Citation Nr: 18144205 Decision Date: 10/24/18 Archive Date: 10/23/18 DOCKET NO. 14-38 822A DATE: October 24, 2018 ORDER 1. The appeal with respect to the issue of entitlement to an initial rating in excess of 10 percent for tinnitus is dismissed. The Veteran’s rRequest to reopen his previously-denied claim for service connection for Bell's palsy is denied. 2. The Veteran’s rRequest to reopen his previously-denied a claim for service connection for posttraumatic stress disorder (PTSD) is granted. 3. Entitlement to service connection for PTSD is granted. 4. Entitlement to service connection for a chronic disability manifested by fatigue is denied. 5. Entitlement to service connection for a right eye disability is denied. 6. Entitlement to service connection for bilateral hearing loss is denied. 7. Entitlement to a rating in excess of 20 percent for status post right thumb fracture with degenerative joint disease is denied.   REMANDED 8. Whether new and material evidence has been received to reopen a claim for service connection for joint and bone pain is remanded. 9. Entitlement to service connection for a headache disability is remanded. 10. Entitlement to service connection for a traumatic brain injury (TBI) claimed as neurological symptoms, is remanded. 11. Entitlement to an initial rating in excess of 50 percent for anxiety disorder, claimed as depression, nervous condition, and sleep disturbances, is remanded. 12. Entitlement to a rating in excess of 20 percent for status post right thumb fracture with degenerative joint disease to include right hand/wrist residuals is remanded. 13. Entitlement to a total disability evaluation based on individual unemployability due to service-connected disabilities (TDIU) is remanded. REFERRED The issue of entitlement to service connection for a right hand/wrist disability was raised at the time that the Veteran filed his original claim in 1991, and although the Veteran was granted service connection for residuals of a right thumb fracture, he has continuously indicated that his disability was for his right hand and testified in February 1993February 1993 at a Regional Office (RO) hearing that his pain was at the bottom of the palm area and on an upper palm area (dorsum). In addition, the issue of entitlement to service connection for a skin disability was raised in a statement. Thus, the issues of entitlement to service connection for a right hand/wrist disability and a skin disability are referred to the Agency of Original Jurisdiction (AOJ) for adjudicationappropriate action. FINDINGS OF FACT 1. On April 24, 2018, prior to the promulgation of a decision in the appeal, the Board received notification from the Veteran that a withdrawal of this appeal with respect to the issue of entitlement to an increased rating for tinnitus was requested. 1.2. A claim for service connection for Bell’s palsy was denied by a May 2000 rating decision that was not appealed. New and material evidence was not received within the year after the Veteran was notified of the May 2000 decision. Requestsrequest to reopen the Veteran’s claim for service connection for Bell’s palsy was were denied in a rating decisions dated in June 2006 and February 2009. The Veteran did not appeal this ese decisions, and new and material evidence was not received within the year after the Veteran was notified of the February 2009 se decisions. 2.3. Evidence submitted subsequent to the February 2009 rating decision is either cumulative or redundant of the evidence of record at the time of the last prior final denial of the claim for service connection for Bell’s palsy, does not relate to an unestablished fact necessary to substantiate the claim, and does not raise a reasonable possibility of substantiating the claim. 3.4. A claim for service connection for PTSD was denied by an October 2004 rating decision that was not appealed. New and material evidence was not received within the year after the Veteran was notified of the October 2004 decision. A request to reopen the Veteran’s claim for service connection for PTSD was denied in a June 2006 rating decision. New and material evidence was not received within the year after the Veteran was notified of the June 2006 decision. 4.5. Evidence submitted subsequent to the June 2006 rating decision is not cumulative or redundant of the evidence of record at the time of the last prior final denial of the claim for service connection for PTSD, relates to an unestablished fact necessary to substantiate the claim, and raises a reasonable possibility of substantiating the claim. 5.6. Resolving all reasonable doubt in the Veteran’s favor, PTSD is at least as likely as not due to combat stressors experienced during service. 6.7. The preponderance of the evidence is against a finding that the Veteran has a chronic disability manifested by fatigue, to include as due to an undiagnosed illness or a medically unexplained chronic multi-symptom illness such as chronic fatigue syndrome; instead symptoms of fatigue are manifestations of his service-connected anxiety disorder for which he is already compensatedThe Veteran’s fatigue results from his insomnia, a symptom of his service-connected psychiatric disability. 7.8. The preponderance of the evidence is against finding that the Veteran has a right eye disability due to a disease or injury in service, to include specific in-service event, injury, or disease. 8.9. The preponderance of the evidence of record is against finding that the Veteran has, or has had at any time during the appeal, a current bilateral hearing loss disability for VA purposes. 0. The Veteran is in receipt of maximum ratings for his status post right thumb fracture with degenerative joint disease with no evidence of ankylosis; he failed, without good cause, to report for a scheduled VA examination on August 19, 2015, in conjunction with a claim for entitlement to an increased evaluation for his right thumb disability. CONCLUSIONS OF LAW 1. The criteria for withdrawal of an appeal by the Veteran as to the issue of entitlement to an initial rating in excess of 10 percent for tinnitus have been met. 38 U.S.C. § 7105 (b)(2), (d)(5); 38 C.F.R. § 20.204. 1.2. The May 2000 rating decision which denied a claim for service connection for Bell’s palsy as well as the June 2006 and February 2009 rating decisions which denied reopening the Veteran’s claim for service connection for Bell’s palsy is are final. 38 U.S.C. § 7105 (c); 38 C.F.R. §§ 3.104, 20.302, 20.1103. 2.3. New and material evidence has not been received, and the claim of entitlement to service connection for Bell’s palsy is not reopened. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 3.4. The October 2004 rating decision which denied a claim for service connection for PTSD as well as the June 2006 rating decision which denied reopening the Veteran’s claim for service connection for PTSD is are final. 38 U.S.C. § 7105 (c); 38 C.F.R. §§ 3.104, 20.302, 20.1103. 4.5. New and material evidence has been received, and the claim of entitlement to service connection for PTSD is reopened. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 5.6. The criteria for service connection for PTSD have been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.304. 6.7. The criteria for service connection for a chronic disability manifested by fatigue have not been met. 38 U.S.C. § 1110, 1117, 5107; 38 C.F.R. § 3.102, 3.303, 3.317. 7.8. The criteria for service connection for a right eye disability have not been are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 8.9. The criteria for service connection for bilateral hearing loss have not been are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 0. The criteria for a rating in excess of 20 percent for status post right thumb fracture with degenerative joint disease have not been met. 3.655, 4.1, 4.7, 4.71a, Diagnostic Code 5228. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty service from December 1990 to May 1991 December 1990 to May 1991; as well as active duty for training from April 1985 to September 1985 April 1985 to September 1985. In April 2018 April 2018, the Veteran testified at a videoconference hearing. A transcript of that hearing is of record. With respect to the issue of entitlement to a rating in excess of 20 percent for residuals of status post right thumb fracture with degenerative joint disease, as noted in more detail below, because the March 1990 injury which caused the right thumb disability may have resulted in additional disability to the Veteran’s right hand/wrist, the Board will expand the Veteran’s claim for an increased rating for a “right thumb fracture” to include any additional right hand/wrist disability resulting from the March 1990 injury. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). In Rice v. Shinseki, 22 Vet. App. 447 (2009), the United States Court of Appeals for Veterans Claims held that a TDIU claim is part and parcel of an increased rating claim when such claim is raised by the record. In this case, in a June 2015 statement, the Veteran raised the matter of unemployability due to his right hand pain. As the issue of entitlement to a higher rating for the Veteran’s service-connected right thumb disability is on appeal, the issue of entitlement to a TDIU is properly before the Board. (As the issues of entitlement to a waiver of overpayment of $3,654.28 and apportionment of the Veteran’s disability benefits are based on completely different law and facts, they are the subjects of separate decisions. See BVA Directive 8430, paragraph 14(c)).   Requests to Withdraw Appeals The Board may dismiss any appeal which fails to allege specific error of fact or law in the determination being appealed. 38 U.S.C. § 7105 (West 20124). An appeal may be withdrawn as to any or all issues involved in the appeal at any time before the Board promulgates a decision. 38 C.F.R. § 20.204 (2016). Withdrawal may be made by the appellant or by his or her authorized representative. 38 C.F.R. § 20.204; see also DeLisio v. Shinseki, 25 Vet. App. 45, 57 (2011). 1. Entitlement to an initial rating in excess of 10 percent for tinnitus Therefore, the issues are withdrawn and are no longer in appellate status. On a VA Form 21-4138, Statement in Support of Claim, received by VA on April 24, 2018, the Veteran requested that the issue of entitlement to an initial rating in excess of 10 percent for tinnitus be withdrawn. The withdrawal was effective immediately upon receipt by VA. 38 C.F.R. § 20.204 (b)(3) (2017). Given the above circumstances, the Board finds that the Veteran’s withdrawal is explicit, unambiguous, and done with a full understanding of the consequences of such action. See DeLisio v. Shinseki, 25 Vet. App. 45, 57 (2011). Thus, the Board finds that the Veteran has withdrawn his appeal and there remains no allegation of errors of fact or law for appellate consideration. The Board, therefore, finds that the Veteran has withdrawn the appeal with respect to the issue of entitlement to an initial rating in excess of 10 percent for tinnitus; and, hence, there remain no allegations of errors of fact or law for appellate consideration with respect to this issue. Accordingly, the Board does not have jurisdiction to review the appeal with respect to this issue and it is dismissed.Accordingly, the Board does not have jurisdiction to review the appeal and the claim is dismissed. In Rice v. Shinseki, 22 447 (2009), the United States Court of Appeals for Veterans Claims held that a TDIU claim is part and parcel of an increased rating claim when such claim is raised by the record. In this case, in a statement, the Veteran raised the matter of unemployability due to his right hand pain. Therefore, the issue is raised by the record and is properly before the Board. (As the issues of entitlement to a waiver of overpayment of $3,654.28 and apportionment of the Veteran’s disability benefits are based on completely different law and facts, they are the subjects of separate decisions. See BVA Directive 8430, paragraph 14(c)). Requests to Reopen Previously-denied Claims A finally adjudicated claim is an application which has been allowed or disallowed by the agency of original jurisdiction, the action having become final by the expiration of one year after the date of notice of an award or disallowance, or by denial on appellate review, whichever is the earlier. See 38 U.S.C. § 7105 (c); 38 C.F.R. §§ 3.104, 20.302, 20.1103. A claimant may reopen a finally adjudicated claim by submitting new and material evidence. New evidence means existing evidence not previously submitted to agency decision makers. Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened, andreopened and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). For purposes of reopening a claim, the credibility of newly submitted evidence is generally presumed unless such evidence is inherently incredible or beyond competence of the witness. See Justus v. Principi, 3 Vet. App. 510, 513 (1992). At any time after VA issues a decision on a claim, if VA receives or associates with the claims file relevant official service department records that existed and had not been associated with the claims file when VA first decided the claim, VA will reconsider the claim, notwithstanding paragraph (a) of this section. 38 C.F.R. § 3.156 (c)(1). Relevant service records as defined by 38 C.F.R. § 3.156 (c) include: (i) service records that are related to a claimed in-service event, injury, or disease, regardless of whether such records mention the Veteran by name; (ii) additional service records forwarded by the Department of Defense or the service department to VA any time after VA’s original request for service records; and (iii) declassified records that could not have been obtained because the records were classified when VA decided the claim. See 38 C.F.R. § 3.156 (c)(1). The record indicates that service personnel records and service treatment records were received in September 2014. These records, however, were already in the file at the time of the previously-denied rating decisions for service connection for Bell’s palsy and PTSD and are considered duplicate records. At the time of a March 1992 rating decision, the Veteran service treatment records from March 1987 to December 1990, including Arizona National Guard Service, were of record. In addition, an October 2004 rating decision noted evidence of record at that time included service personnel records dated from April 1985 through May 1991. Further, at the time of the June 2006 rating decision, service treatment and personnel records dated from April 1985 to May 1991 were of record. 3.303(b), 3.307, 3.309(a). To prevail on the issue of service connection there must be evidence of a current disability, in-service incurrence or aggravation of a disease or injury; and a causal relationship between the present disability and the disease or injury incurred or aggravated during service. See Shedden v. Principi, 381 F.3d 1163, 1166–67 (Fed. Cir. 2004). 4.2. Request to reopen previously-denied claim for service connection for Bell’s palsy In a decision dated in May 2000, the RO denied the Veteran’s claim for service connection for Bell’s palsy on the basis that the Veteran’s service treatment records were absent complaints of or treatment for Bell’s palsy, that Bell’s palsy did not manifest to a compensable degree within one year of service discharge, and that it was not an undiagnosed illness. The Veteran did not appeal this decision; and new and material evidence was not received within the year after the Veteran was notified of the May 2000 decision. Thus, the May 2000 decision is final. The Veteran’s request to reopen his claim was denied in June 2006 on the basis that he did not provide competent medical evidence which demonstrated that his Bell’s palsy could be linked back to his active duty period or was a residual disability associated with a chronic service connected disability. Although the Veteran submitted a nNotice of dDisagreement (NOD) with respect to the June 2006 decision, he did not perfect his appeal. New and material evidence was not received within the year after the Veteran was notified of the decision. Thus, the June 2006 decision is final. The Veteran’s request to reopen his claim was again denied in February 2009 on the basis that the Veteran had not submitted new and material evidence. The Veteran did not appeal the February 2009 decision; and new and material evidence was not received within the year after the Veteran was notified of the decision. Thus, the February 2009 decision is final. The Veteran’s application to reopen his claim of service connection for Bell’s palsy was received in June 2009. Based on the grounds for the previous denials, new and material evidence would consist of evidence of Bell’s palsy in service, evidence of Bell’s palsy to a compensable degree within a year of service, or competent evidence linking Bell’s palsy to the Veteran’s active duty service. In this regard, additional additional evidence received since the last final rating decision in February 2009 rating decision includes service treatment records , various VVA treatment records; lay statements from the Veteran, his wife, and his cousin; and personal hearing testimony from the Veteran. As noted above, the service personnel records and service treatment records noted to have been received in September 2014 are not new records but duplicate records that were already of record at the time of the February 2009 rating decision. Although the record is replete with notations that the Veteran reported that he had Bell’s palsy due to taking pyridostigmine bromide (PYB) pills during Desert Storm, the record is still absent evidence of Bell’s palsy during the Veteran’s active service or to a compensable degree within a year of service. The record is also still absent a competent opinion that the Veteran’s Bell’s palsy is related to his active duty service, to include taking PYB pills during service. The Board has considered the evidence received since the February 2009 rating decision and finds that there is still no evidence that the Veteran’s Bell’s palsy was incurred in or aggravated by active service. Accordingly, the Board finds that the evidence received subsequent to the February 2009 rating decision is not new and material and does not serve to reopen the claim. 5.3. Request to reopen a claim for service connection for PTSDposttraumatic stress disorder (PTSD) In a decision dated in October 2004, the RO denied the Veteran’s claim for service connection for PTSD on the basis that the his service treatment records were absent complaints of or treatment for a mental disorder, the record was absent evidence that he participated in combat, the record was absent corroborating evidence of an in-service stressor. The Veteran did not appeal this decision; and new and material evidence was not received within the year after the Veteran was notified of the October 2004 decision. Thus, the October 2004 decision is final. The Veteran’s request to reopen his claim was denied in June 2006 on the basis that he did not provide evidence which demonstrated that his PTSD could be linked back to his active duty period or was a residual disability associated with a chronic service- connected disability. In October 2006, the Veteran submitted a nNotice of dDisagreement as well as a statement in which he reported that during Desert Shield he cleared roads through the minefields in the demilitarized zone between Saudi Arabia and Kuwait and witnessed many Iraqi casualties. Although the Veteran he submitted a Nnotice of dDisagreement n NOD Notice of Disagreement with respect to the June 2006 decision, he did not perfect his appeal; new and material evidence was not received within the year after the Veteran was notified of these decisions. Thus, the June 2006 decision is final. The Veteran’s application to reopen his claim of service connection for PTSD was received in August 2009. Based on the grounds for the previous denials, new and material evidence would consist of evidence of evidence of PTSD Bell’s palsy in service, evidence of Bell’s palsy to a compensable degree within a year of service, or evidence that he participated in combat, and corroborating evidence of in-service stressor.competent evidence linking Bell’s palsy to the Veteran’s active duty service. As noted above, the service personnel records and service treatment records noted to have been received in September 2014 are not new records but duplicate records that were already of record at the time of the June 2006 rating decision. In this regard, additional evidence received since the June 2006 rating decision includes service treatment records , various treatment records, and personal hearing testimony from the VeteranIn an affidavit received in September 2009, the Veteran reported that while clearing roads, his division was subjected to explosions and fire, incoming as well as outgoing and that the terrible explosions of incoming were enough to cause his horrific nightmares. The Veteran also reported witnessing death and destruction of bodies. . The record also includes a letter from United States Marine Corps, Marine Corps Education Command and attached a command chronology of the Veteran’s unit during the Gulf War which shows that his unit came under hostile fire. See United States Marine Corps, 7th Engineer Support Battalion, Direct Support Command, 1st Force Service Support Group, Command Chronology for the period December 20, 1990 to March 4, 1991. The record further includes In addition, VA treatment records are rreplete with diagnoses of PTSD; and the record also includes a private psychological evaluation conducted in January 2012 diagnosing the Veteran as having PTSD. In regard to the evidence received since the June 2006 rating decision, the Board finds the statements and testimony of the Veteran, the command chronology of the Veteran’s unit during the Gulf War which shows that his unit came under hostile fire, and the private psychological evaluation conducted in January 2012 diagnosing the Veteran as having PTSD are neither cumulative nor redundant. Further, the new evidence is significant in that it is probative of the issue of whether the Veteran has PTSD that may be related to his active duty service. The Board has considered the evidence received since the June 2006 rating decision and finds that there is evidence that the Veteran’s has a diagnosis of PTSD as a result of his combat servicedue to combat. Accordingly, the Board finds that the evidence received subsequent to June 2006 rating decision is new and material and serves to reopen the claim for service connection for PTSD. However, as the declassified Department of Defense records could have been obtained at the time of the June 2006 rating decision because the records were declassified in November 1998, the claim will be reopened and not reconsidered. See 38 C.F.R. § 3.156 (c)(1)(iii). and serves to reopen the claim for service connection for PTSD. Service Connection As noted above, service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service, even if the disability was initially diagnosed after service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Certain chronic diseases will be presumed related to service if they were noted as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if continuity of the same symptomatology has existed since service, with no intervening cause. 38 U.S.C. §§ 1101, 1112, 1113, 1137; Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2012); Fountain v. McDonald, 27 Vet. App. 258 (2015); 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a). To prevail on the issue of service connection there must be evidence of a current disability, in-service incurrence or aggravation of a disease or injury; and a causal relationship between the present disability and the disease or injury incurred or aggravated during service. See Shedden v. Principi, 381 F.3d 1163, 1166–67 (Fed. Cir. 2004). 6.4. Entitlement to service connection for PTSD The Veteran contends that he has PTSD related to his service during the Gulf War. At his videoconference hearing in April 2018, the Veteran testified that he was in an Operation that was within Desert Storm called Task Force Ripper. The Veteran testified:, We were sent up there to clean the land mines. I was actually almost caught up in tank battle. There were a lot of dead bodies everywhere and just the whole scenario is what causes me a lot of stress. I do not know, sometimes I get depressed, sometimes I cannot sleep and I get a lot of anxiety and I just … get really paranoid sometimes. I do not like to go anywhere anymore or places. I stay home a lot and I try to deal with my anxieties there and all the other stuff that happens to me. … The question for the Board is whether the Veteran has PTSD that began during service or is at least as likely as not related to an in-service injury, event, or disease. Service connection for PTSD requires: (1) medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125 (a) ([i.e., a diagnosis under Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5))]; (2) a link, established by medical evidence, between current symptoms and a stressor event in service; and (3) credible supporting evidence that the claimed stressor event in service occurred. 38 C.F.R. §§ 3.304 (f), 4.125(a). The DSM-5, not DSM-IV, applies to cases, such as here, that were certified to the Board since March 19, 2015. See 80 Fed. Reg. 53, 14308 (March 19, 2015). The Board, however, will still consider any private or VA examiner’s discussion of both the DSM-IV and DSM-5 in adjudicating the Veteran’s PTSD claim in order to provide him with every benefit of the doubt. If the evidence establishes that the 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 the Veteran’s service, the Veteran’s lay testimony alone may establish the occurrence of the claimed in-service stressor. See 38 U.S.C. § 1154 (b); see also 38 C.F.R. § 3.304(f)(1). The Board concludes that the Veteran has a current diagnosis of PTSD, competent and credible lay testimony of stressors consistent with the circumstances of his combat service, and a medical nexus opinion which establishes a link between the Veteran’s current PTSD symptoms and his combat service. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). If the evidence establishes that the 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 the Veteran’s service, the Veteran’s lay testimony alone may establish the occurrence of the claimed in-service stressor. See 38 U.S.C. § 1154 (b); see also 38 C.F.R. § 3.304(f)(1). The Veteran submitted an affidavit in October 2010 which noted:, I served with the First Marine Division’s Seventh Engineer Support Battalion 1st [] Service Support Group, Charlie Minefield Company, Task Force- Ripper Desert Storm/Shield from December 04[,] 1990 to May 22[,] 1991. I drove the Explosive Ordinance Disposal teams (E.O.D.) through the Al-Wafra area spearheading the Desert Storm, Task Force Ripper operation on “D-Day” to clear minefields thru to the Kuwaiti Airport and Kuwait City. Before that[,] during Desert Shield I drove supplies, ordinance, food, water through to the various staging areas to prepare for the Desert Storm Operation. I[] also drove supplies from the Port City Of Al-Jubail to various points of the Tapline Road which included Khafji and beyond and was also there during the shelling of Khafji camp. The Veteran’s DD Form 214 indicates that he participated in Operation Desert Shield and Operation Desert Storm from December 4, 1990 to May 22, 1991, that his primary specialty was motor vehicle operator, and that his last duty assignment and major command was with the 7th Engineer Support Battalion (ENGRSPTBN), 1st Force Service Support Group (FSSG). Service personnel records indicate that the Veteran was attached to 7th ENGRSPTBN 1ST FSSG C 6 CO for DU from January 14, 1991, to March 10, 1991. As noted above, the record also includes a command chronology of the Veteran’s unit during the Gulf War which shows that his unit came under hostile fire. See United States Marine Corps, 7th Engineer Support Battalion, Direct Support Command, 1st Force Service Support Group, Command Chronology for the period December 20, 1990 to March 4, 1991. Thus, the Board accepts the Veteran’s combat-related stressors in light of his confirmed combat service during the Gulf War. See 38 C.F.R. § 3.304 (f)(1); see also, 38 U.S.C. § 1154 (b). The Board notes that there is a difference of opinion among the medical professionalsevidnce with respect to whether the Veteran has PTSD related to his conceded combat service. An August 2009 mental health physician note indicates that the Veteran had moderate PTSD and noted combat stress of Gulf war. See Phoenix VAMC records, received December 2010 in VBMS. The record is replete with diagnoses of anxiety disorder, depressive disorder, rule out PTSD, and PTSD. A May 2004 mental heah initial evaluation note indicates that the Veteran reported mixed/war related nightmares/bad dreams of violence, falling since 1992; vivid memories of seeing charred bodies of dead Iraqi soldiers, history of flashbacks, hypervigilance, startle response, history of anxiety/panic attacks beginning five years prior and lasting four hours, history of racing thoughts starting in 1993, history of mood changes since 1993. After mental status examination, impression included PTSD signs and symptoms moderate range reported. A June 2009 mental health note indicates that that Veteran was in the military from 1985 to 1993 and that he was a Desert Storm combat veteran, that he was an explosives driver, that he drove heavy equipment, and that he drove explosive ordinance people to clear land mines into Kuwait. The Veteran reported that he was there for four months and that up at the front, there were a lot of dead bodies, some artillery shells landing, and bullets whizzing by; but he stated that it was not as bad as he thought it was going to be. The Veteran was diagnosed as having depressive disorder NOS and anxiety disorder NOS. See Phoenix VA Medical Center (VAMC) records, received in Veterans Benefits Management System (VBMS). A June 2009 mental health assessment form indicates that the Veteran had combat and had PTSD symptoms of nightmares and racing thoughts. He did not want to talk about symptoms and became tearful. An August 2009 mental health physician note noted that the Veteran was seen for 20 minutes for medication management and minimal psychotherapy services. The physician noted that the Veteran had moderate anxiety, some panic, and moderate PTSD and noted combat stress of Gulf war and that the Veteran was forced to take PYB pills to combat nerve agent attack and had emotional distress from it. The Veteran was diagnosed as having depressive disorder NOS, anxiety disorder NOS, and rule out PTSD. See Phoenix VAMC records, received in VBMS. In January 2012, the Veteran underwent a private psychological evaluation to assist with the planning of his legal case and specifically to determine his mental status. The evaluation consisted of clinical interviews and some psychological tests; the evaluation took approximately eight hours to complete. The Veteran reported that while in the Marines, he deployed to the Persian Gulf for six months during the war. He said that his job during the conflict was to transport explosives and supplies and that he also drove explosive ordinance squads to clear land mines. He stated that he witnessed “a lot of dead Iraqis and burnt bodies.” He reported that he did not see any American casualties or injuries but that his unit captured many “prisoners of war.” He stated that he fired his weapon once during the deployment but that he was unsure if he injured anyone. The Veteran spoke at length about witnessing a man whose face was ripped open and his eye was dangling out of the side of his face. He stated that he thought about this event often, had nightmares about it, and woke up in a panic thinking that he heard a siren signaling that his base was being attacked. The Veteran reported that he checked his backyard for people about twice a day and that sometimes he just sat outside with his dog and watched the yard. The Veteran said that he felt “weird and anxious” and that he drank and used drugs to combat these feelings. The Veteran reported that he had intrusive thoughts about his deployment and that the thoughts made him feel anxious and he felt like he was “going to go there again and like it’s not over. He stated that he felt very uncomfortable and anxious when someone knocked at his door and that he did not like people visiting his house because it made him feel weird and anxious. After mental status examination and psychological testing, he was diagnosed as having chronic PTSD, rule out dysthymic disorder, alcohol dependence in a controlled environment, cannabis abuse, and amphetamine abuse. It was noted that the Veteran clearly met DSM-IV-TR diagnostic criteria for PTSD because his traumatic experience was reexperienced, he avoided stimuli associated with his deployment, and he had a heightened level of arousal. It was also noted that it was unclear whether the Veteran also had a mood disorder. He reported having a history of anxiety and depressive symptoms as a teenager and sought the use of substances likely to cope with these symptoms. The Veteran reported that the symptoms were not particularly problematic to him until after his deployment. See February 2012, Biltmore Evaluation and Treatment Services, Phoenix, Clinical, Forensic, Neuropsychological. T The Veteran underwent VA examination in June 2015. at which time the Veteran reported that he drove explosives in Desert Storm, said that he would supply various units with food and ordinance and would transport troops. The Veteran said that he also did some engineering work like digging. When asked about traumas, he reported that during Task Force Ripper, he built roads through landmines. He said that he was part of the unit that cleared the landmines. He reported that mines were detonated and that they would plow the mines and use detectors to identify subsequent mines. He also reported following an armor unit and said that there was a tank battle with artillery “coming in and out” with explosions. He claimed as part of this, his unit took fire. He reported air support took out the enemy and that they took prisoners. AAfter mental status examination, the examiner found that the Veteran did not have a diagnosis of PTSD that conformed to DSM-5 criteria; instead, he had diagnoses of anxiety disorder and adult antisocial behavior. See June 2015 June 2015, Initial Post Traumatic Stress Disorder (PTSD), Disability Benefits Questionnaire (DBQ). In this case, the The Board notes that effective August 4, 2014, VA amended the portion of its Schedule for Rating Disabilities dealing with mental disorders and its adjudication regulations that define the term “psychosis” to remove outdated references to the DSM-IV and replace them with references to the recently updated Diagnostic and Statistical Manual (Fifth Edition) (the DSM-5). See 79 Fed. Reg. 45,094 (August 4, 2014). VA adopted as final, without change, this interim final rule and clarified that the provisions of this interim final rule do not apply to claims that have been certified for appeal to the Board or are pending before the Board on or before August 4, 2014. See Schedule for Rating Disabilities - Mental Disorders and Definition of Psychosis for Certain VA Purposes, 80 Fed. Reg. 14,308 (March 19, 2015). In the present case, the appeal was certified in February 2018, which is after August 4, 2014. Thus, the amended 38 C.F.R. § 4.125 (a) conforming to the DSM-5 is applicable in the present case. The Board, however, will still consider any private or VA examiner’s discussion of both the DSM-IV and DSM-5 in adjudicating the Veteran’s PTSD claim in order to provide him with every benefit of the doubt. In this case, the Board notes that there is a difference of opinion among the medical professionals. In deciding whether the Veteran has a PTSD diagnosis related to his combat duties in the Gulf War, 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. Evans v. West, 12 Vet. App. 22, 30 (1998). That responsibility is particularly onerous where medical opinions diverge. At the same time, the Board is mindful that it cannot make its own independent medical determinations and that there must be plausible reasons for favoring one medical opinion over another. Id. The Board , however, finds that a more detailed discussion of the specific opinions, credentials of the diagnosticians, and circumstances of opinions in this case would not clarify the matter. It would merely highlight that there is not a clear, rational basis for the Board to prefer one opinion to another. Accordingly, the Board finds that the competent medical evidence of record, both for and against a finding that the Veteran meets the criteria for PTSD related to his combat duties during the Gulf War is in a state of equipoise. Accordingly, reasonable doubt is resolved in favor of the Veteran. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Under the rating schedule, all psychiatric disabilities other than eating disorders are rated together under the General Rating Formula for Mental Disorders based on the level of social and occupational impairment detailed at 38 C.F.R. § 4.130. As such, the effect of the Board’s decision is that the separate grant of service connection for PTSD does not result in a separate disability rating for PTSD apart from the already service-connected acquired psychiatric disorder (anxiety disorder). All ofAll the Veteran’s psychiatric impairment due to the now service-connected PTSD will be rated together with the impairment due to the already service-connected anxiety disorder. A single disability rating will be provided for all social and occupational impairment, whether due to symptoms of PTSD or anxiety disorder. See also 38 C.F.R. § 4.14.   7.5. Entitlement to service connection for a disability manifested by chronic fatigue The Veteran contends that he has chronic fatigue syndrome related to his active duty service. The question for the Board is whether the Veteran has a current diagnosis of chronic fatigue syndrome or a current chronic undiagnosed illness manifested by fatigue; and, if so, whether it began during active service, or is etiologically related to an in-service disease or injury. For Persian Gulf War veterans, service connection for chronic, undiagnosed illnesses (or a medically unexplained chronic multi-symptom illness such as fibromyalgia, chronic fatigue syndrome, or functional gastrointestinal disorders) arising from service in Southwest Asia during the Persian Gulf War may be established under 38 U.S.C. § 1117 and 38 C.F.R. § 3.317. Under those provisions, service connection may be established for objective indications of a chronic disability resulting from an undiagnosed illness or illnesses, provided that such disability (1) became manifest in service on active duty in the Armed Forces in the Southwest Asia theater of operations during the Persian Gulf War, or to a degree of 10 percent or more not later than December 31, 2021; and (2) by history, physical examination, and laboratory tests cannot be attributed to a known clinical diagnosis. To fulfill the requirement of chronicity, the illness must have persisted for six months. 38 U.S.C. § 1117; 38 C.F.R. § 3.317. Signs or symptoms which may be manifestations of undiagnosed illness include, but are not limited to: fatigue, signs or symptoms involving skin, headache, muscle pain, joint pain, neurologic signs or symptoms, neuropsychological signs or symptoms, signs or symptoms involving the respiratory system (upper or lower), sleep disturbances, gastrointestinal signs or symptoms, cardiovascular signs or symptoms, abnormal weight loss, and menstrual disorders. 38 C.F.R. § 3.317 (b). The Board concludes that the preponderance of the evidence is against a finding that the Veteran has a chronic disability manifested by fatigue, to include as due to an undiagnosed illness or a medically unexplained chronic multi-symptom illness such as chronic fatigue syndrome; instead his symptoms of fatigue are manifestations of his service-connected anxiety disorder for which he is already compensated. The Veteran does not have a current diagnosis of chronic fatigue syndrome and has not had one at any time during the pendency of the claim or recent to the filing of the claim. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. § 3.303(a), (d). Despite post-service treatment from 1999 to 2018, these records do not contain a diagnosis of chronic fatigue syndrome. The Veteran underwent VA examination in June 2015 at which time the examiner found that the Veteran did not have and had never been diagnosed as having chronic fatigue syndrome. See June 2015 Gulf War General Medical Examination DBQ. In addition, the preponderance of the evidence weighs against the notion that the Veteran’s fatigue is a manifestation of undiagnosed illness or medically unexplained chronic multi-symptom illness pursuant to the provisions of 38 C.F.R. § 3.317. In November 2004, the Veteran reported for follow-up for a Persian Gulf Registry review completed in 2000. The physician noted that the Veteran had multi-system undiagnosed illness with symptoms of fatigue, arthralgias, muscle twitches, and skin rash. See Phoenix VAMC records, received February 2014 in Compensation and Pension Record Interchange (CAPRI)/VBMS. In contrast, after physical examination of the Veteran and a review of the file, the examiner who conducted the July 2015 Gulf War General Medical Examination found that there was not a diagnosed illness for which no etiology was established and that there was no functional impact of additional signs and/or symptoms that may represent an “undiagnosed illness” or “diagnosed medically unexplained chronic multi-symptom illness.” See June 2015 Gulf War General Medical Examination DBQ. Further, the examiner who conducted the June 2015 PTSD examination attributed the Veteran’s sleep problems with his anxiety. See June 2015, Initial PTSD DBQ. In this case, the Board notes that there is a difference of opinion among the medical professionalsopinions of record as to the etiology of the Veteran’s fatigue. Here, there are legitimate reasons for accepting the VA PTSD examiner’s opinion that the Veteran’s insomnia is due to service-connected psychiatric disorder. The VA physician who attributed the Veteran’s fatigue as part of a multi-system undiagnosed illness did so without any rationale. In contrast, the VA clinical psychologist who conducted the PTSD examination found that the insomnia was directly related to the Veteran’s anxiety. This determination was made after a review of the record and examination of the Veteran and is consistent with the findings of the VA physician who conducted the June 2015 Gulf War General Medical examination and found multifactorial insomnia with inability to fall asleep “due to nervousness.” The Board, therefore, finds that the VA clinical psychologist’s opinion is the most probative opinion regarding the etiology of the Veteran’s insomnia. Thus, the preponderance of the evidence indicates that the Veteran’s fatigue is caused by insomnia which is part and parcel of the Veteran’s service-connected anxiety disorder and not a separate chronic disability. Although the Veteran believes he has a current disability manifested by fatigue due to his active duty service, he is not competent to provide a diagnosis or etiology opinion in this case. The issue is medically complex, as it requires [specialized medical education/knowledge of the interaction between multiple organ systems in the body/the ability to interpret complicated diagnostic medical testing]. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. Accordingly, the Board concludes that the preponderance of the evidence is against the claim for service connection for a chronic disability manifested by fatigue, and the benefit-of-the-doubt rule enunciated in 38 U.S.C. § 5107(b) is not for application. 6.   The Veteran’s service treatment records are absent any treatment for, or diagnosis of, chronic fatigue. In May 2004, the Veteran reported that he stopped sports due to fatigue. See Division of Immigration Health Service records, received in VBMS. In November 2004, the Veteran reported for follow-up for Persian Gulf Registry completed in 2000. The Veteran reported intermittent rash, Bell’s palsy, muscle twitching, fatigue, and arthralgias of knees, hands, and elbows. He also reported chest pain and weight loss. The physician noted that the Veteran had multi-system undiagnosed illness with symptoms of fatigue, arthralgias, muscle twitches, and skin rash. See Phoenix VAMC records, received in Compensation and Pension Record Interchange (CAPRI)/VBMS. In May 2009, the Veteran reported feeling tired or having little energy several days. In June 2009, the Veteran reported that he becomes anxious during the day, cannot get to sleep, and tosses and turns; he then does some mechanical work or cleans the yard so that he can sleep. When he is working, he goes in early but then in the afternoon, he is tired. See Phoenix VAMC records, received in VBMS. As noted above, the Veteran underwent private psychological evaluation in January 2012 at which time he reported difficulty sleeping. He specifically noted having racing thoughts that would keep him up all night and that he would fall asleep while he was at work. The Veteran reported that he worried “about everything” and that he often had nightmares and that he had been prescribed medication for sleep. See , Biltmore Evaluation and Treatment Services, Phoenix, Clinical, Forensic, Neuropsychological. The Veteran underwent Gulf War General Medical Examination in June 2015 at which time he reported fibromyalgia, headaches, and chronic fatigue syndrome. The Veteran complained of insomnia which caused hypersomnolence with fatigue as well as spontaneous onset of frontal to vertex pressure aggravated by insomnia. After review of the file and examination of the Veteran, the VA examiner stated that the Veteran had sleep disturbance and headaches (idiopathic insomnia causing hypersomnolence and fatigue associated with tension headache frontal to vertex pressure) but that he did not meet the criteria for either chronic fatigue syndrome or fibromyalgia. The examiner noted that there was not a diagnosed illness for which no etiology was established and that there was no functional impact of additional signs and/or symptoms that may represent an “undiagnosed illness” or “diagnosed medically unexplained chronic multi-symptom illness.” See Gulf War General Medical Examination DBQ. As noted above, the Veteran underwent VA PTSD examination in June 2015. At that examination, the Veteran reported that when he slept, he was told that he yelled out stuff and was a rough sleeper. He reported that he was constantly jittery and fidgety and said that he could not get himself to calm down. The Veteran reported that he had nightmares and that sleep was difficult. He also reported that he met with a psychiatrist at the prison and that he was taking sertraline and another medication which helped with sleep. See June 2015, Initial PTSD DBQ. A June 2018 mental health note indicated that the Veteran endorsed difficulties with sleep, fatigue, feeling bad about himself, concentration, and catatonia/agitation daily. See Phoenix VAMC records, received in CAPRI/VBMS. 5107(b) is not for application. 18. Entitlement to service connection for a right eye disability The Veteran contends that he has a right eye disability related to his active service. He testified in April 2018 that he has double vision and that it was necessary to blink his eyes in order to get his sight straight. The Board concludes that although the Veteran has several right eye diagnoses, the record is absent evidence of right eye disease or injury, other than refractive error, during the Veteran’s active service and competent evidence of a nexus between currently diagnosed eye conditions and the Veteran’s active duty service. The question for the Board is whether the Veteran has a current right eye disability that began during service or is at least as likely as not related to an in-service injury, event, or disease.The Veteran has current diagnoses of anoxic corneal ulcer of the right eye, right stromal scar, corneal neovascularization, astigmatism, myopia, and presbyopia. VA law provides that refractive errors of the eyes are developmental defects and not disease or injury within the meaning of applicable legislation. 38 C.F.R. §§ 3.303 (c), 4.9. In the absence of superimposed disease or injury, service connection may not be allowed for refractive error of the eyes, including myopia, presbyopia and astigmatism, even if visual acuity decreased in service, as this is not a disease or injury within the meaning of applicable legislation relating to service connection. 38 C.F.R. §§ 3.303 (c), 4.9. In this case, there is no evidence, and the Veteran does not assert, that he suffered a superimposed injury or disease in service in connection with his astigmatism, myopia, or presbyopia. With respect to the anoxic corneal ulcer of the right eye, right stromal scar, and corneal neovascularization, the Board notes that there is evidence of a current disability. There is no evidence, however, that the Veteran suffered from a right eye disease or injury other than refractive error during service. The Veteran’s service treatment records are absent complaints, findings or diagnoses of any right eye problems during service. On examination on separation from his active duty for training period, distant vision in right eye was 20/50 correctable to 20/20. Ophthalmoscopic, pupils, and ocular motility were normal. The examiner noted defective visual acuity. The examiner also noted, “[n]No significant change in health during this period of training duty. On examination in March 1987, distant vision was 20/30 in the right eye. Ophthalmoscopic, pupils, and ocular motility were normal. On examination in September 1988, distant vision in the right eye was not noted to be correctable to 20/40. In addition, the Veteran’s anoxic corneal ulcer of the right eye, right stromal scar, and corneal neovascularization have not been causally related to the Veteran’s active duty service. The Veteran’s right eye corneal ulcer, stromal scar, and corneal neovascularization have been related to contact lens overuse and not to the Veteran’s active duty service. See Phoenix VAMC records, received December 2010 and February 2014 in VBMS and Division of Immigration Health Service records, received December 2015 in VBMS. Post-service treatment records show the Veteran was not diagnosed with anoxic corneal ulcer of the right eye and a right eye stromal scar until 2007, with corneal neovascularization until 2009. See Phoenix VAMC records, received December 2010 and February 2014 in VBMS and Division of Immigration Health Service records, received December 2015 in VBMS. Although the Veteran believes he has a current right eye disability related to his active duty service, he is not competent to provide a diagnosis or etiology opinion in this case. Consequently, the Board gives more probative weight to the competent medical evidence. Jandreau, 492 F.3d at 1377 n.4. Consequently, the Board gives more probative weight to the competent medical evidence. Accordingly, the Board concludes that the preponderance of the evidence is against the claim for service connection for a right eye disability, and the benefit-of-the-doubt rule enunciated in 38 U.S.C. § 5107(b) is not for application.   The Veteran’s service treatment records are absent complaints, findings or diagnoses of any eye problems during service. On examination on separation from his active duty for training period, distant vision in right and left eyes were 20/50 correctable to 20/20. Ophthalmoscopic, pupils, and ocular motility were normal. The examiner noted defective visual acuity. The examiner also noted, “No significant change in health during this period of training duty. On examination in March 1987, distant vision was 20/30 in the right eye and 20/40 in the left eye. Ophthalmoscopic, pupils, and ocular motility were normal. On examination in September 1988, distant vision in the left eye was noted to be 20/400 correctable to 20/40 in both eyes. In a March 2007 eye note, the ophthalmologist noted that the Veteran appeared to have an anoxic corneal ulcer of the right eye secondary to contact overuse. In April 2007, the corneal ulcer was resolving; a right eye stromal scar was noted. In June 2009, the Veteran reported occasional double vision. See Phoenix VAMC records, received in VBMS. In June 2009, the Veteran was diagnosed as having corneal neovascularization in both eyes from extended contact lens use. See Phoenix VAMC records, received in VBMS. In March 2011, the Veteran was seen for an eye examination and complained of blurred vision. Diagnoses included regular astigmatism, myopia, and presbyopia. See Division of Immigration Health Service records, received in VBMS. Initially, the Board notes that the Veteran’s right eye corneal ulcer and stromal scar have been related to contact lens overuse and not to the Veteran’s active duty service. 7. 5107(b) is not for application. 26. Entitlement to service connection for bilateral hearing loss The Veteran contends that he has hearing loss. At the videoconference hearing, the Veteran testified that he hears noises in his ear which always has a drumming or vibrating effect and then he hears a beeping noise. The question for the Board is whether the Veteran has a current hearing loss disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. With respect to claims for service connection for hearing loss, the United States Court of Appeals for Veterans Claims (hereafter “the Court”), has held that the threshold for normal hearing is from 0 to 20 decibels, and that higher threshold levels indicate some degree of hearing loss. Hensley v. Brown, 5 Vet. App. 155, 157 (1993). The Court further opined that 38 C.F.R. § 3.385 then operated to establish when a hearing loss could be service connected. Hensley, 5 Vet. App. at 159. For the purposes of applying the laws administered by the VA, impaired hearing is 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 or greater; or when word recognition scores using the Maryland CNC test are less than 94 percent. 38 C.F.R. § 3.385. The Board concludes that the Veteran does not have a current diagnosis of hearing loss for VA purposes and has not had one at any time during the pendency of the claim or recent to the filing of the claim. The evidence of record does not show audiometric findings that meet the criteria for bilateral hearing loss under VA regulations. Thus, the requirement for a current disability has not been satisfied. A Mental Health Unit Nursing Assessment dated in August 2011 shows that the Veteran’s hearing was within normal limits. See August 2011,[redacted], Registered Nurse; Phoenix VAMC records, received February 2014 in CAPRI/VBMS. On the authorized VA audiological examination in June 2015, pure tone thresholds, in decibels, were as follows:   HERTZ 500 1000 2000 3000 4000 RIGHT 30 25 20 25 30 LEFT 30 25 20 25 35 Speech audiometry revealed speech recognition ability of 100 percent in the right ear and of 95 percent in the left ear. See June 2015, Hearing Loss and Tinnitus DBQ. A Vocational Rehabilitation Medical Clearance Note dated in May 2018 indicated that the Veteran’s hearing was normal. See Phoenix VAMC records, received August 2018 in CAPRI/VBMS. A Mental Health Initial Evaluation Note dated in June 2018 indicated that Veteran reported that he had tinnitus and some hearing difficulty in his right ear and that he had had hearing tests which showed no signs of hearing loss. The provider, a registered nurse, noted, “but it sounds like it to me, especially in this right ear.” See Phoenix VAMC records, received August 2018 in CAPRI/VBMS. Although the Veteran believes he has a current hearing loss disability related to his active duty service, he is not competent to provide a diagnosis or etiology opinion in this case. Consequently, the Board gives more probative weight to the competent medical evidence. Jandreau, 492 F.3d at 1377 n.4. Consequently, the Board gives more probative weight to the competent medical evidence. In the absence of evidence of a current hearing disability that meets VA standards, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223.225 (1992); 38 C.F.R. § 3.385 (for VA purposes, “impaired hearing will be considered to be a disability” only when hearing loss examination results reach certain auditory thresholds). The existence of a current disability is the cornerstone of a claim for VA disability compensation. Degmetich v. Brown, 104 F. 3d 1328 (1997). The evidence must show that the Veteran currently has the disability for which benefits are being claimed. Accordingly, the Board concludes that the preponderance of the evidence is against the claim for service connection for bilateral hearing loss, and the benefit-of-the-doubt rule enunciated in 38 U.S.C. § 5107(b) is not for application. Treatment records from Correctional Health Services of Arizona Department of Corrections indicate that the Veteran’s hearing was within normal limits. See , [redacted], Registered Nurse. VA treatment records indicate that the Veteran reported hearing loss in May 2004. A July 2011 primary care physician note indicated that a review of the systems revealed no hearing deficit. See Phoenix VAMC records, received in CAPRI/VBMS. The Veteran underwent VA Hearing Loss examination in June 2015 at which time he did not demonstrate a hearing disability for VA purposes. See , Hearing Loss and Tinnitus DBQ. A May 2018 Vocational Rehabilitation medical clearance note indicated that the Veteran’s hearing was normal. See Phoenix VAMC records, received in CAPRI/VBMS. A June 2018 mental health initial evaluation note indicates that the Veteran reported that he had had hearing tests which showed no signs of hearing loss; but he stated, “but it sounds like it to me, especially in this right ear.” See Phoenix VAMC records, received in CAPRI/VBMS. REMAND 8. Entitlement to a rating in excess of 20 percent for residuals of status post right thumb fracture with degenerative joint disease to include right hand/wrist residuals The Veteran’s service treatment records note that while setting up a temporary command post during a Reserve drill weekend in March 1990, he was holding onto a stake being driven into the ground by another Marine using a sledge hammer. The stake broke on impact causing the sledge hammer to hit the Veteran’s right thumb. He notified a Corpsman who treated him locally; but the next day after returning to the Reserve Center, the Veteran was taken to the Emergency Room due to increased swelling, pain, and discoloration. On physical examination, there was mild thumb carpal/metacarpal swelling and tenderness to thumb carpal/metacarpal joint to the MP joint. Flexion and extension of the thumb was intact. X-rays showed fracture to the base of the thumb metacarpal with lateral subluxation of the metacarpal off the trapezium; minimally displaced lateral trapezium fracture; possible nondisplaced metacarpal neck fracture of the thumb. The Veteran underwent a closed reduction of the Bennett’s fracture dislocation and insertion of K-wire from the metacarpal into the trapezoid to maintain the reduction. Postoperative x-rays showed anatomic reduction of the dislocation and the fracture. He was put in a short arm thumb spica cast, monitored over night with ice and elevation, and discharged the following day. The trapezium bone is the most lateral bone of the distal row of carpal bones. DORLAND’S ILLUSTRATED MEDICAL DICTIONARY 1363 (31st ed. 2007). The mayo clinic describes that the wrist is made up of two long bones (the radius and the ulna) and eight small (carpal) bones, including the trapezium. See Mayo Clinic, https://www.mayoclinic.org/carpal-bones/img-20007898 (last viewed October 2018). Thus, in addition to the thumb, the record also indicates that the trapezium bone in the Veteran’s wrist was also fractured. The Board notes that the August 2004 VA examiner noted chronic pain of the Veteran’s right lateral wrist with evidence of space narrowing at site of prior injury. Diagnosis was posttraumatic degenerative joint disease right wrist. 1. Since the Veteran’s initial VA examination in January 1992, he has consistently reported that the injury which occurred in March 1990 caused more than just right thumb disability. In order to correctly evaluate the Veteran’s service-connected disability stemming from the March 1990 injury, it is the Board’s determination that the Veteran be provided an additional opportunity to report for a VA examination to determine the current severity of his service-connected right thumb disability and all other residual disability resulting from the March 1990 injury. 2.9. Request to reopen a claim for service connection for joint and bone pain The Veteran submitted a timely notice of disagreement with a March 2014 rating decision, but a statement of the case has not yet been issued. A remand is required for the AOJ to issue a statement of the case. 38 C.F.R. § 20.200; Manlincon v. West, 12 Vet. App. 238, 240-41 (1999). 3.10. Entitlement to service connection for a headache disability The Veteran submitted a timely notice of disagreement with a March 2014 rating decision, but a statement of the case has not yet been issued. A remand is required for the AOJ to issue a statement of the case. 38 C.F.R. § 20.200; Manlincon v. West, 12 Vet. App. 238, 240-41 (1999). 4.11. Entitlement to service connection for a TBI claimed as neurological symptoms The Veteran submitted a timely notice of disagreement with a September 2015 rating decision, but a statement of the case has not yet been issued. A remand is required for the AOJ to issue a statement of the case. 38 C.F.R. § 20.200; Manlincon v. West, 12 Vet. App. 238, 240-41 (1999). 5.12. Entitlement to an initial rating in excess of 50 percent for anxiety disorder, claimed as depression, nervous condition, and sleep disturbances The Veteran submitted a timely notice of disagreement with a July 2015 rating decision, but a statement of the case has not yet been issued. A remand is required for the AOJ to issue a statement of the case. 38 C.F.R. § 20.200; Manlincon v. West, 12 Vet. App. 238, 240-41 (1999). 6.13. Entitlement to a TDIU Finally, because a decision on the remanded referred issues of entitlement to a right hand/wrist disability could significantly impact a decision on the issue of a TDIU, the issues are inextricably intertwined. A remand of the claims for the TDIU issue is required. The matter is REMANDED for the following action: 1. Send the Veteran and his representative a statement of the case that addresses the issues of whether new and material evidence has been received to reopen a claim for service connection for joint and bone pain; entitlement to service connection for a headache disability, entitlement to service connection for a TBI, and entitlement to an initial rating in excess of 50 percent for anxiety disorder. If, AND ONLY IF, the Veteran perfects an appeal by submitting a timely VA Form 9, the issues should be returned to the Board for further appellate consideration. 2. Schedule the Veteran for an examination of the current severity of right thumb disability. The examiner must also identify any residual right hand/wrist residual disability stemming from the March 1990 injury. The examiner must test the Veteran’s active motion, passive motion, and pain with weight-bearing and without weight-bearing. The examiner must also attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. To the extent possible, the examiner should identify any symptoms and functional impairments due to disability caused by the March 1990 injury alone and discuss the effect of such disability on any occupational functioning and activities of daily living. If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, or functional impairment without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). 1. 2.3. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal, including the inextricably intertwined issue of entitlement to a TDIU. YVETTE R. WHITE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD P. Olson, Counsel