Citation Nr: A25035204 Decision Date: 04/16/25 Archive Date: 04/16/25 DOCKET NO. 210714-173649 DATE: April 16, 2025 ORDER Entitlement to a rating greater than 10 percent for painful scar post right inguinal hernia repair is denied. Entitlement to service connection for depression is denied. Entitlement to service connection for right side hernia is denied. Entitlement to a rating greater than 50 percent for tension headaches and migraines has been withdrawn. REMANDED Entitlement to service connection for right shoulder condition is remanded. Entitlement to service connection for left shoulder condition is remanded. Entitlement to service connection for right ankle condition is remanded. Entitlement to service connection for left knee condition is remanded. Entitlement to service connection for sleep apnea is remanded. FINDINGS OF FACT 1. Throughout the period on appeal, the Veteran has one right inguinal scar that is painful. The Veteran's right inguinal scar is not associated with underlying soft tissue damage and covers an area less than 929 square centimeters. It has not resulted in any limitation of motion or other functional deficits at any point during the period on appeal. 2. At no time during the pendency of the claim does the Veteran have current diagnoses of depression and the record does not contain a recent diagnosis of disability prior to the Veteran's filing of the claim. 3. At no time during the pendency of the claim does the Veteran have current diagnoses of right-side hernia and the record does not contain a recent diagnosis of disability prior to the Veteran's filing of the claim. 4. On December 18, 2024, prior to the promulgation of a decision in the appeal, the Board received notification from the appellant, through his representative, that he wished to withdraw the claim of entitlement to a rating greater than 50 percent for headaches. CONCLUSIONS OF LAW 1. The criteria for entitlement to a rating greater than 10 percent for painful scar post right inguinal hernia are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.14, 4.118, Diagnostic Code (DC) 7804. 2. The criteria for service connection for depression are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for service connection for right-side hernia are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for withdrawal of entitlement to a rating greater than 50 percent for tension headaches and migraines by the appellant are met. 38 U.S.C. § 7105; 38 C.F.R. § 20.205. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from August 1970 to October 1993. These matters come before the Board of Veterans' Appeals (Board) on appeal from a December 2020 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In the July 14, 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on December 18, 2024. Therefore, the Board may only consider the evidence of record at the time of the December 2020 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801. If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. However, because the Board is remanding the claims of entitlement to service connection for right shoulder condition, left shoulder condition, right ankle condition, left knee condition, and sleep apnea, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii). INCREASED RATING The Veteran seeks entitlement to a rating in excess of 10 percent for a painful scar, post-right inguinal hernia. Specifically, the Veteran testified at his Board hearing that he had sensitive tissue, limited range of motion, and discomfort related to his scar. See Board hearing transcript, December 18, 2024. Disability evaluations are determined by evaluating the extent to which a veteran's service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Reasonable doubt as to the degree of disability will be resolved in the veteran's favor. 38 C.F.R. § 4.3. It is permissible to switch diagnostic codes to reflect more accurately a claimant's current symptoms. See Read v. Shinseki, 651 F. 3d 1296, 1302 (Fed. Cir. 2011). Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Although a rating specialist is directed to review the recorded history of a disability in order to make a more accurate evaluation, see 38 C.F.R. § 4.2, the regulations do not give past medical reports precedence over current findings. Francisco v. Brown, 7 Vet. App. 55 (1994). Pertinent regulations do not require that all cases show all findings specified by the Rating Schedule, but that findings sufficiently characteristic to identify the disease and the resulting disability and above all, coordination of rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21. Therefore, the Board has considered the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the veteran, as well as the entire history of the veteran's disability in reaching its decision. Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). Separate ratings can be assigned for separate periods based on the facts found - a practice known as "staged" ratings. Francisco v. Brown, 7 Vet. App. 55, 58 (1994); Hart v. Mansfield, 21 Vet. App. 505 (2007). Staged ratings are appropriate whenever the factual findings show distinct periods where the service-connected disability exhibits symptoms that would warrant different ratings. Id. In general, all disabilities, including those arising from a single disease entity, are rated separately, and all disability ratings are then combined in accordance with 38 C.F.R. § 4.25. Pyramiding, the evaluation of the same disability, or the same manifestation of a disability, under different diagnostic codes, is to be avoided when rating a veteran's service-connected disability. 38 C.F.R. § 4.14. It is possible for a veteran to have separate and distinct manifestations from the same injury which would permit rating under several diagnostic codes, however, the critical element in permitting the assignment of several ratings under various diagnostic codes is that none of the symptomatology for any one of the conditions is duplicative or overlapping with the symptomatology of the other condition. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). The basis of disability evaluation is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. The veteran is competent to report symptoms and experiences observable by his senses. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); 38 C.F.R. § 3.159(a). Although the Board has an obligation to provide reasons and bases supporting its decision, there is no obligation to discuss, in detail, the extensive evidence of record. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (holding that the Board must review the entire record but does not have to discuss each piece of evidence). Therefore, the Board will summarize the relevant evidence where appropriate, and the Board's analysis will focus specifically on what the evidence shows, or fails to show, as it relates to the Veteran's claim. When there is an approximate balance of positive and negative evidence as to any issue material to the determination of a matter, VA will resolve reasonable doubt in favor of the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc). Throughout the period on appeal, the Veteran is assigned a 10 percent rating for painful scar post right inguinal hernia repair surgery under 38 C.F.R. § 4.118, Diagnostic Code (DC) 7804. Diagnostic Codes 7800 to 7805 pertain to scars. Under Diagnostic Code 7804, a 10 percent rating is warranted for one or two scars that are unstable or painful. Higher ratings of 20 and 30 percent are warranted if there are three or four, or five or more, unstable or painful scars, respectively. If one or more scars are both unstable and painful, a 10 percent rating is added to the rating that is based on the total number of unstable or painful scars. An unstable scar is one where there is frequent loss of covering of skin over the scar. 38 C.F.R. § 4.118 DC 7804, Note (1). Pursuant to Diagnostic Code 7805, a scar may be rated on any disabling effect(s) not considered as part of Diagnostic Codes 7801 to 7804. Here, the Veteran underwent a VA scar examination in October 2020. In the resultant report, the examiner documented a left and right inguinal scar. Neither scar was found to be unstable or productive of functional limitation, including range of motion limitation. The right inguinal scar was found to be painful and measured as 4 centimeters by 1 centimeter. The left inguinal scar measured as 7 centimeters by 1 centimeter. The approximate total area covered by the scars measured as 11 centimeters squared. Nowhere in the record does it document scar findings contrary to the October 2020 examination report. The Board has considered the applicability of other ratings, but a disability rating under DC 7800 is not warranted because the Veteran's scar is not of the head, face, or neck. Moreover, a rating under DCs 7801 and 7802 is not warranted because the Veteran's scar was not at least 12 square inches (77 sq. cm.), as noted for a 20 percent rating under DC 7801, or 144 square inches (929 sq. cm.), as noted for a 10 percent rating under DC 7802. Finally, as the Veteran's scar did not elicit disabling effects not considered in a rating provided under diagnostic codes 7800-04, an increased disability rating under DC 7805 is not warranted either. The 10 percent rating pursuant to Diagnostic Code 7804 was assigned based on the existence of one painful scar. A higher rating under that code is warranted for three or more painful scars or scars that are painful and unstable. The evidence of record does not reflect the existence of more than one painful scar or any scars that are unstable. Thus, the Board finds that a rating greater than 10 percent for right inguinal scar is not warranted. Because the weight of the evidence is against entitlement to a greater than 10 percent rating the benefit of the doubt rule does not apply. 38 U.S.C. § 5107. The Board has considered whether staged ratings under Hart v. Mansfield, supra is appropriate; however, the Board finds that his symptomatology was been stable throughout the period on appeal. Therefore, assigning staged ratings is not warranted. The Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record in regard to the increased rating claim adjudicated herein. Doucette v. Shulkin, 28 Vet. App. 366 (2017). Additionally, the Board has considered whether an inferred claim for a TDIU has been raised pursuant to Rice v. Shinseki, 22 Vet. App. 447 (2009). The Veteran's current employment status is unknown. The Veteran has also not alleged, and the record does not suggest, that he is unable to obtain and maintain employment due solely to his service connected right side inguinal hernia scar. As such, a Rice claim is not raised. In so finding the above, the Board acknowledges the Veteran's contentions that his right side inguinal hernia scar is more severe than contemplated by the current rating assigned. The Veteran is competent to report symptoms such as pain because this requires only personal knowledge, not medical expertise, as it comes to him through his senses. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). Lay testimony is competent to establish the presence of observable symptomatology, where the determination is not medical in nature and is capable of lay observation. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). However, he is not considered competent to medically attribute or assess the severity of his right side inguinal hernia scar as required in the Diagnostic Code. See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). Therefore, his statements do not constitute competent evidence and, the Board assigns more probative weight to the competent medical evidence of record. Accordingly, resolving all doubt in favor of the Veteran, the Board finds that the evidence is against the assignment of a higher 10 percent rating, for his right side inguinal hernia scar and the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc). SERVICE CONNECTION Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). "To establish a right to compensation for a present disability, a veteran must show: "(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service"- the so-called "nexus" requirement." Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be established for a current disability on the basis of a presumption that certain chronic diseases, including psychosis, manifesting themselves to a certain degree within a certain time after service must have had their onset in service. 38 U.S.C. §§ 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309(a). Generally, the disease must have manifested to a degree of 10 percent or more within one year of service. 38 C.F.R. § 3.307(a)(3). For the showing of chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "chronic." 38 C.F.R. § 3.303(b). When the disease identity is established, there is no requirement of evidentiary showing of continuity. Id. Continuity of symptomatology is required only where the condition noted during service (or in the presumptive period) is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. Id. When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. Id. Continuity of symptomatology is only applicable to those diseases recognized as chronic for VA purposes. Walker v. Shinseki, 708 F.3d 1331 (2013); 38 C.F.R. §§ 3.303(b), 3.309. Pertinent to a claim for service connection, such a determination requires a finding of a current disability that is related to an injury or disease in service. Watson v. Brown, 4 Vet. App. 309 (1993); see also Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); Rabideau v. Derwinski, 2 Vet. App. 141, 143 (1992). Under applicable regulation, the term "disability" means impairment in earning capacity resulting from diseases and injuries and their residual conditions. 38 C.F.R. § 4.1; see also Hunt v. Derwinski, 1 Vet. App. 292, 296 (1991); Allen v. Brown, 7 Vet. App. 439 (1995); Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018) (the term "disability" as used in 38 U.S.C. § 1110 "refers to the functional impairment of earning capacity, not the underlying cause of said disability," and held that "pain alone can serve as a functional impairment and therefore qualify as a disability"). In McClain v. Nicholson, 21 Vet. App. 319, 321 (2007), the Court held that the requirement of the existence of a current disability is satisfied when a claimant has a disability at the time he/she files his/her claim for service connection or during the pendency of that claim, even if the disability resolves prior to adjudication of the claim. However, in Romanowsky v. Shinseki, 26 Vet. App. 289 (2013), the Court held that when the record contains a recent diagnosis of disability prior to a claimant filing a claim for benefits based on that disability, the report of diagnosis is relevant evidence that the Board must address in determining whether a current disability existed at the time the claim was filed or during its pendency. The veteran can provide competent reports of factual matters of which he has first-hand knowledge, such as experiencing pain in service, reporting to sick call, being placed on limited duty, and undergoing physical therapy. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005). Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a lay person is competent to identify the medical condition (noting that sometimes the lay person will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer), (2) the lay person is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. See Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007). Similarly, laypersons are competent to diagnose and provide nexus opinions to some extent, notably where the diagnosis or opinion is not of a complex nature. Id., see also Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch v. McDonough, 999 F.3rd 1391 (2021). The Veteran claimed entitlement to service connection for depression and right-side hernia. However, there is no evidence of current disability in either instance. He was afforded one psychological examination in November 2020. There, after noting six separate primary care records covering a 10-year span in which the Veteran specifically denied depression or anxiety, the examiner determined that the Veteran does not meet the DSM-5 diagnostic criteria for depression. Instead, the examiner determined that the Veteran meets the DSM-5 criteria for somatic symptom disorder. The Board notes that the Veteran was subsequently service connected for somatic symptom disorder secondary to his service-connected headache disability. But, with respect to his claim of entitlement to service connection for depression, the Board must deny the claim. Having not met the first element required to establish entitlement to service connection for depression (i.e., current disability), the Board will not address the remaining two elements. Regarding entitlement to service connection for right side hernia, the record similarly does not reflect a current condition. While the record documents hernia in 1981, it also reflects a well-healed inguinal scar in March 1990, and no sign of hernia in June 1995. See April 12, 2016 Service Treatment Record; November 2020 Medical Treatment Record-Government Facility. The Record also reflects a bilateral inguinal hernia surgery in November 2010. See October 7, 2020 Medical Treatment Record- Non-Government Facility. Nonetheless, there is no evidence of a current hernia. The Board acknowledges the Veteran's contention that discomfort from his hernia has bothered him continuously since service and notes that the Veteran is currently service connected for the painful scar as residual of his previous right side inguinal hernia repair. However, because there is no evidence of current hernia disability, entitlement to service connection must be denied. Having not met the first element required to establish entitlement to service connection for hernia (i.e., current disability), the Board will not address the remaining two elements. In the present case, the evidence of record fails to demonstrate a current diagnosis related to depression and/or right side hernia at any time during the appeal period, and there is no probative evidence of recent diagnosis of such disorders prior to the Veteran's claims. McClain v. Nicholson, supra; Romanowsky v. Shinseki, supra. The Board acknowledges the Court's holding in Saunders but does not find a basis for determining that there is functional impairment related to a diagnosis of depression and/or right side hernia. See Saunders v. Wilkie, supra. The Veteran's treatment records do not show that the Veteran has symptoms which impacts his earning capacity as due to depression and/or right side hernia. As such, the Veteran's complaints of depression and/or right side hernia does not amount to a functional impairment of earning capacity, and Saunders is not applicable in this case. In addition, the record does not reflect, and the Veteran did not allege, that he suffered from impairment of earning capacity due to his claimed depression and/or right side hernia nor impairment that was of similar severity, frequency, and duration as those VA has determined by regulation would cause impaired earning capacity in an average person. Wait v. Wilkie, 33 Vet. App. 8 (2020). The Board notes that the Veteran is competent to report his own symptoms or matters within his personal knowledge. See Jandreau v. Nicholson, supra; Buchanan v. Nicholson, supra. In addition, laypersons may, in some circumstances, opine on questions of diagnosis and etiology. See Davidson v. Shinseki, supra. However, the matter of a medical diagnosis for a disability not capable of lay observation, such as that of depression and/or right side hernia is a matter within the province of trained medical professionals. See Jones v. Brown, supra. In the instant case, there is no suggestion that the Veteran has developed an expertise in the diagnosis of depression and/or right side hernia. Therefore, as the Veteran does not have the appropriate medical training and expertise to competently diagnose obstructive sleep apnea the lay assertions in this regard have no probative value. Jandreau, supra at 1377 n.4 ("[s]ometimes the layperson will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer"); see also Woehlaert v. Nicholson, supra. The Board emphasizes that Congress has specifically limited entitlement to service connection for disease or injury to cases where such incidents have resulted in disability. See 38 U.S.C. §§ 1110, 1131. Thus, where, as here, the probative evidence indicates that the Veteran does not have current diagnoses of depression and/or right side hernia for the entire appeal period, there can be no valid claim for service connection. See Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998); Brammer v. Derwinski, supra. Accordingly, the Board finds that service connection for depression and/or right side hernia is not warranted. The appeal is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, supra. WITHDRAWAL An appeal may be withdrawn as to any or all issues at any time before the Board promulgates a decision. 38 C.F.R. § 20.205. Such withdrawal may be made by the veteran or by his or her authorized representative and, unless done on the record at a hearing, it must be in writing. Id. (must include the name of the veteran, the VA file number, and list the withdrawn issues if the appeal involves multiple issues); see also DeLisio v. Shinseki, 25?Vet. App.?45, 57 (2011) (discussing requirements for withdrawal of a claim). In the present case, the Veteran requested withdrawal of the claim of entitlement to a rating greater than 50 percent for tension headaches and migraine at the December 18, 2024 Board hearing. To be effective, a claim withdrawal must be (1) explicit, (2) unambiguous, and (3) done with a full understanding of the consequences of such action on the part of the veteran. Acree v. O'Rourke, 891 F.3d 1009 (Fed. Cir. 2018). In this matter, the Veterans Law Judge explained the consequences of withdrawing the claim, including effective date of the claim, and the Veteran repeated his wish to withdraw the claim. Thus, the Board finds that his withdrawal is explicit, unambiguous, and made with a full understanding of the consequences. There remain no allegations of error of fact or law for appellate consideration. Hence, the Board does not have jurisdiction to review the appeal of entitlement to an increased disability rating for headache and migraine, and it is dismissed. REASONS FOR REMAND Once VA provides an examination or obtains a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). A medical opinion is adequate "where it is based on consideration of the veteran's prior medical history and examinations and describes the disability, if any, in sufficient detail so that the Board's 'evaluation of the claimed disability will be a fully informed one.'" Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007) (quoting Ardison v. Brown, 6 Vet. App. 405, 407 (1994)). Furthermore, an adequate and thorough examination must consider all other relevant evidence of record, including lay statements. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). An adequate medical opinion does not contain only data and conclusions, "but also a reasoned medical explanation connecting the two." Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). Ultimately, if an examination report does not contain sufficient detail, "it is incumbent upon the rating board to return the report as inadequate for evaluation purposes." 38 C.F.R. § 4.2; see Bowling v. Principi, 15 Vet. App. 1, 12 (2001) (emphasizing the Board's duty to return inadequate examination reports); Hicks v. Brown, 8 Vet. App. 417, 421 (1995) (inadequate medical evaluation frustrates judicial review). 1. Service Connection - Bilateral Shoulder, Right Ankle, and Left Knee Conditions In furtherance of the Veteran's claims of entitlement to service connection for right and left shoulder condition, a VA medical opinion was obtained in December 2020. In it, the examiner opined that the Veteran's right and left shoulder conditions are unrelated to active-duty service because x-ray reports are normal and service treatment records are silent regarding left shoulder symptoms. Furthermore, while the examiner noted that the Veteran was diagnosed with right shoulder pain and contusion due to motor vehicle accident in service, he further noted that subsequent service treatment records, including separation examination, were silent as to right shoulder symptoms. Similarly, in December 2020, VA medical opinions were obtained in furtherance of the Veteran's claims of entitlement to service connection for right ankle and left knee conditions. In those opinions, the examiner opined that the Veteran's in-service injuries were minor and acute and the Veteran's separation examination was silent regarding ongoing symptoms. However, not only are those opinions conclusory, but the absence of treatment records should not be the primary basis for a negative opinion. See Dalton v. Nicholson, 21 Vet. App. 23, 40 (2007) (citing Smith v. Derwinski, 2 Vet. App. 137, 140 (1992)) (noting that an examiner cannot rely on the absence of medical records corroborating an injury to conclude that there is no relationship between the veteran's current disability and his military service). Thus, the Board finds those opinions inadequate for adjudicative purposes and remands to obtain additional opinions. The AOJ's failure to obtain an adequate etiology opinion is a pre-decisional duty to assist error that necessitates a remand for development. 2. Service Connection - Sleep Apnea VA must make reasonable efforts to assist the Veteran in obtaining relevant private treatment records that the Veteran adequately identifies when necessary to substantiate the Veteran's claims. See 38 U.S.C. §5103A. After filing the claim of entitlement to service connection for sleep apnea, the Veteran submitted medical records requests, and medical records were obtained that included notation of referral to a sleep specialist to evaluate for possible obstructive sleep apnea. See October 7, 2020 Medical Treatment Record- Non-Government Facility. However, no attempt was made to obtain those sleep study records. Failure to do so amounts to a pre-decisional duty to assist error requiring remand. The matters are REMANDED for the following actions: 1. Forward the Veteran's claims file to an appropriate VA medical examiner to issue a medical opinion regarding the Veteran's claim of service connection for right and left shoulder disorders. The entire claims file, including a copy of this Remand, must be made available to, and must be reviewed by, the examiner providing the opinion. If, and only if, the examiner determines that an examination should be conducted, one should be scheduled. Thereafter, the examiner should address the following: (a.) Please identify any current disability of the right and left shoulders. "Current" is defined as any condition identified since the filing of the claim in September 2020 to the present. "Disability" includes any diagnosable conditions as well as pain or symptoms that are not diagnosable but, nonetheless, cause functional impairment. (b.) For each disability identified in part (a.), please state whether it is at least as likely as not (meaning the favorable and unfavorable evidence is in approximate balance or nearly equal) that the Veteran's current right and left shoulder disabilities were incurred in, caused by, or related to service. The examiner should consider medical and lay evidence dated both prior to and since the filing of the claim in September 2020. The examiner must provide a complete rationale for any opinion rendered. If the examiner cannot provide an opinion without resort to speculation, he or she should explain why an opinion cannot be provided (e.g., lack of sufficient information or evidence, the limits of medical knowledge, etc.). 2. Forward the Veteran's claims file to an appropriate VA medical examiner to issue a medical opinion regarding the Veteran's claim of service connection for right ankle disorder. The entire claims file, including a copy of this Remand, must be made available to, and must be reviewed by, the examiner providing the opinion. If, and only if, the examiner determines that an examination should be conducted, one should be scheduled. Thereafter, the examiner should address the following: (a.) Please identify any current disability of the right and left shoulders. "Current" is defined as any condition identified since the filing of the claim in September 2020 to the present. "Disability" includes any diagnosable conditions as well as pain or symptoms that are not diagnosable but, nonetheless, cause functional impairment. (b.) For each disability identified in part (a.), please state whether it is at least as likely as not (meaning the favorable and unfavorable evidence is in approximate balance or nearly equal) that the Veteran's current right ankle disabilities were incurred in, caused by, or related to service. The examiner should consider medical and lay evidence dated both prior to and since the filing of the claim in September 2020. The examiner must provide a complete rationale for any opinion rendered. If the examiner cannot provide an opinion without resort to speculation, he or she should explain why an opinion cannot be provided (e.g., lack of sufficient information or evidence, the limits of medical knowledge, etc.). 3. Forward the Veteran's claims file to an appropriate VA medical examiner to issue a medical opinion regarding the Veteran's claim of service connection for left knee disorder. The entire claims file, including a copy of this Remand, must be made available to, and must be reviewed by, the examiner providing the opinion. If, and only if, the examiner determines that an examination should be conducted, one should be scheduled. Thereafter, the examiner should address the following: (a.) Please identify any current disability of the right and left shoulders. "Current" is defined as any condition identified since the filing of the claim in September 2020 to the present. "Disability" includes any diagnosable conditions as well as pain or symptoms that are not diagnosable but, nonetheless, cause functional impairment. (b.) For each disability identified in part (a.), please state whether it is at least as likely as not (meaning the favorable and unfavorable evidence is in approximate balance or nearly equal) that the Veteran's current left knee disabilities were incurred in, caused by, or related to service. The examiner should consider medical and lay evidence dated both prior to and since the filing of the claim in September 2020. The examiner must provide a complete rationale for any opinion rendered. If the examiner cannot provide an opinion without resort to speculation, he or she should explain why an opinion cannot be provided (e.g., lack of sufficient information or evidence, the limits of medical knowledge, etc.). 4. Obtain records from the sleep specialist the Veteran was referred to in September 2020. Medical Treatment records obtained in October 2020 document referral for a sleep specialist in September 2020. If needed, obtain an updated VA 21-4122. Mariah N. Sim Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Sloley, Z. N. 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.