Citation Nr: 18155473 Decision Date: 12/04/18 Archive Date: 12/04/18 DOCKET NO. 13-17 159 DATE: December 4, 2018 ORDER Entitlement to service connection for fibromyalgia, to include generalized muscle weakness, to include as secondary to service-connected right ilioinguinal nerve damage and depressive disorder, is denied. Entitlement to service connection for hypertension, to include as secondary to service-connected right ilioinguinal nerve damage and depressive disorder, is denied. Entitlement to a total disability rating based on individual unemployability (TDIU) for the period from November 29, 2012, to April 27, 2107, and for the period since August 1, 2017, is granted, subject to the laws and regulations governing the payment of monetary benefits. REMANDED Entitlement to service connection for a gastrointestinal disorder, to include gastroesophageal reflux disease (GERD), hiatal hernia, and a disorder manifested by H. pylori, to include as secondary to the service-connected right ilioinguinal nerve damage and depressive disorder, is remanded. Entitlement to service connection for erectile dysfunction, to include as secondary to service-connected right ilioinguinal nerve damage and depressive disorder, is remanded. Entitlement to an initial compensable rating for residual scars is remanded. Entitlement to an initial rating in excess of 10 percent for right ilioinguinal nerve damage is remanded. Entitlement to an initial rating in excess of 50 percent for depressive disorder is remanded. Entitlement to TDIU for the period from April 28, 2017, to July 31, 2017, and for the period prior to November 29, 2012, is remanded. REFERRED The issue of entitlement to service connection for a back disorder, claimed as an abnormal posture, was raised in a September 2014 statement and is referred to the Agency of Original Jurisdiction (AOJ) for adjudication. FINDINGS OF FACT 1. The weight of evidence is against a finding that the Veteran currently has or has had fibromyalgia or a disability manifested by functional impairment due to generalized muscle weakness during the pendency of this appeal. 2. The weight of the evidence is against findings that hypertension was demonstrated in-service, that hypertension was compensably disabling within a year of separation from active duty, that there is a nexus between the current diagnosis of hypertension and service, that hypertension was caused or aggravated by the service-connected right ilioinguinal nerve damage, and that hypertension was caused or aggravated by the service-connected depressive disorder. 3. From November 29, 2012, to April 27, 2017, and since August 1, 2017, the Veteran has been service-connected for right ilioinguinal nerve damage, depressive disorder, and residual scars from postoperative treatment for right ilioinguinal nerve damage. 4. From November 29, 2012, to April 27, 2017, and since August 1, 2017, the service-connected disabilities, which are of a common etiology, have been rated as 60 percent disabling. 5. The weight of evidence shows that the Veteran’s earned income in 2012 was marginal employment. 6. The weight of evidence shows that from November 29, 2012, to April 27, 2017, and since August 1, 2017, the right ilioinguinal nerve damage and depressive disorder have rendered him unemployable from performing all forms of substantially gainful employment that are consistent with his education and occupational experience. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for fibromyalgia, to include generalized muscle weakness, to include as secondary to service-connected right ilioinguinal nerve damage and depressive disorder, have not been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.310 (2017). 2. The criteria for entitlement to service connection for hypertension, to include as secondary to service-connected right ilioinguinal nerve damage and depressive disorder, have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.307, 3.309, 3.310 (2017). 3. The criteria for entitlement to TDIU for the periods from November 29, 2012, to April 27, 2107, and since August 1, 2017, have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.16, 4.19, 4.25, 4.26 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from April 1969 to January 1971. These matters come to the Board of Veterans’ Appeals (Board) from October 2013 (service connection and TDIU claims) and October 2018 (increased ratings) rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO). In May 2016, the Veteran and his spouse testified at a hearing held at the RO before the undersigned Veterans Law Judge and a copy of that hearing has been associated with the electronic record. In April 2018, the Board granted compensation benefits under the provisions of 38 U.S.C. § 1151 for a neurological disability as a result of a bilateral inguinal hernia repair and open umbilical hernia repair performed at a VA medical center in November 2009 as well as service connection for a chronic acquired psychiatric disorder as secondary to the neurological disability resulting from the bilateral inguinal hernia repair and open umbilical hernia repair by way of causation. The Board remanded the claims of entitlement to service connection for fibromyalgia, hypertension, a gastrointestinal disorder, and erectile dysfunction, as well as a claim of entitlement to TDIU. In an October 2018 rating decision, the RO implemented the April 2018 Board decision by granting compensation benefits for right ilioinguinal nerve damage effective October 26, 2010, and assigning an initial 10 percent disability rating effective that same date. The RO granted service connection for depressive disorder effective November 29, 2012, and assigned an initial 50 percent disability rating effective that same date. The RO granted service connection for residual scars from postoperative treatment for right ilioinguinal nerve damage effective March 21, 2014, and assigned an initial zero percent disability rating effective that same date. In a November 2018 statement, the Veteran’s counsel inquired about the status of a May 2018 formal TDIU claim that had not been the subject of a rating decision. The Board notes that TDIU is in appellate status. As stated in the findings of fact and conclusions of law, the Board is granting TDIU for the period from November 29, 2012, to April 27, 2107, and for the period since August 1, 2017, which are the periods when the Veteran has met the schedular criteria for TDIU under 38 C.F.R. § 4.16(a). In a November 2008 rating decision, the RO granted a temporary 100 percent disability rating for the right ilioinguinal nerve damage under 38 C.F.R. § 4.30 (2017) effective from April 28, 2017, to July 31, 2017. Receipt of a 100 percent disability rating for a service-connected disability does not necessarily render moot the issue of entitlement to a TDIU. Bradley v. Peake, 22 Vet. App. 280 (2008). Under the circumstances, the Veteran’s claim for TDIU remains pending during the period from April 28, 2017, to July 31, 2017. The issue of entitlement to TDIU for the period from April 28, 2017, to July 31, 2017, and for the period prior to November 29, 2012, is remanded. In November 2018, the Veteran’s counsel filed a notice of disagreement with the initial assignments of the three disability ratings in the October 2018 rating decision. VACOLS shows that the RO acknowledged receipt of the notice of disagreement but that the RO listed the issue as entitlement to service connection for a depressive disorder. In any event, the Board is taking jurisdiction of these three increased rating issues as these issues are inextricably intertwined with the remaining TDIU issue. Harris v. Derwinski, 1 Vet. App. 180 (1991). On October 5, 2018, the RO issued a supplemental statement of the case on the service connection issues and TDIU. On October 18, 2018, the RO obtained additional VA treatment records. The overwhelming majority of these VA treatment records were considered by the RO in the October 5, 2018, supplemental statement of the case. The new VA treatment records dated in October 2018 that were not considered by the RO in the October 5, 2018, supplemental statement of the case do not pertain to whether the Veteran has fibromyalgia or a disorder manifested by functional impairment due to generalized muscle weakness or whether the hypertension is related to service or a service-connected disability. Therefore, these new VA treatment records are not pertinent to the claims of service connection for fibromyalgia and hypertension. As such, a waiver of AOJ consideration of these VA treatment records is unnecessary. 38 C.F.R. § 20.1304(a) (2017). Service Connection VA’s duties to notify and assist claimants in substantiating a claim for VA benefits are found at 38 U.S.C. §§ 5100, 5102, 5103, 5103A, 5107, 5126 and 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a). The Veteran and his counsel have not raised any issues with the duty to notify or duty to assist except for stating in his June 2013 claim and January 2015 VA Form 9 that VA must advise the Veteran of the existence of negative evidence and how to counter this evidence. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to duty to assist argument). The United States Court of Appeals for the Federal Circuit (Federal Circuit) has specifically found that notice pursuant to VA’s duty to notify “may be generic in the sense that it need not identify evidence specific to the individual claimant’s case (though it necessarily must be tailored to the specific nature of the Veteran’s claim).” Wilson v. Mansfield, 506 F.3d 1055, 1062 (Fed. Cir. 2007). The United States Court of Appeals for Veterans Claims (Court) has further stated since 38 U.S.C. § 5103 (a) “deals only with information and evidence gathering prior to the initial adjudication of a claim... it would be senseless to construe that statute as imposing upon the Secretary a legal obligation to rule on the probative value of information and evidence presented in connection with a claim prior to rendering a decision on the merits itself.” Locklear v. Nicholson, 20 Vet. App. 410, 415 (2006). Therefore, the assertion that the Veteran should have been provided notification as to the existence of negative evidence and how to counter this evidence in this case is meritless. 1. Entitlement to service connection for fibromyalgia, to include generalized muscle weakness, to include as secondary to service-connected right ilioinguinal nerve damage and depressive disorder Governing law and regulations Service connection is warranted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in the line of duty in the active military service or, if pre-existing such service, was aggravated thereby. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Service connection may also be warranted 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). To establish service connection for a claimed disorder, there must be (1) evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) evidence of a nexus between the claimed in-service disease or injury and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999). A 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). Secondary service connection may also be established for a nonservice-connected disability that is aggravated by a service connected disability. In such an instance, a veteran may be compensated for the degree of disability over and above the degree of disability existing prior to the aggravation. 38 C.F.R. § 3.310(b); Allen v. Brown, 7 Vet. App. 439, 448 (1995). In order to establish service connection for a claimed disability on a secondary basis, there must be (1) medical evidence of a current disability; (2) a service-connected disability; and (3) medical evidence of a nexus between the service-connected disease or injury and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). The existence of a current disability is the cornerstone of a claim for VA disability compensation. Degmetich v. Brown, 104 F. 3d 1328 (1997). To be present as a current disability, the claimed condition must be present at the time of the claim for benefits, as opposed to sometime in the distant past. Gilpin v. West, 155 F. 3d 1353 (Fed. Cir. 1998). The Gilpin requirement that there be a current disability is satisfied when the disability is shown at the time of the claim or during the pendency of the claim, even though the disability subsequently resolves. McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). In Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018), the Federal Circuit held that where pain alone results in functional impairment, even if there is no identified underlying diagnosis, pain alone can constitute a disability. Analysis The Veteran filed a claim of entitlement to service connection for a bilateral hip disability in June 2013. In addition to claiming that he has fibromyalgia, the Veteran claims that he has a disability manifested by chronic muscle weakness. The Board must first address the existence of a current disability under both theories of entitlement. Applying the holding in Saunders to claims of muscle weakness, the Board will consider whether the Veteran has a current disability manifested by functional impairment due to chronic muscle weakness. In his June 2013 claim, the Veteran reported that fibromyalgia was diagnosed at a VA medical center in approximately 2011 and that gabapentin was prescribed. VA treatment records reflect that while gabapentin was prescribed in 2010, the drug was prescribed for inguinal pain. VA treatment records, to include the ones dated in 2010 and 2011, do not show a diagnosis of fibromyalgia or a disorder manifested by functional impairment due to chronic muscle weakness. An August 2018 VA examination report reveals that the examiner did not diagnose fibromyalgia or a disorder manifested by functional impairment due to chronic muscle weakness. The examiner noted that treatment records did not document a diagnosis of fibromyalgia, generalized muscle weakness, or symptoms suggestive of either fibromyalgia or generalized muscle weakness. The examiner indicated that the examination was not consistent with fibromyalgia or generalized muscle weakness and that there is no pathology to render a diagnosis. The Veteran complained of lower back pain, pins-and-needles sensation in the left leg, coldness in the left leg, and left leg pain. The examiner noted that the Veteran seemed to be referring to his lumbar spine symptoms and that lumbar degenerative disc disease and degenerative joint disease are different disorders from fibromyalgia. 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). As for the Veteran’s reporting in his June 2013 claim that a VA medical professional diagnosed fibromyalgia, lay person’s account of what medical professional purportedly said, filtered as it is through a lay person’s sensibilities, is generally not persuasive medical evidence unless the lay person is reporting a contemporaneous medical diagnosis. Id; Robinette v. Brown, 8 Vet. App. 69, 77 (1995). In this case, as noted above, the VA treatment records do not show a contemporaneous medical diagnosis of fibromyalgia. The August 2018 VA examination report reflects that the Veteran reported fibromyalgia was diagnosed in 2010 at a VA medical center. That notation is merely the reporting by the Veteran of his asserted history of a diagnosis of fibromyalgia. LeShore v. Brown, 8 Vet. App. 406, 409 (1995). In fact, the examiner noted that the treatment records do not document a diagnosis of fibromyalgia. Thus, the notation in the VA examination report is not competent evidence of a current diagnosis of fibromyalgia. The Board notes that although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), as to the specific issue in this case, the existence of fibromyalgia falls outside the realm of common knowledge of a lay person. See Jandreau, 492 F.3d at 1733 n. 4 (lay persons not competent to diagnose cancer). Therefore, the Veteran is not competent to provide an opinion on the existence of fibromyalgia. In summary, for the reasons and bases set forth above, the Board concludes that the most probative and persuasive evidence weighs against a finding that the Veteran currently has or has had fibromyalgia or a disability manifested by functional impairment due to generalized muscle weakness during the pendency of this appeal. Thus, Hickson and Wallin element (1), current disability, is not satisfied. The preponderance of the evidence is against the claim as to direct and secondary service connection for fibromyalgia or a disability manifested by functional impairment due to generalized muscle weakness, and it is denied. 2. Entitlement to service connection for hypertension, to include as secondary to service-connected right ilioinguinal nerve damage and depressive disorder, Governing law and regulations Where a veteran served ninety days or more of active service, and certain chronic diseases become manifest to a degree of 10 percent or more within one year after the date of separation from such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309(a). While the disease need not be diagnosed within the presumption period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. Id. Among the chronic disorders listed under 38 C.F.R. § 3.309 (a) is cardiovascular-renal disease, including hypertension. For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. 38 C.F.R. § 3.303(b). An alternative to showing chronicity in service is a showing of continuity of symptoms after discharge. The Federal Circuit, however, clarified that this notion of continuity of symptomatology since service under 38 C.F.R. § 3.303 (b), which is an alternative means of establishing the required nexus or linkage between current disability and service, only applies to conditions identified as chronic under 38 C.F.R. § 3.309(a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Analysis VA treatment records as well as the August 2018 VA examination report reflect that the Veteran had hypertension. Therefore, Hickson element (1) and Wallin element (1), current disability, is satisfied. As to Hickson element (2) with regard to in-service disease, the service treatment records do not reveal a diagnosis of hypertension. At a December 1970 separation examination, the Veteran’s blood pressure was 120/82. Hickson element (2), in-service disease or injury, is not met. With regard to Hickson element (3), medical nexus, VA treatment records show an impression of possible hypertension in July 2006. In January 2007, hypertension was diagnosed. No medical professional has indicated that the hypertension was diagnosed within a year of active service. There is no medical evidence showing that hypertension was diagnosed within one year of active service. In fact, the Veteran does not claim that he had hypertension in service or within a year of service. Likewise, the Veteran is not claiming continuity of symptomatology of hypertension. Hence, Hickson element (3), medical nexus, is not established. Turning to the secondary service connection claim for hypertension, service connection is in effect for right ilioinguinal nerve damage and depressive disorder. Thus, Wallin element (2), service-connected disability, is shown. As for Wallin element (3), medical nexus, the August 2018 VA examiner opined that hypertension was not caused by the right ilioinguinal nerve damage or the depressive disorder secondary to the nerve damage. The examiner noted that 2008 and 2009 VA treatment records indicate that hypertension preceded the onset of the service-connected neurological and psychiatric disorders. The examiner described the baseline level of severity of hypertension as needing the blood pressure controlled by two medications in 2008. The examiner opined that level of severity of hypertension was not greater than the baseline level of hypertension. The examiner opined that hypertension was not aggravated beyond its natural progression by either the service-connected neurological disorder or the service-connected psychiatric disorder. The examiner’s rationale was that the Veteran originally took two medications to control his hypertension and that now he only takes one medication. The examiner noted that there has been a reduction in medication for hypertension in the presence of the service-connected neurological and psychiatric disorders. Thus, Wallin element (3), medical nexus, is not met. The Veteran claims that the hypertension is related to the service-connected neurological and psychiatric disorders. The Veteran’s spouse testified that the Veteran did not have hypertension prior to the inguinal hernia surgery resulting in the service-connected neurological disorder and secondary psychiatric disorder. Although lay persons are competent to provide opinions on some medical issues, see Kahana, 24 Vet. App. at 435, the relationships between hypertension and the following – the service-connected ilioinguinal nerve damage and depressive disorder – fall outside the realm of common knowledge of a lay person. See Jandreau, 492 F.3d at1,733 n. 4. Similarly, the dating of the existence of hypertension in the absence of a contemporaneous medical diagnosis falls outside of the realm of common knowledge of a lay person. Id. In short, for the reasons and bases set forth above, the Board concludes that the weight of the evidence is against findings that hypertension was demonstrated in-service, that hypertension was compensably disabling within a year of separation from active duty, that there is a nexus between the current diagnosis of hypertension and service, that hypertension was caused or aggravated by the service-connected right ilioinguinal nerve damage, and that hypertension was caused or aggravated by the service-connected depressive disorder. Accordingly, the preponderance of the evidence is against the claim as to direct and secondary service connection for hypertension, and it is denied. 3. Entitlement to TDIU for the periods from November 29, 2012, to April 27, 2107, and since August 1, 2017 Governing Law and Regulations Total disability ratings for compensation based on individual unemployability may be assigned where the schedular rating is less than total, when it is found that the disabled person is unable to secure or follow a substantially gainful occupation without regard to advancing age as a result of a single service-connected disability ratable at 60 percent or more, or as a result of two or more disabilities, provided at least one disability is ratable at 40 percent or more, and there is sufficient additional service-connected disability to bring the combined rating to 70 percent or more. 38 C.F.R. §§ 3.340, 3.341, 4.16(a). For the above purpose, disabilities resulting from a common etiology or a single accident will be considered a single disability. Also, disabilities affecting the same body system, e.g., orthopedic, will considered one disability. 38 C.F.R. § 4.16(a). Substantially gainful employment suggests a living wage. The ability to work sporadically or obtain marginal employment is not substantially gainful employment. Moore v. Derwinski, 1 Vet. App. 356, 358-59 (1991). Marginal employment generally shall be deemed to exist when a veteran’s earned annual income does not exceed the amount established by the United States Department of Commerce, Bureau of the Census, as the poverty threshold for one person. Marginal employment may also be held to exist on facts found basis (including but not limited to employment in a protected environment such as a family business or sheltered workshop) when earned annual income exceeds the poverty threshold. Consideration shall be given in all claims to the nature of the employment and the reason for termination. 38 C.F.R. § 4.16 (a). For a veteran to prevail on a claim for a total compensation rating based on individual unemployability, the record must reflect some factor, which takes this case outside the norm. The simple fact that a claimant is currently unemployed or has difficulty obtaining employment is not enough. A high rating in itself is recognition that the impairment makes it difficult to obtain or keep employment, but the ultimate question is whether a veteran is capable of performing the physical and mental acts required by employment, not whether he can find employment. Van Hoose v. Brown, 4 Vet. App. 361 (1993) (A high rating is recognition that the impairment makes it difficult to obtain or keep employment.). Analysis From November 29, 2012, to April 27, 2017, and since August 1, 2017, the Veteran has been service-connected for right ilioinguinal nerve damage, depressive disorder, and residual scars from postoperative treatment for right ilioinguinal nerve damage. From November 29, 2012, to April 27, 2017, and since August 1, 2017, the service-connected disabilities, which are of a common etiology, have been rated as 60 percent disabling. Thus, he has a single disability rated as 60 percent disabling for purposes of TDIU. This makes him eligible for consideration under 38 C.F.R. § 4.16(a) From November 29, 2012, to April 27, 2017, and since August 1, 2017. In his March 2011 formal TDIU claim, the Veteran reported that he became too disabled to work in his career as a chef in November 2009 when he last worked full time. He stated that he had three years of college and that he had not had any education and training since he became too disabled to work. In his June 2013 formal TDIU claim, he reported that he became too disabled to work in May 2011 when he last worked full time. In his May 2018 TDIU formal claim, he indicated that he became too disabled to work at the end of 2010 when he last worked full time. In a July 2018 statement, the Veteran reported that his net income in 2012 was approximately $1,500. The amount established by the United States Department of Commerce, Bureau of the Census, as the poverty threshold for one person for 2012 is $11,720. Thus, the weight of evidence shows that the Veteran’s earned income in 2012 was marginal employment. In October 2011, the Social Security Administration granted disability benefits effective November 12, 2009, based on the following severe impairments: entrapment neuropathy, status post hernia repair operation with ilioinguinal neuralgia, genitofemoral neuralgia, and depression/anxiety. The agency found that the Veteran had the residual capacity to perform a limited range of sedentary work, but that his ability to perform that type of work was compromised by psychological factors affected by chronic pain. The agency noted that due to symptoms of depression and anxiety and pain distraction, the Veteran was moderately limited as to the ability to maintain social functioning and as to his ability to maintain attention, concentration, persistence, and pain needed to complete tasks in a timely manner. The agency indicated that his acquired job skills do not transfer to other occupations within residual functional capacity. The agency stated that considering his age, education, work experience, and residual functional capacity, there were no jobs that exist in significant numbers in the national economy that the Veteran can perform. The agency concluded that based on residual functional capacity for full range of sedentary work with consideration of age, education, and work experience, a finding of “disabled” was warranted. An August 2018 VA mental disorders examination report reflects that the examiner determined that the Veteran had an occupational and social impairment with reduced reliability and productivity. The examiner noted that the Veteran had disturbances of motivation and mood. An August 2018 VA peripheral nerves examination report reveals that right ilioinguinal neuropathy impacted the ability to work by limiting the ability to stand and walk. Social Security Administration decisions are relevant but not binding on VA. Collier v. Derwinski, 1 Vet. App. 413, 417 (1991). Though the Social Security Administration considered the Veteran’s age in its determination, the Board places great weight on its findings because the agency considered the following: the Veteran’s functional impairment due to psychological factors affected by chronic pain, whether his acquired job skills transfer to other occupations, and whether jobs exist in significant numbers in the national economy that the Veteran can perform. The weight of evidence shows that from November 29, 2012, to April 27, 2017, and since August 1, 2017, the right ilioinguinal nerve damage and depressive disorder have rendered him unemployable from performing all forms of substantially gainful employment that are consistent with his education and occupational experience. Accordingly, entitlement to TDIU for the period from November 29, 2012, to April 27, 2107, and for the period since August 1, 2017, is in order. REASONS FOR REMAND In the April 2018 remand, the Board directed the AOJ to obtain treatment records from the Iowa City VA Medical Center from 1982 to 1984 because the Veteran reported treatment at that facility for acid reflux. The AOJ contacted the Omaha VA Medical Center, which did not have any treatment records, instead of the Iowa City VA Medical Center. Therefore, the AOJ did not comply with the directives of the Board remand. Stegall v. West, 11 Vet. App. 268 (1998). Moreover, at the August 2018 VA esophageal conditions examination, the Veteran reported that he was treated at the Iowa City VA Medical Center in 1972 for a hiatal hernia. The AOJ should attempt to obtain all records from the Iowa City VA Medical Center from 1971 to 1984 pertaining to treatment for a gastrointestinal disorder. In his June 2013 claim, the Veteran asserted that his erectile dysfunction is possibly due to taking medications for his service-connected disabilities. Another VA examination is necessary to determine whether the erectile dysfunction is caused or aggravated by taking medications for the service-connected right ilioinguinal nerve damage and depressive disorder. In addition, an August 2018 VA medical opinion report reveals that the examiner stated that she could not determine a baseline level of severity of the erectile dysfunction because the exact symptoms of erectile dysfunction and response to medication are not detailed in the records. The examiner, however, stated that Peyronie’s disease and hypertension led to a gradual worsening of erectile dysfunction. Given that the examiner noted evidence of worsening, another examination is warranted. In his June 2013 claim, he reported receiving treatment for erectile dysfunction in 1999 at the VA medical center in “Asheville, GA.” A September 2005 treatment record from the Asheville VA Medical Center suggests that he had received prior treatment from that facility because he was at that facility to get his annual physical. It appears that the Veteran was referring to the Asheville VA Medical Center in North Carolina, but additional clarification is necessary. In any event, the RO should attempt to obtain all records from the Asheville VA Medical Center from January 1999 to September 2005 pertaining to treatment for erectile dysfunction on the assumption that the Veteran was referring to that facility. As noted above, the Social Security Administration determined that the right ilioinguinal nerve damage was a severe impairment. Given the evidence of unemployability due to the service-connected neurological disorder, the RO should refer the Veteran’s claim of entitlement to TDIU for the period from April 28, 2017, to July 31, 2017, and for the period prior to November 29, 2012, to the Under Secretary for Benefits or to the Director of Compensation and Pension Service for consideration of the assignment of an extraschedular rating. 38 C.F.R. § 4.16(b) (2017). In an October 2018 rating decision, the RO implemented the April 2018 Board decision by granting compensation benefits for right ilioinguinal nerve damage effective October 26, 2010, and assigning an initial 10 percent disability rating effective that same date. The RO granted service connection for depressive disorder effective November 29, 2012, and assigned an initial 50 percent disability rating effective that same date. The RO granted service connection for residual scars from postoperative treatment for right ilioinguinal nerve damage effective March 21, 2014, and assigned an initial zero percent disability rating effective that same date. In November 2018, the Veteran’s counsel filed a notice of disagreement with the initial assignments of the three disability ratings in the October 2018 rating decision. A statement of the case has not yet been issued on the increased-rating matters. A remand is required for the AOJ to issue a statement of the case. 38 C.F.R. § 20.200; Manlincon v. West, 12 Vet. App. 238, 240-41 (1999). The matters are REMANDED for the following action: 1. Ask the Veteran to identify all treatment for her erectile dysfunction, to include VA treatment in 1999; gastrointestinal disorder; right ilioinguinal nerve damage; and any other disability pertaining to his TDIU claim, and obtain all identified records. Obtain the Veteran’s VA treatment records from the Iowa City VA Medical Center pertaining to treatment for a gastrointestinal disorder for the period from January 1971 to December 1984. Obtain the Veteran’s VA treatment records from the Asheville VA Medical Center or any other VA facility identified by the Veteran pertaining to treatment for erectile dysfunction for the period from January 1999 to September 2005. 2. After the development in 1 is completed, schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of the erectile dysfunction. The examiner should opine on whether it is at least as likely as not (50 percent or greater) that the erectile dysfunction was caused or aggravated (i.e., permanently worsen beyond the normal progression of the disability) by his service-connected right ilioinguinal nerve damage or depressive disorder, to include any medications used to treat right ilioinguinal nerve damage or depressive disorder. If the examiner finds that the erectile dysfunction was aggravated by the service-connected right ilioinguinal nerve damage, the service-connected depressive disorder, or any medications used to treat right ilioinguinal nerve damage or depressive disorder, then he/she should quantify the degree of aggravation. 3. After the development in 1 is completed, the AOJ should undertake any additional development on the claim of entitlement to service connection for a gastrointestinal disorder based on the evidence of record. 4. After the development in 1 is completed, the AOJ should take any additional development necessary before adjudicating the claim for TDIU, to include referring the claim of entitlement to TDIU for the period from April 28, 2017, to July 31, 2017, and for the period prior to November 29, 2012, to the Under Secretary for Benefits or to the Director of Compensation and Pension Service for consideration of the assignment of an extraschedular rating, if applicable. 5. Send the Veteran and his counsel a statement of the case that addresses the issues of entitlement to an initial compensable rating for residual scars, an initial rating in excess of 10 percent for right ilioinguinal nerve damage, and an initial rating in excess of 50 percent for depressive disorder. If the Veteran perfects an appeal by submitting a timely VA Form 9, the issues should be returned to the Board for further appellate consideration. 6. Thereafter, readjudicate the claims on appeal. If any benefit sought in connection with the claims remains denied, the Veteran and his counsel should be provided with an appropriate Supplemental Statement of the Case (SSOC) and given the opportunity to respond. MICHAEL LANE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD D. Cherry, Counsel