Citation Nr: 18144553 Decision Date: 10/25/18 Archive Date: 10/24/18 DOCKET NO. 15-44 339 DATE: October 25, 2018 ORDER Entitlement to service connection for rheumatoid arthritis is denied. Entitlement to service connection for right and left hip disorders is denied. Entitlement to service connection for a right knee disorder is denied. Entitlement to service connection for right and left ankle disorders is denied. Entitlement to service connection for a right leg disorder is denied. Entitlement to service connection for a vision disorder is denied. The claim for service connection for an acquired psychiatric disorder is reopened. The application to reopen the claim of entitlement to service connection for posttraumatic stress disorder (PTSD) is denied. The application to reopen the claim of entitlement to service connection for a left leg disorder is denied. REMANDED Entitlement to an increased disability evaluation for headaches, residuals of a head injury, currently rated as 30 percent disabling, is remanded. Entitlement to service connection for a spine disorder is remanded. Entitlement to service connection for a disorder manifested by kidney stones is remanded. Entitlement to service connection for an acquired psychiatric disorder is remanded. Entitlement to service connection for a disorder manifested by chest pains is remanded. FINDINGS OF FACT 1. Rheumatoid arthritis was not manifest in service and is not attributable to service. 2. Right and left ankle disorders were not manifest in service and are not attributable to service. 3. Right and left hip disorders were not manifest in service and are not attributable to service. 4. A right knee disorder was not manifest in service and is not attributable to service. 5. A vision disorder was not manifest in service and is not attributable to service. 6. A right leg disorder was not manifest in service and is not attributable to service. 8. In an unappealed August 1986 rating decision, the RO denied service connection for an acquired psychiatric disorder; an unappealed September 1994 rating decision denied the Veteran’s application to reopen the previously denied claim of entitlement to service connection for an acquired psychiatric disorder. 9. In an unappealed September 1994 rating decision, the RO denied service connection for a left leg disorder. 10. In an unappealed April 2010 rating decision, the RO denied service connection for PTSD. 11. The evidence received since the September 1994 rating decision as to the issue of entitlement to service connection for a left leg disorder is cumulative in nature and repetitive of facts that were previously considered. 12. The evidence received since the April 2010 rating decision as to the issue of entitlement to service connection for PTSD is cumulative in nature and repetitive of facts that were previously considered. 13. The evidence received since the September 1994 rating decision is relevant to and probative of the issue of entitlement to service connection for an acquired psychiatric disorder. CONCLUSIONS OF LAW 1. The criteria for service connection for rheumatoid arthritis have not been met. 38 U.S.C. §§ 1101, 1131, 1137, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.310 (2018). 2. The criteria for service connection for right and left ankle disorders have not been met. 38 U.S.C. §§ 1101, 1131, 1137, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.310 (2018). 3. The criteria for service connection for right and left hip disorders have not been met. 38 U.S.C. §§ 1101, 1131, 1137, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.310 (2018). 4. The criteria for service connection for a right knee disorder have not been met. 38 U.S.C. §§ 1101, 1131, 1137, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.310 (2018). 5. The criteria for service connection for a right leg disorder have not been met. 38 U.S.C. §§ 1101, 1131, 1137, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.310 (2018). 6. The criteria for service connection for a vision disorder have not been met. 38 U.S.C. §§ 1101, 1131, 1137, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.310 (2018). 7. The September 1994 and April 2010 rating decisions denying claims for service connection for a left leg disorder, an acquired psychiatric disorder, and PTSD are final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103 (2018). 8. New and material evidence has not been received to reopen the claims for service connection for a left leg disorder and PTSD. 38 U.S.C. § 5108; 38 C.F.R. § 3.156 (2018). 9. New and material evidence has been received to reopen the claim for service connection for an acquired psychiatric disorder. 38 U.S.C. § 5108; 38 C.F.R. § 3.156 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S. Army from September 1979 to August 1980. These matters come before the Board of Veterans’ Appeals (Board or BVA) on appeal from a March 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Newark, New Jersey.   Duties to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA) imposes obligations on VA to provide claimants with notice and assistance. 38 U.S.C. §§ 5102, 5103, 5103A, 5107, 5126; Honoring America's Veterans and Caring for Camp Lejeune Families Act of 2012, Pub. L. No. 112-154, §§ 504, 505, 126 Stat. 1165, 1191-93; 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2017). The VCAA requires VA to assist a claimant at the time that he or she files a claim for benefits. As part of this assistance, VA is required to notify claimants of the evidence that is necessary in substantiating their claims, and provide notice that a disability rating and an effective date for the award of benefits will be assigned if service connection is awarded. 38 U.S.C. § 5103(a); 38 C.F.R. § 3.159(b)(1); Quartuccio v. Principi, 16 Vet. App. 183, 187 (2002); Dingess v. Nicholson, 19 Vet. App. 473, 486 (2006). In this case, the agency of original jurisdiction (AOJ) issued notice letters to the Veteran. This letter explained the evidence necessary to substantiate the Veteran’s application to reopen the previously denied claims of entitlement to service connection, as well as the evidence necessary to substantiate the claims of entitlement to service connection; the letters also explained the legal criteria for entitlement to such benefits. The letters also informed him of his and VA’s respective duties for obtaining evidence. The AOJ decision that is the basis of this appeal was decided after the issuance of an initial, appropriate VCAA notice. As such, there was no defect with respect to timing of the VCAA notice. See Pelegrini v. Principi, 18 Vet. App. 112 (2004). VA also has a duty to assist a veteran with the development of facts pertinent to the appeal. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159(c). This duty includes the obtaining of “relevant” records in the custody of a Federal department or agency under 38 C.F.R. § 3.159(c)(2), as well as records not in Federal custody (e.g., private medical records) under 38 C.F.R. § 3.159(c)(1). VA will also provide a medical examination if such examination is determined to be “necessary” to decide the claim. 38 C.F.R. § 3.159(c)(4). The claims file contains the Veteran’s available service treatment records, reports of post-service treatment, and the Veteran’s own statements in support of his claims. The Veteran was afforded VA examinations responsive to the claims for service connection for chest pain, a vision disorder, ankle disorders, and a right knee disorder. The opinions were conducted by a medical professional, following thorough examination of the Veteran, solicitation of history, and review of the claims file. The examination reports contain all the findings needed to assess the Veteran’s service-connected disabilities on appeal, including history and clinical evaluation. See 38 C.F.R. § 3.327(a) (2018); Palczewski v. Nicholson, 21 Vet. App. 174, 182-83 (2007). As will be discussed below, the weight of the evidence demonstrates that the Veteran has not submitted new and material evidence to reopen his claims of entitlement to service connection for a PTSD and a left leg disorder; likewise, has not submitted any evidence demonstrating that he has rheumatoid arthritis, a right leg disorder, or right and left hip disorders. As such, a remand to provide the Veteran with medical examinations and/or to obtain medical opinions on those matters is not necessary. See Bardwell v. Shinseki, 24 Vet. App. 36 (2010). The Board has reviewed the Veteran’s statements and medical evidence of record and concludes that there is no outstanding evidence with respect to the Veteran’s claims. For these reasons, the Board finds that the VCAA duties to notify and assist have been met. New and Material Evidence to Reopen Service Connection In general, rating decisions and Board decisions that are not timely appealed are final. See 38 U.S.C. §§ 7104, 7105; 38 C.F.R. § 20.1103. If new and material evidence is presented or secured with respect to a claim that has been finally disallowed, the claim shall be reopened and reviewed. See 38 U.S.C. § 5108; 38 C.F.R. § 3.156. Under 38 C.F.R. § 3.156, a claimant may reopen a finally adjudicated claim by submitting new and material evidence. “New” evidence is defined as 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, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). The United States Court of Appeals for Veterans Claims (Court) has interpreted the language of 38 C.F.R. § 3.156(a) as creating a low threshold. Shade v. Shinseki, 24 Vet. App 110 (2010). New and material evidence received prior to the expiration of the appeal period, or prior to the appellate decision if a timely appeal has been filed (including evidence received prior to an appellate decision and referred to the AOJ by the Board without consideration in that decision in accordance with the provisions of 38 C.F.R. § 20.1304(b)(1)), will be considered as having been filed in connection with the claim which was pending at the beginning of the appeal period. 38 C.F.R. § 3.156(b). 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 as an original claim for benefits. 38 C.F.R. § 3.156(c). If it is determined that new and material evidence has been submitted, the claim must be reopened. The evidence is presumed credible for the purposes of reopening a claim, unless it is inherently false or untrue or, if it is in the nature of a statement or other assertion, it is beyond the competence of the person making the assertion. Justus v. Principi, 3 Vet. App. 510 (1992). 1. Whether new and material evidence has been received to reopen a claim of entitlement to service connection for a left leg disorder 2. Whether new and material evidence has been received to reopen a claim of entitlement to service connection for PTSD The RO denied service connection for a left leg disorder in a September 1994 rating decision, and denied service connection for PTSD in an April 2010 rating decision. The Veteran did not file a substantive appeal of either decision, and the decisions became final. See 38 U.S.C. § 7105(c). The September 1994 rating decision denied the Veteran’s claim for service connection of a left leg disorder on the basis that there was no evidence indicating that a left leg disorder was incurred in or caused by service; the rating decision noted that the Veteran had been treated for an acute muscle strain of the left leg in service, but that there was no record of complaints, treatment, or diagnoses related to the left leg at separation from service, and there was no evidence that the Veteran had a current left leg disorder related to an injury or disease during service. Likewise, the April 2010 rating decision denied the Veteran’s claim for service connection of PTSD on the basis that there was no stressor event in service and there was no evidence indicating that the Veteran had been diagnosed with PTSD related to his service in accordance with DSM-IV; there was no record of complaints, treatment, or diagnoses related to PTSD during active service, and no evidence that the Veteran had PTSD related to an injury or disease during service. The rating decision noted that the Veteran’s service records, VA treatment records, and a VA examination report were considered. Evidence received since the April 2010 rating decision includes VA treatment records, a Disability Benefit Questionnaire completed by a private psychologist, and VA examination reports. The VA treatment records noted that there is a diagnosis of PTSD by history. However, none of the records reflect that the Veteran had a confirmed stressor event in service, or that the Veteran has been diagnosed with PTSD in accordance with the DSM-IV/V. Likewise, none of the records reflect that the Veteran’s reported history of PTSD is related to service. The evidence submitted subsequent to the September 1994 rating decision as to the issue of entitlement to service connection for a left leg disorder is not new and material. Neither the VA nor private treatment records demonstrate that the Veteran’s left leg disorder is related to his service. The VA examination reports also fail to demonstrate that the Veteran has a current left leg disorder related to his active duty, including his acute muscle strain of the left leg during service. At the time of the prior decisions, there was no medical evidence indicating that the Veteran’s left leg disorder was causally or etiologically related to his service; the new medical evidence of record does not reflect that any left leg disorder is related to the Veteran’s service. The evidence is cumulative of the evidence already of record at the time of the last denial. The Veteran has not provided any new and material evidence demonstrating that his left leg disorder is due to a disease or injury during service. In sum, the evidence submitted as to the Veteran’s claims of service connection for PTSD and a left leg disorder is cumulative rather than new and material. Although the threshold for reopening a claim is low, the evidence presented in this case is insufficient to reopen the claims. 3. Whether new and material evidence has been received to reopen a claim of entitlement to service connection for an acquired psychiatric disorder The RO initially denied service connection for an acquired psychiatric disorder in August 1986. A September 1994 rating decision denied the Veteran’s application to reopen the claim of entitlement to service connection for an acquired psychiatric disorder. The Veteran did not appeal and the August 1986 and September 1994 rating decisions became final. See 38 U.S.C. § 7105(c). The August 1986 rating decision denied the Veteran’s claim on the basis that there was no evidence that the Veteran had an acquired psychiatric disorder; the Veteran was diagnosed with a personality disorder, which is not a disability under the law. The September 1994 rating decision noted that the Veteran had been diagnosed with a personality disorder and an acquired psychiatric disorder, namely, adjustment disorder with depressed mood, but nonetheless found that the Veteran was not entitled to service connection for his acquired psychiatric disorder because there was no evidence that it was related to service. Since the denial of the Veteran’s claim for service connection of an acquired psychiatric disorder, the evidence added to the record includes VA treatment records, an August 2015 Disability Benefits Questionnaire (DBQ) completed by a private psychologist on behalf of the Veteran, and statements from the Veteran. The evidence submitted subsequent to the September 1994 rating decision as to the issue of service connection for acquired psychiatric disorder is new and material. The claim was previously denied on the basis that there was no evidence that the Veteran’s an acquired psychiatric disorder was related to the Veteran’s service. In essence, at the time of the prior decision, there was no evidence of an etiological relationship between the Veteran’s acquired psychiatric disorder and his service. The additional evidence speaks directly to an element which was not of record. In this regard, the Board notes that VA treatment records and the August 2015 DBQ reflect that the Veteran reported a history of psychiatric symptomatology during and since service. The August 2015 DBQ also reflects that the Veteran current diagnosis of unspecified depressive order had onset during or within one year of separation from service; the DBQ indicates that the Veteran’s siblings indicate that the Veteran did not have psychiatric symptoms prior to service, but that the Veteran was depressed, angry, and unstable when he returned from military service. This evidence cures evidentiary defects; namely, the January 2017 treatment record reflects that there is a possible relationship between the Veteran’s acquired psychiatric disorder and his service. See Kent v. Nicholson, 20 Vet. App. 1, 10 (2006) (finding that “the question of what constitutes material evidence to reopen a claim for service connection depends on the basis on which the prior claim was denied”). Accordingly, the Board finds that the claim for service connection of an acquired psychiatric disorder is reopened. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a) (2018). To establish a right to compensation for a present disability, a Veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service—the so-called “nexus” requirement. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection may be granted for any disease initially diagnosed after service when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. For chronic diseases, if chronicity in service is not established, a showing of continuity of symptoms after discharge is required to support the claim. 38 C.F.R. §§ 3.303(b), 3.309; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Disability which is proximately due to or the result of a service-connected disease or injury shall be service connected. Any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease, will be service connected. However, VA will not concede that a nonservice-connected disease or injury was aggravated by a service-connected disease or injury unless the baseline level of severity of the nonservice-connected disease or injury is established by medical evidence created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the nonservice-connected disease or injury. 38 C.F.R. § 3.310. 1. Entitlement to service connection for rheumatoid arthritis 2. Entitlement to service connection for right and/or left ankle disorders 3. Entitlement to service connection for right and/or left hip disorders 4. Entitlement to service connection for a right knee disorder 5. Entitlement to service connection for a vision disorder 6. Entitlement to service connection for a right leg disorder At the outset, the Board notes that the Veteran does not claim, and the evidence does not reflect, that his claimed disabilities were incurred during combat with the enemy. Therefore, the combat provisions of 38 U.S.C. § 1154 are not applicable. The Board acknowledges that the Veteran, in statements, asserts that he has rheumatoid arthritis, right and left ankle disorders, right and left hip disorders, a right knee disorder, a right leg disorder, and a vision disorder related to events in service. The Board notes that whether service connection is claimed on direct or secondary basis, a necessary element for establishing such a claim is the existence of current disability. In this case, the Veteran must show that he currently has rheumatoid arthritis, right and left ankle disorders, right and left hip disorders, a right knee disorder, a right leg disorder, and a vision disorder due to an event, disease, or injury in service. See Sanchez-Benitez v. Principi, 259 F.3d 1356, 1361-1362 (Fed. Cir. 2001). The Board finds that the weight of the evidence is against the existence of rheumatoid arthritis, right and left ankle disorders, right and left hip disorders, a right knee disorder, a right leg disorder, and a vision disorder. There is no evidence, including the Veteran’s own statements, reflecting that he has been treated or diagnosed with rheumatoid arthritis, right or left ankle disorders, right or left hip disorders, a right knee disorder, a right leg disorder, or a vision disorder. The Board acknowledges that the Veteran has been treated for refractive error in the years since service; however, refractive error is not considered a disease or injury for VA purposes, and provides no basis for service connection in the absence of a superimposed disease or injury. 38 C.F.R. §§ 3.303(c), 4.9; Beno v. Principi, 3 Vet. App. 439, 441 (1992). VA regulations specifically prohibit service connection for refractive errors of the eyes unless the defect was subjected to a superimposed disease or injury that created additional disability. VAOPGCPREC 82-90 (1990), 55 Fed. Reg. 45,711 (1990). Likewise, although VA treatment records reflect a history of chest pain, there is no disability has been diagnosed. In this regard, the Veteran has not provided any medical evidence of treatment, complaints, or diagnoses related to rheumatoid arthritis, right or left ankle disorders, right or left hip disorders, a right knee disorder, a right leg disorder, or a vision disorder in the years since his active duty. In fact, the Veteran has made no assertions of rheumatoid arthritis, right or left ankle disorders, right or left hip disorders, a right knee disorder, a right leg disorder, or a vision disorder related to his active duty except as it relates to his claims for service connection. See Pond v. West, 12 Vet. App. 341 (1999). To the extent that the Veteran has reported a history of rheumatoid arthritis, right or left ankle disorders, right or left hip disorders, a right knee disorder, a right leg disorder, or a vision disorder during and since service, the Board notes that he is competent to report symptoms and whether he has received diagnoses, including when he was first treated or diagnosed. See Kahana v. Shinseki, 24 Vet. App. 428, 433 (2011). To the extent that there are lay statements asserting that the Veteran has rheumatoid arthritis, right or left ankle disorders, right or left hip disorders, a right knee disorder, a right leg disorder, or a vision disorder, related to an in-service event, injury, or illness, the Board finds that the probative value of the general lay assertions are outweighed by the absence of medical evidence of record showing any diagnosis for rheumatoid arthritis, right or left ankle disorders, right or left hip disorders, a right knee disorder, a right leg disorder, or a vision disorder. Moreover, nothing suggests a relationship between his service and the claimed disorders. The Board finds that the probative value of the general lay assertions is also outweighed by the specific, reasoned opinion set out in the February 2014, March 2014, and April 2014 VA examination reports, and corresponding VA medical opinions, as well as the clinical evidence of record. The remote assertions of the Veteran are inconsistent with the clinical evidence of record, which does not demonstrate current complaints, treatment, or diagnoses related to his claimed rheumatoid arthritis, right or left ankle disorders, right or left hip disorders, a right knee disorder, a right leg disorder, or a vision disorder. As such, the Board finds that the VA examination reports are the most probative evidence of record as it is definitive, based upon a complete review of the Veteran’s entire claims file (including prior medical opinions) and consideration of the Veteran’s report of his medical history. See Prejean v. West, 13 Vet. App. 444, 448-49 (2000). The United States Court of Appeals for the Federal Circuit (Federal Circuit) has noted that in order for a veteran to qualify for entitlement to compensation under those statutes, he or she must prove existence of a disability, and one that has resulted from a disease or injury that occurred in the line of duty. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) (Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability). Here, we are faced with nothing more than post-service complaints of rheumatoid arthritis, right or left ankle disorders, right or left hip disorders, a right knee disorder, a right leg disorder, or a vision disorder loss. He has not presented competent evidence of post-service pathology (diagnosis) to account for the lay complaints. See Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000) (a Veteran seeking disability benefits must establish the existence of a disability and a connection between such Veteran’s service and the disability). The Board finds that the preponderance of the evidence is against the claims for service connection of rheumatoid arthritis, right or left ankle disorders, right or left hip disorders, a right knee disorder, a right leg disorder, or a vision disorder. The benefit-of-the-doubt doctrine is therefore not for application, and the claims must be denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; see also Fagan v. Shinseki, 573 F.3d 1282, 1287 (Fed. Cir. 2009). REASONS FOR REMAND 1. Entitlement to an increased disability evaluation for headaches, residuals of a head injury, currently rated as 30 percent disabling, is remanded. The Veteran asserts that the symptoms of his service-connected headaches, residuals of a head injury, is more severe than presently evaluated. The Board observes that Veteran was most recently afforded a VA headaches examination in February 2014 and a VA traumatic brain injury examination in July 2015, and that he has not been provided with examinations which consider the current severity of his service-connected disability on appeal. See Green v. Derwinski, 1 Vet. App. 121, 124 (1991). See also Snuffer v. Gober, 10 Vet. App. 400, 403 (1997) (holding that the Veteran was entitled to a new examination after a two-year period between the last VA examination and the Veteran's contention that the pertinent disability had increased in severity).   2. Entitlement to service connection for a disorder manifested by kidney stones is remanded. 3. Entitlement to service connection for an acquired psychiatric disorder is remanded. 4. Entitlement to service connection for a spine disorder is remanded. 5. Entitlement to service connection for a disorder manifested by chest pain. The Board notes that the Veteran asserts that he has a disorder manifested by kidney stones, a disorder manifested by chest pain, and a spine disorder as a result of his service. Post-service VA treatment records reflect treatment for kidney stones and arthritis, including degenerative changes of the spine and sacroiliac joints. Additionally, the Veteran’s VA treatment records reflect a history of costochondritis and complaints of chest pain. Nevertheless, the Veteran has not yet been afforded VA examinations in connection with the claims for service connection of disorder manifested by kidney stones and a spine disorder. Accordingly, the Board finds that the Veteran should be afforded a VA examination regarding the claims for service connection of a disorder manifested by kidney stones and a spine disorder. See McLendon v. Nicholson, 20 Vet. App. 79 (2006); 38 U.S.C. § 5103A(d)(1); 38 C.F.R. § 3.159(c)(4). The Board acknowledges that, with regard to the Veteran’s claim of entitlement to service connection for a disorder manifested by chest pain, the Veteran’s VA cardiovascular examination was normal. However, the VA examination report did not address whether the Veteran’s complaints of chest pain were related to the Veteran’s costochondritis. Likewise, the Board observes that the Veteran was afforded a VA mental health examination in July 2015, and that the VA examination report reflects a sole Axis I diagnosis of alcohol dependence. Nonetheless, the Board observes that the DBQ submitted by the Veteran and the Veteran’s VA treatment records reflect an Axis I diagnosis of depressive disorder. However, the VA mental disorders examiner did not address the history of treatment for and diagnosis of depressive disorder, nor did the VA examiner attempt to reconcile the findings upon VA examination and in the Veteran’s treatment records. As such, the Board finds that the Veteran should be afforded new VA examinations regarding the claims for service connection of a disorder manifested by chest pain and an acquired psychiatric disorder. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate). VA adjudicators may consider only independent medical evidence to support their findings; they may not rely on their own unsubstantiated medical conclusions. If the medical evidence of record is insufficient, VA is always free to supplement the record by seeking an advisory opinion, or ordering a medical examination to support its ultimate conclusions. See Colvin v. Derwinski, 1 Vet. App. 171 (1991). Furthermore, VA must make all necessary efforts to obtain relevant records in the possession of a Federal agency. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159. VA records are considered to be constructively of record and VA is charged with knowledge of their contents. Bell v. Derwinski, 2 Vet. App. 611 (1992). The matter is REMANDED for the following action: 1. Contact the Veteran and request that he identify the names, addresses, and approximate dates of treatment for all VA and non-VA health care providers who have treated her for the disabilities on appeal. The Veteran should be requested to sign any necessary authorization for release of medical records to VA, and appropriate steps should be made to obtain any identified records. If any requested records are not available, or the search for any such records otherwise yields negative results, that fact must clearly be documented in the claims file. If the records are unavailable, notify the Veteran in accordance with 38 C.F.R. § 3.159. 2. After any additional records are associated with the claims file, the RO should schedule the Veteran for an appropriate examination to determine the nature and etiology of any spine disorder. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. The examiner is requested to review all pertinent records associated with the claims file. The VA examiner should identify all disabilities of the spine. The examiner should then render an opinion as to each identified disability, to include arthritis, including whether it is at least as likely as not (50 percent probability or more) that the identified spine disability is related to active service. The provider is advised that the Veteran is competent to report symptoms, including continuity of symptoms, treatment, and diagnoses and the examiner must take into account, along with the other evidence of record, the Veteran’s statements in formulating the requested opinions. A complete rationale, with specific reference to the relevant evidence of record, should accompany each opinion provided. 3. The RO should schedule the Veteran for an appropriate VA examination in order to determine the nature and etiology of any current disorder manifested by chest pain, including costochondritis, that may be present. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. The examiner is requested to review all pertinent records associated with the claims file. The examiner is asked to provide an opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that any diagnosed disorder manifested by chest pain, including costochondritis, had onset during the Veteran’s active service or was caused by any event, illness, or injury during service. The provider is advised that the Veteran is competent to report symptoms, treatment, and diagnoses and that his reports must be taken into account, along with the other evidence of record, in formulating the requested opinion. A complete rationale, with specific reference to the relevant evidence of record, should accompany each opinion provided. 4. The Veteran should be afforded an appropriate VA examination to determine the nature and etiology of a disorder manifested by kidney stones, if any. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. The examiner is requested to review all pertinent records associated with the claims file. The examiner is asked to provide an opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that any diagnosed disorder manifested by kidney stones had onset during the Veteran’s active service or was caused by any event, illness, or injury during service. If the Veteran’s disorder manifested by kidney stones did not have onset during or was not caused by an event, illness, or injury during service, the VA examiner should render an opinion as to whether it is at least as likely as not (50 percent probability or more) that the identified disability was caused or aggravated by treatment for the Veteran’s service-connected headaches, residuals of a head injury. The provider is advised that the Veteran is competent to report symptoms, including continuity of symptoms, treatment, and diagnoses and the examiner must take into account, along with the other evidence of record, the Veteran’s statements in formulating the requested opinions. A complete rationale, with specific reference to the relevant evidence of record, should accompany each opinion provided. 5. The RO should schedule the Veteran for a VA psychiatric examination in order to determine the nature and etiology of any current acquired psychiatric disorder(s) that may be present. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. The examiner is requested to review all pertinent records associated with the claims file. The examiner should provide an opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that any diagnosed acquired psychiatric disorder, including depressive disorder, had onset during the Veteran’s active service or was caused by any event, illness, or injury during service. The VA examiner must address the Veteran’s contentions that his depressive disorder had onset during his service, as well as the Veteran’s assertions that he suffered from psychiatric symptomatology since his active service. The provider is advised that the Veteran is competent to report symptoms, treatment, and diagnoses and that his reports must be taken into account, along with the other evidence of record, in formulating the requested opinion. A complete rationale, with specific reference to the relevant evidence of record, should accompany each opinion provided. 6. After any additional records are associated with the claims file, the RO should schedule the Veteran for a VA feet examination to ascertain the current severity and manifestations of the Veteran’s service-connected headaches, residuals of a head injury. The claims file should be made available to the examiner for review in connection with the examination. The examination should include a statement as to the effect of the service-connected headaches, residuals of a head injury, on his occupational functioning and daily activities. If the examiner is unable to conduct the required testing or concludes that the required testing is not necessary in this case, he or she should clearly explain why that is so. The VA examiner should provide a complete rationale for any opinions provided. 7. After completing all indicated development, the RO should readjudicate the Veteran’s claims of entitlement to service connection for a disorder manifested by kidney stones, a spine disorder, a disorder manifested by chest pain, and an acquired psychiatric disorder, as well as the claim for an increased disability evaluation for service-connected headaches, residuals of a head injury. If any of the claims remain denied, the Veteran should be furnished with a supplemental statement of the case and afforded a reasonable opportunity for response. (Continued on the next page)   (Continued on the next page) Double Click Here to Sign Gayle Strommen Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Hallie E. Brokowsky, Counsel