Citation Nr: 18150149 Decision Date: 11/14/18 Archive Date: 11/14/18 DOCKET NO. 12-34 389 DATE: November 14, 2018 REMANDED Entitlement to service connection for an equilibrium disability, to include as secondary to service-connected bilateral hearing loss, tinnitus and/or reflex sympathetic dystrophy of the cervical spine with associated neck and shoulder pain, is remanded. Entitlement to service connection for a skin disability, to include as secondary to service-connected reflex sympathetic dystrophy of the cervical spine with associated neck and shoulder pain, is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities is remanded. REASONS FOR REMAND The Veteran served on active duty from January 23, 1991 to July 31, 1991, from October 18, 2001 to September 30, 2002, and from February 17, 2003 to March 4, 2004. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a January 2010 rating decision. In June 2018, the Veteran testified before the undersigned Veterans Law Judge (VLJ) at a video-conference hearing. A transcript of that hearing is of record. 1. Entitlement to service connection for an equilibrium disability, to include as secondary to service-connected bilateral tinnitus and reflex sympathetic dystrophy of the cervical spine with associated neck and shoulder pain, is remanded. The Veteran’s DD-214 for his period of active duty from February 17, 2003 to March 4, 2004 reflects prior active service of four years, three months and 24 days, which is not fully accounted for by his periods of active duty from January 23, 1991 to July 31, 1991, and from October 18, 2001 to September 30, 2002. As such, remand is required to verify the Veteran’s complete dates of active duty. Further, the September 2009 examination evaluating the Veteran’s claim for service connection for an equilibrium disability is inadequate. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate); D’Aries v. Peake, 22 Vet. App. 97, 104 (2008) (holding that an examination must be based on consideration of the claimant’s medical history and must describe the disability in sufficient detail so that the Board’s evaluation of the disability will be a fully informed one). The September 2009 examination report did not advise whether the Veteran has a diagnosis regarding his complaints of an equilibrium disability. The examination report determined that in order to comment on the Veteran’s claimed equilibrium disability an electronystagmography (ENG) would need to be performed. An ENG was performed in October 2009, which found the testing was within normal limits and therefore found no current objective evidence of active inner ear and/or vestibular system pathology causing the Veteran’s history of recurrent imbalance and vertigo. The examination report did not consider whether the Veteran’s equilibrium disability is something other than an inner ear and/or vestibular system disability. The examination report also failed to consider whether the Veteran’s equilibrium disability is caused or aggravated by his service-connected hearing loss, tinnitus and/or reflex sympathetic dystrophy of the cervical spine. The Board finds that a new VA examination is necessary to fully address the nature and etiology of the Veteran’s claimed equilibrium disability. 2. Entitlement to service connection for a skin disability, to include as secondary to service-connected reflex sympathetic dystrophy of the cervical spine with associated neck and shoulder pain, is remanded. VA will provide a medical examination or obtain a medical opinion if the evidence indicates the existence of a current disability or persistent or recurrent symptoms of a disability that may be associated with an event, injury, or disease in service, but the record does not contain sufficient medical evidence to decide the claim. 38 U.S.C. § 5103A(d)(2); 38 C.F.R. § 3.159(c)(4)(i); McLendon v. Nicholson, 20 Vet. App. 79 (2006). The threshold for determining whether the evidence “indicates” that there “may” be a nexus between a current disability and an in-service event, injury, or disease is a low one. McLendon, 20 Vet. App. at 83. The Veteran’s service treatment records indicate a diagnosis of psoriasis during his active service. The Veteran’s VA treatment records show that during the current appeal that the Veteran has had a diagnosis of psoriasis. Further, the Veteran submitted numerous statements from family members describing his skin disability and photographs depicting his skin disability. The above threshold having been met, a VA examination and opinion must be provided to make an informed decision on the Veteran’s claim for service connection for a skin disability. See McLendon, 20 Vet. App. at 83; see also Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991) (the Board is not competent to substitute its own opinion for that of a medical expert). The Veteran’s VA treatment records indicate that the Veteran also received medical treatment from New England Dermatology. The Veteran’s claims folder does not contain these private treatment records. A remand is required to allow VA to obtain authorization and request these records.   3. Entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities is remanded. Because the Veteran’s claims for service connection could have an impact on the issue of a TDIU rating, the Board finds these issues are inextricably intertwined. Therefore, the issue of a TDIU rating must be remanded with the Veteran’s claims for service connection. See 38 C.F.R. § 4.16(a); Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (two issues are “inextricably intertwined” when they are so closely tied together that a final decision on one issue cannot be rendered until a decision on the other issue has been rendered). Accordingly, it must be remanded as well. The matters are REMANDED for the following action: 1. Ask the Veteran to complete and return a VA Form 21-8940, Veteran's Application for Increased Compensation Based on Unemployability. 2. Verify the Veteran’s complete dates of active duty, ACDUTRA, and INACDUTRA. As noted above, his DD-214 for his period of active duty from February 17, 2003 to March 4, 2004 reflects prior active service of four years, three months and 24 days, which is not fully accounted for by his verified periods of active duty from January 23, 1991 to July 31, 1991, and October 18, 2001 to September 30, 2002. 3. Obtain the Veteran’s VA treatment records for the period from January 2012 to the present. 4. Ask the Veteran to complete a VA Form 21-4142 for any physicians and/or facilities adequately identified by the Veteran, including New England Dermatology. Make two requests for the authorized records from any physicians and/or facilities adequately identified by the Veteran, including New England Dermatology, unless it is clear after the first request that a second request would be futile. 5. After the above development is completed, schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any equilibrium disability. (a.) The examiner must identify all current equilibrium disabilities. (b.) The examiner must opine whether any current equilibrium disability is at least as likely as not related to an in-service injury, event, or disease, including a January 2004 in-service fall at Dover Air Force Base. (c.) The examiner must also opine whether it is at least as likely as not that any current equilibrium disability is (i) proximately due to the Veteran’s service-connected bilateral tinnitus and/or hearing loss, or (ii) aggravated beyond its natural progression by the Veteran’s service-connected bilateral tinnitus and/or hearing loss. (d.) The examiner must also opine whether it is at least as likely as not that any current equilibrium disability is (i) proximately due to the Veteran’s service-connected reflex sympathetic dystrophy of the cervical spine with associated neck and shoulder pain, or (ii) aggravated beyond its natural progression by the Veteran’s service-connected reflex sympathetic dystrophy of the cervical spine with associated neck and shoulder pain. All examination findings, along with the complete rationale for all opinions expressed, must be set forth in the examination report. 6. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any skin disability. (a.) The examiner must identify all current skin disabilities, including any psoriasis, residuals of shingles, etc. (b.) The examiner must opine whether any current skin disability is at least as likely as not related to an in-service injury, event, or disease, including a January 2004 in-service fall at Dover Air Force Base. (c.) The examiner must also opine whether it is at least as likely as not that any current skin disability is (i) proximately due to the Veteran’s service-connected reflex sympathetic dystrophy of the cervical spine with associated neck and shoulder pain, or (ii) aggravated beyond its natural progression by the Veteran’s service-connected reflex sympathetic dystrophy of the cervical spine with associated neck and shoulder pain. In providing these opinions, the examiner should address the Veteran’s assertion that he developed a skin disorder in the same areas that he injured when he fell during service, as well as his assertion that he developed shingles on the same nerve root that generates most of his neck pain. All examination findings, along with the complete rationale for all opinions expressed, must be set forth in the examination report. 7. Schedule the Veteran for any additional VA examination(s) necessary to evaluate the issue of a TDIU rating. P.M. DILORENZO Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. Mussey, Associate Counsel