Citation Nr: 18152884 Decision Date: 11/26/18 Archive Date: 11/26/18 DOCKET NO. 18-31 156 DATE: November 26, 2018 ORDER Entitlement to a compensable increased rating for bilateral hearing loss is denied. The application to reopen a claim for service connection for bilateral pes planus is granted. Entitlement to service connection for bilateral pes planus is granted. Entitlement to service connection for degenerative joint disease (DJD) of the left hip is granted. Entitlement to service connection for DJD of the right hip is granted. REMANDED Entitlement to service connection for a right knee disability is remanded. Entitlement to service connection for a left knee disability is remanded. Entitlement to service connection for an acquired psychiatric disorder, to include an adjustment disorder, unspecified, is remanded. FINDINGS OF FACT 1. The Veteran’s bilateral hearing loss is no worse than a level I hearing impairment in each ear. 2. In a February 2016 rating decision, the RO denied entitlement to service connection for bilateral pes planus. The Veteran did not appeal this decision and new and material evidence was not received within one year after it was issued. 3. Evidence received since the February 2016 rating decision relates to an unestablished fact and raises a reasonable possibility of substantiating the claim for service connection for bilateral pes planus. 4. Bilateral pes planus was noted on the Veteran’s August 1986 enlistment examination report. 5. The Veteran’s pre-existing bilateral pes planus increased in severity during active service and there is no clear and unmistakable evidence rebutting the presumption that the disability was aggravated by service. 6. The evidence is at least evenly balanced as to whether the Veteran’s DJD of the left hip is related to his military service. 7. The evidence is at least evenly balanced as to whether the Veteran’s DJD of the right hip is related to his military service. CONCLUSIONS OF LAW 1. The criteria for a compensable increased rating for bilateral hearing loss are not met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.321(b), 4.1, 4.2, 4.7, 4.10, 4.21, 4.85, 4.86, DC 6100. 2. The February 2016 rating decision that denied the Veteran’s claim for entitlement to service connection for bilateral pes planus is final. 38 U.S.C. § 7105(c); 38 C.F.R. §§ 20.302, 20.1103. 3. Since the February 2016 rating decision, new and material evidence has been received to reopen the claim of entitlement to service connection for bilateral pes planus. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 4. The criteria for entitlement to service connection for bilateral pes planus, on an aggravation basis, are met. 38 U.S.C. §§ 1110, 1111, 1131, 1153, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.306. 5. With reasonable doubt resolved in favor of the Veteran, the criteria for entitlement to service connection for DJD of the left hip are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 6. With reasonable doubt resolved in favor of the Veteran, the criteria for entitlement to service connection for DJD of the right hip are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1986 to February 1992. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from April 2017 and September 2017 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO). In the April 2017 rating decision, the RO declined to reopen the previously denied service connection claim for bilateral pes planus and continued the noncompensable rating for bilateral hearing loss. In the September 2017 rating decision, the RO denied entitlement to service connection for acquired psychiatric disorder (characterized by the RO as an adjustment disorder), left hip, right hip, left knee, and right knee disabilities. The acquired psychiatric disorder claim has been recharacterized in light of Clemons v. Shinseki, 23 Vet. App. 1, 4-5 (2009) (a claim should not be limited to the disorder as characterized by the Veteran, but must be characterized and addressed based on the reasonable expectations of the non-expert claimant and the evidence in processing the claim). Increased Rating Disability evaluations are determined by evaluating the extent to which a veteran’s service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Rating Schedule. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. In order to evaluate the level of disability and any changes in condition, it is necessary to consider the complete medical history of the veteran’s condition. Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991). Where, as here, entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Francisco v. Brown, 7 Vet. App. 55 (1994). 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, 510 (2007). Entitlement to a compensable increased rating for bilateral hearing loss. Hearing loss is evaluated under 38 C.F.R. §§ 4.85, 4.86, DC 6100, Tables VI, VIA, and VII of VA’s rating schedule. VA disability compensation for impaired hearing is derived from the application in sequence of two main tables. See 38 C.F.R. § 4.85; Table VI; and Table VII (also DC 6100). Table VI correlates the average pure tone threshold (derived from the sum of the 1000, 2000, 3000, and 4000 Hertz thresholds divided by four) with the ability to discriminate speech, providing a Roman numeral to represent the correlation. The table is applied separately for each ear to derive the values used in Table VII. Table VII is used to determine the disability rating based on the relationship between the values for each ear derived from Table VI. See 38 C.F.R. § 4.85. Table VII is subject to 38 C.F.R. § 3.383 (2017). Section 3.383 pertains to special consideration for paired organs. Compensation is payable for certain combinations of service-connected and non-service-connected disabilities as if both disabilities were service connected, provided the non-service-connected disability is not the result of the Veteran’s own willful misconduct. 38 C.F.R. § 3.383(a). The provision applies when hearing impairment in one ear is compensable to a degree of 10 percent or more as a result of service-connected disability and hearing impairment as a result of non-service-connected disability meets the provisions of § 3.385 in the other ear. 38 C.F.R. § 3.383(a)(3). There are provisions in the rating schedule allowing special consideration to cases of exceptional patterns of hearing impairment. This occurs when there are pure tone thresholds of 55 decibels or more in each of the specified frequencies or when the pure tone threshold is 30 decibels or less at 1000 Hertz and 70 decibels or more at 2000 Hertz. See 38 C.F.R. § 4.86 (2017). In such cases, the rating specialist is to determine the Roman numeral designation for hearing impairment from either Table VI or Table VIA, whichever results in the higher numeral. Each ear will be evaluated separately. Id. The assignment of a rating for hearing loss is achieved by a mechanical application of the rating schedule to the numeric designations assigned after audiometric valuations are rendered. Lendenmann v. Principi, 3 Vet. App. 345, 349 (1992). However, in Martinak v. Nicholson, 21 Vet. App. 447, 455 (2007), the United States Court of Appeals for Veterans Claims (Court) held that in addition to dictating objective test results in a VA audiology examination, a VA audiologist should describe the functional effects caused by a hearing disability in his or her final report. In a March 2018 VA audiology examination, audiometric testing revealed the following pure tone thresholds, in decibels: HERTZ 1000 2000 3000 4000 Average RIGHT 25 35 35 45 35 LEFT 20 35 30 55 35 Speech recognition ability was measured at 100 percent in the right ear and 98 percent in the left ear. The examiner opined that the Veteran’s hearing loss does impact his ordinary conditions of daily life, including his ability to work. The examiner reasoned that his opinion was based on the Veteran’s reports that he is unable to hear certain words. The provisions in the rating criteria for exceptional patterns of hearing impairment are applicable, as the March 2018 audiological pure tone thresholds resulted in 30 decibels or less at 1000 Hertz. Therefore, Table VI or VIA is appropriate, whichever results in the higher numeral. After applying the pure tone averages and speech recognition scores from the March 2018 examination to Table VI, the right ear translates to a level I and the left ear translates to a level I. 38 C.F.R. § 4.85, Table VI. Intersecting level I and level I under Table VII results in a 0 percent rating under the applicable criteria. 38 C.F.R. 4.85, DC 6100. After applying the pure tone averages scores from the March 2018 examination to Table VIA, the right ear translates to a level I and the left ear translates to a level I. Intersecting level I and level I under Table VII results in a 0 percent rating under the applicable criteria. 38 C.F.R. 4.85, DC 6100. Therefore, Table VI or VIA both result in a level I in each ear and results in a 0 percent rating under the applicable criteria. 38 C.F.R. 4.85, DC 6100. Accordingly, the evidence demonstrates the Veteran’s bilateral hearing loss warrants no more than a noncompensable rating. 38 C.F.R. §§ 4.7, 4.385. The Board in no way discounts the difficulties that the Veteran experiences as a result of his bilateral hearing loss. However, the disability ratings for hearing impairment are derived by a mechanical application of the rating schedule to the numeric designation assigned after audiometry results are obtained. Hence, the Board must base its determination on the results of the pertinent VA audiology studies. See Lendenmann, 3. Vet. App. at 345. In other words, the Board is bound by law to apply VA’s rating schedule based on the Veteran’s audiometry results. See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Based on the application of the criteria to the audiometric findings above, and the record presents no basis for assignment of a compensable disability rating for the Veteran’s bilateral hearing loss. In Martinak, 21 Vet. App. At 447, the Court addressed a challenge to VA’s audiological testing practices, specifically, whether VA’s policy of conducting all audiometry testing of hearing loss claimants in a sound-controlled room was valid. The Court also addressed the requirements for an adequate VA audiological examination report. The Court upheld VA’s policy of conducting audiometry testing in a sound controlled room. The Court also held that, in addition to dictating objective test results, a VA audiologist must fully describe the functional effects caused by a hearing disability in his or her final report. As to the facts in this case, during the March 2018 examination, the Veteran reported that he is unable to hear certain words, due to his service-connected bilateral hearing loss. This is sufficient to comply with Martinak. The applicability of the benefit of the doubt doctrine has been considered; however, given the mechanical method in which ratings for hearing loss are derived, that doctrine is not applicable. See 38 U.S.C.§ 5107 (b); 38 C.F.R. §§ 3.102, 41.3; Gilbert,1 Vet. App. at 55-56. Additionally, a request for an entitlement to a total disability rating based on individual unemployability (TDIU), whether expressly raised by a veteran or reasonably raised by the record, is not a separate claim for benefits, but rather involves an attempt to obtain an appropriate rating for a disability as part of a claim for increased compensation. Rice v. Shinseki, 22 Vet. App. 447, 453-54 (2009). In other words, if the claimant or the evidence of record reasonably raises the question of whether a veteran is unemployable due to a disability for which an increased rating is sought, then part and parcel with the increased rating claim is the issue of whether a TDIU is warranted as a result of that disability. Id. In this case, the Veteran has not contended and the evidence does not show that she is unable to maintain or obtain gainful employment due to her service-connected bilateral hearing loss. Therefore, the issue of entitlement to a TDIU, has not been argued by the Veteran or reasonably raised by the evidence of record. The Board has considered the Veteran’s increased rating claim and decided entitlement based on the evidence. The Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, with respect to his claim. See Doucette v. Shulkin, 28 Vet. App. 366, 369-70 (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). New and Material Evidence Whether new and material evidence has been received to reopen a claim for entitlement to service connection for bilateral pes planus. Generally, a claim that has been denied in a final unappealed rating decision may not thereafter be reopened and allowed. 38 U.S.C. § 7105(c). An exception to this rule is 38 U.S.C. § 5108, which provides that if new and material evidence is presented or secured with respect to a claim which has been disallowed, VA will reopen the claim and review it on the merits. The implementing regulation also provides that new and material evidence received prior to the expiration of the appeal period will be considered as having been filed in connection with the claim that was pending at the beginning of the appeal period. 38 C.F.R. § 3.156(b). New evidence is defined as existing evidence not previously submitted to agency decision makers. Material evidence means evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence previously of record, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). In determining whether evidence is new and material, the credibility of the evidence is generally presumed. Justus v. Principi, 3 Vet. App. 510, 512-513 (1992). The United States Court of Appeals for the Federal Circuit (Federal Circuit) has held, however, that evidence that is merely cumulative of other evidence in the record cannot be new and material even if that evidence had not been previously presented. Anglin v. West, 203 F.3d 1343, 1347 (2000). In deciding whether new and material evidence has been received, the Board looks to the evidence submitted since the last final denial of the claim on any basis. Evans v. Brown, 9 Vet. App. 273, 285 (1996). The threshold for determining whether new and material evidence raises a reasonable possibility of substantiating a claim is “low.” Shade v. Shinseki, 24 Vet. App. 110, 117 (2010). Regardless of whether the RO determined new and material evidence had been submitted, the Board must address the issue of the receipt of new and material evidence in the first instance because it determines the Board’s jurisdiction to reach the underlying claims and to adjudicate the claims de novo. See Jackson v. Principi, 265 F.3d 1366, 1369 (2001) (the Board has a jurisdictional responsibility to consider whether it was proper for a claim to be reopened, regardless of whether the previous action denying the claim was appealed to the Board). In February 2016, the RO originally denied the Veteran’s service connection claim for bilateral pes planus, on the basis that there was no evidence that the Veteran’s pes planus, which was noted on his listed examination report, permanently worsened as a result of service. The Veteran did not appeal that decision, nor was new and material evidence associated with the record within one year of its issuance. Accordingly, the February 2016, rating decision is final. See 38 U.S.C. § 7105(c); 38 C.F.R. §§ 3.104, 3.156(a)-(b), 20.302, 20.1103. The relevant evidence of record at the time of the February 2016 rating decision consisted of the Veteran’s service treatment records (STRs) and VA and private treatment records. Specifically, the Veteran’s STRs showed that in his August 1986 enlistment examination report, report of medical history, moderate pes planus was noted. Private VA treatment records revealed a diagnosis of bilateral pes planus. See private treatment record dated May 2002. In December 2016, the Veteran submitted an application to reopen his previously denied claim of entitlement to service connection for bilateral pes planus. Relevant evidence received after the February 2016 rating decision includes the Veteran’s statements and a September 2017 report of consultation and examination. Specifically, the Veteran statements and the September 2017 report of consultation and examination suggest that the Veteran’s pes planus was aggravated beyond the normal progression of the disease due to his rigorous military service training. The Veteran is presumed credible in his reports for the limited purpose of reopening the claim. Justus, 3 Vet. App. at 513. In sum, the Veteran’s statements and the September 2017 report of consultation, which suggest an increase in his pes planus during service, relate to an unestablished fact necessary to substantiate the claim, and raise a reasonable possibility of substantiating the claim. Accordingly, the evidence received since the February 2016 is new and material evidence, and the claim of service connection for bilateral pes planus is reopened. Service Connection Service connection will be granted if the evidence demonstrates that current disability resulted from an injury suffered or disease contracted in active military, naval, or air service. 38 U.S.C. §§1110, 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) current disability; (2) in-service injury or disease; and (3) a relationship between the two. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). Consistent with this framework, service connection is warranted for a disease first diagnosed after service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). 1. Entitlement to service connection for bilateral pes planus. The Veteran asserts that his bilateral pes planus preexisted his military service and that it was aggravated beyond the normal progression of the disease due to his rigorous training during his military service. See report of consultation and examination dated September 2017. Every Veteran is presumed to have been in sound condition at entry into service except as to defects, infirmities, or disorders noted at the time of such entry, or where clear and unmistakable evidence demonstrates that the injury or disease existed before entry and was not aggravated by such service. 38 U.S.C. § 1111. The term “noted,” in 38 U.S.C. § 1111, refers to “[o]nly such conditions as are recorded in examination reports.” 38 C.F.R. § 3.304(b). A pre-existing disease or injury will be considered to have been aggravated by military service where there is an increase in disability during such service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease. 38 U.S.C. § 1153; 38 C.F.R. § 3.306(a). Where the pre-service disability underwent an increase in severity during service, clear and unmistakable evidence is required to rebut the presumption of aggravation. 38 C.F.R. § 3.306(b). These provisions apply to only one situation: where the induction examination notes a preexisting condition that is alleged to have been aggravated. Horn v. Shinseki, 25 Vet. App. 231, 238 (2012) (quoting Wagner v. Principi, 370 F.3d 1089, 1096 (Fed. Cir. 2004) (“[I]f a preexisting disorder is noted upon entry into service... the veteran may bring a claim for service-connected aggravation of that disorder. In that case section 1153 applies and the burden falls on the veteran to establish aggravation.”). For the following reasons, entitlement to service connection for bilateral pes planus is warranted on an aggravation basis. The Veteran’s August 1986 enlistment examination report, report of medical history, moderate, asymptomatic, pes planus was noted. A February 1992 STRs indicated that the Veteran elected not to undergo a separation examination. The Veteran’s bilateral pes planus was noted on his August 1986 enlistment examination report. Thus, bilateral pes planus preexisted the Veteran’s active duty service. 38 C.F.R. § 3.304(b). Therefore, he is not presumed to have been in sound condition at the time of entry into service. See 38 U.S.C.§ 1111. The relevant inquiry now becomes whether his bilateral pes planus increased in severity during his active service. 38 U.S.C. § 1153; 38 C.F.R. § 3.306(a). In this case, there is one medical opinion that addresses this issue. In a September 2017 report of consultation and examination, a private doctor of chiropractic (D.C.) acknowledged that the Veteran’s service enlistment examination report noted bilateral pes planus. The D.C. also indicated that he was still found fit for duty and as the “rigors of military life ensued he developed progressive left and right foot pain which intensified with all weight bearing.” The D.C. explained that the Veteran’s exit physical diagnosis was pes planus compacted by plantar fascitis. The D.C. concluded that the Veteran’s onset of his condition began during service and has persisted to the present day and that his condition is permanent. Although the September 2017 D.C. indicated that the Veteran’s exit physical diagnosis was pes planus compacted by plantar fascitis it is unclear whether the D.C. was referring to the Veteran’s reports of what his symptoms were at the time of his separation from his military service. In an event, the remaining portion of the September 2017 report of consultation and examination is entitled to significant probative weight as the D.C. explained the reasons for his conclusions based on an accurate characterization of the evidence of record. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (most of the probative value of a medical opinion comes from its reasoning). Although the September 2017 D.C. did not provide an explicit opinion addressing whether the Veteran’s pes planus was aggravated during service, it is readily apparent that the September 2017 D.C. implicitly found that the Veteran’s pes planus was aggravated during service beyond the normal progression than the disease, as the September 2017 D.C. provided a rationale for such findings. See Monzingo v. Shinseki, 26 Vet. App. 97, 106 (2012) (the fact that the rationale provided by an examiner “did not explicitly lay out the examiner’s journey from the facts to a conclusion,” did not render the examination inadequate); Acevedo v. Shinseki, 25 Vet. App. 286, 294 (2012) (medical reports must be read as a whole and in the context of the evidence of record). In sum, the evidence sufficiently supports that his preexisting bilateral pes planus permanently increased in severity during active service. For instance, although the Veteran had a preexisting bilateral pes planus, it did not prevent his entry into service. In fact, the Veteran’s enlistment examination report noted that his pes planus was asymptomatic. During the September 2017 private examination, the Veteran reported that he experienced worsening feet pain during service. The Veteran is competent to report matters within his personal knowledge-such as events that occurred in service. See, e.g., Barr v. Nicholson, 21 Vet. App. 303, 307 (2007); Charles v. Principi, 16 Vet. App 370, 374 (2002). In considering the Veteran’s STRs that documented asymptomatic pes planus and the September 2017 report of consultation and examination report that, essentially, found that the Veteran’s pes planus worsened during service due to the rigors of military life establishes that the Veteran’s bilateral pes planus pre-existing pes planus increased in disability during service. Given this evidence, a remand for another opinion at this point could be construed as obtaining additional evidence for the sole purpose of denying a claim, which is impermissible. 38 C.F.R. § 3.304(c) (“The development of evidence in connection with claims for service connection will be accomplished when deemed necessary but it should not be undertaken when evidence present is sufficient for this determination”); Mariano v. Principi, 17 Vet. App. 305, 312 (2003). For the foregoing reasons, the presumption of aggravation has attached, and clear and unmistakable evidence is necessary to rebut that presumption. There is no evidence rebutting the presumption of aggravation. As such, the presumption of aggravation is for application and service connection is warranted for aggravation of the Veteran’s pre-existing bilateral pes planus. 2. Entitlement to service connection for left and right hip disabilities. The Veteran claims that his left and right hip disabilities are due to his military service. Specifically, he asserts that his left and right hip disabilities are related to his military activates during service, such as weightlifting. See report of consultation and examination report dated September 2017. For the following reasons, entitlement to service connection for left and right hip disabilities is warranted The evidence shows that the Veteran was diagnosed with DJD of the left and right hips. See report of consultation and examination report dated September 2017. Accordingly, current disabilities are demonstrated. With respect to the in-service injury requirement, the Veteran reports that he experienced left and right hip pain during service due to in-service weightlifting. See report of consultation and examination dated September 2017. Although the Veteran’s STRs do not note left or right hip pain explicitly, an undated STR notes right leg pain for more than one month. The Veteran is competent to report matters within his personal knowledge-such as events that occurred in service. See, e.g., Barr, 21 Vet. App. at 307; Charles, 16 Vet. App at 374. To this extent, there is no evidence to find that the Veteran is not credible. Thus, the in-service injury requirement has been met. This case turns on the remaining element of service connection, which is whether the Veteran’s left and right hip disabilities are related to his military service. In this case, there is one medical opinion that addresses this issue. In a September 2017 report of consultation and examination, a private D.C. interviewed the Veteran and physically examined him and opined that the Veteran’s DJD of the left and right hip are due to his military service. The private D.C. explained that the Veteran’s left and right hip disabilities are due to heavy lifting during his military service. The D.C. further explained that the Veteran’s hip pain “intensifies upon standing from a seated position and also orienting to the seated position after standing.” The D.C. indicated that “[w]eight bearing including walking and standing causes increased” hip pain. The D.C. stated that constant compensation and adaptation can cause a hip disability. The September 2017 private opinion is afforded probative value as D.C. explained the reasons for his conclusions based on an interview and physical examination of the Veteran. Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007) (quoting Ardison v. Brown, 6 Vet. App. 405, 407 (1994)). “[A] medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. “Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). Importantly, the private D.C., thoroughly explained how the Veteran’s in-service weight lifting caused his current DJD of the left and right hip. In sum, the evidence establishes that the Veteran’s current DJD of the left and right hip disabilities are due to his in-service weightlifting. There is no evidence to the contrary. The evidence is therefore at least evenly balanced as to whether the Veteran’s DJD of the left and right hip disabilities are related to his military service. Therefore, entitlement to service connection for DJD of the left and right hip disabilities are warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. REASONS FOR REMAND 1. Entitlement to service connection for right and left knee disabilities are remanded. The Veteran claims that his left and right knee disabilities are due to his military service. In a September 2017 report of consultation and examination, a private D.C. interviewed the Veteran and physically examined him and diagnosed DJD of the left and right knee. The D.C. provided that the Veteran’s left and right knee disabilities are related to his pes planus. The D.C. provided a rationale for his opinion. Thereafter, the D.C. then stated “it is as likely as not that same is directly and causally related” to the Veteran’s military service. Although the D.C. provided an opinion with a rationale indicating that the Veteran’s right and left knee disabilities are related to his pes planus, it is unclear whether the D.C. was indicating that the Veteran’s pes planus is related to his military service or whether his left and right knee disabilities are related to his military service. The Veteran has not been afforded a VA examination nor has an opinion been obtained to determine the etiology of his left and right knee disabilities. As the evidence indicated that the Veteran has a current left and right knee disabilities that may be associated with service, a remand is warranted to obtain a medical opinion. 2. Entitlement to service connection for an acquired psychiatric disorder is remanded. The Veteran claims that his acquired psychiatric disability is due to his military service. In August 2017, the Veteran was afforded a VA examination. The examiner diagnosed adjustment disorder no opinion was rendered. In a September 2017 report of consultation and examination, a private D.C. diagnosed posttraumatic stress disorder (PTSD) and opined that it is directed and casually related to the Veteran’s military service. The D.C. concluded that the “aforementioned is in the process of being confirmed by the evaluation of the appropriately credentialed and licensed mental health professional while will publish an independent report.” To this extent, the September 2017 D.C. does not have the expertise to provide a diagnosis of PTSD. Furthermore, although the September 2017 D.C. indicated that a mental health professional would provide an independent report to support his findings, such has not been submitted. Furthermore, the September 2017 D.C. did not provide a rationale for the positive nexus opinion rendered. In sum, the evidence is unclear as to the Veteran has a diagnosis of PTSD, in addition to the adjustment disorder, and the etiology thereof. The Veteran has not been afforded a VA examination nor has an opinion been obtained to determine the etiology of his acquired psychiatric disability. As the evidence indicated that the Veteran has a current acquired psychiatric disability and that may be associated with service, a remand is warranted to schedule the Veteran for a VA examination. The matters are REMANDED for the following action: 1. Refer the claims file to an appropriate physician with expertise to address the etiology of the Veteran’s left and right knee disabilities, diagnosed as DJD of the left and right knee. The Veteran does not need to be examined, unless the physician determines otherwise. The physician is requested to review the claims file in its entirety including any recently obtained treatment records. The physician should provide an opinion whether it is as least as likely as not (50 percent probability or more) that the Veteran’s left and right knee disabilities had its onset in service or is otherwise related to service. The physician must provide a rationale for an opinion rendered. 2. Schedule the Veteran for a VA examination by a psychologist or psychiatrist to determine the nature and etiology of his acquired psychiatric disorder. The claims file, to include a copy of this remand, must be send to the examiner for review; consideration of such should be reflected in the completed examination report. All necessary tests should be conducted. The psychiatrist or psychologist should clearly identify all psychiatric disorders, to include an adjustment disorder, that has existed since approximately September 2017 the date of the Veteran’s claim in this case (even if now asymptomatic or resolved). If the psychiatrist or psychologist finds that the Veteran’s meets the criteria for PTSD, the examiner must identify the specific stressor(s) underlying any PTSD diagnosis and comment upon the link between the current symptomatology and the Veteran’s stressor(s). Then, as to any such disability other than PTSD, to include an adjustment disorder, the psychiatrist or psychologist should indicate whether it is as least as likely as not (50 percent probability or more) that a current acquired psychiatric disability had its onset in service, or is otherwise related to service. The psychiatrist or psychologist should not rely solely on the absence of medical records as a basis for the opinion and should consider the Veteran’s statements, particularly his reports of continuity of symptoms. The psychiatrist or psychologist should provide complete rationale for each opinion expressed and conclusion reached. Jonathan Hager Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Castillo, Associate Counsel