Citation Nr: 23012467 Decision Date: 03/01/23 Archive Date: 03/01/23 DOCKET NO. 18-21 666 DATE: March 1, 2023 ORDER An effective date of October 16, 2012, but not earlier, for service connection for status post bunionectomy, left great toe, is granted. An initial 10 percent rating, but not more, for residual of status post bunionectomy, left great toe, is granted. A 10 percent rating, but not more, for residual of status post bunionectomy, right great toe, is granted. Service connection for anemic iron deficiency is denied. Service connection for bilateral pes cavus is denied. Service connection for bilateral Morton's neuroma is denied. Service connection for residuals of a gonococcal infection of lower genitourinary tract is denied. Service connection for vaginitis is denied. Service connection for restless leg syndrome is denied. REMANDED Service connection for a disability characterized by nosebleed is remanded. Service connection for respiratory disability, claimed as bronchitis, is denied. FINDINGS OF FACT 1. The Veteran was originally denied service connection for status post bunionectomy, left great toe, in an unappealed March 2006 rating decision. 2. The Veteran filed a claim to reopen the issue of service connection for status post bunionectomy, left great toe, on October 16, 2012, which was denied in a July 2013 rating decision due to lack of a current disability. 3. Within one year of the July 2013 rating decision, VA obtained new and material evidence showing current findings of status post bunionectomy, left great toe; ultimately, VA obtained a positive medical nexus opinion linking the Veteran's current disability to her active-duty military service. 4. The evidence is in equipoise as to whether the Veteran's residuals of status post bunionectomy, bilateral great toes, included resection of metatarsal head. 5. The Veteran's anemic iron deficiency was not manifested in service or within one year following her separation from service and is not shown to be related to her service. 6. The evidence of record persuasively weighs against finding that the Veteran has had bilateral pes cavus and/or Morton's neuroma at any time during or approximate to the pendency of the claim. 7. The evidence of record persuasively weighs against finding that the Veteran has had residuals of a gonococcal infection of lower genitourinary tract and/or vaginitis at any time during or approximate to the pendency of the claim. 8. The evidence of record persuasively weighs against finding that the Veteran has had restless leg syndrome at any time during or approximate to the pendency of the claim. CONCLUSIONS OF LAW 1. The criteria for an effective date of October 16, 2012, but not earlier, for service connection for status post bunionectomy, left great toe, have been met. 38 U.S.C. §§ 5107, 5110(a); 38 C.F.R. §§ 3.102, 3.400. 2. The criteria for an initial 10 percent rating, but not more, for residual of status post bunionectomy, left great toe, are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.118, Diagnostic Code 7805. 3. The criteria for a 10 percent rating, but not more, for residual of status post bunionectomy, right great toe, are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.118, Diagnostic Code 7805. 4. The criteria for service connection for anemic iron deficiency are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 5. The criteria for service connection for bilateral pes cavus are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 6. The criteria for service connection for bilateral Morton's neuroma are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 7. The criteria for service connection for residuals of a gonococcal infection of lower genitourinary tract are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 8. The criteria for service connection for vaginitis are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 9. The criteria for service connection for restless leg syndrome are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 2000 to September 2005. This matter comes to the Board of Veterans' Appeals (Board) on appeal from an October 2015 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). During the pendency of this appeal, the Veteran was granted service connection for bilateral dry eye syndrome, originally claimed as photophobia. This is a full grant with regard to the Veteran's photophobia claim and it is no longer before the Board. Earlier Effective Date 1. An earlier effective date for service connection for status post bunionectomy, left great toe The Veteran is seeking an effective date earlier than January 21, 2015, for the award of service connection for status post bunionectomy, left great toe. Unless specifically provided otherwise in Chapter 51 of Title 38 of the U.S. Code, the effective date of an award based on an original claim, a claim reopened after final adjudication, or a claim for increase, of compensation, dependency and indemnity compensation, or pension, shall be fixed in accordance with the facts found, but shall not be earlier than the date of receipt of application therefor. 38 U.S.C. § 5110 (a). Generally, the effective date of an award of service connection is the date of separation from service if the claim is received within one year of separation; otherwise, the date of receipt of claim or the date entitlement arose, whichever is later. 38 C.F.R. § 3.400 (b)(2). The Veteran separated from active duty service in September 2005. She filed a claim for bunions and hammertoes in August 2005, prior to her separation. She was scheduled for a VA foot examination in October 2005, but failed to report for that examination. In a March 2006 letter, VA asked the Veteran to notify VA if she was now ready to report for an examination and to inform VA if she had good cause that prevented her from reporting for her examination or future examination. See 38 C.F.R. § 3.655. The Veteran did not respond to that letter and service connection for bilateral bunionectomy surgery was denied in a March 2006 rating decision. The Veteran did not appeal that rating decision or submit new and material evidence within one year of its issuance and it became final. See 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. The Veteran's claim to reopen was received by the RO on October 16, 2012. A February 2013 VA examination showed diagnoses of right foot bunionectomy and left foot hammertoe. In a July 2013 rating decision, service connection was awarded for residuals of a right great toe bunionectomy and left second toe hammertoe, but denied for the left great toe bunionectomy, finding that no current left toe diagnosis was shown. The Veteran did not appeal this rating decision. Nevertheless, new and material evidence was received within one year of its issuance. Specifically, VA treatment records showed diagnoses included bilateral status post bunionectomies and the May 2014 VA foot disability benefits questionnaire (DBQ) note post-surgical hallux valgus (bunions) bilaterally. As the July 2013 rating decision had denied service connection based on a lack of current diagnosis, this new evidence is material and prevents finality of that rating decision with regard to the issue of service connection for left great toe bunionectomy. Thus, the relevant date of claim is October 16, 2012. The question then becomes when entitlement to service connection for left great toe bunionectomy arose. Here, the record supports a finding that entitlement to service connection arose prior to October 2012. The July 2015 VA medical opinion found that the Veteran's left foot bunionectomy and edema were at least as likely as not incurred in or caused by her active duty military service, noting that there was evidence of an in-service onset of this condition and evidence of current, chronic, and continuous care. The record clearly establishes that the Veteran had left foot bunionectomy in service and her reports of residual symptoms predated the October 2012 claim. Indeed, the Veteran initially sought compensation for this during service, but failed to appeal the initial denial, allowing it to become final. Again, the effective date of an award of service connection is the date of receipt of claim or the date entitlement arose, whichever is later. 38 C.F.R. § 3.400 (b)(2). As the relationship between the Veteran's status post bunionectomy, left great toe, to her active-duty service predated the October 2012 claim, the date of that claim shall become the effective date of service connection. Therefore, the Board concludes that the greater weight of evidence indicates the Veteran is entitled to an effective date of October 16, 2012, but no earlier, for the grant of service connection for status post bunionectomy, left great toe. Increased Rating 1. An increased initial rating for residual of status post bunionectomy, left great toe The Veteran was originally granted service connection for residuals of bunionectomy of the left great toe in the October 2015 rating decision on appeal. At that time, this disability was assigned a noncompensable (0 percent) rating effective January 21, 2015. As explained above, this effective date has been changed to October 16, 2012. The Veteran has appealed this initial rating. The Veteran's residuals of bunionectomy of the left great toe are rated under 38 C.F.R. § 4.71a, Diagnostic Code 5280, for unilateral hallux valgus. Under Diagnostic Code 5280, a maximum 10 percent rating is warranted for unilateral hallux valgus severe, if equivalent to amputation of great toe. A maximum 10 percent rating is also warranted for unilateral hallux valgus operated with resection of metatarsal head. 38 C.F.R. § 4.71a, Diagnostic Code 5280. She is also service connected for residual scar under 38 C.F.R. § 4.118, Diagnostic Code 7805. The intent of the Rating Schedule is to recognize actually painful, unstable or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint, even in the absence of arthritis, to include in situations where the disability at issue is not evaluated based on range of motion measurements. 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1, 5 (2011); Southall-Norman v. McDonald, 28 Vet. App. 346 (2016). The February 2013 foot conditions DBQ only diagnosed right foot bunionectomy and left foot hammertoe. Thesee conditions are now separately service-connected. VA treatment records from February 2014 to May 2014 show the Veteran's report of painful right foot plantar callus that developed after bunion surgery, numbness in the feet, and coldness with pale discoloration of skin. Physical examination found light touch sensation intact, slightly diminished dorsalis pedis pulse and posterior tibial pulse, full muscle power, range of motion of the ankle and toe joints within normal limits, mild crepitus in the joints of the bilateral great toes, bunionectomy scars, left hammertoe scars, flexible hammertoes on the right, corns and calluses, an intractable plantar keratosis on the right, atrophic skin changes. No gross obvious pale changes were seen on exam. Her diagnoses included bilateral status post bunionectomies, left status post hammertoe secondary to correction, bilateral right submetatarsal 5 intractable plantar keratosis, and Raynaud's phenomenon. A May 2014 record notes that the Veteran had failed conservative treatment such as shoe gear modification, orthoses, and frequent pairing of hyperkeratoses. The May 2014 foot conditions DBQ diagnosed bilateral post-surgical hallux valgus and bilateral hammertoes. The Veteran reported painful callouses on the bottom of both feet, foot cramps that spontaneously resolved, and pain walking long distances due to the callouses. She was being watched by podiatry for left bunion regrowth. She used custom orthotic inserts and wore a brace at night. She did not report flare-ups or functional loss or impairment related to her foot disabilities. The Veteran had mild or moderate symptoms of bilateral post-surgical hallux valgus. This surgery did not include metatarsal head resection. On examination, the Veteran had subjective pain in both feet. This examiner found less movement than normal on the left, pain on weight-bearing on the right, and deformity bilaterally. There was no pain, weakness, fatigability, or incoordination that significantly limited the functional ability of either foot during flare-ups or when the foot was used repeatedly over time. There was no other functional loss of either foot during flare-ups or when the foot was used repeatedly over time. The Veteran has associated scars, but these were small (measuring 4 cm by 1.5 cm), stable, and not painful. she used a brace at night to decrease foot cramping and custom inserts to decrease pain. The Veteran's foot conditions did not result in functional impairment of an extremity such that no other function remained other than that which would be equally well served by an amputation with prosthesis. Imaging studies did not confirm arthritis. These foot disabilities did not impact the Veteran's ability to work. The November 2014 foot conditions DBQ was limited to a discussion of her status post right foot fifth metatarsal osteotomy with residual recurring callus. The July 2015 VA foot DBQ shows current symptoms of chronic daily bilateral foot pain that was better with rest and worse with sitting, standing, running, and walking. She had a history of hammertoe with deformity. She also reported calluses, dry scaly feet, and daily edema in the morning. The Veteran also reported moderate flare ups occurring at least once per year, but less than once every three month and lasting less than five weeks. The Veteran had mild or moderate symptoms of bilateral post-surgical hallux valgus. This examiner described the Veteran's surgery as equivalent to metatarsal head resection. On examination, the Veteran had physical pain in the bilateral feet, which contributed to functional loss. This bilateral functional loss included less movement than normal, excess fatigability, pain on movement, pain on weight-bearing, pain on non-weight-bearing, swelling, deformity, interference with sitting, and interference with standing. She also had a limp with weight-nearing to the right foot related to right foot hammertoe correction in June 2015. The Veteran did not use an assistive device as a normal mode of locomotion. Her foot conditions did not result in functional impairment of an extremity such that no other function remained other than that which would be equally well served by an amputation with prosthesis. Imaging studies confirmed bilateral arthritis. Functionally, the Veteran's foot conditions rendered her unable to sit, walk, run, or stand for prolonged periods of time without pain. She reported sore incisions, edema, numbness and tingling at the surgical site (left), and pain. her associated scars measured 4 cm by.1 cm on the right foot and 5 cm by.1 cm on the left foot. They were both healed, stable, and non-painful. A November 2015 VA podiatry note shows status post left hammertoe surgery and bilateral hallux limitus. Here, the record has conflicting evidence regarding whether nature of the Veteran's in-service bunionectomies with the July 2015 examiner finding that they included resection of metatarsal heads while the earlier May 2014 examiner found that they did not. The Board finds that the evidence is at least in equipoise as to whether the Veteran's bunionectomy included resection of metatarsal head. Therefore, the Board finds that a 10 percent rating is warranted for the Veteran's residuals of bunionectomy, left great toe. This is the maximum schedular rating available under diagnostic code 5280. The Board has also considered the other Diagnostic Codes pertaining to the foot. Other disability ratings may be assigned only if the symptomatology for a disability is not duplicative or overlapping with the symptomatology of any other disability. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994); see also Lyles v. Shulkin, 29 Vet. App. 107 (2017). In Scott v. Wilkie, the Federal Circuit expressly adopted the Court's holding that disabilities specifically listed in the rating schedule may only be rated under Diagnostic Codes which specifically pertain to them. Scott v. Wilkie, 920 F.3d 1375 (Fed. Cir. 2019) (citing Copeland v. McDonald, 27 Vet. App. 333, 336 (2015)). The Federal Circuit also expressly adopted the Court's holding that unlisted conditions may be rated by analogy to Diagnostic Codes that may not describe the unlisted disability but addresses disabilities that may be productive of similar symptoms. Scott, 920 F.3d 1375 (citing Yancy v. McDonald, 27 Vet. App. 484, 493 (2016). Finally, the Federal Circuit concluded that the Board must also consider assigning separate ratings under analogous Diagnostic Codes, when rating an unlisted service-connected foot disability exhibiting distinct manifestations, even when service connection has also been granted for one of the eight conditions listed in the rating schedule. Id. Here, the Veteran's underlying disability (hallux valgus, i.e. bunion) is specifically listed under the rating schedule and therefore cannot be rated under a different Diagnostic Code. However, the Veteran does have other service-connected disabilities with distinct manifestations, including Raynaud's phenomenon, residuals of right foot fifth metatarsal osteotomy and callus removal, and hammertoe of the second left toe. These disabilities are separately compensated under diagnostic code 7117, 7819-5283, and 5282 respectively. The Veteran has an associated surgical scar; however, there is no indication that this scar is painful, unstable, or large (more than six square inches). No other functional effects have been attributed to this scar. Thus, a separate compensable rating is not warranted. See 38 C.F.R. § 4.118, DC's 7801, 7802, 7804, 7805. In conclusion, the Board finds that the evidence of record persuasively weighs against a compensable rating for residuals of bunionectomy, left great toe. As the evidence of record persuasively weighs against a compensable rating, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). 2. An increased rating for residual of status post bunionectomy, right great toe The Veteran was originally granted service connection for residuals of bunionectomy of the right great toe in a July 2013 rating decision. At that time, this disability was assigned a noncompensable (0 percent) rating effective October 16, 2012. She filed a claim for an increased rating in March 2014 that was denied in a December 2014 rating decision. The Veteran's current increased rating claim was received on January 21, 2015. The Veteran's residuals of bunionectomy of the right great toe are rated under 38 C.F.R. § 4.71a, Diagnostic Code 5280, for unilateral hallux valgus. Again, the record has conflicting evidence regarding whether nature of the Veteran's in-service bunionectomies with the July 2015 examiner finding that they included resection of metatarsal heads while the earlier May 2014 examiner found that they did not. The Board finds that the evidence is at least in equipoise as to whether the Veteran's bunionectomy included resection of metatarsal head. Therefore, the Board finds that a 10 percent rating is warranted for the Veteran's residuals of bunionectomy, right great toe. This is the maximum schedular rating available under diagnostic code 5280. The Board has also considered the other Diagnostic Codes pertaining to the foot. Here, the Veteran's underlying disability (hallux valgus, i.e. bunion) is specifically listed under the rating schedule and therefore cannot be rated under a different Diagnostic Code. However, the Veteran does have other service-connected disabilities with distinct manifestations, including Raynaud's phenomenon, residuals of right foot fifth metatarsal osteotomy and callus removal, and hammertoe of the second left toe. These disabilities are separately compensated under diagnostic code 7117, 7819-5283, and 5282 respectively. Similarly, the Veteran is separately service-connected for an associated scar and has been assigned a noncompensable rating under diagnostic code 7805. There is no indication that a compensable rating is warranted for this scar as the evidence does not show that it is painful, unstable, or large (more than six square inches). No other functional effects have been attributed to this scar. Thus, a compensable rating is not warranted. See 38 C.F.R. § 4.118, DC's 7801, 7802, 7804, 7805. In conclusion, the Board finds that the evidence of record persuasively weighs against a compensable rating for residuals of bunionectomy, right great toe. As the evidence of record persuasively weighs against a compensable rating, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). Service Connection 1. Service connection for anemic iron deficiency The Veteran contends that she discovered that she had iron deficiency anemia after participating in a blood drive during service. She attributes her reduced tolerance for cold to this condition and treats it with iron supplements. Certain chronic diseases will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). If presumptive service connection is not warranted, service connection for anemic iron deficiency may still be granted on a direct basis. The Veteran is claiming service connection for anemic iron deficiency. Anemia is an enumerated condition under 38 C.F.R. § 3.309(a); Walker, 708 F.3d 1331. While treatment for anemic iron deficiency was noted in service, this condition was not shown as chronic. It did not manifest to a compensable degree within a presumptive period and was not noted in service with attributable continuity of symptomatology. Indeed, the record does not establish a diagnosis of anemic iron deficiency or show decrease hemoglobin levels within one year of the Veteran's separation from service. Furthermore, the medical evidence of record, including the VA treatment records, does not show a current diagnosis of anemic iron deficiency or any similar condition. The March 2018 DBQ noted that current diagnostic laboratory results did not support a diagnosis of anemia. While the Veteran believes she has a current diagnosis of anemic iron deficiency, she is not competent to provide a diagnosis in this case. The Veteran's assertion that she has anemic iron deficiency is based on an incidental finding during a blood drive in service and subjective symptoms she describes as decreased cold tolerance. The Board notes that the Veteran is currently service-connected for Raynaud's phenomenon, characterized by bilateral hand pain, paleness, and shininess during cold months. These symptoms potentially overlap the Veteran's reported symptom of decreased cold tolerance. Thus, the issue is medically complex and the Veteran is not competent to provide a diagnosis, as it requires specialized medical education or knowledge to determine whether the Veteran's subjective symptom of decreased cold tolerance is attributable to anemia, anemic iron deficiency, or any condition other than her service-connected Raynaud's phenomenon. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. The Board has also considered 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. Here, the Veteran has not described any functional impairment associated with her subjective symptoms. Accordingly, the evidence is persuasively against the claim. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and service connection for anemic iron deficiency is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 2. Service connection for bilateral pes cavus 3. Service connection for bilateral Morton's neuroma The Veteran is seeking service connection for bilateral pes cavus (claw foot) and bilateral Morton's neuroma. 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 has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the Veteran does not have a current diagnosis of either pes cavus or Morton's neuroma 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). Her VA treatment records, which include podiatry treatment, do not show a diagnosis of either pes cavus or Morton's neuroma. Likewise, no diagnosis of either pes cavus or Morton's neuroma was given in the February 2013, May 2014, November 2014, or July 2015 VA foot examinations. Moreover, the Veteran has not identified any symptoms attributable to either claimed disability that result in functional impairment. To the extent that the claim itself suggests that the Veteran believes she has current diagnoses of these condition, she is not competent to provide a diagnosis in this case. The Veteran has several other foot and toe diagnoses and has not identified any distinct symptoms that she attributes to either claimed disability. There is no indication that she possesses the specialized medical education or knowledge to differentiate between the symptoms associated with her diagnosed foot conditions and those better attributed to pes cavus or Morton's neuroma. See Jandreau, 492 F.3d 1372, 1377, 1377 n.4. Consequently, the Board gives more probative weight to the competent medical evidence. Accordingly, the evidence is persuasively against the claim. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and service connection for pes cavus and/or Morton's neuroma is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 4. Service connection for residuals of a gonococcal infection of lower genitourinary tract 5. Service connection for vaginitis The Veteran is seeking service connection for residuals of a gonococcal infection of lower genitourinary tract and vaginitis. 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 has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the Veteran does not have a current diagnosis of residuals of a gonococcal infection of lower genitourinary tract and/or vaginitis and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky, 26 Vet. App. 289, 294; McClain, 21 Vet. App. 319, 321. The Veteran's VA treatment records do not show vaginitis or any residuals of gonococcal infection. The February 2018 gynecological conditions DBQ shows a prior diagnosis of gonococcal vulvovaginitis in 2002, which was successfully treatment with no adverse residuals. This is consistent with the service treatment records that show treatment for vaginitis and acute gonococcal infection. At the time of this DBQ, the Veteran reported intermittent moderate pain. In an April 2018 addendum, this examiner clarified that the Veteran's reported pain was most likely related to menstruation as no other cause had been specifically diagnosed, and was not associated in any way with her prior gonorrhea or any residuals thereof, of which she has none. While the Veteran believes she has a current diagnosis of residuals of a gonococcal infection of lower genitourinary tract and/or vaginitis, she is not competent to provide a diagnosis in this case. As noted above, her lone symptom is intermittent pain, which the April 2018 addendum attributes to menstruation. There is no indication that the Veteran possesses the specialized medical education or knowledge to differentiate between the intermittent pain associated with menstruation and those better attributed to residuals of a gonococcal infection of lower genitourinary tract and/or vaginitis. See Jandreau, 492 F.3d 1372, 1377, 1377 n.4. Consequently, the Board gives more probative eight to the competent medical evidence. Accordingly, the evidence is persuasively against the claim. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and service connection for residuals of a gonococcal infection of lower genitourinary tract and/or vaginitis is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 6. Service connection for restless leg syndrome The Veteran is seeking service connection for restless leg syndrome. 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 has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the Veteran does not have a current diagnosis of restless leg syndrome 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). VA treatment records do not show a current diagnosis of restless leg syndrome. The March 2018 central nervous system and neuromuscular disease DBQ did not find any current or previous central nervous system conditions and specifically found no diagnosis of restless leg syndrome. At the time of this examination, the Veteran reported that she had not been diagnosed with or treated for restless leg syndrome and did not have any associated symptoms. Instead, she noted that during an in-service sleep study (which ultimately diagnosed narcolepsy), restless leg syndrome had been ruled out. This is consistent with the October 2003 consultation report in the service treatment records. Accordingly, the evidence is persuasively against the claim. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and service connection for restless leg syndrome is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. REASONS FOR REMAND 1. Service connection for a disability characterized by nosebleed is remanded. The Veteran has a current diagnosis of right nasal polyp with recurrent epistaxis (nosebleed). See March 2018 nose conditions DBQ. Additionally, she reported nocturnal nosebleeds due to dryness in-service. See October 2003 sleep disorders consultation. Recently, she reported occasional episodes of light epistaxis, most notably when she wipes her nose in the morning. See March 2018 nose conditions DBQ. Due to its mild severity, she had not undergone treatment for this condition. See id. The March 2018 VA examiner opined that the Veteran's right nasal polyp with recurrent epistaxis is not at least as likely as not related to an in-service injury, event, or disease, including recurrent nocturnal nosebleeds. This opinion seems to rely on both the Veteran's in-service statement that her nosebleeds were related to dryness and the lack of any in-service finding of nasal polyp. In doing so, the examiner appears to presume the absence of a nasal polyp during service based on the Veteran's assertion that her nosebleeds were related to dryness and her failure to pursue treatment for them. The record does not suggest that the Veteran has any specialized medical knowledge. Therefore, deference to her in-service assumption that her nosebleeds were related to dryness is not warranted. An addendum opinion is necessary to address whether these in-service nosebleeds, which are described as occasional mild nocturnal nosebleeds, suggest an in-service onset of nasal polyp. 2. Service connection for a respiratory disability is remanded. The Veteran has a current diagnosis of chronic obstructive pulmonary disease (COPD). See March 2018 respiratory conditions DBQ. Service treatment records show that the Veteran was seen for bronchitis in service but does not establish whether this was acute or chronic bronchitis. Additionally, she reported an in-service onset of symptoms consistent with bronchitis, including recurrent cough and mild phlegm production, which she attributed to regular cigarette smoking. See March 2018 respiratory conditions DBQ. She had not undergone treatment for this condition. See id. The March 2018 VA examiner opined that the Veteran's COPD is not at least as likely as not related to an in-service injury, event, or disease, including bronchitis. The rationale was that chronic bronchitis was not established in service and the Veteran's current pulmonary function testing and diagnostic imaging support a diagnosis of COPD; therefore, there was insufficient evidence to support that COPD is a continuation of the bronchitis documented in service. The Board finds that the medical opinion is inadequate for adjudication of this claim as it is not supported by a detailed rationale, but merely a conclusory statement. As such, a remand is warranted to obtain an adequate medical opinion for her respiratory disability. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding whether it is at least as likely as not that the Veteran's current right nasal polyp with recurrent epistaxis began in service or is otherwise related to her in-service complaints of occasional mild nocturnal nosebleeds. (Continued on the next page) 2. Obtain an addendum opinion from an appropriate clinician regarding whether it is at least as likely as not that the Veteran's current respiratory disability, diagnosed as COPD, began in service or is otherwise related to her in-service bronchitis and/or her complaints of recurrent cough and mild phlegm production since service. 3. Finally, readjudicate the claim on appeal. If any benefit sought on appeal remains denied, then furnish the Veteran and her representative with a supplemental statement of the case and allow them an opportunity to respond. JIMMY L. BARDIN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Houbeck 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.