Citation Nr: 18153205 Decision Date: 11/27/18 Archive Date: 11/27/18 DOCKET NO. 16-17 767 DATE: November 27, 2018 ORDER Entitlement to service connection for an acquired psychiatric disability, to include posttraumatic stress disorder (PTSD) is denied. Entitlement to an initial compensable evaluation for service-connected residuals of a traumatic brain injury (TBI) is denied. REMANDED Entitlement to service connection for a bone disability, to include osteoporosis and osteopenia, is remanded. Entitlement to service connection for a neck disability, to include as secondary to a service-connected disability, is remanded. Entitlement to service connection for a low back disability, to include as secondary to a service-connected disability, is remanded. Entitlement to service connection for a bilateral hip disability, to include as secondary to a service-connected disability, is remanded. Entitlement to service connection for a left foot disability, to include as secondary to a service-connected disability, is remanded. Entitlement to a total evaluation based on individual unemployability due to service-connected disabilities (TDIU) is remanded. Entitlement to an effective date prior to August 16, 2013, for the grant of service connection for right foot tendonitis. FINDINGS OF FACT 1. The Veteran does not have a diagnosed acquired psychiatric disability during the appeal period. 2. For the entire appeal period, the Veteran’s service-connected TBI manifests in no objective residuals, other than those previously separately service-connected, and is rated as “0” in all facets. CONCLUSIONS OF LAW 1. The criteria for service connection for an acquired psychiatric disability, to include PTSD, are not met. 38 U.S.C. §§ 1101, 1112, 1131, 5103, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307(a)(3), 3.309(a) (2017). 2. The criteria for entitlement to an initial compensable rating for residuals of TBI have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.14, 4.124a, Diagnostic Code 8045 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from July 1972 to July 1975. He also has seven days of prior inactive service of an unspecified nature. This matter comes before the Board of Veterans' Appeals (the Board) on appeal from July 2014 and August 2014 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in Lincoln, Nebraska. Characterization of an issue on appeal The Veteran filed claims to establish service connection for PTSD and “a mental disorder,” and the Agency of Original Jurisdiction (AOJ) developed and adjudicated the issues separately throughout the pendency of the appeal. However, to more accurately reflect the psychiatric symptoms reported by the Veteran, the Board has merged these claims and recharacterized the issue as stated on the title page. Clemons v. Shinseki, 23 Vet. App. 1 (2009). 1. Entitlement to service connection for an acquired psychiatric disability, to include PTSD Service connection may be established for a disability resulting from diseases or injuries which are clearly present in service or for a disease diagnosed after discharge from service, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). Service connection for PTSD requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125 (a), a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred. If the evidence establishes that the veteran engaged in combat with the enemy and the claimed stressor is related to that combat, in the absence of clear and convincing evidence to the contrary, and provided that the claimed stressor is consistent with the circumstances, conditions, or hardships of the veteran's service, the veteran's lay testimony alone may establish the occurrence of the claimed in-service stressor. 38 C.F.R. § 3.304 (f) (2017). The Board acknowledges that effective August 4, 2014, VA amended the regulations regarding the evaluation of mental disorders by removing outdated references to DSM IV, AMERICAN PSYCHIATRIC ASSOCIATION: DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS, 4th Edition (1994). The amendments replace those references with references to the recently updated DSM 5. As the Veteran's claim for benefits was certified after August 2014, the evidence will be analyzed under the criteria of both versions of the DSM dependent on when the evidence was created. In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the benefit of the doubt shall be given to the claimant. 38 U.S.C. § 5107 (b). When a reasonable doubt arises regarding service origin, such doubt will be resolved in the favor of the claimant. Reasonable doubt is doubt which exists because of an approximate balance of positive and negative evidence which does not satisfactorily prove or disprove the claim. 38 C.F.R. § 3.102. The question is whether the evidence supports the claim or is in relative equipoise, with the claimant prevailing in either event, or whether a fair preponderance of the evidence is against the claim, in which event the claim must be denied. Gilbert, 1 Vet. App. at 54. The Board has reviewed all of the evidence in the claims file. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, the extensive evidence of record. Indeed, the Federal Circuit has held that the Board must review the entire record, but does not have to discuss each piece of evidence. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Therefore, the Board will summarize the relevant evidence where appropriate, and the Board's analysis below will focus specifically on what the evidence shows, or fails to show, as to the claim. Analysis The Veteran asserts that he has an acquired psychiatric disability, claimed as PTSD and “a mental disorder,” due to in-service stressor events involving the death of a Captain in 1972 and clearing dead bodies and body parts from the scene of a train/car collision in 1974. After review of the record and for the reasons discussed below, the Board concludes that service connection for an acquired psychiatric disability, to include PTSD, is not warranted. The evidence of record, including the Veteran’s statements and VA treatment records are negative for reports of any acquired psychiatric disabilities, or symptoms thereof, until the Veteran reported experiencing anxiety “due to stress” and tested positive on a depression screen. The Veteran was provided VA psychiatric examinations in June 2014 and February 2016 to determine the nature and etiology of any acquired psychiatric disability that may be present during the appeal period. After a review of the complete record and interviews with, and examinations of the Veteran, the VA psychiatrist and psychologist who performed the June 2014 and February 2016 psychiatric examinations, concluded that the Veteran did not meet the criteria for a diagnosis of any acquired psychiatric disability under either version of the DSM. More specifically, both VA examiners ruled out a diagnosis of PTSD because the Veteran’s reported symptoms did not meet the criteria for such. The June 2014 and February 2016 VA examiners’ opinions on these matters are afforded great probative weight, as they are accompanied with rationale citing to specific evidence within the Veteran’s file, to include his lay statements. Analysis of the file indicates that the Veteran does not meet the criteria for a diagnosis of an acquired psychiatric disability now, during his service, or at any point during the pendency of his claim. Clearly, the Veteran is competent to report that which comes to him through his senses, such as experiencing psychiatric symptoms, see Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006); Washington v. Nicholson, 19 Vet. App. 362, 368-69 (2005), and his accounts thereof are considered competent and credible. However, a prerequisite for entitlement to service connection, regardless of engagement in combat against the enemy, is a showing of current disability and the record fails to identify a diagnosis of an acquired psychiatric disability during or since service. The Veteran lacks the required medical education and training, such as to render competent any opinion or statement to the effect that his psychiatric symptoms meet the criteria of a psychiatric diagnosis under the DSM. The existence of a current disability is the cornerstone of a claim for VA disability compensation. 38 U.S.C. § 1110; see Degmetich v. Brown, 104 F. 3d 1328, 1332 (1997) (holding that interpretation of sections 1110 and 1131 of the statute as requiring the existence of a present disability for VA compensation purposes cannot be considered arbitrary). In the absence of proof of a current disability, there can be no valid claim. Boyer v. West, 210 F.3d at 1353; Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) (indicating service connection presupposes a current diagnosis of the condition claimed). There is no evidence of a diagnosed acquired psychiatric disability at any point during the claim period or shortly before the claim period. See McClain v. Nicholson, 21 Vet. App. 319 (2007); Romanowsky v. Shinseki, 26 Vet. App. 289 (2013). In view of the foregoing, the Board must conclude that the preponderance of the evidence is against a finding that the Veteran has a diagnosis of an acquired psychiatric disability. As such, his claim cannot succeed. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application and the claim advanced must be denied. 38 U.S.C. § 5107 (b); see also, generally, Gilbert v. Derwinski, 1 Vet. App. 49 (1990); Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001). 2. Entitlement to an initial compensable evaluation for service-connected residuals of a traumatic brain injury (TBI) Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Each disability must be viewed in relation to its history, and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the veteran working or seeking work. 38 C.F.R. § 4.2. All reasonable doubt will be resolved in the claimant’s favor. 38 C.F.R. § 4.3. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7. Separate ratings can be assigned for separate periods based on the facts found - a practice known as “staged” ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Staged ratings are appropriate whenever the factual findings show distinct periods where the service-connected disability exhibits symptoms that would warrant different ratings. Id. In general, all disabilities, including those arising from a single disease entity, are rated separately, and all disability ratings are then combined in accordance with 38 C.F.R. § 4.25. Pyramiding, the evaluation of the same disability, or the same manifestation of a disability, under different diagnostic codes, is to be avoided when rating a veteran’s service-connected disability. 38 C.F.R. § 4.14. It is possible for a veteran to have separate and distinct manifestations from the same injury which would permit rating under several diagnostic codes, however, the critical element in permitting the assignment of several ratings under various diagnostic codes is that none of the symptomatology for any one of the conditions is duplicative or overlapping with the symptomatology of the other condition. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). The basis of disability evaluation is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. The Veteran’s residuals of TBI are rated under 38 C.F.R. § 4.124a, Diagnostic Code 8045. Diagnostic Code 8045 states that there are three main areas of dysfunction that may result from a TBI and have profound effects on functioning: cognitive (which is common in varying degrees after a traumatic brain injury), emotional/behavioral, and physical. Each of these areas of dysfunction may require evaluation. 38 C.F.R. § 4.124a, Diagnostic Code 8045. Cognitive impairment is defined as decreased memory, concentration, attention, and executive functions of the brain. Executive functions include goal setting, speed of information processing, planning, organizing, prioritizing, self-monitoring, problem solving, judgment, decision making, spontaneity, and flexibility in changing actions when they are not productive. Not all of these brain functions may be affected in a given individual with cognitive impairment, and some functions may be affected more severely than others. In a given individual, symptoms may fluctuate in severity from day to day. VA is to evaluate cognitive impairment under the table titled “Evaluation of Cognitive Impairment and Other Residuals of a Traumatic Brain Injury Not Otherwise Classified.” Subjective symptoms may be the only residual of a TBI or may be associated with cognitive impairment or other areas of dysfunction. Subjective symptoms that are residuals of a TBI, whether or not they are part of cognitive impairment, should be evaluated under the subjective symptoms facet in the table titled “Evaluation of Cognitive Impairment and Other Residuals of a Traumatic Brain Injury Not Otherwise Classified.” However, VA is to separately evaluate any residual with a distinct diagnosis that may be evaluated under another Diagnostic Code even if that diagnosis is based on subjective symptoms, rather than under the “Evaluation of Cognitive Impairment and Other Residuals of a Traumatic Brain Injury Not Otherwise Classified” table. VA is to evaluate emotional/behavioral dysfunction under 38 C.F.R. § 4.130 (Schedule of ratings-mental disorders) when there is a diagnosis of a mental disorder. As will be discussed below, there is no diagnosed acquired psychiatric disability in the Veteran’s case. VA is to evaluate physical (including neurological) dysfunction based on the following list, under an appropriate diagnostic code: Motor and sensory dysfunction, including pain, of the extremities and face; visual impairment; hearing loss/tinnitus; loss of sense of smell/taste; seizures; gait, coordination, and balance problems; speech and other communication difficulties, including aphasia and related disorders, and dysarthria; neurogenic bladder; neurogenic bowel; cranial nerve dysfunctions; autonomic nerve dysfunctions; and endocrine dysfunctions. The preceding list of types of physical dysfunction does not encompass all possible residuals of a TBI. For residuals not listed in 38 C.F.R. § 4.124a, Diagnostic code 8045, that are reported on an examination, VA is to evaluate under the most appropriate Diagnostic Code. Each condition is to be evaluated separately, as long as the same signs and symptoms are not used to support more than one evaluation, and combine under 38 C.F.R. § 4.25 the evaluations for each separately rated condition. The evaluation assigned based on the “Evaluation of Cognitive Impairment and Other Residuals of a Traumatic Brain Injury Not Otherwise Classified” table will be considered the evaluation for a single condition for purposes of combining with other disability evaluations. VA should consider the need for special monthly compensation for such problems as loss of use of an extremity, certain sensory impairments, erectile dysfunction, the need for aid and attendance (including for protection from hazards or dangers incident to the daily environment due to cognitive impairment), being housebound, etc. The table titled “Evaluation of Cognitive Impairment and Other Residuals of a Traumatic Brain Injury Not Otherwise Classified” addresses 10 facets of a TBI related to cognitive impairment and subjective symptoms. It provides criteria for levels of impairment for each facet, as appropriate, ranging from 0 to 3, and a 5th level, the highest level of impairment, labeled “total.” A 100 percent evaluation is assigned if “total” is the level of evaluation for one or more facets. If no facet is evaluated as “total,” the overall percentage evaluation is assigned based on the level of the highest facet as follows: 0 = 0 percent; 1 = 10 percent; 2 = 40 percent; and 3 = 70 percent. The current version of Diagnostic Code 8045 contains the following notes: Note (1): There may be an overlap of manifestations of conditions evaluated under the table titled "Evaluation of Cognitive Impairment and Other Residuals of a Traumatic Brain Injury Not Otherwise Classified" with manifestations of a comorbid mental or neurologic or other physical disorder that can be separately evaluated under another diagnostic code. In such cases, do not assign more than one evaluation based on the same manifestations. If the manifestations of two or more conditions cannot be clearly separated, assign a single evaluation under whichever set of diagnostic criteria allows the better assessment of overall impaired functioning due to both conditions. However, if the manifestations are clearly separable, assign a separate evaluation for each condition. Note (2): Symptoms listed as examples at certain evaluation levels in the table are only examples and are not symptoms that must be present in order to assign a particular evaluation. Note (3): “Instrumental activities of daily living” refers to activities other than self-care that are needed for independent living, such as meal preparation, doing housework and other chores, shopping, traveling, doing laundry, being responsible for one's own medications, and using a telephone. These activities are distinguished from “Activities of daily living,” which refers to basic self-care and includes bathing or showering, dressing, eating, getting in or out of bed or a chair, and using the toilet. Note (4): The terms “mild,” “moderate,” and “severe” traumatic brain injury, which may appear in medical records, refer to a classification of a traumatic brain injury made at, or close to, the time of injury rather than to the current level of functioning. This classification does not affect the rating assigned under Diagnostic Code 8045. Note (5): A veteran whose residuals of a traumatic brain injury are rated under a version of 38 C.F.R. § 4.124a, Diagnostic Code 8045, in effect before October 23, 2008, may request review under Diagnostic Code 8045, irrespective of whether his disability has worsened since the last review. VA will review that Veteran’s disability rating to determine whether the Veteran may be entitled to a higher disability rating under Diagnostic Code 8045. A request for review pursuant to this note will be treated as a claim for an increased rating for purposes of determining the effective date of an increased rating awarded as a result of such review; however, in no case will the award be effective before October 23, 2008. For the purposes of determining the effective date of an increased rating awarded as a result of such review, VA will apply 38 C.F.R. § 3.114, if applicable. 38 C.F.R. § 4.124a, Diagnostic Code 8045. Analysis In the instant case, the Veteran has alleged that he has residuals of his TBI that include post-concussive headaches with light sensitivity and mildly impaired long-term memory. Therefore, he claims that he is entitled to an initial compensable rating for such disability. In June 2014, the Veteran was provided three separate VA examinations to assess the frequency and severity of his TBI residuals. The VA neuropsychological examination report reflects that the Veteran completed the Mini-Mental State Examination (MMSE), the Repeatable Battery for the Assessment of Neuropsychological Status – A Update (RBANS-A Update), and the Wechsler Abbreviated Scales of Intelligence – II (WASI-II), and the results showed the Veteran to be function within normal limits. He performed at, or above average, in all categories except one, and the examiner noted that these test results were a valid estimate of the Veteran’s true intellectual and cognitive abilities. The examiner further stated that the Veteran’s post-service treatment records and test results were not consistent with residual neuropsychological or cognitive deficits from the Veteran’s in-service TBI. A June 2014 TBI examination report reflects that the Veteran asserted that he experienced headaches with light sensitivity secondary to his in-service TBI. On examination, the Veteran reported no complaints memory impairment, attention, concentration, or executive functions. His judgment, social interactions, orientation, motor activity, communication, consciousness, and visual spatial orientation were considered normal, and there were no neurobehavioral effects. Other than headaches with light sensitivity, for which service connection has been established, he did not have any subjective symptoms or any mental, physical, or neurological conditions or residuals attributable to a TBI. His residuals of TBI did not impact his ability to work. Based on the foregoing, a “0” for every facet is assigned. The Veteran was afforded additional VA examination to assess the severity and frequency of his TBI residuals in February 2016. On examination, the Veteran reported no complaints of impairment of memory, attention, concentration, or executive functions. His judgment was normal, social interactions were routinely appropriate, and he was always oriented with normal motor activity. Visual spatial orientation was considered normal. There were no subjective symptoms and no neurobehavioral effects. He could communicate by, and comprehend, spoken and written language and had normal consciousness. His residuals of TBI did not impact his ability to work. Based on the foregoing, a “0” for every facet is assigned. Although the Veteran noted changes in his memory in the prior two years, the examiner stated that this recent change would be unrelated to his in-service TBI due to the delayed onset. Additional testing was completed, and the Veteran scored within the normal range on the Cognistat 2015 test and RBANS testing results were the same as when administered in June 2014. The examiner noted that the June 2014 WASI-II test results were consistent with his educational and work history. As in June 2014, the examiner stated that the interview and test results were not consistent with any neuropsychological residuals of the Veteran’s service-connected TBI. Based on the foregoing, the Board finds that an initial compensable rating for the Veteran’s residuals of a TBI is not warranted. In this regard, objective testing has revealed no residuals other than those previously service-connected (headaches with light sensitivity), and he has been evaluated as “0” in all facets. In this regard, as discussed by the February 2016 VA examiner, the Veteran’s claimed residuals are too far removed from his head injury to be related to his in-service TBI (mild memory impairment) or are already compensated in the ratings assigned for his service-connected headache disability. 38 C.F.R. § 4.14; Esteban, supra. In this regard, while the Veteran is competent to report symptomatology such as memory impairment, he is not competent, as a lay person, to relate this symptom to a specific diagnosis such as a TBI. Therefore, his statements attributing his subjective symptomatology to his TBI are afforded little probative weight compared to the reasoned opinion from the February 2016 VA examiner. Consequently, his claim for an initial compensable rating for residuals of a TBI must be denied. The Board has also considered whether staged ratings under Fenderson, supra, are appropriate for the Veteran’s service-connected residuals of a TBI; however, the Board finds that the Veteran’s symptomatology referable to his residuals of a TBI has been stable throughout the period on appeal. In making its determinations in this case, the Board has also carefully considered the Veteran’s contentions with respect to the nature of his service-connected disability at issue and notes that his lay testimony is competent to describe certain symptoms. The Veteran’s history and symptom reports have been considered, including as presented in the medical evidence discussed above, and has been contemplated by the evaluation that has been assigned. Moreover, the competent medical evidence offering detailed specific findings pertinent to the rating criteria is the most probative evidence with regard to evaluating the pertinent symptoms of the service-connected disability at issue. As such, while the Board accepts the Veteran’s assertions with regard to the matters he is competent to address, the Board relies upon the more competent medical evidence with regard to the specialized evaluation of functional impairment, symptom severity, and details of clinical features of the service-connected condition at issue. Neither the Veteran, his representatives, nor the record have raised any other issues with regard to his claim seeking a compensable initial evaluation, to include consideration of an extraschedular evaluation. 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 denying the Veteran’s claim seeking a compensable initial evaluation, the Board has considered the applicability of the benefit of the doubt doctrine. However, the preponderance of the evidence is against the issue of entitlement to an initial compensable rating for residuals of a TBI. As such, that doctrine is not applicable in the instant appeal, and such must be denied. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. REASONS FOR REMAND 1. Entitlement to service connection for a bone disability, to include osteoporosis and osteopenia, is remanded. The record reflects that the Veteran has osteopenia and severe osteoporosis. The June 2014 VA examiner opined that osteopenia was not due to any incident of the Veteran’s military service, but no such opinion addressing the etiology of his osteoporosis was offered. As such, the June 2014 is inadequate for the purpose of readjudicating this issue, and a remand to obtain an adequate nexus opinion is necessary. 2. Entitlement to service connection for a neck disability, to include as due to a service-connected disability, is remanded. 3. Entitlement to service connection for a low back disability, to include as secondary to a service-connected disability is remanded. 4. Entitlement to service connection for a bilateral hip disability, to include as secondary to a service-connected disability, is remanded. 5. Entitlement to service connection for a left foot disability, to include as secondary to a service-connected disability, is remanded. Initially, the Board observes that there is no nexus opinion addressing the etiology of the Veteran’s neck disability under any theory of entitlement. A remand to obtain such a nexus opinion is required. Further, in statements from the Veteran dated in February 2014, June 2015, and April 2016, the Veteran asserted that the disabilities of his neck, low back, left foot, and hips were aggravated beyond the normal progression of the conditions be his service-connected knee disabilities. Although nexus opinions addressing secondary causation of the hips, low back, and left foot disabilities were obtained in February 2016, these opinions do not address the Veteran’s theory of aggravation. This is critical in the current case, as it appears that the Veteran’s low back, hip, left foot, and neck pre-date his knee disabilities. As such, these issues must be remanded for the purpose of obtaining adequate nexus opinions addressing the Veteran’s asserted theories of entitlement. 6. Entitlement to a total evaluation based on individual unemployability due to service-connected disabilities (TDIU) is remanded. The Board must defer readjudication of the Veteran’s claim to establish TDIU at this time, as the issue is intertwined with the other issues being remanded by the Board. 7. Entitlement to an effective date prior to August 16, 2013, for the grant of service connection for right foot tendonitis. In June 2015, the Veteran expressed timely disagreement with the assigned initial evaluation and effective date for the award of service connection for right foot tendonitis. While the Veteran was provided a Statement of the Case (SOC) readjudicating the issue seeking a compensable initial evaluation for this disability, the issue seeking an earlier effective date for the award of service connection for this disability was not addressed. As this issue does not appear in the electronic Veterans Appeals Control and Locator System (VACOLS) as an appealed issue (currently or previously), the Board concludes that a remand is necessary so that the Veteran may be provided an SOC readjudicating this issue. 38 C.F.R. § 19.26 (2017); Manlincon v. West, 12 Vet. App. 238 (1999). Lastly, to ensure completeness of the file, updated VA and private treatment records should be sought, obtained, and associated with the file. The matters are REMANDED for the following actions: 1. The AOJ must provide the Veteran and his representative a statement of the case (SOC) readjudicating the issue of entitlement an effective date prior to August 16, 2013, for the grant of service connection for right foot tendonitis. The SOC should include a discussion of all relevant evidence considered and citation to all pertinent law and regulations. Thereafter, the Veteran and his representative should be given an opportunity to perfect an appeal by submitting a timely substantive appeal in response thereto. The AOJ should advise the Veteran and his private attorney that the file will not be returned to the Board for appellate consideration of the issue following the issuance of the SOC unless an appeal is perfected. 2. The AOJ must obtain and associate with the file all updated records of VA treatment from the VAMC in Omaha, Nebraska, and all associated facilities, dated after May 4, 2016. 3. The AOJ must contact the Veteran and request that he complete a release for outstanding private treatment records pertinent to his disabilities pertinent to the issues remanded by the Board. In these releases, the Veteran should provide a time period in which he was treated at each facility identified. The AOJ should then obtain the records identified by the Veteran and undertake translation, if necessary. All records obtained should be associated with the Veteran's file. If any identified and requested records are not available, or if the search for any such records otherwise yields negative results, that fact should clearly be documented in the file, and the Veteran should be informed in writing. 4. Thereafter, the AOJ must request that the Veteran be scheduled for an appropriate VA examination to determine the nature and etiology of any identified disabilities of the neck, low back, hips, left foot, and bones. The complete electronic record must be made available to, and reviewed by, the VA examine prior to conducting the examinations. All necessary studies and tests should be conducted. Thereafter, the examiner must address the following: a. Identify or rule out disabilities affecting the Veteran’s: i. neck ii. low back iii. left foot iv. either hip v. bones (specifically, osteoporosis) b. For each disability identified in subpart (a), provide an opinion concerning whether such is at least as likely as not proximately due to or the result of any incident of the Veteran’s service. c. For each disability identified in subpart (a), provide an opinion concerning whether such is at least as likely as not caused by a service-connected disability (including any disability identified above for which it is opined that service connection is warranted). d. For each disability identified in subpart (a), provide an opinion concerning whether such is at least as likely as not aggravated by a service-connected disability (including any disability identified above for which it is opined that service connection is warranted). If the examiner cannot provide an opinion without resorting to mere speculation, this should be so stated along with supporting rationale. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to the particular question. 5. Thereafter, the AOJ must complete any additional evidentiary development necessary to adjudicate a claim for TDIU, to specifically include collecting and verifying information concerning the Veteran’s educational and occupational history and/or scheduling him for an appropriate VA examination to determine the impact of the Veteran’s service-connected disabilities (alone and in concert) have on his employability. 6. Thereafter, the AOJ must readjudicate the Veteran's pending issues in light of any additional evidence added to the record. If any benefit sought on appeal remains denied, the Veteran and his representative should be furnished with a Supplemental Statement of the Case and be afforded the applicable opportunity to respond before the record is returned to the Board for further review. Michael J. Skaltsounis Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Scott W. Dale, Counsel