Citation Nr: 18139891 Decision Date: 10/01/18 Archive Date: 10/01/18 DOCKET NO. 15-46 406 DATE: October 1, 2018 ORDER Entitlement to service connection for bilateral hearing loss is denied. Entitlement to service connection for a psychiatric disability diagnosed as an anxiety disorder is granted. Entitlement to a rating in excess of 10 percent for tinnitus is denied. Entitlement to an effective date prior to July 22, 2013, for service connection for tinnitus is denied. REMANDED Entitlement to service connection for left shoulder tendinopathy is remanded. Entitlement to service connection for right shoulder degenerative joint disease with tendinopathy is remanded. Entitlement to service connection for left lower extremity radiculopathy (claimed as nerve and toes tingling) is remanded. Entitlement to service connection for right lower extremity radiculopathy (claimed as nerve and toes tingling) is remanded. Entitlement to service connection for degenerative disc and joint disease of the lumbosacral spine with stenosis is remanded. Entitlement to a total disability rating for compensation based upon individual unemployability (TDIU) is remanded. FINDINGS OF FACT 1. The Veteran does not have hearing loss for VA purposes in either his right or left ear. 2. A psychiatric disorder diagnosed as an anxiety disorder has been related to the Veteran’s military service. 3. The Veteran is in receipt of the maximum schedular rating available for tinnitus. 4. The Veteran’s claim for entitlement to service connection for tinnitus was received on July 22, 2013. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for bilateral hearing loss have not been met. 38 U.S.C. §§ 1101,1112, 1113, 1131, 5103A, 5107 (2012); 38 C.F.R. § 3.102, 3.303, 3.304, 3.385, 4.3 (2017). 2. The criteria for entitlement to service connection for a psychiatric disability diagnosed as an anxiety disorder have been met. 38 U.S.C. §§ 1101, 1131, 1154, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304 (2017). 3. The criteria for entitlement to a rating in excess of 10 percent for tinnitus have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.3, 4.7, 4.10, 4.87, DC 6260 (2017). 4. The criteria for entitlement to an effective date prior to July 22, 2013, for service connection for tinnitus have not been met. 38 U.S.C. §§ 5110, 5103A, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.155, 3.159, 3.400 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Marine Corps from June 1980 to June 1984. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a November 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Denver, Colorado. Service Connection 1. Entitlement to service connection for hearing loss The Veteran contends that his hearing loss is due to his military service. Service connection may be granted for a disability resulting from 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 may be granted for any disease initially diagnosed after service 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 for a disability requires evidence of: (1) a current disability; (2) a disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Service connection may only be granted for a current disability; when a claimed condition is not shown, there may be no grant of service connection. See 38 U.S.C. 1131; Rabideau v. Derwinski, 2 Vet. App. 141 (1992). In the absence of proof of a present disability, there can be no valid claim for service connection. See Degmetich v. Brown, 104 F.3d 1328 (1997); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The requirement that a current disability be present is satisfied when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim, even if the disability resolves prior to the adjudication of the claim. See McClain v. Nicholson, 21 Vet. App. 319 (2007). The threshold for normal hearing is from 0 to 20 decibels. Hensley v. Brown, 5 Vet. App. 155, 157 (1993). For the purposes of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. 3.385 Turning to the medical evidence at hand, the Veteran underwent a VA audiology examination in September 2013. The examiner recorded pure tone thresholds, in decibels, at 500, 1000, 2000, 3000, 4000, 6000, and 8000 hertz (Hz) were as follows: 20, 20, 05, 15, 20, 25, 35, for the right ear, with an average of 15; and 15, 10, 05, 05, 25, 25, and 25 for the left ear, with an average of 11. The Veteran’s Maryland CNC speech recognition scores were 98 percent in the right ear and 100 percent in the left ear. Following the examination, the examiner noted that the Veteran may have impaired hearing in his right ear but it did not meet the criteria to be considered a disability for VA purposes. The examiner also opined that the Veteran’s left ear had normal hearing. See September 2013 VA examination. In October 2013, the examiner included an addendum opinion and stated that “the enlistment audiogram showed hearing WNL 500-6k AU. An opinion for hearing loss was not given since the hearing loss is non-disabling per 38 C.F.R. 3.385 right ear and WNL left ear on this exam.” See October 2013 addendum opinion. In addition to the VA examination, the Board notes that in August 2013, the Veteran submitted a private audiological examination. The examination report showed that the Veteran had an average pure tone of 15 in both ears and a 100 percent speech discrimination score in both ears. See July 2013 private audiological report. In sum, the Board finds that service connection for bilateral hearing loss is not warranted. After a review of the record, the Board has found no evidence that demonstrates that the Veteran suffers bilateral hearing loss for VA compensation purposes. Accordingly, based on the VA examination results and evidence of record, service connection for bilateral hearing loss must be denied because there is no current disability. See Brammer, supra. To the extent the Veteran asserts that he does in fact have bilateral hearing loss, the objective clinical testing outweighs the lay opinion, as audiometric testing is required to determine whether there is hearing loss for VA purposes compared to a lay assertion on the matter. Jandreau v. Nicholson, 492 F 3d 1372, 1377 (Fed Cir 2007). The Board notes that it does not doubt the credibility of the Veteran’s reports of being exposed to noise during service as he can attest to factual matters of which he had first-hand knowledge; however, the VA examiner’s opinion is of more probative value than the Veteran’s lay statements. Washington v. Nicholson, 19 Vet. App. 362, 368 (2005). For the above stated reasons, the preponderance of the evidence is against the claim, the benefit of the doubt doctrine does not apply, and service connection for bilateral hearing loss must be denied 2. Entitlement to service connection for a psychiatric disability to include anxiety and post-traumatic stress disorder (PTSD). The Veteran asserts that his psychiatric disability is due to his military service. Service connection is warranted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in the line of duty in the active military service or, if pre-existing such service, was aggravated thereby. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. If a condition noted during service is not shown to be chronic, then generally a showing of continuity of symptomatology after service is required for service connection if the disability is one that is listed at 38 C.F.R. § 3.309(a). 38 C.F.R. § 3.303(b); see also Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013)). In addition, service connection may also be granted on the basis of a post-service initial diagnosis of a disease, where the physician relates the current condition to the period of service. 38 C.F.R. § 3.303(d). Other specifically enumerated 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, 1113; 38 C.F.R. §§ 3.307, 3.309. In order to establish service connection for the claimed disorder, there must be (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999). The requirement of a current disability is “satisfied when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim.” See McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). Service connection for PTSD requires a medical diagnosis of PTSD in accordance with 38 C.F.R. § 4.125(a); a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred. 38 C.F.R. § 3.304(f). The evidence required to support the occurrence of an in-service stressor varies depending on whether the appellant was engaged in combat with the enemy. If the evidence establishes that a veteran engaged in combat with the enemy and the claimed stressor is related to that combat, in the absence of clear and convincing evidence to the contrary, and provided that the claimed stressor is consistent with the circumstances, conditions, or hardships of such veteran’s service, his lay testimony alone may establish the occurrence of the claimed in-service stressor. 38 U.S.C. § 1154(b) (2012); 38 C.F.R. § 3.304(f). Effective July 13, 2010, if a stressor claimed by a veteran is related to that veteran’s fear of hostile military or terrorist activity and a VA psychiatrist or psychologist, or a psychiatrist or psychologist with whom VA has contracted, confirms that the claimed stressor is adequate to support a diagnosis of PTSD and that a veteran’s symptoms are related to the claimed stressor, in the absence of clear and convincing evidence to the contrary, and provided the claimed stressor is consistent with the places, types, and circumstances of that veteran’s service, lay testimony alone may establish the occurrence of the claimed in-service stressor. “[F]ear of hostile military or terrorist activity” means that a veteran experienced, witnessed, or was confronted with an event or circumstance that involved actual or threatened death or serious injury, or a threat to the physical integrity of the veteran or others, such as from an actual or potential improvised explosive device; vehicle-imbedded explosive device; incoming artillery, rocket, or mortar fire; grenade; small arms fire, including suspected sniper fire; or attack upon friendly military aircraft, and the veteran’s response to the event or circumstance involved a psychological or a psycho-physiological state of fear, helplessness, or horror. See 75 Fed. Reg. 39,843 (Jul. 13, 2010) (codified at 38 C.F.R. § 3.304(f)(3)). The requirement of a current disability is “satisfied when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim.” See McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). Lay statements may serve to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability or symptoms of disability subject to lay observation. 38 U.S.C. § 1153(a); 38 C.F.R. § 3.303(a); Jandreau v. Nicholson, 492 F.3d 1372 (Fed Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). Although lay persons are competent to provide opinions on some medical issues, some medical issues fall outside the realm of common knowledge of a lay person. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). Generally, the degree of probative value which may be attributed to a medical opinion issued by a VA or private treatment provider takes into account such factors as its thoroughness and degree of detail, and whether there was review of the claims file. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000). Also significant is whether the examining medical provider had a sufficiently clear and well-reasoned rationale and a basis in objective supporting clinical data. See Bloom v. West, 12 Vet. App. 185, 187 (1999); Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998); see also Claiborne v. Nicholson, 19 Vet. App. 181, 186 (2005) (rejecting medical opinions that did not indicate whether the physicians actually examined the veteran, did not provide the extent of any examination, and did not provide any supporting clinical data). In evaluating the evidence in any given appeal, it is the responsibility of the Board to weigh the evidence and decide where to give credit and where to withhold the same and, in so doing, accept certain medical opinions over others. Schoolman v. West, 12 Vet. App. 307, 310-11 (1999). In this regard, the Board has been charged with the duty to assess the credibility and weight given to evidence. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006); Charles v. Principi, 16 Vet. App. 370 (2002); Klekar v. West, 12 Vet. App. 503, 507 (1999); Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). Indeed, the Court has declared that in adjudicating a claim, the Board has the responsibility to do so. Bryan v. West, 13 Vet. App. 482, 488-89 (2000); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992). In doing so, the Board is free to favor one medical opinion over another, provided it offers an adequate basis for doing so. Owens v. Brown, 7 Vet. App. 429, 433 (1995). Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits under the laws administered by VA. VA shall consider all information and medical and lay evidence of record. Where there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). As to a current diagnosis, the Veteran’s psychiatric disability has been diagnosed to be an anxiety disorder. As to the in-service incurrence, the Veteran reported that his Marine unit was stationed off the coast of Lebanon in 1981. While stationed off the coast of Lebanon, the Veteran’s unit was placed on alert several times in the event that circumstances required them to enter Beirut to secure the American embassy. In turn, the Veteran reported that he was afraid that he was going to be killed or kill someone if he had to enter Beirut. The other stressful experience that the Veteran has identified is when he was stationed at the Marine Barracks in Washington, D.C. While in Washington, D.C., the Veteran stated that he was assigned to the ceremonial Honor Guard and he was present at the burials of many Marines to include Marines who were killed in the bombing of the Marine barracks in Lebanon. Initially, the Board has reviewed the Veteran’s service treatment records and military personnel records. The Veteran’s personnel records confirm that his unit was stationed off the coast of Lebanon in 1981 and that he was also stationed in Washington, D.C. Moreover, the Board notes that the Veteran’s service treatment records did not show a diagnosis or treatment for a psychiatric condition; but his personnel records did show that he was administratively counseled for consuming alcoholic beverages prior to his ceremonial unit duties. Turning to the medical evidence at hand, the Veteran attended a VA examination in October 2013. The examiner diagnosed the Veteran with an anxiety disorder and stated that “there are several reasons the Veteran's symptoms do not fully meet the requirements for a diagnosis of PTSD, but the primary reason is that the Veteran's reported PTSD Trauma Stressor does not meet the requirements of extreme trauma as defined by the DSM-IV.” See October 2013 VA examination. The Board notes that the examiner merely found that the Veteran did not meet the criteria for a diagnosis of PTSD and did not provide an etiological opinion as to whether the Veteran’s diagnosed anxiety condition was due to his experiences on active duty. Accordingly, the Board finds that this opinion has limited probative value. See Davidson, supra. In addition to the VA examination, the Board notes that the Veteran submitted a private psychiatric evaluation. The Veteran’s private doctor interviewed him and reviewed the Veteran’s claims file. The Veteran reported to the examiner that after he returned from Beirut he “became easily startled, easily upset, had difficulty sleeping, always stressed out, panic attacks in crowds of people, nightmares, self-medicated with alcohol and marijuana, flashbacks, mood swings, engaged in risky behavior, legal issues and difficulty concentrating.” After an interview of the Veteran and a review of his claims file, Dr. H. H-G. diagnosed the Veteran with unspecified anxiety disorder and opined that “it is the opinion of this expert that the Veteran suffers from unspecified anxiety disorder more likely than not began in military service, continues uninterrupted to the present and prevents him from maintaining substantially gainful employment.” See Dr. H. H-G. March 2016 psychological report. Lastly, the Board has reviewed the Veteran’s VA treatment records and the Board notes that his medical records reflect that the Veteran has a diagnosis of PTSD from VA and has also participated in mental health counseling for this disability. In sum, the Board finds that service connection for an acquired psychiatric disorder, diagnosed as an anxiety disorder, is warranted. In reaching this conclusion, the Board has reviewed the available lay statements, his medical history, and the available medical opinions. After a review of the record, the Board finds that the evidence, both positive and negative as to the issue of service connection for an anxiety disorder is at least in equipoise. While the record does reveal a diagnosis of PTSD and psychiatric treatment for this condition, this disability has not been linked to service and the Board does not find that any further development would assist in the substantiation of a claim for service connection for this psychiatric disability, especially given the fact that the most recent VA examiner did not find that the Veteran’s symptoms met the criteria for PTSD and the Veteran submitted a medical opinion that only supported service connection for an anxiety disorder. Therefore, based on the foregoing and resolving all reasonable doubt in the Veteran’s favor, the Board finds that service connection is only warranted for a psychiatric disorder, diagnosed as an anxiety disorder. 3. Entitlement to a rating in excess of 10 percent for tinnitus The Veteran is seeking a rating in excess of 10 percent for his tinnitus. Disability evaluations are determined by the application of a schedule of ratings which is based, as far as can practically be determined, on the average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Each service-connected disability is rated on the basis of specific criteria identified by Diagnostic Codes. 38 C.F.R. § 4.27. When rating the Veteran’s service-connected disability, the entire medical history must be borne in mind. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). The Court has held that a claimant may experience multiple distinct degrees of disability that might result in different levels of compensation from the time the increased rating claim was filed until a final decision is made. Hart v. Mansfield, 21 Vet. App. 505 (2007). Separate compensable evaluations may be assigned for separate periods of time if such distinct periods are shown by the competent evidence of record during the appeal, a practice known as staged ratings. See Fenderson v. West, 12 Vet. App. 119, 126 (1999). Regulations require that where there is a question as to which of two evaluations is to be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Moreover, when an unlisted condition is encountered, it will be permissible to rate on the basis of a closely related disease or injury in which not only the function affected, but the anatomical location and symptomatology are closely analogous. 38 C.F.R. § 4.20 (2015). The Veteran’s tinnitus is currently rated under 38 C.F.R. § 4.87, DC 6260. Under Diagnostic Code 6260, only a single 10 percent rating is warranted for tinnitus, whether the sound is perceived as being in one ear, both ears, or in the head. 38 C.F.R. § 4.87, Diagnostic Code 6260, Note (2). This is the maximum schedular rating assignable for tinnitus. See Smith v. Nicholson, 451 F.3d 1344, 1349-50 (Fed. Cir. 2006). Although, the Veteran argues that he is entitled to a rating in excess of 10 percent for his tinnitus, Diagnostic Code 6260 precludes an evaluation in excess of a single 10 percent schedular rating for tinnitus. Under these circumstances, the disposition of this claim is based on the law, and not the facts of the case, and the claim for an increased schedular rating must be denied based on a lack of entitlement under the law. See Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). Extra Considerations. The Board finds that the Veteran has not raised the matter of an extraschedular rating and that the evidence does not present exceptional or unusual circumstances. Doucette v. Shulkin, 28 Vet. App. 366 (2017) (holding that either a Veteran must assert that a schedular rating is inadequate or the evidence must present exceptional or unusual circumstances). As such, no further action as to this matter is required. 4. Entitlement to an effective date prior to July 22, 2013 for service connection for tinnitus The Veteran is seeking an earlier effective date for the award of service connection for tinnitus. Unless Chapter 38 of the United States Code specifically provides otherwise, the effective date of an evaluation and grant of pension, compensation, or dependency and indemnity compensation based on an original claim, a claim reopened after final disallowance, or a claim for increase will be the date of receipt of the claim or the date entitlement arose, whichever is the later. See 38 U.S.C. 5110 (a) (2012); 38 C.F.R. 3.400 (2017). An earlier effective date may be granted prior to the date of the filing of the claim for a rating increase if it is ascertainable that an increase in disability occurred within one year prior to the filing of the claim. See 38 U.S.C. 5110 (b)(2) (2012); 38 C.F.R. 3.400 (o)(2) (2017). The effective date for a grant of service connection is the day following the date of separation from active service or the date entitlement arose, if the claim is received within one year after separation from active service; otherwise date of receipt of claim, or date entitlement arose, whichever is later. See 38 U.S.C. 5110 (a) (2012); 38 C.F.R. 3.400 (b)(2)(i) (2017). A “claim” is a formal or informal communication in writing requesting a determination of entitlement or evidencing a belief in entitlement to a benefit. See 38 C.F.R. 3.1 (p) (2017). “Date of receipt” of a claim, information, or evidence means the date on which a claim, information, or evidence was received by VA. See 38 C.F.R. 3.1 (r) (2017). Any documented communication from, or action by, a veteran indicating intent to apply for a benefit under laws administered by VA may be considered an informal claim. See 38 C.F.R. 3.155 (b) (2017). To determine when a claim was received, the Board must review all communications in the claims file that may be construed as an application or claim. See Quarles v. Derwinski, 3 Vet. App. 129, 134 (1992). Generally, the effective date for service connection is not based on the date a disability began, but rather on the date of receipt of the claim. See Lalonde v. West, 12 Vet. App. 377, 382 (1999). A review of the claims file reveals that VA received the Veteran’s VA-Form 21-526b seeking service connection for tinnitus was received on July 22, 2013. After careful consideration, the Board finds that the entitlement to an earlier effective date for the grant of service connection for tinnitus is not warranted. After a review of the record, the Board notes that VA did not receive any communication from the Veteran or his representative indicating an intent to claim service connection for this disability prior to July 22, 2013. For the above stated reasons, the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine does not apply, and the claim for entitlement to an earlier effective date for service connection for tinnitus, must be denied. See 38 U.S.C. 5107 (b) (2012); 38 C.F.R. 3.102 (2017); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). REASONS FOR REMAND Although the Board sincerely regrets the additional delay, it is necessary to ensure that there is a complete record upon which to decide the Veteran’s claims so that he is afforded every possible consideration. 1. Entitlement to service connection for left shoulder tendinopathy is remanded. 2. Entitlement to service connection for right shoulder degenerative joint disease with tendinopathy is remanded. In May 2013, the Veteran attended a VA examination for his bilateral shoulder disabilities. After a review of the examination, the Board finds this examination inadequate because the examiner did not base their opinion on an accurate set of facts. Specifically, the examiner did not take into account any of the Veteran’s lay statements and simply relied on the absence of treatment records when she rendered her opinion. Thus, a remand is required to obtain a more complete medical opinion as to the nature and etiology of the Veteran’s bilateral shoulder conditions. See 38 U.S.C. § 5103A(d) (2012); 38 C.F.R. § 3.310 (2015); Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (holding that when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate); Bloom v. West, 13 Vet. App. 185, 187 (1999) (a medical opinion without supporting clinical data or other rationale does not provide the required degree of medical certainty). 3. Entitlement to service connection for degenerative disc and joint disease of the lumbosacral spine with stenosis is remanded. In September 2013, the Veteran attended a VA examination for his lumbar spine condition. After a review of the examination, the Board finds this examination inadequate because the examiner did not base their opinion on an accurate set of facts. The Board notes that the examiner acknowledged that the Veteran had a diagnosis of a lumbar strain while in service, but the examiner’s opinion did not include an analysis as to whether the lumbar strain could explain the Veteran’s present disability. Moreover, the examiner did not take into account any of the Veteran’s lay statements and simply relied on the absence of treatment records when he rendered his opinion. Thus, a remand is required to obtain a more complete medical opinion as to the nature and etiology of the Veteran’s lumbar spine condition. Barr, supra; Bloom, supra. 4. Entitlement to service connection for left lower extremity radiculopathy (claimed as nerve and toes tingling) is remanded. 5. Entitlement to service connection for right lower extremity radiculopathy (claimed as nerve and toes tingling) is remanded. In May 2013, the Veteran attended an examination for these issues. The examiner found that these disabilities were less likely than not due to the Veteran’s military service. The examiner found that the condition was less likely than not incurred in or caused by the Veteran’s military service. The Board also finds this examination to be inadequate because the examiner did not provide a clear rationale as to why the Veteran’s condition was not related to his military service. The Board notes that the examiner again relied on the absence of treatment records and did not opine as to whether the Veteran’s condition was due to a post-service accident that the Veteran reported or his military service. Moreover, the bilateral lower extremity disabilities are inextricably intertwined with the Veteran’s lumbar spine condition that is still on appeal. Therefore, further development is needed and a final decision on the issue of entitlement to bilateral radiculopathy of the lower extremities cannot be rendered at this time. See Harris v. Derwinski, 1 Vet. App. 180 (1991) (two issues are “inextricably intertwined” when they are so closely tied together that a final decision on one issue cannot be rendered until a decision on the other issue has been rendered). 6. TDIU is remanded. The Board acknowledges that the Veteran’s claim for an increased rating for tinnitus includes a claim for TDIU when it is expressly raised by the Veteran or reasonably raised by the record. After a review of the record, the Board finds that the claim for TDIU has been raised by the record. Specifically, the Board notes that the audiological examiner noted that the Veteran’s tinnitus impacted his ability to work. Moreover, the Board has now granted service connection for a psychiatric condition in which the private examiner found that the Veteran’s anxiety impacted his ability to maintain gainful employment. For the above stated reasons, the issue of entitlement to TDIU has been raised by the record and is part and parcel to the Veteran’s increased ratings claim. See Rice v. Shinseki, 22 Vet. App. 447. Thus, this issue must be remanded for further development and then adjudication by the RO. The matters are REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records from January 6, 2016. 2. Schedule the Veteran for a VA examination to determine the nature an etiology of his bilateral shoulder condition. The electronic claims file must be reviewed by the examiner. All indicated studies and testing must be conducted, and all pertinent symptomatology must be reported in detail. After a review of the claims file, the examiner should provide answers to the following questions: (A). Identify all shoulder disabilities that are currently present. (B). Is it at least as likely as not (50 percent probability or greater) that the Veteran’s bilateral shoulder disabilities, had their onset in service or is caused by or related at least in part to his active service? (C). Is it at least as likely as not that the Veteran’s bilateral shoulder disorders manifested in the first post-service year? The examiner’s opinion should include a discussion to account for the Veteran’s account that he carried “a lot of weight” while in the Marine Corps and that his bilateral shoulder disabilities started while he was in the service. 3. Schedule the Veteran for a VA examination to determine the nature an etiology of his lumbar spine disorder and bilateral radiculopathy of the lower extremities. The electronic claims file must be reviewed by the examiner. All indicated studies and testing must be conducted, and all pertinent symptomatology must be reported in detail. After a review of the claims file, the examiner should provide answers to the following questions: (A). Identify all low back disorders that are currently present. (B). Is it at least as likely as not (50 percent probability or greater) that the Veteran’s low back disorder, had its onset in service or is caused by or related at least in part to his active service? (C). Is it at least as likely as not that the Veteran’s low back disorder manifested itself in the first post-service year? The examiner’s opinion should include a discussion regarding the Veteran’s in-service diagnosis of a lumbar strain in September 1981. The examiner’s opinion should include a discussion regarding the Veteran’s contentions that his lumbar spine condition began shortly after leaving the service. (D). Is it at least as likely as not (50 percent probability or greater) that the Veteran’s bilateral radiculopathy of the lower extremities, had its onset in service or is caused by or related at least in part to his active service? (E). If service connection is granted for a lumbar spine condition, is it at least as likely as not that the Veteran’s bilateral radiculopathy of the lower extremities is caused by, aggravated by, or related to the Veteran’s lumbar spine disability? The VA examination report must include a complete rationale for all opinions expressed. In providing all of the requested opinions, the examiner should consider the Veteran’s competent lay claims regarding the observable symptoms he has experienced. In providing the requested opinions, the examiner cannot rely exclusively on the absence of relevant treatment in the Veteran’s medical history. If the examiner feels that any of the requested opinions cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge (i.e. no one could respond given medical science and the known facts) or by a deficiency in the record or the examiner (i.e. additional facts are required, or the examiner does not have the needed knowledge or training). 4. As to the Veteran’s claim for TDIU, provide the Veteran with a VA Form 21-8940 in connection with the claim for entitlement to TDIU, and request that he supply the requisite information. 5. The RO should take any steps that it deems necessary to properly develop and adjudicate the Veteran’s claim for TDIU. Michael J. Skaltsounis Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Rescan, Associate Cousel