Citation Nr: 24001933 Decision Date: 01/11/24 Archive Date: 01/11/24 DOCKET NO. 20-16 574 DATE: January 11, 2024 ORDER Entitlement to service connection for human immunodeficiency virus (HIV) is denied. Entitlement to service connection for a gastrointestinal condition, to include as secondary to a service-connected disability, is denied. Entitlement to service connection for bilateral carpal tunnel syndrome (CTS) is denied. Entitlement to service connection for a bilateral wrist condition, to include as secondary to a service-connected disability, is denied. Entitlement to service connection for epididymitis is denied. Entitlement to service connection for a left testis condition, to include as secondary to a service-connected disability, is denied. Entitlement to service connection for a penile condition, to include as secondary to a service-connected disability, is denied. Entitlement to service connection for an acquired psychiatric disorder, to include as secondary to a service-connected disability, is denied. Entitlement to service connection for a bilateral foot disability is granted. Entitlement to service connection for a bilateral foot condition as secondary to service-connected bilateral foot disability is denied. Entitlement to service connection for a vision condition is denied. Entitlement to service connection for bilateral renal cysts is denied. REMANDED Entitlement to service connection for a cervical spine condition is remanded. Entitlement to service connection for right upper extremity peripheral neuropathy as secondary to a service-connected disability is remanded. Entitlement to service connection for tinnitus, to include as secondary to a service-connected disability, is remanded. Entitlement to service connection for a thoracolumbar spine condition is remanded. Entitlement to service connection for left lower extremity peripheral neuropathy as secondary to a service-connected disability is remanded. Entitlement to service connection for a bilateral knee condition is remanded. Entitlement to a temporary total disability rating due to convalescence or hospitalization in excess of 21 days is remanded. FINDINGS OF FACT 1. The probative evidence persuasively weighs against showing the Veteran's HIV was incurred or aggravated during a period of active service. 2. The most probative evidence persuasively weighs against showing the Veteran has a current gastrointestinal disability. 3. The most probative evidence persuasively weighs against showing the Veteran has a current left and/or right CTS disability. 4. The most probative evidence persuasively weighs against showing the Veteran has a current left and/or right wrist disability. 5. The probative evidence persuasively weighs against showing the Veteran's epididymitis was incurred or aggravated during a period of active service. 6. The probative evidence persuasively weighs against showing the Veteran's left testis disability was incurred or aggravated during a period of active service or is secondary to a service-connected disability. 7. The probative evidence persuasively weighs against showing the Veteran has a current penile disability that was incurred or aggravated during a period of active service or is secondary to a service-connected disability. 8. The probative evidence persuasively weighs against showing the Veteran's acquired psychiatric disorder was incurred or aggravated during a period of active service or is secondary to a service-connected disability. 9. The most probative evidence shows the Veteran's bilateral foot disability, diagnosed as acquired pes cavus and plantar fasciitis, was incurred during a period of active military service. 10. The most probative evidence persuasively weighs against showing the Veteran has a left and/or right foot condition, including callosities, as secondary to his service-connected bilateral foot disability. 11. The Veteran's vision loss based upon refractive error is not a disability for which service connection can be granted, and the probative evidence persuasively weighs against showing he has any other current left and/or right eye pathology. 12. The probative evidence persuasively weighs against showing the Veteran's bilateral renal cyst disability was incurred or aggravated during a period of active service. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for an HIV disability have not been met. 38 U.S.C. §§ 101, 1110, 1131; 38 C.F.R. §§ 3.6, 3.303. 2. The criteria for entitlement to service connection for a gastrointestinal disability, including as secondary to a service-connected disability, have not been met. 38 U.S.C. §§ 101, 1110, 1131; 38 C.F.R. §§ 3.6, 3.303, 3.310. 3. The criteria for entitlement to service connection for a bilateral CTS disability have not been met. 38 U.S.C. §§ 101, 1110, 1131; 38 C.F.R. §§ 3.6, 3.303. 4. The criteria for entitlement to service connection for a bilateral wrist disability, including as secondary to a service-connected disability, have not been met. 38 U.S.C. §§ 101, 1110, 1131; 38 C.F.R. §§ 3.6, 3.303, 3.310. 5. The criteria for entitlement to service connection for an epididymitis disability have not been met. 38 U.S.C. §§ 101, 1110, 1131; 38 C.F.R. §§ 3.6, 3.303. 6. The criteria for entitlement to service connection for a left testis disability, including as secondary to a service-connected disability, have not been met. 38 U.S.C. §§ 101, 1110, 1131; 38 C.F.R. §§ 3.6, 3.303, 3.310. 7. The criteria for entitlement to service connection for a penile disability, including as secondary to a service-connected disability, have not been met. 38 U.S.C. §§ 101, 1110, 1131; 38 C.F.R. §§ 3.6, 3.303, 3.310. 8. The criteria for entitlement to service connection for an acquired psychiatric disorder, including as secondary to a service-connected disability, have not been met. 38 U.S.C. §§ 101, 1110, 1131; 38 C.F.R. §§ 3.6, 3.303, 3.310. 9. The criteria for entitlement to service connection for a bilateral foot disability, diagnosed as acquired pes cavus and plantar fasciitis, have been met. 38 U.S.C. §§ 101, 1110, 1131; 38 C.F.R. §§ 3.6, 3.303, 3.304. 10. The criteria for entitlement to service connection for a bilateral foot disability, reported as calluses, as secondary to service-connected bilateral foot disability have not been met. 38 U.S.C. §§ 101, 1110, 1131; 38 C.F.R. §§ 3.6, 3.303, 3.310. 11. The criteria for entitlement to service connection for a vision disability have not been met. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. 12. The criteria for entitlement to service connection for a bilateral renal cyst disability have not been met. 38 U.S.C. §§ 101, 1110, 1131, 5107; 38 C.F.R. §§ 3.6, 3.102, 3.303. INTRODUCTION The Veteran served honorably on active duty in the United States Air Force Reserve during Peacetime and the Gulf War Era, from February 1984 to June 1987, and in the Air National Guard from April 1989 to December 1994, followed by periods of active duty for training (ACDUTRA) and inactive duty training (INACDUTRA) in the Air National Guard until his retirement in July 2006. These matters come before the Board of Veterans' Appeals (Board) on appeal from a January 2018 Rating Decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). As this appeal has been developed under VA's Legacy system of review, the current Appeals Modernization Act (AMA) system of review is not applicable. Following the Veteran's submission of a Notice of Disagreement (NOD) in January 2019, the RO issued a February 2020 Statement of the Case (SOC). In April 2020, the Veteran timely submitted a substantive appeal (VA Form 9) as it was postmarked within 60 days of the SOC date. 38 U.S.C. § 7105; 38 C.F.R. §§ 19.22, 19.52, 20.110. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Service Connection Generally, 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, the so-called "nexus" requirement. See Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). In certain cases, competent lay evidence may demonstrate the presence of any of these elements. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). Additionally, service connection may be granted for any injury or disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes the disease or injury was incurred in service. 38 C.F.R. § 3.303(d). Certain specifically enumerated "chronic" disorders will be presumed to have been incurred in service if they manifested to a compensable degree within the first year following separation from active duty. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. The presumption for chronic diseases relaxes the evidentiary requirements for establishing entitlement to service connection. See Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2012) ("[t]he clear purpose of [§ 3.303(b)] is to relax the requirements of § 3.303(a) for establishing service connection for certain chronic diseases" and only applies to the chronic diseases set forth in § 3.309(a)). If the evidence is not sufficient to show that the disease was chronic at the time of service, then the claim may be established with evidence of a continuity of symptoms after service, which is a distinct and lesser evidentiary burden than the nexus element of the three-part test under Shedden. Id.; C.F.R. § 3.303(b). Secondary service connection may be granted for a disability that is proximately due to, or aggravated by, a service-connected disease or injury. 38 C.F.R. § 3.310. In order to establish entitlement to secondary service connection, there must be: (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). The term "Veteran" is defined in 38 U.S.C. § 101(2) as "a person who served in the active military, naval, or air service, and who was discharged or released therefrom under conditions other than dishonorable." The term "active military, naval, or air service" includes: (1) active duty, (2) any period of ACDUTRA during which the individual concerned was disabled or died from a disease or injury incurred or aggravated in line of duty, and (3) any period of INACDUTRA during which the individual concerned was disabled or died from an injury incurred or aggravated in line of duty. 38 U.S.C. § 101(24); 38 C.F.R. § 3.6(a); see McManaway v. West, 13 Vet. App. 60, 67 (1999). ACDUTRA is defined, in part, as "full-time duty in the Armed Forces performed by reserves for training purposes." 38 U.S.C. § 101(22); 38 C.F.R. § 3.6(c). INACDUTRA is generally duty (other than full-time duty) prescribed for Reserves or duty performed by a member of the National Guard of any State (other than full-time duty). 38 U.S.C. § 101(23); 38 C.F.R. § 3.6(d). Annual training is an example of ACDUTRA, while weekend drills are INACDUTRA. Although service on active duty alone is sufficient to meet the statutory definition of "Veteran," service on ACDUTRA or INACDUTRA, without more, will not suffice to give one Veteran status. See Donnellan v. Shinseki, 24 Vet. App. 167, 172 (2010). Before Veteran status can be established for a period of such service, it must first be established that a claimant was disabled from a disease or injury incurred or aggravated in line of duty during ACDUTRA, or that he or she was disabled from an injury incurred or aggravated in line of duty during INACDUTRA. The fact that a claimant has established status as a Veteran for other periods of service (e.g., a prior period of active duty) does not obviate the need to establish that he is also a Veteran for purposes of the period of ACDUTRA or INACDUTRA where the claim for benefits is based on that period of ACDUTRA or INACDUTRA. See Mercado-Martinez v. West, 11 Vet. App. 415 (1998). In accordance with 38 U.S.C. § 106, VA has the authority to determine whether a claimant was in active service, including ACDUTRA or INACDUTRA, at the time a claimed injury occurred. VA regulations governing requirements for establishing service for VA benefits purposes require military service department verification of the appellant's service. See Duro v. Derwinski, 2 Vet. App. 530, 532 (1992); 38 C.F.R. § 3.203. "[O]nly official service department records can establish if and when an individual was serving on active duty, [ACDUTRA], or [INACDUTRA]." See Cahall v. Brown, 7 Vet. App. 232, 237 (1994). Moreover, the advantage of certain evidentiary presumptions, provided by law, that assist Veterans in establishing service connection for a disability do not extend to those who claim service connection based upon a period of ACDUTRA or INACDUTRA. See Paulson v. Brown, 7 Vet. App. 466, 470-71 (1995); see also Biggins v. Derwinski, 1 Vet. App. 474, 479 (1991). Therefore, the application of 38 C.F.R. §§ 3.307, 3.309 (presumption of service incurrence), 3.306 (presumption of aggravation), and 38 U.S.C. §§ 1110, 1111, 1131 (presumption of soundness) is not available for the Veteran during any period of ACDUTRA or INACDUTRA. See Smith v. Shinseki, 24 Vet. App. 40, 47 (2010). Finally, the Board must determine whether the evidence persuasively favors the claim or if there is an approximate balance of positive and negative evidence (i.e., relative equipoise) regarding any issue material to the determination of a matter, with the Veteran prevailing in either event, or whether the evidence persuasively weighs against the claim in which case it must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see Lynch v. McDonough, 999 F.3d 1391 (Fed. Cir. 2021); Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Entitlement to service connection for HIV is denied. The Veteran seeks service connection for HIV which he reports was diagnosed during his "time in the military." For the reasons explained below, the Board finds entitlement to service connection for HIV is not warranted. Service treatment records (STRs) indicate the Veteran first tested positive for HIV in July 2005. Private (i.e., non-VA) treatment records continued to reflect an HIV diagnosis in April 2017. As such, the Board finds the Veteran has a current HIV disability. See Shedden, 381 F.3d at 1166-67. Next, aside from the Veteran's statement that HIV was diagnosed during his "time in the military," he has not offered lay or medical evidence addressing a link between the disease and a period of "active" service. Notably, while his military personnel records (MPRs) do reflect a one-day Air National Guard drill "training" beginning and ending on Friday, July 8, 2005, the "official service department records" do not reflect he was serving on active duty or a period of ACDUTRA at the time of the HIV disease was incurred, which was diagnosed on July 14, 2005. See Cahall, 7 Vet. App. at 237; Duro, 2 Vet. App. at 532. This is significant because, as previously noted, entitlement to service connection for a disease requires that it be incurred or aggravated during a period of active duty or ACDUTRA. 38 U.S.C. § 101(24); 38 C.F.R. § 3.6(a). The Board recognizes a VA medical opinion was not sought in connection with the Veteran's claim. VA must provide a medical examination and/or obtain a medical opinion when there is: (1) competent evidence the Veteran has a current disability; (2) evidence establishing he suffered an event, injury, or disease in service or has a disease or symptoms of a disease within a specified presumptive period; (3) an indication the current disability or symptoms may be associated with service; and (4) insufficient medical evidence to make a decision. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). While the Veteran has a current HIV disability, the record does not contain evidence that the disease was incurred or aggravated during a period of "active" service (i.e., active duty or ACDUTRA) as established by the official service department records. Thus, a VA examination and/or opinion is not warranted. Although the Board acknowledges the Veteran's contention that he was diagnosed with HIV "in the military," the official service department records do not show that he was serving on active duty or a period of ACDUTRA in the Air National Guard at the time the disease was incurred or diagnosed. See Cahall, 7 Vet. App. at 237; Duro, 2 Vet. App. at 532. Because the evidence does not suggest his disease was incurred or aggravated during a period of active service, "Veteran" status does not apply for this claim. As such, the Board finds the probative evidence persuasively weighs against entitlement to service connection for HIV, and the benefit of the doubt doctrine is not for application. See Lynch, 999 F.3d 1391. Therefore, the service connection claim for HIV must be denied. Entitlement to service connection for a gastrointestinal condition, to include as secondary to a service-connected disability, is denied. The Veteran contends service connection is warranted for "diarrhea (secondary to: HIV)." For the reasons explained below, the Board finds entitlement to service connection for a gastrointestinal condition is not warranted. As an initial matter, STRs dated September 1985 reflect the Veteran complained of abdominal pain after eating "big meals." Potential assessments were alternatively noted as muscle spasm and rule out hiatal hernia. In a January 1997 Report of Medical History, the Veteran denied gastrointestinal complaints. A January 1997 Report of Medical Examination is also silent for a gastrointestinal condition. Private treatment records dated October 2013 were negative for gastrointestinal complaints. A January 2014 colonoscopy revealed a normal colon. The Veteran was afforded a VA examination in December 2017 (report received January 2018) and diagnosed with a "functional intestinal condition in 1985." The examination noted the Veteran's in-service complaints of abdominal pain "cleared" and "he was able to control his symptoms by controlling his stress level." While the Veteran endorsed "'looser' stools," he "denied diarrhea when specifically asked" and reported having "regular [bowel movements] now," with no constipation, abdominal pain, or discomfort. The examination noted the prior "normal" colonoscopy. The VA opinion found "it is less likely as not that the Veteran has had any chronic GI condition related to his military service" and "his GI complaints while on active duty ... were acute and due to stress and resolved with re-assurance." According to the opinion, "there is no documentation that this condition ever re-occurred in the ensuing 33 years," and the Veteran "does not meet the published criteria ... for a diagnosis of Irritable Bowel Syndrome." The Board assigns probative weight to the VA opinion as it is based upon a personal examination of the Veteran, familiarity with his pertinent medical history, is not inconsistent with the other medical evidence, and is fully articulated and contains a clear conclusion with supporting data and a soundly reasoned medical explanation connecting the two. See McCray v. Wilkie, 31 Vet. App. 243, 257 (2019). The Board has also considered the Veteran's report of experiencing "looser stools," which he is competent to provide as doing so requires only personal knowledge and not medical expertise. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); Layno v. Brown, 6 Vet. App. 465, 469 (1994). Notably, the Veteran has not alleged direct service connection and, instead, attributes his symptoms to HIV. Nevertheless, the Veteran does not have the education and expertise in diagnosing and treating gastrointestinal conditions. In this respect, the Board assigns greater probative weight to the December 2017 VA examination report which assessed no current gastrointestinal disability. As noted previously, the first element required for entitlement to service connection is the presence of a current disability. See Shedden, 381 F.3d at 1166-67. Upon careful review, the Board observes no medical evidence of record suggesting the Veteran has a current gastrointestinal disability. While the Veteran endorsed "looser stools" during the December 2017 VA examination, he denied diarrhea, constipation, or weight loss and was taking no medication for gastrointestinal complaints. The Veteran reported "he eats whatever he wants when he wants." In the absence of proof of a present disability, there can be no valid claim for service connection. See Gilpin v. West, 155 F.3d 1353, 1356 (Fed. Cir. 1998); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Based upon careful review of the lay and medical evidence of record, the Board finds the most probative evidence persuasively weighs against the Veteran having a current gastrointestinal disability. Because the evidence does not suggest he has a gastrointestinal disease that manifested or was incurred or aggravated during a period of active service, "Veteran" status does not apply for this claim. As such, the Board finds the most probative evidence persuasively weighs against entitlement to service connection for a gastrointestinal disability, and the benefit of the doubt doctrine is not for application. See Lynch, 999 F.3d 1391. Therefore, the service connection claim for a gastrointestinal condition must be denied. Entitlement to service connection for bilateral CTS is denied. Entitlement to service connection for a bilateral wrist condition, to include as secondary to a service-connected disability, is denied. The Veteran seeks service connection for bilateral CTS and a bilateral "wrist condition" as "secondary" to CTS. As these claims involve application of similar facts to identical law, they were be addressed together. For the reasons explained below, the Board finds entitlement to service connection for left and/or right CTS and/or other wrist condition is not warranted. STRs include a May 1990 note that diagnosed a ganglion cyst on the right wrist. A Report of Medical Examination dated January 1997 reported "occasional discomfort involving metacarpophalangeal joints of 1st digit bilaterally." In his March 2017 statement the Veteran reported that, "over the course of [his] military career," he experienced "pain in [his] wrists due to the repetitive nature of movement required in an office environment" and he had lost grip strength bilaterally. He also described having "an aching and stiffness in both wrists which affect [his] ability to type or use a calculator for any extended period." A VA examination was conducted in December 2017 (report received January 2018) and the Veteran described his wrists as "'weak' and 'achy,'" but did "not know when it began and was unable to identify whether he was in the service or not." He denied any wrist injury, "except 'computer work for 30 years,'" as well as "any paresthesias in his hand, wrists, or arms." Wrist range of motion (ROM) and muscle strength were reported as normal and equal bilaterally, and there was no localized tenderness or crepitus. The examination noted normal and equal grip strength bilaterally, as well as "Phalen's and Tinel's were normal, negative, and equal bilaterally" with "no sensory loss on either upper extremity to monofilament testing." The VA opinion determined it was "more likely as not [the Veteran] does not have [CTS] or any other wrist joint or peripheral neurological condition," and complaints of "wrist symptoms after a day of use/typing more likely as not reflect a simple use/overuse situation which is normal, expected, and not pathological." The Board assigns probative weight to the VA opinion as it is based upon a personal examination of the Veteran, familiarity with his pertinent medical history, is not inconsistent with the other medical evidence, and is fully articulated and contains a clear conclusion with supporting data and a soundly reasoned medical explanation connecting the two. See McCray, 31 Vet. App. at 257. The rationale reflects the opinion was based upon the examination results and the absence of evidence "documenting any wrist complaints at all (military or private)." The Board has also considered the Veteran's report of experiencing "weak and achy" wrists, which he is competent to provide as doing so requires only personal knowledge and not medical expertise. See Jandreau, 492 F.3d at 1377; Layno, 6 Vet. App. at 469. However, he does not have education and expertise in diagnosing and treating wrist conditions, including CTS. In this respect, the Board assigns greater probative weight to the December 2017 VA examination report which assessed no current left or right wrist disability and determined that complaints of "wrist symptoms after a day of use/typing more likely as not reflect a simple use/overuse situation which is normal, expected, and not pathological." Again, the first element required for entitlement to service connection is the presence of a current disability. See Shedden, 381 F.3d at 1166-67. Upon careful review, the Board finds the most probative evidence of record does not reflect the Veteran has a current left or right CTS or wrist disability. While he described his wrists as "'weak' and 'achy'" during the December 2017 VA examination, he denied "any paresthesias in his hand, wrists, or arms" and objective testing was normal bilaterally. In the absence of proof of a present disability, there can be no valid claim for service connection, including on a secondary basis. See Gilpin, 155 F.3d at 1356; Brammer, 3 Vet. App. at 225. Based upon careful review of the lay and medical evidence of record, the Board finds the most probative evidence persuasively weighs against the Veteran having a current left or right wrist disability, to include CTS. Because the evidence does not suggest he has a wrist disease that manifested or was incurred or aggravated during a period of active service, or a wrist disability due to injury during a period of INACDUTRA, "Veteran" status does not apply for this claim. As the evidence weighs persuasively against the claim, the benefit of the doubt doctrine is not for application. See Lynch, 999 F.3d 1391. Thus, the Veteran's claims for service connection for bilateral CTS and a bilateral wrist condition as secondary thereto must be denied. Entitlement to service connection for epididymitis is denied. Entitlement to service connection for a left testis disability, to include as secondary to a service-connected disability, is denied. Entitlement to service connection for a penile condition, to include as secondary to a service-connected disability, is denied. The Veteran seeks service connection for epididymitis, as well as a left testicle and penile condition he contends are secondary to epididymitis. As these claims involve similar facts and application of identical law, they will be addressed together herein. For the reasons explained below, the Board finds entitlement to service connection for epididymitis, a left testicle condition, and/or a penile condition is not warranted. STRs include a January 1997 Report of Medical examination noting the Veteran had "epididymitis about May 1995" and his "left testicle is only about 1.5 cm in diameter due to severe epididymitis." Private treatment records dated June 2001 indicate episodes of hemospermia and a history of epididymitis, and physical examination revealed "an atrophic left testis." In February 2006, the Veteran expressed interest in receiving a testicular prosthesis which was accomplished in April 2006. In October 2013, "erectile dysfunction and slow stream" were reported as negative. First, the evidence of record does not reflect the Veteran's epididymitis was chronic and, instead, indicates the condition ultimately resolved. Nevertheless, the evidence does reflect he continued to experience genitourinary system conditions (e.g., hemospermia) including resulting left testis atrophy and removal. As such, the Board finds the Veteran has a current genitourinary system disability. See Shedden, 381 F.3d at 1166-67. The Veteran reported "at one point I was diagnosed with epedidymitis [sic], my left testicle became inflamed." According to him, "once the epedidymitis [sic] ran its course my testicle died and I lost the testicle." The Veteran also reported that, "secondary to the epedidymitis [sic] I suffer loss of sexual function and desire and self confidence [sic]." Notably, the Veteran has not offered lay evidence addressing a link between the genitourinary system disability and a period of "active" service. A private medical opinion was received from Dr. J.E., a physician, in January 2019. According to Dr. J.E., "in May of 1995 while in the Air National Guard, the [Veteran] started having severe left scrotal pain with swelling, fever and chills," and "went to a civilian doctor and was diagnosed with severe epididymitis." He opined "it is more likely than not" the Veteran's "severe epididymitis leading to removal of the testicle is service connected because of the occurrence of symptoms when he was serving in the Air National Guard." However, Dr. J.E.'s opinion does not address the Veteran's periods of active duty or ACDUTRA and, instead, appears to be based upon his service in the Air National Guard generally. As a result, the opinion is of no probative value for purposes of determining whether the Veteran's epididymitis and/or resulting left testis atrophy and removal were incurred during or aggravated by a period of active service as established by the official service department records. See McCray v. Wilkie, 31 Vet. App. 243, 257 (2019); Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The Board recognizes a VA medical opinion was not sought in connection with the Veteran's claims. While the Veteran has a current genitourinary system disability, the record does not contain evidence that the epididymitis disease and resulting left testicle atrophy and removal, or a "penile condition," was incurred or aggravated during a period of "active" service (i.e., active duty or ACDUTRA) as established by the official service department records. Thus, a VA examination and/or opinion(s) is not warranted. See McLendon, 20 Vet. App. 79. As previously discussed, service connection for a disease requires it be incurred or aggravated during a period of active duty or ACDUTRA, and incurrence or aggravation of a pertinent injury during a period of INACDUTRA is not reflected in the medical evidence or alleged by the Veteran. 38 U.S.C. § 101(24); 38 C.F.R. § 3.6(a). Here, the Veteran's epididymitis reportedly occurred in May 1995 and the "official service department records" do not establish he was serving on active duty or a period of ACDUTRA at the time. See Cahall, 7 Vet. App. at 237; Duro, 2 Vet. App. at 532. Because the evidence does not suggest his epididymitis and resulting left testis removal, or a "penile condition" (described as "loss of sexual function and desire"), were incurred or aggravated during a period of active service or were the result of an injury during a period of INACDUTRA, "Veteran" status does not apply for these claims. Thus, the Board finds the probative evidence persuasively weighs against entitlement to service connection for epididymitis and/or resulting left testis disability, or a penile condition, and the benefit of the doubt doctrine is not for application. See Lynch, 999 F.3d 1391. Therefore, the service connection claim for epididymitis, as well as the service connection claims for a left testis disability and penile condition as secondary thereto, must be denied. Entitlement to service connection for an acquired psychiatric disorder, to include as secondary to a service-connected disability, is denied. The Veteran seeks service connection for posttraumatic stress disorder (PTSD) which he attributes to the loss of a testicle and being diagnosed with HIV. Because the evidence of record reflects a different diagnosis of "major depressive disorder with panic attacks, recurrent, moderate," the Board has recharacterized the issue on appeal more broadly to reflect the evidence and contentions more accurately. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). For the reasons explained below, the Board finds entitlement to service connection for an acquired psychiatric disorder is not warranted. First, the Veteran was afforded a VA examination in November 2017 which diagnosed major depressive disorder with panic attacks, recurrent, moderate. Symptoms reportedly involved depressed mood, anxiety, suspiciousness, panic attacks more than once a week, chronic sleep impairment, mild memory loss, and disturbances of motivation and mood. As such, the Board finds the Veteran has a current acquired psychiatric disorder disability. See Shedden, 381 F.3d at 1166-67. STRs include a January 1997 Report of Medical History in which the Veteran denied having "depression or excessive worry" and indicated being "in good health taking no medication." A January 1997 Report of Medical Examination is silent for complaints, treatment, or diagnosis of a mental illness. STRs also include a March 2003 private treatment note from Dr. J.G, a physician with Hillcrest Medical Group. He noted the Veteran "was diagnosed with his first onset of major depressive disorder on April 16, 2002," and "the precipitating events included the financial stresses associated with a concurrent divorce." According to Dr. J.G., the Veteran "had no other comorbid diagnoses" or "prior history of depression," and "was treated with a three month course of Celexa ... and ... had no further episodes of depression and his prognosis remains excellent." As noted previously, the Veteran underwent a VA examination in November 2017 which diagnosed major depressive disorder with panic attacks, recurrent, moderate. According to the examination report, while the Veteran "sought therapy when he went through a divorce" and "was prescribed some medication in 2001" until "he stopped it," no other mental health treatment had been rendered. The Veteran reportedly denied "any significant stressor event while on active duty" or "a traumatic event while in military service." Nevertheless, the VA examiner opined it "was at least as likely as not" the Veteran's major depressive disorder with panic attacks, recurrent, moderate, was "incurred in or caused by the claimed in-service injury, event, or illness." By way of rationale, the opinion states that the condition was "diagnosed April 16, 2002" "while Veteran was serving in the [Oklahoma Air National Guard]" and "related to financial and marital stress associated with a divorce." However, the VA opinion does not address the Veteran's periods of active duty or ACDUTRA and, instead, appears to be based upon his service in the Air National Guard generally. As a result, the opinion is of no probative value for purposes of determining whether the Veteran's acquired psychiatric disorder disease was incurred during or aggravated by a period of active service as established by the official service department records. See McCray, 31 Vet. App. at 257; Nieves-Rodriguez, 22 Vet. App. at 304. Again, service connection for a disease requires it be incurred or aggravated during a period of active duty or ACDUTRA, and incurrence or aggravation of a pertinent injury during a period of INACDUTRA is not reflected in the medical evidence or alleged by the Veteran. 38 U.S.C. § 101(24); 38 C.F.R. § 3.6(a). Here, the Veteran's official service department records do not establish he was serving on active duty or a period of ACDUTRA in either 2001 or 2002, when he was briefly treated with medication. See Cahall, 7 Vet. App. at 237; Duro, 2 Vet. App. at 532. Because the evidence does not suggest his acquired psychiatric disorder was incurred or aggravated during a period of active service, "Veteran" status does not apply for this claim. Turning to the Veteran's contention that the acquired psychiatric disorder is "due to the loss of the testicle" and "also due to the HIV," secondary service connection requires, inter alia, nexus evidence establishing a connection between a service-connected disability and the disability for which service connection is sought. 38 C.F.R. § 3.310; see Wallin, 11 Vet. App. at 512. As this Board decision finds entitlement to service connection for HIV, epididymitis, and resulting left testis disability are not warranted, service connection for an acquired psychiatric disorder as secondary to such conditions is also not warranted. Based upon the foregoing, the Board finds the probative evidence persuasively weighs against entitlement to service connection for an acquired psychiatric disorder on either a direct or secondary basis, and the benefit of the doubt doctrine is not for application. See Lynch, 999 F.3d 1391. Therefore, the service connection claim for an acquired psychiatric disorder must be denied. Entitlement to service connection for a bilateral foot disability is granted. Entitlement to service connection for a bilateral foot condition as secondary to service-connected bilateral foot disability is denied. The Veteran contends service connection is warranted for bilateral plantar fasciitis. Additionally, he contends a bilateral "foot condition" as secondary to plantar fasciitis is warranted. As these claims involve similar facts and application of identical law, they will be addressed together herein. Further, the Board has recharacterized the issues on appeal more broadly to reflect the evidence more accurately. For the reasons explained below, the Board finds entitlement to service connection for a bilateral foot disability (diagnosed as acquired pes cavus and plantar fasciitis) is warranted, but service connection for a separate bilateral foot condition (described as "calluses") as secondary thereto is not. First, a private treatment note dated September 2016 reflects an assessment of left foot plantar fasciitis and use of arch supports. Private treatment records dated October and November 2016 indicate the Veteran had, inter alia, left foot plantar fasciitis and bilateral short Achilles and he was to continue using pre-fabricated orthotic devices. A December 2017 VA examination (report received January 2018) assessed him with bilateral pes cavus and plantar fasciitis. As such, the Board finds the Veteran has a current bilateral foot disability. See Shedden, 381 F.3d at 1166-67. STRs dated March 1984 reflect the Veteran complained of sharp pains in the arches of both feet while walking and standing. He was assessed with "fasciitis." In a March 1987 Report of Medical History, the Veteran acknowledged having foot trouble and complained of "tissue strain in feet bilaterally, secondary to marching, treated with tennis shoes." A March 1989 Report of Medical Examination noted bilateral pes cavus. In a January 1997 Report of Medical History, the Veteran did not acknowledge having foot trouble and the Report of Medical Examination of the same date is also silent for a foot condition. In a March 2017 statement, the Veteran reported having "to visit the medical facility" during basic training "due to stabbing pains in both feet" and "the diagnosis was fasciitis due to the marching and shoes." He stated that he "was placed on a tennis shoe waiver with no marching" and, "over the years," he has experienced "ongoing pain in both feet" with prolonged standing and physical activity. A VA examination was conducted in October 2017 and, despite the Veteran's report of experiencing bilateral foot pain over the years and the examination noting "pressure applied to medial side of feet near the arch causes increase in burning sensation," no diagnosed foot condition was assessed. According to the examination, the Veteran's "symptoms are subjective only" and there was "no evidence of record or on today's exam of a bilateral foot condition." The VA negative nexus opinion stated that, "during service, condition was acute only," "there is no evidence of chronicity of care," and "it has been 33 years since Veteran had complaints of foot pain during the service." However, the VA opinion ignores the 2016 private treatment records that were contained within the claims file at the time. Notably, the private treatment records report the Veteran's left foot pain "has been on-again and off-again for the last 30 years." Essentially, the opinion is conclusory and based heavily, if not exclusively, upon a lack of medical treatment evidence and without discussing pertinent medical evidence and the Veteran's report of experiencing ongoing symptoms since he was on active duty. See Buchanan v. Nicholson, 451 F.3d 1331, 1337 (2006). As such, the October 2017 VA opinion is afforded no probative weight. See McCray, 31 Vet. App. at 257; Nieves-Rodriguez, 22 Vet. App. at 304. Another VA examination was conducted in December 2017 (reports received January 2018) and noted the Veteran's diagnosis of bilateral plantar fasciitis in April 1984. According to the examination report, "the Veteran had no foot problems prior to entering the service," and "several weeks later he was seen for a left foot problem/'heel contusion' from playing basketball" and "restricted from running." The report noted that "he continued to have foot problems and over the years was seen several times and eventually diagnosed with bilateral pes cavus and bilateral plantar fasciitis" which, according to the report, "in retrospect this was more likely as not his diagnoses all along." The VA opinion determined that: it is more likely as not that the Veteran's bilateral foot conditions of ... pes planus and plantar fasciitis first started during his military active duty service time during his first enlistment (2-9-1984 to 6-19-1987 DD 2014). The VA opinion states, "the Veteran's foot problems are well documented but it did take a while to get the diagnoses straightened out." As rationale, the opinion states that, "pes cavus causes excess strain on the plantar fascia and leads to irritation and inflammation, with resultant pain, of the plantar fascia," and "particularly so with the physical rigors of the military lifestyle." The Board assigns probative weight to the December 2017 VA opinion as it is based upon a personal examination of the Veteran, familiarity with his pertinent medical history, is not inconsistent with the other probative medical evidence, and is fully articulated and contains a clear conclusion with supporting data and a soundly reasoned medical explanation connecting the two. See McCray, 31 Vet. App. at 257; Nieves-Rodriguez, 22 Vet. App. at 304. A private medical opinion was submitted by Dr. J.E. in January 2019. Dr. J.E. concluded "it is more likely than not, that the [Veteran's] foot pain is service connected because of the occurrence of symptoms when he was in basic training." According to Dr. J.E., "due to vigorous physical training in combat boots with no arch support and high arches caused the [Veteran] to have severe pain and instability in the feet" and that, "due to his high arches, an excessive amount of weight is placed on the ball of the feet when walking and standing." He noted the Veteran "developed painful calluses, hammertoes and plantar fasciitis." Notably, the medical evidence of record does not reflect "painful calluses" or "hammertoes" and, as such, the Board is not satisfied the opinion is based upon sufficient facts or data or familiarity with the Veteran's pertinent medical history. See McCray, 31 Vet. App. at 257; Nieves-Rodriguez, 22 Vet. App. at 304. Thus, the Board assigns limited probative weight to Dr. J.E.'s opinion. Nevertheless, the Board finds the most probative evidence shows the Veteran's bilateral foot disability, diagnosed as acquired pes cavus and plantar fasciitis, was incurred during a period of active military service. 38 C.F.R. § 3.303(d). Thus, entitlement to service connection for a bilateral foot disability on a direct basis is granted. Turning to the Veteran's separate claim for a bilateral foot condition as "secondary" to his service-connected bilateral foot disability, according his March 2017 statement, due to "pain in the fascia" he walks "on the sides" of his feet causing "calluses to form on the heals [sic] and outter [sic] edges of both feet." The Veteran is competent to report observing such foot callosities. See Jandreau, 492 F.3d at 1377; Layno, 6 Vet. App. at 469. However, the medical treatment and examination evidence of record does not reflect callosities or other related foot manifestations aside from those being granted service connection herein. In this respect, the Board assigns greater probative weight to the medical evidence which does not reflect a separate, secondary left and/or right foot disability. In the absence of proof of a present disability, there can be no valid claim for service connection, including on a secondary basis. See Gilpin, 155 F.3d at 1356; Brammer, 3 Vet. App. at 225. Based upon careful review of the lay and medical evidence of record, the Board finds the most probative evidence persuasively weighs against the Veteran having a left and/or right foot condition, including callosities, as secondary to his service-connected bilateral foot disability. As the evidence weighs persuasively against the claim, the benefit of the doubt doctrine is not for application. See Lynch, 999 F.3d 1391. Thus, the Veteran's service connection claim for a bilateral foot condition as secondary to his service-connected bilateral foot disability must be denied. Entitlement to service connection for a vision condition is denied. The Veteran seeks service connection for an "eye (vision)" condition which he attributes to military service. For the reasons explained below, the Board finds entitlement to service connection for a vision condition is not warranted. In his March 2017 statement, the Veteran noted having "perfect eye sight" when he entered the military and "within months of starting continued work on computer screens [he] was forced to get glasses to aid in seeing the screen." He reported feeling "the prolonged use of computers" caused his eyesight to "deteriorate." STRs include a December 1983 Report of Medical Examination reflecting the Veteran entered active military service with 20/20 distant vision bilaterally and 20/25 right near vision and 20/30 left near vision. However, in October 1984 he was noted to have an "astigmatism" and was prescribed eyewear and continued to be followed for vision loss. A March 1987 Report of Medical Examination noted defective distant and near visual acuity bilaterally. A diagnosis of "myopia" was reported in April 1987. A January 1997 Report of Medical Examination indicated 20/200 uncorrected distant vision bilaterally. A private medical opinion was received from Dr. J.E. in January 2019 that noted the Veteran "had 20/20 vision in bilateral eyes when he joined" the Air Force and, "within six months after working on the computer and keyboarding, [he] had difficulty with reading and decreased vision" and "was prescribed glasses." According to Dr. J.E., "it is more likely than not, that the [Veteran's] visual loss is service connected because of the occurrence of symptoms after starting the use of the computer and keyboarding when he was serving." However, the lay and medical evidence of record does not indicate the Veteran has a current disability for VA compensation purposes. Refractory errors such as myopia, presbyopia, and astigmatism are considered developmental defects and are not eligible for service connection. 38 C.F.R. §§ 3.303(c), 4.9. Actual pathology, other than refractive error, is required to support impairment of visual acuity. In the present matter, the evidence does not reflect any current eye disorder other than a refractive error for which service connection cannot be awarded under VA regulations. The Board recognizes the Veteran was not afforded a VA examination regarding this matter. However, as the competent evidence does not suggest the Veteran has a current "disability" for VA purposes, a VA examination is not warranted. See McLendon, 20 Vet. App. 79. Based upon the foregoing, the Board finds the probative evidence of record persuasively weighs against the Veteran having a current eye disability other than refractive error. As the evidence weighs persuasively against the claim, the benefit of the doubt doctrine is not for application. See Lynch, 999 F.3d 1391. Therefore, service connection for a vision condition based upon refractive error must be denied. Entitlement to service connection for bilateral renal cysts is denied. The Veteran seeks service connection for "cyst/benign growth" and, according to his March 2017 statement, notes that an "MRI indicated renal cysts on both sides, one measuring 12mm in diameter and the other measuring 10mm in diameter." According to the Veteran, he has "not had further explanation or evaluation of these cysts." For the reasons explained below, the Board finds entitlement to service connection for bilateral renal cysts is not warranted. First, the Veteran is correct that a September 2016 private MRI report of the lumbar spine noted bilateral renal cysts. Another MRI of the lumbar spine dated November 2017 also revealed "T2 hyperintense foci seen within each kidney, statistically likely representing cysts." Although this is the most recent evidence of such, resolving reasonable doubt in the Veteran's favor, the Board finds he has a current diagnosis of bilateral renal cysts. See Shedden, 381 F.3d at 1166-67; 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Turning to the question of in-service incurrence, STRs are silent for complaints, treatment, or diagnosis of a kidney condition. Indeed, the first evidence of renal cysts is the incidental finding by the September 2016 lumbar spine MRI. The Board recognizes a VA medical opinion was not sought in connection with the Veteran's claim. While the Veteran has a current diagnosis of bilateral renal cysts, the record does not contain evidence that the cyst(s) disease was incurred or aggravated during a period of "active" service (i.e., active duty or ACDUTRA) as established by the official service department records. Thus, a VA examination and/or opinion(s) is not warranted. See McLendon, 20 Vet. App. 79. Again, service connection for a disease requires it be incurred or aggravated during a period of active duty or ACDUTRA, and incurrence or aggravation of a pertinent injury during a period of INACDUTRA is not reflected in the medical evidence or alleged by the Veteran. 38 U.S.C. § 101(24); 38 C.F.R. § 3.6(a). Here, the Veteran's official service department records do not establish he was serving on active duty or a period of ACDUTRA in 2016 when bilateral renal cysts were first observed. See Cahall, 7 Vet. App. at 237; Duro, 2 Vet. App. at 532. Because the probative evidence does not suggest his bilateral renal cysts manifested or was incurred or aggravated during a period of active service, "Veteran" status does not apply for this claim. In sum, the Veteran has not articulated a theory of entitlement to service connection for bilateral renal cysts first diagnosed incidentally over 10 years after he retired from the Air National Guard. Thus, the Board finds the probative evidence persuasively weighs against entitlement to service connection for bilateral renal cysts and the benefit of the doubt doctrine is not for application. See Lynch, 999 F.3d 1391. Therefore, the service connection claim for bilateral renal cysts must be denied. REASONS FOR REMAND Entitlement to service connection for a cervical spine condition is remanded. In a March 2017 statement, the Veteran reported his neck pain started during "active duty" and he "was seen by the doctors and was normally given pain medication or muscle relaxers for pain relief." According to his statement, "over the years this pain has increased and has become a constant pain." In October 2017, the Veteran underwent a VA examination which diagnosed degenerative arthritis of the cervical spine. The Veteran stated, "around 1986 [he] started noticing neck tightness and spasms" that has "progressively worsened over time." He endorsed "constant neck pain that radiates down in right arm" and receiving private treatment for same. The VA opinion concluded it "was less likely than not" his cervical spine disability was related to service. By way of rationale, the opinion noted that, "during service condition was acute only," the Veteran noted being "in good health" during a January 1997 examination, and "it has been 31 years since Veteran's claimed onset without chronicity of care." However, the opinion is based heavily, if not exclusively, upon a lack of medical treatment evidence and without discussing the Veteran's report of experiencing progressively worsening symptoms since "around 1986" when he was on active duty. See Buchanan v. Nicholson, 451 F.3d 1331, 1337 (2006). The opinion also does not discuss any other etiology for the cervical spine condition. Another VA examination was conducted in December 2017 (report received January 2018). At the time, the Veteran indicated his neck condition started "'many years ago,'" "while in the service," and "has been episodic ... until about 3 years ago when it became more constant." The VA opinion concluded "it is less likely as not" his cervical spine conditions are related to military service, including "two minor and acute neck and trapezius muscle strains that occurred 9 months apart while on active duty in 1994." As rationale, the opinion noted the Veteran did "not mention any neck conditions on any of his multiple available [histories and physicals]," and "there is no evidence of chronicity with no documentation of any neck conditions" between 1994 and 2009. Instead, the opinion determined such conditions "more likely as not ... are related to his age, genetics and a life time [sic] of wear and tear." However, the opinion is once again based heavily, if not exclusively, upon a lack of medical treatment evidence and without addressing the Veteran's reports of symptoms manifesting in and continuing since service. Id. Moreover, attribution of his neck conditions to "age, genetics and a life time [sic] of wear and tear," without discussing pertinent facts to support such, appears speculative. As a result, the VA opinions do not contain fully articulated and soundly reasoned medical explanations connecting pertinent supportive facts or data to the conclusions reached. See McCray v. Wilkie, 31 Vet. App. 243, 257 (2019). A private opinion by Dr. J.E. submitted in January 2019 indicated the Veteran "worked as an accountant and payroll personnel for 14 years and 90% of his work was on a computer with keyboarding for at least 8 to 12 hours a day," in addition to "vigorous physical training." He noted the Veteran "went to the medic on several occasions in 1993 and 1994" and a November 2016 MRI "showed degenerative disc disease with disc protrusion at C6-7 and C5-6" with "neural foraminal stenosis." Dr. J.E. opined "it is more likely than not" the Veteran's cervical spine condition "is service connected because of the occurrence of symptoms when he was serving in the [Air Force] from extensive keyboard use as well as physical training," because "abnormal biomechanical stresses ... caused more stresses and abnormal strains on the vertebrae and disc structures," which contributed "to cervical strain, degenerative arthritis and subsequent deranged discs." However, the opinion is conclusory as it is devoid of discussion of pertinent lay or medical evidence reflecting an etiological relationship between the Veteran's in-service complaints and subsequent cervical spine diagnoses over 20 years later. Moreover, it is unclear what 14-year period Dr. J.E. is referring to. As such, the opinion does not contain a fully articulated and soundly reasoned medical explanation connecting pertinent supportive facts or data to the conclusion reached. See McCray, 31 Vet. App. at 257. Thus, the matter must be remanded to afford the Veteran another VA examination and procure a medical opinion adequate for adjudication purposes. Entitlement to service connection for right upper extremity peripheral neuropathy as secondary to a service-connected disability is remanded. In a March 2017 statement, the Veteran reported having "radiating nerve pains down [his] right arm." According to his statement, "the pains originate in [his] neck and upper back and travels down [his] right arm," and involves "tingling" into the fingers. As an initial matter, the Veteran was afforded a VA examination in October 2017. He endorsed experiencing radicular symptoms in the right upper extremity "since around 1986." Mild right upper extremity constant pain, paresthesias and/or dysesthesias, and numbness, and decreased sensation were reported. The Veteran was assessed with mild incomplete paralysis of the right radial nerve. Nevertheless, the abbreviated VA opinion summarily concluded that because the cervical spine condition was not service-connected, and "it has been 21 years since Veteran's discharge of service without evidence of chronicity of care," "no nexus or plausible secondary relationship is established." Another VA examination was conducted in December 2017 (report received January 2018). Notably, the examination did not report an onset for right upper extremity symptoms because, unlike the October 2017 VA examination, no sensory deficits or incomplete paralysis were observed. The VA opinion concluded that, while it "may be true" the Veteran's neuropathic condition is "from his neck arthritis" and "it is possible that the symptoms are produced intermittently," "his cervical arthritis is not related to his military service." However, because the Board is remanding for additional development the service connection claim for a cervical spine condition, the issue of entitlement to service connection for right upper extremity radicular symptoms as secondary thereto must also be remanded as inextricably intertwined. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (two or more issues are inextricably intertwined if one claim could have significant impact on the other). Entitlement to service connection for tinnitus, to include as secondary to a service-connected disability, is remanded. In a March 2017 statement, the Veteran reported having "ringing in both ears" which he contends is "secondary to the neck pain." The Veteran underwent a VA examination in November 2017 and reported "the tinnitus probably started around 1992 and he is unsure how it began." He indicated the "constant ringing makes it difficult to hear clear." Nevertheless, the abbreviated VA opinion summarily concluded it is "less likely than not" the Veteran's tinnitus was caused by or a result of military noise exposure, as the "Veteran's job activities during service had a low probability of noise exposure." However, because the Board is remanding for additional development the service connection claim for a cervical spine condition, the issue of entitlement to service connection for tinnitus as secondary thereto must also be remanded as inextricably intertwined. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). Entitlement to service connection for a thoracolumbar spine condition is remanded. In a March 2017 statement, the Veteran reported his low back pain started during "active duty" and he "was seen by the doctors and was normally given pain medication or muscle relaxers for pain relief." According to his statement, "over the years this pain has increased and has become a constant pain." In October 2017, the Veteran underwent a VA examination which diagnosed degenerative arthritis of the thoracolumbar spine. During the examination, the Veteran stated, "around 1986 [he] started having low back pain that has "progressively worsened over time and is starting to affect his left lower extremity." The VA opinion concluded it "was less likely than not" his thoracolumbar spine disability was related to service. By way of rationale, the opinion noted that, "during service condition was acute only," the Veteran noted being "in good health" during a January 1997 examination, and "it has been 22 years since Veteran's documented back spasms without chronicity of care." However, the opinion is based heavily, if not exclusively, upon a lack of medical treatment evidence and without discussing the Veteran's report of experiencing progressively worsening symptoms since "around 1986" when he was on active duty. See Buchanan, 451 F.3d at 1337. The opinion also does not discuss any other etiology for the thoracolumbar spine condition. Another VA examination was conducted in December 2017 (report received January 2018). At the time, the Veteran indicated his back condition had persisted "for years" and he was "scheduled or surgery next week." The report noted he had "several acute episodes in the service." The VA opinion determined "it is less likely as not" his thoracolumbar spine conditions are related to military service. As rationale, the opinion concluded that "acute lumbar strain does not cause disc degeneration and/or arthritis and is not listed as a risk factor." Instead, the opinion determined such conditions "more likely as not ... are related to the usual risk factors ... such as age, genetics, smoking, and a lifetime of wear and tear." However, the VA opinion is conclusory and attribution of his neck conditions to "age, genetics and a life time [sic] of wear and tear," without discussing pertinent facts to support such, appears speculative. As a result, the VA opinions do not contain fully articulated and soundly reasoned medical explanations connecting pertinent supportive facts or data to the conclusions reached. See McCray, 31 Vet. App. at 257. A private opinion by Dr. J.E. submitted in January 2019 indicated the Veteran "worked as an accountant and payroll personnel for 14 years and 90% of his work was on a computer with keyboarding for at least eight to twelve hours a day," in addition to "vigorous physical training." He noted the Veteran "went to the medic on different occasions in 1989 and 1992," "diagnosed with lumbar strain at that time," and diagnostic imaging in 2016 and 2017 revealed, inter alia, degenerative changes, neural foraminal stenosis, multi-level disc bulges, and facet hypertrophy. Dr. J.E. opined "it is more likely than not" the Veteran's thoracolumbar spine condition "is service connected because of ... repeated injury to his lower back while working as a payroll personnel and accountant," because "abnormal biomechanical stresses ... caused more stresses and abnormal strains on the vertebrae and disc structures," which contributed "to lumbosacral strain, degenerative arthritis and subsequent deranged discs." However, the opinion is conclusory as it is devoid of discussion of pertinent lay or medical evidence reflecting an etiological relationship between the Veteran's in-service complaints and subsequent lumbar spine diagnoses over 20 years later. As such, the opinion does not contain a fully articulated and soundly reasoned medical explanation connecting pertinent supportive facts or data to the conclusion reached. See McCray, 31 Vet. App. at 257. Thus, the matter must be remanded to afford the Veteran another VA examination and procure a medical opinion adequate for adjudication purposes. Entitlement to service connection for left lower extremity peripheral neuropathy as secondary to a service-connected disability is remanded. In his March 2017 statement, the Veteran reported having "radiating nerve pains down [his] left leg" and "in [his] left foot" "secondary to the back pain." According to his statement, "the pains originate in [his] low back and travel down [his] left hip, thigh, and into the heal of [his] foot." The Board has recharacterized the issue on appeal to reflect the Veteran's contentions and the evidence more accurately. Additionally, the Veteran filed a separate service connection claim for "radiating" left foot pain as secondary to a thoracolumbar spine condition; however, such manifestation would be part and parcel of the claim for left lower extremity peripheral neuropathy and, therefore, is incorporated herein. As an initial matter, the Veteran was afforded a VA examination in October 2017. He endorsed experiencing radicular symptoms in the left lower extremity "since around 1986." Mild left lower extremity constant pain, paresthesias and/or dysesthesias, and numbness, and decreased sensation were reported. He was assessed with mild incomplete paralysis of the left sciatic nerve. Nevertheless, the abbreviated VA opinion summarily concluded that because the thoracolumbar spine condition was not service-connected, and "it has been 21 years since Veteran's discharge of service without evidence of chronicity of care," "no nexus or plausible secondary relationship is established." Another VA examination was conducted in December 2017 (report received January 2018). Notably, the examination did not report an onset for left lower extremity symptoms because, unlike the October 2017 VA examination, no sensory deficits or incomplete paralysis were observed. The VA opinion concluded "it is possible he has fleeting or transient symptoms ("sciatica") from his back," but "his back spondylosis/arthritis is not related to his military service." However, because the Board is remanding for additional development the service connection claim for a thoracolumbar spine condition, the issue of entitlement to service connection for left lower extremity radicular symptoms as secondary thereto must also be remanded as inextricably intertwined. See Harris, 1 Vet. App. at 183. Entitlement to service connection for a bilateral knee condition is remanded. In his March 2017 statement, the Veteran reported having "continuous trouble with both knees" including "periods where the knees will just give out and [he] will not be able to put any weight on them." The Veteran was afforded a VA examination in December 2017 (reports received January 2018) which reported a diagnosis of bilateral knee degenerative arthritis. He endorsed "occasional pain (right worse than the left) and has had swelling," and indicated "this started in basic training." The Veteran stated that "after leaving active duty occasionally his knees would flare with pain and swelling" with increased activity, and he reported an "occasional popping sensation in his knees." The VA opinion concluded "it is less likely as not" the Veteran's bilateral knee arthritis is related to his military service and, instead, is "more likely as not ... related to his age, genetics, tobacco use, and a lifetime of wear and tear which are the most common risk factors for degenerative arthritis in the general population." As rationale, the opinion stated, "there is no documentation of any knee condition" and the Veteran did not report a knee condition(s) during active military service. However, the opinion is based heavily, if not exclusively, upon a lack of medical treatment evidence and without discussing the Veteran's report of experiencing symptoms of occasional pain and swelling since he was on active duty. See Buchanan, 451 F.3d at 1337. Additionally, attribution of his bilateral knee condition(s) to "age, genetics, tobacco use, and a lifetime of wear and tear," without discussing pertinent facts to support such, appears speculative. As a result, the VA opinion does not contain a fully articulated and soundly reasoned medical explanation connecting pertinent supportive facts or data to the conclusion reached. See McCray, 31 Vet. App. at 257. Thus, the matter must be remanded to afford the Veteran another VA examination and procure a medical opinion adequate for adjudication purposes. Entitlement to a temporary total disability rating due to convalescence or hospitalization in excess of 21 days is remanded. In his March 2017 statement, the Veteran reported that, "due to the bad discs in the neck and back, [he] will require surgery to repair or replace the discs" and "will be unable to work for extended periods of time ranging from three to six weeks for the neck and six to eight weeks for the back." As a result, he seeks a "temporary total disability" rating. Because a decision on the remanded issues of entitlement to service connection for cervical spine and thoracolumbar spine disabilities, and other related disabilities, could significantly impact a decision on the Veteran's claim for a temporary total rating, they are inextricably intertwined. See Harris, 1 Vet. App. at 183. Thus, the claim for a temporary total rating must also be remanded. Accordingly, these matters are REMANDED for the following actions: 1. Obtain any relevant VA treatment records and undertake all reasonable efforts to obtain any additional private records identified by the Veteran, then associate such records with the claims file. The claims file must be annotated to reflect such efforts. 2. After completing directive #1 above, schedule the Veteran for a VA examination with an examiner who has not previously offered an opinion in these matters and possessing the necessary expertise to fully assess and render an opinion regarding the nature, severity, and likely etiology of his cervical spine and thoracolumbar spine conditions, including any associated neurological manifestations, as well as his bilateral knee conditions. The claims file must be made available to the examiner and reviewed in conjunction with this examination. A full history must be obtained from the Veteran as he is competent to attest to factual matters of which he has first-hand knowledge, such as onset and continuity of observable signs and symptoms. All pertinent signs and symptoms, including when initially manifesting and any continuity/progression over time, must be elicited from the Veteran and reported in detail. Any indicated studies must be performed and the results fully reported. Based upon a review of the claims file, the Veteran's full history, and the examination results, the examiner must offer an opinion as to: (a.) Whether it is AT LEAST AS LIKELY AS NOT (i.e., at least approximately balanced, or nearly equal, if not higher) any cervical spine condition(s) manifested during a period of active service (i.e., active duty and/or ACDUTRA) or is due to or aggravated by a disease or injury incurred during a period of active service; OR is due to or aggravated by an injury incurred during a period of INACDUTRA (e.g., weekend drills). In offering the above opinion, the examiner must assess the nature and severity of any associated left and/or right upper extremity radicular symptoms and address whether it is at least as likely as not the Veteran's claimed tinnitus is proximately due to or aggravated by the cervical spine. (b.) Whether it is AT LEAST AS LIKELY AS NOT (i.e., at least approximately balanced, or nearly equal, if not higher) any thoracolumbar spine condition(s) manifested during a period of active service (i.e., active duty and/or ACDUTRA) or is due to or aggravated by a disease or injury incurred during a period of active service; OR is due to or aggravated by an injury incurred during a period of INACDUTRA (e.g., weekend drills). In offering the above opinion, the examiner must assess the nature and severity of any associated left and/or right lower extremity radicular symptoms. (c.) Whether it is AT LEAST AS LIKELY AS NOT (i.e., at least approximately balanced, or nearly equal, if not higher) any left and/or right knee condition(s) manifested during a period of active service (i.e., active duty and/or ACDUTRA) or is due to or aggravated by a disease or injury incurred during a period of active service; OR is due to or aggravated by an injury incurred during a period of INACDUTRA (e.g., weekend drills). The examiner is advised the mere absence of evidence does not automatically equate to unfavorable evidence. The Veteran's statements regarding the onset and any continuity/progression of pertinent signs and symptoms must be fully considered and discussed. All opinions expressed must be fully articulated and contain clear conclusions with references to supporting data (i.e., pertinent evidence of record and, as warranted, medical literature) and soundly reasoned medical explanations connecting the two. 3. After ensuring full compliance with the remand directives, readjudicate all claims on appeal. Danette Mincey Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Worsham, 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.