Citation Nr: 18155846 Decision Date: 12/06/18 Archive Date: 12/06/18 DOCKET NO. 16-56 076 DATE: December 6, 2018 REMANDED Entitlement to an earlier effective date for the grant of service connection for posttraumatic stress disorder (PTSD) is remanded. Entitlement to service connection for a left shoulder disability is remanded. Entitlement to service connection for a low back disability is remanded. Entitlement to service connection for a bilateral knee disability is remanded. Entitlement to service connection for a left ankle disability is remanded. Entitlement to service connection for tinnitus is remanded. Entitlement to service connection for a bilateral hearing loss disability is remanded. Entitlement to service connection for a skin disability is remanded. Entitlement to service connection for an anxiety/sleep disability, to include as secondary to service-connected PTSD, is remanded. Entitlement to service connection for dental trauma is remanded. Entitlement to service connection for erectile dysfunction, to include as secondary to service-connected PTSD, is remanded. REASONS FOR REMAND The Veteran served on active duty from July 25, 2011 to July 24, 2015. The case comes before the Board of Veterans’ Appeals (the Board) on appeal from November 2015 and December 2017 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO). 1. Entitlement to service connection for a left shoulder disability, a low back disability, a bilateral knee disability, a left ankle disability, tinnitus, a hearing loss disability, a skin disability, an anxiety/sleep disability, dental trauma, and erectile dysfunction are remanded. Pertaining to the Veteran’s claims for service connection for his left shoulder disability, a low back disability, a bilateral knee disability, a left ankle disability, tinnitus, a hearing loss disability, a skin condition, an anxiety/sleep disability, dental trauma, and erectile dysfunction, the Veteran was scheduled for a VA examination in August 2015, and failed to report for his examinations. The failure to report notification indicates that the Veteran could not attend the examination due to work. However, the VA examination was not rescheduled, despite the Veteran’s assertion of his good cause for his failure to appear. Therefore, after a review of the electronic claims file, the Board remands these matters to provide the Veteran the opportunity to attend a VA examination to determine the current nature and etiology of his asserted disabilities. The Veteran is reminded that VA’s duty to assist is not always a one-way street. Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). Rather, the Veteran must cooperate in obtaining the evidence necessary to adjudicate the Veteran’s claim, including attending VA exams. See, e.g., 38 C.F.R. §§ 3.159 (c) (requiring claimant to “cooperate fully with VA’s efforts” to obtain both VA and non-VA medical records) and 3.655(b) (setting forth potential consequences when a veteran fails to appear for a scheduled examination). The Veteran should be aware, that a failure to appear at a scheduled examination without good cause will result in a determination based on the record. 2. Entitlement to an earlier effective date for the grant of service connection for PTSD is remanded. A rating decision dated December 2018 granted service connection for PTSD effective February 22, 2017. However, in July 2018, the Veteran filed an NOD asserting an earlier effective date for the grant of his PTSD. The RO has not furnished a Statement of the Case (SOC) concerning the issue. Therefore, the Board must remand this issue for the RO to issue an SOC and to provide the Veteran and his representative an opportunity to perfect an appeal. Manlicon v. West, 12 Vet. App. 238 (1999). The matters are REMANDED for the following action: 1. Obtain all outstanding VA and/ or private treatment records. Should such exist, associate the records with the Veteran’s electronic claims file. For any private treatment records, obtain the appropriate signed releases from the Veteran, and associate any additional records with the claim. 2. Following completion of directive (1), arrange for the Veteran to undergo VA examinations to determine the nature and etiology of any current of the following disabilities: (1) left shoulder disability; (2) a low back disability; (3) a bilateral knee disability; (4) a left ankle disability; (5) tinnitus; (6) a bilateral hearing loss disability; (7) a skin disability; (8) an anxiety/sleep disability; (9) dental trauma, and (10) erectile dysfunction. The RO is directed to communicate with the Veteran to schedule the Veteran for VA examinations at a time that works with his work schedule, if possible. The Veteran is hereby notified that it is his responsibility to report for his scheduled examination and to cooperate in the development of the claim. The consequence for failure to report for a VA examination without good cause for an original claim may negatively affect the outcome of his claim. 38 C.F.R. §§ 3.158, 3.655(2017). For each examination, the claims folder must be thoroughly reviewed by the examiner in connection with the examination, and a complete history should be elicited directly from the Veteran. Any tests and studies deemed necessary by the examiner should be conducted. All findings should be reported in detail. The VA examiner is to opine to the following: (1) left shoulder disability (a) Identify the Veteran’s current left shoulder disability. (b) For each disability noted in (a), is it at least as likely as not (a 50 percent probability or more) that the current left shoulder disability had its onset in service, or is otherwise related to the Veteran’s military service? (2) low back disability (c) Identify the Veteran’s current low back disability. (d) For each disability noted in (c), is it at least as likely as not (a 50 percent probability or more) that the current low back disability had its onset in service, or is otherwise related to the Veteran’s military service? (3) bilateral knee disability (e) Identify the Veteran’s current bilateral knee disability. (f) For each disability noted in (e), is it at least as likely as not (a 50 percent probability or more) that the current bilateral knee disability had its onset in service, or is otherwise related to the Veteran’s military service? (4) left ankle disability (g) Identify the Veteran’s left ankle disability. (h) For each disability noted in (g), is it at least as likely as not (a 50 percent probability or more) that the current left ankle disability had its onset in service, or is otherwise related to the Veteran’s military service? (5) tinnitus (i) Is it at least as likely as not (a 50 percent probability or more) that the Veteran’s current tinnitus had its onset in service, or is otherwise related to the Veteran’s military service? The VA examiner is directed to report any assertions of onset, to include any assertions of continued symptomatology since service. (6) bilateral hearing loss disability (j) Identify whether the Veteran has a current bilateral hearing loss disability. (k) For each disability noted in (j), is it at least as likely as not (a 50 percent probability or more) that the current hearing loss disability had its onset in service, or is otherwise related to the Veteran’s military service? The VA examiner is directed to report any assertions of onset, to include any assertions of continued symptomatology since service. (7) skin disability (l) Identify the Veteran’s current skin disability. (m) For each disability noted in (l), is it at least as likely as not (a 50 percent probability or more) that the current skin disability had its onset in service, or is otherwise related to the Veteran’s military service? (8) anxiety/sleep disability (n) Identify the Veteran’s current anxiety/sleep disability. (o) For each disability noted in (n), is it at least as likely as not (a 50 percent probability or more) that the current anxiety/sleep disability had its onset in service, or is otherwise related to the Veteran’s military service? (p) For each disability noted in (n), was such disability caused or aggravated (i.e., permanently worsened beyond the natural progression of the disorder) by the Veteran’s service-connected PTSD? (9) dental trauma (q) Identify the Veteran’s current dental disorders. The examiner must answer the following: (i) Does he have impairment of the mandible loss of a portion of the ramus loss of a portion of the maxilla, or loss of teeth due to loss of substance of the body of the maxilla or mandible? (ii) Does he have defective or missing teeth tooth disease, dental abscess, or disease of the periodontal tissue? (r) If the Veteran has the following disorders - impairment of the mandible loss of a portion of the ramus, loss of a portion of the maxilla, or loss of teeth due to loss of substance of the body of the maxilla or mandible - is it at least as likely as not (i.e., probability of 50 percent or greater) that any of these problems began in or is related to active service? (s) If the Veteran has the following disorders -defective or missing teeth tooth disease dental abscess, or disease of the periodontal tissue - is it at least as likely as not (i.e. probability of 50 percent or greater) that any of these problems began in or is related to active service? (10) erectile dysfunction (t) Identify the Veteran’s current erectile dysfunction disability. (u) For each disability noted in (t), is it at least as likely as not (a 50 percent probability or more) that the current erectile dysfunction disability had its onset in service, or is otherwise related to the Veteran’s military service? (v) For each disability noted in (t), was such disability caused or aggravated (i.e., permanently worsened beyond the natural progression of the disorder) by the Veteran’s service-connected PTSD? The examiner is reminded that the term “as likely as not” does not mean “within the realm of medical possibility,” but rather that the evidence of record is so evenly divided that, in the examiner’s expert opinion it is as medically sound to find in favor of the proposition as it is to find against it. A full and complete rationale for any opinion expressed is required. If the examiner feels that the requested opinions cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a 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). Jones v. Shinseki, 23 Vet. App. 382 (2010). 3. Adjudicate the issue of entitlement to an earlier effective date for the grant of service connection for PTSD, and if the full benefit sought remains denied, issue an appropriate statement of the case SOC) and provide the Veteran and his representative the requisite period of time to respond. The Veteran is advised that a timely Substantive Appeal will be necessary to perfect an appeal to the Board concerning this matter. 38 C.F.R. § 20.302 (b) (2018). 4. After completing directives (1) and (2), readjudicate the claims for entitlement to service connection on appeal. If a benefit sought remains denied, issue an appropriate supplemental statement of the case (SSOC) and provide the Veteran and his representative the requisite period of time to respond. The case should then be returned to the Board for further appellate review, if otherwise in order. Michael Pappas Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Tunis, Associate Counsel