Citation Nr: 22015176 Decision Date: 03/16/22 Archive Date: 03/16/22 DOCKET NO. 17-61 497 DATE: March 16, 2022 ORDER As new and material evidence has been received, the claim for service connection for tinnitus is reopened; to this extent only, the appeal is granted. As new and material evidence has been received, the claim for service connection for a right knee condition is reopened; to this extent only, the appeal is granted. As new and material evidence has been received, the claim for service connection for osteoporosis of the skull as secondary to hyperparathyroidism is reopened; to this extent only, the appeal is granted. The application to reopen a previously denied claim of entitlement to service connection for tuberculosis is denied. The application to reopen a previously denied claim of entitlement to service connection for thoracic outlet syndrome is denied. Service connection for tinnitus is granted. Service connection for a left hand/arm condition, diagnosed as left sided median and ulnar sensory neuropathy, is granted. Service connection for residuals of pilonidal cyst is granted. REMANDED Entitlement to service connection for a right knee condition is remanded. Entitlement to service connection for a left shoulder condition is remanded. Entitlement to service connection for a neck condition is remanded. Entitlement to service connection for a sleep disorder is remanded. Entitlement to service connection for headaches is remanded. Entitlement to service connection for osteoporosis of the skull is remanded. Entitlement to service connection for a thyroid condition, to include hyperparathyroidism, is remanded. Entitlement to a rating in excess of 10 percent prior to March 25, 2015 for dermatitis is remanded. Entitlement to a rating in excess of 30 percent from March 25, 2015 for dermatitis is remanded. Entitlement to a rating in excess of 10 percent for benign positional vertigo is remanded. FINDINGS OF FACT 1. The Veteran's claims for service connection for tinnitus, a right knee condition, and osteoporosis of the skull secondary to hyperparathyroidism were previously denied by a May 1997 rating decision; the Veteran did not appeal the decision and documentation constituting new and material evidence was not actually or constructively received within the one-year appeal period. 2. Additional evidence received since the May 1997 rating decision is not cumulative or redundant of the evidence of record at the time of that decision, relates to unestablished facts necessary to substantiate the claims for service connection for tinnitus, a right knee condition, and osteoporosis of the skull secondary to hyperparathyroidism, and raises a reasonable possibility of substantiating the claims. 3. The Veteran's claim for service connection for tuberculosis was previously denied by a February 1999 rating decision; the Veteran did not appeal the decision and documentation constituting new and material evidence was not actually or constructively received within the one-year appeal period. 4. Additional evidence received since the February 1999 rating decision is cumulative or redundant of the evidence of record at the time of that decision and does not raise a reasonable possibility of substantiating the claim for service connection for tuberculosis. 5. The Veteran's claim for service connection for thoracic outlet syndrome was most recently denied by a May 2013 rating decision; the Veteran did not appeal the decision and documentation constituting new and material evidence was not actually or constructively received within the one-year appeal period. 6. Additional evidence received since the May 2013 rating decision is cumulative or redundant of the evidence of record at the time of that decision and does not raise a reasonable possibility of substantiating the claim for service connection for thoracic outlet syndrome. 7. The evidence is in approximate balance as to whether the Veteran's current tinnitus started in service and has continued since service. 8. The evidence is in approximate balance as to whether symptoms of a chronic disease of neuropathy of the left upper extremity, currently diagnosed as left sided median and ulnar sensory neuropathy, were noted in service with continuity of symptomatology thereafter. 9. The Veteran's scar residuals of pilonidal cyst began during active service. CONCLUSIONS OF LAW 1. The May 1997 rating decision denying service connection for tinnitus, a right knee condition, and osteoporosis of the skull secondary to hyperparathyroidism is final. 38 U.S.C. § 7105 (2012); 38 C.F.R. §§ 3.104, 3.156, 19.20, 19.21, 19.52, 20.1103 (2021). 2. Evidence received since the May 1997 rating decision is new and material to reopen the claims for service connection for tinnitus, a right knee condition, and osteoporosis of the skull secondary to hyperparathyroidism. 38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156 (2021). 3. The February 1999 rating decision denying service connection for tuberculosis is final. 38 U.S.C. § 7105 (2012); 38 C.F.R. §§ 3.104, 3.156, 19.20, 19.21, 19.52, 20.1103 (2021). 4. Evidence received since the February 1999 rating decision is not new and material, and the criteria for reopening of the claim for entitlement to service connection for tuberculosis are not met. 38 U.S.C. § 5108 (2012); 38 C.F.R. § § 3.156 (2021). 5. The May 2013 rating decision denying service connection for thoracic outlet syndrome is final. 38 U.S.C. § 7105 (2012); 38 C.F.R. §§ 3.104, 3.156, 19.20, 19.21, 19.52, 20.1103 (2021). 6. Evidence received since the May 2013 rating decision is not new and material, and the criteria for reopening of the claim for entitlement to service connection for thoracic outlet syndrome are not met. 38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156 (2021). 7. The criteria for service connection for tinnitus are met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2021). 8. The criteria for service connection for a left hand/arm condition, diagnosed as left sided median and ulnar sensory neuropathy, are met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2021). 9. The criteria for service connection for residuals of pilonidal cyst are 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 in the United States Army from December 1965 to December 1967 and December 1974 to July 1983. These matters are before the Board of Veterans' Appeals (Board) on appeal from September 2014 and May 2015 rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO). In a June 2017 rating decision, the Agency of Original Jurisdiction (AOJ) increased the Veteran's rating for his dermatitis to 30 percent effective March 25, 2015. The Veteran testified before the Board at a hearing held by the undersigned in February 2021. A transcript of the hearing is of record. The transcript was provided to the Veteran in January 2022, as requested by the Veteran at the February 2021 hearing. At the hearing, the Veteran was granted a 60-day abeyance period for the submission of additional evidence to support his claims. That period of time has lapsed, and no additional evidence has been received. Hence, the claims will be considered on the basis of the current record. The AOJ has characterized the claims for service connection for headaches, a sleep disorder, and a left shoulder condition as petitions to reopen. These claims were initially denied in a September 2014 rating decision. Following the receipt of a March 2015 VA Form 21-526, Application for Disability Compensation and Related Compensation Benefits, the AOJ issued a rating decision in May 2015 reopening and denying the claims on the merits. In June 2015, the Veteran submitted a VA 21-0958, Notice of Disagreement (NOD) appealing the claims denied in the September 2014 rating decision. Therefore, as the June 2015 NOD was received within the one-year appeal period of the September 2014 rating decision, the September 2014 rating decision did not become final. Accordingly, the headaches, sleep disorder, and left shoulder condition claims are on appeal from the September 2014 rating decision and have been characterized as original claims of service connection as a result. Likewise, the Veteran's petition to reopen his claims of entitlement to service connection for tinnitus and thoracic outlet syndrome and claims for increased ratings for benign positional vertigo and dermatitis were denied in a September 2014 rating decision. Following the receipt of a March 2015 VA Form 21-526, Application for Disability Compensation and Related Compensation Benefits, the AOJ issued a rating decision in May 2015 reopening and denying the Veteran's claims for service connection for tinnitus and thoracic outlet syndrome on the merits. Furthermore, the AOJ denied the Veteran's increased rating claims for his service-connected benign positional vertigo and dermatitis. In June 2015, the Veteran submitted a NOD appealing the claims denied in the September 2014 rating decision. Therefore, as the June 2015 NOD was received within the one-year appeal period of the September 2014 rating decision, the September 2014 rating decision did not become final. Accordingly, the claims in this paragraph are on appeal from the September 2014 rating decision. New and Material Evidence Generally, a claim which has been denied may not thereafter be reopened and allowed based on the same record. 38 U.S.C. §§ 7104, 7105. However, pursuant to 38 U.S.C. § 5108, if new and material evidence is presented or secured with respect to a claim which has been disallowed, the VA Secretary shall reopen the claim and review the former disposition of the claim. New evidence is defined as existing evidence not previously submitted to agency decision makers. Material evidence is defined as existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. 38 C.F.R. § 3.156(a). New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. Id. In determining whether evidence is "new and material," the credibility of the new evidence must be presumed. Fortuck v. Principi, 17 Vet. App. 173, 179-80 (2003); Justus v. Principi, 3 Vet. App. 510, 513 (1992). The threshold for determining whether new and material evidence raises a reasonable possibility of substantiating a claim is "low." See Shade v. Shinseki, 24 Vet. App. 110, 117 (2010). Furthermore, in determining whether this low threshold is met, VA should not limit its consideration to whether the newly received evidence relates specifically to the reason why the claim was last denied, but instead should ask whether the evidence could reasonably substantiate the claim were the claim to be reopened, either by triggering the VA Secretary's duty to assist or through consideration of an alternative theory of entitlement. Shade, 24 Vet. App. at 118. Regardless of the AOJ's determination as to whether new and material evidence has been received, the Board must address the issue of the receipt of new and material evidence in the first instance because it determines the Board's jurisdiction to reach the underlying claim and to adjudicate the claim de novo. See Woehlaert v. Nicholson, 21 Vet. App. 456, 460-61 (2007) (citing Barnett v. Brown, 83 F.3d 1380, 1383 (Fed. Cir. 1996). If the Board determines that the evidence submitted is both new and material, it must reopen the case and evaluate the claim in light of all the evidence. Justus, 3 Vet. App. at 512. Such evidence is presumed to be credible for the purpose of determining whether the case should be reopened; once the case is reopened, the presumption as to the credibility no longer applies. Id. at 513. 1. New and material evidence having been received, the claim for service connection for tinnitus is reopened. A claim for service connection for tinnitus was previously denied in a May 1997 rating decision. The AOJ denied the claim on the basis of the Veteran's tinnitus not occurring in or being related to service. The Veteran did not appeal the May 1997 rating decision, nor was any new and material evidence actually or constructively received within a year following the decision; therefore, the decision became final. 38 U.S.C. § 7105(c); 38 C.F.R. §§ 3.104, 3.156, 19.20, 19.21, 19.52, 20.1103. The Veteran's petition currently before the Board to reopen his claim for tinnitus was received by the AOJ in June 2014. The AOJ granted the Veteran's petition to reopen his previously denied claim and denied the claim on the merits in a September 2014 rating decision. Although the AOJ reopened the claim in the September 2014 decision, the Board must independently consider the question of whether new and material evidence has been received because it goes to the Board's jurisdiction to reach the underlying claim and adjudicate the claim de novo. See Jackson v. Principi, 265 F.3d 1366 (Fed. Cir. 2001); Barnett, 83 F.3d at 1384. The Board finds the Veteran has submitted new and material evidence since the May 1997 rating decision denying service connection for tinnitus. The Veteran stated at his February 2021 Board hearing that he began having ringing in his ears after his first vertigo incident, which was during his military service. See February 2021 Board Hearing Transcript, at 17. The evidence of the Veteran's tinnitus beginning during his active service was not before adjudicators when the Veteran's claim was last denied in May 1997, and the evidence is not cumulative or redundant of the evidence of record at the time of that decision. The evidence also relates to an unestablished fact necessary to substantiate the claim for service connection for tinnitus and raises a reasonable possibility of substantiating the claim. Accordingly, the claim is reopened. 2. New and material evidence having been received, the claim for service connection for a right knee condition is reopened. A claim for service connection for a right knee condition was previously denied in a May 1997 rating decision. The AOJ denied the claim on the basis of the Veteran not having a current right knee disability. The Veteran did not appeal the May 1997 rating decision, nor was any new and material evidence actually or constructively received within a year following the decision; therefore, the decision became final. 38 U.S.C. § 7105(c); 38 C.F.R. §§ 3.104, 3.156, 19.20, 19.21, 19.52, 20.1103. The Veteran's petition currently before the Board to reopen his claim for a right knee condition was received by the AOJ in March 2015. In a March 2015 rating decision and September 2017 statement of the case, the AOJ denied the Veteran's petition to reopen his previously denied claim of entitlement to service connection for a right knee condition. The Board finds the Veteran has submitted new and material evidence since the May 1997 rating decision denying service connection for a right knee condition. The Veteran stated at his February 2021 Board hearing that he has had symptoms of a right knee condition, including stiffness, since he hit his knee on a truck tailgate during his service. See February 2021 Board Hearing Transcript, at 13-15. Furthermore, the Veteran stated he takes aspirin for his right knee symptoms. Id. at 14. This evidence illustrates that the Veteran's right knee stiffness may cause functional impairment of earning capacity. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018) (if pain alone results in functional impairment, even if there is no identified underlying diagnosis, such pain can constitute a disability); see also Wait v. Wilkie, 33 Vet. App. 8 (2020) (to establish the presence of a disability pursuant to Saunders, there must be competent evidence specific to the claimant tending to show that his or her impairment rises to a level to affect earning capacity). The evidence that the Veteran's stiffness may cause functional impairment of earning capacity was not before adjudicators when the Veteran's claim was last denied in May 1997, and the evidence is not cumulative or redundant of the evidence of record at the time of that decision. The evidence also relates to an unestablished fact necessary to substantiate the claim for service connection for a right knee condition and raises a reasonable possibility of substantiating the claim. Accordingly, the claim is reopened. 3. New and material evidence having been received, the claim for service connection for osteoporosis of the skull secondary to hyperparathyroidism is reopened. A claim for service connection for osteoporosis of the skull secondary to hyperparathyroidism was previously denied in a May 1997 rating decision. The AOJ denied the claim on the basis of the Veteran not having a current disability of osteoporosis of the skull or hyperparathyroidism. The Veteran did not appeal the May 1997 rating decision, nor was any new and material evidence actually or constructively received within a year following the decision; therefore, the decision became final. 38 U.S.C. § 7105(c); 38 C.F.R. §§ 3.104, 3.156, 19.20, 19.21, 19.52, 20.1103. The Veteran's petition currently before the Board to reopen his claim for osteoporosis of the skull secondary to hyperparathyroidism was received by the AOJ in March 2015. In a March 2015 rating decision and September 2017 statement of the case, the AOJ denied the Veteran's petition to reopen his previously denied claim of entitlement to service connection for osteoporosis of the skull secondary to hyperparathyroidism. The Board finds the Veteran has submitted new and material evidence since the May 1997 rating decision denying service connection for osteoporosis of the skull secondary to hyperparathyroidism. The Veteran stated at his February 2021 Board hearing that he was diagnosed with osteoporosis of the skull in service and was told there was not anything he could do for it other than monitor the condition. See February 2021 Board Hearing Transcript, at 8. Furthermore, the Veteran stated that VA treatment providers call his condition "osteoporosis of the skull." Id. at 10. In addition, the Veteran stated that his osteoporosis of the skull stems from bumping his head on communication shelters during his military occupational specialty (MOS) as a lineman. Id. at 9. He also testified that he continued to be monitored for osteoporosis of the skull and for hyperparathyroidism. The evidence of an in-service event and the Veteran continuing to be monitored for osteoporosis of the skull and hyperparathyroidism was not before adjudicators when the Veteran's claim was last denied in May 1997, and the evidence is not cumulative or redundant of the evidence of record at the time of that decision. The evidence also relates to unestablished facts necessary to substantiate the claim for service connection for osteoporosis of the skull secondary to hyperparathyroidism and raises a reasonable possibility of substantiating the claim. Accordingly, the claim is reopened. 4. The application to reopen a previously denied claim of entitlement to service connection for tuberculosis is denied. A claim for service connection for tuberculosis was previously denied in a February 1999 rating decision. The AOJ denied the claim on the basis of the Veteran not having a current tuberculosis disability. The Veteran did not appeal the February 1999 rating decision, nor was any new and material evidence actually or constructively received within a year following the decision; therefore, the decision became final. 38 U.S.C. § 7105(c); 38 C.F.R. §§ 3.104, 3.156, 19.20, 19.21, 19.52, 20.1103. The Veteran's petition currently before the Board to reopen his claim for tuberculosis was received by the AOJ in March 2015. In a March 2015 rating decision and September 2017 statement of the case, the AOJ denied the Veteran's petition to reopen his previously denied claim of entitlement to service connection for tuberculosis. In the Veteran's case, new evidence received since the February 1999 rating decision includes an April 2017 VA treatment record that reflects that chest X-rays show no scarring or evidence of active lung disease. Furthermore, the April 2017 VA treatment record reflects that the Veteran was assured that more treatment or surveillance of potential tuberculosis was unnecessary. Additional new evidence includes the Veteran's testimony at the February 2021 Board hearing that he has no current respiratory problems. See February Board Hearing Transcript, at 24. Furthermore, the Veteran stated that he was diagnosed with tuberculosis in 1976 or 1977 during his active service and was on medications around that time. Id. at 21, 23. The pertinent additional evidence is largely duplicative or cumulative of previously considered evidence, which already revealed the Veteran's history of tuberculosis during service. The Board finds that while some of the evidence added to the record is new, as VA did not previously consider it, it is not material because it does not demonstrate a current diagnosis of active tuberculosis, which was the basis for the previous denial of the claim. Notably, the April 2017 VA treatment record indicates that the Veteran did not have an active lung disease. As such, there is no new evidence that could reasonably substantiate the claim were the claim to be reopened, including by triggering VA's duty to assist or by raising an alternative theory of entitlement. Thus, the evidence, by itself or when considered in conjunction with the evidence previously of record, is not new and material. Therefore, reopening of the claim for service connection for tuberculosis is not warranted. The benefit-of-the-doubt doctrine is not applicable to applications to reopen a claim unless the threshold burden of submitting new and material evidence has been met. Annoni v. Brown, 5 Vet. App. 463, 467 (1993). 5. The application to reopen a previously denied claim of entitlement to service connection for thoracic outlet syndrome is denied. A claim for service connection for thoracic outlet syndrome was most recently denied in a May 2013 rating decision. The AOJ denied the claim on the basis that the Veteran had not submitted new and material evidence to reopen a previously denied claim that was originally denied on the basis of the Veteran's thoracic outlet syndrome not being secondary to cervical ribs. See September 1995 Rating Decision. The Veteran did not appeal the May 2013 rating decision, nor was any new and material evidence actually or constructively received within a year following the decision; therefore, the decision became final. 38 U.S.C. § 7105(c); 38 C.F.R. §§ 3.104, 3.156, 19.20, 19.21, 19.52, 20.1103. The Veteran's petition currently before the Board to reopen his claim for thoracic outlet syndrome was received by the AOJ in June 2014. The AOJ granted the Veteran's petition to reopen his previously denied claim and denied the claim on the merits in a September 2014 rating decision. Although the AOJ reopened the claim in the September 2014 decision, the Board must independently consider the question of whether new and material evidence has been received because it goes to the Board's jurisdiction to reach the underlying claim and adjudicate the claim de novo. See Jackson, 265 F.3d 1366; Barnett, 83 F.3d at 1384. In the Veteran's case, new evidence received since the May 2013 rating decision includes VA treatment records showing continued diagnoses, including in May 2016, February 2017, and August 2017, of thoracic outlet syndrome. The VA records also show diagnostic evidence, including a January 2016 electromyography (EMG), a March 2017 electroencephalogram (EEG), and a September 2017 thoracic outlet syndrome study, that the Veteran does not have a thoracic outlet syndrome disability. Additional new evidence includes the Veteran's testimony at the February 2021 Board hearing that he was diagnosed with thoracic outlet syndrome when he got out of the military. See February Board Hearing Transcript, at 12. Irrespective of the conflicting evidence noted above regarding whether the Veteran has a current thoracic outlet syndrome disability, continued diagnoses of thoracic outlet syndrome since the May 2013 rating decision do not relate to an unestablished fact necessary to substantiate the merits of the claim as it was determined prior to the initial September 1995 rating decision that the Veteran had a diagnosis of thoracic outlet syndrome. The continued evidence of a current thoracic outlet syndrome disability is essentially cumulative of the evidence of record at the time of the May 2013 rating decision, which denied the Veteran's petition to reopen based on the evidence not being new and material. Furthermore, the evidence added to the file since the May 2013 rating decision does not indicate that the Veteran's thoracic outlet syndrome was incurred in service. Notably, the Veteran stated at his Board hearing that he was diagnosed with thoracic outlet syndrome when he exited service, and he stated the record has "mysteriously disappeared." See February 2021 Board Hearing Transcript, at 12. However, a review of the record illustrates that the Veteran's July 1983 separation examination is in the record, and the examination contains no diagnosis of thoracic outlet syndrome. In addition, the new evidence does not indicate that there is a nexus between any current thoracic outlet syndrome disability and his service or that any service-connected disability has caused or aggravated his thoracic outlet syndrome. There has not been a positive medical opinion submitted indicating any relationship to the Veteran's service or a service-connected disability. As such, there is no new evidence that could reasonably substantiate the claim were the claim to be reopened, including by triggering VA's duty to assist or by raising an alternative theory of entitlement. Thus, the evidence, by itself or when considered in conjunction with the evidence previously of record, is not new and material. Therefore, reopening of the claim for service connection for thoracic outlet syndrome is not warranted. The benefit-of-the-doubt doctrine is not applicable to applications to reopen a claim unless the threshold burden of submitting new and material evidence has been met. Annoni, 5 Vet. App. at 467. Service Connection Service connection may be granted for disability resulting from disease or injury incurred or aggravated during active military service. 38 U.S.C. §§ 1110, 1131. Generally, service connection requires (1) the existence of a present disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Certain chronic diseases (e.g., tinnitus and peripheral nerve conditions as organic diseases of the nervous system) may be presumptively service connected if they become manifest to a degree of 10 percent or more within one year of leaving qualifying military service. 38 C.F.R. §§ 3.307, 3.309. If a condition listed as a chronic disease in § 3.309(a) is noted during service, but is either shown not to be chronic or the diagnosis could be legitimately questioned, then a showing of continuity of related symptomatology after discharge is required to support the claim. 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F.3d 1331(Fed. Cir. 2013). 1. Service connection for tinnitus is granted. The Veteran and his representative contend the Veteran is entitled to service connection for tinnitus due to in-service noise exposure. See February 2021 Board Hearing Transcript. The Board concludes that the Veteran's tinnitus began during service and has continued since that time. At his February 2021 Board hearing, the Veteran reported that he has ringing in his ears that began during service. Tinnitus is "subjective" as its existence is generally determined by whether or not the Veteran claims to experience it. For VA purposes, tinnitus has been specifically found to be a disorder with symptoms that can be identified through lay observation alone. See Charles v. Principi, 16 Vet. App. 370 (2002). Therefore, the Veteran's statements are competent and credible evidence of a current disability of tinnitus. In addition, the Board finds the Veteran competent and credible with regard to his claim of experiencing symptoms of tinnitus during his active service and the continuity of symptoms since service. The Veteran's service personnel records illustrate the Veteran's MOS was that of a lineman, which poses a high exposure to acoustic trauma. Furthermore, the Veteran reported at his Board hearing that he was exposed to hazardous noise in the form of generators in his MOS as a lineman. See February 2021 Board Hearing, at 17. Therefore, the Board finds that the Veteran's exposure to hazardous noise is consistent with the circumstances of his periods of active duty and is a qualifying "injury" during such service. The Board also finds the Veteran's statements about ringing in his ears beginning during his active duty and continuing since that time to be both competent and credible, as they are consistent with his noise exposure injury. In sum, the Veteran has tinnitus and was exposed to hazardous noise during his active military service. The Board finds the Veteran's statements that he began experiencing tinnitus in service and has been experiencing tinnitus continuously since his discharge from active service to be competent and credible. Therefore, they have significant probative value. Resolving any reasonable doubt in favor of the Veteran, the Board finds that service connection for tinnitus is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 2. Service connection for a left hand/arm condition is granted. The Veteran and his representative contend the Veteran is entitled to service connection for his left hand/arm condition since it is related to his MOS during his service. See February 2021 Board Hearing Transcript, at 12. The Veteran has a current diagnosis of left sided median and ulnar sensory neuropathy as evidenced by a March 2017 EEG. Neuropathy, as a peripheral nerve condition is an enumerated condition under 38 C.F.R. § 3.309(a); Walker, 708 F.3d 1331. A May 1983 service treatment record contains a diagnosis of paresthesia of the left upper extremity and the Veteran reported having parasthesia off and on since 1980. Furthermore, the Veteran's July 1983 separation examination contains a diagnosis of paresthesia of the left hand. In addition, a January 1981 service treatment record reflects that the Veteran reported numbness in his left hand. At the February 2021 hearing, the Veteran testified that his arm and hand condition goes back to when he was in communications in service and that losing feeling in his arm and hand is an ongoing thing since his service. See February 2021 Board Hearing, at 12. The Board finds the Veteran's statements regarding continuity of symptomatology since service to be both competent and credible. As a condition involving paresthesia of the left upper extremity was noted during service, but at the time was not shown to be a chronic disease, and the Veteran has provided competent and credible evidence showing a continuity of symptomatology since service, the Board finds that the evidence is in approximate balance as to whether the Veteran had a neuropathy condition of his left upper extremity in service. Therefore, resolving any reasonable doubt in favor of the Veteran, the Board finds that service connection for a left hand/arm condition, diagnosed as left sided median and ulnar sensory neuropathy, is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 3. Service connection for residuals of pilonidal cyst is granted. The Veteran and his representative contend the Veteran is entitled to service connection for residuals of pilonidal cyst removal during his service. See February 2021 Board Hearing Transcript, at 20-21. The Board concludes that the Veteran has a current disability that is related to an in-service injury. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). A June 2017 VA examination shows the Veteran has a current diagnosis of scar due to pilonidal cyst. The service treatment records show the Veteran had a procedure in March 1977 to remove a pilonidal cyst, and the service treatment records reflect there was a postoperative wound infection following the cystectomy. Thus, the question becomes whether the current disability is related to service. On this question there is a probative opinion in favor of the claim. In June 2017, a VA examiner opined that the Veteran's scar due to pilonidal cystectomy is at least as likely as not related to the Veteran's March 1977 in-service surgery. In support of the opinion, the VA examiner noted that the Veteran's report of his scar beginning in his service is corroborated by documentation in the medical record. Furthermore, the examiner noted that there is no intervening event following the Veteran's separation from service that would be a more likely cause of the Veteran's current condition. Given that the June 2017 VA examiner provided a thorough review of the record, examined the Veteran, that he took into consideration the Veteran's prior medical history and lay statements, and provided a sufficient rationale for the Board to evaluate the claim, the Board gives much probative weight to the VA examiner's opinion. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302 (2008). Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for residual of pilonidal cyst removal is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. REASONS FOR REMAND 1. Entitlement to service connection for a right knee condition is remanded. The Board cannot make a fully-informed decision on the issue of entitlement to service connection for a right knee condition as it is unclear from the record whether the Veteran has a right knee condition that causes functional impairment of earning capacity that is related to his service, to include a November 1967 in-service incident where the Veteran suffered trauma to his right knee and/or to his MOS as a lineman. See Saunders, 886 F.3d 1356; see also Wait, 33 Vet. App. 8. Thus, a remand is required to obtain a VA examination as to the nature and etiology of any right knee condition. 2. Entitlement to service connection for a neck condition is remanded. The Board cannot make a fully-informed decision on the issue of entitlement to service connection for a neck condition because no VA examiner has provided an opinion as to whether the Veteran's current neck condition is related to his service, to include the duties of his military occupational specialty as a lineman. Thus, a remand is required to obtain a VA examination as to the nature and etiology of the Veteran's neck condition. 3. Entitlement to service connection for a left shoulder condition is remanded. The Veteran contends he has a left shoulder condition that is related to his duties as a lineman during his service. See February 2021 Board Hearing Transcript, at 11-12. The Board cannot make a fully-informed decision on the issue of entitlement to service connection for a left shoulder condition as it is unclear from the record whether the Veteran has a left shoulder condition that causes functional impairment of earning capacity that is related to his MOS in service. See Saunders, 886 F.3d 1356; see also Wait, 33 Vet. App. 8. Thus, a remand is required to obtain a VA examination as to the nature and etiology of any left shoulder condition. 4. Entitlement to service connection for a sleep disorder is remanded. The Veteran contends he has a sleep disorder that is related to his service-connected skin condition and his now service-connected left sided median and ulnar sensory neuropathy. See February 2021 Board Hearing Transcript, at 22. Specifically, he testified that he cannot sleep because of itching from his skin condition and because of numbness and pain in his left upper extremity. Furthermore, the record reflects that the Veteran reported at August 2004 and March 2015 VA appointments that he is unable to sleep secondary to pain. March and April 2018 VA treatment records reflect that he was undergoing physical therapy with one goal being to address his pain in the left arm in order to sleep better. Thus, a remand is required to obtain a VA examination as to the nature and etiology of any sleep disorder. 5. Entitlement to service connection for headaches is remanded. The Veteran contends he has a headache disability that is related to his duties as a lineman during his service when he would hit his head. See February 2021 Board Hearing Transcript, at 16. The Board cannot make a fully-informed decision on the issue of entitlement to service connection for a headache condition because no VA examiner has provided an opinion as to whether the Veteran has a chronic headache condition that is related to his service, to include the duties of his military occupational specialty as a lineman. Thus, a remand is required to obtain a VA examination as to the nature and etiology of any headache disability. 6. Entitlement to service connection for osteoporosis of the skull is remanded. 7. Entitlement to service connection for a thyroid condition, to include hyperparathyroidism, is remanded. Although the claim seeking service connection for osteoporosis of the skull and for a thyroid condition were previously addressed as a single claim, the Veteran contended at his February 2021 Board hearing that he is claiming that he has a thyroid condition that is a separate disability from the skull condition. Thus, the Board has separated these claims to ensure that they are properly addressed. Additionally, the Board has expanded the reopened claim regarding the thyroid to be for a thyroid condition, to include hyperparathyroidism, to ensure that any thyroid diagnosis is considered. See Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009). The Board acknowledges that an August 1976 X-ray showed osteoporosis of the skull due to hyperparathyroidism or anemia or longterm treatment with steroids. However, the July 1983 separation examination contains no mention of a skull condition or of a thyroid condition. Furthermore, the medical evidence of record after the Veteran's service does not reflect a diagnosis related to the skull or of a thyroid condition. The Board notes that the Veteran reported at his Board hearing that VA is monitoring him for the skull and thyroid condition. As the record is unclear whether the Veteran has a current disability of osteoporosis of the skull or of the thyroid, a VA examination is necessary as to the nature and etiology of any skull and thyroid condition. 8. An increased rating for dermatitis is remanded. 9. An increased rating for benign positional vertigo is remanded. The Veteran most recently underwent a VA examination for his service-connected skin condition and peripheral vestibular condition in June 2017. The record reflects that the symptoms of his conditions have worsened since the June 2017 examination. Regarding his dermatitis, the Veteran indicated at his February 2021 Board hearing that the symptoms of his skin condition have worsened over the years, including that his dermatitis covers more of his body, and he has taken more medications and higher dosages of his medications. Regarding his peripheral vestibular disorder, the June 2017 VA examination report reflects that the Veteran did not take continuous medication for his condition, and the examiner indicated that the record indicates the Veteran's prescription for Meclizine was last filled on September 2, 2015. However, a review of the record, including the Veteran's hearing testimony, indicates that the Veteran still takes Meclizine on a continuous basis. Furthermore, the Veteran's representative indicated at the Board hearing that the Veteran's symptoms of his peripheral vestibular condition have worsened. Given the evidence of worsening of the Veteran's service-connected disabilities since the June 2017 VA examinations and the need for more current findings necessary to rate his dermatitis and peripheral vestibular condition, new examinations are needed. 38 C.F.R. § 3.327(a); Palczewski v. Nicholson, 21 Vet. App. 174, 182 (2007). The matters are REMANDED for the following actions: 1. Obtain any updated VA treatment records from April 2018 to the present. Contact the Veteran and afford him the opportunity to identify or submit any pertinent evidence in support of his claims, to include records of any private treatment. Based on his response, attempt to procure copies of all records which have not been obtained from identified treatment sources. If any of the records requested are unavailable, clearly document the claims file to that effect and notify the Veteran of any inability to obtain these records, in accordance with 38 C.F.R. § 3.159(e). 2. After completing the development requested in item 1, provide the Veteran an appropriate VA examination (or telehealth interview, if an in-person examination is not feasible) for the Veteran's right knee, neck, and left shoulder claims. The electronic claims file must be made available to the examiner for review in connection with the examination. All indicated tests should be conducted, and the reports of any such studies incorporated into the examination reports to be associated with the claims file. After reviewing the claims file, the examiner should address the following: (a.) Right Knee i) Does the Veteran have a diagnosis of any right knee condition or any symptoms that cause functional impairment of earning capacity? ii) For any diagnosed right knee condition/functional impairment of earning capacity, is it at least as likely as not (approximately a 50 percent or greater probability) that such is related or attributable to his military service, to include the November 1967 in-service incident where the Veteran suffered trauma to his right knee and/or to his military occupational specialty as a lineman, which required him to climb poles? (b.) Neck Condition Is it at least as likely as not (approximately a 50 percent or greater probability) that any neck condition is related or attributable to his military service, to include the duties of his military occupational specialty as a lineman? (c.) Left Shoulder Condition i) Does the Veteran have a diagnosis of any left shoulder condition, or any symptoms that cause functional impairment of earning capacity? ii) For any diagnosed left shoulder condition/functional impairment of earning capacity, is it at least as likely as not (approximately a 50 percent or greater probability) that such is related or attributable to his military service, to include the duties of his military occupational specialty as a lineman? iii) Is it at least as likely as not (approximately a 50 percent or greater probability) that any diagnosed left shoulder condition/functional impairment of earning capacity is caused by his service-connected left sided median and ulnar sensory neuropathy? iv) Is it at least as likely as not (approximately a 50 percent or greater probability) that any diagnosed left shoulder condition/functional impairment of earning capacity is aggravated by (i.e., any increase in the severity beyond its natural progression) his service-connected left sided median and ulnar sensory neuropathy? v) If, and only if, it is determined that the Veteran's neck condition is at least as likely as not related to service, is it at least as likely as not (approximately a 50 percent or greater probability) that any diagnosed left shoulder condition/functional impairment of earning capacity is caused by his neck condition? vi) If, and only if, it is determined that the Veteran's neck condition is at least as likely as not related to service, is it at least as likely as not (approximately a 50 percent or greater probability) that any diagnosed left shoulder condition/functional impairment of earning capacity is aggravated by (i.e., any increase in the severity beyond its natural progression) his neck condition? In rendering the opinions for the questions in (a.) through (c.), the examiner is advised that the Veteran is competent to report his symptoms and history and that such reports must be acknowledged and considered in formulating any opinion. The examiner must fully explain the rationale for any opinion, with citation to supporting clinical data/lay statements, as deemed appropriate. If the examiner cannot provide the requested opinion without resorting to speculation, he or she should expressly indicate this and provide supporting rationale as to why an opinion cannot be made without resorting to speculation. 3. After completing the development requested in item 1, provide the Veteran an appropriate VA examination (or telehealth interview, if an in-person examination is not feasible) for the Veteran's sleep disorder, headache, osteoporosis of the skull and hyperparathyroidism claims. The electronic claims file must be made available to the examiner for review in connection with the examination. All indicated tests should be conducted, and the reports of any such studies incorporated into the examination reports to be associated with the claims file. After reviewing the claims file, the examiner should address the following: (a.) Sleep Disorder i) Does the Veteran have a diagnosis of any chronic sleep disorder or any symptoms, including insomnia, that cause functional impairment of earning capacity? ii) For any diagnosed sleep disorder/functional impairment of earning capacity, is it at least as likely as not (approximately a 50 percent or greater probability) that any diagnosed sleep disorder/functional impairment of earning capacity is caused by the Veteran's service-connected dermatitis and/or his service-connected left sided median and ulnar sensory neuropathy? iii) For any diagnosed sleep disorder/functional impairment of earning capacity, is it at least as likely as not (approximately a 50 percent or greater probability) that any diagnosed sleep disorder/functional impairment of earning capacity is aggravated by the Veteran's service-connected dermatitis and/or his service-connected left sided median and ulnar sensory neuropathy? (b.) Headaches i) Does the Veteran have a diagnosis of a chronic headache disability or any symptoms that cause functional impairment of earning capacity? ii) For any diagnosed chronic headache disability/functional impairment of earning capacity, is it at least as likely as not (approximately a 50 percent or greater probability) that such is related or attributable to his military service, to include the duties of his military occupational specialty as a lineman where he struck his head? (c.) Osteoporosis of the Skull i) Does the Veteran have a diagnosis of osteoporosis of the skull or any symptoms that cause functional impairment of earning capacity? In addressing this question, the examiner is requested to consider the August 1976 X-ray that showed osteoporosis of the skull. ii) For any diagnosed osteoporosis of the skull disability/functional impairment of earning capacity, is it at least as likely as not (approximately a 50 percent or greater probability) that such is related or attributable to his military service, to include the duties of his military occupational specialty as a lineman where he struck his head? In rendering the opinions for the questions in (a.) through (c.), the examiner is advised that the Veteran is competent to report his symptoms and history and that such reports must be acknowledged and considered in formulating any opinion. The examiner must fully explain the rationale for any opinion, with citation to supporting clinical data/lay statements, as deemed appropriate. If the examiner cannot provide the requested opinion without resorting to speculation, he or she should expressly indicate this and provide supporting rationale as to why an opinion cannot be made without resorting to speculation. 4. After completing the development requested in item 1, provide the Veteran an appropriate VA examination (or telehealth interview, if an in-person examination is not feasible) for the Veteran's thyroid condition claim. The electronic claims file must be made available to the examiner for review in connection with the examination. All indicated tests should be conducted, and the reports of any such studies incorporated into the examination reports to be associated with the claims file. After reviewing the claims file, the examiner should address the following: (a.) Does the Veteran have a diagnosis of a thyroid condition, to include hyperparathyroidism, or any symptoms that cause functional impairment of earning capacity? In addressing this question, the examiner is requested to consider the August 1976 X-ray of the skull that showed "diffuse salt and pepper appearance which is characteristic of osteoporotic changes due to hyperparathyroidism or anemia or longterm treatment with steroids." (b.) For any diagnosed thyroid disability/functional impairment of earning capacity, is it at least as likely as not (approximately a 50 percent or greater probability) that such is related or attributable to his military service, to include the duties of his military occupational specialty as a lineman where he struck his head? The examiner is advised that the Veteran is competent to report his symptoms and history and that such reports must be acknowledged and considered in formulating any opinion. The examiner must fully explain the rationale for any opinion, with citation to supporting clinical data/lay statements, as deemed appropriate. If the examiner cannot provide the requested opinion without resorting to speculation, he or she should expressly indicate this and provide supporting rationale as to why an opinion cannot be made without resorting to speculation. 5. After completing the development requested in item 1, schedule the Veteran for an appropriate VA examination (or telehealth interview, if an in-person examination is not feasible) to evaluate the severity of the Veteran's dermatitis. The entire claims file should be made available to the examiner in conjunction with this request. All testing deemed necessary to rate a skin disability under the criteria of the rating schedule must be conducted and the results reported in detail. 6. After completing the development requested in item 1, schedule the Veteran for an appropriate VA examination (or telehealth interview, if an in-person examination is not feasible) to evaluate the severity of the Veteran's peripheral vestibular disorder. The entire claims file should be made available to the examiner in conjunction with this request. All testing deemed necessary to rate a peripheral vestibular disorder under the criteria of the rating schedule must be conducted and the results reported in detail. M. SORISIO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board N. Breitbach, 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.