PSYCHOSIS

MARCUS N. FULTON · 2026 · Case ID: A26022156

MIXED

Summary

The Veteran served honorably in the Air Force from November 1985 to June 1993. This case involves appeals for service connection for several conditions, including a psychiatric disability, obstructive sleep apnea (OSA), bilateral hearing loss, neck disability, right shoulder disability, right middle finger disability, right ankle disability, and left leg disability. The Board granted service connection for a psychiatric disability other than major depressive disorder (MDD), finding that the Veteran's PTSD symptoms could not be separated from his existing MDD, and resolved doubt in his favor. Service connection for OSA was also granted, with the Board finding the evidence in equipoise that OSA was caused or aggravated by service-connected disabilities, particularly long-term opioid use for RSD. Service connection for a neck disability was granted based on continuity of symptomatology and the Board resolving doubt in the Veteran's favor, finding the evidence evenly balanced. Service connection for right upper extremity radiculopathy was granted as secondary to the newly service-connected neck disability, with the Board finding a nexus supported by VA examinations. However, claims for bilateral hearing loss, right ankle disability, left shoulder disability, left wrist disability, an increased rating for right wrist disability, right middle finger arthritis, and left lower extremity numbness were remanded due to pre-decisional duty-to-assist errors. Specifically, the Board found the VA examiner's opinion on hearing loss inadequate for failing to use the correct standard for pre-existing conditions, and the examination for the right ankle did not adequately address functional impairment. Remands were also ordered for left shoulder/wrist disabilities and left lower extremity/right middle finger disabilities due to inadequate examinations and potential duty-to-assist errors related to cancelled VA appointments.

Rationale

Overlapping symptoms between PTSD and service-connected MDD; Resolution of doubt in Veteran's favor; Conditions inseparable

Service Branch

AIR FORCE

Special Benefit

NO SPECIAL BENEFIT

Docket No.

190731-44612

Full Decision Text

Citation Nr: A26022156
Decision Date: 03/11/26 Archive Date: 03/11/26

DOCKET NO. 190731-44612
DATE: March 11, 2026

ORDER

New and relevant evidence having been received, the claims for service connection for a psychiatric disability, obstructive sleep apnea (OSA), bilateral hearing loss, a neck disability, a right shoulder disability, a right middle finger disability, a right ankle disability, and a left leg disability, are reopened.

Entitlement to service connection for a psychiatric disability other than major depressive disorder (MDD) is granted.

Entitlement to service connection for obstructive sleep apnea (OSA) is granted.

Entitlement to service connection for a neck disability is granted.

Entitlement to service connection for a right shoulder disability is granted.

REMANDED

Entitlement to service connection for bilateral hearing loss is remanded.

Entitlement to service connection for a right ankle disability is remanded.

Entitlement to service connection for a left shoulder disability is remanded.

Entitlement to service connection for a left wrist disability is remanded.

Entitlement to a rating in excess of 10 percent for a right wrist disability is remanded.

Entitlement to service connection for arthritis of the right middle finger is remanded.

Entitlement to a compensable rating for a right middle finger disability is remanded.

Entitlement to a rating in excess of 20 percent for left lower extremity numbness with inability to sweat in left foot is remanded.

Entitlement to service connection for a left lower extremity disability is remanded.

FINDINGS OF FACT

1. Evidence received since the unappealed October 2018 rating decision is new and relevant to the issues of entitlement to service connection a psychiatric disability, obstructive sleep apnea (OSA), bilateral hearing loss, a neck disability, a right shoulder disability, a right middle finger disability, a right ankle disability, and a left leg disability.

2. The Veteran's PTSD cannot be dissociated from his service-connected MDD.

3. Resolving reasonable doubt in favor of the Veteran, the competent and credible evidence of record is at least in equipoise that his OSA was caused or aggravated by his service-connected disabilities.

4. Resolving reasonable doubt in favor of the Veteran, the competent and credible evidence of record is at least in equipoise that the Veteran's neck disability is due to his service-connected reflex sympathetic dystrophy (RSD) of the left upper extremity.

5. The Veteran's right upper extremity radiculopathy is due to his service-connected neck disability.

CONCLUSIONS OF LAW

1. New and relevant evidence sufficient to readjudicate the claims for entitlement service connection for a psychiatric disability, obstructive sleep apnea (OSA), bilateral hearing loss, a neck disability, a right shoulder disability, a right middle finger disability, a right ankle disability, and a left leg disability, has been received. 38 U.S.C. §§ 101 (35), 1110, 5108.

2. Resolving reasonable doubt in favor of the Veteran, the criteria for service connection for PTSD are met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.310.

3. The criteria for service connection for OSA have been met. 38 U.S.C. §§ 1110; 5107; 38 C.F.R. §§ 3.102, 3.303.

4. Resolving all reasonable doubt in the Veteran's favor, the criteria for entitlement to service connection for a neck disability have been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

5. The criteria for service connection for right upper extremity radiculopathy, as secondary to a neck disability, have been met. 38 U.S.C. §§ 101 (24), 1110, 1131, 5107; 38 C.F.R. §§ 3.6, 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served honorably from November 1985 to June 1993.

These matters come before the Board of Veterans' Appeals (Board) on appeal from a June 2019 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO).

In a July 2019 VA Form 10182, the Veteran requested the hearing lane of the
radiculopathy, as secondary to a neck disability, have been met. 38 U.S.C. §§ 101 (24), 1110, 1131, 5107; 38 C.F.R. §§ 3.6, 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served honorably from November 1985 to June 1993.

These matters come before the Board of Veterans' Appeals (Board) on appeal from a June 2019 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO).

In a July 2019 VA Form 10182, the Veteran requested the hearing lane of the rating decisions under the Veterans Appeals Improvement Modernization Act of 2017 (AMA). Under the Board Hearing Docket, the Board is limited to review of the evidence in the record up to and until the date of the rating decision on appeal and any evidence submitted at the Board hearing and within 90 days following the hearing. See 38 C.F.R. § 20.202 (b).

In December 2024, the Veteran attended a hearing with the undersigned VLJ; a transcript of the hearing is of record.

NEW AND RELEVANT EVIDENCE

VA will readjudicate a claim if new and relevant evidence is presented or secured. 84 Fed. Reg. 138, 169 (Jan. 18, 2019) (to be codified at 38 C.F.R. § 3.156 (d)). In this regard, "new evidence" is existing evidence not previously submitted to agency decisionmakers, while "relevant evidence" is evidence that tends to prove or disprove the matter at issue. 84 Fed. Reg. 138, 169 (Jan. 18, 2019) (to be codified at 38 C.F.R. § 3.2501 (a)(1)).

1. The claim for service connection for a psychiatric disability, OSA, bilateral hearing loss, a neck disability, a right shoulder disability, a right middle finger disability, a right ankle disability, and a left leg disability, is reopened.

Under the AMA, the new and relevant evidentiary standard for readjudication is less burdensome than the new and material evidence standard for reopening under the legacy system. As the Veteran's claims were denied under the AMA, the Board will assess the Veteran's claim under the new and relevant evidentiary standard.

In support of reopening the previously denied claim, Social Security Administration (SSA) records, VA examinations, statements in support of the claim, and the Veteran's December 2024 hearing transcript have been generated and associated with the record. These are new in that they were not previously part of the record before agency adjudicators. They are relevant in that they support a nexus between the Veteran's disabilities and his service and/or service-connected disabilities. Therefore, the Board holds that the evidence is sufficient to reopen the claims.

SERVICE CONNECTION

Service connection will be granted for a disability resulting from a disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Service connection requires: (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. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); see also Caluza v. Brown, 7 Vet. App. 498 (1995). Service connection may also 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 may also be established on a secondary basis for a disability that is shown to be proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show that a current disability exists and that the current disability results from the service-connected disability. 38 U.S.C. §§ 1110, 1131; Spicer v. McDonough, 61 F.4th 1360, 1364 (Fed. Cir. 2023) (holding that section 1110 "requires compensation when a service-connected disease or injury is a but-for cause of a present-day disability").

In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which
result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show that a current disability exists and that the current disability results from the service-connected disability. 38 U.S.C. §§ 1110, 1131; Spicer v. McDonough, 61 F.4th 1360, 1364 (Fed. Cir. 2023) (holding that section 1110 "requires compensation when a service-connected disease or injury is a but-for cause of a present-day disability").

In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990).

A lay person is competent to report on the onset and reoccurrence of current symptomatology. Layno v. Brown, 6 Vet. App. 465, 470 (1994). The Board must determine on a case-by-case basis whether a veteran's particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011).

VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with a claimant prevailing in either event. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. The claimant is entitled to the benefit of the doubt when there is an "approximate" (meaning nearly equal) balance of positive and negative evidence regarding any material determination. See Lynch v. McDonough, 999 F.3d 1391 (2021); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001).

2. Entitlement to service connection for an acquired psychiatric disability other than MDD is granted.

The Veteran contends that service connection is warranted for a psychiatric disability other than MDD. The Veteran is already service-connected for MDD. A January 2019 VA psychiatric examination report shows that the Veteran met the criteria for posttraumatic stress disorder (PTSD). Significantly, the examiner noted that the symptoms of the Veteran's PTSD overlap with his service-connected MDD. When, as here, it is impossible to separate the effects of a service-connected disability and a nonservice-connected disability, reasonable doubt must be resolved in the veteran's favor and the symptoms in question attributed to the service-connected disability. See Mittleider v. West, 11 Vet. App. 181, 182 (1998).

In view of the foregoing, the Board finds that the symptoms of the Veteran's PTSD cannot be dissociated from the Veteran's service-connected MDD. With resolution of all reasonable doubt in the Veteran's favor, it is concluded that the evidence supports service connection for PTSD. 38 U.S.C. § 5107(b).

3. Entitlement to service connection for OSA is granted.

The Veteran contends that he has sleep apnea due to his service or, in the alternative, as due to service-connected disabilities.

The record documents an assessment for sleep apnea. See e.g. October 2012 VA Examination. The remaining inquiry is whether the diagnosis was due to service. See 38 C.F.R. § 3.310.

There is evidence to suggest that there is a relationship between the Veteran's service-connected disabilities, to include medication taken therefor. The Veteran has documented long-term opioid use for his service-connected RSD. For example, in a July 2014 VA treatment record, the Veteran was advised and consented to long term opioid therapy for pain, which detailed the benefits and risks of long term opioid therapy, to include the risk of sleep apnea. An April 2011 VA psychiatric examination opined that the Veteran's sleep issues are due to pain and medication taken for pain. An October 2012 VA examination opined that "it appears that sleep impairment is secondary to pain rather than a mood disorder."

The Veteran has a current diagnosis of OSA and the medical evidence is at least in equipoise as to whether the Veteran's OSA is due to or aggravated by his service-connected disabilities.

4. Entitlement to service connection for a neck disability is granted.

The Veteran has a current neck disability. See October 2017 VA Treatment Note. The first element of service connection has therefore been met.

The second element of secondary service connection is evidence of a service-connected disability. The Veteran is service
April 2011 VA psychiatric examination opined that the Veteran's sleep issues are due to pain and medication taken for pain. An October 2012 VA examination opined that "it appears that sleep impairment is secondary to pain rather than a mood disorder."

The Veteran has a current diagnosis of OSA and the medical evidence is at least in equipoise as to whether the Veteran's OSA is due to or aggravated by his service-connected disabilities.

4. Entitlement to service connection for a neck disability is granted.

The Veteran has a current neck disability. See October 2017 VA Treatment Note. The first element of service connection has therefore been met.

The second element of secondary service connection is evidence of a service-connected disability. The Veteran is service-connected for left upper extremity RSD. The second element of secondary service connection has been established.

The third and final element of secondary service connection is medical evidence establishing a nexus (i.e., link) between the current disability and the service-connected disability.

Medical evidence in favor of a nexus includes VA examinations, VA treatment notes, and private treatment records that document pain in connection with the Veteran's left upper extremity RSD. For example, an April 2017 VA treatment noted documented "neck and shoulder pain that dated back to when he was in the Air Force." A March 2003 VA treatment record documented "continued neck pain with symptoms occurring every 2 or 3 weeks with associated "neck swelling that lasts for a couple of days."

The Board finds that regarding the third element of service connection, a nexus between the injury and present disability, the Veteran has demonstrated that a continuity of symptomatology has been established consistent report of neck pain and injury in service, and that he has experienced neck pain since service that is attributable to his current neck disability.

In this regard, service treatment records (STRs) document multiple complaints of neck pain, both independent of and concurrent with the Veteran's left upper extremity RSD. The Veteran's continued report of a neck injury in service and clearly weighs in favor of finding that an injury did in fact occur. Moreover, the Veteran has attempted multiple additional times to establish service connection for his neck disability since service that weighs in favor of establishing the credibility of the Veteran and continuity of symptomatology.

While VA medical examinations weigh against the claim, the examiners did not diagnose the Veteran with a neck disability, despite the extensive documentation and existence of neck pain, and thus did not provide opinions on whether such was due to service.

The Veteran is competent to report about neck pain and history, as it consists of readily observable symptoms. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Furthermore, he has indicated, and medical treatment records corroborate, that neck pain started in service and has continued since service. There is no evidence to suggest that the Veteran is an unreliable historian. The Board finds that the Veteran's reports about a continuity of symptomatology beginning in service are probative to show a relationship to service for the current neck disability.

For the reasons set forth above, the Board finds that the evidence is evenly balanced as to whether the Veteran's current neck disability is related to service. See Buchanan v. Nicholson, 451 F.3d 1331, 1335 (Fed. Cir. 2006) (lay evidence may be sufficient in and of itself to substantiate a service connection claim). Thus, resolving reasonable doubt in the Veteran's favor, the Board finds that service connection for a cervical spine disability is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

5. Entitlement to service connection for a right shoulder disability is granted.

The Veteran believes that service connection for a right shoulder disability is warranted.

The first element of secondary service connection is evidence of a current disability. The clinical evidence documents the Veteran's current diagnosis of right upper extremity radiculopathy. See e.g. April 2015 VA Examination. Therefore, the first element of secondary service connection has been established.

The second element of secondary service connection is evidence of a service-connected disability. The Veteran is herein, service connected for a neck disability. The second element of secondary service connection has been established.

The third and final element of secondary service connection is medical evidence establishing a nexus (i.e., link) between the current disability and the service-connected disability.

Medical evidence in favor of a nexus includes a VA examination which found that the Veteran's right upper extremity radiculopathy was due to his now service-connected neck disability. See April 2015 VA Examination. The Board notes that there is no medical evidence against a nexus between these two disabilities. Therefore, the third and final element of secondary service connection has been established; service connection for right upper extremity radiculopathy is granted.
evidence of a service-connected disability. The Veteran is herein, service connected for a neck disability. The second element of secondary service connection has been established.

The third and final element of secondary service connection is medical evidence establishing a nexus (i.e., link) between the current disability and the service-connected disability.

REASONS FOR REMAND

Under the Appeals Modernization Act (AMA), the Board must remand a claim to correct an error by the RO to satisfy its duty to assist the Veteran under 38 U.S.C. § 5103A if the error occurred prior to the RO decision on appeal. 38 U.S.C. § 5103A (f)(2)(A); 38 C.F.R. § 20.802 (a). The Board may also remand a claim to correct any other RO error "in satisfying a regulatory or statutory duty, if correction of the error would have a reasonable possibility of aiding in substantiating" the claim. 38 C.F.R. § 20.802 (a). As explained below, pre-decisional duty-to-assist errors have been identified.

1. Entitlement to service connection for bilateral hearing loss is remanded.

The Veteran contends that his bilateral hearing loss is due to service.

A September 2011 VA examiner determined that an opinion could not be provided without resort to speculation. The examiner had determined that the Veteran had hearing loss that pre-existed service.

In finding that the hearing loss pre-existed service, the examiner used an incorrect standard. A Veteran is presumed to have been sound upon entry into active service, except as to defects, infirmities, or disorders noted at the time of the acceptance, examination, or enrollment. 38 U.S.C. § 1111; 38 C.F.R. § 3.304 (b). The term "noted" refers to "[o]nly such conditions as are recorded in examination reports." 38 C.F.R. § 3.304 (b). A "[h]istory of preservice existence of conditions recorded at the time of examination does not constitute a notation of such conditions." 38 C.F.R. § 3.304 (b)(1); see Crowe v. Brown, 7 Vet. App. 238, 245 (1994). When no preexisting condition is noted upon examination for entry into service, a Veteran is presumed to have been sound upon entry, and the burden then shifts to VA to rebut the presumption of soundness. Wagner v. Principi, 370 F.3d 1089, 1096 (Fed. Cir. 2004); 38 C.F.R. § 3.304. To rebut the presumption of soundness under 38 U.S.C. § 1111, there must be clear and unmistakable evidence that (1) a Veteran's disability existed prior to service, and (2) that the preexisting disability was not aggravated during service. Id. The examiner did not use this standard when assessing that the Veteran's hearing loss was a condition that pre-dated the Veteran's service. As the September 2011 etiology opinion is inadequate to evaluate the claim, an additional opinion must be obtained. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (once VA undertakes to provide an examination, it must provide an adequate one).

2. Entitlement to service connection for a right ankle disability is remanded.

The Veteran contends entitlement to service connection for a right ankle disability.

The Veteran was afforded a VA examination in May 2008. The examiner found no diagnosis for a right ankle disability. No opinion was provided as the Veteran had no diagnosis. However, a diagnosis is not required to establish service connection for symptoms that result in functional impairment in earning capacity. 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 examination report does not adequately address whether the Veteran's reported symptoms translate to functional impairment in earning capacity consistent with Saunders prior to the conclusion that a nexus opinion is not warranted based on a lack of a current disability.
had no diagnosis. However, a diagnosis is not required to establish service connection for symptoms that result in functional impairment in earning capacity. 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 examination report does not adequately address whether the Veteran's reported symptoms translate to functional impairment in earning capacity consistent with Saunders prior to the conclusion that a nexus opinion is not warranted based on a lack of a current disability. A more detailed opinion is necessary to ensure a fully informed decision on the Veteran's service connection claim for a right ankle disability, as well as compliance with VA's duty to assist.

Where VA provides an examination in a service connection claim, the examination must be adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). A predecisional duty to assist error has occurred, and remand is required. 38 U.S.C. § 5103A (b)(1); 38 C.F.R. § 20.802 (a).

3. Entitlement to service connection for a left shoulder disability other than RSD is remanded.

4. Entitlement to service connection for a left wrist disability is remanded.

VA must provide an examination or obtain an opinion when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifested during an applicable presumptive period for which the claimant qualifies; and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service or with another service-connected disability; but (4) there is insufficient competent medical evidence on file for the Secretary to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79 (2006).

The Veteran's claim for service connection for a left shoulder and left wrist disability meet the McLendon elements for a VA examination. The evidence of record shows the Veteran complains of pain and numbness of the left shoulder and left wrist that are due to his left upper extremity RSD. The failure to obtain an examination and medical opinion was a pre-decisional duty to assist error and remand is required. McLendon, 20 Vet. App. 79.

5. Entitlement to a rating in excess of 10 percent for a right wrist disability is remanded.

6. Entitlement to service connection for arthritis of the right middle finger is remanded.

7. Entitlement to a compensable rating for a right middle finger disability is remanded.

8. Entitlement to a rating in excess of 20 percent for left lower extremity numbness with inability to sweat in left foot is remanded.

9. Entitlement to service connection for a left lower extremity disability is remanded.

September 2018 February 2019 Exam Requests indicate VA examinations for the claimed disabilities were cancelled, only noting, "No Show." The AMA rating decision on appeal denied an increased rating based in part on the Veteran's failure to appear for the scheduled examination. The Board notes that the Veteran has participated in claims both before and after these cancelled examinations and questions whether the Veteran was notified.

A failure to report to a scheduled VA examination (without good cause) requires the claim must be adjudicated based on the evidence of record (if the claim is an original service-connection claim). However, the record provides no basis for determining whether the Veteran was adequately informed of an agreed time of the scheduled examination for which a "No Show" was noted. Accordingly, the Board finds the rescheduling of the examination (with documentation of notification) is required, and the failure to follow-up under the circumstances was a pre-decisional duty-to-assist error.

The matters are REMANDED for the following action:

1. Schedule the Veteran for a VA examination from an appropriate clinician to determine the nature and etiology of the Veterans bilateral hearing loss.

(a.) The clinician should provide an opinion as to whether the bilateral hearing loss clearly and unmistakably existed prior to service and, if so, whether it increased in severity during the Veteran's period of active-duty service.

(b.) If the clinician makes a finding that a pre-existing existing bilateral hearing loss was not aggravated or that any increase in severity was due to the natural progress of the condition, such conclusions must be supported by evidence that is clear and unmistakable (i.e. undebatable).

(c.) If the clinician is unable to say that the bilateral hearing loss clearly and unmistakably pre
1. Schedule the Veteran for a VA examination from an appropriate clinician to determine the nature and etiology of the Veterans bilateral hearing loss.

(c.) If the clinician is unable to say that the bilateral hearing loss clearly and unmistakably pre-existed service, the claim becomes one for direct service connection and the clinician should opine as to whether it is at least as likely not (likelihood is at least approximately balanced or nearly equal, if not higher) that the bilateral hearing loss had onset during service or is related to any incident of service.

2. Schedule the Veteran for a VA examination to obtain an opinion on his claimed right ankle disability that is at least as likely as not the result of an in-service disease or injury.

The examiner is advised a diagnosis is not required to establish service connection for symptoms that result in functional impairment in earning capacity. As a result, if there is no diagnosis to account for the Veteran's reported symptoms, the examiner must address whether the reported symptoms are productive of functional impairment in earning capacity. If the Veteran's symptoms do result in functional impairment in earning capacity, the examiner must provide a nexus opinion despite a lack of diagnosis.

3. Schedule the Veteran for a VA examination to determine whether the Veteran has a left shoulder and left wrist disability other than left upper extremity RSD. Provide an opinion on whether it is at least as likely as not a left shoulder and left wrist disability is caused or aggravated by the left upper extremity RSD.

4. Schedule the Veteran for VA examination for the claim of entitlement to an increased rating for his right wrist disability.

5. Schedule the Veteran for VA examinations to determine the current level of disability of his left lower extremity disability and right middle finger disability, to include whether additional disabilities exist that warrant separate evaluations for such disabilities.

Marcus N. Fulton

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Love, Kelsey

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.

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