Citation Nr: 18149327 Decision Date: 11/09/18 Archive Date: 11/09/18 DOCKET NO. 14-02 755 DATE: November 9, 2018 ORDER A claim for service connection for left hip disability is reopened. A claim for service connection for right hip disability is reopened. Entitlement to service connection for hearing loss is denied. Entitlement to initial disability rating higher than 50 percent for posttraumatic stress disorder (PTSD) is dismissed. REMANDED Entitlement to service connection for left knee disability is remanded. Entitlement to service connection for right knee disability is remanded. Entitlement to service connection for left leg disability is remanded. Entitlement to service connection for right leg disability is remanded. Entitlement to service connection for left hip disability is remanded. Entitlement to service connection for right hip disability is remanded. Entitlement to service connection for left foot disability is remanded. Entitlement to service connection for right foot disability is remanded. Entitlement to service connection for respiratory disorders is remanded. Entitlement to service connection for hypertension is remanded. Entitlement to an initial disability rating higher than 10 percent for gastroesophageal reflux disorder (GERD) is remanded. Entitlement to an initial disability rating higher than 10 percent for low back disability is remanded. Entitlement to an initial disability rating higher than 0 percent for a scar at the right hip is remanded Entitlement to an initial disability rating higher than 0 percent for disability of the right little finger is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. FINDINGS OF FACT 1. Evidence received since a February 2009 rating decision denying service connection for hip disability addresses claimed left hip injuries in service and claimed connection of left hip problems to service-connected low back disability. 2. Evidence received since a February 2009 rating decision denying service connection for hip disability addresses claimed right hip injuries in service and claimed connection of right hip problems to service-connected low back disability. 3. The Veteran has not had hearing levels that are considered a hearing impairment disability for purposes of VA disability compensation. 4. In a transcribed July 2018 Board hearing, prior to promulgation of a decision on the appeal for an initial disability rating higher than 50 percent for PTSD, the Veteran stated that he was withdrawing that appeal. CONCLUSIONS OF LAW 1. Evidence received since February 2009 is new and material to a claim for service connection for left hip disability. 38 U.S.C. §§ 5108, 7104, 7105 (2012); 38 C.F.R. § 3.156 (2017). 2. Evidence received since February 2009 is new and material to a claim for service connection for right hip disability. 38 U.S.C. §§ 5108, 7104, 7105; 38 C.F.R. § 3.156. 3. No hearing impairment disability was incurred or aggravated in service. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.303, 3.385 (2017) 4. The criteria for withdrawal, by the Veteran, of a substantive appeal for a higher disability rating for PTSD have been met. 38 U.S.C. § 7105(b)(2), (d)(5) (2012); 38 C.F.R. §§ 20.202, 20.204 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS 1. Reopening of a claim for service connection for left hip disability The Veteran reports that he had left hip injuries in service. He contends that current left hip problems are related to the injuries in service. He also contends that his left hip problems are secondary to problems in his low back and his knees. In September 2008 the Veteran submitted a claim for service connection for hip disability. In a February 2009 rating decision, a United States Department of Veteran Affairs (VA) Regional Office (RO) denied service connection for hip disability. A VA decision becomes final when a claimant does not file a notice of disagreement (NOD) within one year after the decision is issued. 38 U.S.C. § 7105. A decision also becomes final if a claimant files a timely NOD, but does not file a timely substantive appeal. 38 U.S.C. § 7105. The Veteran did not file a timely NOD with the February 2009 decision. That decision became final. A final decision on a claim that has been denied shall be reopened if new and material evidence with respect to that claim is presented or secured. 38 U.S.C. §§ 5108, 7104(b). The United States Court of Appeals for Veterans Claims (Court) has ruled that, if the United States Board of Veterans Appeals (Board) determines that new and material evidence has been submitted, the case must be reopened and evaluated on all the evidence, both new and old. Manio v. Derwinski, 1 Vet. App. 140, 145 (1991). New and material evidence received within a year after the decision will be considered as having been filed in connection with the claim. 38 C.F.R. § 3.156(b). If service department records not previously associated with the claims file are received, VA will reconsider the claim. 38 C.F.R. § 3.156(c). In December 2010 the Veteran sought service connection for left and right hip disabilities. In a March 2013 rating decision, the RO denied reopening of claims for left or right hip disability. The Veteran appealed the March 2013 decision. In order to reopen a previously and finally disallowed claim, there must be new and material evidence presented or secured since the last time that the claim was finally disallowed on any basis (not only since the last time that the claim was disallowed on the merits). Evans v. Brown, 9 Vet. App. 273 (1996). The February 2009 rating decision is the only final disallowance on any basis of service connection for left hip disability. The Board will consider whether new and material evidence has been submitted since that decision. 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). The Court has interpreted the language of 38 C.F.R. § 3.156(a) as creating a low threshold, and viewed the phrase “raises a reasonable possibility of substantiating the claim” as “enabling rather than precluding reopening.” The Court emphasized that the regulation is designed to be consistent with 38 C.F.R. § 3.159(c)(4), which “does not require new and material evidence as to each previously unproven element of a claim.” Shade v. Shinseki, 24 Vet. App. 110 (2010). See also Evans v. Brown, supra, at 284 (1996) (the newly presented evidence need not be probative of all the elements required to award the claim, but only need to be probative in regard to each element that was a specified basis for the last disallowance). For the purpose of establishing whether new and material evidence has been submitted, the credibility of evidence is presumed unless the evidence is inherently incredible or consists of statements that are beyond the competence of the person or persons making them. See Justus v. Principi, 3 Vet. App. 510, 513 (1992); Meyer v. Brown, 9 Vet. App. 425, 429 (1996); King v. Brown, 5 Vet. App. 19, 21 (1993). Service connection may be established on a direct basis for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Service connection may be granted on a secondary basis for a disability that is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Aggravation of a non-service-connected disease or injury by a service-connected disability may also be service-connected. 38 C.F.R. § 3.310(b). VA has established service connection for the Veteran’s low back disability. The Veteran’s claims for service connection for knee disabilities are pending on appeal. The evidence of record in February 2009 includes the Veteran’s claim and medical records from during and after service. The Veteran claimed that he sustained a broken hip during service. Neither his service treatment records nor VA treatment records from 2008 and 2009 reflect any hip fracture. The evidence added since February 2009 includes more recent statements from the Veteran. He reported that he has left hip problems, manifested by pain. He contended that the current problems are attributable to injuries that he sustained in falls and other accidents in service. He also contended that his left hip problems are secondary to problems in his low back and his knees The evidence added since February 2009 relates to claims that current left hip problems are related to injuries in service or to service-connected low back disability. Those are unestablished facts that are necessary to grant service connection for left hip disability. The new evidence enables rather than precludes reopening of the claim, and so raises a reasonable possibility of substantiating the claim. Thus, there is evidence that is both new and material. The Board grants reopening of the claim. Having reopened the claim, the Board must consider service connection on its merits. The Board finds, however, that additional evidence is needed. The Board is remanding the reopened claim for development as described in the remand section, below. 2. Reopening of a claim for service connection for right hip disability The Veteran reports that he had right hip injuries in service. He contends that current right hip problems are related to the injuries in service, or are secondary to his low back problems and/or his bilateral knee problems. As noted above, in September 2008 he submitted a claim for service connection for hip disability, described as broken hip. In the February 2009 rating decision, the RO denied service connection for hip disability. The Veteran did not file an NOD with the February 2009 decision, and it became final. In December 2010 the Veteran sought service connection for left and right hip disabilities. In a March 2013 rating decision, the RO denied reopening of claims for left or right hip disability. The Veteran appealed the March 2013 decision. The February 2009 rating decision is the only final disallowance on any basis of service connection for right hip disability. The Board will consider whether new and material evidence has been submitted since that decision. The evidence of record in February 2009 includes the Veteran’s claim and medical records from during and after service. The Veteran claimed that he sustained a broken hip during service. His service treatment records do not reflect any finding of hip fracture. VA treatment records from 2008 and 2009 reflect reports of bilateral hip pain. In May 2008 x-rays showed fracture of the right hip, specifically the femoral neck. The evidence added since February 2009 includes statements from the Veteran. In those statements he reported that accidents in service, including a fall through a grate and a motorcycle accident, caused right hip injuries. He contended that right hip fracture found on x-rays in 2008 was sustained in the motorcycle accident. He contended that the current problems are attributable to injuries that he sustained in falls and other accidents in service. He also contended that his right hip problems are secondary to problems in his low back and his knees. The evidence added since February 2009 relates to claims that current right hip problems are related to injuries in service or to service-connected low back disability. Those are unestablished facts that are necessary to grant service connection for right hip disability. The new evidence enables rather than precludes reopening of the claim, and so raises a reasonable possibility of substantiating the claim. Thus, there is evidence that is both new and material. The Board grants reopening of the claim. Having reopened the claim, the Board must consider service connection on its merits. The Board finds, however, that additional evidence is needed. The Board is remanding the reopened claim for development as described in the remand section, below.   3. Service connection for hearing loss The Veteran contends that noise exposure during service caused current hearing loss. For VA disability benefits purposes, impaired hearing is considered a disability when the auditory threshold for any of the frequencies of 500, 1000, 2000, 3000, and 4000 Hertz is 40 decibels or greater; the auditory thresholds for at least three of these frequencies are 26 decibels or greater; or speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. The Board must assess the credibility and weight of all the evidence, including the medical evidence, to determine its probative value, accounting for evidence which it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. See Masors v. Derwinski, 2 Vet. App. 181 (1992); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992); Hatlestad v. Derwinski, 1 Vet. App. 164 (1991); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Equal weight is not accorded to each piece of evidence contained in the record; every item of evidence does not have the same probative value. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a claim, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107. To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert, 1 Vet. App. at 54. The Veteran reports that during service his regular duties were in boiler rooms, which were extremely noise environments. His service records show boiler maintenance duties consistent with work in boiler rooms. In testing of his hearing during service, the auditory thresholds at the relevant frequencies did not meet the 38 C.F.R. § 3.385 criteria for hearing loss disability. Speech recognition was not tested. The Veteran had VA testing of his hearing in September 2011. On that audiological evaluation, thresholds, in decibels, were as follows:   HERTZ 500 1000 2000 3000 4000 RIGHT 15 25 10 30 35 LEFT 10 15 5 30 30 In each ear, the thresholds did not meet met the 38 C.F.R. § 3.385 criteria for hearing loss disability. Speech recognition scores were 100 percent in the right ear and 96 percent in the left ear. Those scores did not meet the 38 C.F.R. § 3.385 criteria for hearing loss disability. The Veteran had noise exposure during service. However, testing during and after service did not show hearing loss disability as defined for purposes of VA benefits. Therefore, service connection for hearing loss is denied. 4. Disability rating for PTSD The Veteran appealed the initial 50 percent disability rating that an RO assigned for his PTSD. He essentially contended that the effects of his PTSD warrant a higher rating. In July 2018 the Veteran had a Travel Board hearing before the undersigned Veterans Law Judge. The Veteran stated that he was withdrawing his appeal for an increased rating for PTSD. A transcript of the hearing was made and associated with his claims file. Under 38 U.S.C. § 7105, the Board may dismiss any appeal that fails to allege specific error of fact or law in the determination being appealed. A substantive appeal may be withdrawn in writing at any time before the Board promulgates a decision. 38 C.F.R. §§ 20.202, 20.204(b). In July 2018 the Veteran explicitly, unambiguously, and with a full understanding of the consequences, withdrew the claim for a higher rating for PTSD The undersigned clearly identified the withdrawn issue, and the Veteran affirmed that he was requesting a withdrawal as to the appeal. Prior to the hearing, there was a full discussion as to the consequences of withdrawing the appeal. See Acree v. O’Rourke, 891 F.3d 1009 (Fed. Cir. 2018). There is no remaining allegation of error of fact or law. Accordingly, the Board does not have jurisdiction over this appeal, and it is dismissed. REASONS FOR REMAND 1. Service connection for left knee disability The Board is remanding this claim for additional VA medical opinion. The Veteran contends that left knee injuries during service produced disability that continued after service and through the present. He reports that during service he fell through an open grate, fell about eight feet, and landed on machinery below. He states that he sustained multiple injuries, including injury of the left and right knees and legs. He relates that he also sustained knee and leg injuries on other occasions in service, including with falling between deck plates and down ladders, and with a motorcycle accident. He reports that after service he worked mainly in construction. In March 2012 a VA physician noted that the Veteran had multiple knee injuries during service. He noted that after service the Veteran did construction work, “which,” he stated, “is known for its toll on many body parts.” The clinician expressed the opinion that the Veteran’s current knee problems were due to injuries during and after service. He opined that an injury in service in August 1971 was likely only a small contributor to the present situation, and was less likely than not the cause of the current knee problems. The 2012 opinion addresses a relevant question, but does not address other questions pertinent to service connection, and does not reflect the evidentiary standards that VA uses. For disability to be service-connected, it is not necessary for one of multiple injuries in service to be the predominant cause of the current disability. The Board is remanding the issue of a new file review and opinions. The necessary opinion subjects are: whether it is at least as likely as not that a current disability had onset in service, whether it is at least as likely as not that the combined effects of injuries and events in service produced chronic disability, and whether the current disability is clearly attributable only to events after service. 2. Service connection for right knee disability The Board is remanding this claim for additional VA medical opinion. The Veteran contends that right knee injuries during service produced disability that continued after service and through the present. As with his left knee claim, he reports that he sustained right knee injuries in a fall through a grate and in other falls and accidents. The March 2012 VA opinion applied to disorders of the left and right knees. For the reasons explained in the left knee section, above, the Board is also remanding the right knee issue for new opinion addressing relevant questions. 3. Service connection for left leg disability The Board is remanding this claim for additional VA medical opinion. The Veteran contends that left leg injuries during service produced disability that continued after service and through the present. He has indicated that claimed disabilities of each leg are essentially the same as claimed disabilities of each knee. In the 2018 Board hearing, he related that his current disorders of both legs were manifested by pain in both knees. The assembled evidence and the needed evidentiary development discussed in the above left knee section also apply to the left leg claim. 4. Service connection for right leg disability The Board is remanding this claim for additional VA medical opinion. For the right leg claim, the development needed on remand is the same as for the left knee, right knee, and left leg claims. 5. Service connection for left hip disability The Board is remanding this reopened claim for a VA medical examination. The Veteran contends that current left hip problems are related to the injuries in service, or are secondary to problems in his low back and his knees. He has not had a VA medical examination addressing the nature and likely etiology of current left hip disorders. The Board is remanding for a VA clinician to review the file, examine the Veteran, and provide opinions as to the likely etiology of current left hip disorders. 6. Service connection for right hip disability The Board is remanding this reopened claim for a VA medical examination. The Veteran contends that current right hip problems are related to the injuries in service, or are secondary to problems in his low back and his knees. He has not had a VA medical examination addressing the nature and likely etiology of current right hip disorders. The Board is remanding for a VA clinician to review the file, examine the Veteran, and provide opinions as to the likely etiology of current right hip disorders. 7. Service connection for left foot disability The Board is remanding this claim for a VA medical examination. The Veteran contends that his bilateral foot pain is secondary to his service-connected low back disability, and to disorders of the hips and knees, for which he is seeking service connection. He also contends that his duties in service, which he states were physically demanding and required prolonged standing, led to problems with both feet and both ankles. The Veteran reports that a physician has identified congenital foot and ankle problems. He contends that, even if any foot and ankle problems existed before service, those problems were aggravated in service. When he was examined for entrance to service, the examiner did not find any foot or ankle abnormality. The Veteran has not had a VA medical examination addressing the nature and likely etiology of current foot disorders. The Board is remanding for a VA clinician to review the file, examine the Veteran, and provide opinions as to the likely etiology of such disorders. 8. Service connection for right foot disability The Board is remanding this claim for a VA medical examination. The history and development considerations for right foot disability are the same as those discussed in the left foot section, above. 9. Service connection for respiratory disorders The Board is remanding this claim for another VA medical examination. The Veteran contends that in his service duties in boiler rooms he was exposed to asbestos. He contends that asbestos exposure caused asbestosis and other current respiratory problems including breathing difficulty, asthma, and sleep apnea. The Veteran’s service records show that his duties were working with boilers. Post-service medical records from 2008 forward show progressive respiratory problems, including shortness of breath, sleep apnea, and asthma. On imaging and PFT there is evidence of restrictive lung disease and of nodules in the lungs. Treatment for the Veteran’s respiratory disorders includes medications, CPAP, and home oxygen. In VA treatment records from 2011 through 2017, lists of problems include asbestosis. In a February 2013 examination, the examiner found that there was no physical evidence of asbestosis. The assembled evidence contains conflict and leaves questions as to whether the Veteran has asbestosis, and whether his current respiratory disorders are related to his asbestos exposure in service. The Board is remanding the claim for detailed VA medical file review, examination, and opinions addressing the pertinent questions. 10. Service connection for hypertension The Board is remanding this claim for a VA medical examination. The Veteran contends that current hypertension is attributable to events in service, or is secondary to his service-connected PTSD. Medical records from 2008 forward reflect diagnosis of hypertension. The assembled medical records do not directly address the etiology of his hypertension. The Board is remanding the issue for a VA examination with file review and opinions as to the likelihood that his hypertension is related to service or is caused or aggravated by his PTSD. 11. Disability rating for GERD The Board is remanding this claim for a VA medical examination. The Veteran contends that the effects of his GERD warrant a disability rating higher than the initial 10 percent rating that an RO assigned. The RO has evaluated the Veteran’s GERD under 38 C.F.R. § 4.114, Diagnostic 7346. That code addresses symptoms and effects of hiatal hernia, such as pain, vomiting, hematemesis, melena, dysphagia, pyrosis, regurgitation, weight loss, anemia, and impairment of health. The most recent VA examination regarding his GERD was in September 2016. The examination report addressed symptoms noted in Diagnostic Code 7346, and also addressed symptoms noted in 38 C.F.R. § 4.114, Diagnostic Code 7305, which is for duodenal ulcer. Diagnostic Code 7305 addresses some of the same symptoms as Diagnostic Code 7346, and also considers the frequency and duration of symptoms. In the 2016 examination, the Veteran reported that his GERD and hiatal hernia were treated with medication, but that symptoms still occurred, especially with lying down or stooping. He related that symptoms included pyrosis, regurgitation, and substernal pain. He indicated that he had nausea in episodes that lasted one to nine days and occurred four or more times per year. He reported that reflux disturbed his sleep, in episodes that lasted one to nine days and occurred four or more times per year. He stated that bending or squatting could cause regurgitation and pain. On testing anemia was not found. In the 2018 Board hearing, the Veteran reported that nausea and heartburn were constant. He stated that acid from reflux had damaged his teeth. He stated that reflux awakened him at night four to five times a week. He reported history of coughing up blood while sleeping, without recent episodes. He indicated that he fought anemia as a result. At the hearing he related symptomatology worse than that noted in the 2016 examination. Therefore, the Board is remanding the claim for a new examination to obtain current findings. 12. Disability rating for low back disability The Board is remanding this claim for a VA medical examination. The Veteran contends that the effects of his low back disability warrant a disability rating higher than the initial 10 percent rating that an RO assigned. The most recent VA examination addressing the Veteran’s low back was in February 2013. In the 2018 Board hearing, the Veteran reported that his low back disability had worsened since the 2013 examination. Therefore, the Board is remanding the claim for a new examination to obtain current findings. 13. Disability rating higher for right hip scar The Board is remanding this claim for a VA medical examination. The Veteran contends that the effects of his right hip scar warrant a disability rating higher than the initial 0 percent rating that an RO assigned. The most recent VA examination addressing the Veteran’s right hip scar was in February 2013. The examiner found that the scar was not tender or painful. In the 2018 Board hearing, the Veteran reported that the scar was tender and affected his walking. As his account suggests worsening of the effects of the scar since the 2013 examination, the Board is remanding the claim for a new examination to obtain current findings. 14. Disability rating for right little finger disability The Board is remanding this claim for a VA medical examination. The Veteran contends that the effects of his right little finger disability warrant a disability rating higher than the initial 0 percent rating that an RO assigned. The most recent VA examination addressing the Veteran’s right little finger disability was in February 2013. The examiner found that the right little finger had limitation of motion, but could move to touch the thumb and the palm. The examiner found that right hand had 5/5 grip strength. In the 2018 Board hearing, the Veteran reported that his right little finger had pain and weakness, such that he had no grip strength. As his account suggests worsening of the finger disability since the 2013 examination, the Board is remanding the claim for a new examination to obtain current findings. 15. TDIU The Board is remanding this issue for reconsideration after completion of remand actions on issues that are intertwined with the TDIU claim. The Veteran contends that the effects of his service-connected PTSD and low back disability make him unable to work. Findings on examination of his low back on remand will likely be relevant to the effect of that disability on his capacity for employment. He also contends that his employment capacity is reduced by bilateral knee disabilities, for which he is seeking service connection. Development on remand and reconsideration of those claims will likely be relevant to the TDIU claim. Therefore, the RO is to reconsider the TDIU claim after completion of the other remand actions. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA file review and opinions addressing the likely etiology of current disorders of the left and right knees and legs. Provide his expanded claims file to an appropriate clinician for review. Ask the reviewer to list current disorders of each knee and each leg that are shown by the record. Ask the reviewer to express opinions, with respect to each current disorder of either knee and either leg: (a) Is it at least as likely as not that the disorder had onset in service? (b) Is it at least as likely as not that the combined effects of injuries and events in service led to the current disorder? (c) Is the current disorder clearly attributable only to injuries and events after service? Ask the reviewer to provide clear reasons and bases for all conclusions and opinions. 2. Schedule the Veteran for a VA examination to address the nature and likely etiology of current disorders of the left and right hips. Provide the expanded claims file to the examiner. Ask the examiner to review the claims file and examine the Veteran. Ask the examiner to provide diagnoses for all current disorders of each hip. Ask the examiner, for each current disorder of each hip, to provide opinions as to whether it is at least as likely as not that the disorder (a) had onset in service, (b) is attributable to injuries in service, (c) is proximately due to or aggravated by low back disorders, or (d) is proximately due to or aggravated by knee disorders. Ask the examiner to provide clear reasons and bases for all conclusions and opinions. 3. Schedule the Veteran for a VA examination to address the nature and likely etiology of current disorders of the left and right feet. Provide the expanded claims file to the examiner. Ask the examiner to review the claims file and examine the Veteran. Ask the examiner to provide diagnoses for all current disorders of each foot. Ask the examiner, for each current disorder of each foot, to provide opinions as to whether it is at least as likely as not that the disorder (a) had onset in service, (b) is attributable to injuries or prolonged weightbearing in service, or (c) is proximately due to or aggravated by disorders in the low back, hips, and/or knees. Ask the examiner to provide clear reasons and bases for all conclusions and opinions. 4. Schedule the Veteran for a VA examination, by a pulmonologist or other appropriate physician with specialized training in respiratory conditions, to address the likely etiology of his respiratory disorders. Provide the expanded claims file to the examiner for review. Inform the examiner that VA recognizes that the Veteran’s service duties handling ships’ boilers were consistent with heavy exposure to free asbestos. Ask the examiner to review the claims file and examine the Veteran. Ask the examiner to provide a determination as to whether the Veteran has asbestosis. Ask the examiner to provide an opinion as to what diagnosis accounts for the Veteran’s shortness of breath. Ask the examiner to provide opinions, with respect to the Veteran’s asthma, sleep apnea, lung nodules, and restrictive lung disease, whether it is at least as likely as not, for each disorder, that the disorder is related to his history of asbestos exposure. Ask the examiner to provide clear reasons and bases for all conclusions and opinions. 5. Schedule the Veteran for a VA examination to address the likely etiology of his hypertension. Provide the expanded claims file to the examiner for review. Ask the examiner to review the claims file and examine the Veteran. Ask the examiner to provide opinions as to whether it is at least as likely as not that the Veteran’s hypertension (a) had onset during service or within a year after separation from service, (b) is proximately caused by his posttraumatic stress disorder (PTSD), or (c) is aggravated by his PTSD. Ask the examiner to provide clear reasons and bases for all conclusions and opinions. 6. Schedule the Veteran for a VA examination to address the current manifestations of his gastroesophageal reflux (GERD) disorders. Provide the expanded claims file to the examiner for review. Ask the examiner to review the claims file and examine the Veteran. Ask the examiner to obtain detailed history and provide detailed findings, including, but not limited to, whether there is epigastric distress, pyrosis, regurgitation, substernal, arm, or shoulder pain, vomiting, hematemesis, melena, anemia, and/or impairment of health; and the severity, frequency, and duration of such symptoms. 7. Schedule the Veteran for a VA examination to address the current manifestations of his low back disability. Provide the expanded claims file to the examiner for review. Ask the examiner to review the claims file and examine the Veteran. Ask the examiner to conduct all necessary tests of the function and functional impairment of the Veteran’s low back, specifically including findings as to ranges of motion, whether there is pain on active and passive motion, and whether there is pain on motion with and without weightbearing. Ask the examiner to report whether the low back has functional impairment due to pain, weakness, fatigability, or incoordination, or with repeated use or flare-ups. Ask the examiner to describe any functional impairment from such factors as equivalent to degrees of additional loss of motion, if feasible. Ask the examiner to state whether the Veteran has an intervertebral disc disorder. Ask the examiner to note the total duration, in days or weeks, over the preceding year, of any incapacitating episodes of intervertebral disc disorder symptoms. As the examiner to describe the effects of the low back disability on capacity for employment. 8. Schedule the Veteran for a VA examination to address the current manifestations of his right hip scar. Provide the expanded claims file to the examiner for review. Ask the examiner to review the claims file and examine the Veteran. Ask the examiner to state whether there is objective evidence of pain or tenderness to palpation in the scar. Ask the examiner to indicate whether the scar affects walking. As the examiner to describe the effects of the right hip scar on capacity for employment. 9. Schedule the Veteran for a VA examination to address the current manifestations of his right little finger disability. Provide the expanded claims file to the examiner for review. Ask the examiner to review the claims file and examine the Veteran. Ask the examiner to conduct all necessary tests of the function and functional impairment of the Veteran’s right little finger. Ask the examiner to report range of motion, whether there is pain on active and passive motion, and whether there is pain on motion with and without weightbearing. Ask the examiner to compare motion and function of the right little finger to motion and function of the left little finger. Ask the examiner to report whether the right little finger has functional impairment due to pain, weakness, fatigability, or incoordination, or with repeated use or flare-ups. Ask the examiner to describe any functional impairment from such factors as equivalent to degrees of additional loss of motion, if feasible. As the examiner to describe the effects of the right little finger disability on capacity for employment. 10. Then review the expanded claims file and review the claims for service connection for disabilities of the left and right knees, legs, hips, and feet, for service connection for respiratory disorders and hypertension, and for higher disability ratings for GERD, low back disability, right hip scar, and right little finger disability. 11. Then review the expanded claims file and review the claim for a TDIU. Then, if any of the remanded claims are not granted to the Veteran’s satisfaction, issue a supplemental statement of the case and afford the Veteran and his representative an opportunity to respond. Thereafter, return the case to the Board for appellate review, if otherwise in order. K. PARAKKAL Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD K. J. Kunz, Counsel