Citation Nr: 18148303 Decision Date: 11/07/18 Archive Date: 11/07/18 DOCKET NO. 13-00 392A DATE: November 7, 2018 ORDER The request to reopen the finally disallowed claim of entitlement to service connection for left ear hearing loss is granted. Entitlement to service connection for left ear hearing loss is granted. Entitlement to service connection for diabetes mellitus is denied. Entitlement to separate service connection for partial loss of function of the lower extremities is denied. Entitlement to a rating in excess of 10 percent for tinnitus is denied. Entitlement to a rating in excess of 10 percent for degenerative joint disease of the right knee is denied. Entitlement to a rating in excess of 10 percent for degenerative joint disease of the left knee is denied. Entitlement to a rating in excess of 10 percent for traumatic degenerative joint disease in the interphalangeal joints of the right foot with hallux valgus is denied. Entitlement to a rating in excess of 10 percent for left foot strain with hallux valgus and calcaneal spur is denied. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is granted, subject to the laws and regulations governing the award of monetary benefits. REMANDED Entitlement to service connection for a low back disorder, to include mild degenerative disc disease of the lumbar spine, is remanded. Entitlement to service connection for a disability manifested by right sciatic radicular pain is remanded. Entitlement to service connection for peripheral neuropathy of the upper and lower extremities is remanded. Entitlement to a heart disorder, to include ischemic heart disease, is remanded. Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD). Entitlement to a rating in excess of 10 percent for right ear hearing loss is remanded. FINDINGS OF FACT 1. The evidence received since the January 2009 rating decision is new, relates to an unestablished fact, and raises a reasonable possibility of substantiating the claim of service connection for left ear hearing loss. 2. The evidence is at least in relative equipoise as to whether the Veteran’s left ear hearing loss is related to service. 3. The Veteran is not shown to have a current disability of diabetes mellitus, type II. 4. The record evidence does not establish that the Veteran has a separate disability manifested by partial loss of function of the lower extremities, and the evidence of record shows that the Veteran’s functional impairment on use of the lower extremities is associated with his service-connected feet, knee, and hip disabilities, as currently contemplated by the assignment of the combined disability rating. 5. The Veteran’s service-connected tinnitus is evaluated as 10 percent disabling, which is the maximum rating authorized under Diagnostic Code 6260. 6. For the entire appeal period, the Veteran’s right knee limitation of motion with degenerative joint disease is manifested by pain, and flexion limited to no less than 60 degrees, even with consideration of functional loss due to pain, weakness, incoordination, fatigue, or other symptoms. 7. For the entire appeal period, the Veteran’s left knee limitation of motion with degenerative joint disease is manifested by pain, and flexion limited to no less than 60 degrees, even with consideration of functional loss due to pain, weakness, incoordination, fatigue, or other symptoms. 8. The Veteran’s right foot traumatic degenerative joint disease is productive of moderate impairment. 9. The Veteran’s left foot strain is productive of moderate impairment. 10. The Veteran’s service-connected disabilities render him incapable of securing or following a substantially gainful occupation, considering the impairment from the disorders and his educational and employment history. CONCLUSIONS OF LAW 1. The January 2009 rating decision denying service connection for left ear hearing loss is final. 38 U.S.C. § 7105 (2012); 38 C.F.R. § 20.1103 (2018). 2. The criteria for reopening the claim of entitlement to service connection for left ear hearing loss have been met. 38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156(a) (2018). 3. The criteria for service connection for left ear hearing loss have been met. 38 U.S.C. §§ 1110, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2018). 4. The criteria for service connection for diabetes mellitus, type II, to include as secondary to herbicide exposure, have not been met. 38 U.S.C. §§ 1110, 1116, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2018). 5. The criteria for separate service connection for partial loss of function of the lower extremities have not been met. 38 U.S.C. §§ 1110, 5017(b) (2012); 38 C.F.R. §§ 3.102, 3.303, 3.310 (2018). 6. There is no legal basis for the assignment of a schedular rating in excess of 10 percent for tinnitus. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.87, Diagnostic Code 6260 (2018). 7. The criteria for a rating in excess of 10 percent for left knee degenerative joint disease have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.7, 4.71a (2018). 8. The criteria for a rating in excess of 10 percent for right knee degenerative joint disease have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.7, 4.71a (2018). 9. The criteria for a rating in excess of 10 percent for right foot traumatic degenerative joint disease have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a (2018). 10. The criteria for a rating in excess of 10 percent for left foot strain have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a (2018). 11. The criteria for a total disability rating based on individual unemployability have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.340, 3.341, 4.16 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 1969 to October 1973, September 2001 to July 2002, and February 2003 to April 2004. This appeal to the Board of Veterans’ Appeals (Board) arose from rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO). In May 2015, the Board remanded the claims for further development, to include the issuance of a statement of the case. In a December 2016 rating decision, service connection was granted for a bilateral hip strain with limitation of flexion and extension. This represents a full grant of the benefits sought with respect to those service connection issues. In January 2017, the Veteran requested a videoconference hearing. He withdrew his request for a hearing in correspondence dated in July 2018. Upon review of the evidence, the Board has recharacterize the appealed issue concerning a mental disability as one for an acquired psychiatric disorder, to include PTSD and a depressive disorder. See Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009), New and Material Evidence The Secretary must reopen a finally disallowed claim when new and material evidence is presented or secured with respect to the claim. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. New evidence means existing evidence not previously submitted to agency decision makers. Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). There is a low threshold to raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156 (a) (2017); Shade v. Shinseki, 24 Vet. App. 110 (2010); Evans v. Brown, 9 Vet. App 273 (1996); Hodge v. West, 155 F.3d 1356 (Fed. Cir. 1998). For the limited purpose of determining whether evidence is new and material, the credibility of the evidence is to be presumed. Justus v. Principi, 3 Vet. App. 510, 511 (1992). Service connection for left ear hearing loss was previously denied by the RO in a January 2009 rating decision. That decision was predicated on the finding that the evidence showed the Veteran did not have left ear hearing disability according to VA standards. The Veteran was informed in writing of the adverse decision and his appellate rights; he did not submit a timely notice of disagreement with the decision. 38 C.F.R. §§ 20.303. New and material evidence pertaining to left ear hearing loss was not received by VA, or constructively in its possession, within one year of written notice to the Veteran of the January 2009 rating decision. 38 C.F.R. § 3.156(b). Therefore, the January 2009 rating decision became final. 38 U.S.C. § 7195(c); 38 C.F.R. § 20.1103. The evidence associated with the record since the January 2009 rating decision includes a VA examination and opinion, variously dated VA treatment records, and a private opinion. The Veteran’s VA treatment records reveal a diagnosis of bilateral hearing loss and the September 2013 private opinion provides that the Veteran’s bilateral hearing loss is due to service. The Board finds that the Veteran’s VA treatment records and private opinion are of such significance that they raise a reasonable possibility of substantiating the claim for service connection. That evidence addresses the reason of the previous denial as it contains evidence showing a left ear hearing disability within VA standards, as well as evidence that indicates a nexus relating it to service. As new and material evidence has been received, the request to reopen the claim of entitlement to service connection for left ear hearing loss is granted. Service Connection Service connection is warranted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in the line of duty in the active military service or, if pre-existing such service, was aggravated thereby. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). If a condition noted in service is not shown to be chronic, then a showing of continuity of symptomatology after service will be required to establish service connection. 38 C.F.R. § 3.303 (a). In this regard, the record does not indicate nor does the Veteran allege in-service symptoms of diabetes that have been recurrent since service. Generally, in order to prove service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of a disease or injury, (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). 1. Entitlement to service connection for left ear hearing loss. The Veteran contends that that he has a left ear hearing loss disability that can be attributed his exposure to loud noise in service The Veteran’s service treatment records reveal no pertinent complaint or finding of a left ear hearing loss disability by VA standards. A November 2012 VA examination report contains audiometric results showing 45 decibels at 4000 hertz for the left ear, and reflects a left ear hearing loss disability within in VA standards. 38 C.F.R. § 3.385. The VA examiner, however, did not provide an etiology opinion since the claims file was not made available for review. Although the record may include a June 2012 VA medical opinion indicating the Veteran’s left ear hearing loss is less likely as not related to service, the record also includes a September 2013 private treatment record, in which an audiologist expressed the opinion that the Veteran’s hearing loss was at least as likely as not related to his military service. In support of the private opinion, the audiologist noted the Veteran’s report of in-service noise exposure related to working as an engine mechanic. The audiologist stated that upon examination, the Veteran showed bilateral symmetric, mild-to-moderate sensorineural hearing loss and that it was apparent that his hearing loss was the result of a high noise environment while on active duty. Considering the totality of the evidence and resolving reasonable doubt in the Veteran’s favor, Board finds that the evidence is at least in relative equipoise as to whether the Veteran’s left ear hearing loss is due to in-service noise exposure. As such, service connection for left ear hearing loss is granted. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 2. Entitlement to service connection for diabetes mellitus, to include as secondary to herbicide exposure. The Veteran contends that service connection is warranted for diabetes mellitus. Specifically, in August 2011, the Veteran contended that his claimed Type II diabetes was a result of service. The Veteran’s VA treatment records reflect no diagnosis of diabetes mellitus. In an August 2011 private treatment record, the physician noted that the Veteran was diagnosed with diabetes and stated that it was due to Agent Orange. The physician then amended his statement to reflect that the Veteran had a diabetic blood glucose reading, but that his A1C hemoglobin labs were in range and did not produce a diabetic reading. In a December 2012 general DBQ, the examiner did not note a diagnosis of diabetes or any other endocrine disorder. In October and November 2013 VA treatment records, the Veteran denied having diabetes. Treatment records, dated from September 2010 to September 2015, do not show a diagnosis of diabetes. The Board acknowledges the August 2011 blood glucose reading, but notes that it is not indicative of a diagnosis of diabetes mellitus. As previously noted, in an amended statement from the Veteran’s private physician, the A1C hemoglobin lab results were in range and did not produce a diabetic reading. See Saunders v. Wilkie, 886 F3d 1356 (Fed. Cir. 2018). Neither the Veteran nor his representative have offered any additional lay statements or medical evidence that the Veteran indeed has a diagnosis of diabetes mellitus, type II, and there are thus no such statements to which the Board must assign probative value. Without a current diagnosis of diabetes mellitus type II, there is the absence of proof of a present disability and there can be no valid claim. See Degmetich v. Brown, 155 F.3d 1353 (Fed. Cir. 1998); Brammer v. Brown, 3 Vet. App. 223, 225 (1992). The evidence in this case is not so evenly balanced to allow application of the benefit-of-the-doubt rule as required by law and VA regulations. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. The preponderance is against the claim of entitlement to service connection for diabetes mellitus type II, to include as secondary to herbicide exposure. Because the first element to service connection, i.e., a currently disability, has not been met, service connection on any basis for diabetes mellitus, type II, must be denied. 3. Entitlement to separate service connection for partial loss of function of the lower extremities. The Veteran contends separate service connection is warranted for partial loss of function of his lower extremities. In an August 2011 private report, Dr. P.J.Y. comments that due to the combination of symptoms and dysfunction as indicated on examinations of the Veteran’s feet, knees, and hips, the Veteran has a loss of functional ability of 50 percent or more on use of his lower extremities. In this regard, the record evidence reflects that the service connection is in effect for left ankle arthritis with tenosynovitis (rated 20 percent), left knee degenerative joint disease (rated 10 percent), right knee degenerative joint disease (rated 10 percent), traumatic degenerative joint disease of the interphalangeal joints of the right foot with hallux valgus (rated 10 percent), left foot strain with hallus valgus and calcaneal spur (rated 10 percent), right hip strain with limitation of extension (rated 10 percent), left hip strain with limitation of extension (rated 10 percent), right hip strain with limitation of flexion (noncompensable), and left hip strain with limitation of flexion (noncompensable). Based on the combined rating, including the bilateral factor, for the service-connected disability resulting from the Veteran’s lower extremities, the Veteran is currently shown to be 60 percent disabled, which contemplates the level of impairment due to his limited functional ability on the use of his lower extremities, and thus appears to be consistent with Dr. P.J.Y.’s comments in the August 2011 report. See 38 C.F.R. §§ 4.25, 4.26, 4.71a, Diagnostic Codes 5010, 5251, 5271, and 5284. Moreover, when the Veteran was examined by VA in March 2017, he was able to walk, although limited to short distances, and he ambulated with an ankle brace and the occasional use of a cane. According to the VA examiner, the Veteran did not demonstrate functioning so diminished that amputation with prothesis would equally serve the Veteran. As such, because the evaluation of the same manifestations under different diagnoses is to be avoided, 38 C.F.R. § 4.14, the evidence does not show a separate disability manifested by partial loss of function of the lower extremities that is not considered in the combined 60 percent disability rating. Accordingly, separate service connection for partial loss of function of the lower extremities is not warranted. Increased Rating Disability ratings are determined by applying the criteria set forth in VA’s Schedule for Rating Disabilities, found in 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. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise the lower rating will be assigned. 38 C.F.R. § 4.7. All benefit of the doubt will be resolved in the Veteran’s favor. 38 C.F.R. § 4.3. 4. Entitlement to a rating in excess of 10 percent for tinnitus. The Veteran contends that a rating in excess of 10 percent is warranted for tinnitus. Tinnitus is evaluated under Diagnostic Code 6260, which was revised effective June 13, 2003, in part to clarify existing VA practice that only a single 10 percent evaluation may be assigned for recurrent tinnitus, whether the sound is perceived as being in one ear, both ears, or in the head. 38C.F.R. §4.87, Diagnostic Code 6260, Note 2. The Veteran is currently in receipt of the maximum 10 percent initial evaluation of his tinnitus. A schedular rating in excess of 10 percent for the Veteran’s tinnitus must therefore be denied as a matter of law. 5. Entitlement to a rating in excess of 10 percent for degenerative joint disease of the right knee. The Veteran’s right knee disability is rated as 10 percent under Diagnostic Codes 5260-5010. The Veteran is seeking a higher rating. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the evaluation assigned. 38 C.F.R. § 4.27. Diagnostic Code 5010 provides ratings that arthritis due to trauma, substantiated by x-ray findings is to be rated as degenerative arthritis under Diagnostic Code 5003. Diagnostic Code 5003 provides that degenerative arthritis established by x-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic code(s) for the specific joint(s) involved. When, however, the limitation of motion of the specific joint(s) involved is noncompensable under the appropriate diagnostic code(s), a 10 percent rating is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under Diagnostic Code 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm or satisfactory evidence of painful motion. In the absence of limitation of motion, a 10 percent rating is warranted if there is x-ray evidence of involvement of two or more major joints or two or more minor joint groups and a 20 percent rating is authorized if there is x-ray evidence of involvement of two or more major joints or two or more minor joint groups and there are occasional incapacitating exacerbations. 38 C.F.R. § 4.71a, Diagnostic Code 5003. Limitation of motion of the knee is contemplated in 38 C.F.R. § 4.71a, Diagnostic Codes 5260 and 5261. Normal range of knee motion is 140 degrees of flexion and zero degrees of extension. 38 C.F.R. § 4.71, Plate II (2017). Diagnostic Code 5260 provides for a 10 percent rating for flexion that is limited to 45 degrees. A 20 percent rating is warranted where flexion is limited to 30 degrees. A 30 percent rating may be assigned where flexion is limited to 15 degrees. The relevant medical evidence of record during the appeal period includes VA examinations and private treatment reports, which the Board will discuss chronologically. An August 2011 private treatment record, authored by Dr. P.Y., notes a diagnosis of degenerative joint disease of the right knee with decreased range of motion and pain on motion. A December 2012 VA examination noted a diagnosis of degenerative joint disease, right knee. Range of motion testing revealed flexion of 105 degrees and extension to 0 with no evidence of painful motion. The Veteran’s post-repetitive motion was 90 degrees of flexion. There was no evidence of instability or patellar subluxation. In a private Report of Consultation and Examination dated in September 2013, and again authored by Dr. P.Y., reveals lateral instability in the right knee. An August 2016 VA contract examination showed a diagnosis of degenerative joint disease, right knee. Range of motion testing revealed flexion to 110 degrees with no pain on motion. Range of motion decreased to 100 degrees after repetitive use. There was no evidence of instability or patellar subluxation. After reviewing the evidence of record, the Board finds that a rating in excess of 10 percent for the Veteran’s right knee limitation of motion with degenerative joint disease is not warranted as there is no evidence that flexion was ever limited to, or more nearly approximated, 30 degrees so as to warrant assignment of a 20 percent rating under Diagnostic Code 5260. The Board is cognizant of the Veteran’s competency and credibility to report constant pain. However, even considering additional functional loss due to pain, there is no evidence that flexion was ever limited to, or more nearly approximated, 30 degrees so as to warrant assignment of a 20 percent rating under Diagnostic Code 5260. In fact, flexion was never found to be limited to 60 degrees or less in the right knee. The rating criteria require flexion limited to at least 60 degrees for a 10 percent rating. The current 10 percent evaluation contemplates the Veteran’s reported functional loss due to painful movement. As demonstrated, the range of motion findings considered here, and the 10 percent evaluation currently assigned, already account for functional loss due to painful movement. As such, a rating in excess of 10 percent is not warranted under 38 C.F.R. § 4.40 or 38 C.F.R. § 4.45. The Board acknowledges that in advancing this appeal, the Veteran, believes that his disability is more severe than the assigned disability rating reflects. However, the competent medical evidence offering detailed specific specialized determinations pertinent to the rating criteria are the most probative evidence with regard to evaluating the pertinent symptoms for the disability on appeal; the medical evidence also contemplates the Veteran’s descriptions of his symptoms. A rating in excess of 10 percent is not warranted at any time during the appeal period. See Hart v. Mansfield, 21 Vet. App. 505 (2007). 6. Entitlement to a rating in excess of 10 percent for degenerative joint disease of the left knee. The Veteran’s left knee disability is rated as 10 percent under Diagnostic Codes 5260-5010. The Veteran is seeking a higher rating. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the evaluation assigned. 38 C.F.R. § 4.27. Diagnostic Code 5010 provides ratings that arthritis due to trauma, substantiated by x-ray findings is to be rated as degenerative arthritis under Diagnostic Code 5003. Diagnostic Code 5003 provides that degenerative arthritis established by x-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic code(s) for the specific joint(s) involved. When, however, the limitation of motion of the specific joint(s) involved is noncompensable under the appropriate diagnostic code(s), a 10 percent rating is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under Diagnostic Code 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm or satisfactory evidence of painful motion. In the absence of limitation of motion, a 10 percent rating is warranted if there is x-ray evidence of involvement of two or more major joints or two or more minor joint groups and a 20 percent rating is authorized if there is x-ray evidence of involvement of two or more major joints or two or more minor joint groups and there are occasional incapacitating exacerbations. 38 C.F.R. § 4.71a, Diagnostic Code 5003. Limitation of motion of the knee is contemplated in 38 C.F.R. § 4.71a, Diagnostic Codes 5260 and 5261. Normal range of knee motion is 140 degrees of flexion and zero degrees of extension. 38 C.F.R. § 4.71, Plate II (2017). Diagnostic Code 5260 provides for a 10 percent rating for flexion that is limited to 45 degrees. A 20 percent rating is warranted where flexion is limited to 30 degrees. A 30 percent rating may be assigned where flexion is limited to 15 degrees. The relevant medical evidence of record during the appeal period includes VA examinations and private treatment reports, which the Board will discuss chronologically. An August 2011 private treatment record, authored by Dr. P.Y., notes a diagnosis of degenerative joint disease of the left knee with decreased range of motion and pain on motion. A December 2012 VA examination noted a diagnosis of degenerative joint disease, left knee. Range of motion testing revealed flexion of 90 degrees and extension to 0 with no evidence of painful motion. There was no evidence of instability or patellar subluxation. An August 2016 VA contract examination showed a diagnosis of degenerative joint disease, left knee. Range of motion testing revealed flexion to 110 degrees with pain on motion. Range of motion decreased to 95 degrees after repetitive use. There was no evidence of instability or patellar subluxation. After reviewing the evidence of record, the Board finds that a rating in excess of 10 percent for the Veteran’s left knee limitation of motion with degenerative joint disease is not warranted as there is no evidence that flexion was ever limited to, or more nearly approximated, 30 degrees so as to warrant assignment of a 20 percent rating under Diagnostic Code 5260. The Board is cognizant of the Veteran’s competency and credibility to report constant pain. However, even considering additional functional loss due to pain, there is no evidence that flexion was ever limited to, or more nearly approximated, 30 degrees so as to warrant assignment of a 20 percent rating under Diagnostic Code 5260. In fact, flexion was never found to be limited to 60 degrees or less in the left knee. The rating criteria require flexion limited to at least 60 degrees for a 10 percent rating. The current 10 percent evaluation contemplates the Veteran’s reported functional loss due to painful movement. As demonstrated, the range of motion findings considered here, and the 10 percent evaluation currently assigned, already account for functional loss due to painful movement. As such, a rating in excess of 10 percent is not warranted under 38 C.F.R. § 4.40 or 38 C.F.R. § 4.45. The Board acknowledges that in advancing this appeal, the Veteran, believes that his disability is more severe than the assigned disability rating reflects. However, the competent medical evidence offering detailed specific specialized determinations pertinent to the rating criteria are the most probative evidence with regard to evaluating the pertinent symptoms for the disability on appeal; the medical evidence also contemplates the Veteran’s descriptions of his symptoms. A rating in excess of 10 percent is not warranted at any time during the appeal period. See Hart v. Mansfield, 21 Vet. App. 505 (2007). 7. Entitlement to a rating in excess of 10 percent for traumatic degenerative joint disease in the interphalangeal joints of the right foot with hallux valgus. The Veteran’s right foot disability is rated as 10 percent under Diagnostic Codes 5283-5010. The Veteran is seeking a higher rating. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the evaluation assigned. 38 C.F.R. § 4.27. Here, DC 5283 evaluates malunion of or nonunion of the tarsal or metatarsal bones, and DC 5010 evaluates traumatic arthritis. Under Diagnostic Code 5010, traumatic arthritis is rated as degenerative arthritis under 38 C.F.R. § 4.71a, Diagnostic Code 5003. 38 C.F.R. § 4.71a, Diagnostic Code 5003, 5010. Degenerative arthritis is rated on the basis of limitation of motion under the appropriate diagnostic code for the joint involved, with a 10 percent evaluation assigned for limited motion that is noncompensable under the appropriate diagnostic code. 38 C.F.R. § 4.71a, Diagnostic Code 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion, but in the absence of limitation of motion a compensable rating for degenerative arthritis can be assigned when there is X-ray evidence of the involvement of 2 or more major joints or 2 or more minor joint groups (10 percent), or X-ray evidence of the same with occasional incapacitating exacerbations (20 percent). Id. DC 5283 pertains to malunion of or nonunion of the tarsal or metatarsal bones. Moderate disability warrants a 10 percent rating, moderately severe disability warrants a 20 percent rating, and severe disability warrants a 30 percent rating. Actual loss of the foot warrants a 40 percent rating. 38 C.F.R. § 4.71a, Diagnostic Code 5283 (2017). Diagnostic Code 5010, applicable to traumatic arthritis, is evaluated as degenerative arthritis, based on limitation of motion of the specific joint involved. 38 C.F.R. § 4.20. The words “moderate,” “moderately severe,” and “severe,” as used in the various diagnostic codes are not defined in the VA Schedule for Rating Disabilities. Rather than applying a mechanical formula, the Board must evaluate all of the evidence, to the end that its decisions are “equitable and just.” 38 C.F.R. § 4.6. The relevant medical evidence of record during the appeal period includes VA examinations and private treatment reports, which the Board will discuss chronologically. An August 2015 DBQ revealed multiple diagnoses, including varicose veins, hyperkeratosis, hallux valgus, foot and ankle arthritis, left foot arthralgia, bilateral pes planus, and left foot sinus tarsi syndrome. The Veteran reported foot pain, which was noted as sharp, as well as stiffness. On examination, there was no evidence of swelling on use, characteristic calluses, or extreme tenderness of the plantar surfaces of the feet. The examiner noted that there was evidence of marked deformity and marked pronation of the right foot. The examiner noted that your left and right foot hallux valgus was causing alteration of the weight bearing line. There was no evidence of inward bowing of the Achilles tendon or marked inward displacement or severe spasms of the Achilles tendon. The examiner further noted that the Veteran could no longer run for fitness exams. He stated that you can walk, but not for prolonged periods of time. The examiner also stated that severe pain and swelling limited the Veteran’s functional ability during flare-ups or when your foot is used repeatedly over a period of time. Private treatment records, dated March 2013 to September 2016, were also reviewed. These records showed treatment for burning pain in both feet, as well as a diagnosis of peripheral neuropathy. An August 2016 DBQ revealed diagnoses of foot and ankle arthritis, left flat foot and left posterior tibial tendonitis. The Veteran reported that he could not walk for long periods of time without having pain and that he had limited range of motion. The examiner noted that the Veteran had limited inversion and eversion and moderate to severe pain in both feet. Medical evidence from Dr. D. S., dated from September 2013 to August 2016 reveals treatment for bilateral hallux valgus and tendonitis tibial and notes complaints of foot pain. Medical evidence from Dr. N.R., dated from May 2008 to May 2011, reveal ongoing foot pain issues since his 1996 right foot injury. Medical evidence from the Social Security Administration revealed that the Veteran was granted disability benefits due to osteoarthrosis and allied disorders, including ankylosis of the right foot, capsulitis, status-post surgery to the right foot, left foot arthritis with tenosynovitis, degenerative joint disease in both knees, degenerative arthritis in both hips, hyperlipidemia, hypertension and obesity. An August 2016 VA contract examination revealed a diagnosis of traumatic degenerative joint disease in the interphalangeal joints of the right foot with hallux valgus. The Veteran reported due to an increase in pain of the left foot, he had to overcompensate using the right foot. The Veteran reported that his pain was severe and that he suffered from an abnormal gait. The Veteran denied flare-ups, and reported that he was unable to stand or walk for extended periods of time. On examination, there was no objective evidence of right foot pain on physical examination. The examiner noted that the Veteran reported that he had pain only with weight bearing. The examiner noted that the Veteran had mild to moderate hallux valgus in both feet and that he had not had any surgery for this condition. The examiner noted that pain, weakness, fatigability, or incoordination did not significantly limit functional ability during flare-ups or when the foot is used repeatedly over a period of time. An August 2016 lay statement, provided by the Veteran’s wife, revealed that the Veteran had difficulties of being on his feet for extended periods or while sitting for extended periods of time. She further noted that since 2010, the Veteran’s gait has deteriorated and that he avoids activities that require climbing and other activities due to the fear of falling. In a May 2017 vocational assessment, the Veteran reported that his typical day includes running short errands and doing small chores around the house. The Veteran reported that he is unable to sit or stand for more than a half hour at a time and that he must often change positions. The Veteran also reported that when he goes shopping, he must use a cart to help him ambulate through the stores and that he walks very slowly and rests for short periods. The vocational expert also opined that the Veteran was incapable of both physical and sedentary employment. Upon review of the evidence of record, the Board finds that a rating of 10 percent is warranted throughout the appeal period based upon moderate symptoms and resulting functional limitations caused by his traumatic DJD in interphalangeal joints of the right foot with hallux valgus. Under Diagnostic Code 5283, a 10 percent rating is warranted for moderate disability resulting from malunion or nonunion of tarsal or metatarsal bones. The Board finds that the functional limitations reported by the Veteran due to this disability do not more nearly approximate moderately severe or severe limitation. The Veteran is noted to be able to walk short distances before the onset of pain and he can stand for short periods of time without pain. The evidence also indicates that the Veteran’s condition warrants the constant use of a brace, but no other assistive device is necessary to ambulate. The August 2016 examiner further noted that the Veteran had no functional impairment as it relates solely to his right foot. Accordingly, the Board finds that a 10 percent rating, but no higher, under DC 5283 is warranted throughout the appeal period. The Board also finds that a higher rating is not available based upon the Veteran’s documented traumatic arthritis of the right foot under DC 5010 or DC 5003. Under 38 C.F.R. § 4.71a, DC 5010, traumatic arthritis is evaluated under DC 5003 (arthritis degenerative). Degenerative arthritis is rated on the basis of limitation of motion of the specific joint involved. When limitation of motion is noncompensable, a 10 percent rating is for application for each major joint or group of minor joints. In the absence of limitation of motion, a 10 percent rating is warranted for degenerative arthritis of two or more major joints or two or more minor joint groups, and a maximum schedular 20 percent rating is assigned for degenerative arthritis of two or more major joints or two or more minor joint groups, with occasional incapacitating episodes. Here, the Veteran’s condition does not indicate arthritis of more than one group of minor joints and has not resulted in periods of prescribed bed rest (incapacitating episodes); accordingly, a higher evaluation under DC 5010, 5003 is not available. 8. Entitlement to a rating in excess of 10 percent for left foot strain with hallux valgus and calcaneal spur. The Veteran’s right foot disability is rated as 10 percent under Diagnostic Code 5284. The Veteran is seeking a higher rating. Specifically, DC 5284 pertains to “other foot injuries.” Moderate disability warrants a 10 percent rating, moderately severe disability warrants a 20 percent rating, and severe disability warrants a 30 percent rating. Actual loss of the foot warrants a 40 percent rating. 38 C.F.R. § 4.71a, DC 5283. The words “moderate,” “moderately severe,” and “severe,” as used in the various diagnostic codes are not defined in the VA Schedule for Rating Disabilities. Rather than applying a mechanical formula, the Board must evaluate all of the evidence, to the end that its decisions are “equitable and just.” 38 C.F.R. § 4.6. The relevant medical evidence of record during the appeal period includes VA examinations, VA treatment reports, and private treatment reports, which the Board will discuss chronologically. An August 2015 DBQ revealed multiple diagnoses, including varicose veins, hyperkeratosis, hallux valgus, foot and ankle arthritis, left foot arthralgia, bilateral pes planus, and left foot sinus tarsi syndrome. The Veteran reported foot pain, which was noted as sharp, as well as stiffness. On examination, there was no evidence of swelling on use, characteristic calluses, or extreme tenderness of the plantar surfaces of the feet. The examiner noted that there was evidence of marked deformity and marked pronation of the right foot. The examiner noted that your left and right foot hallux valgus was causing alteration of the weight bearing line. There was no evidence of inward bowing of the Achilles tendon or marked inward displacement or severe spasms of the Achilles tendon. The examiner further noted that the Veteran could no longer run for fitness exams. He stated that you can walk, but not for prolonged periods of time. The examiner also stated that severe pain and swelling limited the Veteran’s functional ability during flare-ups or when his foot is used repeatedly over a period of time. The examiner further noted that while the Veteran could walk, he could not do so for prolonged periods of time. Further, the examiner stated that severe pain and swelling limited the Veteran’s functional ability during flare-ups or when his foot is used repeatedly over a period of time. Private treatment records, dated March 2013 to September 2016, were also reviewed. These records showed treatment for burning pain in both feet, as well as a diagnosis of peripheral neuropathy. Medical evidence from Dr. D.S, dated September 9, 2013 to August 11, 2016, was reveals treatment for bilateral hallux valgus and tendonitis tibial and notes complaints of foot pain. Medical evidence from Dr. R.R., dated from September 2010 to November 2015, reveals treatment for a left foot possible plantar wart and/or foreign body as well as complaints of chronic ankle pain and decreased range of motion. Medical evidence from Dr. N.R., dated from May 2008 to May 2011, reveals treatment for sinus tarsitis left ankle with residual pain and weakness due to a traumatic injury to the right forefoot. The records also reference complaints of ongoing foot issues since the Veteran’s 1996 right foot injury. The Veteran reported that he overcompensated and favored the left foot and ankle area as a result of his right foot injury, which caused significant issues with degenerative arthritis of the left ankle joint as well as tendinitis and nerve inflammation of the left ankle. Medical evidence from Dr. P.Y., dated from August 2011 to September 2013, reveals that the Veteran suffered from increased swelling and pain in the anterolateral aspect of the left foot and ankle. An August 2011 treatment report shows that the Veteran’s left foot dorsiflexion was limited by 50 percent or more with evidence of pain. It was also noted that the Veteran’s left foot/ankle inversion was zero degrees and ankylosed in that position. An August 2016 VA contract examination revealed a diagnosis of left foot strain with hallux valgus and calcaneal spur. The Veteran reported that his left foot pain had increased and that he had to compensate by using his right side. The Veteran reported severe pain and an abnormal gait. The Veteran denied any flare-ups, but reported that he was able to stand or walk for extended periods of time. On examination, there was no objective evidence of left foot pain on physical examination. The Veteran had pain only with weight bearing. The examiner noted that the Veteran had mild to moderate hallux valgus in both feet and that he had not had any surgery for this condition. The examiner noted that pain, weakness, fatigability, or incoordination did not significantly limit functional ability during flare-ups or when the foot was used repeatedly over a period of time. VA treatment records dated from September 2010 to September 2015 reveal complaints of left foot and ankle pain. An August 2016 DBQ revealed diagnoses of foot and ankle arthritis, left flat foot and left posterior tibial tendonitis. The Veteran reported that he had sharp pain and aching stiffness in his left ankle. The Veteran also reported that he could not walk for long periods of time without having pain and that he had a limited range of motion. The examiner further noted that the Veteran had a limited inversion and eversion and moderate to severe pain in both feet. It was noted that he had swelling and localized tenderness of the left ankle, and there was no evidence of left ankle muscle atrophy or instability. An August 2016 lay statement, provided by the Veteran’s wife, revealed that the Veteran had difficulties of being on his feet for extended periods or while sitting for extended periods of time. She further noted that since 2010, the Veteran’s gait has deteriorated and that he avoids activities that require climbing and other activities due to the fear of falling. A March 2017 VA examination revealed a diagnosis of left ankle arthritis with tenosynovitis and tibial tendonitis, which the examiner stated was diagnosed as early as 2008. The Veteran reported constant left ankle pain, which was aggravated with the use or with weight bearing. The Veteran also reported that he suffers from daily momentary flare-ups during which restrict his ability to stand to 20 to 30 minutes and the ability to walk for only short distances. The Veteran also reported that he treats his condition with an ankle brace, topical pads and steroid injections. On examination, upon repetitive range of motion testing of the left ankle, dorsiflexion was limited to 10 degrees and plantar flexion was limited to 5 degrees. There was objective evidence of pain on range of motion testing. The examiner stated that ambulation would especially be impeded on uneven surfaces. There was no evidence of left ankle ankylosis on examination. The examiner also stated that pain, weakness, fatigability or incoordination did not significantly limit functional ability with repeated use over a period of time and that he was unable to comment if your condition was significantly limited during a flare-up without resort to mere speculation as you were not experiencing a flare-up at the time of the evaluation. In a May 2017 vocational assessment, the Veteran reported that his typical day includes running short errands and doing small chores around the house. The Veteran reported that he is unable to sit or stand for more than a half hour at a time and that he must often change positions. The Veteran also reported that when he goes shopping, he must use a cart to help him ambulate through the stores and that he walks very slowly and rests for short periods. The vocational expert also opined that the Veteran was incapable of both physical and sedentary employment. Based on a review of the entire evidence of record, it is determined that your service-connected left foot strain with hallux valgus and calcaneal spur continues to warrant an evaluation of 10 percent based on evidence of a moderate foot disability. Specifically, the Board finds that the functional limitations reported by the Veteran due to this disability do not more nearly approximate moderately severe or severe limitation. The Veteran is noted to be able to walk short distances before the onset of pain and he can stand for short periods of time without pain. The evidence also indicates that the Veteran’s condition warrants the use of a brace and that he uses orthotics, steroid injections, and topical pads to relieve pain, but no other assistive device is necessary to ambulate. The March 2017 examiner further noted that the Veteran’s left foot condition did not impact his ability to perform any type of occupational task. Accordingly, the Board finds that a 10 percent rating, but no higher, under DC 5283 is warranted throughout the appeal period. 9. Entitlement to TDIU. The Veteran seeks entitlement to TDIU, based on service-connected disabilities. See March 2016 Application for Unemployability. Total disability ratings for compensation based upon individual unemployability may be assigned where the schedular rating is less than total, when it is found that the disabled person is unable to secure or follow a substantially gainful occupation as a result of a single service-connected disability ratable at 60 percent or more, or as a result of two or more disabilities, provided that at least one disability is ratable at 40 percent or more and there is sufficient additional service-connected disability to bring the combined rating to 70 percent or more. See 38 C.F.R. §§ 3.340, 3.341, 4.16(a). It is the established policy of VA that all Veterans who are unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities shall be rated as totally disabled. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The Veteran meets the minimum percentage requirements, set forth in 38 C.F.R. § 4.16 (a), for award of a TDIU rating on a schedular basis. The Veteran is currently service connected for left ankle arthritis evaluated as 20 percent disabling from April 15, 2009; degenerative joint disease of the left knee as 10 percent from March 24, 2008; degenerative joint disease of the right knee as 10 percent disabling from March 24, 2008; traumatic degenerative joint disease of the right foot as 10 percent disabling from March 24, 2008; tinnitus as 10 percent from March 24, 2008; left foot strain as 10 percent from April 15, 2009; right hip strain with limitation of extension as 10 percent from August 18, 2011; left hip strain with limitation of extension as 10 percent from August 18, 2011; right ear hearing loss as 0 percent from March 24, 2008; left hip strain with limitation of flexion as 0 percent from August 18, 2011; and right hip strain with limitation of flexion as 0 percent from August 18, 2011. The Veteran’s combined evaluation is 70 percent from August 18, 2011. Accordingly, as of that date, the Veteran met the schedular criteria for Individual Unemployability. The remaining question is whether the Veteran is unable to secure and follow a substantially gainful occupation because of his service-connected disabilities. The Veteran reported that his service-connected disabilities prevent him from working, and that he left his last job due to such. The Veteran has a high school diploma and attended a community college for one year. The Veteran, however, did not obtain any degrees or certifications. The Veteran’s work history, prior to enlistment included working as a carpenter’s assistant. During military service, the Veteran served as an electrician’s mate. Following separation, the Veteran worked as an electrician, an x-ray technician, as a private contractor at a nuclear power plant, a quality control technician, a sales associate, a weld inspector, and most recently, as a plans examiner and builder inspector. His responsibility as a plans examiner was to review site plans for site developments and ensure that the plans were in code compliance. As a building inspector, he would go to building sites and inspect the construction to make sure it was consistent with the building permits and in compliance with the codes. The jobs required that the Veteran be out in the field to visit building sites and required walking, climbing, bending, squatting, and lifting. In an August 2011 Amended Report of Consultation and Examination, authored by a private physician, it was noted that due to reasons of orthopedic deficits and dysfunction of both feet, both hips, both knees, and the lumbar spine to include sciatic radicular pain and partial loss of use of the lower extremities, in addition to hearing impairment, non-service connected diabetes and upper and lower diabetic peripheral neuropathy, and ischemic heart disease, the Veteran is deemed to be personally unemployable. Medical evidence from the Social Security Administration (SSA)revealed that the Veteran was granted disability benefits due to osteoarthrosis and allied disorders, including ankylosis of the right foot, capsulitis, status-post surgery to the right foot, left foot arthritis with tenosynovitis, degenerative joint disease in both knees, degenerative arthritis in both hips, hyperlipidemia, hypertension and obesity. The SSA concluded that the Veteran is unable to stand or walk for even two hours in an eight-hour day and that he cannot sit for up to six hours in an eight-hour day, and he has recurrent physical pain and takes medications that precludes his ability to sustain a competitive work pace through an eight-hour day. It was further noted that the Veteran was required to elevate both feet when sitting. In a November 2012 C&P audio examination, the examiner opined that the Veteran’s hearing loss impacted ordinary conditions of daily life. Specifically, the Veteran noted that talking to people in a crowd, restaurant, or other place with ambient noise is bothersome and that it was hard to stay with a conversation sometimes. The examiner also opined that the Veteran’s tinnitus impacted ordinary conditions of daily life. Specifically, the Veteran noted that it was affecting his sleep and sometimes made it hard while listening to a conversation. In an August 2016 C&P foot examination, the examiner opined that the Veteran’s left foot strain with hallux valgus and calcaneal spur and traumatic degenerative joint disease in the interphalangeal joints of the right foot with hallux valgus impacted his ability to perform occupational tasks. Specifically, the examiner noted that his conditions caused pain with weight bearing. In an August 2016 C&P hip and thigh examination, the examiner opined that the Veteran’s bilateral hip condition impacted his ability to perform occupational tasks. Specifically, the examiner noted that the functional impact included bilateral hip pain when walking and standing. In an August 2016 C&P knee examination, the examiner opined that the Veteran’s bilateral knee osteoarthritis impacted his ability to perform occupational tasks. Specifically, the examiner noted that the functional impact included pain with standing and walking. In a March 2017 ankle C&P examination, the examiner noted that his condition did not impact his ability to perform any occupational task. The examiner did not that there was evidence of pain on passive range of motion testing and in non-weight bearing and that the Veteran demonstrated a chronically compromised gait in the mechanics of ambulation from his right foot condition. The Veteran submitted an independent Vocational Assessment, dated in May 2017. In the assessment, the consultant reported that she reviewed the Veteran’s claims file and held a telephone conversation with the Veteran to complete the analysis. The consultant reported that the Veteran stopped working in 2009. She further reported that the Veteran’s service-connected disability of bilateral foot pain, bilateral knee, and hip pain secondary to his right foot injury prevented him from securing and following a substantially gainful occupation. The vocational expert specifically noted that the Veteran had limitations in standing, walking, sitting, crouching, stooping, and kneeling. She also disagreed with the finding that the Veteran could do sedentary work. She noted that the Veteran could ot sit for a prolonged period, that he must change his position every 15-30 minutes and that he must elevate his feet. She also noted chronic pain and medications resulting in impaired concentration and an impaired ability to work at a productive pace. Additionally, she noted that the Veteran has never been employed in a sedentary occupation and that his ability to learn new skills would be negatively impacted by his functional limitations. The Board notes there is probative evidence both for and against the Veteran’s TDIU. VA examiners during the relevant appeals period have suggested that some of his disabilities are mild in nature and do not have cause any functional impairment. However, these examiners based these opinions solely on individual service-connected disabilities, rather than the combined effect of all of the Veteran’s service-connected disabilities. The Board finds that when the Veteran’s service-connected disabilities are considered together, the Veteran is limited in his capacity for both physical and sedentary employment, particularly when considering his employment and educational history. The Board acknowledges that the VA examiners found that the Veteran’s service-connected disabilities, alone, did not impact his ability to work. Nevertheless, the Board disagrees due to the May 2017 vocational consultant’s explanations that the Veteran’s conditions adversely affected his ability to physically perform tasks at the expected exertion level. As such, the Board finds that the foregoing evidence in favor of granting a TDIU is at least in equipoise and, resolving reasonable doubt in favor of the Veteran, TDIU is granted. The competent and credible medical and lay evidence of record strongly suggests that the Veteran’s collective service-connected disabilities, to include hearing loss, tinnitus, bilateral knee disabilities, bilateral hip disabilities, and bilateral foot disabilities are of a nature and severity as to preclude him from engaging in substantially gainful employment. 38 C.F.R. § 4.16 (a). The record shows that he is currently unemployed and has been unemployed since 2009. The record also shows that these service-connected disabilities play a major role in his inability to obtain and maintain employment, in that they affect his physical ability to perform work on a consistent or continual basis. Based on this evidence and resolving all reasonable doubt in the Veteran’s favor, the Board finds that the criteria for TDIU have been met. 38 C.F.R. § 4.16. REASONS FOR REMAND 1. Entitlement to service connection for low back disorder, to include mild degenerative disc disease of the lumbar spine, is remanded. The Veteran contends that service connection is warranted for mild degenerative disc disease of the lumbar spine. The Veteran’s service treatment records reveal no complaints, treatment, or diagnosis of a back condition. In an August 2011 private treatment note, a physician stated that the Veteran had a diagnosis of degenerative joint disease of the lumbar spine with a decreased range of motion and pain on motion. The physician related to the diagnosis to the Veteran’s bilateral feet and service. In a May 2013 VA examination, the Veteran was diagnosed with mild degenerative disc disease of the lumbar spine with sciatica; the impressions also included arthritis. The examiner noted that the Veteran’s back condition was less likely than not caused by his service-connected foot condition. The rationale for the stated opinion was a lack of objective medical evidence to support the claim. The Veteran’s private treatment records show complaints of back pain. Similarly, in a January 2014 treatment record, a magnetic resonance imaging (MRI) revealed that the Veteran had a bulging disc in his lumbar spine. In an August 2016 VA examination, the examiner noted the previous diagnosis of degenerative arthritis of the spine. The examiner opined that the back condition was less likely proximately due to or the result of his service-connected condition. The rationale provided was that a nexus had not been established and that his back condition was more consistent with age related changes. After a review of the record, the Board finds that remand is warranted for a new medical examination and opinion. This is so because the May 2013 and August 2016 VA medical opinions require further clarification to address direct service connection and to fully address secondary service connection. 2. Entitlement to service connection for a disability manifested by right sciatic radicular pain is remanded. The Veteran contends that service connection is warranted for right sciatic radicular pain. The Veteran’s service treatment records reveal no complaints, treatment, or diagnosis of a nerve condition. An August 2011 private treatment report reveals a diagnosis of radiculopathy of the left leg. The physician noted that the condition was related to the Veteran’s back condition and service. In a May 2013 VA examination, the examiner diagnosed the Veteran with right leg sciatic radiculopathy. The examiner noted that the Veteran’s condition was caused by his back condition. Given that the issue of service connection for a disability manifested by right sciatic radicular pain is inextricably intertwined with the issue of service connection for a low back disorder, to include mild degenerative disc disease of the lumbar spine, a remand is in order for prior adjudication of the low back issue. 3. Entitlement to service connection for peripheral neuropathy of the upper and lower extremities is remanded. The Veteran contends that that he entitlement to service connection for peripheral neuropathy of the upper and lower extremities. The Veteran’s service treatment records reflect no pertinent complaints, treatment, or diagnosis of this condition. A Report of Consultation and Examination authored by Dr. P.Y., dated in August 2011, notes a diagnosis of diabetic peripheral neuropathy of the upper and lower extremities and related this condition to the Veteran’s non-service connected diabetes mellitus. A private treatment record, dated in February 2013, noted that the Veteran had a tingling sensation in both feet, some numbness of his left finger and hypothenar eminence. The Veteran also reported that he had trouble writing with his right hand and said that his right hand shakes a bit. The impressions were of a primarily sensory peripheral neuropathy as well as the neuropathy on the right and carpal tunnel syndrome. A March 2013 private treatment record, authored by Dr. P.N., reveals a diagnosis of mild bilateral carpal tunnel syndrome as well as axonal peripheral neuropathy, cause unknown. A private treatment record, dated in August 2013, reveals that the Veteran’s diagnosis of peripheral neuropathy was of unknown origin and that his lab studies and nerve conduction study did not indicate an obvious source for his neuropathy. The physician, however, noted that the Veteran reported that he was exposed to diesel exhaust fumes, to include trichloroethylene, and that she was concerned about such exposure. The physician also noted that she would order additional testing to learn more about the Veteran’s neuropathy and that she would research trichloroethylene to determine whether there is a link between this and his symptoms, as there had been no other obvious cause. In a September 2013 private treatment record, authored by Dr. P.Y., the physician noted that the Veteran’s peripheral neuropathy of the upper and lower extremities was due to service, to include as secondary to exposure to Agent Orange and exposure to trichloroethylene while aboard a submarine. The physician also noted that the submarine that the Veteran was on was within one mile of the shore of Vietnam and that through the snorkel, the Veteran was exposed to Agent Orange. A Peripheral Nerve Conditions DBQ, dated in July 2015 noted a diagnosis of peripheral neuropathy, with an onset date of 2014. The examiner did not provide an etiology opinion. A Peripheral Nerve Conditions DBQ, dated in August 2016 noted a diagnosis of idiopathic peripheral neuropathy. The examiner also noted exposure to TCE. In the medical history section of the report, the examiner noted that the Veteran had exposure to TCE during his service and that he had a slow progression of peripheral neuropathy since then. To date, no VA examiner has provided an opinion as to whether the Veteran’s peripheral neuropathy of the upper and lower bilateral extremities is related to military service, to include as due to exposure to an herbicide agent or TCE. As such, an addendum opinion to determine the nature and etiology of his peripheral neuropathy is necessary. 4. Entitlement to service connection for ischemic heart disease is remanded. The Veteran contends that service connection is warranted for ischemic heart disease. In a private Report of Consultation and Examination by Dr. P.Y., dated in August 2011, the physician rendered a provisional diagnosis of ischemic heart disease and noted that a certified cardiologist was recommended to further the additional diagnosis of ischemic heart disease and arrive at a treatment plan. The physician also noted that the provisional diagnosis of ischemic heart disease was more likely than not related to Agent Orange exposure and the Veteran’s military service. The Veteran’s treatment records noted that the Veteran had a left heart catheterization. To date, no examiner has provided an opinion as to whether the Veteran has ischemic heart disease and whether such is related to military service, to include exposure to an herbicide agent. 5. Entitlement to service connection for an acquired psychiatric disorder, to include PTSD is remanded. The Board finds that additional development is required before the remaining PTSD claim on appeal is decided. The Veteran has contended that he has PTSD that is related to service. Specifically, he reported that, while aboard the USS Darter (SS-576), there was an explosion in the engine room and there was a flooding casualty when a seal was blown at a 400-foot depth. In support of his claim, the Veteran submitted two buddy statements to corroborate the in-service stressor event. An August 2016 DBQ reveals diagnoses of PTSD and depressive disorder. No etiology was provided. In light of the Veteran’s reported in-service stressor and the PTSD diagnosis of record, the Board finds that the Veteran should be afforded a VA examination to determine the nature and etiology of any currently present PTSD. McLendon v. Nicholson, 20 Vet. App. 79 (2006). 6. Entitlement to a rating in excess of 10 percent for right ear hearing loss is remanded. In view of the grant of service connection for left ear hearing, the Board finds that issue of a rating in excess of 10 percent for right ear hearing loss should be returned to the Agency of Original Jurisdiction (AOJ) for the assignment of a disability rating to reflect current impairment of bilateral hearing loss in light of the expanded grant. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.85, 4.867. Accordingly, a remand is warranted for further adjudicative action at AOJ level. The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any mild degenerative joint disease of the lumbar spine. The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease. The examiner must also opine as to whether the Veteran’s condition is at least as likely as not (1) proximately due to a service-connected disability, to include his right foot disorder or (2) aggravated beyond its natural progression by a service-connected disability. A complete rationale for the opinion is required. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any noted cardiovascular disability, to include ischemic heart disease. The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, to include in-service exposure to an herbicide agent. 3. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his bilateral hearing loss. 4. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of his peripheral neuropathy. The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, to include in-service exposure to TCE and/or an herbicide agent. 5. Schedule the Veteran for a VA examination by a psychiatrist or psychologist with sufficient expertise to determine the nature and etiology of any currently present acquired psychiatric disorder, to include PTSD. The claims file must be made available to, and reviewed by the examiner. Any indicated studies should be performed. Based on the examination results and the review of the record, the examiner should provide an opinion as to whether it is at least as likely as not (a 50 percent or better probability) that the currently present acquired psychiatric disorder, to include PTSD is etiologically related to the Veteran’s active service, including as a result of his reported in-service stressors. The examiner should presume that the Veteran is a reliable historian. The rationale for all opinions expressed must be provided. DEBORAH W. SINGLETON Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Tiffany N. Hanson, Associate Counsel