Citation Nr: A25035691 Decision Date: 04/17/25 Archive Date: 04/17/25 DOCKET NO. 240808-463053 DATE: April 17, 2025 ORDER Entitlement to service connection for a right leg disorder is denied. Entitlement to service connection for a left ankle disorder is denied. Entitlement to service connection for a dental condition, including loss of teeth, is denied. Entitlement to service connection for an acquired psychiatric disorder, to include substance abuse disorder, is denied. REMANDED Entitlement to an initial rating in excess of 20 percent for degenerative disc disease of the thoracolumbar spine is remanded. Entitlement to an initial rating in excess of 10 percent for right lower extremity radiculopathy is remanded. Entitlement to an initial rating in excess of 10 percent for left lower extremity radiculopathy is remanded. Entitlement to a compensable rating for coccydynia is remanded. Entitlement to an initial compensable rating for a surgical incision of the lumbar spine is remanded. Entitlement to service connection for diabetes mellitus type II as secondary to service connected degenerative disc disease of the thoracolumbar spine is remanded. Entitlement to service connection for hypertension as secondary to service connected degenerative disc disease of the thoracolumbar spine is remanded. Entitlement to service connection for a kidney disorder as secondary to service connected degenerative disc disease of the thoracolumbar spine is remanded. Entitlement to service connection for a bilateral eye disorder as secondary to service connected degenerative disc disease of the thoracolumbar spine is remanded. Entitlement to service connection for prostate cancer as secondary to service connected degenerative disc disease of the thoracolumbar spine is remanded. Entitlement to service connection for a gastrointestinal disorder as secondary to service connected degenerative disc disease of the thoracolumbar spine is remanded. Entitlement to service connection for a heart disorder as secondary to service connected degenerative disc disease of the thoracolumbar spine is remanded. FINDINGS OF FACT 1. At no time during the pendency of the claim does the Veteran have a diagnosis for a right leg disorder, and the record does not contain a recent diagnosis of such disability prior to the Veteran's filing of a claim. 2. At no time during the pendency of the claim does the Veteran have a diagnosis for a left ankle disorder, and the record does not contain a recent diagnosis of such disability prior to the Veteran's filing of a claim. 3. The Veteran does not have a dental condition involving loss of substance of body of maxilla or mandible, or of the soft tissue surrounding that region, or had a dental disability resulted from in-service trauma necessary for service connection for compensation purposes. 4. At no time during the pendency of the claim does the Veteran have a diagnosis of an acquired psychiatric disorder to include a substance abuse disorder, and the record does not contain a recent diagnosis of such disability prior to the Veteran's filing of a claim. CONCLUSIONS OF LAW 1. The criteria for service connection for a right leg disorder have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for a left ankle disorder have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for service connection for a dental condition, including the loss of teeth, have not been met. 38 U.S.C. §§ 1110, 1712; 38 C.F.R. §§ 3.303, 3.304, 4.150, 17.161. 4. The criteria for service connection for an acquired psychiatric disorder, to include a substance abuse disorder, have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had honorable active duty service from April 1963 to September 1965. He was discharged from his second period of service from September 1965 to April 1966 with an other than honorable discharge, which was determined to be dishonorable for VA purposes in a September 1986 Administrative Decision. These matters come before the Board of Veterans' Appeals (Board) on appeal from rating decisions issued in December 2023, March 2024, and July 2024 by a Department of Veterans Affairs (VA) Regional Office (RO). The rating decisions on appeal constitute initial decisions; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies. In the August 2024 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held in November 2024 before the undersigned Veterans Law Judge; a hearing transcript has been associated with the claims file. Therefore, the Board may only consider the evidence of record at the time of the agency of original jurisdiction (AOJ) decisions on appeal, as well as any evidence submitted by the Veteran [or representative] 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. The Board notes that the Veteran was previously denied entitlement to service connection for a left ankle disorder, service connection for a right leg disorder, service connection for alcoholism, and service connection for dental condition. In the July 2024 AMA decision, the AOJ found that new and relevant evidence was submitted to warrant readjudicating the claims for service connection for dental care, a left ankle disorder, a right leg disorder, and substance abuse disorder. The Board is bound by these favorable findings. 38 C.F.R. § 3.104(c). The Board notes that when a claimant makes a claim, the claimant is seeking service connection for symptoms regardless of how those symptoms are diagnosed or labeled. As such, the Board has recharacterized the issue of entitlement to service connection for a substance abuse disorder as entitlement to service connection for an acquired psychiatric disorder, to include substance abuse disorder. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). Service Connection Criteria Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). VA benefits are not payable unless the period of service upon which the claim was based was terminated by discharge or release under conditions other than dishonorable. 38 U.S.C. § 101(18); 38 C.F.R. § 3.12(a). A September 1986 administrative decision found that the portion of the Veteran's service from April 12, 1963 through April 11, 1965 is considered to have been characterized as service under honorable conditions for VA purposes and the portion of the Veteran's service from April 12, 1965 through April 14, 1966 is considered to be characterized as service under other than honorable conditions for VA purposes. For a 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." Continuity of symptomatology is required where the condition noted during service is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. If the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. 38 C.F.R. § 3.303(b). 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); 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"). The existence of a current disability is the cornerstone of a claim for VA disability compensation. See Degmetich v. Brown, 104 F.3d 1328, 1332 (1997) (holding that §§ 1110 and 1131's requirement of the existence of a present disability for VA compensation purposes cannot be considered arbitrary); see also McClain v. Nicholson, 21 Vet. App. 319, 323 (2007) (holding that the requirement of a current disability is met when a claimant has a disability at the time a claim for VA compensation is filed or during the pendency of that claim). Consequently, the evidence of record must show that the Veteran currently has the disability for which benefits are being claimed. 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). 1. Entitlement to service connection for a right leg disorder is denied. 2. Entitlement to service connection for a left ankle disorder is denied. The Veteran contends that service connection is warranted for right leg and left ankle disorder, both of which are related to military service. See March 2024 Supplemental Claim Application (VA Form 20-0995). A July 2024 rating decision made a favorable finding that the Veteran had a qualifying event, injury or disease that had its onset in service as the August 1965 service treatment record indicates treatment for a linear non-displaced fracture of the posterior malleolus. The Veteran's service treatment records during his first period of honorable service are negative for any complaints, treatment or diagnoses of a right leg disorder. The Service treatment records show that the Veteran was seen for treatment of a contusion of the left ankle following an automobile accident; the impression was ankle sprain. The March 1966 service discharge examination found the Veteran's lower extremities to be normal and were negative for any complaints or finding related to a right leg and/or a left ankle disorder. The post-service records do not show a diagnosis of a right leg and/or a left ankle disorder. Although an August 1998 treatment note reflect complains of ankle pain, no pertinent diagnosis of a left ankle disorder was noted. The Board finds that, as the record does not reflect current diagnoses of a right leg and/or a left ankle disorder, the cornerstone element of service connection has not been met, and service connection is not warranted. Brammer v. Derwinski, supra. Post-service treatment records during the pendency of the Veteran's instant claims do not indicate the Veteran complained of or was treated for pain in the right leg, nor do they document a diagnosis of a right leg and/or a left ankle disorder. No further discussion of the remaining elements is necessary. The Board acknowledges the Court of Appeals for Veterans Claims (Court's) holding in Saunders but does not find a basis for determining that there is functional impairment related to a diagnosis of a right leg and/or a left ankle disorder. See Saunders v. Wilkie, 886 F.3d. 1356 (2018). Moreover, the Veteran has not alleged manifestations 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, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). 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 right leg disorder and a left ankle disorder, are not capable of lay observation, such as that of a, is a matter within the province of trained medical professionals. See Jones v. Brown, 7 Vet. App. 134, 137-38 (1994). In the instant case, there is no suggestion that the Veteran has developed an expertise in the diagnosis of a right leg disorder and/or a left ankle disorder. Therefore, the Board finds that he does not have the appropriate medical training and expertise to competently diagnose a disability manifested by chronic pain in the right leg and/or the left ankle, and 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, 21 Vet. App. 456 (2007). 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 a right leg disorder and a left ankle disorder for the entire appeal period, there can be no valid claim service connection. See Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998); Brammer v. Derwinski, supra. In the absence of proof of a present disability (and, if so, of a nexus between that disability and service), there can be no valid claim for service connection. See Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000); Brammer v. Derwinski, supra. Therefore, as the evidence of record shows that the Veteran does not have a current diagnosis of a right leg disorder and a left ankle disorder, the Board concludes that service connection is not warranted, and no further discussion of the remaining elements is necessary. See Watson v. Brown, supra; see also Coburn v. Nicholson, 19 Vet. App. 427, 431 (2006) (finding that the absence of any one element will result in denial of service connection). The Board notes that the Veteran has not been afforded a VA examination addressing his claimed disabilities involving his right leg disorder and/or left ankle disorder. However, the Board finds that such an examination is not required. In this regard, in determining whether the duty to assist requires that a VA medical examination be provided, or medical opinion obtained with respect to a veteran's claim for benefits, there are four factors for consideration. These four factors are: (1) whether there is competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) whether there is evidence establishing that an event, injury, or disease occurred in service, or evidence establishing certain diseases manifesting during an applicable presumption period; (3) whether there is an indication that the disability or symptoms may be associated with the appellant's service or with another service-connected disability; and (4) whether there otherwise is sufficient competent medical evidence of record to make a decision on the claim. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4). With respect to the third factor above, the Court has stated that this element establishes a low threshold and requires only that the evidence "indicates" that there "may" be a nexus between the current disability or symptoms and the appellant's service. McLendon v. Nicholson, 20 Vet. App. 79 (2006). As noted above, the service treatment records are otherwise negative for complaints, treatments or diagnoses related to a right leg disorder. Further, the evidence does not indicate that the Veteran has a current right leg and/or a left ankle disorder. See McLendon v. Nicholson, supra. In this regard, while the Veteran has advanced such a theory, a mere conclusory generalized lay statement that service event or illness caused the current condition is insufficient to require the Secretary to provide an examination. See Waters v. Shinseki, 601 F.3d 1274, 1278 (2010). The Court has held that VA is not required to provide a medical examination when there is not credible evidence of an event, injury, or disease in service. See Bardwell v. Shinseki, 24 Vet. App. 36 (2010). Therefore, the Board finds that a VA examination and/or opinion is not necessary to decide these claims. Based on the foregoing, the Board finds that service connection for a right leg disorder and a left ankle is not warranted. The appeals are denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, supra. 3. Entitlement to service connection for a dental disorder, to include loss of teeth, is denied. The Veteran seeks to establish service connection for a dental disorder, including loss of his teeth, which he believes had its onset in service. See August 2024 VA Form 10182. At his November 2024 Board hearing, the Veteran maintained that he started losing teeth when he went overseas. For VA compensation purposes the loss of teeth due to the loss of substance of the body of the maxilla or mandible are disabilities but only if due to bone loss through trauma or disease such as osteomyelitis. See 38 C.F.R. § 4.150, Diagnostic Code 9913. It is noted that the loss of the alveolar process as a result of periodontal disease are not disabling for VA purposes. If VA determines that a dental condition is due to service trauma, the claimant will be eligible for VA outpatient dental treatment without the usual restrictions of timely application and one-time treatment. See 38 U.S.C. § 1712(a)(1)(C); Mays v. Brown, 5 Vet. App. 302 (1993); 38 C.F.R. § 17.161(c). Service trauma does not include the intended effects of treatment provided during the veteran's military service. VA Gen. Prec. Op. 5-97 (Jan. 22,1997); 38 C.F.R. § 17.161. The United States Court of Appeals for the Federal Circuit confirmed that service trauma does not include the intended results of proper medical treatment provided by the military. Nielson v. Shinseki, 607 F.3d 802, 805 (Fed. Cir. 2010). VA regulations provide that certain common dental conditions, including periodontal disease, can be service connected only for the purposes of establishing eligibility for outpatient dental care. See 38 U.S.C. § 1712(a); 38 C.F.R. §§ 3.381(a), 17.161. The Veteran's service treatment records do not show any trauma to his mouth or jaw area and show only routine dental care. Post service treatment records show that the Veteran has received ongoing treatment for dental problems. During a preoperative evaluation in May 2004, it was noted that the Veteran had dentures upper and lower set, capped teeth, loose teeth and diseased gums. A July 2019 pharmacy note reflects that the Veteran reported that he was eating only one to two meals per day because he still did not have teeth because his teeth had been stolen from his car. The Board concludes that the Veteran does not have a dental disorder that may be service connected for VA treatment or compensation purposes. It is noted that the Veteran has not contended, nor does the evidence indicate, that any missing teeth or bone and tissue loss constitutes loss of substance of body of the maxilla or the mandible due to trauma or disease such as osteomyelitis. See 38 C.F.R. § 4.150 (noting that current legal authority only allows compensation for certain types of dental and oral conditions, such as impairment of the mandible, loss of a portion of the ramus, and loss of a portion of the maxilla.). At his November 2024 Board hearing, the Veteran stated that he just started losing his teeth during service without any indication as to whether a dental or oral problem developed due to a specific trauma or disease. In reaching this determination, the Board has also considered the lay assertions of record, including the contentions of the Veteran in support of a medical nexus. Although he believes that he has a dental disorder due to service, neither the Veteran nor his representative in this case is competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of anatomical relationships, disease pathology and interpretation of complicated diagnostic medical testing. Therefore, it is outside the competence of the Veteran or his representative in this case because the record does not show that they have the skills or medical training to make such a determination. Jandreau v. Nicholson, supra; see also Kahana v. Shinseki, supra. The Board notes that the Veteran has not been afforded a VA examination addressing his claimed dental disorder to include the loss of teeth. However, the Board finds that such an examination is not required. In this regard, in determining whether the duty to assist requires that a VA medical examination be provided, or medical opinion obtained with respect to a veteran's claim for benefits, there are four factors for consideration. These four factors are: (1) whether there is competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) whether there is evidence establishing that an event, injury, or disease occurred in service, or evidence establishing certain diseases manifesting during an applicable presumption period; (3) whether there is an indication that the disability or symptoms may be associated with the veteran's service or with another service-connected disability; and (4) whether there otherwise is sufficient competent medical evidence of record to make a decision on the claim. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4). With respect to the third factor above, the Court has stated that this element establishes a low threshold and requires only that the evidence "indicates" that there "may" be a nexus between the current disability or symptoms and the veteran's service. McLendon v. Nicholson, supra. The service treatment records are otherwise negative for complaints, treatments or diagnoses related to the loss of teeth or dental trauma. Further, the evidence does not indicate that his current dental disorder to include the loss of teeth may be related to his military service. See McLendon v. Nicholson, supra. In this regard, while the Veteran himself has advanced such a theory, a mere conclusory generalized lay statement that service event or illness caused the claimant's current condition is insufficient to require the Secretary to provide an examination. See Waters v. Shinseki, supra. The Court has held that VA is not required to provide a medical examination when there is not credible evidence of an event, injury, or disease in service. See Bardwell v. Shinseki, supra. Therefore, the Board finds that a VA examination and/or opinion is not necessary to decide this claim. Accordingly, the Board finds that service connection for a dental disorder, to include the loss of teeth, is not warranted. The appeal is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, supra. 4. Entitlement to service connection for an acquired psychiatric disorder, to include a substance abuse disorder, is denied. The Veteran asserts that he suffers from a substance abuse disorder that development as a result of an acquired psychiatric disorder that is related to active military service. See March 2024 VA Form 20-0995. During the November 2024 Board hearing, the Veteran testified that he developed an opiod addiction due to the medications used to treat his lumbar spine disorder. Service connection generally may not be awarded for alcohol or drug abuse. See 38 U.S.C. § 1110 ("no [VA] compensation shall be paid if the disability is the result of the veteran's own willful misconduct or abuse of alcohol or drugs"); see also 38 U.S.C. § 105(a). Service connection for alcohol and drug abuse may only be established on a secondary basis where it is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). In Allen v. Principi, the Court of Appeals for the Federal Circuit held that a veteran could receive compensation for an alcohol or drug abuse disability acquired as secondary to, or as a symptom of, the veteran's service-connected disability. See Allen v. Principi, 237 F.3d 1368 (Fed. Cir. 2001). Specifically, "where there is clear medical evidence establishing that alcohol or drug abuse is caused by a veteran's primary service-connected disability, and where the alcohol or drug abuse disability is not due to willful wrongdoing." See Allen, 237 F. 3d at 1381. The Veteran's service treatment records during his first period of honorable service are negative for any complaints, treatment or diagnoses of any psychiatric disorder or substance related disorder. A March 1966 discharge examination noted that the Veteran was diagnosed with antisocial personality disorder. Post service treatment records, VA as well as private treatment reports, are negative for an acquired psychiatric disorder and/or any alcohol or substance related disorder. As the record does not reflect a current diagnosis related to an acquired psychiatric disorder and/or substance use disorder the cornerstone element of service connection has not been met, and service connection is not warranted. See Boyer v. West, supra; Brammer v. Derwinski, supra. The current clinical records do not support a diagnosis of an acquired psychiatric disorder that confirms with the Diagnostic and Statistical Manual of Mental Disorders (5th Ed.) DSM-5 as is required for compensation for psychiatric disabilities. See Martinez-Bodon v. Wilkie, 32 Vet. App. 393 (2020). No further discussion of the remaining elements is necessary. 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 an acquired psychiatric disorder. See Saunders v. Wilkie, supra. Moreover, the Veteran has not alleged manifestations 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, supra. 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 an acquired psychiatric disorder and/or a substance abuse disorder, to include substance abuse disorder, 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 an acquired psychiatric disorder and/or a substance abuse disorder. Therefore, as he does not have the appropriate medical training and expertise to competently diagnose an acquired psychiatric disorder and/or a substance abuse disorder the lay assertions in this regard have no probative value. Jandreau v. Nicholson, supra; see also Woehlaert v. Nicholson, supra. The Board notes that the Veteran has not been afforded a VA examination addressing his claimed acquired psychiatric disorder, including substance related disorder. However, the Board finds that such an examination is not required. In this regard, in determining whether the duty to assist requires that a VA medical examination be provided, or medical opinion obtained with respect to a veteran's claim for benefits, there are four factors for consideration. These four factors are: (1) whether there is competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) whether there is evidence establishing that an event, injury, or disease occurred in service, or evidence establishing certain diseases manifesting during an applicable presumption period; (3) whether there is an indication that the disability or symptoms may be associated with the veteran's service or with another service-connected disability; and (4) whether there otherwise is sufficient competent medical evidence of record to make a decision on the claim. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4). With respect to the third factor above, the Court has stated that this element establishes a low threshold and requires only that the evidence "indicates" that there "may" be a nexus between the current disability or symptoms and the veteran's service. McLendon v. Nicholson, supra. The service treatment records are otherwise negative for complaints, treatments or diagnoses related to an acquired psychiatric disorder and/or substance related disorder. Further, the evidence does not indicate that the Veteran has an acquired psychiatric disorder and/or substance related disorder that may be related to his military service. See McLendon v. Nicholson, supra. In this regard, while the Veteran himself has advanced such a theory, a mere conclusory generalized lay statement that service event or illness caused the claimant's current condition is insufficient to require the Secretary to provide an examination. See Waters v. Shinseki, supra. The Court has held that VA is not required to provide a medical examination when there is not credible evidence of an event, injury, or disease in service. See Bardwell v. Shinseki, supra. Therefore, the Board finds that a VA examination and/or opinion is not necessary to decide this claim. In summary, the controlling question in this case is answered in the negative. In the absence of proof of a present disability (and, if so, of a nexus between that disability and service), there can be no valid claim for service connection. See Boyer v. West, supra; Brammer v. Derwinski, supra. Therefore, as the evidence of record shows that the Veteran does not have current diagnosis of an acquired psychiatric disorder and/or a substance abuse disorder, the Board concludes that service connection is not warranted, and no further discussion of the remaining elements is necessary. See Watson v. Brown, supra; see also Coburn v. Nicholson, supra. In light of the foregoing, the Board finds that service connection for an acquired psychiatric disorder to include substance abuse is not warranted. The appeal is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, supra. REASONS FOR REMAND 1. Entitlement to an initial rating in excess of 20 percent for degenerative disc disease of the thoracolumbar spine is remanded. 2. Entitlement to an initial rating in excess of 10 percent for right lower extremity radiculopathy is remanded. 3. Entitlement to an initial rating in excess of 10 percent for left lower extremity radiculopathy is remanded. 4. Entitlement to an initial compensable rating for coccydynia is remanded. 5. Entitlement to an initial compensable rating for a surgical incision of the lumbar spine is remanded. The Veteran contends that his lumbar spine disorder, coccydynia and radiculopathy in the lower extremities are more disabling than reflected by the ratings currently assigned. See August 2024 VA Form 10182. The Veteran was provided a VA examination with regard to his lumbar spine and associated radiculopathy in January 2024. The examiner reported that the Veteran did not experience flare-ups of the thoracolumbar spine condition; however, the Veteran reported experiencing functional impairment to include an inability to run, stand or sit more than 20 minutes, an inability to drive more than one hour, an inability to bend forward to pick things up and inability to life or carry objects over 15 pounds. The examiner indicated that the Veteran did not perform passive range of motion because it was not medically advisable for him to do such, and no estimates were provided. Additionally, range of motion estimates to account for flare-ups were not provided, as the examiner indicated that the Veteran did not experience flare-ups. Moreover, the examiner noted the Veteran had bilateral lumbar tenderness with light palpation and he had slow guarded movements. The examiner stated that straight leg raising tests could not be performed. Further, while the examiner noted a finding of sciatic nerve involvement in both lower extremities, the examiner did not indicate the overall impairment associated with his right and left lower extremity sciatic nerve radiculopathy. As such, the Board finds that it is unable to adequately assess the Veteran's lumbar spine disorder, coccydynia and right and left lower extremity radiculopathy disabilities based on the findings contained within the January 2024 VA examination, and that the findings reported are not in compliance with the requirements outlined in Sharp v. Shulkin, 29 Vet. App. 26 (2017). Therefore, the Veteran should be afforded new a VA examination(s) to determine the currently level of severity of all impairment resulting from his lumbar spine disorder, coccydynia and right and left lower extremity sciatic nerve radiculopathy. The Board finds that new VA examinations are required to determine the current nature and severity of the Veteran's degenerative disc disease of the thoracolumbar spine, coccydynia, surgical incision of the lumbar spine, and right and left lower extremity radiculopathy. On remand, such an examination should be conducted. See Barr v. Nicholson, 21 Vet. App. 303 (2007). The failure to obtain an adequate examination is a pre-decisional duty to assist error. The Board also notes that, in a November 2024 statement, the Veteran, through his representative, has asserted a Francway challenge against the VA examiners that conducted the January 2024 VA examinations pertaining to the back conditions and the scars; the April 2024 VA examinations for hypertension, diabetes mellitus, scars, kidney conditions, heart conditions, stomach conditions and male reproductive organs; the May 2024 VA eye examination; as well as the July 2024 examination for hearing loss and tinnitus. See Francway v. Wilkie, 930 F.3d 1377, 1381 (Fed. Cir. 2019). Specifically, the representative requested the examiners' curriculum vitae. In Francway, the Court held that a claimant appellant must raise a specific challenge to the competency of a VA examiner before the VA is required to respond with information about the examiner's qualifications. Francway, 930 F.3d at 1381. The Federal Circuit has held that any challenge to the expertise of a VA examiner must set forth the specific reasons why the claimant concludes that the examiner is not qualified to give an opinion. Bastien v. Shinseki, 599 F.3d 1301, 1307 (Fed. Cir. 2010) (quoting Rizzo v. Shinseki, 580 F.3d 1288, 1291 (Fed. Cir. 2009). Typically, a claimant must have the ability to secure from the VA the information necessary to raise the competency challenge. Francway, 930 F.3d at 1381. Once the request is made for information as to the competency of the examiner, absent unusual circumstances, the VA's duty to assist requires it provide a claimant with the curriculum vitae and other information about the qualifications of the VA examiner. Id. However, pursuant to the provisions of the AMA, the Board reviews the record only to correct pre-decisional duty to assist errors or to satisfy a regulatory or statutory duty. 38 C.F.R. § 20.802(a). In this case, the AMA rating decisions on appeal were issued in December 2023, March 2024, and July 2024, with the examinations and medical opinions pertaining to the issues on appeal occurring prior to the rating decisions. The AOJ has not responded to the arguments of the Veteran regarding the competency of the VA examiner. Therefore, a remand is necessary in order to satisfy a regulatory or statutory duty. 38 C.F.R. § 20.802. 5. Entitlement to service connection for diabetes mellitus type II as secondary to service connected degenerative disc disease of the thoracolumbar spine is remanded. 6. Entitlement to service connection for hypertension as secondary to service connected degenerative disc disease of the thoracolumbar spine is remanded. 7. Entitlement to service connection for a kidney disorder as secondary to service connected degenerative disc disease of the thoracolumbar spine is remanded. 8. Entitlement to service connection for a bilateral eye disorder as secondary to service connected degenerative disc disease of the thoracolumbar spine is remanded. 9. Entitlement to service connection for prostate cancer as secondary to service connected degenerative disc disease of the thoracolumbar spine is remanded. 10. Entitlement to service connection for a gastrointestinal disorder as secondary to service connected degenerative disc disease of the thoracolumbar spine is remanded. 11. Entitlement to service connection for a heart disorder as secondary to service connected degenerative disc disease of the thoracolumbar spine is remanded. The Veteran contends that he developed diabetes mellitus type II, hypertension, a kidney disorder, a bilateral eye disorder, a gastrointestinal disorder and a heart disorder due to medications used to treat his lumbar spine disorder. See March 2024 VA Form 21-526EZ. A July 2024 rating decision made favorable findings that the Veteran had a diagnosed eye disability namely pseudophakia, glaucoma, age-related macular degeneration and irregular astigmatism, had been diagnosed with diabetes mellitus type II, diagnosed with hypertension, diagnosed with renal insufficiency and diagnosed with prostate cancer and erectile dysfunction; the Board is bound by these favorable findings. An April 2024 VA examiner opined that the claimed conditions were less likely than not proximately due to or the result of the service connected conditions. The rationale provided by the examiner was that there was no medical or scientific evidence to establish a nexus between the claimed conditions, including diabetes mellitus, hypertension, kidney disease, prostate cancer, heart condition, gastrointestinal issues and the currently service connected conditions; the examiner stated that there was no nexus that has been established between these conditions. However, an opinion as to secondary aggravation was not provided. See Atencio v. O'Rourke, 30 Vet. App. 74, 91 (2018) (holding that aggravation of a condition by a service-connected disability must be considered independently of direct causation, and medical examinations must provide adequate reasoning and conclusions on both points); El-Amin v. Shinseki, 26 Vet. App. 136, 140 (2013) (holding that medical opinions addressing the issue of secondary service connection are inadequate when they fail to adequately encompass the question of aggravation). Moreover, the opinion regarding secondary causation was provided with minimal rationale. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). This opinion is therefore insufficient to decide the appeals. Moreover, as discussed above, the Veteran's attorney requested the qualifications of the April 2024 examiner. Francway, 940 F.3d at 1308. A May 2024 VA examiner opined that the claimed bilateral eye condition was less likely than not proximately due to or the result of the Veteran's service connected conditions. The examiner noted that the Veteran has been diagnosed with ocular conditions of glaucoma, pseudophakia, macular degeneration and irregular astigmatism. The examiner indicated that these conditions have no connection whatsoever to the listed conditions, including degenerative disc disease of the thoracolumbar spine, surgical incision of the lumbar spine, coccydynia, right and left lower extremity radiculopathy. The examiner further noted that those conditions are all spine conditions with no relation to the eye or ophthalmic pathology. The examiner also noted that tinnitus is an ear condition which is not related in any way to the Veteran's ocular conditions. However, an opinion as to secondary aggravation was not provided. See Atencio v. O'Rourke, supra; El-Amin v. Shinseki, supra. Moreover, the opinion regarding secondary causation was provided with minimal rationale. See Nieves-Rodriguez v. Peake, supra. This opinion is therefore insufficient to decide the appeal. Moreover, as discussed above, the Veteran's attorney requested the qualifications of the May 2024 VA examiner. Francway, 940 F.3d at 1308. A February 2025 opinion from Dr. G.S. was submitted by the Veteran in the post-hearing evidence window. The provider opined that, based on the medical documentation and considering the Veteran has been on long term use of acetaminophen and opioids for many years due to his service-connected thoracolumbar degenerative disc disease and diabetes mellitus type II is associated with the long-term use of both acetaminophen and opioids, the Veteran as likely as not has a service-connected disability of diabetes mellitus type II, hypertension heart disease, hypertension, a kidney disorder and bilateral eye disorder. However, an opinion as to secondary aggravation was not provided. See Atencio v. O'Rourke, supra; El-Amin v. Shinseki, supra. Moreover, the opinion regarding secondary causation was provided with without a rationale. See Nieves-Rodriguez v. Peake, supra. This opinion is therefore insufficient to decide the appeal. The Board finds that a new VA examination is required to determine the etiology of the Veteran's claimed diabetes mellitus type II, hypertension, a kidney disorder, bilateral eye disorder, a prostate disorder, a gastrointestinal disorder and a heart disorder. On remand, such an etiology opinion should be obtained. See Barr v. Nicholson, supra. The failure to obtain an adequate examination is a pre-decisional duty to assist error. The matters are REMANDED for the following actions: 1. The AOJ should secure the credentials, including but not limited to the curriculum vitae, of the VA examiners who provided the January 2024, April 2024 and May 2024 opinions. (The examiner's information may be redacted as deemed warranted). Upon receipt, their credentials should be associated with the claims file, with a copy provided to the Veteran and his attorney. If the requested credentials are unattainable, then the Veteran and his attorney should be notified, and this too should be documented in the claims file. 2. Schedule the Veteran for a VA examination by an appropriate medical professional to address the severity of the Veteran's service connected degenerative disc disease of the lumbar spine and coccydynia. The claims file, to include a copy of this Remand, should be made available to and reviewed by the examiner. All indicated tests and studies should be accomplished and all symptomatology should be identified. The examiner should respond to the following: (A) Provide a full description of the disabilities and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria. (B) In so doing, test the Veteran's range of motion for active and passive motion, in weight-bearing and non-weight-bearing. (C) If there is evidence of pain on motion, the examiner must indicate the degree of range of motion at which such pain begins if there is any additional loss of range of motion. (D) It is also imperative that the examiner comment on the functional limitations caused by flare-ups and repetitive use due to the Veteran's disability. The examiner should state whether the examination is taking place during a period of flare-up and/or after repeated use over time. If not, the examiner should ask the Veteran to describe the flare-ups, if any, she experiences, including frequency, duration, characteristics, precipitating and alleviating factors, severity and/or extent of functional impairment she experiences during a flare-up of his joints and/or after repeated use over time. Based on the Veteran's lay statements and the other evidence of record, the examiner should provide an opinion estimating any additional degrees of limited motion caused by functional loss during a flare-up or after repeated use over time. (E) If it is not feasible to determine the extent to which the Veteran experiences additional functional loss on repeated use over time or during flare-ups without resorting to speculation, the examiner must provide an explanation for why that is so. The examiner is further advised that the inability to provide an opinion without resorting to speculation must be based on the limitation of knowledge in the medical community at large and not a limitation weather based on lack of expertise, insufficient information, or unprocured testing of the individual examiner. (F) The examiner is also asked to provide an opinion as to whether the evidence of record shows that the Veteran's thoracolumbar spine disability resulted in ankylosis OR the functional equivalent of ankylosis of the spine (i.e., functional ankylosis of the spine) at any point during the appeal period, to include during flare-ups or after repeated use over time. A rationale should be provided for any opinion offered. 3. Schedule the Veteran for a VA medical examination by an appropriate medical professional to determine the current severity of his service-connected right and left lower extremity radiculopathy. The electronic claims file, including a copy of this Remand, must be made available to the examiner and reviewed in conjunction with the examination. All appropriate tests, studies, and consultations should be accomplished, and all clinical findings should be reported in detail. The examiner should provide a full description of the disabilities and report all signs and symptoms necessary for evaluating the Veteran's right and left lower extremity radiculopathy under the rating criteria. The examiner should indicate the specific nerve groups involved, and whether such disabilities more nearly approximate mild, moderate, or severe incomplete paralysis or complete paralysis of the affected nerve. A rationale should be provided for all opinions offered. The medical opinion must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resorting to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. 4. Obtain an addendum opinion with an appropriate examiner for the Veteran's claimed conditions, including his hypertension, diabetes mellitus type II, a kidney disorder, a heart disorder, prostate cancer, a bilateral eye disorder and gastroesophageal reflux disease. (A) Is it at least as likely as not (the likelihood is at least approximately balance or nearly equal, if not higher) that the Veteran's hypertension was caused or aggravated by his service connected degenerative disc disease of the thoracolumbar spine? The examiner should consider the Veteran's contention that medication used to treat his lumbar spine disorder resulted in his hypertension. (B) Is it at least as likely as not (the likelihood is at least approximately balance or nearly equal, if not higher) that the Veteran's diabetes mellitus type II was caused or aggravated by his service connected degenerative disc disease of the thoracolumbar spine? The examiner should consider the Veteran's contention that medication used to treat his lumbar spine disorder resulted in his diabetes mellitus type II. (C) Is it at least as likely as not (the likelihood is at least approximately balance or nearly equal, if not higher) that the Veteran's kidney disorder was caused or aggravated by his service connected degenerative disc disease of the thoracolumbar spine? The examiner should consider the Veteran's contention that medication used to treat his lumbar spine disorder resulted in his kidney disorder. (D) Is it at least as likely as not (the likelihood is at least approximately balance or nearly equal, if not higher) that the Veteran's eye disorder was caused or aggravated by his service connected degenerative disc disease of the thoracolumbar spine? The examiner should consider the Veteran's contention that medication used to treat his lumbar spine disorder resulted in his eye disorder. (E) Is it at least as likely as not (the likelihood is at least approximately balance or nearly equal, if not higher) that the Veteran's prostate disorder was caused or aggravated by his service connected degenerative disc disease of the thoracolumbar spine? The examiner should consider the Veteran's contention that medication used to treat his lumbar spine disorder resulted in his prostate disorder. (F) Is it at least as likely as not (the likelihood is at least approximately balance or nearly equal, if not higher) that the Veteran's gastrointestinal disorder was caused or aggravated by his service connected degenerative disc disease of the thoracolumbar spine? The examiner should consider the Veteran's contention that medication used to treat his lumbar spine disorder resulted in his gastrointestinal disorder. (G) Is it at least as likely as not (the likelihood is at least approximately balance or nearly equal, if not higher) that the Veteran's heart disorder was caused or aggravated by his service connected degenerative disc disease of the thoracolumbar spine? The examiner should consider the Veteran's contention that medication used to treat his lumbar spine disorder resulted in his heart disorder. A rationale should be provided for all opinions offered. (Continued on the next page) ? The medical opinion must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resorting to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. KRISTY L. ZADORA Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Suzie Gaston, 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.