4. Entitlement to an initial rating greater than 30 percent for pes cavus with hallux valgus and metatarsalgia of both feet; entitlement to an initial disability rating greater than 10 percent for bilateral weak feet; and entitlement to an initial disability rating greater than 10 percent for degenerative arthritis of both feet are remanded. Review of the claims file reflects that the Veteran last underwent a VA foot examination assessing the severity of his bilateral pes cavus, bilateral weak feet, and degenerative arthritis in September 2012, almost 9 years ago. The Board finds that a new VA examination should be provided, as the September 2012 VA examination is too remote in time to assess the current severity of his symptoms. Accordingly, the Veteran should be provided with a new VA examination to assess the current severity of his bilateral pes cavus, bilateral weak feet, and degenerative arthritis. Palczewski v. Nicholson, 21 Vet. App. 174 (2007); Weggenmann v. Brown, 5 Vet. App. 281, 284 (1993); Caffrey v. Brown, 6 Vet. App. 377, 381 (1994) (finding that the Board should have ordered a contemporaneous examination of veteran because a 23-month old exam was too remote in time to adequately support the decision in an appeal for an increased rating); see also 38 C.F.R. § 3.326(a). 5. Entitlement to a TDIU is remanded. The claim for entitlement to a TDIU is intertwined with the claims for entitlement to increased ratings for bilateral pes cavus, bilateral weak feet, and degenerative arthritis of the feet, remanded herein; accordingly, it must also be remanded. Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (holding that issues are inextricably intertwined and must be considered together when a decision concerning one could have a significant impact on the other). Additionally, the Board herein grants entitlement to service connection for CMT and entitlement to service connection for axonal polyneuropathy of the right and left lower extremities. The assignment of initial disability ratings and effective dates for these disabilities may have a significant impact upon the issue of entitlement to a TDIU. Accordingly, the issue of entitlement to a TDIU is also inextricably intertwined with those matters. Id. Therefore, adjudication of the issue of entitlement to a TDIU must be deferred pending the assignment of initial ratings and effective dates for the now service-connected CMT and axonal polyneuropathy of the right and left lower extremities. The matters are REMANDED for the following action: 1. The AOJ should contact the Veteran and request that he clarify whether he is seeking service connection for a right foot disorder or a left foot disorder as a residual of his in-service right foot infection. The AOJ is asked to advise the Veteran that the service treatment records document only treatment for a right foot infection. 2. Provide the Veteran with a new VA examination by an appropriate clinician to determine the etiology of his left knee instability. The Veteran's claims file, all electronic records, and a copy of this remand must be reviewed by the examiner, and the examiner must state that this evidence was reviewed in the examination report. All pertinent symptomatology and findings must be reported in detail. All indicated tests and studies must be accomplished. Based upon a complete review of the evidence of record, the VA examiner must provide the following opinions: (a.) Is it at least as likely as not (i.e., a 50 percent probability or more) that any left knee instability currently diagnosed, or diagnosed during the appeal, even if currently resolved, was caused by or incurred as a result of the Veteran's active duty service? (b.) Is it at least as likely as not that any left knee instability currently diagnosed, or diagnosed during the appeal even if currently resolved, was caused or aggravated by the Veteran's CMT? Aggravation is defined as any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease. The examiner is advised that a finding that the left knee instability was aggravated beyond the normal progression due to a service-connected disability does not require evidence of permanent worsening and may encompass any additional impairment in earning capacity resulting from an already service-connected condition. A complete rationale for all opinions must be provided. The examiner must consider and discuss all pertinent evidence in the claims file, to specifically include the Veteran's lay statements regarding in-service and post-service symptomatology. Also, the examiner is advised that the Veteran is competent to report observable symptomatology. 3. Provide the Veteran with a VA examination by appropriate clinician to determine the etiology of the Veteran's foot symptoms, which he contends are residuals of an in-service right foot infection. The Veteran's claims file, all electronic records, and a copy of this remand must be reviewed by the examiner, and the examiner must state that this evidence was reviewed in the examination report. All pertinent symptomatology and findings must be reported in detail. All indicated tests and studies must be accomplished. Based upon a complete review of the evidence of record, the VA examiner must state whether it is at least as likely as not (i.e., a 50 percent probability or more) that any foot disorder currently diagnosed, or diagnosed during the appeal, even if currently resolved, was caused by or incurred as a result of the Veteran's active duty service, to include the in-service right foot infection. The examiner must consider and discuss all pertinent evidence in the claims file, to specifically include the Veteran's lay statements. The examiner is advised that the Veteran is competent to report observable symptomatology. 4. Provide the Veteran with a new VA examination by appropriate clinician to determine the etiology of the Veteran's thoracolumbar spine disorder. The Veteran's claims file, all electronic records, and a copy of this remand must be reviewed by the examiner, and the examiner must state that this evidence was reviewed in the examination report. All pertinent symptomatology and findings must be reported in detail. All indicated tests and studies must be accomplished. Based upon a complete review of the evidence of record, the VA examiner must provide the following opinions: (a.) Is it at least as likely as not (i.e., a 50 percent probability or more) that any thoracolumbar spine disorder currently diagnosed, or diagnosed during the appeal, even if currently resolved, was caused by or incurred as a result of the Veteran's active duty service? (b.) Is it at least as likely as not that any thoracolumbar spine disorder currently diagnosed, or diagnosed during the appeal even if currently resolved, was caused or aggravated by the Veteran's CMT? Aggravation is defined as any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease. The examiner is advised that a finding that the thoracolumbar spine disability was aggravated beyond the normal progression due to a service-connected disability does not require evidence of permanent worsening and may encompass any additional impairment in earning capacity resulting from an already service-connected condition. The examiner must consider and discuss all pertinent evidence in the claims file, to specifically include the in-service evidence of low back symptoms and the Veteran's lay statements. The examiner is advised that the Veteran is competent to report observable symptomatology. 5. Schedule the Veteran for a new VA examination to assess the current severity of his bilateral pes cavus, degenerative arthritis of the feet, and bilateral weak feet. The claims file should be reviewed by the examiner. All necessary tests should be performed, and the results reported. All symptomatology associated with the Veteran's bilateral pes cavus, degenerative arthritis of the feet, and bilateral weak feet should be reported. ANTHONY C. SCIRÉ, JR Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Katz, 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.