Citation Nr: 18150686 Decision Date: 11/15/18 Archive Date: 11/15/18 DOCKET NO. 17-65 042 DATE: November 15, 2018 ORDER Entitlement to service connection for a right shoulder condition is denied. Entitlement to service connection for a left shoulder condition is denied. Entitlement to service connection for a low back condition is denied. Entitlement to service connection for a neck condition is denied. Entitlement to service connection for a right hip condition is denied. Entitlement to service connection for a left hip condition is denied. Entitlement to service connection for a right knee condition is denied. Entitlement to service connection for a left knee condition is denied. Entitlement to service connection for a right ankle condition is denied. Entitlement to service connection for a left ankle condition is denied. Entitlement to service connection for a right foot condition is denied. Entitlement to service connection for a left foot condition is denied. Entitlement to service connection for chronic gastritis is denied. Entitlement to service connection for peptic ulcer is denied. Entitlement to service connection for neuropathy, right upper extremity is denied. Entitlement to service connection for neuropathy, left upper extremity is denied. Entitlement to service connection for neuropathy, right lower extremity is denied. Entitlement to service connection for neuropathy, left lower extremity is denied. Entitlement to service connection for bronchial asthma is denied. Entitlement to service connection for diabetes mellitus, type II, to include as due to herbicide exposure, is denied. REMANDED The issue of entitlement to service connection for bilateral hearing loss is remanded. The issue of entitlement to service connection for tinnitus is remanded. The issue of entitlement to service connection for inguinal hernia is remanded. The issue of entitlement to service connection for right carpal tunnel syndrome is remanded. The issue of entitlement to service connection for left carpal tunnel syndrome is remanded. The issue of right parietal arteriovenous malformation with residuals of cognitive dysfunction and seizures is remanded. The issue of entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), depression, and anxiety is remanded. The issue of entitlement to a total disability rating based on individual unemployability due to service-connected disability (TDIU) is remanded. FINDINGS OF FACT 1. The competent evidence of record does not demonstrate a diagnosis of a right shoulder disability proximate to the claim, or during the appeal period. 2. The competent evidence of record does not demonstrate a diagnosis of a left shoulder disability proximate to the claim, or during the appeal period. 3. The competent evidence of record does not demonstrate a diagnosis of a low back disability proximate to the claim, or during the appeal period. 4. The competent evidence of record does not demonstrate a diagnosis of a neck disability proximate to the claim, or during the appeal period. 5. The competent evidence of record does not demonstrate a diagnosis of a right hip disability proximate to the claim, or during the appeal period. 6. The competent evidence of record does not demonstrate a diagnosis of a left hip disability proximate to the claim, or during the appeal period. 7. The competent evidence of record does not demonstrate a diagnosis of a right knee disability proximate to the claim, or during the appeal period. 8. The competent evidence of record does not demonstrate a diagnosis of a left knee disability proximate to the claim, or during the appeal period. 9. The competent evidence of record does not demonstrate a diagnosis of a right ankle disability proximate to the claim, or during the appeal period. 10. The competent evidence of record does not demonstrate a diagnosis of a left ankle disability proximate to the claim, or during the appeal period. 11. The competent evidence of record does not demonstrate a diagnosis of a right foot disability proximate to the claim, or during the appeal period. 12. The competent evidence of record does not demonstrate a diagnosis of a left foot disability proximate to the claim, or during the appeal period. 13. The competent evidence of record does not demonstrate a diagnosis of chronic gastritis proximate to the claim, or during the appeal period. 14. The competent evidence of record does not demonstrate a diagnosis of a peptic ulcer proximate to the claim, or during the appeal period. 15. The competent evidence of record does not demonstrate a diagnosis of neuropathy, right upper extremity, proximate to the claim, or during the appeal period. 16. The competent evidence of record does not demonstrate a diagnosis of neuropathy, left upper extremity, proximate to the claim, or during the appeal period. 17. The competent evidence of record does not demonstrate a diagnosis of neuropathy, right lower extremity, proximate to the claim, or during the appeal period. 18. The competent evidence of record does not demonstrate a diagnosis of neuropathy, left lower extremity, proximate to the claim, or during the appeal period. 19. The competent evidence of record does not demonstrate a diagnosis of bronchial asthma, proximate to the claim, or during the appeal period. 20. The competent evidence of record does not demonstrate a diagnosis of diabetes mellitus, type II, proximate to the claim, or during the appeal period. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a right shoulder condition, have not been met. 38 U.S.C. §§ 1101, 1110, 5103, 5103A, 5107 (b) (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2018). 2. The criteria for entitlement to service connection for a left shoulder condition, have not been met. 38 U.S.C. §§ 1101, 1110, 5103, 5103A, 5107 (b) (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2018). 3. The criteria for entitlement to service connection for a low back condition, have not been met. 38 U.S.C. §§ 1101, 1110, 5103, 5103A, 5107 (b) (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2018). 4. The criteria for entitlement to service connection for a neck condition, have not been met. 38 U.S.C. §§ 1101, 1110, 5103, 5103A, 5107 (b) (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2018). 5. The criteria for entitlement to service connection for a right hip condition, have not been met. 38 U.S.C. §§ 1101, 1110, 5103, 5103A, 5107 (b) (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2018). 6. The criteria for entitlement to service connection for a left hip condition, have not been met. 38 U.S.C. §§ 1101, 1110, 5103, 5103A, 5107 (b) (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2018). 7. The criteria for entitlement to service connection for a right knee condition, have not been met. 38 U.S.C. §§ 1101, 1110, 5103, 5103A, 5107 (b) (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2018). 8. The criteria for entitlement to service connection for a left knee condition, have not been met. 38 U.S.C. §§ 1101, 1110, 5103, 5103A, 5107 (b) (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2018). 9. The criteria for entitlement to service connection for a right ankle condition, have not been met. 38 U.S.C. §§ 1101, 1110, 5103, 5103A, 5107 (b) (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2018). 10. The criteria for entitlement to service connection for a left ankle condition, have not been met. 38 U.S.C. §§ 1101, 1110, 5103, 5103A, 5107 (b) (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2018). 11. The criteria for entitlement to service connection for a right foot condition, have not been met. 38 U.S.C. §§ 1101, 1110, 5103, 5103A, 5107 (b) (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2018). 12. The criteria for entitlement to service connection for a left foot condition, have not been met. 38 U.S.C. §§ 1101, 1110, 5103, 5103A, 5107 (b) (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2018). 13. The criteria for entitlement to service connection for chronic gastritis, have not been met. 38 U.S.C. §§ 1101, 1110, 5103, 5103A, 5107 (b) (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2018). 14. The criteria for entitlement to service connection for a peptic ulcer, have not been met. 38 U.S.C. §§ 1101, 1110, 5103, 5103A, 5107 (b) (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2018). 15. The criteria for entitlement to service connection for neuropathy, right upper extremity, have not been met. 38 U.S.C. §§ 1101, 1110, 5103, 5103A, 5107 (b) (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2018). 16. The criteria for entitlement to service connection for neuropathy, left upper extremity, have not been met. 38 U.S.C. §§ 1101, 1110, 5103, 5103A, 5107 (b) (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2018). 17. The criteria for entitlement to service connection for neuropathy, right lower extremity, have not been met. 38 U.S.C. §§ 1101, 1110, 5103, 5103A, 5107 (b) (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2018). 18. The criteria for entitlement to service connection for neuropathy, left lower extremity, have not been met. 38 U.S.C. §§ 1101, 1110, 5103, 5103A, 5107 (b) (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2018). 19. The criteria for entitlement to service connection for bronchial asthma have not been met. 38 U.S.C. §§ 1101, 1110, 5103, 5103A, 5107 (b) (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2018). 20. The criteria for entitlement to service connection for diabetes mellitus, type II, have not been met. 38 U.S.C. §§ 1101, 1110, 5103, 5103A, 5107 (b) (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1973 to April 1976. These matters come before the Board of Veterans’ Appeals (Board) on appeal of a March 2017 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in San Juan, Puerto Rico. Service Connection Service connection may be established for disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. § 1110 (2012); 38 C.F.R. § 3.303 (2017). To establish service connection for a disability, the Veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The existence of a current disability is the cornerstone of a claim for VA disability compensation. 38 U.S.C. § 1110; see Degmetich v. Brown, 104 F.3d 1328, 1332 (1997) (holding that interpretation of 38 U.S.C. §§ 1110 and 1131 as requiring the existence of a present disability for VA compensation purposes cannot be considered arbitrary). In the absence of proof of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). 1. Entitlement to Service Connection for a Bilateral Shoulder Condition, Bilateral Hip Condition, Bilateral Knee Condition, Bilateral Ankle Condition, Bilateral Foot Condition, Low Back Condition, and Neck Condition The Veteran contends that he has a bilateral shoulder condition, bilateral hip condition, bilateral knee condition, bilateral ankle condition, bilateral foot condition, low back condition, and neck condition (musculoskeletal conditions) that are directly related to his active service. See VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits, received March 2016. In this case, the evidence of record does not contain probative evidence of the claimed musculoskeletal conditions at any time proximate to, or during, the claim. During the pendency of the claim the Veteran has received VA medical treatment and VA received the Veteran’s medical records relating to his application for Social Security Administration (SSA) benefits. The VA medical treatment records are negative for any complaints or treatments related to the claimed musculoskeletal conditions. Additionally, the medical records associated with the Veteran’s application for SSA benefits do not contain diagnoses related to the Veteran’s alleged musculoskeletal conditions and relate to medical treatment received many years prior to his current claims. The Board acknowledges the November 2015 private treatment letter that contains diagnoses for bilateral shoulder, hip, knee, ankle, and feet degenerative joint disease. However, there is no evidence that the private examiner reviewed the record, interviewed the Veteran or conducted an in-person examination. Additionally, there is no evidence that the Veteran was provided an x-ray related to the arthritis diagnoses. As such, there is no competent medical evidence confirming diagnoses for bilateral shoulder, hip, knee, ankle, and feet degenerative joint disease. Thus, the most probative evidence fails to demonstrate that it is at least as likely as not that the Veteran has the claimed musculoskeletal disabilities that had an onset during active service or that he has the claimed musculoskeletal disabilities that are otherwise causally or etiologically related to his active service. The Board acknowledges that the Veteran was not afforded a VA examination relating directly to his musculoskeletal conditions claims. On these facts, however, examinations are not required. 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). In this case, the claim does not meet these requirements for obtaining a VA medical opinion. Because the weight of the evidence demonstrates no indication of a current disability, no examination is required. Absent evidence that indicates that the Veteran has a current claimed disability that is related to an injury or symptoms in service, the Board finds that a VA examination or opinion is not necessary for disposition of the claims. Accordingly, the Board finds that VA’s duty to assist with respect to obtaining VA examinations or opinions with respect to the Veteran’s claims related to his claimed musculoskeletal conditions have been met. 38 C.F.R. § 3.159 (c) (4). The Board acknowledges the Veteran’s assertions that he has the above musculoskeletal conditions. However, he has not been shown to have the medical training and knowledge required to diagnose such conditions. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011); Buchanan v. Nicholson, 451 F. 3d 1331, 1336-37. Therefore, his assertions are not considered competent and do not weigh against the probative value of the medical treatment records, including the VA treatment records and medical records related to his SSA disability claim, which do not show diagnoses of the claimed musculoskeletal conditions. As noted above, the threshold requirement for service connection is competent medical evidence of the existence of the claimed disability at some point during the course of the appeal or in proximity to the claim. See Degmetich, 104 F. 3d at 1332; Brammer, 3 Vet. App. at 225; see also McClain v. Nicholson, 21 Vet. App. 319 (2007); Romanowsky v. Shinseki, 26 Vet. App. 289 (2013). While the Veteran has this complaint, a complaint, or symptoms, are not a “disability” for VA purposes. The Board cannot grant service connection for a symptom. Although the Board recognizes the Veteran’s sincere belief in his claims, the most probative evidence of record does not show that he had the claimed musculoskeletal disabilities at any point during or in proximity to the appeal period. The Board is cognizant of the recent holding in Saunders v. Wilkie which stated that where pain causes functional impairment, a disability for VA compensation purposes exists, even if there is no underlying diagnosis. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). In sum, pain alone resulting in functional impairment is in fact a disability, and should not be summarily discounted as a bar to benefits based on a finding of no current diagnosis. However, the Veteran does not claim, nor do his medical records show, that he experiences any functional impairment due to his claimed musculoskeletal conditions. As such, the Veteran’s complaints of pain relating to his musculoskeletal conditions claims do not amount to a functional impairment of earning capacity, and Saunders is not applicable in this case. In the absence of proof of a current disability, there can be no valid claim. Brammer, 3 Vet. App. at 225. In this case there is an absence of competent evidence of bilateral shoulder, bilateral hip, bilateral knee, bilateral ankle, bilateral foot, low back and/or neck disability during or in proximity to the appeal period. Without evidence of a current diagnosis of the above conditions the Board need not address the other elements of service connection. The preponderance of the evidence is therefore against the claims, the benefit-of-the-doubt doctrine is not for application, and the claims must be denied. 38 U.S.C. § 5107 (b); see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 2. Entitlement to Service Connection for Chronic Gastritis, Peptic Ulcer, Bilateral Upper Extremity Neuropathy, Bilateral Lower Extremity Neuropathy, Bronchial Asthma, and Diabetes Mellitus, Type II The Veteran contends that he has chronic gastritis, peptic ulcer, bilateral upper extremity neuropathy, bilateral lower extremity neuropathy, bronchial asthma, and diabetes mellitus, type II, that are directly related to his active service. See VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits, received March 2016. In this case, the evidence of record does not contain probative evidence of the claimed conditions at any time proximate to, or during, the claim. During the pendency of the claim the Veteran has received VA medical treatment and submitted his application for SSA benefits. The VA medical treatment records are negative for any complaints or treatments related to the claimed conditions. Furthermore, a December 2016 VA treatment record notes that the Veteran is not diabetic and not asthmatic. Additionally, the medical records associated with the Veteran’s application for SSA benefits do not contain diagnoses related to the Veteran’s conditions and relate to medical treatment received many years prior to his current claims. The Board acknowledges the November 2015 private treatment letter that contains diagnoses for diabetes mellitus, type II, diabetic neuropathy upper/lower extremities, bronchial asthma, peptic ulcer disease and chronic gastritis. However, there is no evidence that the November 2015 private examiner reviewed the record, interviewed the Veteran or conducted an in-person examination. Additionally, the VA treatment records do not contain complaints or treatment for the above conditions. As such, there is no competent medical evidence confirming diagnoses for diabetes mellitus, type II, diabetic neuropathy upper/lower extremities, bronchial asthma, peptic ulcer disease and/or chronic gastritis. Thus, the most probative evidence fails to demonstrate that it is at least as likely as not that the Veteran has current diagnoses for diabetes mellitus, type II, diabetic neuropathy upper/lower extremities, bronchial asthma, peptic ulcer disease and/or chronic gastritis that had their onset during active service or that there are current diagnoses for diabetes mellitus, type II, diabetic neuropathy upper/lower extremities, bronchial asthma, peptic ulcer disease and/or chronic gastritis that are otherwise causally or etiologically related to his active service. The Board acknowledges that the Veteran was not afforded a VA examination relating directly to these claims. On these facts, however, an examination is not required. 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). In this case, the claims do not meet these requirements for obtaining a VA medical opinion. Because the weight of the evidence demonstrates no indication of a current disability, no examination is required. Absent evidence that indicates that the Veteran has a current claimed disability that is related to an injury or symptoms in service, the Board finds that a VA examination or opinion is not necessary for disposition of the claim. Accordingly, the Board finds that VA’s duty to assist with respect to obtaining a VA examination or opinion with respect to the Veteran’s claims for entitlement to service connection for diabetes mellitus, type II, diabetic neuropathy upper/lower extremities, bronchial asthma, peptic ulcer disease and chronic gastritis have been met. 38 C.F.R. § 3.159 (c) (4). The Board acknowledges the Veteran’s assertions that he has diabetes mellitus, type II, diabetic neuropathy upper/lower extremities, bronchial asthma, peptic ulcer disease and chronic gastritis. However, he has not been shown to have the medical training and knowledge required to diagnose such conditions. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011); Buchanan v. Nicholson, 451 F. 3d 1331, 1336-37. Therefore, his assertions are not considered competent and do not weigh against the probative value of the medical treatment records, including the VA treatment records and SSA medical records, which do not show complaints of, treatment for or diagnoses for diabetes mellitus, type II, diabetic neuropathy upper/lower extremities, bronchial asthma, peptic ulcer disease and chronic gastritis. As noted above, the threshold requirement for service connection is competent medical evidence of the existence of the claimed disability at some point during the course of the appeal or in proximity to the claim. See Degmetich, 104 F. 3d at 1332; Brammer, 3 Vet. App. at 225; see also McClain v. Nicholson, 21 Vet. App. 319 (2007); Romanowsky v. Shinseki, 26 Vet. App. 289 (2013). While the Veteran has this complaint, a complaint, or symptoms, are not a “disability” for VA purposes. The Board cannot grant service connection for a symptom. Although the Board recognizes the Veteran’s sincere belief in his claims, the most probative evidence of record does not show that he had diabetes mellitus, type II, diabetic neuropathy upper/lower extremities, bronchial asthma, peptic ulcer disease and chronic gastritis at any point during or in proximity to the appeal period. In the absence of proof of a current disability, there can be no valid claim. Brammer, 3 Vet. App. at 225. In this case there is an absence of proof of diabetes mellitus, type II, bilateral upper extremities neuropathy, bilateral lower extremities neuropathy, bronchial asthma, peptic ulcer disease and chronic gastritis disability during or in proximity to the appeal period. Without evidence of current diagnoses of diabetes mellitus, type II, neuropathy upper/lower extremities, bronchial asthma, peptic ulcer disease and chronic gastritis the Board need not address the other elements of service connection. The preponderance of the evidence is therefore against the claims, the benefit-of-the-doubt doctrine is not for application, and the claims must be denied. 38 U.S.C. § 5107 (b); see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). VA’s Duty to Notify and Assist With respect to the Veteran’s claims herein, VA has met all statutory and regulatory notice and duty to assist provisions. See 38 U.S.C. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126 (2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326 (2017); see also Scott v. McDonald, 789 F.3d 1375 (Fed. Cir. 2015). REASONS FOR REMAND The Board finds that further development is necessary before a decision on the merits may be made relating to the remaining issues on appeal. Initially, the Board notes that the Veteran’s service treatment records, other than his entrance examination, are unavailable. In February 2017, the Regional Office sent a letter to the Veteran informing him that his military records could not be located and therefore were unavailable for review. The letter further informed the Veteran of other documents that can substitute for service treatment records. However, the February 2017 letter did not request that the Veteran complete and submit a NA Form 13055, Request for Information Needed to Reconstruct Medical Data. Accordingly, a remand is required so that the Veteran can be provided an NA Form 13055. In cases where service records are unavailable, VA has a heightened obligation to explain its findings and to consider the benefit-of-the-doubt rule. O’Hare v. Derwinski, 1 Vet. App. 365, 367 (1991). This is not to say that there is a heightened benefit-of-the-doubt rule or a heightened duty to assist. Rather, VA has a heightened duty to consider the applicability of the benefit-of-the-doubt rule, to assist the claimant in developing a claim, and to explain its decision when the Veteran’s service treatment records are not available. See Ussery v. Brown, 8 Vet. App. 64 (1995). Furthermore, the legal standard for proving a claim for service connection is not lowered. Instead, VA has a heightened obligation to evaluate and discuss in its decision all the evidence that may be favorable to the Veteran. See Russo v. Brown, 9 Vet. App. 46 (1996). 1. Entitlement to Service Connection for Bilateral Hearing Loss and Tinnitus The Veteran seeks entitlement to service connection for bilateral hearing loss and tinnitus. The Veteran was provided a VA examination as to his bilateral hearing loss and tinnitus in March 2017. VA has a duty to ensure that any medical examination or opinion it provides is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). A medical opinion is adequate where it is based upon consideration of the full medical history and describes a disability in sufficient detail so that the Board’s evaluation will be fully informed. Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). Here, the Board finds the March 2017 VA examination relating to the Veteran’s bilateral hearing loss and tinnitus is inadequate for decision-making purposes. Specifically, the March 2017 VA examiner stated that the Veteran’s service treatment records were not available to review, therefore there were no audiological examinations prior to March 2015. However, a review of the Veteran’s military personnel records, reflects that his June 1973 entrance examination is part of the record. Additionally, the June 1973 entrance examination contains an audiological examination. As such, the Veteran’s claims file contains an audiological examination prior to March 2015. As the examination, is not adequate for decision-making purposes, the Veteran must be provided an addendum opinion to address the June 1973 entrance examination and whether the Veteran’s current bilateral hearing loss and tinnitus are etiologically related to an in-service event, injury, or disease. 2. Entitlement to Service Connection for Inguinal Hernia The Veteran contends that he has inguinal hernia related to his active service. VA treatment records reflect that the Veteran had bilateral inguinal hernia surgery in January 2008. However, the Veteran’s claims file does not contain medical records related to the January 2008 bilateral inguinal hernia surgery. On remand, the Veteran must be asked to complete authorization forms concerning any private medical treatment and/or submit copies of any relevant records related to his January 2008 bilateral inguinal hernia surgery. 38 U.S.C. § 5103A (c); 38 C.F.R. § 3.159 (c) (1). 3. Entitlement to Service Connection for Bilateral Carpal Tunnel Syndrome The Veteran contends that he has bilateral carpal tunnel syndrome that is directly related to his active service. An October 2004 VA aid and attendance or housebound examination contains a diagnosis of bilateral carpal tunnel syndrome. Additionally, an August 2003 VA treatment record reflects that the Veteran stated he was diagnosed with bilateral carpal tunnel syndrome by a private examiner. However, the record does not contain the private examination. On remand, the Veteran must be asked to complete authorization forms concerning any private medical treatment and/or submit copies of any relevant records related to his bilateral carpal tunnel syndrome. 38 U.S.C. § 5103A (c); 38 C.F.R. § 3.159 (c) (1). 4. Entitlement to Service Connection for Right Parietal Arteriovenous Malformation with Residuals of Cognitive Dysfunction and Seizures The Veteran contends that he has a seizure disorder that is directly related to his active service. The Veteran was provided a VA epilepsy and narcolepsy examination in November 2004 relating to his claim for pension and special monthly pension benefits. The VA examiner diagnosed the Veteran with right parietal arteriovenous malformation with secondary seizures. The VA examiner noted that the Veteran had gamma knife surgery for a vascular malformation in the right parietal region ten years earlier. Additionally, the Veteran’s medical records reflect that he received treatment at the University of Virginia. However, the Veteran’s claims file does not contain these private medical records. On remand, the Veteran must be asked to complete authorization forms concerning any private medical treatment and/or submit copies of any relevant records related to his right parietal arteriovenous malformation and seizures. 38 U.S.C. § 5103A (c); 38 C.F.R. § 3.159 (c) (1). 5. Entitlement to Service Connection for an Acquired Psychiatric Disability to Include PTSD, Depression, and Anxiety The Veteran contends that he has PTSD that is causally related to his active service. Service connection for PTSD requires (1) medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125 (a); (2) a link, established by medical evidence, between current symptoms and an in-service stressor; and (3) credible supporting evidence that the claimed in-service stressor occurred. See 38 C.F.R. § 3.304 (f). 38 C.F.R. § 4.125 (a) requires that the diagnosis of PTSD must conform to the criteria of the American Psychiatric Association, Diagnostic and Statistical Manual for Mental Disorders (DSM). For cases certified to the Board after August 4, 2014, such as the present case, the diagnosis of PTSD must be in accordance with the DSM Fifth Edition (DSM-V). 38 C.F.R. § 4.125 (a) (2017); Schedule for Rating Disabilities-Mental Disorders and Definition of Psychosis for Certain VA Purposes, 80 Fed. Reg. 14,303 (March 19, 2015) (updating 38 C.F.R. § 4.125 to reference DSM-5). In June 2016, the Veteran submitted a statement describing an in-service stressor of being kicked between the testicles by a sergeant wearing his military boots and that due to the incident he has problems urinating. The Board finds that a remand is required so that the AOJ may take appropriate action to further identify and verify the in-service stressor reported by the Veteran. The Board notes that the in-service stressor reported by the Veteran relates to a personal assault. If a PTSD claim is based on in-service personal assault, evidence from sources other than the Veteran’s service records may corroborate the Veteran’s account of the stressor incident. VA will not deny a PTSD claim that is based on in-service personal assault without first advising the claimant that evidence from sources other than the Veteran’s service records or evidence of behavior changes may constitute credible supporting evidence of the stressor and allowing him or her the opportunity to furnish this type of evidence or advise VA of potential sources of such evidence. VA may submit any evidence that it receives to an appropriate medical or mental health professional for an opinion as to whether it indicates that a personal assault occurred. 38 C.F.R. § 3.304 (f) (5). In this case, there is no indication in the record that the Veteran has been provided the appropriate notice advising him that VA will consider evidence from sources other than the service treatment records. He has not been apprised of all types of evidence he may submit in support of his claim. On remand, the Veteran must be advised of the types of information and evidence necessary to substantiate a claim for service connection for PTSD based on in-service personal assault in accordance with 38 C.F.R. § 3.304 (f) (5). In addition, the private medical treatment records reflect that the Veteran has current diagnoses of depression and anxiety. Additionally, the November 2015 private treatment letter reflects that the Veteran attends comprehensive psychiatric and psychological therapy. However, the private psychiatric and psychological medical records are not part of the record. On remand, the Veteran must be asked to complete authorization forms concerning any private medical treatment and/or submit copies of any relevant records related to his psychiatric and psychological therapy. 38 U.S.C. § 5103A (c); 38 C.F.R. § 3.159 (c) (1). 6. Entitlement to a TDIU The claim for a TDIU is inextricably intertwined with the Veteran’s service connection claims. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (the prohibition against the adjudication of claims that are inextricably intertwined is based upon the recognition that claims related to each other should not be subject to piecemeal decision-making or appellate litigation). Additionally, the Board notes that the record for review may be incomplete. The most recent VA treatment records are from August 2017. VA treatment records, even if not in the claims file, are considered part of the record on appeal because they are within VA’s constructive possession. See 38 U.S.C. § 5103A (2012); Bell v. Derwinski, 2 Vet. App. 611 (1992). On remand, updated VA treatment records must be obtained and associated with the record. The matters are REMANDED for the following action: 1. Provide the Veteran with notice that meets the requirements under 38 U.S.C. § 5103A (b) (2) and 38 C.F.R. § 3.159 (e), including (a) the identity of specific records that cannot be obtained, (b) an explanation as to the efforts that were made to obtain the records, (c) a description of any further action to be taken by VA with respect to the claims, and (d) that the Veteran is ultimately responsible for providing the evidence. Specifically, the Veteran must be notified of the unavailability of his service treatment records, and informed of alternative sources of evidence he may provide to support his claims, including VA military files, statements from service medical personnel, buddy statements, employment physical examination reports, medical evidence from civilian/private medical providers by whom the Veteran was treated, and pharmacy prescription records, etc. The Veteran must also be asked to fill out the National Archives (NA) Form 13055 (Request for Information Needed to Reconstruct Medical Data) and the NA Form 13075 (Questionnaire about Military Service). The Veteran must be given an opportunity to respond. 2. If the Veteran completes and returns the NA Form 13055 and NA Form 13075 as requested above, the RO should contact the Records Reconstruction Unit of the NPRC, or any other appropriate agency or department, supply the Veteran’s completed NA Form 13055 and 13075, and request an additional search from alternate sources, including the Surgeon General’s Office (SGO) records, sick reports and any other sources. All efforts to obtain these records should be documented and any negative response should be recorded in the claims file. Efforts to obtain these records should only end if they do not exist or further efforts to obtain them would be futile. 38 C.F.R. § 3.159 (c) (2). 3. Obtain all outstanding treatment records relevant to the matters being remanded, to include from August 2017. 4. Contact the Veteran and request that he complete and submit to VA a signed authorization for disclosure of medical records to VA for each private medical health care provider from whom he has received treatment for the disabilities at issue on appeal. The Board is specifically interested in records relating to the Veteran’s January 2008 bilateral inguinal hernia surgery, his treatment at the University of Virginia related to his right parietal arteriovenous malformation and seizures, his diagnosis of bilateral carpal tunnel syndrome, and his psychiatric and psychological therapy. After receiving any completed authorization form(s), undertake all appropriate efforts to attempt to obtain the identified records. All development efforts with respect to this directive should be associated with the claims file. The Veteran is encouraged to submit directly to VA any outstanding, relevant medical records in her possession. 5. Request that the Veteran provide more specific details concerning the alleged in-service incident in which he was kicked by a sergeant. The Veteran should be asked to identify the names of people who were involved in the incident, the place where the incident occurred, and a more specific date or time frame for the incident. In accordance with 38 C.F.R. § 3.304 (f) (5), the Veteran must also be advised of the types of information and evidence necessary to substantiate a claim for service connection for PTSD based on an in-service personal assault. The Veteran must be informed that evidence from sources other than his service records may constitute credible supporting evidence of the stressor. The AOJ should review any response from the Veteran regarding the PTSD claim and prepare a complete summary of all claimed stressors based upon review of all pertinent evidence. The AOJ should make an appropriate request to the Joint Services Records Research Center (JSRRC) for verification of any stressors, as appropriate. Any additional development recommended by JSRRC should be accomplished. If the stressors cannot be verified, the AOJ should prepare a formal finding stating why verification could not be completed, and listing the steps taken in the attempt to verify the stressors 6. After completing the first four remand directives, forward the record and copy of this Remand to the examiner who conducted the March 2017 VA audiological examination or, if that examiner is not available, to an equally qualified VA clinician for preparation of an addendum opinion. After reviewing the record, the examiner is asked to address the following: (a.) Is it at least as likely as not (50 percent or greater probability) that the Veteran’s current bilateral hearing loss disability is caused by or otherwise etiologically related to service, to include in-service noise exposure? The VA examiner should address the June 1973 entrance examination containing an audiological examination. The examiner must note that, under applicable law, the absence of in-service evidence of a hearing loss disability is not always fatal to a service connection claim. See Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992). Evidence of a current hearing disability and a medically sound basis for attributing that disability to service may serve as a basis for a grant of service connection for hearing loss where there is credible evidence of acoustic trauma due to significant noise exposure in service. See Hensley v. Brown, 5 Vet. App. 155, 159 (1993). (b.) Is it at least as likely as not (50 percent or greater probability) that the Veteran’s current tinnitus is caused by or otherwise etiologically related to service, to include in-service noise exposure? (Continued on the next page)   7. After completion of the above, review the expanded record, including the evidence entered since the most recent statement of the case, and determine whether service connection and entitlement to a TDIU may be granted. If any benefit sought remains denied, furnish the Veteran with a supplemental statement of the case. The appropriate period should be allowed for response before the appeal is returned to the Board. KELLI A. KORDICH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD B. G. LeMoine, Associate Counsel