Citation Nr: 18145236 Decision Date: 10/26/18 Archive Date: 10/26/18 DOCKET NO. 16-09 903 DATE: October 26, 2018 ORDER New and material evidence has been received, and the claim for service connection for visual impairment, also claimed as diabetic retinopathy, secondary to service-connected diabetes mellitus, type II, is re-opened. New and material evidence has been received, and the claim for service connection for hypertension, secondary to service-connected diabetes mellitus, type II, is re-opened. New and material evidence has been received, and the claim for service connection for erectile dysfunction, secondary to service-connected diabetes mellitus, type II, has been re-opened. New and material evidence has been received, and the claim for service connection for left lower extremity peripheral neuropathy, secondary to service-connected diabetes mellitus, type II, is re-opened. New and material evidence has been received, and the claim for service connection for right lower extremity peripheral neuropathy, secondary to service-connected diabetes mellitus, type II, is re-opened. New and material evidence has been received, and the claim for service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), depression and anxiety, is re-opened. Service connection for visual impairment, also claimed as diabetic retinopathy, secondary to service-connected diabetes mellitus, type II, is denied. Service connection for hypertension, secondary to service-connected diabetes mellitus, type II, is denied. Service connection for erectile dysfunction, secondary to service-connected diabetes mellitus, type II, is granted. Service connection for left lower extremity peripheral neuropathy, secondary to service-connected diabetes mellitus, type II, is granted. Service connection for right lower extremity peripheral neuropathy, secondary to service-connected diabetes mellitus, type II, is granted. Service connection for depression with PTSD is granted. A compensable rating for Hepatitis C is denied. REMANDED Entitlement to a total disability evaluation based on individual unemployability (TDIU) due to service-connected disabilities is remanded. FINDINGS OF FACT 1. The evidence associated with the claims file following the May 2012 denial of the Veteran’s claim for service connection for visual impairment, also claimed as diabetic retinopathy, is new and material evidence. 2. The evidence associated with the claims file following the May 2012 denial of the Veteran’s claim for service connection for hypertension is new and material evidence. 3. The evidence associated with the claims file following the May 2012 denial of the Veteran’s claim for service connection for erectile dysfunction is new and material evidence. 4. The evidence associated with the claims file following the May 2012 denial of the Veteran’s claim for service connection for left lower extremity peripheral neuropathy is new and material evidence. 5. The evidence associated with the claims file following the May 2012 denial of the Veteran’s claim for service connection for right lower extremity peripheral neuropathy is new and material evidence. 6. The evidence associated with the claims file following the May 2012 denial of the Veteran’s claim for service connection for an acquired psychiatric disorder, to include PTSD, depression and anxiety, is new and material evidence. 7. 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 diagnosis of visual impairment, also claimed as diabetic retinopathy. 8. The preponderance of the evidence is against finding that the Veteran has hypertension is at least as likely as not secondary to his service-connected diabetes mellitus, type II. 9. Resolving reasonable doubt in the Veteran’s favor, his erectile dysfunction is at least as likely as not secondary to his service-connected diabetes mellitus, type II. 10. Resolving reasonable doubt in the Veteran’s favor, his left lower extremity peripheral neuropathy is at least as likely as not secondary to his service-connected diabetes mellitus, type II. 11. Resolving reasonable doubt in the Veteran’s favor, his right lower extremity peripheral neuropathy is at least as likely as not secondary to his service-connected diabetes mellitus, type II. 12. Resolving reasonable doubt in the Veteran’s favor, his depression with PTSD is at least as likely as not related to an in-service injury, event, or disease. 13. The Veteran’s service-connected Hepatitis C is non-symptomatic. CONCLUSIONS OF LAW 1. New and material evidence has been received to reopen a claim for service connection for visual impairment, also claimed as diabetic retinopathy. 38 U.S.C. § 5108, 7105; 38 C.F.R. §§ 3.156, 20.1103. 2. New and material evidence has been received to reopen a claim for service connection for hypertension. 38 U.S.C. § 5108, 7105; 38 C.F.R. §§ 3.156, 20.1103. 3. New and material evidence has been received to reopen a claim for service connection for erectile dysfunction. 38 U.S.C. § 5108, 7105; 38 C.F.R. §§ 3.156, 20.1103. 4. New and material evidence has been received to reopen a claim for service connection for left lower extremity peripheral neuropathy. 38 U.S.C. § 5108, 7105; 38 C.F.R. §§ 3.156, 20.1103. 5. New and material evidence has been received to reopen a claim for service connection for right lower extremity peripheral neuropathy. 38 U.S.C. § 5108, 7105; 38 C.F.R. §§ 3.156, 20.1103. 6. New and material evidence has been received to reopen a claim for service connection for an acquired psychiatric disorder, to include PTSD, depression and anxiety. 38 U.S.C. § 5108, 7105; 38 C.F.R. §§ 3.156, 20.1103. 7. The criteria for service connection for visual impairment, also claimed as diabetic retinopathy, as secondary to service-connected diabetes mellitus, type II, have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 8. The criteria for service connection for hypertension, as secondary to service-connected diabetes mellitus, type II, have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 9. The criteria for service connection for erectile dysfunction, as secondary to service-connected diabetes mellitus, type II, have been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 10. The criteria for service connection for left lower extremity peripheral neuropathy, as secondary to service-connected diabetes mellitus, type II, have been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 11. The criteria for service connection for right lower extremity peripheral neuropathy, as secondary to service-connected diabetes mellitus, type II, have been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 12. The criteria for service connection for depression with PTSD have been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 13. The criteria for a compensable disability rating for Hepatitis C have not been met. 38 U.S.C. §§ 1155, 5103(a), 5103A, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.124a, Diagnostic Code 7354. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from May 1966 to May 1968, to include one year of foreign service in Vietnam. The Veteran earned the Vietnam Campaign Medal with Device 60, the Vietnam Service Medal with Bronze Service Star, and a National Defense Service Medal. These matters come before the Board of Veterans’ Appeals (Board) from a rating decision issued by a Regional Office (RO) of the Department of Veterans Affairs (VA) dated in January 2014. The Veteran submitted a notice of disagreement with these findings in March 2014. A statement of the case was issued in January 2016, and the Veteran timely perfected his appeal in February 2016. Although the Veteran initially requested a Board hearing, he later withdrew that hearing request in writing in April 2018. Before deciding the service connection claims on their merits, the Board must first consider whether new and material evidence has been received to reopen these claims (visual impairment claimed as diabetic retinopathy; hypertension; erectile dysfunction; left lower extremity peripheral neuropathy; right lower extremity peripheral neuropathy; and an acquired psychiatric disorder). 38 U.S.C. §§ 5108, 7105. This is so regardless of the RO’s actions. See Barnett v. Brown, 83 F.3d 1380 (Fed. Cir. 1996) and VAOPGCPREC 05-92. As discussed fully below, new and material evidence has been submitted to reopen these claims. As to the remaining two issues on appeal, the Veteran seeks an increased, compensable rating for his service-connected hepatitis C, and entitlement to TDIU due to his service-connected disabilities. These matters are now before the Board for adjudication. The issue concerning TDIU is addressed in the Remand section. All of the remaining matters are discussed in the decision below. New and Material Evidence VA may reopen and review a claim that has been previously denied if new and material evidence is submitted. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). New evidence is evidence not previously submitted to agency decision makers. Material evidence is 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 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 Board must review all evidence submitted by or on behalf of a claimant since the last final denial on any basis to determine whether a claim must be reopened. Evans v. Brown, 9 Vet. App. 273 (1996). New and material evidence is not required as to each previously unproven element of a claim. Shade v. Shinseki, 24 Vet. App. 110 (2010). 1. Whether new and material evidence has been submitted to reopen the claim of entitlement to service connection for visual impairment claimed as diabetic retinopathy. 2. Whether new and material evidence has been submitted to reopen the claim of entitlement to service connection for hypertension. 3. Whether new and material evidence has been submitted to reopen the claim of entitlement to service connection for erectile dysfunction. 4. Whether new and material evidence has been submitted to reopen the claim of entitlement to service connection for right lower extremity peripheral neuropathy. 5. Whether new and material evidence has been submitted to reopen the claim of entitlement to service connection for left lower extremity peripheral neuropathy. 6. Whether new and material evidence has been submitted to reopen the claim of entitlement to service connection for an acquired psychiatric disorder, to include PTSD, depression and anxiety. The Veteran seeks service connection for five disabilities that he claims are secondary to his service-connected diabetes mellitus, type II (visual impairment claimed as diabetic retinopathy; hypertension; erectile dysfunction; left lower extremity peripheral neuropathy; and, right lower extremity peripheral neuropathy). In addition, the Veteran also seeks service connection for a sixth issue on a direct basis: an acquired psychiatric disorder, to include PTSD, depression and anxiety. In a May 2012 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO), the Veteran’s claim for service connection for all six issues was denied. The Veteran was notified of the denial, but did not perfect an appeal, and the May 2012 rating decision became final. 38 U.S.C. § 7105(b); 38 C.F.R. §§ 3.104, 20.302, 20.1103. In July 2013, the Veteran filed to reopen all six service connection claims. Evidence added to the claims file since the final May 2012 rating decision includes private treatment records from Raleigh Neurology Associates; VA treatment records and examinations from the Durham and Salisbury VAMCs; treatment records from a private psychologist; and, additional lay statements from the Veteran. In particular, a June 2013 VA examination provides a nexus between the Veteran’s erectile dysfunction and his service-connected diabetes; the private treatment records indicate a nexus between the Veteran’s lower extremity peripheral neuropathy and his service-connected diabetes; and, a March 2018 mental health examination provides a diagnosis of PTSD and a nexus to service. These VA and private treatment records and opinions constitute new and material evidence as no evidence establishing a relationship between the Veteran’s claimed issues and service was present at the time of the May 2012 rating decision. The new evidence thus relates to unestablished facts necessary to substantiate the claims. Accordingly, the Board finds that the threshold for reopening the claims has been met and the claims for service connection for visual impairment claimed as diabetic retinopathy; hypertension; erectile dysfunction; left lower extremity peripheral neuropathy; right lower extremity peripheral neuropathy; and, an acquired psychiatric disorder to include PTSD, depression and anxiety are reopened. Duty to Notify and Assist The Veteran has not raised any issues with the duty to notify. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board . . . to search the record and address procedural arguments when the veteran fails to raise them before the Board”). The Board also finds that the duty to assist requirements have been fulfilled. All relevant, identified, and available evidence has been obtained, and VA has notified the appellant of any evidence that could not be obtained. Also of record are VA examinations conducted in January 2009, January 2011, March 2011, June 2013, October 2013, and December 2013. The Veteran has not referred to any additional, unobtained, relevant, available evidence. Thus, the Board finds that VA has satisfied the duty to assist. No further notice or assistance to the Veteran is required to fulfill VA’s duty to assist in development. Smith v. Gober, 14 Vet. App. 227 (2000); Dela Cruz v. Principi, 15 Vet. App. 143 (2001); Quartuccio v. Principi, 16 Vet. App. 183 (2002). Service Connection To prevail on a direct service connection claim, there must be competent evidence of (1) a current disability, (2) in-service incurrence or aggravation of a disease or injury, and (3) a nexus between the in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). 7. Entitlement to service connection for visual impairment claimed as diabetic retinopathy. The Veteran contends that he is entitled to service connection for visual impairment, claimed as diabetic neuropathy, as secondary to his service-connected diabetes mellitus, type II. The question for the Board is whether the Veteran has a current disability that is proximately due to, or the result of, a service-connected disability. The Board finds that the competent and credible evidence of record does not establish a current diagnosis of visual impairment or diabetic retinopathy. Service treatment records reflect no complaint, diagnosis, or treatment for visual impairment or diabetic retinopathy. At the time of entry into service, the Veteran’s March 1966 Entrance Report of Medical Examination reflects a normal examination, and he was determined to be fit for duty. At the time of exit from service, the Veteran’s April 1968 Exit Report of Medical Examination reflects a normal examination, and there were no defects or diagnosis of any eye condition noted. VA treatment records from the Salisbury VAMC include a March 2013 eye consult which reflects that the right and left retinal images showed no diabetic retinopathy. The Veteran underwent a VA examination for diabetes in June 2013. As part of this examination, the VA examiner specifically opined that there was no evidence of any diabetes-associated eye complications, finding that the only diagnosis associated with the Veteran’s diabetes is his erectile dysfunction. The Veteran underwent another VA examination for diabetes in March 2015. This VA examiner opined there were no complications due to diabetes such as diabetic retinopathy. The Board notes that the medical evidence noted above is consistent with the findings in the prior VA examinations of record. A January 2009 VA examiner concluded there was no diabetic caused functional impairment or disability, specifically finding a diagnosis of diabetes mellitus, type II, without ophthalmic signs. A January 2011 VA examiner similarly concluded the Veteran had diabetes mellitus, type II, without diabetic retinopathy. The Board notes that the existence of a current disability at any time during the current appeal period is the cornerstone of a claim for VA disability compensation. 38 U.S.C. § 1131; see Degmetich v. Brown, 104 F.3d 1328, 1332 (1997) (holding that sections 1110 and 1131 of the statute as requiring the existence of a present disability for VA compensation purposes cannot be considered arbitrary). Evidence must show that, at some time during the current appeal period, the Veteran has the disability for which benefits are being claimed. Here, however, as noted above, the competent and credible evidence of record does not establish that, at any time during the current appeal period, the Veteran had a confirmed diagnosis of visual impairment or diabetic retinopathy. In this regard, the Board notes that Congress has specifically limited service connection to instances where there is current disability (during the current appeal period) that has resulted from disease or injury. 38 U.S.C. § 1131. In the absence of a current disability during the current appeal period, the analysis ends, and the claim for service connection for visual impairment claimed as diabetic retinopathy cannot be granted. See Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). In so finding, the Board is aware of the single treatment record, dated in September 2010, that was contained in the Salisbury VAMC medical records, which reflects mild diabetic retinopathy of the right eye, with no diabetic retinopathy noted in the left eye. However, the Board notes that a subsequent Salisbury VAMC record, dated in March 2013, found no diabetic retinopathy in either eye, which is consistent with the other medical evidence of record. Further, the September 2010 assessment of right eye retinopathy falls well outside the current appeal period. The Board thus finds that the weight of the evidence strongly supports a finding that the Veteran does not have a confirmed, consistent diagnosis of retinopathy and has not had such a diagnosis at any time during the appeal period. In reaching this conclusion, the Board has also considered the benefit-of-the-doubt doctrine; however, as the preponderance of the evidence is against the claim of entitlement to service connection for visual impairment claimed as diabetic retinopathy, that doctrine is not applicable. See 38 U.S.C.A § 5107(b); 38 C.F.R. § 3.102. 8. Entitlement to service connection for hypertension. The Veteran contends that he is entitled to service connection for hypertension, as secondary to his service-connected diabetes mellitus, type II. The question for the Board is whether the Veteran has a current disability that is proximately due to, or the result of, a service-connected disability. The Board finds that the competent and credible evidence of record does not establish a nexus between the Veteran’s currently diagnosed hypertension and his service-connected diabetes. A review of the Veteran’s service treatment records indicates no complaint, diagnosis, or treatment for hypertension. At the time of entry into service, the Veteran’s March 1966 Entrance Report of Medical Examination reflects a normal examination, including a blood pressure reading of 110/60, and the Veteran was determined to be fit for duty. At the time of exit from service, the Veteran’s April 1968 Exit Report of Medical Examination, reflects a normal examination, including a blood pressure reading of 110/80, and no diagnosis of hypertension was noted. Post service treatment records, from VA and private treatment providers, reflect the Veteran was diagnosed with hypertension in 2005, over 40 years after his separation from service. The Veteran underwent a VA examination for diabetes in June 2013. As part of this examination, the VA examiner specifically noted that there was no evidence of any diabetes-associated renal or cardiac complications, finding that the only diagnosis associated with the Veteran’s diabetes is his erectile dysfunction. The Veteran underwent another VA examination for diabetes in March 2015. This VA examiner also specifically opined there were no complications due to the Veteran’s diabetes, to specifically include hypertension. The Board notes that the medical evidence noted above is consistent with the findings in the prior VA examinations of record. A March 2011 VA examiner opined that the Veteran’s hypertension is less likely than not caused by diabetes mellitus, Type II. As rationale, the examiner stated the Veteran’s hypertension has been under good control with medication and there is no evidence of nephropathy or heart disease. Upon consideration of the medical evidence of record, the Board finds that the Veteran has a current diagnosis of hypertension, but the record is void of any medical nexus opinions linking the diagnosed hypertension to the Veteran’s time in active duty service. In this case, the only evidence in favor of the Veteran’s claim consists of his own statements concerning his belief that his hypertension, diagnosed 40 years after service, is due to, or aggravated by, his service-connected diabetes. Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), as to the specific issue in this case, it falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Although the Veteran is competent to report symptoms of hypertension such as dizziness, the claimed disability is not the type of condition that is amenable to lay determination regarding its etiology, as specific findings are needed to properly determine etiology. Id.; see Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). Accordingly, the Board finds that the record does not contain any credible and supported medical evidence of a nexus between the Veteran’s currently diagnosed hypertension and his service-connected diabetes mellitus. As the evidence fails to substantiate a nexus between the claimed condition and service-connected disability, the criteria to establish entitlement to service connection on a secondary basis have not been met. Service connection for hypertension must be denied. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 55. 9. Entitlement to service connection for erectile dysfunction. The Veteran contends that he is entitled to service connection for erectile dysfunction, as secondary to his service-connected diabetes mellitus, type II. The question for the Board is whether the Veteran has a current disability that is proximately due to, or the result of, a service-connected disability. The Board concludes that the Veteran has a current diagnosis of erectile dysfunction that is proximately due to, or the result of, his service-connected diabetes mellitus. Post service treatment records, from the VA and private treatment providers, reflect the Veteran has a current diagnosis of erectile dysfunction, but no nexus opinion is provided in these records. The Veteran underwent a VA examination for diabetes in June 2013. As part of this examination, the VA examiner specifically opined that the Veteran’s erectile dysfunction is due to his diabetes mellitus, type II. The Veteran underwent another VA examination for diabetes in March 2015. This VA examiner opined there were no complications due to diabetes such as erectile dysfunction, adding that there was no objective evidence to support a diagnosis of diabetes at the time. In light of the medical evidence above, while the evidence is not unequivocal, it has nonetheless placed the record in relative equipoise. In particular, the Board looks to the statements from the Veteran’s June 2013 VA examiner, who indicated the Veteran’s current diagnosis of erectile dysfunction is at least as likely as not related to his diabetes. The Board finds the March 2015 VA examiner’s opinion ot be inadequate, as the overwhelming evidence of record contains a diagnosis of diabetes. As such, and resolving all reasonable doubt in the Veteran’s favor, the Veteran’s service-connection claim for erectile dysfunction as secondary to his service-connected diabetes is granted. 10. Entitlement to service connection for left lower extremity peripheral neuropathy. 11. Entitlement to service connection for right lower extremity peripheral neuropathy. The Veteran contends that he is entitled to service connection for left lower extremity peripheral neuropathy and right lower extremity peripheral neuropathy, both as secondary to his service-connected diabetes mellitus, type II. The question for the Board is whether the Veteran has current disabilities that are proximately due to, or the result of, a service-connected disability. The Board concludes that the Veteran has current diagnoses of left lower extremity peripheral neuropathy and right lower extremity peripheral neuropathy, that are proximately due to, or the result of, his service-connected diabetes mellitus. Post service treatment records from private treatment providers reflect the Veteran has current diagnoses of left lower extremity peripheral neuropathy and right lower extremity peripheral neuropathy. In particular, medical records from Raleigh Neurology Associates contain a September 2012 record that reflects the Veteran’s neuropathy is diabetic in nature. In addition, a December 2015 medical record reflects the Veteran returned for a follow up for his neuritic pain and his physician specifically noted, “IN HIS PARTICULAR SITUATION WE WOULD CONSIDER HIS NEUROPATHY TO BE DIABETIC IN NATURE” (emphasis in original). The Veteran underwent a VA examination for diabetes in June 2013. As part of this examination, the VA examiner specifically noted that there was no evidence of any diabetes-associated renal, cardiac, or eye complications, finding that the only diagnosis associated with the Veteran’s diabetes is his erectile dysfunction. The Veteran underwent another VA examination for peripheral nerve conditions in October 2013. The examiner opined that it is less likely as not that the Veteran’s peripheral neuropathy is related to or aggravated by his diabetes. As rationale, the examiner stated the history provided by the Veteran indicates he developed prediabetes and peripheral neuropathy symptoms in the late 1990s, but there are no records to confirm this. Other records state the Veteran developed peripheral neuropathy symptoms in his left leg and foot only in 2008, and that he had a normal neurological examination in his lower extremities, except for loss of vibration. In 2010, following spinal surgery, testing showed only bilateral lumbar radiculopathy with no evidence of any diabetic peripheral neuropathy. The examiner opined that it would not be possible to have such longstanding diabetic peripheral neuropathy without abnormalities being recorded on the 2010 testing. The examiner further opined that the Veteran’s peripheral neuropathy was not related to his diabetes, which was noted to be mild and diet controlled. The Veteran underwent another VA examination for diabetes in March 2015. This VA examiner opined there were no complications due to diabetes such as diabetic peripheral neuropathy. In light of the medical evidence above, while the evidence is not unequivocal, it has nonetheless placed the record in relative equipoise. In particular, the Board looks to the statements from the Veteran’s treating physician at Raleigh Neurology Associates, who indicated the Veteran’s currently diagnosed left and right lower extremity peripheral neuropathy is at least as likely as not related to his diabetes. As such, and resolving all reasonable doubt in the Veteran’s favor, the service-connection claim for left lower extremity peripheral neuropathy and right lower extremity peripheral neuropathy secondary to service-connected diabetes is granted. 12. Entitlement to service connection for an acquired psychiatric disorder, to include PTSD, depression and anxiety. The Veteran contends that he is entitled to service connection for an acquired psychiatric disorder to include PTSD, depression and anxiety. The question for the Board is whether the Veteran has a current disability that is proximately due to, or the result of, his military service. The Board concludes that the Veteran has a current diagnosis of depression with PTSD that is a result of his military service. The Veteran underwent a VA examination for PTSD in December 2013. The examiner opined that the criteria for a PTSD diagnosis were not met, and diagnosed the Veteran with an unspecified depressive disorder. The examiner opined that it is less likely than not the Veteran’s depressive disorder was incurred in or caused by an in-service injury, event or illness. As rationale, the examiner stated that although the Veteran reports recurrent nightmares, depressive symptoms predominate the clinical picture and cause functional impairment. However, due to a lack of documentation of mental health issues in service treatment records and post-service treatment records for over 40 years since service separation, no clear causative relationship between the current symptoms and the Veteran’s military service can be determined. The Veteran underwent an examination by a private psychologist in March 2018. This examiner diagnosed the Veteran with PTSD and major depressive disorder and opined that the symptoms of the two disabilities overlap and cannot be differentiated. The examiner then opined that it is at least as likely as not that the Veteran’s PTSD and major depressive disorder developed as a result of stressors from his service in Vietnam. In light of the above, while the evidence is not unequivocal, it has nonetheless placed the record in relative equipoise. In particular, the Board looks to the statements from the private examiner in March 2018, which indicate that the Veteran began having PTSD symptoms while in service that have continued to the present, and that his current diagnoses of major depressive disorder and PTSD are at least as likely as not related to his confirmed service in Vietnam. The Board deems the December 2013 VA examination to be inadequate as the rationale is premised solely on the fact that the Veteran did not obtain mental health treatment for years after service. As such, and resolving all reasonable doubt in the Veteran’s favor, the Veteran’s service-connection claim for depression with PTSD is granted. Increased Rating 13. Entitlement to a compensable rating for Hepatitis C. Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities. 38 C.F.R. Part 4. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Hepatitis C is rated under 38 C.F.R. § 4.114, Diagnostic Code 7354. Under this diagnostic code, a 100 percent rating is warranted for near-constant debilitating symptoms (such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain). A 60 percent rating is warranted where hepatitis C manifests with daily fatigue, malaise, and anorexia, with substantial weight loss (or other indication of malnutrition), and hepatomegaly, or; incapacitating episodes (with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain) having a total duration of at least six weeks during the past 12-month period, but not occurring constantly. A 40 percent rating is warranted for daily fatigue, malaise, and anorexia, with minor weight loss and hepatomegaly, or; incapacitating episodes (with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain) having a total duration of at least four weeks, but less than six weeks, during the past 12-month period. A 20 percent rating is warranted for daily fatigue, malaise, and anorexia (without weight loss or hepatomegaly), requiring dietary restriction or continuous medication, or; incapacitating episodes (with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain) having a total duration of at least two weeks, but less than four weeks, during the past 12-month period. A 10 percent rating is warranted for intermittent fatigue, malaise, and anorexia, or; incapacitating episodes (with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain) having a total duration of at least one week, but less than two weeks, during the past 12-month period. A 0 percent rating is warranted if non-symptomatic. Here, the Veteran was granted service connection for hepatitis C in a January 2014 rating decision and assigned a noncompensable rating of 0 percent. The Veteran appealed, claiming he is entitled to a higher, compensable rating. After review of the medical and lay evidence in this case, the Board finds that a compensable disability rating is not warranted as the Veteran’s hepatitis C is non-symptomatic. The Veteran underwent a VA examination for hepatitis in December 2013. The examiner indicated in the written report that the examiner had reviewed the claims file and conducted a telephone interview with the Veteran. The examiner noted the Veteran’s Durham VAMC medical records show that he was found to have hepatitis C on routine screening at his first primary care visit in March 2010; that the diagnosis was confirmed by positive quantitative RNA testing in May 2010; that his liver enzymes have remained normal; and, that the records show no current symptoms from his hepatitis C. The examiner also noted that the records show Veteran has not received treatment for hepatitis C. Finally, the examiner noted the Veteran does not currently have any signs or symptoms attributable to hepatitis C. VA treatment records from Durham VAMC are also associated with the claims file. In summary, these records reflect the Veteran’s hepatitis C has been non-symptomatic throughout the appeal period. A July 2014 record notes a diagnosis of hepatitis C with no evidence of active infection. Similarly, a November 2015 record also notes a diagnosis of hepatitis C with no evidence of active infection. A review of the December 2013 VA examination and the VA treatment records establishes that the Veteran has not had any symptoms associated with his hepatitis C diagnosis throughout the appellate period. The Board thus finds that the Veteran’s symptoms are substantially similar to those enumerated in the 0 percent (non-compensable) rating for the appellate review period. The Board finds, further, that a rating of 10 percent or higher is not appropriate in this case at any point during the review period because the record does not reflect a time when the Veteran exhibited any symptoms of hepatitis C, including those identified as warranting a higher rating, such as fatigue, malaise, and anorexia, or; incapacitating episodes (with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain) having a total duration of at least one week, but less than two weeks, during the past 12-month period. In conclusion, for the appellate review period, the Veteran’s hepatitis C has been non-symptomatic; therefore, a compensable rating is not warranted. The preponderance of the evidence is against the assignment of any higher rating. 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). REASONS FOR REMAND 14. Entitlement to TDIU is remanded. The Board finds that additional action is required by the RO prior to appellate review of the Veteran’s claim for TDIU. In the decision above, the Board has granted service connection for erectile dysfunction, left lower extremity peripheral neuropathy, right lower extremity peripheral neuropathy, and depression with PTSD. The RO has not yet effectuated this grant, which will potentially impact the pending appeal for TDIU. Thus, a decision on the TDIU claim would be premature at this time. The matter is REMANDED for the following action: After effectuating the grants of service connection contained in this Board decision, and assigning disability ratings to each, readjudicate the Veteran’s claim for entitlement to TDIU. If TDIU remains denied, provide the Veteran and his representative with a supplemental statement of the case and allow an appropriate period of time for response. Thereafter, return the case to the Board. CAROLINE B. FLEMING Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Jiggetts, Associate Counsel