Citation Nr: 18152951 Decision Date: 11/27/18 Archive Date: 11/26/18 DOCKET NO. 14-23 109 DATE: November 27, 2018 REMANDED Entitlement to service connection for a bilateral leg disability, to include blocked bilateral arteries, is remanded. Entitlement to service connection for a heart disability, to include as secondary to service-connected right inguinal hernia, is remanded. Entitlement to service connection for a left inguinal hernia, to include as secondary to service-connected right inguinal hernia, is remanded. Entitlement to service connection for a psychiatric disability, to include as secondary to service-connected right inguinal hernia, claimed as posttraumatic stress disorder (PTSD), adjustment disorder and depression, is remanded. Entitlement to service connection for post aortofemoral bypass residuals, to include as secondary to service-connected right inguinal hernia, is remanded. Entitlement to a rating in excess of 10 percent for right inguinal hernia is remanded. Entitlement to a total disability evaluation based on individual unemployability (TDIU) is remanded. REASONS FOR REMAND Initially, the Board notes that in September 2016, the Board remanded the appeal for the Veteran to be provided a hearing addressing the issues of service connection for a bilateral leg disability, a left inguinal hernia, and post aortofemoral bypass residuals; an increased rating for right inguinal hernia; and entitlement to a TDIU. (An August 2015 Board hearing addressing the issues of service connection for a heart disability and psychiatric disability has already been held.) In November 2018 correspondence, however, the Veteran withdrew this hearing request. In September 2016, the Board also remanded the appeal for VA examinations addressing the etiology of any current heart disability and any current acquired psychiatric disability. No such examinations have been conducted. Stegall v. West, 11 Vet. App. 268 (1998). In addition, as to the acquired psychiatric disorder claim, it is not clear whether the Veteran is also including PTSD among the claimed disorders. In this regard, in February 2011, the Veteran submitted a statement and called the RO withdrawing his claim for PTSD. In April 2011, he called the RO requesting to reopen the claim for PTSD but in June 2011 correspondence he withdrew the claim again after which the RO sent him a letter confirming the withdrawal. Despite this, in December 2011 the representative submitted additional argument pertaining to a claim for PTSD but in May 2013 the Veteran called to withdraw the claim for PTSD a third time. The same month the representative submitted additional information pertaining to the PTSD claim. An August 2013 rating decision, the subject of this appeal, denied entitlement to service connection for adjustment disorder, also claimed as severe depression, but notified the Veteran that the claim for PTSD had been considered withdrawn based on the Veteran’s May 2013 request. Although there was no objection, at the August 2015 hearing the Veteran again referred to PTSD in the context of his claim for an acquired psychiatric disorder. As to the scope of this claim, the Board is cognizant of the need to consider, among other things, the Veteran’s lay description of the disorder and the reasonable expectations of the non-expert claimant. Clemons v. Shinseki, 23 Vet. App. 1, 4-5 (2009). In this case, however, it is very difficult for the Board to ascertain the Veteran’s expectations. At this juncture, the Board has included PTSD within the claim for an acquired psychiatric disorder, as indicated above. On remand, it would be helpful if the Veteran and his representative could clearly state whether the Veteran wishes to have this disorder included in the claim for service connection for an acquired psychiatric disorder. Thereafter, the AOJ should undertake any appropriate development to include verification of any claimed stressors. As to the other service connection claims, the Veteran also recently raised a new theory of entitlement. In June and July 2018 statements, the Veteran and his representative alleged exposure to unspecified chemicals while serving in the Alabama Army National Guard from 1978 to 1979 where he did digging near Fort McClellan and Pelham Range. Previously, in November 2009 correspondence, the Veteran also claimed that he had been exposed to radiation and some kind of gas in service. On remand, therefore, records from the Veteran’s period of National Guard service should be obtained. Thereafter, all appropriate development should be conducted regarding the alleged exposure to chemicals and, to the extent he still so contends, radiation and gas. As to the claim for an increased rating for right hernia, the most recent examination of that disability took place in July 2010. The Board therefore finds that a new examination should be obtained. See Green v. Derwinski, 1 Vet. App. 121, 124 (1991) (VA has a duty to provide the Veteran with a thorough and contemporaneous medical examination). The issue of entitlement to a TDIU is intertwined with the above issues. The matters are REMANDED for the following action: 1. Request that the Veteran and his representative clarify whether the Veteran wishes to have PTSD included in the scope of the claim for service connection for an acquired psychiatric disorder. Depending upon the Veteran’s response, if indicated, conduct any development that may be necessary to verify any reported stressor. Identify the dates of each period of the Veteran’s ACDUTRA and INACDUTRA while serving in the Alabama Army National Guard. Then, obtain all service treatment records for such verified periods of service, including reports of entrance, separation, and periodic/annual physical examinations not currently in the claims file. 3. Undertake all appropriate development regarding the Veteran’s alleged exposure to chemicals from 1978 to 1979 and, to the extent he still so contends, radiation and gas. 4. Schedule the Veteran for a VA examination to determine the nature and etiology of his heart disability and psychiatric disability. The entire claims file must be reviewed by the examiner. All necessary testing should be conducted. The examiner should provide an opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that any current heart and psychiatric disabilities (if any) are related to the Veteran’s active service or to the Veteran’s service-connected right inguinal hernia. The examiner should provide an opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that any current heart and psychiatric disabilities (if any) were aggravated the Veteran’s service-connected right inguinal hernia. The examination report must include a complete rationale for all opinions expressed. If the examiner feels that a requested opinion cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by deficiency in the state of general medical knowledge (i.e. no one could respond given medical science and the known facts) or by a deficiency in the record or the examiner (i.e. additional facts are required, or the examiner does not have the needed knowledge or training). 5. Schedule the Veteran for a VA examination to evaluate the current severity of his right inguinal hernia. The electronic claims folder should be made available to the examiner for review in conjunction with the examination and the examiner should acknowledge such review in the examination report. Any indicated studies should be performed. The examination should be conducted in accordance with the current disability benefits questionnaire or examination worksheet applicable to inguinal hernia. (Continued on the next page)   6. After completing any additional development deemed necessary, readjudicate the claims. If any benefit requested on appeal is not granted to the Veteran’s satisfaction, the appellant and his representative should be furnished a supplemental statement of the case, and provided an opportunity to respond. The case should then be returned to the Board for further appellate consideration, if in order. GAYLE STROMMEN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Matthew Schlickenmaier, Counsel