Citation Nr: 18152295 Decision Date: 11/21/18 Archive Date: 11/21/18 DOCKET NO. 16-49 460 DATE: November 21, 2018 ISSUES 1. Entitlement to service connection for vision impairment, claimed as eyesight loss. 2. Entitlement to an effective date prior to July 31, 2015 for the 50 percent rating for post-traumatic stress disorder (PTSD), also claimed as sleeplessness and chronic depression. 3. Entitlement to service connection for hypertension, claimed as high blood pressure, to include as secondary to service-connected post-traumatic stress disorder. 4. Entitlement to service connection for hemorrhoids with blood in stool. 5. Entitlement to service connection for a hernia disability. 6. Entitlement to service connection for a dental disability, claimed as teeth damage, temporomandibular disorder (TMJ), grinding. 7. Entitlement to an evaluation in excess of 10 percent for fracture of the right ankle. 8. Entitlement to an evaluation in excess of 50 percent from July 31, 2015 for post-traumatic stress disorder, also claimed as sleeplessness and chronic depression. ORDER Entitlement to service connection for vision impairment, claimed as eyesight loss, is denied. Entitlement to an effective date prior to July 31, 2015 for the 50 percent rating for PTSD, also claimed as sleeplessness and chronic depression, is denied. REMANDED Entitlement to service connection for hypertension, claimed as high blood pressure, to include as secondary to service-connected PTSD is remanded. Entitlement to service connection for hemorrhoids with blood in stool is remanded. Entitlement to service connection for a hernia disability is remanded. Entitlement to service connection for a dental disability, claimed as teeth damage, TMJ, grinding is remanded. Entitlement to an evaluation in excess of 10 percent for fracture of the right ankle is remanded. Entitlement to an evaluation in excess of 50 percent from July 31, 2015 for post-traumatic stress disorder, also claimed as sleeplessness and chronic depression is remanded. FINDINGS OF FACT 1. Vision impairment, also claimed as eyesight loss, is a refractive error, rather than a disability due to disease or injury, for which VA compensation is available. 2. The Veteran filed his initial application for service connection for post-traumatic stress disorder, received by VA on September 19, 2003. 3. A January 4, 2011 rating decision granted service connection for post-traumatic stress disorder. The RO assigned a 30 percent rating effective September 19, 2003. 4. The Veteran filed his claim for an increased rating for post-traumatic stress disorder, also claimed as sleeplessness and chronic depression, received by VA on July 31, 2015. 5. Prior to July 31, 2015, there were no pending claims for PTSD that remained unadjudicated, nor is it factually ascertainable that the Veteran’s disability increased in severity during the one-year period preceding his July 31, 2015 claim for an increased rating. 6. A December 29, 2015 rating decision later granted a 50 percent rating for post-traumatic stress disorder, also claimed as sleeplessness and chronic depression, effective July 31, 2015. CONCLUSIONS OF LAW 1. Vision impairment claimed as and manifested by poor eyesight was not incurred in or aggravated by service. 38 U.S.C. §§ 1110, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304, 4.9 (2017). 2. There is no legal entitlement to an effective date prior to July 31, 2015, for the grant of a 50 percent rating for post-traumatic stress disorder, also claimed as sleeplessness and chronic depression. 38 U.S.C. §§ 5101, 5110 (2012); 38 C.F.R. § 3.400 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1992 to October 2000. This matter is before the Board of Veterans Appeals (Board) on appeal from a December 2015 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Anchorage, Alaska. During the pendency of this appeal, a January 2017 rating decision in part denied entitlement to a total disability rating based on individual unemployability (TDIU). The issue was fully adjudicated. The Veteran has not filed a timely Notice of Disagreement (NOD) with respect to this issue. Therefore, it is not before the Board at this time. As a threshold matter, the Board observes that this Decision and Remand encompasses the issues of entitlement to an effective date prior to July 31, 2015 for the 50 percent rating for PTSD, also claimed as sleeplessness and chronic depression; and evaluation of PTSD, currently rated at 50 percent disabling. These involve the same service-connected disability. Here, we have issued a decision with respect to the earlier effective date claim. The increased rating claim has been remanded for additional development. As discussed later, the increased rating claim being remanded only concerns the period effective July 31, 2015. In other words, it does not include the period prior to July 31, 2015. That consideration is part of the earlier effective date claim, for which we have issued a decision below. Duties to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations impose obligations on VA to provide claimants with notice and assistance. 38 U.S.C. §§ 5102, 5103, 5103A, 5107 (2012); 38 C.F.R. §§3.102, 3.156(a), 3.159, 3.326(a) (2017). The Veteran in this case has not referred to any deficiencies in either the duties to notify or assist; therefore, the Board may proceed to the merits of the claim. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015, cert denied, U.S.C. Oct.3, 2016) (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 [appellant] fails to raise them before the Board”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to an appellant's failure to raise a duty to assist argument before the Board). The Board has reviewed all of the evidence in the Veteran’s claims file. Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by the Veteran or obtained on his behalf be discussed in detail. Rather, the Board’s analysis below will focus specifically on what evidence is needed to substantiate the claim and what the evidence in the claims file shows, or fails to show, with respect to the claim. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) and Timberlake v. Gober, 14 Vet. App. 122, 128-130 (2000). 1. Entitlement to service connection for vision impairment, claimed as eyesight loss The Board incorporates its discussion from the sections above by reference. To establish service connection a Veteran must generally 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). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). VA is required to give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits. 38 U.S.C. § 1154 (a). Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). By way of background, the Service Treatment Records (STRs) include a February 2000 Report of Medical Examination from months before the Veteran was recommended for separation by a Medical Board. The Veteran wrote, “I am not in good health.” He denied wearing glasses or contact lenses, and denied vision in both eyes. The related contemporaneous Report of Medical Examination disclosed a clinically normal evaluation of the head, face, neck and scalp, and eyes – general. It did not indicate evidence of corrective vision care. Additional STRs include a Medical Evaluation Board Narrative with examination from February 2000. It shows ongoing impressions of and treatment for a right knee disability. The Veteran was found to be physically unfit due to this and it was recommended that he be discharged. It follows that there is no other separation examination of record. Years later, the Veteran filed his claims currently on appeal, received by VA on July 31, 2015. A December 2015 rating decision denied the Veteran’s various claims, including for service connection for impaired vision claimed as eyesight loss. In February 2016, the Veteran filed a VA Form 9 and Notice of Disagreement (NOD) with attached lay argument, all received by VA in February 2016. We have construed these documents as his timely NOD, and there has been no prejudice to the Veteran. The Board observes that the claimed eyesight loss or refractive error is not a service-connectable disability entity for VA purposes. The term “disability,” as used for VA purposes, refers to a condition resulting in an impairment of earning capacity. Allen v. Brown, 7 Vet. App. 439, 448 (1995). Refractive errors of the eyes are congenital or developmental defects and not disease or injury within the meaning of applicable legislation. 38 C.F.R. §§ 3.303 (c), 4.9; McNeely v. Principi, 3 Vet. App. 357, 364 (1992). In the absence of superimposed disease or injury, service connection may not be allowed for refractive error of the eyes, including myopia, presbyopia, and astigmatism, even if visual acuity decreased in service, as this is not a disease or injury within the meaning of applicable legislation relating to service connection. Id. Indeed, VA regulations specifically prohibit service connection for refractory errors of the eyes unless such defect was subjected to a superimposed disease or injury which created additional disability. See VAOPGCPREC 82-90 (July 18, 1990) (cited at 55 Fed. Reg. 45,711) (Oct. 30, 1990) (service connection may not be granted for defects of congenital, developmental or familial origin, unless the defect was subject to a superimposed disease or injury). Post-service VA treatment records reflect that the Veteran denied blurred vision, however, he reported photophobia in April 2002. See, e.g., April 12, 2002 Primary Care Note. Years later, the Veteran reported spots in his eyes and halos around people before the onset of headaches. See, e.g., February 26, 2010 Primary Care Note. In more recent VA treatment records, the Veteran repeatedly denied problems with vision. In this case, there is also no evidence that the Veteran’s claimed eyesight loss has caused any impairment of earning capacity or is a manifestation of other disease or injury for which service connection may be granted at this time. To the extent the Veteran contends he has impairment from his time in service, it would not be subject to compensation because it is still not a disease or injury within the law providing for compensation. 38 U.S.C. § 1110. While service connection may be granted, in limited circumstances, for superimposed disability on a constitutional or developmental abnormality, there is no allegation or evidence that such occurred in this case. See VAOPGCPREC 82-90, 55 Fed. Reg. 45,711 (1990); see also Carpenter v. Brown, 8 Vet. App. 240, 245 (1995); Monroe v. Brown, 4 Vet. App. 513, 514-15 (1993). In other words, there is also no need to address aggravation because the Veteran does not establish that a particular injury or disease resulting in disability was incurred coincident with service. 38 C.F.R. § 3.303. As such, a consideration of the presumption of soundness is not applicable. In the absence of proof of another current disability for which service connection may be granted, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223 (1992). Accordingly, the claim is denied as a matter of law. 2. Entitlement to an effective date prior to July 31, 2015 for the 50 percent rating for post-traumatic stress disorder, also claimed as sleeplessness and chronic depression The Board incorporates its discussion from the sections above by reference. As referenced in the Introduction and the Remand sections, this decision is for the earlier effective date claim, which necessarily includes the one year prior to the date of application for an increased rating, July 31, 2015. In other words, the decision covers the period from July 31, 2014 to July 31, 2015. The issue of evaluation of PTSD, currently rated at 50 percent disabling effective July 31, 2015, is discussed as a separate issue in the Remand section below. Unless specifically provided otherwise in this chapter, the effective date of an award based on an original claim, a claim reopened after final adjudication, or a claim for increase, of compensation, dependency and indemnity compensation, or pension, shall be fixed in accordance with the facts found, but shall not be earlier than the date of receipt of application therefor. 38 U.S.C. § 5110 (a) Subsection (b) provides: (1) The effective date of an award of disability compensation to a veteran shall be the day following the date of the veteran’s discharge or release if application therefor is received within one year from such date of discharge or release. (2) (A) The effective date of an award of disability compensation to a veteran who submits an application therefor that sets forth an original claim that is fully-developed (as determined by the Secretary) as of the date of submittal shall be fixed in accordance with the facts found, but shall not be earlier than the date that is one year before the date of receipt of the application. (3) The effective date of an award of increased compensation shall be the earliest date as of which it is ascertainable that an increase in disability had occurred, if application is received within one year from such date. 38 U.S.C. § 5110 (b). Subject to the provisions of section 5101 of this title, where compensation, dependency and indemnity compensation, or pension is awarded or increased pursuant to any Act or administrative issue, the effective date of such award or increase shall be fixed in accordance with the facts found but shall not be earlier than the effective date of the Act or administrative issue. In no event shall such award or increase be retroactive for more than one year from the date of application therefor or the date of administrative determination of entitlement, whichever is earlier. 38 U.S.C. § 5110 (g). In relation to claims for an increased rating, the effective date is the date of receipt of the claim or the date entitlement arose, whichever is later. 38 C.F.R. § 3.400 (o). The exception to this rule states that the effective date of an award of increased compensation will be the earliest date that it is factually ascertainable that an increase in disability occurred, if a claim or a statement of intent to file a claim is received within one year of the date of increase. 38 U.S.C. § 5110 (b)(3); 38 C.F.R. § 3.400 (o)(2); Gaston v. Shinseki, 605 F. 3d 979, 983 (Fed. Cir. 2010). If it is not factually ascertainable that an increase in disability has occurred within the one-year period, the effective date is the date of receipt of claim. The Board notes that the mere existence of medical evidence of a disorder does not establish an intent to seek service connection, or entitlement to an earlier effective date. See Brannon v. West, 12 Vet. App. 32, 35 (1998); Lalonde v. West, 12 Vet. App. 377, 382 (1999). Rather, a formal or informal claim must be filed in order for any type of benefit to accrue or be paid, and a claim for service connection must indicate an intent to apply for that benefit. See 38 U.S.C. § 5101 (a); 38 C.F.R. §§ 3.151 (a), 3.155(a); Jones v. West, 136 F.3d 1296, 1299 (Fed. Cir. 1998). A review of the procedural history is instructive. The Veteran filed a claim for service connection received by VA on September 19, 2003. Next, a January 5, 2005 rating decision denied service connection for post-traumatic stress disorder (PTSD). An October 18, 2005 rating decision also denied service connection for major depressive disorder (MDD). The Veteran timely appealed. Next, following an April 2009 Board Remand, the RO issued a January 4, 2011 rating decision granting service connection for PTSD. A 30 percent rating was assigned from September 19, 2003, the Veteran’s original date of claim. This rating decision became final. Years later, the Veteran filed a new claim received by VA on July 31, 2015. He listed symptoms of “sleeplessness and chronic depression.” The RO construed this as a claim for an increased rating and earlier effective date for PTSD, and the Veteran did not contend otherwise. The appeal continued. A December 29, 2015 rating decision granted an increased rating of 50 percent for post-traumatic stress disorder, also claimed as sleeplessness and chronic depression. This was effective July 31, 2015, the date of the Veteran’s claim for an increased rating. The Veteran timely appealed, and the case is now before the Board. The Veteran contends that he is entitled to an earlier effective date for the 50 percent rating for PTSD with sleeplessness and chronic depression. Because the Veteran’s January 4, 2011 rating decision for PTSD became final, the only date of claim to which the Board could assign the effective date is July 31, 2015. This is the current effective date for the 50 percent evaluation. It follows that the claim has not been continuously on appeal since the original grant of service connection. The next step is to ascertain the date that the Veteran’s entitlement arose. As the date entitlement arose is later than the date of claim, it cannot be used to award an earlier effective date. Having determined that the effective date in this case is the date of claim, and the only relevant date of claim for an increased rating for PTSD is July 31, 2015, the Board must now assess whether it is factually ascertainable that the Veteran’s disability increased in severity during the one year prior to his date of claim. Pursuant to Gaston, if there is evidence of worsening of the disability within the one-year period, the effective date becomes the date that the worsening of the disability is factually ascertainable. 605 F. 3d 979. By way of background, five years prior to the December 2015 VA examination upon which the current 50 percent evaluation is largely based, the Veteran had been afforded a November 2010 VA examination. The November 2010 VA examination showed that the Veteran’s occupational and social functioning was “moderate.” There was occasional decrease in work efficiency but “generally satisfactorily functioning.” He was gainfully employed and taking care of one of his children. He was currently taking two classes and working toward a degree to become a paralegal. Later VA treatment records show ongoing treatment for and impressions of PTSD. A September 2014 VA Mental Health Note shows, “The pts psychotropic medications were reviewed, no side effects reported, no changes made. The pt notes that he continues to work as a fireman and as a paralegal. He reports job satisfaction with both professions.” A February 2015 VA Mental Health Note is similar. It shows, “The pts psychotropic medications were reviewed, no side effects reported, no changes made. The pt notes that he lost his job as a paralegal, ‘because the attorney that I was working for got disbarred. She didn’t tell me that she was fighting it for 8 years.’ The pt continues to work at the local fire department as a fire-fighter. He reports job satisfaction. The pt denies SI/HI or sx of psychosis. He is pleasant, cooperative, and easy to engage in conversation.” Likewise, the December 2015 VA examiner opined that PTSD was manifested by, “Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation.” The Veteran earned his associate’s degree in paralegal studies in 2011. He rented a duplex. He had flashbacks two to three times per month. His last bar fight was in March 2015. He was able to work as a part time fire fighter and EMT for weekend call. He reported taking psychotropic medication, which he found helpful. Additional VA treatment records are substantially the same, and show ongoing psychiatric care. In the instant case, we find that it is not factually ascertainable that there was an increase in severity of the Veteran’s PTSD one year prior to July 31, 2015. The Board observes that the Veteran’s PTSD was rated at 30 percent from September 2003 until he filed his claim in July 2015. There is no medical or lay evidence in the record indicating that the worsening of PTSD was factually ascertainable between July 31, 2014 and July 31, 2015. We note that psychiatric symptoms may wax and wane, and have considered the frequency of reported symptoms. See Vazquez-Claudio v. Shinseki, 713 F.3d 112, 116-17 (Fed. Cir. 2013). The Board acknowledges the Veteran’s sincere belief that he is entitled to an earlier effective date. The appropriate effective date for the award of a 50 percent increased rating for PTSD in this case is July 31, 2015, the date of receipt of the Veteran’s claim for an increased rating for PTSD. 38 U.S.C. § 5110 (b)(3) (2012); 38 C.F.R. § 3.400 (o) (2017). Therefore, we conclude that an effective date prior to July 31, 2015 for the grant of a 50 percent rating for PTSD is not warranted. Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). In reaching these conclusions, the Board finds that the preponderance of the evidence is against the claims. As such, the benefit of the doubt rule is not for application, and the claims must be denied. 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). REASONS FOR REMAND 1. Entitlement to service connection for hypertension, claimed as high blood pressure, to include as secondary to post-traumatic stress disorder is remanded. The Board incorporates its discussion from the sections above by reference. A remand to the agency of original jurisdiction (AOJ) is necessary for additional development for review and disposition through an Supplemental Statement of the Case (SSOC), pursuant to 38 C.F.R. §§ 19.31 and 19.37(a). In lay argument attached to his February 2016 Notice of Disagreement (NOD), the Veteran clarified his theory of entitlement and reasons for disagreement: Hypertension as a result of untreated PTSD in the service, also documented in the service but either treated with Aspirin or ignored at Aid stations as migraines or hypochondriac rants. VA reevaluation of current rating was unnecessary but also overlooked concurrent medical issues steaming from medical issues already on file or on record. This Appeal is being filed late due to unforeseen prolonged illness. All of these issues have yet to be addressed by a complete review of the substantial medical records provided previously and a complete exam of the veteran on all of these issues. Indeed, except as provided in § 3.300(c), disability which is proximately due to or the result of a service-connected disease or injury shall be service connected. When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. 38 C.F.R. § 3.310 (a). Any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease, will be service connected. However, VA will not concede that a nonservice-connected disease or injury was aggravated by a service-connected disease or injury unless the baseline level of severity of the nonservice-connected disease or injury is established by medical evidence created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the nonservice-connected disease or injury. 38 C.F.R. § 3.310 (b). As a threshold matter, the Board notes that the RO did not consider the Veteran’s secondary service connection theory of entitlement or properly characterize the issue. We have recharacterized the issue on the title page. On remand, and given the Veteran’s contentions, this theory of entitlement should be fully developed and adjudicated by the RO in the first instance. Moreover, as to any duty to provide an examination and/or seek a medical opinion, the Board notes that in the case of a claim for disability compensation, the assistance provided to the claimant shall include providing a medical examination or obtaining a medical opinion when such examination or opinion is necessary to make a decision on the claim. Therefore, a VA examination with medical opinion is warranted. 38 U.S.C § 5103A(d); McLendon v. Nicholson, 20 Vet. App. 79 (2006). Second, in the June 2018 Informal Hearing Presentation (IHP), the Veteran through his representative avers in part: Furthermore.; Local VA dental records are available but have not been reviewed from Anchorage, AK or Ft. Richardson. Anchorage, AK VA rehabilitation records are also available but have not been reviewed or requested. Broken Ankle, Bone Spurs & arthritis Chronicity and Continuity Analogous Ratings, Eye Sight loss & High Blood Pressure/hypertension-Chronicity and Continuity Analogous Ratings, Untreated Hernia, Chronicity and Continuity, Analogous Ratings, Hemorrhoid, blood in Stool, Chronicity and Continuity; Analogous Ratings, Dental damage and TMJ, Chronicity and Continuity, Analogous Ratings; while extensive medical, mental treatment from San Antonio, or the Alaska VA have not been found or reviewed in their entirety. Even though evaluations and treatment has taken place within those facilities. Accordingly, any outstanding VA treatment records since May 2016 should be included in the claims file. See Bell v. Derwinski, 2 Vet. App. 611 (1992). 2. Entitlement to service connection for hemorrhoids, with blood in stool is remanded. 3. Entitlement to service connection for a hernia is remanded. The Board incorporates its discussion from the sections above by reference. In the VA Form 9 dated February 12, 2016 and submitted as part of the Veteran’s NOD, the Veteran avers in part, “The untreated hernia was documented with the previously annotated back injuries but ignored and untreated without substantial weight loss in the service.” As conceded by VA in the August 2016 SOC, VA treatment records currently in the claims file show complaints of hernia and diagnostic impressions of hemorrhoids. However, there is still no nexus opinion. VA must provide an examination when the record contains competent evidence that the claimant has a current disability or signs and symptoms of a current disability, the record indicates that the disability or signs and symptoms of disability may be associated with active service; and the record does not contain sufficient information to make a decision on the claim. 38 U.S.C. § 5103A (d) (2012); McLendon v. Nicholson, 20 Vet. App. 79 (2006). As the evidence of record is not sufficient to decide the claim, additional examinations and medical opinions are necessary. 4. Entitlement to service connection for a dental disability, claimed as teeth damage, TMJ, grinding is remanded. The Board incorporates its discussion from the sections above by reference. By way of background, in the February 2000 Report of Medical History, the Veteran denied severe tooth or gum trouble. In the Veteran’s February 2016 NOD, he wrote in part, “All dental fillings previously done by the VA have failed at this point, having lost multiple critical fillings.” The August 2016 SOC describes VA’s unsuccessful attempts to obtain the Veteran’s service dental records. It shows, “Because your records are unavailable for review service connection is denied. If these records are located a new decision will be rendered.” It shows in part, “In this case dental records are unavailable for review therefore, a determination for dental treatment only could not be made.” The VA treatment records already in the claims file contain notations of dental procedures. The Board observes that the Statement of the Case must be complete enough to allow the appellant to present written and/or oral arguments before the Board of Veterans’ Appeals. 38 C.F.R. § 19.29. First, the record shows that medical STRs were obtained and associated with the claims file in 2000. More recently, VA sent a January 2016 request for copies of the Veteran’s STRs, which returned negative responses culminating in an April 25, 2016 VA Memorandum from the VA Records Management Center. However, it is clear that at least some STRs existed as of 2000. VA’s duty to assist requires exhaustive efforts to ensure all records in the custody of a Federal department or agency, including VA and military service departments, are associated with the claims file. 38 C.F.R. § 3.159 (c)(2) (2017). The Veteran has identified missing dental Service Treatment Records. VA must make another concerted attempt to obtain these dental records, and notify the Veteran if they do not exist or further efforts to obtain them would be futile. If determined to be necessary, the Veteran should be contacted to provide additional identifying detail to assist in locating the missing records. With regard to the potentially missing service treatment records, the Board observes that the Court of Appeals for Veterans Claims (Court) has held that in cases where records once in the hands of the Government are lost, the Board has a heightened obligation to explain its findings and conclusions and to consider carefully the benefit-of-the-doubt rule. See O’Hare v. Derwinski, 1 Vet. App. 365, 367 (1991). Second, there is already evidence of disability in the VA treatment records and based upon the Veteran’s lay statements. The Board again notes that when service records are unavailable through no fault of the Veteran, VA has a heightened duty to assist. See Washington v. Nicholson, 19 Vet. App. 362, 369-70 (2005); Cuevas v. Principi, 3 Vet. App. 542, 548 (1992); O’Hare, 1 Vet. App. 365, 367. Accordingly, on remand, the Veteran should be afforded a VA examination in order to elicit a full history regarding any in-service events, injuries, or treatment. Third, in the September 2016 VA Form 9, the Veteran asserts in part, “Furthermore.; Local VA dental records are available but have not been reviewed from Anchorage, AK or Ft. Richardson.” He reiterated this in the June 2018 IHP. Accordingly, any outstanding VA treatment records, to include dental records, since May 2016 should be included in the claims file and considered by the AOJ. 5. Entitlement to an evaluation in excess of 10 percent for fracture of the right ankle is remanded. 6. Entitlement to an evaluation in excess of 50 percent from July 31, 2015 for post-traumatic stress disorder, also claimed as sleeplessness and chronic depression is remanded. The Board incorporates its discussion from the sections above by reference. With respect to PTSD, as discussed in the Introduction section above, the earlier effective date claim has already been adjudicated. Therefore, the period for consideration on remand is evaluation of PTSD effective July 31, 2015, the date of the Veteran’s increased rating claim. Under 38 C.F.R. § 19.31, the AOJ will provide a Supplemental Statement of the Case (SSOC) to the appellant and his/her representative when there are any material changes in, or additions to, the information included in the SOC or any prior SSOC, to include receipt of additional pertinent evidence. If the pertinent evidence is received from a source other than the appellant or his/her representative prior to transfer of the case to the Board, solicitation of a waiver of AOJ review is not appropriate, and the case must be remanded for a new SSOC. 38 U.S.C. § 7105(e); 38 C.F.R. §§ 19.31, 19.37(a). Here, in addition to pertinent evidence relating to the each of the above-named issues undergoing necessary development, there are VA examinations with medical opinions that have not been reviewed by the AOJ. For example, there is a September 30, 2016 VA psychiatric examination and a September 30, 2016 VA ankle examination. There is also a recent February 2018 VA right ankle examination. There are records from the Social Security Administration (SSA). The AOJ did not issue an SSOC after this evidence was associated with the record. There has been no waiver of AOJ review. As the relevant medical records developed by VA were received prior to the November 2016 transfer of the case to the Board, the matter must be remanded for AOJ review and issuance of an SSOC. 38 C.F.R. § 20.904(a)(2). Consequently, a remand is warranted. The matters are REMANDED for the following action: 1. Obtain updated copies of the Veteran’s VA treatment records since May 2016, including from Anchorage, Alaska and Fort Richardson, and associate them with the Veteran’s claims folder. 2. Conduct a search by all appropriate means to identify and obtain complete service treatment records to include dental records for this Veteran from service. All attempts to secure this evidence, to include any negative response, must be documented in the claims file. In compliance with 38 C.F.R. § 3.159 (c) (2), the AOJ must make as many requests as are necessary to obtain records in the custody of a Federal department or agency and shall not end its efforts to obtain those records unless it concludes that the records sought do not exist or that further efforts to obtain those records would be futile. If, after all procedurally appropriate actions to locate and secure the records have been made and the AOJ concludes that such records do not exist, that further efforts to obtain the records would be futile, the AOJ must make a formal finding to that effect. The AOJ must notify the Veteran of (a) the identity of the specific records that cannot be obtained, (b) an explanation as to the efforts that were made to obtain those records, (c) a description of any further action to be taken by VA with respect to the claims, and (d) notice that the Veteran is ultimately responsible for providing the evidence. 38 C.F.R. § 3.159 (e). The Veteran must then be given an opportunity to respond. 3. Please schedule the Veteran for a VA examination to determine the nature and etiology of any hypertension, claimed as high blood pressure. The claims file should be made available to the VA examiner. For each diagnosed disability, the VA examiner is requested to answer whether it is at least as likely as not (a 50 percent or greater probability) that the disability was incurred in or is otherwise related to the Veteran’s active military service. The VA examiner should also opine whether any diagnosed hypertension is proximately due to, the result of, or aggravated by the Veteran’s service-connected disabilities, including post-traumatic stress disorder. The examiner should provide a rationale for all opinions expressed. 4. Please schedule the Veteran for a VA examination to determine the nature and etiology of any hemorrhoids. The claims file should be made available to the VA examiner. For each diagnosed disability, the VA examiner is requested to answer whether it is at least as likely as not (a 50 percent or greater probability) that the disability was incurred in or is otherwise related to the Veteran’s active military service. The examiner should provide a rationale for all opinions expressed. 5. Please schedule the Veteran for a VA examination to determine the nature and etiology of any hernia disability. The claims file should be made available to the VA examiner. For each diagnosed disability, the VA examiner is requested to answer whether it is at least as likely as not (a 50 percent or greater probability) that the disability was incurred in or is otherwise related to the Veteran’s active military service. The examiner should provide a rationale for all opinions expressed. 6. Please schedule the Veteran for a VA examination to determine the nature and etiology of any dental disability, claimed as teeth damage, TMJ, grinding. The claims file should be made available to the VA examiner. For each diagnosed disability, the VA examiner is requested to answer whether it is at least as likely as not (a 50 percent or greater probability) that the disability was incurred in or is otherwise related to the Veteran’s active military service. The examiner must elicit a full history from the Veteran and consider the lay statements of record. The Veteran is competent to attest to factual matters of which he has first-hand knowledge. The examiner should provide a rationale for all opinions expressed. 7. Readjudicate the claims for (1) entitlement to an evaluation in excess of 10 percent for fracture of right ankle and (2) entitlement to an evaluation in excess of 50 percent for post-traumatic stress disorder, also claimed as sleeplessness and chronic depression, based upon the evidence of record. Attention is directed to the findings of the September 30, 2016 and February 2018 VA examiners. 8. After completing the above, and any other necessary development, any claim(s) remaining on appeal must be readjudicated in light of all pertinent evidence and legal authority. If any benefit sought is not granted, issue the Veteran and his representative an appropriate supplemental statement of the case (SSOC). Michael Pappas Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Department of Veterans Affairs