Citation Nr: 18148302 Decision Date: 11/08/18 Archive Date: 11/07/18 DOCKET NO. 15-37 628 DATE: November 8, 2018 ORDER Entitlement to service connection for diabetes mellitus, type two is denied. New and material evidence has been submitted to re-open the claim of entitlement to service connection for a right foot disability. To this extent only, the claim is granted. New and material evidence has been submitted to re-open the claim of entitlement to service connection for a left foot disability. To this extent only, the claim is granted. New and material evidence has been received to re-open the claim of entitlement to service connection for migraines. To this extent only, the claim is granted. Entitlement to a compensable rating for scarring of the right ear is denied. Entitlement to a separate initial rating in excess of 10 percent for a painful scar of the right ear is denied. Entitlement to a compensable rating for scars of the fourth finger of the right hand is denied. Entitlement to a rating in excess of 10 percent for tinnitus is denied. REMANDED Entitlement to service connection for hypertension is remanded. Entitlement to service connection for a left leg disability is remanded. Entitlement to service connection for a left foot disability is remanded. Entitlement to service connection for a right foot disability is remanded. Entitlement to service connection for a migraine disability is remanded. Entitlement to service connection for residuals of a head injury is remanded. Entitlement to service connection for a back disability is remanded. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that the Veteran’s diabetes mellitus, type two, began during active service or is otherwise related to an in-service injury, event, or disease. 2. In a July 1963 rating decision, the RO denied service connection for right and left foot disabilities. The Veteran did not timely appeal this decision, nor did he submit new and material evidence within one year of the decision. 3. Additional evidence has been received since the July 1963 rating decision that relates to an unestablished fact that is necessary to substantiate the claims for service connection for a right and left foot disabilities. 4. In a February 1972 rating decision, the RO denied service connection for migraines. The Veteran did not timely appeal this decision, nor did he submit new and material evidence within one year of the decision. 5. Additional evidence has been received since the February 1972 rating decision that relates to an unestablished fact that is necessary to substantiate the claim for service connection for migraines. 6. The Veteran’s right ear scar has been shown to be painful; there is no probative evidence that the scar has been productive of any disfiguring characteristics. 7. The Veteran’s scar of the fourth finger of the right hand has not been shown to be either painful or unstable, nor does it occupy an area or areas of 144 square inches or greater. 8. The Veteran’s service-connected tinnitus is assigned a 10 percent rating, which is the maximum rating authorized under Diagnostic Code (DC) 6260. CONCLUSIONS OF LAW 1. The criteria for service connection for diabetes mellitus, type two, are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.159, 3.303(a). 2. The July 1963 rating decision that denied entitlement to service connection for right and left foot disabilities is final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. 3. Evidence received since the July 1963 rating decision is new and material. Thus, this new evidence warrants reopening the claims of entitlement to service connection for right and left foot disabilities. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). 4. The February 1972 rating decision that denied entitlement to service connection for migraines is final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. 5. Evidence received since February 1972 rating decision is new and material. Thus, this new evidence warrants reopening the claims of entitlement to service connection for migraines. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). 6. The criteria for entitlement to a compensable rating for a right ear scar have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.118, DC 7805. 7. The criteria for entitlement to an initial rating in excess of 10 percent for a painful scar of the right ear have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.118, DC 7804. 8. The criteria for entitlement to a compensable rating for a scar of the fourth finger of the right hand have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.118, DC 7805. 9. The criteria for an initial rating in excess of 10 percent for tinnitus have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.87, DC 6260. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1954 to August 1956. This appeal arose to the Board of Veterans’ Appeals (Board) from multiple rating decisions of the Department of Veterans Affairs (VA) Regional Offices (ROs) in Roanoke, Virginia and New York, New York. In December 2017, the Veteran participated in a hearing before the undersigned. A transcript of the hearing is of record. VA’s Duties to Notify and Assist Pursuant to the Veterans Claims Assistance Act (VCAA), VA has duties to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C. §§ 5102, 5103, 5103A, 5107 (2012); 38 C.F.R. § 3.159 (2017). In this case, those requirements have been met. By correspondence dated June 2016, VA notified the Veteran of the information and evidence needed to substantiate and complete the claims; no further notification is required. VA has also satisfied the duty to assist. The claims folder contains service treatment records, VA medical center records, and private treatment records. The Veteran has not identified any outstanding records that are relevant to his claims. The RO did not afford the Veteran a VA examination for his claim for service connection for diabetes mellitus, type two. In McClendon v. Nicholson, 20 Vet. App. 79 (2006), the United States Court of Appeals for Veterans Claims (Court) reviewed the criteria for determining when an examination is required by applicable regulation and how the Board applies 38 C.F.R. § 3.159(c). The three salient benchmarks are: competent evidence of a current disability; establishment of an in-service event, injury, or disease; and indication that the current disability may be associated with an in-service event. The record does not show that the Veteran’s diabetes was incurred in or aggravated by service. As discussed below, the service treatment records show no diagnosis of or treatment for diabetes; and none of the post-service evidence relates any current findings of diabetes related to his military service. Therefore, the Board finds that the evidence of record does not trigger the necessary of an examination in order to decide the claim on the merits. See 38 C.F.R. § 3.159(c). In sum, there is no evidence of any VA error in notifying or assisting the Veteran that reasonably affects the fairness of this adjudication. See 38 C.F.R. § 3.159. Service Connection Claims Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a link between the claimed in-service disease or injury and the present disability. Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d). In addition, for veterans who have served 90 days or more of active service after December 31, 1946, there is a presumption of service connection for certain chronic diseases if the disability is manifest to a compensable degree within one year of discharge from service. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. 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, as distinguished from merely isolated findings or a diagnosis including the word “chronic.” Continuity of symptomatology after discharge is required where the condition noted during service is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. 38 C.F.R. § 3.303(b); see Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013) (the theory of continuity of symptomatology can be used only in cases involving those conditions explicitly recognized as chronic as per 38 C.F.R. § 3.309(a)). 1. Entitlement to service connection for diabetes mellitus, type two The Veteran contends that he is entitled to service connection for diabetes mellitus, type two. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a current diagnosis of diabetes, the preponderance of the evidence is against finding that it began during active service, or is otherwise related to an in-service injury, event, or disease. 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), (d). The Veteran contends that his diabetes mellitus, type two, is related to service. A review of the Veteran’s service treatment records demonstrates that he never complained of nor received treatment for diabetes in service. Thus, there is no indication that the Veteran suffered from diabetes in service—throughout service and reserve duty, the Veteran continually stated that he was in good health and did not mention any ongoing health issues. The first indication of treatment for diabetes in the Veteran’s VA records is in 2001, almost 45 years after his separation. Thus, aside from the Veteran’s contentions, there is no favorable evidence supporting the Veteran’s claim. A layperson, such as the Veteran, is competent to report observable symptoms, such as pain or seizures. However, the question of whether his current diabetes is related to his service is a complex medical question, not capable of lay observation. See Jandreau v. Nicholson, 492 F.3d 1372, 1376 (Fed. Cir. 2007) (noting that lay witness are capable of diagnosing dislocated shoulder); Barr v. Nicholson, 21 Vet. App. 308 -09 (2007) (finding that lay testimony is competent to establish the presence of varicose veins). Because the evidence does not indicate that Veteran has the appropriate training, experience, or expertise to provide a medical opinion concerning the etiology of his diabetes, he is not competent to comment on the etiology. The Board understands the Veteran’s claims that his time in service caused his diabetes. Unfortunately, the Veteran has provided no competent evidence supporting his claims. In sum, the Board finds that the preponderance of the evidence is against the claim for diabetes mellitus, type two. As discussed above, the Veteran’s diabetes was first diagnosed many years after service and there is no competent evidence relating such disability to service. There is likewise no evidence that diabetes mellitus, type two, developed within one year of the Veteran’s separation from service, nor is there is competent evidence of continuous diabetes symptoms since service. See 38 C.F.R. § 3.303(b); Walker, 708 F.3d 1331. Service connection must be denied. 2. Whether new and material evidence has been submitted to re-open the claims of entitlement to service connection for a right foot disability, a left foot disability, and migraines The Veteran seeks entitlement to service connection for right and left foot disabilities, as well as migraines. Implicit in this claim is the contention that new and material evidence has been received which is sufficient to reopen previously disallowed claims. Generally, a claim that has been denied in a final unappealed rating decision may not thereafter be reopened and allowed. 38 U.S.C. § 7105(c). An exception to this rule is 38 U.S.C. § 5108, which provides that if new and material evidence is presented or secured with respect to a claim which has been disallowed, VA shall reopen the claim and review the former disposition of the claim. New evidence means existing evidence not previously submitted to agency decisionmakers. 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 threshold for determining whether new and material evidence raises a reasonable possibility of substantiating a claim is “low.” See Shade v. Shinseki, 24 Vet. App. 110, 117 (2010). Furthermore, in determining whether this low threshold is met, VA should not limit its consideration to whether the newly submitted evidence relates specifically to the reason why the claim was last denied, but instead should ask whether the evidence could reasonably substantiate the claim were the claim to be reopened, either by triggering the VA Secretary’s duty to assist or through consideration of an alternative theory of entitlement. Id. at 118. Evidence is presumed to be credible for the purpose of determining whether the case should be reopened; once the case is reopened, the presumption as to the credibility no longer applies. Justus v. Principi, 3 Vet. App. 510, 513 (1992). The evidence must be both new and material; if the evidence is new, but not material, the inquiry ends and the claim cannot be reopened. Smith v. West, 12 Vet. App. 312 (1999). The Veteran filed original claims for service connection for bilateral foot disabilities and was denied in a July 1963 rating decision because the evidence did not demonstrate that the Veteran suffered any foot-related injuries in service. The Veteran was notified but did not appeal the decision. Accordingly, the rating decision is final. See 38 U.S.C. § 7105(c); 38 C.F.R. § 20.1103. Subsequently, the Veteran filed the instant application to reopen his claim. As part and parcel of that application, the Veteran submitted his VA medical records in which a VA physician stated that the Veteran’s right and left foot weakness was due to residuals of a traumatic brain injury (TBI) caused in service; the Veteran’s claim for service connection for a TBI is currently pending. Accordingly, this new documentation from the Veteran’s doctor proffers evidence of a previously unestablished element of the claim, and the claim will be reopened. The Veteran filed original claims for service connection for his migraines and was denied in a February 1972 rating decision because the evidence did not demonstrate that the Veteran’s migraines were caused or incurred in service. The Veteran was notified but did not appeal the decision. Accordingly, the rating decision is final. See 38 U.S.C. § 7105(c); 38 C.F.R. § 20.1103. Subsequently, the Veteran filed the instant application to reopen his claim. As part and parcel of that application, the Veteran submitted his VA medical records in which a VA physician stated that the Veteran’s residuals of a TBI caused migraines and headaches; the Veteran’s claim for service connection for a TBI is currently pending. Accordingly, this new documentation from the Veteran’s doctor proffers evidence of a previously unestablished element of the claim, and the claim will be reopened. Increased Rating Claims Disability ratings are determined by evaluating the extent to which a Veteran’s service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing his symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. If two evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation; otherwise, the lower evaluation will be assigned. 38 C.F.R. § 4.7. The Veteran’s entire history is to be considered when making disability evaluations. See generally 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). 1. Entitlement to a compensable rating for scar of the right ear; and entitlement to an initial rating in excess of 10 percent for painful scar of the right ear The Veteran contends that his right ear scar warrants an increased rating. He is currently in receipt of a noncompensable rating for a right ear scar, under DC 7805, and a separate 10 percent rating for a painful scar of the right ear, under DC 7804. See 38 C.F.R. § 4.118. Notably, the evidence reflects that both of these ratings are for a single scar. DC 7804 provides that a 10 percent rating is warranted for one or two scars that are unstable or painful; a 20 percent rating is warranted for three or four scars that are unstable or painful; and a 30 percent rating is warranted for five or more scars that are unstable or painful. Note (1) to DC 7804 provides that an unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. Note (2) provides that if one or more scars are both unstable and painful, the rater should add 10 percent to the evaluation that is based on the total number of unstable or painful scars DC 7805 provides that VA should evaluate any disabling effect(s) not considered in a rating provided under DCs 7800-7804 under an “appropriate” DC. In pertinent part, DC 7801 is not applicable, as it addresses scars not of the head, face, or neck that are deep and nonlinear. DC 7802 provides a maximum 10 percent rating based on surface area for scars that are superficial and nonlinear. A rating under DC 7802 need not be considered in this case, as the Veteran is being awarded a 10 percent rating under the criteria of DC 7804. DC 7800 is potentially applicable, as it applies to scars or disfigurement of the head, face, or neck. This DC provides that an increased 30 percent rating is warranted with visible or palpable tissue loss and either gross distortion or asymmetry of one feature or paired set of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or; with two or three characteristics of disfigurement. (Higher schedular ratings are warranted for more severe symptoms.) Note (1) to this DC provides that the eight characteristics of disfigurement are: (i) scar 5 or more inches in length; (ii) scar at least one-quarter inch wide at widest part; (iii) scar adherent to underlying tissue; (iv) scar contour or scar elevated or depressed on palpation; (v) skin hypo-or hyper-pigmented in an area exceeding six square inches (39 square cm); (vi) skin texture abnormal (irregular, atrophic, shiny, scaly, etc.) in an area exceeding six square inches (39 square cm); (vii) underlying soft tissue missing in an area exceeding six square inches (39 square cm); and (viii) skin indurated and inflexible in an area exceeding six square inches (39 square cm). Having reviewed the evidence, the Board finds that the Veteran’s currently assigned evaluations for his right ear scarring are appropriate, and increased ratings are not warranted. In October 2013, the Veteran underwent a VA examination which showed a scar on the right temporal area, near his right ear. The scar was observed to be neither painful nor unstable; the Veteran reported that the scar was asymptomatic. The examiner noted that the scar was 3 cm x 0 cm in size (approximately 0.5 square cms) and was well healed and non-tender. The scar was observed to be hypopigmented. No functional impact was noted. On VA examination in August 2015, the examiner indicated that the Veteran’s right ear scar was painful. The examiner observed that the scar was well healed and slightly pigmented; however, it blended well with surrounding skin and showed no asymmetry or other deformity. It was approximately 2.6 cm by 1 mm in thickness (the examiner noted that it was “barely visible”). It was slightly tender to touch. No distortion or tissue loss was noted. No functional limitation was noted. After reviewing the record, the Board can find no probative evidence that the criteria for increased ratings under any of the potentially applicable DCs have been met. As noted above, there is no competent evidence to suggest that the Veteran has the equivalent of three or more scars on his right ear (or symptoms analogous to scars) that are painful and/or unstable, as is required for a higher rating under DC 7804. Likewise, although the Veteran’s right ear scar has been noted to be hypopigmented, it is not of a size that would warrant compensable rating under DC 7800. No other disfiguring features have been observed over the course of the appeal period. The Board has considered the Veteran’s lay statements with respect to his scar symptoms—specifically, that his right ear scar is painful. These lay reports are consistent with the objective medical findings, and align with the criteria for a 10 percent rating under DC 7804—i.e., a single scar that is painful and/or unstable. Accordingly, the Board finds that the Veteran’s lay statements, in combination with the VA examination findings, are entirely consistent with a 10 percent rating. Neither the Veteran nor his representative have raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 369-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the record). In sum, the evidence deemed most probative by the Board establishes that the symptoms associated with the Veteran’s right ear scar are equivalent to a single, painful scar. There is no evidence of three or more scars that are painful or unstable, and there is no additional probative evidence that warrants a higher rating under the criteria discussed above. Accordingly, entitlement to increased ratings will not be granted. 2. Entitlement to a compensable rating for a scar of the fourth finger of the right hand The Veteran contends that his scar on the fourth finger of his right hand warrants an increased rating. He is currently in receipt of a noncompensable rating for this scar, under DC 7805. See 38 C.F.R. § 4.118. The Veteran first underwent a VA examination in October 2013. At that time, his scar on the right fourth finger was observed to be 1 cm in length. The examiner noted that the scar was neither painful nor unstable, and was well healed and non-tender. No functional impact was noted. The Veteran underwent a second VA examination in August 2015, which confirmed a scar on his right fourth finger. The scar was observed to be 2.4 cm in length and 1 mm in thickness. It was well healed and did not cause any limitation of mobility. It was slightly hypo-pigmented but blended well with the surrounding skin. The Veteran reported that the scar was painful; however, the examiner opined that, as the scar was well healed and barely visible, such pain was most likely attributable to nonservice-connected neuropathy (which was itself attributable to nonservice-connected diabetes mellitus, type two). After reviewing the record, the Board can find no probative evidence that the criteria for increased ratings under any of the potentially applicable DCs have been met. As illustrated in the examinations discussed above, there is no competent evidence to suggest that the Veteran’s right finger scar is painful and/or unstable, in and of itself, as is required for a compensable rating under DC 7804. DC 7800 is inappropriate, as this particular scar does not involve the head, face, or neck; and a compensable rating under DC 7801 or DC 7802 is likewise not warranted due to the scar’s relatively small size. The Board has considered the Veteran’s lay statements with respect to his scar symptoms—specifically, that his scar is painful. However, the Board finds that the August 2015 VA examiner’s conclusion that such pain is more likely attributable to neuropathy to be more probative than his lay statements. The Board notes that the question of medical etiology regarding the Veteran’s finger pain is a complex medical question, not capable of lay observation. See Jandreau, 492 F.3d at 1376. The Veteran has not demonstrated that he possesses the medical expertise needed to provide competent lay testimony on this matter. Furthermore, neither the Veteran nor his representative have raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette, 28 Vet. App. at 369-70. In sum, the evidence deemed most probative by the Board establishes that the symptoms associated with the Veteran’s right fourth finger scar are equivalent to a single scar that is neither painful nor unstable. There is no additional probative evidence that warrants a compensable rating under the criteria discussed above. Accordingly, entitlement to a compensable rating will not be granted. 3. Entitlement to a rating in excess of 10 percent for tinnitus The Veteran seeks an initial rating in excess of 10 percent for tinnitus, which is rated under DC 6260. Disability ratings are determined by application of the criteria set forth in VA’s Schedule for Rating Disabilities, which is based on average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. When a question arises as to which of two ratings applies under a particular Diagnostic Code, the higher rating is assigned if the disability more closely approximates the criteria for the higher rating. Otherwise, the lower rating applies. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3. The RO rated the Veteran’s tinnitus under DC 6260 of 38 C.F.R. § 4.87. This DC provides a maximum rating of 10 percent. In Smith v. Nicholson, 19 Vet. App. 63, 78 (2005) the U.S. Court of Appeals for Veterans Claims (CAVC) held that earlier versions of DC 6260 required the assignment of dual ratings for bilateral tinnitus. VA appealed this decision to the U.S. Court of Appeals for the Federal Circuit (Federal Circuit). In Smith v. Nicholson, 451 F.3d. 1344 (Fed. Cir. 2006), the Federal Circuit concluded that the CAVC erred in not deferring to VA’s interpretation of its own regulations, 38 C.F.R. § 4.25 (b) and DC 6260, which limit a veteran to a single disability rating for tinnitus, regardless of whether the tinnitus is unilateral or bilateral. The Veteran’s service-connected tinnitus has been assigned the maximum schedular rating available for the disorder. 38 C.F.R. § 4.87, DC 6260. As there is no legal basis upon which to award a higher schedular evaluation for tinnitus (or a separate evaluation for each ear), the Veteran’s appeal must be denied. Sabonis v. Brown, 6 Vet. App. 426 (1994). REASONS FOR REMAND 1. Entitlement to service connection for hypertension is remanded. The Veteran contends that he is entitled to service connection for hypertension. As part of his application, the Veteran submitted medical records from the 1970s, only a few years after he exited service. Those records indicate that the Veteran suffered from several heart attacks and cardiac conditions at a very young age. Those records, however, are written in Spanish and the majority of the records were found illegible and thus untranslatable. As hypertension is a leading cause of cardiac conditions, without more information, the Board can neither grant nor deny the Veteran’s claim. As such, an examination is in order, with a Spanish-speaking examiner, to determine the chronology of the Veteran’s hypertension, based on the untranslated records. 2. Entitlement to service connection for a head injury, to include a TBI, as well as service connection secondary to a head injury for headaches, a left leg disability, and a right and left foot disability is remanded. The Veteran has filed a claim for service connection for residuals of a head injury. A letter from the Veteran’s treating physician in October 1972 states that the Veteran was suffering from dizziness due to an in-service trauma in 1956. The Veteran’s medical files continue to demonstrate that he seeks treatment for a head injury. As such, an examination to determine whether or not the Veteran is suffering from a head injury due to service is necessary. Concerning the Veteran’s claims for service connection for headaches, a left leg disability, and a right and left foot disability, secondary to his claim for service connection for a head injury, within the Veteran’s VA medical files are routine examinations from his VA neurologist in July 2015. The neurologist stated that the Veteran suffered from residuals of a head injury due to a motor vehicle accident while in service. Due to those residuals, the Veteran suffered from peripheral neuropathy of the left leg, as well as numbness in his right and left feet and headaches. As such, examinations are in order to determine whether or not the Veteran’s left leg disability, right and left foot disability, and headache condition are connected to service. 3. Entitlement to service connection for a back disability. The Veteran contends that he is entitled to service connection for a back disability. At his hearing, he explained that he suffered from compressed vertebra and that his time in service compressed the vertebra even more. The Veteran’s service treatment records indicate that he suffered from a possible fractured vertebra before entering service. The Veteran received a VA examination in October 2013 in which the examiner confirmed that the Veteran suffered from degenerative disc disease of the lumbar spine, but did not provide an opinion as to whether or not the Veteran’s time in service aggravated his vertebral disc condition. As such, an examination is in order to determine if the Veteran’s time in service aggravated beyond the normal course of the disease his back disability. The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination—if possible, with a Spanish-speaking examiner—to determine the nature and etiology of his hypertension. The examiner is asked to review the claims file, particularly evidence of cardiac pathology and records, in Spanish, pertaining to the Veteran’s chronology of hypertension. The examiner should then provide the following information: a. Whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran’s hypertension is related to his military service. b. Whether it is as least as likely as not (a 50 percent probability or greater) that the Veteran’s hypertension was caused or aggravated by any other service-connected disability. c. If it is determined that there is another likely etiology for the Veteran’s claimed hypertension, that should be stated. 2. Schedule the Veteran for an examination to determine the nature and etiology of any current residuals from his claimed in-service head injury. The examiner should identify any current residuals of such an injury, and should then provide the following information: a. Whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran suffered a head injury related to his military service. The examiner should specifically discuss an October 1972 letter from the Veteran’s treating physician stating that the Veteran was suffering from dizziness due to an in-service trauma in 1956, as well as recent treatment notes from the Veteran’s VA neurologist indicating a history of in-service head injury. b. Whether it is as least as likely as not (a 50 percent probability or greater) that the Veteran’s bilateral foot disabilities, left leg disability, or headaches were caused or aggravated by any such head injury. c. If it is determined that there is another likely etiology for the Veteran’s claimed disabilities, that should be stated. 3. Schedule the Veteran for an examination to determine the nature and etiology of his back disability. The examiner is asked to review the claims file, including the Veteran’s lay statements pertaining to his chronology of back problems. The examiner should then provide the following information: a. Whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran’s back disability was caused or permanently aggravated by his military service. The examiner should specifically discuss the Veteran’s lay testimony regarding in-service aggravation of his back problems. b. If it is determined that there is another likely etiology for the Veteran’s claimed back disability, that should be stated. LESLEY A. REIN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. Ryan, Associate Counsel