Citation Nr: 18149652 Decision Date: 11/13/18 Archive Date: 11/13/18 DOCKET NO. 16-23 034 DATE: November 13, 2018 ORDER Entitlement to service connection for an acquired psychiatric disorder other than posttraumatic stress disorder (PTSD) is granted. Entitlement to an initial disability rating in excess of 70 percent for PTSD is granted. Entitlement to service connection for a left wrist disability is denied. Entitlement to service connection for a left ankle disability is denied. Entitlement to service connection for a right knee disability is denied. Entitlement to service connection for an eye disability is denied. Entitlement to service connection for hypertension is denied. Entitlement to service connection for pseudofolliculitis barbae is denied. Entitlement to service connection for a chronic headache disability is denied. Entitlement to service connection for left arm numbness is denied. Entitlement to an initial disability rating in excess of 10 percent for tinnitus is denied. Entitlement to an effective date prior to February 15, 2011 for the grant of service connection for PTSD is denied. Entitlement to a total disability rating based on individual unemployability (TDIU), due to service connected disabilities is dismissed. REMANDED Entitlement to service connection for arthritis is remanded. Entitlement to service connection for a back disability is remanded. Entitlement to service connection for a left knee disability is remanded. Entitlement to service connection for a right ankle disability is remanded. Entitlement to service connection for a left foot disability is remanded. Entitlement to service connection for a right foot disability is remanded. Entitlement to service connection for hepatitis is remanded. FINDINGS OF FACT 1. The Veteran’s unspecified depressive disorder was caused by his service-connected PTSD. 2. During the entire period of the claim, the Veteran’s PTSD, with unspecified depressive disorder has most nearly approximated total social and occupational impairment. 3. The preponderance of the evidence is against finding that the Veteran’s claimed left wrist disability began during active service, or is otherwise related to an in-service injury, event, or disease. 4. The preponderance of the evidence is against finding that the Veteran’s claimed left ankle disability began during active service, or is otherwise related to an in-service injury, event, or disease. 5. The preponderance of the evidence is against finding that the Veteran’s claimed right knee disability began during active service, or is otherwise related to an in-service injury, event, or disease. 6. The preponderance of the evidence is against finding that the Veteran’s claimed eye disability began during active service, or is otherwise related to an in-service injury, event, or disease. 7. The preponderance of the evidence is against finding that hypertension began during active service, or is otherwise related to an in-service injury, event, or disease, and the Veteran’s hypertension did not manifest to a compensable degree within the applicable one-year presumptive period following his discharge from active duty. 8. The preponderance of the evidence is against finding that the Veteran’s claimed pseudofolliculitis barbae began during active service, or is otherwise related to an in-service injury, event, or disease. 9. The preponderance of the evidence is against finding that the Veteran’s claimed chronic headache disability began during active service, or is otherwise related to an in-service injury, event, or disease. 10. The preponderance of the evidence is against finding that the Veteran’s claimed left arm numbness began during active service, or is otherwise related to an in-service injury, event, or disease. 11. The Veteran’s service-connected tinnitus is assigned a 10 percent rating, which is the maximum rating authorized under Diagnostic Code 6260 (2017). 12. The Veteran’s claim of entitlement to service connection for PTSD was received on February 15, 2011, more than one year following his separation from active service. 13. A TDIU is considered a lesser benefit than a 100 percent schedular rating, and the grant of a 100 percent rating renders moot the issue of entitlement to a TDIU for the period when the 100 percent rating is in effect. CONCLUSIONS OF LAW 1. The Veteran’s unspecified depressive disorder is proximately due to or the result of a service-connected disability. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.310 (2018). 2. The Veteran’s PTSD, with unspecified depressive disorder, warrants a rating of 100 percent throughout the entire period of the claim. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.3, 4.7, 4.130, Diagnostic Codes 9411, 9435 (2018). 3. The criteria for service connection for a left wrist disability have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2018). 4. The criteria for service connection for a left ankle disability have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2018). 5. The criteria for service connection for a right knee disability have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2018). 6. The criteria for service connection for an eye disability have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2018). 7. The criteria for service connection for hypertension have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.309 (2018). 8. The criteria for service connection for pseudofolliculitis barbae have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2018). 9. The criteria for service connection for a chronic headache disability have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2018). 10. The criteria for service connection for left arm numbness have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2018) 11. There is no legal basis for the assignment of a schedular evaluation in excess of 10 percent for tinnitus. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.87, Diagnostic Code 6260 (2018); Smith v. Nicholson, 451 F.3d 1344 (Fed. Cir. 2006). 12. The criteria for an effective date earlier than February 15, 2011, for the award of service connection for PTSD have not been met. 38 U.S.C. § 5110 (2012); 38 C.F.R. § 3.400 (2018). 13. Entitlement to a TDIU rating is dismissed as moot. VAOPGCPREC 6-99; 64 Fed. Reg. 52, 375 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from July 1981 to July 1984. These matters are before the Board of Veterans’ Appeals (Board) on appeal from rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO). Duty to Assist The Veterans Claims Assistance Act of 2000 (VCAA), codified in pertinent part at 38 U.S.C. §§ 5103, 5103A (2012), and the pertinent implementing regulation, codified at 38 C.F.R. § 3.159 (2018), provide that VA will assist a claimant in obtaining evidence necessary to substantiate a claim but is not required to provide assistance to a claimant if there is no reasonable possibility that such assistance would aid in substantiating the claim. The record reflects that service treatment records have been obtained. The Veteran was also afforded an opportunity for a hearing before a Decision Review Officer of the Regional Office (RO), or a Veterans Law Judge at the Board of Veteran’s Appeals, but declined. The Board has also considered whether a VA examination is required in this case, relative to the Veteran’s claims for service connection for a right knee disability, eye disability, hypertension, left ankle disability, pseudofolliculitis barbae, left wrist disability, left arm numbness, and chronic headache disability. VA must provide a medical examination or obtain medical opinion when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) evidence establishing that an event, injury, or disease occurred in service, or establishing that certain diseases manifested during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran’s service or with another service-connected disability, but (4) there is insufficient competent medical evidence on file for the Secretary to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79 (2006); see also 38 U.S.C. § 5103A(d)(2) (2012), 38 C.F.R. § 3.159(c)(4)(i) (2018). The third prong, which requires that the evidence of record “indicate” that the claimed disability or symptoms “may be” associated with the established event, disease or injury is a low threshold. McLendon, 20 Vet. App. at 83. The Veteran’s service treatment records are negative for a diagnosis of or treatment for a right knee disability, eye disability, hypertension, left ankle disability, pseudofolliculitis barbae, left wrist disability, left arm numbness, or chronic headache disability, or any symptoms thereof. There is no competent evidence suggesting these disabilities are related to active service. Therefore, a VA examination or obtain are not required in response to these claims. Neither the Veteran nor his representative have identified any outstanding evidence that could be obtained to substantiate these claims. The Board is also unaware of any such evidence. Therefore, the Board is also satisfied that VA has complied with its duty to assist the Veteran in the development of the facts pertinent to these claims. Accordingly, the Board will address the merits of the claims. Further, as a preliminary matter the Board notes that, with respect to the Veteran’s claims for an increased rating for tinnitus and entitlement to an earlier effective date for the grant of service connection for PTSD, the pertinent facts in this case are not in dispute and the law is dispositive. Consequently, there is no additional evidence that could be obtained to substantiate the claims, and no further action is required to comply with VA’s duties to notify and assist. See Manning v. Principi, 16 Vet. App. 534, 542 (2002); VAOPGCPREC 5-2004 (June 23, 2004). Legal Criteria-Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active duty. 38 U.S.C. § 1110 (2012); 38 C.F.R. § 3.303 (2018). Where a veteran served for at least 90 days during a period of war or after December 31, 1946, and manifests hypertension to a degree of 10 percent within one year from the date of termination of such service, such disease shall be presumed to have been incurred or aggravated in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112, 1137 (2012); 38 C.F.R. §§ 3.307, 3.309 (2019). Service connection may also be granted for disability which is proximately due to or the result of service-connected disability. 38 C.F.R. § 3.310(a). Legal Criteria-Disability Ratings Disability evaluations are determined by the application of the VA’s Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4 (2018). The percentage ratings in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 3.321(a), 4.1 (2018). Where a question arises as to which of two ratings applies under a particular code, the higher rating is assigned if the disability more closely approximates the criteria for the higher rating. 38 C.F.R. § 4.7 (2018). It is not expected, especially with the more fully described grades of disabilities, that all cases will show all the findings specified; findings sufficiently characteristic to identify the disease and the disability therefrom are sufficient; and above all, a coordination of rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21 (2018). Burden of Proof Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits under laws administered by the Secretary. The Secretary shall consider all information and lay and medical evidence of record in a case before the Secretary with respect to benefits under laws administered by the Secretary. 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 (2012); 38 C.F.R. § 3.102 (2018); see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 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. Factual Background and Analysis The Board notes that it has reviewed all the evidence of record, with an emphasis on the evidence relevant to this appeal. Although the Board has an obligation to provide reasons and bases supporting its decision, there is no need to discuss, in detail, every piece of evidence of record. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (holding that VA must review the entire record, but does not have to discuss each piece of evidence). Hence, the Board will summarize the relevant evidence where appropriate and the Board’s analysis below will focus specifically on what the evidence shows, or fails to show, as to the claims. Unspecified Depressive Disorder The Veteran has claimed service connection is warranted for an acquired psychiatric disorder other than PTSD. A March 2016 mental disorders disability benefit questionnaire submitted by the Veteran’s private clinician indicates the Veteran meets the clinical criteria for a diagnosis of an unspecified depressive disorder. During that assessment, the Veteran’s treating clinician attributed the Veteran’s depressive disorder to both his military service, and his service-connected tinnitus. Further, in the course of a June 2012 VA examination, the examiner indicated the Veteran’s depressed mood was also attributable to his service-connected PTSD. Accordingly, the Board concludes that service connection for an unspecified depressive disorder is warranted. PTSD Rating and Entitlement to a TDIU Rating The Veteran seeks an initial disability rating in excess of 70 percent for his acquired psychiatric disorders. For the reasons stated below, the Board finds a 100 percent schedular rating is warranted throughout the entire appeal period. PTSD and unspecified depressive disorder are rated under the General Rating Formula for Mental Disorders. In pertinent part, it provides the following: Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships................. 70 Total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name....... 100 38 C.F.R. § 4.130, Diagnostic Codes 9411 and 9435 (2018). Critically, the Board observes that the above-noted evaluation criteria for a 70 percent disability rating indicates an array of symptoms, which are likely sufficient to cause impairment and deficiencies in most areas of life functioning, to include work, school, family relations, judgment, thinking, or mood. Such symptoms need not rise to the level of activity preclusion, but rather negatively influence or impact upon most areas of life functioning. A higher 100 percent rating is warranted when the evidence indicates total impairment. The Board has carefully reviewed the Veteran’s treatment reports from the Little Rock VA Medical Center, to include a January 2012 statement from his treating psychiatrist indicating that the Veteran’s symptoms of insomnia, hypervigilance, social isolation, anger problems, mood swings, and paranoia. The Board has also considered the results of a June 2012 VA examination report noting that the Veteran had inter alia suicidal thoughts on a weekly basis and had multiple episodes of physical violence with family members. The Board has also thoroughly reviewed a psychiatric assessment and mental disorders disability benefit questionnaire submitted by Dr. H. H. and the vocational assessment from Dr. S.B., which both indicate that the Veteran had near-continuous panic and depression that affected his ability to function independently, appropriately, and effectively, suicidal ideation, persistent delusions, persistent auditory and visual hallucinations, and an inability to perform activities of daily living. Further, the Board has considered the Veteran’s own statements, as well as numerous lay statements from the Veteran’s spouse, brother, cousin, and mother. In sum, these records show the Veteran received consistent mental health care throughout the period of this appeal. The above-noted evidence shows the Veteran has experienced numerous symptoms and significant impairment, which include: severely diminished concentration / memory, paranoia, social isolation, agitation, anger outbursts, anxiety, feelings of helplessness and hopelessness, irritability, aggression, poor impulse control, near continuous depression and panic attacks, anhedonia, intrusive thoughts, dysfunctional sleep with frequent nightmares, significant relationship problems, impaired judgment and insight, avoidance of stimuli, chronic mood impairment, a constricted affect, suspiciousness, difficulty maintaining relationships, visual / auditory hallucinations, suicidal ideations, impaired ability to adapt to stressful circumstances, neglect of personal hygiene, and intermittent inability to perform activities of daily living. Further, the evidence indicates the Veteran has not maintained gainful employment since 2006. In this case, the evidence indicates the Veteran’s psychiatric manifestations have resulted in deficiencies in all areas of life functioning. Specifically, his symptoms have significantly impaired his ability to work, caused him marked social impairment and isolation, considerable impact on his family functioning, caused patent deficiencies in judgment, impaired his ability to successfully further his education, and resulted in severe mood impairments. The Veteran clearly has experienced impairments and deficiencies in all areas of life (work, school, family relations, judgment, thinking, and mood). The Board again notes a 70 percent rating is warranted when psychiatric manifestations cause impairment in most areas of life functioning; however, this Veteran’s psychiatric manifestations have resulted in impairments in all areas of life. As such, the Board has afforded the Veteran the benefit of reasonable doubt, and finds his disability picture more nearly approximates the criteria necessary for a 100 percent disability rating. In closing, the Board notes that a TDIU is considered a lesser benefit than a 100 percent schedular rating, and the grant of a 100 percent rating renders moot the issue of entitlement to a TDIU for the period when the 100 percent rating is in effect. VAOPGCPREC 6-99; 64 Fed. Reg. 52, 375 (1999). As such, this issue is dismissed, because a 100 percent schedular rating has been assigned throughout the entire appeal period. Right knee, Eye, Hypertension, Left ankle, Pseudofolliculitis barbae, Left wrist, Left arm numbness, and Headache Disability Claims The Veteran asserts that service connection is warranted for a right knee disability, eye disability, hypertension, left ankle disability, pseudofolliculitis barbae, left wrist disability, left arm numbness, and a chronic headache disability. The question for the Board is whether the Veteran’s currently claimed disabilities began during service or are at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the preponderance of the evidence is against finding that the disabilities began during active service, or are otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). A careful review of the Veteran’s service treatment records fails to show he was ever treated for or diagnosed with any of the above claimed disabilities. Additionally, the Veteran’s March 12, 1984 report of medical examination does not indicate any ongoing problems that could be associated with the above-claimed disabilities. Further, following a comprehensive review of the file, the Board notes the Veteran has not provided any specific details as to how or why he felt these disabilities were consequentially related to his military service. While the Veteran is competent to report that he believes his disabilities should be service-connected, his reports are largely not credible due to internal inconsistency and inconsistency with other evidence in the record. In this respect, the Board notes that the most probative evidence of record shows the Veteran did not experience any right knee, eye, hypertension, left ankle, pseudofolliculitis barbae, left wrist, left arm numbness, or chronic headache disabilities in service, and the Veteran has not provided any indication as to how or why these claimed disabilities may be the result of an in-service injury, event, or disease. Regarding his hypertension claim, outpatient treatment records from the Little Rock VA Medical Center (VAMC) indicate he was diagnosed with hypertension in November 2010, many years after his discharge from active duty. As such, there is no indication this disability manifest to a compensable degree within the one-year period following his discharge from active duty, and therefore, service connection is also not warranted on a presumptive basis under 38 C.F.R. § 3.309(a) (2018). In sum, the Board finds the preponderance of the evidence weighs against findings that a right knee disability, eye disability, hypertension, left ankle disability, pseudofolliculitis barbae, left wrist disability, left arm numbness, or chronic headache disability were incurred during or are otherwise related to the Veteran’s period of active duty. For this reason, the Board must deny these claims. Tinnitus Rating The Veteran was awarded service connection and a 10 percent rating for tinnitus in an October 2012 rating decision. The originating agency denied the Veteran’s request for a higher rating because the maximum schedular rating authorized for tinnitus is 10 percent. In Smith v. Nicholson, 19 Vet. App. 63, 78 (2005), the Court held that the pre-1999 and pre-June 13, 2003, versions of Diagnostic Code 6260 required the assignment of dual ratings for bilateral tinnitus. VA appealed this decision to the U.S. Court of Appeals for the Federal Circuit (Federal Circuit). In Smith v. Nicholson, 451 F.3d 1344 (Fed. Cir. 2006), the Federal Circuit concluded that the Court erred in not deferring to VA’s interpretation of its own regulations, 38 C.F.R. § 4.25 and Diagnostic Code 6260, which limit a veteran to a single 10 percent disability rating for tinnitus, regardless of whether the tinnitus is unilateral or bilateral. The Veteran’s service-connected tinnitus is evaluated as 10 percent disabling, which is the maximum schedular rating available for such disability. See 38 C.F.R. §4.87, Diagnostic Code 6260 (2018). As there is no legal basis upon which to award a separate schedular evaluation for tinnitus in each ear or a higher schedular rating for tinnitus, the Veteran’s claim for such a benefit is without legal merit. Sabonis v. Brown, 6 Vet. App. 426 (1994). Effective Date for PTSD Generally, the effective date of an award based on an original claim for compensation benefits, if received more than one year after the claimant’s discharge from service, shall be the date of receipt of the claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110(a) (2012); 38 C.F.R. § 3.400(b)(2)(i) (2018). The effective date, “shall be fixed in accordance with the facts found but shall not be earlier than the date of receipt of application therefore.” 38 U.S.C. § 5110(a) (2018). The record shows the Veteran submitted an initial claim for service connection for PTSD on February 15, 2011. A May 2016 rating decision granted service connection for PTSD, effective from February 15, 2011. The Veteran expressed disagreement with the assigned effective date. The evidence does not indicate the Veteran expressed any intent to file a claim for service connection for PTSD prior to February 15, 2011. Therefore, in the absence of a valid earlier claim, the earliest possible effective date is February 15, 2011. See 38 C.F.R. § 3.400(b)(2)(i) (2018). Accordingly, the claim must be denied. REASONS FOR REMAND The Board finds that additional development is required before the remaining claims on appeal are decided. As noted above, VA must provide a medical examination or obtain a medical opinion when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) evidence establishing that an event, injury, or disease occurred in service, or establishing that certain diseases manifested during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran’s service or with another service-connected disability, but (4) there is insufficient competent medical evidence on file for the Secretary to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79 (2006); see also 38 U.S.C. § 5103A(d)(2) (2012), 38 C.F.R. § 3.159(c)(4)(i) (2018). The third prong, which requires that the evidence of record “indicate” that the claimed disability or symptoms “may be” associated with the established event, disease or injury is a low threshold. McLendon, 20 Vet. App. at 83. To date, the Veteran has not been afforded a VA examination regarding his left knee, left foot, right foot, hepatitis C, back, arthritis, or right ankle disability claims. A review of the Veteran’s STRs shows he was treated for left knee pain in April 1982 and September 1983, for low back pain in November 1983, for foot problems in August 1982 and April 1984, and for a right ankle sprain in December 1981. In addition, the RO has conceded the Veteran was the victim of a military sexual assault, which may have resulted in his current hepatitic C. The Veteran’s outpatient treatment records from the Little Rock VAMC note that he has received treatment for the claimed disabilities. With respect to the Veteran’s claim for arthritis, the evidence shows arthritic changes affecting the Veteran’s back, and as such, the Board has considered that claim to be part of the Veteran’s claimed back disability. Based on the foregoing, the Board finds VA examinations and medical opinions are necessary to address these issues. On remand, relevant ongoing medical records should also be obtained. 38 U.S.C. § 5103A(c) (2012); see also Bell v. Derwinski, 2 Vet. App. 611 (1992) (VA medical records are in constructive possession of the agency, and must be obtained if the material could be determinative of the claim). Accordingly, these matters are REMANDED for the following actions: 1. Undertake appropriate development to obtain any outstanding records pertinent to the Veteran’s remaining claims. If any requested records are not available, the record should be annotated to reflect such and the Veteran notified in accordance with 38 C.F.R. § 3.159(e). 2. After the above is completed to the extent possible, schedule the Veteran for appropriate VA examinations to determine the nature of his claimed left knee, left foot, right foot, hepatitis C, back, arthritis, and right ankle disabilities and determine whether any such disability is related to service. All pertinent evidence of record must be made available to and reviewed by the examiner(s). Any indicated studies should be performed. Following a review of the relevant records and lay statements, the examiner should state an opinion with respect to whether any diagnosed left knee, left foot, right foot, hepatitis C, back, or right ankle disability at least as likely as not (a 50 percent probability or greater) incurred during his period of active service or is otherwise related to his active service. In addressing the Veteran’s hepatitis, the examiner should specifically indicate whether the claimed disability may be the result of the Veteran’s military sexual assault. A complete rationale should be provided for all opinions and conclusions expressed. If an examiner is unable to provide any required opinion, he or she should explain why. If an examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation as to why this is so. J. A. Anderson Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD G. Fraser, Counsel