Citation Nr: 18149219 Decision Date: 11/09/18 Archive Date: 11/08/18 DOCKET NO. 16-53 259 DATE: November 9, 2018 ORDER New and material evidence having been received, the claim of entitlement to service connection for a lumbar spine disability is reopened. Entitlement to service connection for plantar fasciitis with calcaneal spurs is denied. Entitlement to service connection for bilateral hearing loss is denied. Entitlement to service connection for erectile dysfunction is denied. Entitlement to a rating in excess of 10 percent for service-connected left leg varicose veins is denied. Entitlement to a rating in excess of 10 percent for service-connected right leg varicose veins is denied. REMANDED Entitlement to service connection for a lumbar spine disability is remanded. Entitlement to service connection for a cervical spine disability is remanded. Entitlement to service connection for a bilateral hip disability is remanded. Entitlement to service connection for right knee patellofemoral pain syndrome is remanded. Entitlement to service connection for a bilateral ankle disability is remanded. Entitlement to service connection for tinnitus is remanded. Entitlement to service connection for diabetes mellitus is remanded. Entitlement to service connection for a neurologic disability affecting the arms and hands, claimed as neuropathy and radiculopathy is remanded. Entitlement to service connection for a neurologic disability affecting the legs, claimed as neuropathy and radiculopathy is remanded. Entitlement to service connection for an acquired psychiatric disability, to include posttraumatic stress disorder (PTSD), anxiety, and depression is remanded. Entitlement to a total disability rating based upon individual unemployability (TDIU) is remanded. FINDINGS OF FACT 1. In a final July 2005 decision, the Board determined that new and material evidence sufficient to reopen the claim of entitlement to service connection for a lumbar spine disability had not been received. 2. Evidence added to the record since the final July 2005 Board decision is not cumulative or redundant of the evidence of record at the time of the final decision and raises a reasonable possibility of substantiating the claim of entitlement to service connection for a lumbar spine disability. 3. The most competent, credible, and probative evidence does not establish that the Veteran’s current bilateral plantar fasciitis with calcaneal spurs were incurred during or as a result of his military service. 4. The Veteran’s current bilateral hearing loss did not manifest in service or within one year of service, and there is no competent evidence linking his current hearing loss to his noise exposure in service. 5. The most competent, credible, and probative evidence of record does not establish that the Veteran’s erectile dysfunction, obstructive sleep apnea, or various respiratory disabilities were incurred during or as a result of his military service. 6. For the entire appeal period, the preponderance of the evidence shows the Veteran’s service-connected left and right leg varicose veins were manifested by pain and fatigue after prolonged standing and walking, edema that has ranged from intermittent to persistent, and no more than intermittent stasis pigmentation, all of which are relieved by elevation and compression hosiery. CONCLUSIONS OF LAW 1. The July 2005 Board decision denying service connection for a back disorder is final. 38 U.S.C. §§ 7103, 7104 (2012); 38 C.F.R. §§ 20.1100, 20.1105 (2018). 2. New and material evidence has been received to reopen the claim of entitlement to service connection for a lumbar spine disability. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. § 3.156. 3. The criteria for service connection for plantar fasciitis with calcaneal spurs have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.303, 3.309. 4. The criteria for service connection for bilateral hearing loss have not been met. 38 U.S.C. §§ 1131, 1112, 1113, 5107; 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309, 3.385. 5. The criteria for service connection for erectile dysfunction, obstructive sleep apnea, and a respiratory disability have not been met. 38 U.S.C. §§ 1101, 1112, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 6. The criteria for a rating in excess of 10 percent for service-connected left leg varicose veins have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321 (b)(1), 4.1, 4.3, 4.7, 4.10, 4.104, Diagnostic Code (DC) 7120. 7. The criteria for a rating in excess of 10 percent for service-connected right leg varicose veins have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321 (b)(1), 4.1, 4.3, 4.7, 4.10, 4.104, DC 7120. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1977 to March 1980. This matter is on appeal from February 2015 and May 2016 rating decisions. Reopened Claim 1. Whether new and material evidence has been submitted to reopen a claim of entitlement to service connection for a lumbar spine disability In a June 1997 rating decision, the RO denied entitlement to service connection for a back disorder. The Veteran perfected an appeal of the denied claim but, in July 1999, the Board denied entitlement to service connection for a back disorder on the basis that there was no competent evidence of a nexus between the current lumbar spine disability and an in-service disease or injury. At that time, the evidentiary record contained the Veteran’s service treatment records (STRs), which document complaints of occasional back pain which he attributed to a parachuting injury in November 1977, as well as post-service medical evidence showing a diagnosis of degenerative changes in the left sacroiliac joints and minimal lumbar spondylosis as early as October 1999. There was, however, no medical evidence establishing a link between his current back disability and military service. The Veteran did not appeal the July 1999 Board decision, file a motion to vacate, file a motion for reconsideration, or file a motion to revise the decision based on clear and unmistakable error. Unless the Chairman of the Board orders reconsideration, or one of the other exceptions to finality applies, all Board decisions are final on the date stamped on the face of the decision. See 38 U.S.C. § 7104; 38 C.F.R. § 20.1100. As such, the July 1999 Board decision became final. 38 U.S.C. § 7105, 38 C.F.R. § 20.1100, 20.1105. The Veteran attempted to reopen his back claim in December 2002 but, in an August 2003 rating decision, the RO denied the claim on the basis that the newly submitted evidence did not relate to an unestablished fact necessary to substantiate the claim or raise a reasonable possibility of substantiating the claim. The Veteran perfected an appeal of the RO’s decision but, in July 2005, the Board determined new and material evidence had not been submitted to reopen the previously denied claim of service connection for a back disorder. The Veteran did not appeal the July 2005 Board decision, file a motion to vacate, file a motion for reconsideration, or file a motion to revise the decision based on clear and unmistakable error. Therefore, the July 2005 Board decision became final. Most recently, in October 2014, the Veteran attempted to reopen his low back/lumbar spine claim. In support of his claim, the Veteran initially submitted duplicate copies of private treatment records that were already of record and previously considered by the RO and Board. As such, in a February 2015 rating decision, the RO denied the Veteran’s claim by determining new and material evidence had not been submitted to reopen the lumbar spine claim. However, in June 2015 - during the one-year appeal period following the February 2015 rating decision - the Veteran submitted a statement from Dr. Quesada who opined that it is more probable than not that his current musculoskeletal disorders, including chronic low back pain and degenerative disc disease of the lumbar spine, are secondary to his military service. This evidence is new, as it was not of record at the time of the previous final denial. This evidence is also material, as it raises a reasonable possibility of substantiating the claim of entitlement to service connection for a low back or lumbar spine disability and provides a link between the current lumbar spine disability and the Veteran’s military service. Therefore, as new and material evidence has been received, the Veteran’s claim of entitlement to service connection for a lumbar spine disability is reopened. Service Connection 2. Entitlement to service connection for plantar fasciitis with calcaneal spurs The Veteran is seeking service connection for a foot disability which he has asserted was incurred as a result of his parachuting duties during military service. The STRs reflect that, in November 1977, the Veteran complained of pain in his right leg and foot; however, objective examination and x-rays of his foot were normal. The diagnostic impression was a contusion but, notably, there are no further complaints or treatment for foot pain or problems in the STRs. The clinician who performed his separation examination in January 1980 noted the Veteran had tinea pedis on his feet but no other foot problems, including a musculoskeletal foot disability, were noted at separation from service. The September 2015 VA examination report contains a diagnosis of bilateral plantar fasciitis with calcaneal spurs. Therefore, the remaining question is whether there is a nexus, or link, between the Veteran’s current bilateral foot disability and his military service. After examining the Veteran and reviewing the claims file, the September 2015 VA examiner opined that the Veteran’s bilateral plantar fasciitis and calcaneal spurs are less likely as not related to or a result of an injury in service. In making this determination, the examiner noted there is no evidence of evaluation or treatment for foot pain in the STRs but that feet were mentioned in the STRs when the Veteran was evaluated for pain related to superficial thrombophlebitis; however, the examiner noted that the foot problems noted in the STRs had no etiologic correlation with a musculoskeletal condition such as calcaneal spurs. Based on the foregoing, the Board finds that the preponderance of the evidence is against the Veteran’s claim of service connection for bilateral plantar fasciitis with calcaneal spurs. While the Veteran has a current diagnosis, the most probative evidence of record demonstrates that such is not related to his service. In this regard, the Board places great probative weight on the September 2015 VA opinion that the Veteran’s bilateral plantar fasciitis and calcaneal spurs is less likely than not related to service, which has a clear conclusion and supporting data, as well as a reasoned medical explanation connecting the two. Additionally, there is no opposing medical opinion is of record, and the VA opinion outweighs the lay assertions provided by the Veteran, as the VA examiner has specified training and experience that the Veteran is not shown to have. In this regard, the Veteran, as a lay person, is not competent to attribute his plantar fasciitis and calcaneal spurs to any instance of his service, as he has not demonstrated that he is an expert in determining the etiology of a musculoskeletal foot disability. Indeed, the etiology of a musculoskeletal foot disability such as plantar fasciitis and calcaneal spurs is a complex question that requires medical expertise regarding the impact of repeated trauma to the feet. In this case, a trained professional examined the Veteran, reviewed the record, and opined that the Veteran’s bilateral plantar fasciitis with calcaneal spurs is not likely related to his military service. Therefore, the August 2015 VA opinion is considered more probative than the lay assertions of record. For the foregoing reasons, the Board finds the preponderance of the evidence is against a finding that the Veteran’s current bilateral plantar fasciitis with calcaneal spurs is causally or etiologically related to any disease, injury, or incident in service. Therefore, service connection is not warranted, the benefit of the doubt doctrine is not applicable, and the Veteran’s claim is denied. 3. Entitlement to service connection for bilateral hearing loss The Veteran has asserted that his current diagnosis of bilateral sensorineural hearing loss is related to his duties as an infantryman during service. The Veteran’s STRs do not contain any complaints, treatment, or findings related to hearing loss. In fact, the Veteran’s hearing was within normal limits during audiologic examinations conducted at entrance and separation from service. See STRs dated November 1976 and January 1980. Despite the Veteran’s normal hearing during service, his DD214 reflects that his military occupational specialty (MOS) in the Army was an antiarmor weapons crewman attached to an infantry unit. As such, the Board finds the Veteran’s reports of exposure to noise while performing his duties during service is consistent with the circumstances of his service. Moreover, the Veteran is competent to testify as to his in-service noise exposure. See 38 C.F.R. § 3.159 (a)(2); Washington v. Nicholson, 19 Vet. App. 362, 368 (2005); Layno v. Brown, 6 Vet. App. 465, 469-70 (1994). Thus, the Veteran’s in-service noise exposure is conceded. The January 2015 VA examination report contains a diagnosis of bilateral hearing loss and establishes that the Veteran has a bilateral hearing disability within VA standards. See 38 C.F.R. § 3.385. Therefore, the remaining question is whether there is a nexus, or link, between the Veteran’s current hearing loss and his acknowledged noise exposure during service. After examining the Veteran and reviewing the claims file, the audiologist who conducted the January 2015 VA examination opined that the Veteran’s hearing loss is not related to his military service, noting that the Veteran demonstrated normal bilateral hearing throughout service, including at separation from service and that there is no evidence of any further audiological follow-up after January 1980. In this regard, the VA examiner noted that the first follow-up occurred in October 2011, 31 years after separation from service. Based on the foregoing, the Board finds that the preponderance of the evidence is against the Veteran’s claim for service connection for hearing loss. While the evidence shows the Veteran has current bilateral hearing loss for VA purposes, the most probative evidence of record demonstrates that such is not related to his service. Indeed, the January 2015 VA opinion is afforded great probative weight as it has a clear conclusion and supporting data, as well as a reasoned medical explanation connecting the two. Notably, there is no opposing medical opinion is of record, and the VA opinion outweighs the Veteran’s assertions connecting his hearing loss to military noise exposure. While the Veteran believes his current hearing loss is related to his military service, he, as a lay person, is not competent to attribute his hearing loss to any instance of his service, as he has not demonstrated that he is an expert in determining the etiology of hearing loss. Indeed, the etiology of hearing loss is a complex question that requires medical expertise that involves the impact of acoustic trauma and loud noises on the auditory functioning of the ear. In this case, a trained professional examined the Veteran, reviewed the record, and opined that the Veteran’s current hearing loss is not likely related to his in-service noise exposure. Therefore, the January 2015 VA opinion is considered more probative than the lay assertions of record. Moreover, the clinical evidence of record fails to show that bilateral hearing loss was diagnosed until 2015, more than 40 years after service discharge. In this regard, the Board recognizes the Veteran is competent to provide evidence regarding the lay observable symptoms of his hearing impairment; however, for VA compensation purposes, audiometric testing conducted by a state-licensed audiologist is required to diagnose hearing impairment. As a result, the Board must rely on the medical evidence of record in that regard. Consequently, presumptive service connection, to include on the basis of continuity of symptomatology, for bilateral hearing loss is not warranted. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309; Walker v. Shinseki, 708 F.3d 1331, 1338-40 (Fed. Cir. 2013). For the reasons explained above, the Board finds the preponderance of the evidence is against a finding that the Veteran’s bilateral hearing loss is causally or etiologically related to any disease, injury, or incident in service. Additionally, hearing loss did not manifest to a compensable degree within one year of the Veteran’s discharge from service. Therefore, service connection for bilateral hearing loss is not warranted, the benefit of the doubt doctrine is not applicable, and the Veteran’s claim is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 4. Entitlement to service connection for erectile dysfunction The medical evidence of record establishes that the Veteran has been diagnosed with erectile dysfunction. See e.g., VA treatment record dated January 2015. While the Veteran has filed a claim seeking service connection for erectile dysfunction, he has not identified any event, injury, or disease in service to which his current diagnosis of erectile dysfunction may be related. Additionally, the STRs do not contain any complaints of or treatment for symptoms generally associated with or attributed to erectile dysfunction. While the post-service medical evidence documents the Veteran’s erectile dysfunction, the medical evidence of record attributes the Veteran’s erectile dysfunction to the medication he takes for his non-service-connected hypertension disability. Indeed, physicians have noted that they discussed the possibility of changing the Veteran’s hypertension medication due to the high incidence of erectile dysfunction associated therewith but that the Veteran agreed to continue his medications since the problem was mild. See December 2005 VA treatment record. There is no opposing medical evidence or opinion of record that attributes the Veteran’s erectile dysfunction to any in-service event or service-connected disability. In his June 2015 statement, Dr. Quesada noted the Veteran has a loss of libido and sexual dysfunction and, to the extent that his statement was submitted as establish a relationship between the Veteran’s sexual dysfunction and his military service, the Board finds his statement is inadequate to support the grant of service connection, as he did not provide a rationale in support of any such opinion. Indeed, Dr. Quesada did not note that the Veteran stated that his erectile dysfunction began during service or was otherwise related thereto; nor did he provide any data to support a conclusion that the Veteran’s erectile dysfunction was incurred during service or was otherwise related to service. Given the lack of competent lay or medical evidence identifying an in-service event, injury, or disease to which the Veteran’s erectile dysfunction may be related, the Board finds a VA examination and/or opinion are not needed in conjunction with this claim. See Bardwell v. Shinseki, 24 Vet. App. 36, 40 (2010) (holding that, where the evidence has failed to establish an in-service injury, disease, or event, VA is not obligated to provide a medical examination). Indeed, absent evidence at least suggestive of an in-service event, injury, or disease to which a competent medical opinion could relate the Veteran’s erectile dysfunction, there is no reasonable possibility that a VA examination or opinion could aid in substantiating the claim of service connection for OSA or the claimed respiratory disabilities without being speculative. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (holding that a medical opinion based on an inaccurate factual premise is not probative). Given the foregoing, the Board finds the preponderance of the evidence is against the grant of service connection for erectile dysfunction, as there is no evidence that the disability began during service or is related to any event, injury, or disease in service. Instead, the most competent, credible, and probative evidence establishes that the Veteran’s erectile dysfunction is related to treatment for a disability that has not been attributed to his military service. Therefore, the benefit-of-the-doubt doctrine is not applicable in this case and the Veteran’s claim is denied. 5. Entitlement to service connection for obstructive sleep apnea (OSA) 6. Entitlement to service connection for a respiratory disability, to include asthma, bronchitis, and rhinitis is remanded. The medical evidence of record establishes that the Veteran has been diagnosed with and treated for OSA, as well as asthma, bronchitis, and allergic rhinitis. While the Veteran has filed a claim seeking service connection for OSA and his various respiratory disabilities, he has not identified any event, injury, or disease in service to which his current diagnoses may be related. He has not provided any information or evidence indicating when his disabilities began or the reason why he believes these disabilities are related to his period of military service. In this regard, the Board finds probative that the STRs do not contain any complaints of or treatment for symptoms generally associated with or attributed to OSA, asthma, bronchitis, and rhinitis, including his January 1980 separation examination. Moreover, a February 1980 report of medical history reflects that the Veteran specifically denied having asthma. Notably, while the post-service medical evidence documents the Veteran’s OSA and various respiratory disabilities, there is no medical evidence or opinion of record that attributes his OSA or respiratory disabilities to any in-service event or service-connected disability. Nevertheless, in support of his claim, the Veteran has submitted the June 2015 statement from Dr. Quesada who notes the Veteran’s diagnoses of OSA, allergic rhinitis, bronchial asthma, and bronchitis and opined that his cardiopulmonary disabilities are more probable than not secondary to his military service. However, Dr. Quesada did not provide a rationale or any other data in support of his opinion, thereby rendering his statement inadequate and insufficient to support the grant of service connection in this case. The Board has considered whether Dr. Quesada’s opinion triggers VA’s duty to provide the Veteran a VA examination in conjunction with his claims; however, because the Veteran has not identified any in-service event, injury, or disease to which his diagnoses may be related, there is no duty for VA to provide an examination. See Bardwell, supra; Reonal, supra. Given the foregoing, the Board finds the preponderance of the evidence is against the grant of service connection for OSA and a respiratory disability, to include asthma, bronchitis, or allergic rhinitis, as there is no credible or probative evidence establishing that the claimed disabilities began during service or are related to any event, injury, or disease in service. Therefore, the benefit-of-the-doubt doctrine is not applicable in this case and the Veteran’s claims are denied. Increased Rating 7. Entitlement to a rating in excess of 10 percent for service-connected left leg varicose veins 8. Entitlement to a rating in excess of 10 percent for service-connected right leg varicose veins In October 2014, the Veteran filed a claim seeking an increased rating for his service-connected varicose veins disabilities. The Veteran’s service-connected left and right leg varicose veins disabilities are separately rated 10 percent disabling under 38 C.F.R. § 4.104, DC 7120. Under that code, a 10 percent rating is warranted for intermittent edema of extremity or aching and fatigue in leg after prolonged standing or walking, with symptoms relieved by elevation of extremity or compression hosiery, while a 20 percent rating is warranted for persistent edema, incompletely relieved by elevation of extremity, with or without beginning stasis pigmentation or eczema. A 40 percent rating is warranted for persistent edema and stasis pigmentation or eczema, with or without intermittent ulceration, while a 60 percent rating is warranted for persistent edema or subcutaneous induration, stasis pigmentation or eczema, and persistent ulceration. A 100 percent rating is warranted for massive board-like edema with constant pain at rest. The objective evidence of record shows the Veteran has varicose veins in both legs, which he has reported is manifested by daily pain that extends from his calves to posterior knees, a burning sensation in his calves, and a feeling of heaviness and tiredness when the veins are swollen and noticeable. See e.g., January 2015 VA examination; see also February 2014 VA treatment record. During the January and September VA examinations, the Veteran endorsed having aching and fatigue in both legs with prolonged standing and walking. In January 2015, he stated that the symptoms are relieved by elevation and compression hosiery but no such information is provided or discussed in the September 2015 examination report. See January 2015 VA examination; September 2015 VA examination. The January 2015 VA examiner noted that the Veteran had beginning stasis pigmentation and intermittent edema in both lower extremities, whereas the September 2015 VA examiner stated that the Veteran has intermittent and persistent edema in the left leg only. In this regard, the January 2015 VA examiner also described the veins in the left leg as large and covered 19 by 9 centimeters (cms) of the left calf, while large varicose veins were not seen or felt on the right leg. See Id. Based on the foregoing, the Board finds that a rating in excess of 10 percent is not warranted for the Veteran’s left and right leg varicose veins at any point during the appeal period. Indeed, while the evidence shows that he experiences edema in his legs which has been variously described as intermittent and persistent, the preponderance of the evidence reflects that his various symptoms, including aching and fatigue, are relieved by elevation or compression hosiery. As noted, the Veteran specifically reported that his symptoms were, in fact, received by elevation and compression hosiery during the January 2015 VA examination, and the other evidence of record, inclusive of the September 2015 VA examination and VA and non-VA treatment records, do not contain any evidence or assertion to the contrary. Similarly, while beginning stasis pigmentation was noted in both legs during the January 2015 examination, the subsequent and other medical evidence of record does not document any findings of stasis pigmentation in the legs to support a finding that pigmentation has persisted throughout the appeal period. Instead, the preponderance of the evidence shows that the Veteran’s left and right leg varicose veins are consistent with the disability contemplated by the 10 percent rating under DC 7201, as the Veteran experiences aching and fatigue after prolonged standing and walking, edema that has ranged from intermittent to persistent, and no more than intermittent stasis pigmentation, all of which are relieved by elevation of the extremities and compression hosiery. Accordingly, the Board finds the preponderance of the evidence weighs against the grant of a rating in excess of 10 percent for the Veteran’s service-connected left and right leg varicose veins, and the Veteran’s claims must be denied. REASONS FOR REMAND 1. Entitlement to service connection for a lumbar spine disability is remanded. 2. Entitlement to service connection for a cervical spine disability is remanded. 3. Entitlement to service connection for right knee patellofemoral pain syndrome is remanded. 4. Entitlement to service connection for a bilateral hip disability is remanded. 5. Entitlement to service connection for a bilateral ankle disability is remanded. The Veteran’s STRs reflect that he sought treatment for left knee and lower back pain and problems after a parachute jump in November 1977. While the STRs do not contain any other complaints or treatment as a result of parachute jumps, the Veteran attributes his current lumbar spine, cervical spine, right knee, bilateral hip, and bilateral ankle disabilities to parachute jumps he performed during service. In June 2015, the Veteran submitted a statement from Dr. Quesada who opined that it is more probable than not that his current musculoskeletal disorders, including degenerative disc and joint disease of the lumbar and cervical spines, bilateral knees, bilateral hips, and bilateral ankles, are secondary to his military service. Dr. Quesada did not provide a rationale in support of his opinion, thereby rendering the opinion inadequate; however, the medical opinion and other evidence of record triggers VA’s duty to obtain a VA examination and opinion, as it indicates that the current lumbar spine, cervical spine, right knee, bilateral hip, and bilateral ankle disabilities may be related to his military service. 38 U.S.C. § 5103A(d)(2); 38 C.F.R. § 3.159(c)(4)(i); McLendon v. Nicholson, 20 Vet. App. 79 (2006). Therefore, as the Veteran has not been afforded a VA examination in conjunction with these claims, the Board finds VA must provide an examination and obtain a medical opinion that addresses the likely etiology of his disabilities. 6. Entitlement to service connection for tinnitus is remanded. During a January 2015 VA audio examination, the Veteran denied having tinnitus and, thus, the examiner did not provide a nexus opinion. However, in his June 2015 statement, Dr. Quesada stated that, since service, the Veteran has complained of tinnitus secondary to “high noise” during service. Dr. Quesada did not, however, provide an opinion that attributed the Veteran’s tinnitus to his military service. Given the foregoing evidence, the Board finds an updated audiologic examination and opinion is needed to address the likelihood that the Veteran’s tinnitus is related to his military service. 7. Entitlement to service connection for diabetes mellitus is remanded. In January 2015, the Veteran was afforded a VA examination wherein the examiner noted that he was initially diagnosed with type II diabetes mellitus in 2010; however, the examiner did not provide an opinion regarding the likely etiology of his disability. In his June 2015 statement, Dr. Quesada attributed the Veteran’s diabetes mellitus to his military service but his opinion is inadequate because he did not provide a rationale. Therefore, an addendum VA opinion is needed to address the likely etiology of the Veteran’s diabetes mellitus. 8. Entitlement to service connection for a neurologic disability affecting the arms and hands, claimed as neuropathy and radiculopathy, is remanded. 9. Entitlement to service connection for a neurologic disability affecting the legs, claimed as neuropathy and radiculopathy, is remanded. In October 2014, the Veteran filed a claim seeking service connection for radiculopathy affecting the right and left lower extremities as secondary to his lumbar spine disability. In this regard, the medical evidence shows the Veteran has been diagnosed with lumbosacral radiculopathy. See e.g., March 2003 EMG and NCV report. However, in June 2015, Dr. Quesada stated that the Veteran has diabetic neuropathy, which suggests that the Veteran’s neurologic symptoms are attributable to his diabetes mellitus. The Veteran has also been diagnosed with bilateral carpal tunnel syndrome in his hands, which has not been specifically attributed to any particular disability. See e.g., August 2004 statement Dr. Marchan; June 2015 statement Dr. Quesada. Given the foregoing, the Board finds the claims of service connection for a neurologic disability affecting the arms, hands and legs are inextricably intertwined with the lumbar spine and diabetes mellitus claims. Therefore, adjudication of these claims, to include any additional evidentiary development, is deferred pending the requested action on those claims. 10. Entitlement to service connection for an acquired psychiatric disability, to include posttraumatic stress disorder (PTSD), anxiety, and depression is remanded. The Veteran has asserted that his variously claimed disabilities have caused him to experience depression, anxiety, flashbacks, and insomnia. See September 2015 Veteran statement. In June 2015, the Veteran submitted a statement from Dr. Quesada who opined that it is more probable than not that his current psychological disorders, including generalized anxiety disorder, major depressive disorder, and PTSD, are secondary to his military service. Dr. Quesada did not provide a rationale in support of his opinion, thereby rendering the opinion inadequate; however, the medical opinion and other evidence of record triggers VA’s duty to obtain a VA examination and opinion regarding the likely etiology of any currently diagnosed psychiatric disability. 11. Entitlement to a total disability rating based upon individual unemployability (TDIU) is remanded. The Veteran’s TDIU claim is inextricably intertwined with the service connection claims being remanded herein, as well as issues that are being adjudicated in another appeal before VA. Therefore, adjudication of the TDIU issue should be deferred until all of the issues for which the Veteran has initiated an appeal have been completed. The matters are REMANDED for the following action: 1. Schedule the Veteran for an appropriate VA examination(s) to evaluate the current nature and severity of his current lumbar spine, cervical spine, right knee, bilateral hip, bilateral ankle, and neurologic disabilities. The claims folder should be made available to the examiner for review prior to the scheduled examinations. (a) After examining the Veteran, and performing any necessary studies, the examiner should provide a diagnosis for the claimed lumbar spine, cervical spine, right knee, bilateral hip, bilateral ankle, and neurologic disabilities affecting the arms, hands, and legs. (b) Then, for each identified diagnosis, the examiner should provide an opinion as to whether it is as likely as not (i.e., to at least a 50-50 degree of probability) that any current disability was incurred in or is otherwise related to military service, to include as a result of parachute jumps performed during service. The examiner must consider the medical evidence of record, as well as the Veteran’s lay assertions as to the onset and continued nature of his disabilities after service. (c) With respect to each identified neurologic disability affecting the Veteran’s arms, hands, and legs, the examiner should opine whether it is at as likely as not (i.e., a probability of 50 percent) that the disability is caused OR aggravated by his service-connected lumbar spine and/or diabetes mellitus disabilities. (d) An opinion must be provided regarding causation and aggravation with respect to the lumbar spine and diabetes mellitus disability. (e) A rationale must be provided for each opinion offered. 2. Schedule the Veteran for an appropriate VA examination(s) to evaluate the current nature and severity of his tinnitus disability. The claims folder should be made available to the examiner for review prior to the scheduled examination. After interviewing and examining the Veteran, the examiner should provide an opinion that it is as likely as not (i.e., a probability of 50 percent) that the Veteran’s tinnitus was incurred in or is otherwise related to his military service, to include his duties as an infantryman? A rationale must be provided in support of any opinion provided. 3. Return the claims file to the January 2015 VA diabetes examiner for an addendum opinion. If the January 2015 examiner is no longer available, another appropriate medical professional should be requested to provide the opinion. The need for an additional examination is left to the discretion of the examiner. After reviewing the record, the examiner should address whether it is as likely as not (i.e., a probability of 50 percent) that the Veteran’s diabetes mellitus is related to his military service? A rationale must be provided in support of any opinion provided. 4. Schedule the appellant for a VA mental health examination. After examining the entire record, the examiner should provide the following opinions: (a) Identify all psychiatric disabilities manifested since July 2015. In rendering this opinion, the VA examiner should address whether any previous diagnoses were incorrect, if applicable. The examiner must state specifically whether the Veteran has a diagnosis of PTSD under DSM-5 criteria. (b) For each psychiatric disability identified above, opine whether it is at least as likely as not (50 percent or higher degree of probability) that the disability was incurred during or as a result of the Veteran’s military service or secondary to any of his claimed disabilities? (d) A rationale must be provided for each opinion offered. Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A.J. Turnipseed, Counsel