Citation Nr: 22014121 Decision Date: 03/11/22 Archive Date: 03/11/22 DOCKET NO. 18-08 639 DATE: March 11, 2022 ORDER Entitlement to a compensable evaluation for a right knee residual scar is denied. Entitlement to service connection for chest trauma is denied. Entitlement to service connection for a left knee disability is denied. REMANDED Entitlement to a compensable evaluation for traumatic brain injury (TBI) is remanded. Entitlement to service connection for a right shoulder disability is remanded. Entitlement to service connection for a thoracolumbar spine disability is remanded. Entitlement to service connection for a cervical spine disability is remanded. Entitlement to service connection for a right knee disability is remanded. Entitlement to service connection for headaches is remanded. Entitlement to service connection for an acquired psychiatric disability, to include posttraumatic stress disorder (PTSD) is remanded. Entitlement to a 10 percent evaluation based on multiple, noncompensable, service-connected disabilities is remanded. FINDINGS OF FACT 1. The evidence supports a finding that the Veteran did not have, at any time throughout the appellate period, a painful or unstable right knee scar, or one affecting an area at least 6 square inches (39 sq. cm). 2. The evidence of record is against finding that the Veteran has had a chest trauma disability at any time during or approximate to the pendency of the claim. 3. The evidence of record is against finding that the Veteran has had a left knee disability at any time during or approximate to the pendency of the claim. CONCLUSIONS OF LAW 1. The criteria for entitlement to a compensable evaluation for right knee residual scar have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. § 4.118, Diagnostic Code 7805 (2021). 2. The criteria for service connection for a chest trauma disability are not met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2021). 3. The criteria for service connection for a left knee disability are not met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2021). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from February 1983 to July 1991. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a December 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Columbia, South Carolina. The Veteran was afforded a hearing before the undersigned in March 2020. A transcript of said hearing is of record. The Veteran died in November 2021, and the Appellant is his surviving spouse. In December 2021, the Agency of Original Jurisdiction (AOJ) substituted the Appellant as the claimant. Increased Rating Disability evaluations are determined by evaluating the extent to which a Veteran's service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing his symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. If two evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation; otherwise, the lower evaluation will be assigned. 38 C.F.R. § 4.7. Any reasonable doubt regarding a degree of disability is resolved in favor of the Veteran. 38 C.F.R. § 4.3. "Staged" ratings may be appropriate for any rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007). 1. Entitlement to a compensable evaluation for a right knee residual scar The Appellant seeks a compensable rating for the right knee residual scar as the substituted claimant. The Veteran contended he was entitled to a compensable rating for his right knee residual scar. The Veteran's right knee scar is rated under Diagnostic Code 7805 for other scars (including linear scars) and other effects of scars evaluated under Diagnostic Codes 7800, 7801, 7802, and 7804. The Board notes that VA amended the criteria for rating skin disabilities effective from August 13, 2018. However, Diagnostic Code 7805 was not changed by the August 13, 2018, amendments. Diagnostic Code 7805 instructs that any disabling effects not considered in a rating provided under Diagnostic Codes 7800-04 be evaluated under an appropriate Diagnostic Code. The Board finds that the evidence weighs persuasively against the assignment of a compensable rating for the Veteran's right knee scar under Diagnostic Code 7805 as there are no other disabling effects not considered in a rating provided under Diagnostic Codes 7800-04. In this regard, the Veteran was afforded a VA knee examination in December 2014. The examiner acknowledged that the Veteran had a right knee scar. However, it was noted that the scar was neither painful nor unstable, and did not have a total area equal to or greater than 39 square centimeters. The Veteran further testified during a hearing before the undersigned in March 2020 that the location of his knee scar was just where it's tender, and his issue was not whether the scar was bothering him but rather his knee problem which is separately evaluated. Indeed, the Veteran stated that his testimony relates mainly to his knee disability, and he did not distinguish his scar as separately disabling. The Board has also considered the other Diagnostic Codes pertaining to scars. However, the Veteran's right knee scar was not of the head, face, or neck, was not deep and nonlinear, and was not associated with underlying soft tissue damage. Although it was superficial and not associated with underlying soft tissue damage, it did not cover an area or areas of 144 square inches or greater. Moreover, the Veteran's scar was not unstable or painful. Therefore, Diagnostic Codes 7800, 7801, 7802, and 7804, both prior to and from August 13, 2018, are inapplicable. In this regard, review of medical records shows that they are silent for complaint or treatment of a knee scar. There is no indication, including by the Veteran, that his knee scar was disabling. Finally, there is no evidence in medical records that the scar was deep, was associated with any soft tissue damage, was unstable or painful. The Veteran is competent to report observable symptoms, to include tenderness, and his reports are credible. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). However, he did not assert, and records do not show, that the Veteran's right knee scar was manifest by any disabling effects not considered in a rating provided under Diagnostic Codes 7800-04. In conclusion, the Board finds that the evidence weighs persuasively against the claim for a compensable rating for a right knee scar. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. Service Connection 2. Entitlement to service connection for chest trauma The Appellant seeks entitlement to service connection for a chest trauma disability as the substituted claimant. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). The question for the Board is whether the Veteran had a current disability that began during service or was at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the Veteran did not have a current diagnosis of a chest trauma disability and had not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). The December 2014 VA examiner evaluated the Veteran and determined that, while he experienced subjective symptoms of chest pain through the appellate period, this was pain associated with either bronchitis, GERD, or small transient spontaneous pneumothorax not chest trauma in service. Furthermore, the examiner reviewed the Veteran's medical record in addition to conducting a physical examination. It was noted that the Veteran did not have a chest or lung diagnosis of record, and there was no evidence in service records of trauma to the chest. The examiner acknowledged the Veteran's lay testimony that he hit his chest on the dashboard during a motor vehicle accident in 1984. The Board further acknowledges testimony of chest pain by the Veteran. However, the Veteran's statements are not competent medical evidence as a chest diagnosis would require the ability to interpret complicated diagnostic medical testing which the Veteran is not shown to possess. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Furthermore, it is inconsistent with contemporaneous treatment records, which are indeed silent for complaint, treatment or diagnosis of chest trauma. Consequently, the Board gives more probative weight to the December 2014 VA examiner's findings. Additionally, review of the Veteran's post service treatment records shows that they are silent for treatment or diagnosis of a chest disability. In fact, on several occasions including in November 2015 and July 2016, the Veteran specifically denied having any chest pains, and chest radiology was normal. The Board notes that it is cognizant of Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018), in which the Federal Circuit held that "pain alone, without an accompanying diagnosis of a present disease, can qualify as a disability" if it "reaches the level of a functional impairment of earning capacity." Id. at 1367-69. However, though the Veteran's reports of pain are credible, the Veteran himself indicated during the December 2014 VA examination that his cough and congestion began the year prior after inhaling dust, and that although his chest made contact with the dashboard of a car during a motor vehicle accident in service, he did not have any problems with his respiratory system at the time or thereafter. Furthermore, no functional impact was alleged or noted as a result of any chest condition. Consequently, the Board gives more probative weight to the competent medical evidence, and service connection, absent a diagnosis, must be denied. 3. Entitlement to service connection a left knee disability The Appellant seeks entitlement to service connection for a left knee disability as the substituted claimant. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). The question for the Board is whether the Veteran had a current disability that began during service or was at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the Veteran did not have a current diagnosis of left knee disability and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). The December 2014 VA examiner evaluated the Veteran and determined that, while the Veteran did sustain a right knee injury, and reported bilateral knee pain, in service, there is no evidence of any left knee disability at service discharge or thereafter. The examiner acknowledged the Veteran's reports of bilateral knee pain when running during service, but also indicated that x-rays were negative and improvement was noted after rest and a brace. Furthermore, the examiner conducted a physical examination, which found the left knee to be entirely normal. Contemporaneous x-rays were also reviewed and found to be normal. And no functional impact was noted as a result of either knee. The Board acknowledges the Veteran's lay testimony of record, including sworn testimony before the undersigned in March 2020. The Veteran testified his left knee was tender and caused difficulty with climbing stairs. He also reported soreness and swelling on the top side of the left knee, exacerbated when doing work. He also stated he got treatment for his knees on or about 2015, explaining that after separation, he essentially just dealt with the pain until he could no longer. However, the Veteran's statements are not competent medical evidence as a knee diagnosis would require the ability to interpret complicated diagnostic medical testing which the Veteran is not shown to possess. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Furthermore, it is inconsistent with contemporaneous treatment records, which are indeed silent for complaint, treatment or diagnosis of a left knee disability. In this regard, while review of service records does show knee pain complaints, radiographic imaging, including in May 1984, was normal. Additionally, review of the Veteran's post service treatment records shows that they are silent for treatment or diagnosis of a left knee. Consequently, the Board gives more probative weight to the December 2014 VA examiner's findings. The Board notes that it is cognizant of Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018), in which the Federal Circuit held that "pain alone, without an accompanying diagnosis of a present disease, can qualify as a disability" if it "reaches the level of a functional impairment of earning capacity." Id. at 1367-69. However, though the Veteran's reports of pain are credible, there is no functional impact identified by the Veteran or by the examiner with regard to his left knee. Consequently, the Board gives more probative weight to the competent medical evidence, and service connection, absent a diagnosis, must be denied. REASONS FOR REMAND 1. Entitlement to a compensable evaluation for traumatic brain injury (TBI) is remanded. When VA undertakes to obtain an examination/opinion, it must ensure that the examination/opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). A medical opinion/examination is considered adequate "where it is based on consideration of the veteran's prior medical history and examinations and also describes the disability, if any, in sufficient detail so that the Board's evaluation of the claimed disability will be a fully informed one." Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). The Veteran was afforded a VA TBI examination in September 2017 to assess the nature and severity of his TBI. The Board agrees with the appellant, who contends through the representative's brief of May 2020 that this VA examination is inadequate for adjudication purposes. The examiner indicated that the Veteran had no complaints of memory, concentration or executive functions. The examiner further indicated that the Veteran did not have any functional impact as a result of his TBI. However, these findings are inconsistent with the available medical record. Specifically, review of VA medical records reflects that in April 2016, prior to the 2017 VA examination, the Veteran reported headaches which were increasing in severity, poor memory, poor concentration, poor appetite and constant ringing in the ears. In July 2016, the Veteran again complained of headaches, nausea, memory disturbance, ringing in the ears, and the provider assessed that the Veteran had trouble with attention and visual spatial pattern recognition. Furthermore, the Veteran submitted a statement in September 2017, noting that he was not asked about concentration, attention or memory lapses during his latest VA TBI examination, and that he mentioned symptoms including ringing of the ears which were not addressed by the examiner. Finally, the Board notes that while the Veteran reported subjective complaints relating to TBI, none were noted as part of the TBI assessment. As such, the Board also finds the September 2017 VA examination to be internally inconsistent. Therefore, an adequate VA opinion assessing the severity of the Veteran's TBI disability should be obtained. 2. Entitlement to service connection for a right shoulder disability is remanded. When VA undertakes to obtain an examination/opinion, it must ensure that the examination/opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). A medical opinion/examination is considered adequate "where it is based on consideration of the veteran's prior medical history and examinations and also describes the disability, if any, in sufficient detail so that the Board's evaluation of the claimed disability will be a fully informed one." Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). The Veteran was afforded a VA shoulder examination in December 2014. The VA examiner noted the Veteran's diagnoses of shoulder strain and rotator cuff tear. The examiner also acknowledged in-service injuries, including a motor vehicle accident and a fall. It was opined that the right shoulder disability is less likely than not related to service because there is no medical evidence of treatment after separation from service for many years. The Board notes that a significant lapse in time between service and post-service medical treatment may be considered a factor in the analysis, but that such absence of documented treatment, in and of itself, is not a basis for discrediting his lay statements of continuity. See Maxson v. Gober, 230 F.3d 1330 (Fed. Cir. 2000); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). Since a current disability and in service injuries are acknowledged, and the only rationale provided for the negative opinion involves passage of time for documented treatment, the service connection claim for a right shoulder disability must be remanded for an addendum opinion. 3. Entitlement to service connection for a thoracolumbar spine disability is remanded. 4. Entitlement to service connection for a cervical spine disability is remanded. When VA undertakes to obtain an examination/opinion, it must ensure that the examination/opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). A medical opinion/examination is considered adequate "where it is based on consideration of the veteran's prior medical history and examinations and also describes the disability, if any, in sufficient detail so that the Board's evaluation of the claimed disability will be a fully informed one." Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). The Veteran was afforded VA cervical and thoracolumbar spine examinations in December 2014. The VA thoracolumbar spine examiner noted the Veteran's diagnosis of lumbosacral strain, and the cervical spine examiner noted the diagnosis of cervical strain and degenerative arthritis. It was opined that these disabilities are less likely than not related to service, essentially for the same reason that there is no medical evidence of treatment after separation from service for many years though in-service injuries were acknowledged. The Board notes that a significant lapse in time between service and post-service medical treatment may be considered a factor in the analysis, but that such absence of documented treatment, in and of itself, is not a basis for discrediting his lay statements of continuity. See Maxson v. Gober, 230 F.3d 1330 (Fed. Cir. 2000); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). Since current disabilities and in service injuries are acknowledged, and the only rationale provided involves passage of time for documented treatment, the service connection claims for cervical and thoracolumbar spine disabilities must be remanded for addendum opinions. 5. Entitlement to service connection for a right knee disability is remanded. When VA undertakes to obtain an examination/opinion, it must ensure that the examination/opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). A medical opinion/examination is considered adequate "where it is based on consideration of the veteran's prior medical history and examinations and also describes the disability, if any, in sufficient detail so that the Board's evaluation of the claimed disability will be a fully informed one." Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). The Veteran was afforded a VA right knee examination in December 2014 to assess the nature and etiology of his right knee disability. Pertinently, the examiner noted a diagnosis of right knee pain, and on physical examination, it was noted that this pain is productive of limitation in range of motion and functional loss. Nevertheless, the examiner opined that the right knee disability is less likely than not related to service, reasoning that the Veteran did not have a current knee disability. The Board notes Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018), in which the Federal Circuit held that "pain alone, without an accompanying diagnosis of a present disease, can qualify as a disability" if it "reaches the level of a functional impairment of earning capacity." Id. at 1367-69. In this case, the examiner clearly stated that the Veteran's right knee pain was productive of functional impairment. Furthermore, the Board notes that the Veteran testified during the March 2020 hearing before the undersigned that his right knee gives way, to the point that it slows him down significantly, especially when going up and down stairs. He further testified his right knee was weak and painful. In light of the holding in Saunders, and credible testimony of significant functional loss, as well as medical evidence of functional loss, the Board finds the December 2014 VA examination inadequate for adjudication purposes. As such, the service connection claim for a right knee disability must be remanded for an addendum opinion. 6. Entitlement to service connection for headaches is remanded. When VA undertakes to obtain an examination/opinion, it must ensure that the examination/opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). A medical opinion/examination is considered adequate "where it is based on consideration of the veteran's prior medical history and examinations and also describes the disability, if any, in sufficient detail so that the Board's evaluation of the claimed disability will be a fully informed one." Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). The Veteran was afforded a VA headache examination in December 2014. The Veteran reported chronic headaches since service. The examiner indicated he found no evidence of headache complaints in service, nor within one year of the VA examination in the Veteran's medical record. Furthermore, the examiner opined that the Veteran's headaches are less likely than not related to service, reasoning that there is no evidence of a headache diagnosis. First and foremost, the Board notes that the Veteran is competent to report an observed history of chronic headaches, even as a layperson as pain is an observable symptom. Furthermore, in Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018), the Federal Circuit held that "'disability' in 38 U.S.C. § 1110 refers to the functional impairment of earning capacity" and that "pain in the absence of a presently diagnosed condition can cause functional impairment," en route to its conclusion that "pain alone, without an accompanying diagnosis of a present disease, can qualify as a disability." 886 F.3d at 1363, 1368, 1369. The examination is problematic in that it is also based on an inaccurate medical history. While the examiner states there is no evidence of headache complaints in service, review of service treatment records shows that records in September 1983, January 1987 and December 1988 reflect complaints of headaches. Furthermore, there are multiple headache complaints in post-service VA medical records, including in July and September 2015, and is in fact diagnosed with headaches in November 2015 and in July 2016 for which he was prescribed Topamax. Additionally, the examiner made no mention of the Veteran's sworn testimony before the undersigned, when the Veteran explained the continuity of his symptomatology and current symptoms. As such, the service connection claim for a headache disability must be remanded for an addendum opinion. 7. Entitlement to service connection for an acquired psychiatric disability, to include posttraumatic stress disorder (PTSD) is remanded. When VA undertakes to obtain an examination/opinion, it must ensure that the examination/opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). A medical opinion/examination is considered adequate "where it is based on consideration of the veteran's prior medical history and examinations and also describes the disability, if any, in sufficient detail so that the Board's evaluation of the claimed disability will be a fully informed one." Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). The Veteran was afforded a VA PTSD examination in December 2014. The examiner indicated there is no PTSD diagnosis, nor is one warranted under the DSM-5 criteria. The examiner did, however, note that the Veteran had adjustment disorder with depressed mood. The examiner opined that the Veteran's adjustment disorder is less likely than not related to service, reasoning that he has functioned well since service, has not sought a significant level of care and does not meet all the criteria for the diagnosis. As for the Veteran's claimed PTSD, no etiological opinion was provided given the lack of diagnosis. Nonetheless, the examiner acknowledged in reviewing the Veteran's medical file that the Veteran does in fact have a diagnosis of PTSD of record. Furthermore, the examiner acknowledged the Veteran's in-service stressors as valid, including a motor vehicle accident and seeing dead bodies in Kuwait. The Veteran was also clinically assessed to have symptoms of depressed mood, chronic sleep impairment and disturbances of motivation and mood. Additionally, the Board notes that the Veteran was diagnosed with anxiety and depressive disorder. See January 2014 VA medical records. Given the contradictory information contained within the VA examination itself, as well as the conflicting information on the one hand the VA examiner indicating the Veteran does not qualify for a PTSD diagnosis, and on the other, the Veteran already having been diagnosed with PTSD, the Board finds the December 2014 VA examination inadequate for adjudication purposes. Furthermore, the Board is perplexed that the examiner acknowledged the Veteran's in-service stressors as valid, yet concluded that his current psychological disability is unrelated to service. As such, the service connection claim for an acquired psychiatric disability must be remanded for an addendum opinion. 8. Entitlement to a 10 percent evaluation based on multiple, noncompensable, service-connected disabilities is remanded. While the Board remands the issues noted above for additional evidentiary development, including entitlement to a compensable evaluation for a TBI which is one of two currently noncompensably rated disabilities those decisions may impact this claim for a 10 percent evaluation for multiple noncompensable disabilities. As such, these issues are inextricably intertwined. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). The matters are REMANDED for the following action: 1. Obtain and associate with the claims file any outstanding VA and private treatment records pertinent to the Veteran's disabilities remanded herein. Thereafter, obtain an addendum opinion to determine the nature and severity of his traumatic brain injury (TBI). All pertinent symptomatology and findings should be reported in detail utilizing the Compensation and Pension Examination TBI Guidelines. After a thorough review of the claims file, the examiner is asked to address the degree to which the service-connected TBI disability was manifested by facets of cognitive impairment including to memory, attention, concentration, and executive functions; judgment; social interaction; orientation; motor activity; visual spatial orientation; subjective symptoms; neurobehavioral effects; communication; and consciousness. Specifically, clarify whether the Veteran had any psychomotor impairment, whether any such impairment was related to the Veteran's TBI, and the nature and severity of any such impairment. In doing so, reconcile the September 2017 VA examiner's findings with the Veteran's April 2016 reports of headaches which were increasing in severity, poor memory, poor concentration, poor appetite, and constant ringing in the ears; July 2016 complaints of headaches, nausea, memory disturbance, ringing in the ears, and the provider's assessment that the Veteran had trouble with attention and visual spatial pattern recognition. The examiner must also address the Veteran's lay statements of record. 2. Obtain addendum opinions regarding the nature and etiology of the Veteran's lumbar and cervical spine disabilities; right knee disability; and headache disability. The examiner should offer an opinion as to whether it is at least as likely as not (i.e. 50 percent or higher probability) that any lumbar spine or cervical spine disabilities; right knee disability; and headache disability had their onset in service, or are related to events in service, to include a motor vehicle accident and a fall. The examiner should consider the following: A July 1984 treatment record reflecting complaints of low back and neck pain, and diagnosing the Veteran with a strain; Current diagnoses low back and neck of degenerative arthritis and strains as per the 2014 VA examination; In-service right knee injuries, including in January 1986, for which the Veteran sought treatment; Functional limitations relating to the Veteran's right knee pain; Records in September 1983, January 1987 and December 1988 reflecting complaints of headaches; Post-service VA medical records, including in July and September 2015, as well as headaches diagnoses in November 2015 and in July 2016 for which he was prescribed Topamax; And the Veteran's competent lay statements regarding current symptomatology and continuity of symptomatology since service. 3. Obtain an addendum opinion regarding the nature and etiology of the Veteran's psychiatric disability. The VA psychiatric examiner should offer an opinion as to whether it is at least as likely as not (i.e. 50 percent or higher probability) that any acquired psychiatric disabilities, to include PTSD, anxiety and depression, had their onset in service, or are related to events in service, to include a motor vehicle accident and seeing dead bodies in Kuwait. The examiner should consider the following: Diagnoses of PTSD, anxiety and depressive disorder contained in VA medical records, including in January 2014; In-service stressors found to meet DSM-5 criteria by the December 2014 VA examiner; And the Veteran's competent lay statements of record, describing continuity of symptomatology and current symptoms. The medical reasons for accepting or rejecting the Veteran's statements regarding continuity since service should be set forth in detail. Caroline B. Fleming Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Comninos, Georgio 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.