Citation Nr: 22015072 Decision Date: 03/16/22 Archive Date: 03/16/22 DOCKET NO. 18-18 983A DATE: March 16, 2022 ORDER Entitlement to service connection for hypothyroidism with benign tumor is denied. Entitlement to service connection for radiculopathy of the left lower extremity is granted. Entitlement to an initial rating of 10 percent, but no higher, prior to December 4, 2019, and a rating of 50 percent, but no higher, thereafter for unspecified trauma disorder with posttraumatic stress disorder (PTSD), is granted. Entitlement to a compensable rating for hypertension is denied. REMANDED Entitlement to a rating in excess of 10 percent for degenerative disc disease of the thoracolumbar spine is remanded. Entitlement to service connection for radiculopathy of the right lower extremity is remanded. FINDINGS OF FACT 1. The probative evidence of record does not show that the Veteran's hypothyroidism is related to his active-duty service. 2. The probative evidence of record is at least in relative equipoise that the Veteran's radiculopathy of the left lower extremity is related to his service-connected back condition. 3. Prior to December 4, 2019, the Veteran's psychiatric disorder manifested to occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress. 4. From December 4, 2019, the Veteran's psychiatric disorder has manifested to occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped, speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short and long term memory impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. 5. The Veteran's hypertension has not manifested to diastolic pressure predominantly 100 or more, systolic pressure predominantly 160 or more, or a history of diastolic pressure predominantly 100 or more that requires continuous medication for control. CONCLUSIONS OF LAW 1. The criteria for service connection for hypothyroidism with benign tumor have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.303(c), 3.304. 2. The criteria for service connection for radiculopathy of the left lower extremity have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.310. 3. The criteria for an initial rating of 10 percent, but no higher, prior to December 4, 2019, and a rating of 50 percent, but no higher, thereafter for unspecified trauma disorder with posttraumatic stress disorder (PTSD), have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.1, 4.3, 4.7, 4.10, 4.125, 4.126, 4.130, Diagnostic Codes 9410-11. 4. The criteria for a compensable rating for hypertension have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.3, 4.7, 4.14, 4.21, 4.104, Diagnostic Code 7101. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Navy from June 1986 to June 2006. In April 2021, the Veteran was provided a hearing with the undersigned Veterans Law Judge and a transcript of the proceeding is of record. Service Connection Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). In order to establish service connection, the record must show competent evidence of three things: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d, 1362, 1366 (Fed. Cir. 2009). When considering such a claim for service connection, the Board must consider on a case-by-case basis, the competence and sufficiency of lay evidence offered to support a finding of service connection. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009) (quoting Jandreau v. Nicholson, 492 F.3d 1372, 1377 Fed. Cir. 2007)). The mere conclusory or generalized lay statements that a service event or illness caused a current disability are insufficient. Waters v. Shinseki, 601 F.3d 1274, 1278 (2010). 1. Entitlement to Service Connection: Hypothyroidism The Veteran contends that his hypothyroidism is related to his active-duty service. As an initial matter, the Board notes that the Veteran has been diagnosed with hypothyroidism with benign tumor. Thus, the issue turns upon whether there is evidence of an in-service event or injury and a nexus between the claimed in-service event or injury and the present disability. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The Board finds there is not. In March 2016, the Veteran attended a VA examination. The examiner opined that it was less likely than not that the hypothyroidism was incurred in or caused by his active-duty service. The examiner rationalized that service treatment records and available medical records were silent for thyroid condition until July 2008. The examiner further noted that the Veteran received an examination in December 2006, and it was noted his neck and thyroid were normal. The Board notes that the Veteran's service treatment records are silent for any diagnosis of a thyroid condition or symptoms related to his neck. Further, his VA treatment records do not show symptoms of a thyroid condition until May 2008, two years after his active-duty service. Additionally, as noted by the March 2016 examiner, the Veteran received a VA examination in December 2006, only 6 months after his active-duty service, and his neck was noted as normal with no thyromegaly, nodules, or bruits. Therefore, the Board finds the March 2016 VA opinion to be of significant probative value in determining that the Veteran's hypothyroidism is not related to his active-duty service. The Board notes that the probative value of medical opinion evidence is based on the medical experts' personal examination of the patient, their knowledge, and skill in analyzing the data, and their medical conclusion. As is true with any piece of evidence, the credibility and weight to be attached to these opinions are within the province of the adjudicator. Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993). Here, the reviewing physician's opinion was based on review of the Veteran's lay contentions, his reported medical history, and review of the medical evidence of record. Further, a complete and thorough rationale was provided for the opinion rendered and is consistent with the evidence of record. The Board acknowledges the Veteran's assertions his hypothyroidism is due to his active-duty service. The Board recognizes that lay persons are competent to provide medical opinions on some medical issues. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). However, although the Veteran is competent to report his symptoms, any opinion regarding whether any thyroid disability is related to his military service requires medical expertise that the Veteran has not demonstrated since hypothyroidism can have many causes. See Jandreau v. Nicholson, 492 F.3d 1372, 1376 (2007). Further, the Board again notes that the Veteran was not diagnosed until 2008, two years after his active-duty service, as well as showed no symptoms of a thyroid issue in a December 2006 examination shortly after his discharge. The Board concludes that, as the evidence persuasively favors against service connection, it is not in approximate balance, and the benefit-of-the-doubt doctrine does not apply. See Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). 2. Entitlement to Service Connection: Radiculopathy of the Left Lower Extremity The Veteran contends that his radiculopathy of the left lower extremity is related to his active-duty service, to include his thoracolumbar spine disability. Service connection on a secondary basis essentially requires evidence sufficient to show: (1) that a current disability exists; and (2) that the current disability was either caused or aggravated by a service-connected disability. 38 C.F.R. § 3.310. In April 2021, the Veteran submitted a private opinion. The physician noted review of the Veteran's service treatment records, treatment records, and examined the Veteran. The physician then opined that the Veteran's radiculopathy and peripheral neuropathy of the lower extremities were most likely caused by or result of (51 percent probability or better) his degenerative disc disease of the thoracolumbar spine. The examiner rationalized the Veteran suffers from pain and radiculopathy that radiates to his posterior leg and foot bilaterally. The Board recognizes that a March 2016 examiner opined the Veteran's radiculopathy is not related to his active-duty service because the Veteran did not suffer from such conditions. However, the Board notes that the evidence of shows multiple documentations of lumbar radiculopathy in the Veteran's medical records, to include an August 2006 diagnosis of radiculopathy of the left lower extremity, and therefore the Board places low probative weight on the March 2016 opinion as it was based on an inaccurate factual premise. Therefore, the Board finds the April 2021 private opinion to be of significant probative value in determining that the Veteran's radiculopathy of the left lower extremity is related to his service-connected thoracolumbar spine disability. The Board notes that the probative value of medical opinion evidence is based on the medical experts' personal examination of the patient, their knowledge, and skill in analyzing the data, and their medical conclusion. As is true with any piece of evidence, the credibility and weight to be attached to these opinions are within the province of the adjudicator. Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993). Here, the reviewing physician's opinion was based on review of the Veteran's lay contentions, his reported medical history, review of the medical evidence of record, and reviewed medical literature. Further, a complete rationale was provided for the opinion rendered and is consistent with the evidence of record. Thus, the Board concludes that the probative evidence of record is for the claim and the benefit of the doubt doctrine has been applied. See Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). Increased Rating Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities. 38 C.F.R. Part 4. The Board determines the extent to which a veteran's service-connected disability adversely affects his/her ability to function under the ordinary conditions of daily life, and the assigned rating is based, as far as practicable, upon the average impairment of earning capacity in civil occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.10. Where there is a question as to which of two ratings should be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R.§ 4.7. Generally, the degree of disabilities specified are considered adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the several grades of disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities and the criteria for specific ratings. However, the evaluation of the same disability under various diagnoses, known as pyramiding, is to be avoided. 38 C.F.R. § 4.14. When an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). In a claim for a greater original rating after an initial award of service connection, all of the evidence submitted in support of the veteran's claim is to be considered. See Fenderson v. West, 12 Vet. App. 119 (1999); 38 C.F.R. § 4.2. However, consideration must be given as to whether staged ratings should be assigned to reflect entitlement to a higher rating at any point during the pendency of the claim. See Fenderson v. West, 12 Vet. App. 119 (1999); see also Hart v. Mansfield, 21 Vet. App. 505 (2007). Additionally, when evaluating a mental disorder, the rating agency shall consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the veteran's capacity for adjustment during periods of remission. The rating agency shall assign an evaluation based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner's assessment of the level of disability at the moment of the examination. 38 C.F.R. § 4.126 (a) (2021). When evaluating the level of disability from a mental disorder, VA also will consider the extent of social impairment, but shall not assign an evaluation solely on the basis of social impairment. 38 C.F.R. § 4.126 (b). 1. Entitlement to an Increased Rating: Psychiatric Disorder The Veteran's service-connected unspecified trauma disorder is rated as non-compensable under Diagnostic Code (DC) 9410 of the General Rating for Mental Disorders Under DC 9410, a 10 percent rating is provided for occupational and social impairment due to mild transient symptoms which decrease work efficiency and ability to perform occupational tasks not only during periods of significant stress, or symptoms controlled by continuous medication. 38 C.F.R. § 4.130, DC 9410. A 30 percent evaluation is warranted for occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events). Id. A 50 percent disability rating is warranted when there is occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped, speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short and long term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. Id. A 70 percent disability rating is warranted for occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); inability to establish and maintain effective relationships. Id. Finally, a 100 percent disability rating is warranted when there is total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. Id. In September 2015, was seen at a mental health clinic. The Veteran reported some improvement in his depression and anxiety. The Veteran was casually dressed with good hygiene. He was alert and oriented to time, place, and person. The patient was cooperative and responsive with appropriate eye contact. His mood was reported as okay, and his affect was congruent. He had normal speech, rhythm, rate, and tone. His thought processes were linear and thought content appeared goal directed. He had no paranoia, delusions, or obsessions. The Veteran did not have suicidal ideation or homicidal ideation. His memory was grossly intact. His insight and judgment appeared average. The Veteran appeared to be experiencing depression and anxiety related to past combat trauma and was precipitated by external stressors. He reported experiencing flashbacks and nightmares of his combat deployment. His symptoms were clinically significant in social, occupational, and interpersonal areas of functioning. In March 2016, the Veteran attended a VA examination. The examiner stated that a mental condition has been formally diagnosed and there is no indication in the records made available, the clinical interview in the current examination, and psychological test results, that symptoms of a mental disorder cause clinically significant impairment in current occupational and social functioning. The Veteran was alert and fully oriented. His speech was normal in rate, tone, and syntax. His thought content and process were unremarkable. His mood was euthymic with full and reactive affect. He did not have hallucinations or delusions. He denied any suicidal and homicidal ideation, intent, and planning. He did not have any impairment in attention, concentration, or memory. In December 2019, the Veteran was seen at the VA medical center for a mental health consultation. The Veteran reported depressive symptoms and nightmares. He reported "bottling things up" and putting up a façade so people do not know something is wrong. He reported snapping at his wife, issues with his sex life, lack of desire, being numb, and inability to feel affection. The Veteran stated he has intrusive memories. The Veteran's symptoms were irritability or aggression, hypervigilance, heightened startle response, difficulty concentrating, and difficulty sleeping. The Veteran was cooperative. His mood was overwhelmed and scared. His affect was sad and tearful. His speech was normal in rate, rhythm, tone, and expressive. His thought process was productive, spontaneous, and there was no evidence of loose associations. He was alert and oriented to time, location, situation, and date. His concentration, attention, judgment, and insight were intact. The Veteran was seen at the VA medical center for a psychiatric visit in April 2020. The Veteran reported having a difficult week and issues related to the COVID-19 pandemic. He reported his work environment has been extremely stressful. The Veteran was noted as easy going; however, his mood can switch easily. He reported being easily frustrated and letting things build, which he subsequently takes out on his wife. The Veteran's symptoms were depression, anxiousness, nightmares, and sleep disturbance. The Veteran reported he did not have hallucinations, suicidal ideation, homicidal ideation, or problems at work. He denied a history of past suicide attempts, denied feelings of hopelessness, thoughts to kill himself, or plans to hurt himself or others. In June 2020, the Veteran was seen at the VA medical center. The Veteran reported doing good. He reported mild mood swings but denied sustained depressed mood or associated signs and symptoms. He denied any suicidal or homicidal ideations. He denied any symptoms of hypomania or mania. His sleep was good, but he still suffered from occasional nightmares. He reported his work was going well. He stated he has a business with a partner that is understanding of his psychiatric and medical conditions. He reported a better relationship with his wife, stating she allows him 20 minutes to wind down when he comes home from work. The Veteran was seen again for a psychiatric visit in October 2020. The Veteran reported he got into a physical fight with a friend. He reported that his friend was in the wrong. The Veteran reported he did have a gun in the car but used deep breathing and thoughts about his wife and children to calm down. He reported he is usually calm but can go to extreme quickly. He stated his anxiety with PTSD can set in quickly. He gave an example of a ballon popping at a child's birthday party and getting scared. He denied any suicidal or homicidal ideations. He reported having nightmares three to four times a week. He also reported having daymares a few times a week. He stated he tries to distract himself when this happens. His appetite was good. He reported that he believes his medication has helped with his irritability slightly. In November 2020, the Veteran had a telephone follow-up with the VA medical center for his psychiatric disorder. The Veteran reported that his medicine had been effective in reducing his irritability and rage reactions. He reported being under stress because his son recently suffered a burn injury and moved back in with them. He stated that this caused him to have flashbacks of past military trauma, but he was able to cope. He reported no lashing out or being involved in any physical fights. He reported still having occasional nightmares. His mood was euthymic. His behavior was appropriate, pleasant, and cooperative with appropriate participation in the session. He reported his mood was good. His speech rate, rhythm, and volume were normal. His thought process was clear, logical, coherent, linear, and goal directed. He denied any psychotic symptoms, including hallucinations or delusions. He denied suicidal or homicidal ideations. He was oriented to person, place, time, and situation. His immediate, recent, and remote memory were intact. His judgment was adequate, and his insight was fair. In February 2021, the Veteran was seen for another therapy visit at the VA medical center. The Veteran reported still being irritable. He stated he is still irritable with more down and anxious moods since having COVID. He reported his son's injuries have triggered flashbacks. He stated he sleeps but doesn't think he gets REM sleep. He denied any suicidal and homicidal ideations. He reported still working in the mailroom at the VA. He was positive for mild irritability, anxiety, and depressed mood. His behavior is appropriate, pleasant, and cooperative with appropriate participation in the session. His hygiene and grooming are appropriate. He made good eye contact and a friendly rapport was established. His mood was reported as okay. His speech rate, rhythm, and volume were normal. His thought process was clear, logical, coherent, linear, and goal directed. His denied psychotic symptoms, to include any hallucinations and delusions. He was oriented to person, place, time, and situation. His recent and remote memory were intact. His judgment was adequate, and his insight was fair. The Veteran also attended a VA examination in February 2021. The examiner diagnosed the Veteran with PTSD and stated that it was a progression of his unspecified trauma. The examiner noted the Veteran's condition causes occupational and social impairment with deficiencies in most areas such as work, school, family relations, judgment, and thinking and/or mood. The Veteran reported still being employed. The Veteran's overall symptoms were depressed mood, anxiety, suspiciousness, chronic sleep impairment, mild memory loss, disturbances of motivation and mood, difficulty establishing and maintaining effective work and social relationships, suicidal ideation, and impaired impulse control, such as unprovoked irritability with periods of violence. The Veteran also had exaggerated startle response, hypervigilance, social withdrawal, heightened anxiety states, intrusive memories, nightmares, disrupted focus, and avoidance of cues or triggers. The Veteran was found capable of handling his financial affairs. After review of the evidence of record, the Board finds that an initial rating of 10 percent, but no higher, is warranted prior to December 4, 2019. Although the March 2016 examiner noted the Veteran had not shown any symptoms, the Board finds that the evidence of record shows the Veteran suffered from depression, anxiety, flashbacks, and nightmares. Further, the September 2015 psychologist noted the Veteran's symptoms caused distress in social, occupational, and interpersonal areas of functioning. However, the Board finds that a rating in excess of 10 percent prior to December 4, 2019, is not warranted. The Veteran's overall symptoms appeared to be milder in nature. The Veteran did not report outbursts of anger, exaggerated startle response, memory loss, chronic sleep impairment, or panic attacks during this period. Nor did the evidence show that the Veteran had abnormal speech, difficulty in understanding complex commands, impaired judgment, or impaired thinking. He also did not have difficulty in establishing and maintaining effective relationships, as he reported during his March 2016 VA examination that people who know him often say he is friendly and that he was a deacon in his church. He further did not have consistent need for therapy, as his medical records show he was seen for his psychiatric condition infrequently during this period. Thus, the evidence prior to December 4, 2019 does not meet the frequency, level, and severity as would be required for a 30 percent or 50 percent rating. However, the Board finds that a rating of 50 percent, but no higher, from December 4, 2019, is warranted. During this period, the Veteran's symptoms were depression, anxiety, irritability, nightmares, outbursts of anger, hypervigilance, easily startled, difficulty concentrating, and difficulty sleeping. The Veteran further reported getting into a physical altercation and has maintained consistent therapy visits during this period. Thus, the Board finds that his overall symptoms rise to the severity to warrant a 50 percent rating from December 4, 2019. However, the Board finds that a rating in excess of 50 percent is not warranted for any time on appeal. While the examiner in February 2021 noted the Veteran's condition causes occupational and social impairment with deficiencies in most areas such as work, school, family relations, judgment, and thinking and/or mood, the evidence of record does not show severe impairment in his familial or work relationships, as he has reported a good relationship with his children, his business partner, and although he's reported periods of stress with his wife, he's reported an overall good relationship and continued improvement in their relationship. Although the Veteran reported passive suicidal thoughts during his April 2021 hearing, as well as it being noted on his February 2021 VA examination, the Board notes that the Veteran has consistently denied having suicidal ideation in all of his VA medical center therapy visits. In fact, the Veteran was seen for a psychiatric visit in February 2021 shortly before his VA examination and he reported no suicidal ideation, to include any thoughts, plans, or intention of suicide, as well as no attempts. The Veteran has also at no time reported having any homicidal ideation, hallucinations, delusions, or obsessional rituals. While the Veteran has reported some difficulty in maintaining work relationships and concentration, the Veteran has continued to successfully work full time. In fact, the Veteran has consistently reported his work to be going well and reported having a good relationship with his business partner. The Board acknowledges that the Veteran was in a physical altercation in October 2020. However, the Veteran reported he did not start the altercation and practiced the breathing techniques he learned in therapy to calm himself down. The Veteran has further reported no other instances of violence. Therefore, the Board finds that his symptoms do not rise to the level of being a persistent danger to himself or others. The Board also recognizes that the February 2021 examiner noted mild memory loss. However, in all of the Veteran's VA medical center visits, to include his February 2021 visit right before his VA examination, the Veteran reported no memory issues and was found to have immediate, remote and recent memory intact. Lastly, the Board notes the Veteran has always been found to be oriented to person, place, time, or situation, as well as have adequate judgement, good or fair insight, normal speech, appropriate grooming, and a clear and logical thought process. Therefore, the Board does not find that the overall frequency, severity, and duration of the Veteran's unspecified trauma with PTSD rises to the level of severity as needed for a 70 percent or 100 percent rating at any time on appeal. The Board also acknowledges the Veteran's assertions that he is entitled to higher rating because his symptoms are worse, to include his statements at his April 2021 Board hearing. The Board recognizes that lay persons are competent to provide medical opinions on some medical issues. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). However, the Board has considered the Veteran's statements and finds them credible and consistent with the ratings assigned. Accordingly, the Board concludes that a rating of 10 percent, but no higher, prior to December 4, 2019, and a rating of 50 percent, but no higher, thereafter is warranted. The benefit of the doubt doctrine has been applied. See Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). 2. Entitlement to a compensable rating for hypertension The Veteran's hypertension is rated as 0 percent disabling under 38 C.F.R. § 4.104, Diagnostic Code 7101. Under Diagnostic Code 7101, a 10 percent rating is warranted for diastolic pressure predominantly 100 or more, or; systolic pressure predominantly 160 or more, or; for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control. A 20 percent rating is warranted for diastolic pressure predominantly 110 or more, or; systolic pressure predominantly 200 or more. A maximum rating of 60 percent is warranted where there are diastolic pressure readings that are predominantly 120 or more. Id. In March 2016, the Veteran attended a VA examination. The Veteran's treatment plan did require continuous medication for his hypertension. The Veteran did not have a history of diastolic blood pressure (BP) elevation to predominantly 100 or more. The Veteran's most recent BP readings were 134/86 (systolic/diastolic), 134/85, and 128/85, providing an average rating of 132/85. The Veteran had no other pertinent physical findings, scars, or treatment for his condition. VA treatment records do not record any BP findings showing diastolic pressure of 100 or more or systolic pressure of 160 or more. In May 2019 and July 2019, the Veteran's BP was 133/81, and in November 2020 his BP was 98/66. Private medical records show the Veteran's BP was 118/79 in November 2020, and 120/85 in October 2020. After reviewing the evidence of record, the Board finds that a compensable rating for the Veteran's service-connected hypertension is not warranted. At no time during the pendency of the appeal has the Veteran's blood pressure shown readings of diastolic pressure predominantly 100 or more, or; systolic pressure predominantly 160 or more. The Board acknowledges that the Veteran does have need for continuous medication; however, the Veteran does not show a consistent history of a diastolic pressure of 100 or more. In fact, his service records show BP readings of 110/60 in October 1984, 118/84 in June 1995, 160/80 in May 2005, 137/78 in April 2006, and 142/73 in June 2006. Additionally, his BP readings immediately following his service were 130/85 and 127/87 in December 2006, 129/83 in July 2008, 128/84 in November 2008, and 135/84 in June 2009. Thus, the evidence of record does not show a history of diastolic pressure of 100 or more. The Board again acknowledges the Veteran's assertions that he is entitled to a higher rating because his symptoms are worse. The Board recognizes that lay persons are competent to provide medical opinions on some medical issues. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). However, after review of evidence of record, the Board finds the medical evidence of record does not support a compensable rating for the Veteran's condition. Accordingly, an initial compensable rating for the Veteran's hypertension disability is not warranted. The benefit of the doubt doctrine is not for application. See Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). REASONS FOR REMAND Although the Board regret further delay, a remand is required prior to adjudication of the Veteran's remaining claims. 1. Entitlement to Service Connection: Radiculopathy of the Right Lower Extremity The Veteran contends that he currently suffers from radiculopathy of the right lower extremity that is related to his service-connected thoracolumbar spine disability. The Board finds that the evidence of record is unclear whether the Veteran currently suffers from a radiculopathy disability in his right lower extremity. While there are some complaints of bilateral paresthesias of the lower extremities, the majority of the evidence only notes symptoms and complaints for his left lower extremity. Therefore, the Board finds that a remand is required in order to obtain a new VA examination to determine whether a radiculopathy disability of the right lower extremity is present. 2. Entitlement to an Increased Rating: Thoracolumbar spine The Veteran contends that his service-connected thoracolumbar disability is more severe than the rating provided. At the Veteran's April 2021 hearing, the Veteran reported worsening symptoms in his thoracolumbar spine disability. He reported not being able to bend over without excruciating pain, needing to use a cane, and flare-ups all the time with pain, to include throbbing in his legs. The Board notes that his last VA examination was six years ago in February 2016. Thus, the Board finds that a remand is required in order to obtain an examination to determine the current severity of the Veteran's condition. See Weggenmann v. Brown, 5 Vet. App. 281 (1993). The matters are REMANDED for the following action: 1. Obtain and associate with the Veteran's electronic claims file any outstanding VA treatment records and private medical records relevant to the Veteran's claims. 2. After all outstanding records have associated with the claims file, schedule the Veteran with an appropriate examiner to determine of any radiculopathy of right lower extremity is present, to include paresthesias or peripheral neuropathy. The record and a copy of this Remand must be made available to the examiner. Following a review of the entire record, to include the Veteran's competent lay statements, as well as the Veteran's reports regarding the onset and progression of his current symptomatology, the examiner should opine as to the following: (a) Does the Veteran currently suffer a radiculopathy disability of the right lower extremity, to include any peripheral neuropathy or paresthesias? (b) Is it at least at least as likely as not (50 percent probability or more) that any radiculopathy disability of the right lower extremity due to his service-connected thoracolumbar spine disability? (c) Is it at least as likely as not (50 percent probability or more) that the any radiculopathy disability of the right lower extremity is aggravated by his service-connected thoracolumbar spine disability? "Aggravation" is defined as any worsening beyond the natural progression of the disability. In offering any opinion, the examiner must consider the full record, to include the lay statements regarding in-service incurrence, and the opinion should reflect such consideration. A clearly-stated rationale for any opinion offered should be provided and must not be based solely on the lack of any in-service records. If the examiner is unable to provide an opinion without resort to speculation, he or she should explain whether the inability is due to the limits of the examiner's medical knowledge, medical knowledge in general or there is evidence that, if obtained, would permit the opinion to be provided. 3. Schedule the Veteran for a VA examination with an appropriate examiner to determine the current severity of his thoracolumbar disability. The examiner should discuss all findings in terms of the General Rating Formula for Diseases and Injuries of the Spine, Diagnostic code 5243. The pertinent rating criteria must be provided to the examiner, and the findings reported must be sufficiently complete to allow for a rating under all alternate criteria. The examiner should further determine whether any thoracolumbar disability is manifested by weakened movement, excess fatigability, incoordination, flare-ups, or pain. If feasible, the examiner must assess the additional functional impairment on repeated use or during flare-ups in terms of the degree of additional range of motion loss, using lay observations specifically elicited from the Veteran for each disability. The examiner should also determine whether the Veteran's additional impairment on flare-ups or repetitive use is the functional equivalent of ankylosis of thoracolumbar or entire spine. In offering any opinion, the examiner must consider the full record, to include the lay statements regarding symptoms and the opinion should note that consideration. A clearly stated rationale must be provided for any opinion offered. JENNIFER HWA Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Negron, 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.