Citation Nr: 18151249 Decision Date: 11/16/18 Archive Date: 11/16/18 DOCKET NO. 10-21 890 DATE: November 16, 2018 ORDER As new and material evidence has not been received, the claim of entitlement to service connection for diabetes is not reopened. As new and material evidence has not been received, the claim of entitlement to service connection for a bilateral shoulder condition is not reopened. As new and material evidence has not been received, the claim of entitlement to service connection for a heart condition is not reopened. As new and material evidence has been received, the claim of entitlement to service connection for a back condition is reopened. As new and material evidence has been received, the claim of entitlement to service connection for a neck condition is reopened. As new and material evidence has been received, the claim of entitlement to service connection for a bilateral knee condition is reopened. As new and material evidence has been received, the claim of entitlement to service connection for hypertension is reopened. As new and material evidence has been received, the claim of entitlement to service connection for prostate condition is reopened. A compensable rating for erectile dysfunction is denied. An initial rating higher than 30 percent prior to December 6, 2012 and in excess of 70 percent thereafter for PTSD with alcohol abuse/dependence is denied. REMANDED Entitlement to service connection for a back condition is remanded. Entitlement to service connection for a neck condition is remanded. Entitlement to service connection for a bilateral knee condition is remanded. Entitlement to service connection for hypertension, to include as due to herbicide exposure and/or secondary to service-connected PTSD with alcohol abuse/dependence, is remanded. Entitlement to service connection for a prostate condition, to include as due to herbicide exposure and/or secondary to service-connected PTSD with alcohol abuse/dependence, is remanded. Entitlement to a total disability rating due to individual employability (TDIU) prior to December 6, 2012 is remanded. FINDINGS OF FACT 1. In a November 2013 VA rating decision, the claims of entitlement to service connection for diabetes, bilateral shoulder condition, neck condition, and bilateral knee condition were denied; the Veteran was notified of this action and of his appellate rights, but did not file a timely notice of disagreement (NOD) with respect to these issues or submit new and material evidence within a year thereafter. 2. The evidence received since the November 2013 VA rating decision, regarding service connection for diabetes, is cumulative and redundant and does not raise the possibility of substantiating this claim. 3. The evidence received since the November 2013 VA rating decision, regarding service connection for bilateral shoulder condition, is cumulative and redundant and does not raise the possibility of substantiating this claim. 4. The evidence received since the November 2013 VA rating decision, regarding service connection for neck condition, is not cumulative and redundant and raises the possibility of substantiating this claim. 5. In a June 1993 VA rating decision, the claim of entitlement to service connection for back condition was denied; the Veteran was notified of this action and of his appellate rights, but did not file a timely NOD with respect to that issue or submit new and material evidence within a year thereafter. 6. In December 2006 and November 2013 VA rating decisions, the claims to reopen service connection for back condition were denied; the Veteran was notified of these actions and of his appellate rights, but did not file a timely NOD with respect to that issue or submit new and material evidence within a year thereafter. 7. The evidence received since the November 2013 VA rating decision, regarding service connection for back condition, is not cumulative and redundant and raises the possibility of substantiating this claim. 8. The evidence received since the November 2013 VA rating decision, regarding service connection for bilateral knee condition, is not cumulative and redundant and raises the possibility of substantiating this claim. 9. In a November 2013 VA rating decision, the claim of entitlement to service connection for valvular heart disease and hypertrophic cardiomyopathy (claimed as heart problems/condition) was denied; the Veteran was notified of this action and of his appellate rights, but did not file a timely NOD with respect to that issue or submit new and material evidence within a year thereafter. 10. In a July 2015 VA rating decision, the claim to reopen service connection for valvular heart disease and hypertrophic cardiomyopathy (claimed as heart problems/condition) now claimed as coronary artery disease (CAD) was denied and in a March 2016 VA rating decision service connection for valvular heart disease and hypertrophic cardiomyopathy (claimed as heart problems/condition and CAD) was reopened and denied on the merits; the Veteran was notified of these actions and of his appellate rights, but did not file a timely NOD with respect to that issue or submit new and material evidence within a year thereafter. 11. The evidence received since the March 2016 VA rating decision, regarding service connection for a heart condition, is cumulative and redundant and does not raise the possibility of substantiating this claim. 12. In a November 2013 VA rating decision, the claims of entitlement to service connection for hypertension and prostate condition were denied and the previous denial was continued in November 2014 and April 2015 VA rating decisions on a secondary basis; the Veteran was notified of these actions and of his appellate rights, but did not file a NOD with respect to these issues or submit new and material evidence within a year thereafter. 13. The evidence received since the April 2015 VA rating decision, regarding service connection for hypertension and prostate condition, is not cumulative and redundant and raises the possibility of substantiating these claims. 14. For the entire appeal period, the Veteran’s erectile dysfunction has been manifested by loss of erectile power, but has not been manifested by penile deformity. 15. For the appeal period prior to December 6, 2012, the Veteran’s PTSD was not manifested by severe manifestations that more nearly approximate occupational and social impairment with reduced reliability and productivity, occupational and social impairment with deficiencies in most areas, or total occupational and social impairment. 16. For the period since December 6, 2012, the Veteran’s PTSD has not been manifested by more severe manifestations that more nearly approximate total occupational and social impairment. CONCLUSIONS OF LAW 1. The June 1993 VA rating decision denying entitlement to service connection for back condition is final. 38 U.S.C. § 7105(b), (d) (2012); 38 C.F.R. §§ 3.104, 20.302, 20.1103 (2018). 2. The December 2006 and November 2013 VA rating decisions, denying reopening the issue of entitlement to service connection for back condition, are final. 38 U.S.C. § 7105(b), (d); 38 C.F.R. §§ 3.104, 20.302, 20.1103. 3. The November 2013 VA rating decision denying entitlement to service connection for diabetes, bilateral shoulder condition, valvular heart disease and hypertrophic cardiomyopathy (claimed as heart problems/condition), neck condition, and bilateral knee condition is final. 38 U.S.C. § 7105(b), (d); 38 C.F.R. §§ 3.104, 20.302, 20.1103. 4. New and material evidence has not been received since the November 2013 VA rating decision to reopen the claim for service connection for diabetes. 38 U.S.C. §§ 1110, 5108, 7104(b) (2012); 38 C.F.R. §§ 3.156, 3.303 (2018). 5. New and material evidence has not been received since the November 2013 VA rating decision to reopen the claim for service connection for bilateral shoulder condition. 38 U.S.C. §§ 1110, 5108, 7104(b); 38 C.F.R. §§ 3.156, 3.303. 6. New and material evidence has been received since the November 2013 VA rating decision to reopen the claim for service connection for back condition. 38 U.S.C. §§ 1110, 5108, 7104(b); 38 C.F.R. §§ 3.156, 3.303. 7. New and material evidence has been received since the November 2013 VA rating decision to reopen the claim for service connection for neck condition. 38 U.S.C. §§ 1110, 5108, 7104(b); 38 C.F.R. §§ 3.156, 3.303. 8. New and material evidence has been received since the November 2013 VA rating decision to reopen the claim for service connection for bilateral knee condition. 38 U.S.C. §§ 1110, 5108, 7104(b); 38 C.F.R. §§ 3.156, 3.303. 9. The July 2015 and March 2016 VA rating decisions, denying reopening the issue of entitlement to service connection for valvular heart disease and hypertrophic cardiomyopathy (claimed as heart problems/condition) now claimed as CAD, are final. 38 U.S.C. § 7105(b), (d); 38 C.F.R. §§ 3.104, 20.302, 20.1103. 10. New and material evidence has not been received since the March 2016 VA rating decision to reopen the claim for service connection for a heart condition. 38 U.S.C. §§ 1110, 5108, 7104(b); 38 C.F.R. §§ 3.156, 3.303. 11. The April 2015 VA rating decision denying entitlement to service connection for hypertension and prostate condition is final. 38 U.S.C. § 7105(b), (d); 38 C.F.R. §§ 3.104, 20.302, 20.1103. 12. New and material evidence has been received since the April 2015 VA rating decision to reopen the claim for service connection for hypertension. 38 U.S.C. §§ 1110, 5108, 7104(b); 38 C.F.R. §§ 3.156, 3.303. 13. New and material evidence has been received since the April 2015 VA rating decision to reopen the claim for service connection for prostate condition. 38 U.S.C. §§ 1110, 5108, 7104(b); 38 C.F.R. §§ 3.156, 3.303. 14. The criteria for entitlement to a compensable rating for erectile dysfunction have not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.1, 4.20, 4.27, 4.31, 4.115b, Diagnostic Code (DC) 7522 (2018). 15. The criteria for entitlement to an initial rating in excess of 30 percent prior to December 6, 2012 and in excess of 70 percent thereafter for PTSD have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.126, 4.130, DC 9411 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from May 1966 to May 1968. In a July 2015 decision, the Board denied the Veteran’s claim for entitlement to an initial rating in excess of 30 percent prior to December 6, 2012 and in excess of 70 percent thereafter for PTSD with alcohol abuse/dependence. The Veteran appealed the July 2015 Board decision to the United States Court of Appeals for Veterans Claims (Court). In a February 2017 Memorandum Decision, the Court set aside the July 2015 Board decision and remanded this issue to the Board. In December 2017, the Board remanded the issue, along with TDIU, pursuant to the Memorandum Decision and these issues have been returned to the Board for appellate review. With regard to the issues of reopening service connection for diabetes, bilateral shoulder condition, and heart condition, as well as higher ratings for service-connected erectile dysfunction and PTSD, neither the Veteran nor his representative has raised any other issues with the duty to notify or duty to assist. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). New and Material Evidence Unappealed rating decisions are final with the exception that a claim may be reopened by the submission of new and material evidence. When an appellant seeks to reopen a claim based on new evidence, VA must first determine whether the additional evidence is “new and material.” Second, if VA determines that new and material evidence has been added to the record, the claim is reopened and VA must evaluate the merits of the appellant’s claim considering all the evidence, both new and old. Manio v. Derwinski, 1 Vet. App. 140 (1991); Barnett v. Brown, 83 F.3d 1380, 1383 (Fed. Cir. 1996); Butler v. Brown, 9 Vet. App. 167, 171 (1996). “New” evidence means evidence not previously submitted to VA decision makers. “Material” evidence means evidence that relates to an unestablished fact necessary to substantiate the claim. Cumulative or redundant evidence is not new and material. 38 C.F.R. § 3.156(a). To reopen, the new and material evidence must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). This is a low threshold that is meant to enable, rather than preclude, reopening. Shade v. Shinseki, 24 Vet. App. 110 (2010). The focus is not on whether the evidence remedies the principle reason for the previous denial, but whether the evidence, taken together, would at least trigger the duty to assist by providing a medical opinion. Id. at 117. 1. Diabetes The Agency of Original Jurisdiction (AOJ) initially denied the Veteran’s service connection claim for diabetes in a November 2013 rating decision. At that time, the relevant evidence of record consisted of the Veteran’s service treatment records, his post-service treatment records, and his lay statements. Upon consideration of this evidence, the AOJ denied the claim for diabetes, reasoning that the Veteran did not have a current valid diagnosis of diabetes. The Veteran was notified of this decision and of his appellate rights, but did not file a timely NOD or submit new and material evidence within one year of the November 2013 rating decision. Therefore, the November 2013 VA rating decision is final. 38 U.S.C. § 7105(c); 38 C.F.R. §§ 3.104, 20.302, 20.1103. The Board finds against reopening the claim of entitlement to service connection for diabetes. Since the November 2013 final denial on this matter, the evidence associated with the claims file includes the Veteran’s post-service treatment records and his lay statements. On careful review of the record, the Board has determined that new and material evidence to reopen the claim for service connection for diabetes has not been submitted. The claim was previously denied on the basis that the Veteran did not have diagnosis of diabetes. The evidence associated with the claims file is cumulative and does not establish that the Veteran has a current diagnosis of diabetes. Because the evidence submitted since the last final decision on this matter is cumulative and/or does not relate to an unestablished fact necessary to substantiate the claim for service connection for diabetes, the Veteran has not submitted new and material evidence. Thus, the Board concludes that new and material evidence has not been received to reopen the claim for service connection for diabetes. Therefore, the request to reopen the claim is denied. 2. Bilateral Shoulder The AOJ initially denied the Veteran’s service connection claims for bilateral shoulder condition in a November 2013 rating decision. At that time, the relevant evidence of record consisted of the Veteran’s service treatment records, his lay statements, and his post-service treatment records showing diagnoses of arthritis, impingement syndrome, and arthralgia. Upon consideration of this evidence, the AOJ denied the claim, reasoning that service treatment records did not show evidence of an in-service injury or manifestation of a bilateral shoulder condition. The Veteran was notified of this decision and of his appellate rights, but did not file a timely NOD or submit new and material evidence within one year of the November 2013 rating decision. Therefore, the November 2013 VA rating decision is final. 38 U.S.C. § 7105(c); 38 C.F.R. §§ 3.104, 20.302, 20.1103. Evidence received since the November 2013 VA rating decision includes new, but not material, evidence related to an unestablished fact necessary to substantiate this claim on appeal. As a result, this claim is not reopened. 38 U.S.C. §§ 1110, 5108; 38 C.F.R. §§ 3.156(a), 3.303. 3. Heart The AOJ initially denied the Veteran’s service connection claim for valvular heart disease and hypertrophic cardiomyopathy (claimed as heart problems/condition) in a November 2013 rating decision. At that time, the relevant evidence of record consisted of the Veteran’s service treatment records, his post-service treatment records, and his lay statements. Upon consideration of this evidence, the AOJ denied the claim for a heart condition, reasoning that there was no evidence of an in-service injury or manifestation of the disease. The Veteran was notified of this decision and of his appellate rights, but did not file a timely NOD or submit new and material evidence within one year of the November 2013 rating decision. Therefore, the November 2013 VA rating decision is final. 38 U.S.C. § 7105(c); 38 C.F.R. §§ 3.104, 20.302, 20.1103. In June 2015, the Veteran requested to reopen service connection for a heart condition. In a July 2015 VA rating decision, the claim to reopen service connection for valvular heart disease and hypertrophic cardiomyopathy (claimed as heart problems/condition) now claimed as CAD was denied. In a March 2016 VA rating decision, the claim was reopened but denied on the merits to include consideration of in-service herbicide exposure. The Veteran was notified of these actions and of his appellate rights, but did not file a timely NOD or submit new and material evidence within a year thereafter. Therefore, the March 2016 VA rating decision is final. Id. Evidence received since the March 2016 VA rating decision includes new, but not material, evidence related to an unestablished fact necessary to substantiate this claim on appeal. As a result, this claim is not reopened. 38 U.S.C. §§ 1110, 5108; 38 C.F.R. §§ 3.156(a), 3.303. 4. Back The AOJ initially denied the Veteran’s service connection claim for a back condition in a June 1993 rating decision. At that time, the relevant evidence of record consisted of the Veteran’s service treatment records, his post-service treatment records, and his lay statements. Upon consideration of this evidence, the AOJ denied the claim for a back condition. In so finding, the AOJ acknowledged the Veteran’s in-service reports of back pain during service, but found that the condition was asymptomatic and resolved at the time of the separation examination. The AOJ also indicated that the Veteran first reported having back pain in May 1990, decades after his discharge from service. Since there was no evidence of a chronic disease in service and no evidence of continuity of symptomatology since service, the AOJ denied the claim. The Veteran did not appeal or submit new and material evidence within one year of the June 1993 rating decision; thus, that denial of service connection for a back condition is final. 38 U.S.C. § 7105(c) (1991); 38 C.F.R. § § 3.104, 20.302, 20.1103 (1992). The Veteran filed a request to reopen his service connection claim in August 2006. The AOJ denied that request by way of a December 2006 rating decision, reasoning that the Veteran did not submit new and material evidence to support his claim. The relevant evidence at that time consisted of the Veteran’s service-treatment records, post-service treatment records, and lay statements of argument. The Veteran did not appeal or submit new and material evidence within one year of the December 2006 rating decision; thus, that decision is final. 38 U.S.C. § 7105(c) (2002); 38 C.F.R. § § 3.104, 20.302, 20.1103 (2006). The Veteran’s request to reopen his service connection claim was denied by way of a November 2013 rating decision. The relevant evidence at that time consisted of the Veteran’s service treatment records, post-service treatment records, and lay statements. The AOJ reasoned that the Veteran did not submit new and material evidence to substantiate his claim. The Veteran was notified of this decision and of his appellate rights, but did not file a timely NOD or submit new and material evidence within one year of the November 2013 rating decision. Therefore, the November 2013 VA rating decision is final. 38 U.S.C. § 7105(c); 38 C.F.R. §§ 3.104, 20.302, 20.1103. Evidence received since the November 2013 VA rating decision includes a November 2017 private treatment record which documents a current diagnosis of segmental and somatic dysfunction of the lumbar region. Since this evidence was not previously considered and it raises a possibility of substantiating the Veteran’s claim, it constitutes new and material evidence. As a result, this claim is reopened. 38 U.S.C. § 1110, 5108; 38 C.F.R. §§ 3.156(a), 3.303. 5. Neck The AOJ initially denied the Veteran’s service connection claim for a neck condition in a November 2013 rating decision. At that time, the relevant evidence of record consisted of the Veteran’s service treatment records, his post-service treatment records, and his lay statements. Upon consideration of this evidence, the AOJ denied the claim for a neck condition, reasoning that there was no evidence of an in-service injury or manifestation of a neck condition. The Veteran was notified of this decision and of his appellate rights, but did not file a timely NOD or submit new and material evidence within one year of the November 2013 rating decision. Therefore, the November 2013 VA rating decision is final. 38 U.S.C. § 7105(c); 38 C.F.R. §§ 3.104, 20.302, 20.1103. Evidence received since the November 2013 VA rating decision includes an August 2017 private psychiatric evaluation report which documents the Veteran’s reported in-service injury to the neck, characterized as heavy lifting of artillery while in Vietnam. Since this evidence raises a possibility of substantiating the Veteran’s claim, it constitutes new and material evidence. As a result, this claim is reopened. 38 U.S.C. § 1110, 5108; 38 C.F.R. §§ 3.156(a), 3.303. 6. Bilateral Knee The AOJ initially denied the Veteran’s service connection claims for bilateral knee condition in a November 2013 rating decision. At that time, the relevant evidence of record consisted of the Veteran’s service treatment records, his post-service treatment records, and his lay statements. Upon consideration of this evidence, the AOJ denied the claim, reasoning that service treatment records did not show evidence of an in-service injury or manifestation of a bilateral knee condition. The Veteran was notified of this decision and of his appellate rights, but did not file a timely NOD or submit new and material evidence within one year of the November 2013 rating decision. Therefore, the November 2013 VA rating decision is final. 38 U.S.C. § 7105(c); 38 C.F.R. §§ 3.104, 20.302, 20.1103. Evidence received since the November 2013 VA rating decision includes an August 2017 private psychiatric evaluation report which documents the Veteran’s reported bilateral knee discomfort and a June 2018 VA treatment record documenting injection treatment for the right knee. Since this evidence raises a possibility of substantiating the Veteran’s claim, it constitutes new and material evidence. As a result, this claim is reopened. 38 U.S.C. § 1110, 5108; 38 C.F.R. §§ 3.156(a), 3.303. 7. Hypertension The AOJ initially denied the Veteran’s service connection claim for hypertension in a November 2013 rating decision. At that time, the relevant evidence of record consisted of the Veteran’s service treatment records, his post-service treatment records, and his lay statements. Upon consideration of this evidence, the AOJ denied the claim for hypertension, reasoning that there was no evidence of an in-service injury or manifestation of the disease. In a December 2013 statement, the Veteran raised the theory of contention on a secondary basis due to his service-connected PTSD. In November 2014 and April 2015 VA rating decisions, the previous denial was continued. The Veteran was notified of these decisions and of his appellate rights, but did not file a timely NOD or submit new and material evidence within one year of the April 2015 rating decision. Therefore, the April 2015 VA rating decision is final. 38 U.S.C. § 7105(c); 38 C.F.R. § § 3.104, 20.302, 20.1103. Evidence received since the April 2015 VA rating decision includes a June 2018 written brief by the Veteran’s representative raising the contention of service connection for hypertension as due to in-service herbicide exposure. Since this theory was not previously considered and it raises a possibility of substantiating the Veteran’s claim, it constitutes new and material evidence. As a result, this claim is reopened. 38 U.S.C. § 1110, 5108; 38 C.F.R. §§ 3.156(a), 3.303. 8. Prostate The AOJ initially denied the Veteran’s service connection claim for a prostate condition in a November 2013 rating decision. At that time, the relevant evidence of record consisted of the Veteran’s service treatment records, his post-service treatment records, and his lay statements. Upon consideration of this evidence, the AOJ denied the claim for a prostate condition, reasoning that there was no evidence of an in-service injury or manifestation of a prostate condition. In a December 2013 statement, the Veteran raised the theory of contention on a secondary basis due to his service-connected PTSD. In November 2014 and April 2015 VA rating decisions, the previous denial was continued. The Veteran was notified of these decisions and of his appellate rights, but did not file a timely NOD or submit new and material evidence within one year of the April 2015 rating decision. Therefore, the April 2015 VA rating decision is final. 38 U.S.C. § 7105(c); 38 C.F.R. § § 3.104, 20.302, 20.1103. Evidence received since the April 2015 VA rating decision includes a July 2017 private treatment record showing current assessments of nodular prostate with lower urinary tract symptoms and benign prostatic hyperplasia (BPH) without lower urinary tract symptoms following clinical evaluation of the Veteran’s prostate. A November 2017 VA examination for male reproductive organ conditions also documented abnormal clinical findings of the prostate. Since this evidence was not previously considered and it raises a possibility of substantiating the Veteran’s claim, it constitutes new and material evidence. As a result, this claim is reopened. 38 U.S.C. § 1110, 5108; 38 C.F.R. §§ 3.156(a), 3.303. Increased Rating Disability evaluations are determined by evaluating the extent to which a Veteran's service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing his symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. If two evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation; otherwise, the lower evaluation will be assigned. 38 C.F.R. § 4.7. Staged ratings are appropriate for any rating claim when the factual findings show distinct time periods during the appeal period where the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007). The Veteran’s disability should be viewed in relation to its history. 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Where entitlement to compensation has already been established and an increase in the disability rating is at issue, such as for the service-connected erectile dysfunction in this case, the present level of disability is of primary concern. Although a rating specialist is directed to review the recorded history of a disability to make a more accurate evaluation, the regulations do not give past medical reports precedence over current findings. 38 C.F.R. § 4.2; Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Given the nature of the present claim for higher initial evaluations for service-connected PTSD with alcohol use/dependence, the Board has considered all evidence of severity since the effective date for the award of service connection in May 2007. Fenderson v. West, 12 Vet. App. 119 (1999). 9. Erectile Dysfunction As a preliminary matter, in the November 2013 VA rating decision, service connection for erectile dysfunction as a complication of his service-connected PTSD was granted. The Veteran was assigned a noncompensable (0 percent) rating effective for the entire rating period from February 23, 2012. See 38 C.F.R. § 4.115b, DC 7522. The Board also notes that the Veteran is already receiving special monthly compensation (SMC) for his erectile dysfunction, under 38 C.F.R. § 3.350(a), for loss of use of a creative organ. See 38 U.S.C. § 1114(k) (2018). Impotence is compensated by SMC, and that benefit has already been awarded to the Veteran. In September 2017, the Veteran’s request for a compensable rating for the issue on appeal was obtained and associated with the record. The Board considers whether a compensable rating for erectile dysfunction is warranted at any time since or within one year prior to the date of claim on September 26, 2017. Under DC 7522, a 20 percent rating is assigned for deformity of the penis with loss of erectile power. 38 C.F.R. § 4.115b. In every instance where the schedule does not provide a compensable evaluation for a diagnostic code, a noncompensable evaluation will be assigned when the requirements for a compensable evaluation are not met. 38 C.F.R. § 4.31. The Board notes that review of the regulations for evaluation of genitourinary conditions discloses no other diagnostic that more appropriately reflects the disability at issue. 38 C.F.R. §§ 4.20, 4.27. See Butts v. Brown, 5 Vet. App. 532 (1993) (choice of diagnostic code should be upheld if supported by explanation and evidence). Based on the evidence of record, the Board finds that a compensable evaluation for erectile dysfunction is not warranted. Although the Veteran has loss of erectile power, the medical evidence of record neither indicates, nor does he contend, that he has any physical deformity of his penis. The VA examination report and treatment records during the appeal period do not indicate any a physical deformity of the penis. Without evidence of deformity of the penis, there is no basis for the assignment of a compensable evaluation for erectile dysfunction. Here, the requirement under Diagnostic Code 7522 of deformity of the penis “with” loss of erectile power clearly means that both factors are required. 38 C.F.R. § 4.115b; see Melson v. Derwinski, 1 Vet. App. 334 (1991) (use of the conjunctive “and” in a statutory provision meant that all of the conditions listed in the provision must be met); compare Johnson v. Brown, 7 Vet. App. 95 (1994) (only one disjunctive “or” requirement must be met in order for an increased rating to be assigned). As such, a compensable rating for erectile dysfunction is not warranted. 10. PTSD with alcohol abuse/dependence The Veteran filed his initial claim requesting service connection for PTSD in May 2005 and the issue was denied in a December 2005 VA rating decision. On May 2, 2007, the Veteran’s claim to reopen the previously denied issue was obtained and the issue of service connection for PTSD was granted on the merits in a July 2009 Board decision. The Veteran was assigned a 30 percent disability rating for the entire appeal period effective from May 2, 2007. See 38 C.F.R. § 4.130, Diagnostic Code 9411. Within one year, the Veteran expressed disagreement with the initial disability rating assigned and perfected the issue on appeal. During the course of the appeal, in a February 2013 VA rating decision, a 70 percent disability rating was assigned effective from December 6, 2012 for PTSD with alcohol use/dependence. Id. Since the 30 and 70 percent disability ratings are not the maximum ratings available prior to December 6, 2012 or thereafter, the issue has been characterized accordingly. See AB v. Brown, 6 Vet. App. 35 (1993). As such, the Board considers whether an initial rating in excess of 30 percent prior to December 6, 2012 and in excess of 70 percent thereafter for PTSD with alcohol use/dependence is warranted in this case. All psychiatric disorders are evaluated under a general rating formula for mental disorders. 38 C.F.R. § 4.130. A 30 percent rating is assigned for occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with routine behavior, self-care, and normal conversation, due to such symptoms as depressed mood, anxiety, suspiciousness, panic attacks weekly or less often, chronic sleep impairment, and mild memory loss, such as forgetting names, directions, or recent events. A 50 percent rating is assigned for occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. A 70 percent evaluation is warranted for 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 situations (including work or a work-like setting); and inability to establish and maintain effective relationships. Finally, a total schedular rating of 100 percent is warranted when the disorder results in 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 mental and personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. The symptoms listed in the rating schedule are not intended to constitute an exhaustive list, but rather serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. See Mauerhan v. Principi, 16 Vet. App. 436 (2002). Nevertheless, all ratings in the general rating formula are associated with objectively observable symptomatology, and “a veteran may only qualify for a given disability rating under § 4.130 by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration.” Vazquez-Claudio v. Shinseki, 713 F.3d 112, 117 (Fed. Cir. 2013). Further, “§ 4.130 requires not only the presence of certain symptoms but also that those symptoms have caused occupational and social impairment in most of the referenced areas.” Id. Thus, “[a]lthough the veteran’s symptomatology is the primary consideration, the regulation also requires an ultimate factual conclusion as to the veteran's level of impairment in ‘most areas.’” Id. at 118. As such, the Board will consider both the Veteran’s specific symptomatology as well as the occupational and social impairment associated with the rating code to determine whether an increased evaluation is warranted. The nomenclature employed in the portion of VA’s Rating Schedule that addresses service-connected psychiatric disabilities is based upon the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, of the American Psychiatric Association (also known as “DSM-IV”). 38 C.F.R. § 4.130. The DSM-IV contains a Global Assessment of Functioning (GAF) scale, with scores ranging between zero and 100 percent, representing the psychological, social, and occupational functioning of an individual on a hypothetical continuum of mental health-illness. The Board notes that DSM-IV has been recently updated with a Fifth Edition (DSM-V). Effective August 4, 2014, VA issued an interim rule amending the portion of its Schedule for Rating Disabilities dealing with mental disorders and its adjudication regulations to refer to certain mental disorders in accordance with DSM-V. The provisions of the interim final rule only apply, however, to all applications for benefits that are received by VA or that are pending before the AOJ on or after August 4, 2014. The claim on appeal was originally certified to the Board in July 2009, thus, the DSM-IV applies in this case. According to the applicable rating criteria, when evaluating a mental disorder, the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the Veteran’s capacity for adjustment during periods of remission must be considered. 38 C.F.R. § 4.126(a). In addition, the evaluation must be based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner’s assessment of the level of disability at the moment of the examination. Id. Further, when evaluating the level of disability from a mental disorder, the extent of social impairment is considered, but the rating cannot be assigned solely the basis of social impairment. 38 C.F.R. § 4.126(b). A. Prior to December 6, 2012 Turning to the facts of the case, the Veteran’s initial assignment of a 30 percent disability rating was primarily based on the Veteran’s VA and private treatment records. According to the medical records, the Veteran endorsed sleep impairment and nightmares, along with alcohol dependence, but denied suicidal and homicidal ideations. There was no evidence of visual or auditory hallucinations and the Veteran was noted as “stable.” See Private Treatment Records from 2007 through 2010. At the June 2010 VA examination, the Veteran reported sleeping about four to six hours a night. He stated he had nightmares about once a week or once every two weeks. There was no evidence of panic attacks, homicidal or suicidal thoughts, or any significant impairments in thinking or communication. While he presented as a vague historian and indicated that he had memory problems, the clinician did not observe any gross memory deficits. His mental status examination was normal. While he did not maintain any friendships, he maintained a good relationship with his wife, children and grandchildren. The examiner indicated that the Veteran’s lack of social connectivity was by choice and appeared to be unrelated to his PTSD. He stated that he liked to work on cars and work in his yard. Ultimately, the clinician described his PTSD as chronic and mild. In an October 2011 medical assessment, the Veteran reported having intrusive thoughts and nightmares related to service, along with chronic sleep impairment. He stated that he did not like being around crowds or loud noises and he preferred to isolate himself. He self-medicated with alcohol and described issues with anger. He denied suicidal or homicidal thoughts and had a relatively normal mental status examination. Subsequent private treatment records reflect the Veteran’s chronic sleep impairment and nightmares, along with panic attacks once or twice a week. See Private Treatment Records dated May 2011 through October 2012. The Veteran also reported issues with isolation, anger, and alcohol consumption. See VA Treatment Notes dated February through May 2012. Additionally, the Veteran was assigned multiple GAF scores during the appeal period, to include a score of 62 by the July 2010 VA examiner. Scores between 61 and 70 reflect mild symptoms (e.g., depressed mood and mild insomnia), or some difficulty in social, occupational, or school functioning (e.g., occasional truancy, or theft within the household), but when the individual is functioning pretty well and has some meaningful interpersonal relationships. See 38 C.F.R. §§ 4.125, 4.130. Higher scores correspond to better functioning of the individual. Upon consideration of the evidence, the Board finds that an initial rating in excess of 30 percent is not warranted for the period prior to December 6, 2012. During this period, the Veteran endorsed issues with anger, isolation, and panic attacks, along with a longstanding history of alcohol consumption. While he had nightmares and sleep impairment, the Veteran did not endorse homicidal or suicidal ideation or hallucinations. The Veteran’s mental status remained relatively normal during this period. The Board finds that based on the objective medical evidence of record and the frequency, duration, and severity of his symptoms during this period, the currently assigned 30 percent rating adequately contemplates his symptoms, to include his alcohol consumption. The Veteran always remained oriented in all spheres and displayed no evidence of psychosis, mania, suicidal or homicidal ideations, or hallucinations. While he did not maintain effective social relationships, his judgment and concentration remained intact. Although he vaguely described having issues with memory on one occasion, the Board finds that this instance of memory issues is not substantial enough to warrant a higher rating. Similarly, the Board recognizes the Veteran’s reports of panic attacks, but finds that the severity, frequency, and duration of the panic attacks, in light of that of his other symptoms during the five-year time period, is not sufficient to assign a higher rating for the entire period. While considering the Veteran’s entire psychological history and his overall mental health picture as evidenced during the relevant period, the Board finds that the Veteran’s symptoms are adequately contemplated by the assigned 30 percent rating. As such, an initial rating in excess of 30 percent is not warranted prior to December 6, 2012. B. Since December 6, 2012 In a December 2012 letter, the Veteran’s treating psychologist indicated that the Veteran experienced intrusive thoughts about five to ten times per month, along with about half a dozen nightmares per month. He described significant sleep disturbance and issues with memory and concentration. The Veteran disliked crowds and noise and remained hypervigilant in many instances. He endorsed a tendency to isolate himself and remain emotionally detached. While he denied suicidal or homicidal thoughts, he rated his depression an eight or nine on a scale of one to ten. At the December 2012 VA examination, the examiner indicated that the Veteran had a significant and longstanding history of alcohol abuse/dependence secondary to his PTSD. The Veteran’s PTSD symptoms included depressed mood, anxiety, chronic sleep impairment, suspiciousness, and difficulty adapting to stressful circumstances. His alcohol abuse symptoms included mild memory loss, tremor/mild ataxia, social disinhibition, impaired impulse control and circumstantial speech. Both disabilities resulted in difficulty concentrating, irritability, and difficulty establishing and maintaining effective work and social relationships. The examiner found that the Veteran’s PTSD and alcohol abuse resulted in both social and occupational impairment with an occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. However, the Veteran was generally functioning satisfactorily with normal routine behavior, self-care, and conversation. The Veteran indicated that he and his wife recently separated, which led to him living alone. He stated that he had little social contact outside of his residence. The Veteran conceded having some issues with anger, and irritability, which impacted his social relationships. While the Veteran denied active or passive suicidal ideation, he did endorse passive homicidal ideation, particularly when he was frustrated or irritable. The examiner further noted that the Veteran’s PTSD and alcohol abuse had significant effects on his marriage, as indicated by his recent separation, and his isolation from others, which was secondary to his anger, irritability, and general social disinhibition. Subsequent treatment records reflect that the Veteran’s alcohol dependence was in early partial remission. While he continued to have nightmares and sleep impairment, he did not endorse homicidal or suicidal ideation. He also described instances of hypervigilance and hyperactive startle, along with flashbacks. He did report issues with concentration and short-term memory; however, his mental status examinations were otherwise relatively normal. See VA Treatment Records dated December 2013 to January 2015. At the March 2015 VA examination, the examiner diagnosed PTSD and mild alcohol use disorder. The Veteran reported having intrusive thoughts, avoidance symptoms, negative alterations in cognitions and mood, and marked alterations in arousal and reactivity. He also described drinking alcohol much less than previously. The examiner categorized the Veteran’s symptoms as moderate to severe. While the Veteran’s symptoms resulted in some difficulty in daily functioning, he generally functioned reasonably well and maintained some meaningful relationships with his family and his peer support group. However, he also had difficulty concentration, impaired memory, irritability, and some difficulty getting along with other people, along with decreased motivation and mood. While he described his mood as “a little depressed,” his mental status examination was otherwise relatively normal and denied any suicidal or homicidal thoughts and hallucinations. Ultimately, the examiner concluded that the Veteran’s mental health symptoms resulted in occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform tasks. However, he was generally functioning satisfactorily with normal routine behavior, self-care and conversation. In August 2017, the Veteran was afforded a private psychiatric assessment. The clinician discussed the Veteran’s history of PTSD symptoms and alcohol abuse and the impact the Veteran’s symptoms would have on his ability to work. Most recently, in July 2018, the Veteran was afforded a VA examination to assess the severity of his PTSD. At that time, the Veteran reported the following symptoms: flashbacks, avoidance, hyperarousal, hypervigilance, suspiciousness, depressed mood, anxiety, chronic sleep impairment, difficulty concentration, poor energy levels, decreased motivation, loss of interest in activities, and feeling detached from others. The clinician found that the Veteran’s disability caused occupational and social impairment with deficiencies in most areas. Additionally, the Veteran was assigned multiple GAF scores during the appeal period, to include a score of 55 by a VA examiner in a February 2013 addendum report. Scores between 51 and 60 reflect moderate symptoms (e.g., flat affect and circumstantial speech, occasional panic attacks) or moderate difficulty in social, occupational, or school functioning (e.g., few friends, conflicts with peers or co-workers). See 38 C.F.R. §§ 4.125, 4.130. Higher scores correspond to better functioning of the individual. Based on the above, the Board finds that an initial rating higher than 70 percent is not warranted, as the Veteran’s PTSD does not meet, or more nearly approximate, total occupational and social impairment. Specifically, the evidence of record since December 6, 2012 does not show the Veteran has total social and occupational impairment. The clinical evidence of record does not establish, and the Veteran has not alleged, gross impairment in thought processes or communication, delusions, hallucinations, grossly inappropriate behavior, intermittent inability to perform activities of daily living or disorientation to time or place. The Veteran maintains relations with his spouse albeit strained with multiple periods of separation. He also endorses anger, chronic sleep impairment, some alcohol dependence, irritability, and flashbacks. He has consistently denied suicidal and homicidal ideations and while the Veteran has reported memories difficulties, memory loss for names of close relatives, own occupation or own name has not been demonstrated. See Vazquez-Claudio, 713 F.3d at 116-17. In conclusion, the Veteran does not manifest either the symptomatology or the impairment required for a 100 percent rating for the service-connected PTSD at any time during the appeal period since December 6, 2012. In so concluding, the Board finds that the Veteran’s report of symptomatology to be credible, and the Board has resolved inconsistencies in his favor. However, when it comes to the overall impact on his occupational and social functioning, the Board places greater probative weight to the lay and medical evidence, including expert examiner opinions as to occupational and social impact, which reflects that the overall frequency, severity and duration of symptoms does not meet, or more nearly approximate, the criteria for a 100 percent schedular rating. As such, an initial rating in excess of 70 percent is not warranted since December 6, 2012. Lastly, with regard to both issues on appeal decided above for higher ratings, the Board has considered the Veteran’s reported history of symptomatology related to the service-connected erectile dysfunction and PTSD pursuant to seeking VA compensation benefits and at VA and private treatment sessions. He is competent to report such symptoms and observations because this requires only personal knowledge as it comes through one’s senses. Layno v. Brown, 6 Vet. App. 465, 470 (1994). However, his statements do not rise to a level of competency to identify the specific level of psychiatric impairment according to the appropriate diagnostic codes and relevant rating criteria. In this case, such competent evidence concerning the nature and extent of the Veteran’s disabilities has been provided in the medical evidence of record. As such, the Board finds these records to be more probative than the Veteran’s subjective reports of worsened symptomatology. See Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991). REASONS FOR REMAND 1. Entitlement to service connection for a back condition 2. Entitlement to service connection for a neck condition 3. Entitlement to service connection for a bilateral knee condition Due to the similar dispositions for the claims on appeal, the Board will address them in a common discussion below. Review of the record shows that private treatment records dated in November 2017 show treatment and diagnoses of the lumbar and cervical spines. The August 2017 private psychiatric evaluation report and June 2018 VA treatment record document treatment for and reported bilateral knee pain. A March 2011 VA treatment record shows the Veteran’s report of aching knees and long history of pain in various joints. The Board also notes that the August 2017 private psychiatric evaluation report noted the Veteran’s reported heavy lifting of artillery shells while in Vietnam during his period of active service. As such, the Board finds that additional development is needed to determine the existence and etiology of the Veteran’s neck, back, and bilateral knee conditions. See 38 U.S.C. § 1110; 38 C.F.R. § 3.303 (2018); McLendon v. Nicholson, 20 Vet. App. 79 (2006). 4. Entitlement to service connection for hypertension, to include as due to herbicide exposure and/or secondary to service-connected PTSD with alcohol abuse/dependence As noted above, the Veteran’s representative raised the theory of entitlement to service connection for hypertension as due to the Veteran’s in-service herbicide exposure in a June 2018 written brief. Review of the record shows that while a March 2015 VA examiner provided a medical opinion regarding the etiology of the Veteran’s hypertension on a direct and secondary basis regarding causation, the record is silent for any consideration by a VA examiner regarding the Veteran’s presumed in-service herbicide exposure and aggravation of the service-connected PTSD on hypertension. As such, the Board finds that additional development is needed to determine the etiology of the Veteran’s hypertension on a direct basis and secondary basis regarding aggravation. See 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.310 (2018); McLendon, 20 Vet. App. at 79. 5. Entitlement to service connection for a prostate condition, to include as due to herbicide exposure and/or secondary to service-connected PTSD with alcohol abuse/dependence At the October 2013 VA examination for male reproductive system conditions, the Veteran was diagnosed with erectile dysfunction and prostate hypertrophy; however, a medical opinion regarding the etiology of the diagnosed prostate condition was not provided. In December 2013, the Veteran requested service connection for his prostate condition as secondary to his service-connected PTSD, and as noted above, review of the record shows the Veteran served in Vietnam and there is no affirmative evidence that the Veteran did not have herbicide exposure therein. As noted above, during the course of the appeal, a July 2017 private treatment record shows current assessments following clinical evaluation of the Veteran’s prostate. As such, the Board finds that additional development is needed to determine the existence and etiology of the Veteran’s current prostate disorder on direct and secondary bases. See 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.310 (2018); McLendon, 20 Vet. App. at 79. 6. Entitlement to TDIU prior to December 6, 2012 In December 2017, the Board determined that the issue of TDIU was raised during the appeal period for higher initial ratings for service-connected PTSD with alcohol abuse/dependence. See Rice v. Shinseki, 22 Vet. App. 447 (2009). During the course of the appeal, the issue of TDIU was granted in a September 2018 VA rating decision effective from December 6, 2012, which represents a full grant of the benefits sought during the appeal period since December 6, 2012 so it is no longer on appeal before the Board. As a result, the issue of TDIU prior to December 6, 2012 (May 2, 2007 to December 5, 2012) remains on appeal for appellate review. When the percentage requirements are not met under 38 C.F.R. § 4.16(a), entitlement to TDIU on an extraschedular basis may be granted in exceptional cases when the Veteran is unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities. 38 C.F.R. § 4.16(b). After review of the record, the Veteran’s combined schedular disability ratings do not meet the minimum requirements in 38 C.F.R. § 4.16(a) for consideration of a TDIU on a schedular basis at any time during the appeal period prior to December 6, 2012. See 38 C.F.R. § 4.25 (2018). As a result, the Board considers whether there is evidence to warrant assignment of a TDIU rating on an extraschedular basis, pursuant to 38 C.F.R. § 4.16(b). During the course of the appeal, a December 2012 statement from VA Vet Center treating physicians concluded the Veteran has been unemployed since 2010 and PTSD continues to limit him occupationally by making it difficult to maintain substantial gainful activity. In May 2012 and December 2013, the Veteran completed VA Forms 21-8940 in which he reported that his service-connected PTSD prevents him from securing or following any substantially gainful occupation and last worked full time in 2009/2010 as a security officer. In a June 2017 statement, the Veteran reported he was initially hired as a day-time security guard but quickly transitioned to the night shift because he could not stand to be around people and was quickly irritated by people asking him questions. He also noted frequently drinking before his work shifts and while on the job and ultimately left because of his service-connected PTSD. In the August 2017 private psychiatric evaluation report, the clinician concluded it is at least as likely as not that the Veteran is unable to secure and follow a substantially gainful employment, part time or full time, solely due to service-connected PTSD, and this has been true from December 2009 when he quit his job as a night security guard to the present. The Board finds the pertinent evidence discussed above raises the question of whether the Veteran’s service-connected PTSD with alcohol abuse/dependence rendered him unable to follow a substantially gainful occupation during the appeal period prior to December 6, 2012. The matters are REMANDED for the following actions: 1. Refer the issue of entitlement to a TDIU prior to December 6, 2012 (May 2, 2007 to December 5, 2012) to the Director of the Compensation Service for extraschedular consideration consistent with 38 C.F.R. § 4.16(b). 2. Then, schedule the Veteran for an examination with an appropriate clinician for his back condition. The entire claims file and a copy of this remand must be made available to the examiner for review, and the examiner must specifically acknowledge receipt and review of these materials in any reports generated. The examiner must provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s back condition (i) began during active service, (ii) is related to an incident of service, to include heavy lifting while performing in-service duties and documented treatment for pain in 1968, or (iii) if any present symptoms of arthritis began within one year after discharge from active service. The examiner must provide all findings, along with a complete rationale for his or her opinion(s) in the examination report. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion. 3. Schedule the Veteran for an examination with an appropriate clinician for his neck condition. The entire claims file and a copy of this remand must be made available to the examiner for review, and the examiner must specifically acknowledge receipt and review of these materials in any reports generated. The examiner must provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s neck condition (i) began during active service, (ii) is related to an incident of service, to include heavy lifting while performing in-service duties, or (iii) if any present symptoms of arthritis began within one year after discharge from active service. The examiner must provide all findings, along with a complete rationale for his or her opinion(s) in the examination report. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion. 4. Schedule the Veteran for an examination with an appropriate clinician for his bilateral knee condition. The entire claims file and a copy of this remand must be made available to the examiner for review, and the examiner must specifically acknowledge receipt and review of these materials in any reports generated. The examiner must provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that any current right and/or left knee disorder (i) began during active service, (ii) is related to an incident of service, to include heavy lifting while performing in-service duties, or (iii) if any present symptoms of arthritis began within one year after discharge from active service. The examiner must provide all findings, along with a complete rationale for his or her opinion(s) in the examination report. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion. 5. Schedule the Veteran for an examination with an appropriate clinician for his hypertension. The entire claims file and a copy of this remand must be made available to the examiner for review, and the examiner must specifically acknowledge receipt and review of these materials in any reports generated. The examiner must opine as to the following: (a.) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s hypertension is related to an incident of service, to include presumed herbicide exposure. (b.) Whether it is at least as likely as not that the Veteran’s hypertension was aggravated beyond its natural progression by his service-connected PTSD with alcohol abuse/dependence. The examiner must provide all findings, along with a complete rationale for his or her opinion(s) in the examination report. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion. 6. Schedule the Veteran for an examination with an appropriate clinician for his prostate disorder. The entire claims file and a copy of this remand must be made available to the examiner for review, and the examiner must specifically acknowledge receipt and review of these materials in any reports generated. The examiner must opine as to the following: (a.) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s current prostate disorder began during active service or is related to an incident of service, to include presumed herbicide exposure. (b.) Whether it is at least as likely as not that the Veteran’s current prostate disorder was proximately due to or the result of his service-connected PTSD with alcohol abuse/dependence. (c.) Whether it is at least as likely as not that the Veteran’s current prostate disorder was aggravated beyond its natural progression by his service-connected PTSD with alcohol abuse/dependence. The examiner must provide all findings, along with a complete rationale for his or her opinion(s) in the examination report. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion. 7. Then, review the examination reports and medical opinions to ensure that the requested information was provided. If any report or opinion is deficient in any manner, the RO must implement corrective procedures. (Continued on the next page)   8. Then, readjudicate the claims. If any decision is adverse to the Veteran, issue a Supplemental Statement of the Case and allow the applicable time for response. Then, return the case to the Board. T. Blake Carter Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. Orie, Associate Counsel