Citation Nr: 18155911 Decision Date: 12/06/18 Archive Date: 12/06/18 DOCKET NO. 14-34 523 DATE: December 6, 2018 ORDER New and material evidence having been presented, the claims of entitlement to service connection for a skin condition and for an acquired psychiatric disorder, to include as secondary to service-connected disabilities, are reopened. To this limited extent only, the appeal of those issues is granted. Entitlement to service connection for obstructive sleep apnea is granted. Entitlement to service connection for hypertension is denied. Entitlement to an evaluation in excess of 10 percent for service-connected tinnitus is denied. Entitlement to a compensable evaluation for the service-connected surgical scar of the neck is denied. Entitlement to an effective date prior to October 27, 2008, for the award of service connection for Scheuermann's disease is denied. Entitlement to an effective date prior to July 19, 2017, for the award of service connection for tinnitus is denied. REMANDED Entitlement to service connection for headaches is remanded. Entitlement to service connection for a skin condition is remanded. Entitlement to service connection for an acquired psychiatric disorder, to include as secondary to service-connected disabilities, is remanded. Entitlement to an evaluation in excess of 40 percent from March 31, 2015, to January 1, 2018, and in excess of 10 percent thereafter for the service-connected lumbar disability is remanded. Entitlement to an evaluation in excess of 20 percent for service-connected Scheuermann's disease is remanded. Entitlement to a TDIU is remanded. FINDINGS OF FACT 1. The Veteran’s first claim of service connection for a skin condition was denied in an August 2005 rating decision; the Veteran filed a timely notice of disagreement but did not file a substantive appeal in response to the November 2005 statement of the case. 2. Evidence submitted since the August 2005 rating decision became final was not previously considered by agency decision makers; is neither cumulative nor redundant of the evidence already of record; relates to unestablished facts; and raises a reasonable possibility of substantiating the Veteran’s claims for service connection for a skin condition. 3. The Veteran’s first claim of service connection for an acquired psychiatric disorder was denied in a September 2014 rating decision that was not appealed; no further evidence relevant to the Veteran’s service connection claims was submitted for a period of one year following the September 2014 rating decision. 4. Evidence submitted since the September 2014 rating decision was not previously considered by agency decision makers; is neither cumulative nor redundant of the evidence already of record; relates to unestablished facts; and raises a reasonable possibility of substantiating the Veteran’s claims for service connection for bilateral hearing loss and tinnitus. 5. The competent evidence of record indicates the diagnosed obstructive sleep apnea is aggravated by the Veteran’s service-connected neck and back disabilities. 6. There is no evidence in the record reflecting the onset of hypertension during service or within a year of separation, and there is no evidence of a nexus between the Veteran’s current hypertension and his active service. 7. The Veteran’s service-connected tinnitus is assigned an evaluation of 10 percent, which is the maximum evaluation authorized under the governing diagnostic code. 8. The Veteran’s service-connected surgical scar of the neck does not have any characteristic of disfigurement, nor is it painful or unstable. 9. The Veteran applied for service connection for a cervical spine disability within a year of separating from active duty service, but this application was denied in a rating decision that became final; he next applied for service connection for a cervical spine disability on October 27, 2008. 10. The Veteran’s first and only application for service connection for tinnitus was received on July 19, 2017, after entitlement arose. CONCLUSIONS OF LAW 1. New and material evidence has been received since the August 2005 denial became final; the criteria for reopening the previously denied claim for a skin condition have been met. 38 U.S.C. §§ 5108, 7104, 7105; 38 C.F.R. §§ 3.156, 20.302, 20.1103. 2. New and material evidence has been received since the September 2014 denial became final; the criteria for reopening the previously denied claim for an acquired psychiatric disorder have been met. 38 U.S.C. §§ 5108, 7104, 7105; 38 C.F.R. §§ 3.156, 20.302, 20.1103. 3. The criteria for establishing service connection for obstructive sleep apnea have been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.310. 4. The criteria for establishing service connection for hypertension have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303. 5. The criteria for establishing an evaluation in excess of 10 percent for tinnitus have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.7, 4.10, 4.87, Diagnostic Code 6260. 6. The criteria for a compensable evaluation for the service-connected surgical scar of the neck have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 4.1-4.10, 4.118, Diagnostic Codes 7800, 7804. 7. The criteria for an effective date prior to July 19, 2017, for service connection for bilateral tinnitus have not been met. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.400(b)(2), (q)(2). REFERRED The issue of service connection for radiculopathy of the lower extremities was raised in an October 2018 written statement and is referred to the Agency of Original Jurisdiction (AOJ) for adjudication. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty with the United States Army from May 1974 to August 1975. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2016, March 2017, August 2017, and October 2017 rating decisions issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Board notes that, in relation to the issue of an increased rating for the service-connected lumbar spine disability, the Veteran submitted a written statement in March 2017 requesting a hearing on the proposed reduction from a 40 percent evaluation to a 10 percent evaluation. This request was submitted to the RO prior to the Veteran’s timely notice of disagreement appealing the September 2016 and March 2017 rating decisions relating to the evaluation of the lumbar spine disability, on which the Veteran requested a decision review officer. The Veteran later declined the opportunity for a personal hearing on the issue before the Board on the November 2017 substantive appeal, which appealed the issue of an increased rating for the lumbar spine disability to the Board. Therefore, the Board does not find that there is a hearing request pending at this time. As an initial matter, the Board notes the Veteran has applied for service connection for psychiatric disorders on more than one occasion, including depression, posttraumatic stress disorder, and a mental health condition, generally. As the Veteran lacks the medical knowledge to describe the universe of his claim, the Board has recharacterized his claims of service connection for individual mental health disorders as one of service connection for an acquired psychiatric disorder, to include an unspecified anxiety disorder and depression. See Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009). To best comport with the evidence of record, the Board will also consider a secondary theory of entitlement. New and Material Evidence A decision of the RO becomes final and is not subject to revision on the same factual basis unless a notice of disagreement is filed within one year of the notice of the decision, or new and material evidence is received during the appeal period after the decision. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.156, 20.302, 20.1103. If a claim of entitlement to service connection has been previously denied and that decision became final, the claim can be reopened and reconsidered only if new and material evidence is presented with respect to that claim. 38 U.S.C. § 5108; see Manio v. Derwinski, 1 Vet. App. 140, 145 (1991). VA must review all of the evidence submitted since the last final rating decision in order to determine whether the claim may be reopened. See Hickson v. West, 12 Vet. App. 247, 251 (1999). The threshold is low and does not require new and material evidence regarding each element of the claim that had not been proved in the prior final decision. Shade v. Shinseki, 24 Vet. App. 110, 117 (2010). For purposes of determining whether new and material evidence has been received to reopen a finally adjudicated claim, the recently submitted evidence will be presumed credible. Justus v. Principi, 3 Vet. App. 510, 513 (1992). New evidence is defined as existing evidence not previously submitted to agency decision-makers. Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156 (a). 1. Whether new and material evidence has been received to reopen a claim for service connection for a skin condition The Veteran filed his initial claim for service connection for a skin condition in March 2005, claiming that working with radio equipment caused radio frequency burns that recur as outbreaks on his arms and legs. The RO denied service connection for that claim in an August 2005 rating decision based on a finding that there was no current disability and no evidence of a nexus between any current disability and the Veteran’s in-service work with radio equipment. The Veteran was filed a timely notice of disagreement with the decision, and a statement of the case was issued in November 2005. The Veteran did not file a substantive appeal within sixty days of that statement of the case, so the August 2005 rating decision became final. See 38 C.F.R. §§ 3.156(b), 20.200, 20.201, 20.1103. New and material evidence is therefore required to reopen the claim of service connection for a skin condition. See 38 U.S.C. § 5108; 38 C.F.R. § 3.156; Jackson v. Principi, 265 F.3d 1366 (Fed. Cir. 2001). Since the August 2005 rating decision, evidence of a current disability has been associated with the record, as the Veteran was diagnosed with actinic keratoses in January 2015 as well as a squamous cell carcinoma in 2010. Therefore, the Board finds that new and material evidence which tends to substantiate the Veteran’s claim of service connection for a skin condition has been received in this case, and the claim is reopened. See 38 C.F.R. § 3.156(a); Shade v. Shinseki, 24 Vet. App. 110, 117 (2010) (medical evidence indicating a medical opinion is warranted is sufficient to reopen a claim). 2. Whether new and material evidence has been received to reopen a claim for service connection for an acquired psychiatric disorder, to include as secondary to service-connected disabilities The Veteran filed his initial claim for depression as secondary to the service-connected cervical spine disability in July 2014. The RO denied service connection for that claim in a September 2014 rating decision based on a finding that there was no indication of incurrence during service and there was no evidence of a nexus between depression and any service-connected disability. The Veteran was notified of that decision in a September 2014 notice letter. The Veteran did not submit any additional evidence respecting the claim or a notice of disagreement with the decision within one year of that notice letter. As no timely notice of disagreement or new and material evidence was received during the appeal period following the September 2014 notice letter, the September 2014 rating decision became final. See 38 C.F.R. §§ 3.156(b), 20.200, 20.201, 20.1103; Buie v. Shinseki, 24 Vet. App. 242, 252 (2010). New and material evidence is therefore required to reopen the claim of service connection for an acquired psychiatric disorder. See 38 U.S.C. § 5108; 38 C.F.R. § 3.156; Jackson v. Principi, 265 F.3d 1366 (Fed. Cir. 2001). Since the September 2014 rating decision, evidence of other psychiatric diagnoses has been associated with the record, as well as some evidence of a nexus between the Veteran’s psychiatric disorder and his service-connected disabilities. Therefore, the Board finds that new and material evidence which tends to substantiate the Veteran’s claim of service connection for an acquired psychiatric disorder has been received in this case, and the claim is reopened. See 38 C.F.R. § 3.156(a); Shade v. Shinseki, 24 Vet. App. 110, 117 (2010) (medical evidence indicating a medical opinion is warranted is sufficient to reopen a claim). Service Connection Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Establishing service connection generally requires (1) medical 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) medical evidence of a nexus between the current disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); see also 38 C.F.R. § 3.303, Hickson v. West, 12 Vet. App. 247, 252-53 (1999). Service connection may be granted for any disease initially diagnosed after service, when all the evidence, including that pertinent to service, establishes the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection may be granted on a secondary basis for a disability that is shown to be proximately due to or aggravated by a service-connected disease or injury. 38 C.F.R. § 3.310(a). Service connection on a secondary basis may not be granted without medical evidence of a current disability and medical evidence of a nexus between the current disability and a service-connected disability. See Wallin v. West, 11 Vet. App. 509, 512-14 (1998); see also Allen v. Brown, 7 Vet. App. 439, 488 (1995). 3. Entitlement to service connection for a sleep disorder In February 2018, the Veteran underwent a sleep study that resulted in a diagnosis of obstructive sleep apnea. At an examination with a private physician in July 2018, the Veteran reported that his CPAP mask used to treat the sleep apnea hurts his neck, and that he is frequently awakened by back and neck pain that requires repositioning before he is able to return to sleep. This results in often not getting a full, restful night’s sleep, with a significant lack of stamina, difficulty focusing, and increased irritability the following day. The private physician cited medical literature indicating that hydrocodone, which the Veteran is prescribed to treat the chronic pain resulting from his service-connected neck and back disabilities, is an opiate analgesic, which can precipitate or exacerbate sleep disordered breathing. The physician noted that opiates result in increased respiratory pauses, irregular breathing, and shallow breaths; as sleep apnea involves pauses in breathing and shallow breaths during sleep, the introduction of medication which results in respiratory pauses, irregular breathing, and shallow breaths increases the risk for harmful respiratory events. The physician opined that it is as likely as not that the medication prescribed to treat the Veteran’s service-connected back and neck disabilities aided in the development of the obstructive sleep apnea and continues to permanently aggravate it. As the record reflects evidence of a current disability of obstructive sleep apnea and medical evidence of a nexus between the sleep apnea and service-connected disabilities, service connection on a secondary basis is warranted. 4. Entitlement to service connection for hypertension The Veteran filed an application for service connection for high blood pressure, or hypertension, in July 2017. However, the Veteran did not make any specific contentions regarding its onset or why he believes this disability should be service connected. Certain chronic diseases will be granted service connection on a presumptive basis if there is evidence they manifested within a year of separation from service. 38 C.F.R. §§ 3.307(a), 3.309(a). Hypertension is among these chronic diseases. 38 C.F.R. § 3.309(a). The Veteran’s VA treatment records reflect a diagnosis of hypertension during the pendency of this claim; he is treated for hypertension with medication. However, there is no indication in the Veteran’s service treatment records of any high blood pressure readings while in service, nor any consultation with a doctor regarding the onset of hypertension. Likewise, there is no evidence within the first year after the Veteran separated from service regarding this issue. As noted above, there are no lay statements from the Veteran regarding a connection between his current hypertension disability and his active duty service. As there is therefore no indication that the current disability might be associated with the Veteran’s service, there is no requirement that VA obtain a medical opinion on this issue. See McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). As there is no evidence of an in-service incurrence of hypertension, onset within a year of separation, or of a nexus between the current disability and the Veteran’s service, service connection for hypertension is not warranted. Increased Rating Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities and are intended to represent the average impairment of earning capacity resulting from disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. When there is a question as to which of two ratings apply, VA will assign the higher of the two where the disability picture more nearly approximates the criteria for the next higher rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Disabilities must be viewed in relation to their entire history. 38 C.F.R. § 4.1. VA is required to interpret reports of examination in light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability. 38 C.F.R. § 4.2. Any reasonable doubt regarding the degree of disability will be resolved in favor of the claimant. 38 C.F.R. § 4.3. VA is also required to evaluate functional impairment on the basis of lack of usefulness and the effects of the disabilities upon the claimant’s ordinary activity. 38 C.F.R. § 4.10; see generally Schafarth v. Derwinski, 1 Vet. App. 589 (1991). 5. Entitlement to an evaluation in excess of 10 percent for service-connected tinnitus The maximum schedular rating available for tinnitus is 10 percent. 38 C.F.R. § 4.87; see also Smith v. Nicholson, 451 F.3d 1344 (Fed. Cir. 2006). Throughout the entire initial rating period on appeal, the Veteran has been in receipt of a 10 percent disability rating for tinnitus. Under Diagnostic Code 6260, a single 10 percent rating is assigned for tinnitus, whether the sound is perceived as being in one ear, both ears, or in the head. 38 C.F.R. § 4.87, DC 6260, Note 2. As the maximum schedular rating for tinnitus has already been assigned, a higher schedular rating is not available, and the Veteran’s claim for an evaluation in excess of 10 percent for bilateral tinnitus must be denied. 6. Entitlement to a compensable evaluation for the service-connected surgical scar of the neck The Veteran is currently in receipt of a noncompensable evaluation for the service-connected surgical scar on his right anterior lateral neck. He is rated under Diagnostic Code 7800, which governs disfigurement of the head, face or neck. This code section provides for a 10 percent evaluation where there is one characteristic of disfigurement. A 30 percent evaluation is warranted for visible or palpable tissue loss and either gross distortion or asymmetry of one feature or paired set of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips); or, with two or three characteristics of disfigurement. A 50 percent evaluation is assigned for visible or palpable tissue loss and either gross distortion or asymmetry of two features or paired sets of features (nose, chin, forehead, eyes, ears, cheeks, lips); or, with four or five characteristics of disfigurement. An 80 percent evaluation is assigned when there is visible or palpable tissue loss and either gross distortion or asymmetry of three or more features or paired sets of features (nose, chin, forehead, eyes, ears, cheeks, lips); or, with six or more characteristics of disfigurement. 38 C.F.R. § 4.118, DC 7800. The eight characteristics of disfigurement for the purposes of evaluation under section 4.118 are: scars 5 or more inches (13 or more cm.) in length; scars at least one-quarter inch (0.6 cm.) wide at widest part; surface contour of scar elevated or depressed on palpation; scar adherent to underlying tissue; skin hypo- or hyper-pigmented in an area exceeding six square inches (39 cm.); skin texture abnormal (irregular, atrophic, shiny, scaly, etc.) in an area exceeding six square inches (39 sq. cm.); underlying soft tissue missing in an area exceeding six square inches (39 sq. cm.); and, skin indurate and inflexible in an area exceeding six square inches (39 sq. cm.). Id., Note 1. The Veteran underwent a VA scars examination in September 2016, at which the examiner identified five scars – on the Veteran’s neck, right wrist, right knee, and left knee. Only the surgical scar located on the Veteran’s right anterior lateral neck is service-connected, as it is associated with surgery to treat the Veteran’s service-connected Scheuermann’s disease. The examiner measured this scar to be approximately 8.5 centimeters long by 0.2 centimeters wide. The scar was not noted to be painful or unstable, with no objective evidence of pain upon examination, and there was no elevation, depression, adherence to underlying tissue, or missing underlying tissue. There was no abnormal pigmentation or texture of the skin of the neck, and no distortion of any facial features due to the neck scar. The scar was not noted to result in any functional limitation. The Veteran has not submitted any lay statements describing the surgical scar or any symptoms he experiences. Considering this evidence, an increase in evaluation for the service-connected surgical scar of the neck is not warranted. The service-connected scar is not more than 5 inches in length or one-quarter inch wide, and there is no elevation or depression, adherence to underlying tissue, abnormal pigmentation or texture, or missing underlying tissue. As such, there are no characteristics of disfigurement; the criteria for a 10 percent evaluation requires one characteristic of disfigurement. The other applicable diagnostic code is 7804, which governs painful or unstable scars. Under this code, a 10 percent evaluation is assigned for 1 or 2 unstable or painful scars; a 20 percent evaluation is assigned for 3 or 4 unstable or painful scars; and, a 30 percent evaluation is assigned for 5 or more unstable or painful scars. See 38 C.F.R. § 4.118, DC 7804. Note 1 indicates that an unstable scar is one where, for any reason, there is frequent loss of covering over the scar. Additionally, if one or more scars are both unstable and painful, an extra 10 percent will be added to the evaluation that is based on the total number of unstable or painful scars. See id., Note 2. However, as the evidence shows the service-connected scar is not painful or unstable, a compensable evaluation is not warranted and use of this rating criteria does not benefit the Veteran. As neither applicable diagnostic code provides for a compensable evaluation for the service-connected surgical scar of the neck, the Veteran’s application for an increased evaluation must be denied. Effective Date Unless specifically provided otherwise in the statute, the effective date of an award based on an original claim for compensation benefits is the date of receipt of the claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400(b)(2). A claim received within one year of separation from active service will be assigned an effective date of the day following separation. 38 U.S.C. §5110 (b)(1); 38 C.F.R. § 3.400(b)(2). Where a claim has been finally adjudicated and then reopened at a later date, the effective date of any subsequent award is the date of receipt of the new claim or the date entitlement arose, whichever is later. 38 C.F.R. § 3.400(q)(2). If there is a prior final VA denial of the benefit sought, the effective date cannot be earlier than a subsequent claim to reopen. Leonard v. Principi, 17 Vet. App. 447 (2004); Sears v. Principi, 16 Vet. App. 244, 246-50 (2002). The date of receipt is the date on which a claim, information, or evidence is received by VA. 38 C.F.R. § 3.1(r). 7. Entitlement to an effective date prior to October 27, 2008, for service-connected Scheuermann's disease The Veteran initially applied for service connection for a cervical spine disability in March 1976, within a year of separation from active duty military service. This application was denied in July 1976 when he failed to report for the examination. He was notified of this decision in a July 1976 notice letter, but did appeal the decision or submit new evidence. The Veteran next applied for service connection for a cervical spine disability in a written statement submitted in October 2008. He was granted service connection for Scheuermann’s disease in an August 2012 rating decision, effective October 27, 2008, the date the written statement was received. As the Veteran’s initial claim was denied in a rating decision that became final, the effective date cannot be earlier than the subsequent claim to reopen. Therefore, although the Veteran applied for service connection within a year of discharge, the appropriate effective date is not the day after discharge. Rather, the appropriate effective date is October 27, 2008, the date the Veteran’s petition to reopen the cervical spine claim was received. 8. Entitlement to an effective date prior to July 19, 2017, for service-connected tinnitus The Veteran submitted an application for service connection for tinnitus that was received on July 19, 2017. Prior to this, there were no other formal or informal applications for service connection for tinnitus. The Veteran was granted service connection in an August 2017 rating decision, effective July 19, 2017. The Veteran did not make any specific allegations regarding his claim for an earlier effective date for tinnitus. At the August 2017 VA audiology examination, the Veteran reported that he first noticed tinnitus symptoms during basic training. Therefore, the date of application for service connection, July 19, 2017, is later than the date entitlement to the benefit arose, and is the appropriate effective date. The Veteran’s petition for an earlier effective date for service connection for tinnitus is denied. REASONS FOR REMAND 1. Entitlement to service connection for headaches is remanded. The Veteran submitted a claim of service connection for headaches, but made no statements in association with this claim regarding the nature of the headaches or how long he has been experiencing them. However, a May 2013 progress note in the Veteran’s VA treatment records reflects complaint of chronic headaches three to four times a week since 1975, when he was in service; a May 2011 VA eye clinic note also reflects complaints of chronic headaches approximately three times a week. The Veteran has not been afforded a VA examination in relation to this claim; as there is an indication the chronic headaches may be related to service, an examination is necessary. See McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). 2. Entitlement to service connection for a skin condition is remanded. The Veteran maintains that exposure to radio waves in service resulted in radio frequency burns, and that these recur as outbreaks on his arms and legs. The Veteran has submitted evidence of similar burns resulting from x-rays; there is also evidence in the claims file of diagnoses of actinic keratoses and a squamous-cell carcinoma. A remand is necessary to obtain an examination addressing whether there is any current diagnosis of a skin condition that is related to service, including exposure to radio waves. See McLendon, 20 Vet. App. at 83. 3. Entitlement to service connection for an acquired psychiatric disorder, to include as secondary to service-connected disabilities is remanded. The Veteran was not afforded a VA psychiatric examination, but did submit a disability benefits questionnaire and opinion letter completed by a private psychologist. This opinion is insufficient to support a grant of service connection, as it is unclear whether it states the diagnosed unspecified anxiety disorder aggravates the Veteran’s service-connected disabilities, or whether the medical disability caused the unspecified anxiety disorder. Further, the private psychologist indicated the unspecified anxiety disorder was the only diagnosis, and did not address the other diagnoses in the record, including a mood disorder and depressive disorder. On remand, an examination is necessary to address these deficiencies. 4. Entitlement to an evaluation in excess of 40 percent prior to January 1, 2018, and in excess of 10 percent thereafter for the service-connected lumbar disability is remanded. In response to a September 2016 rating decision proposing a reduction in the Veteran’s lumbar spine disability rating from 40 percent to 10 percent, the Veteran submitted a disability benefits questionnaire completed by a private physician. This examination showed a much more limited range of motion and set of functional limitations than the September 2016 VA examination that prompted the rating reduction proposal, but it does not appear the RO considered this evidence in any of its subsequent adjudications of the issue. On remand, the RO should obtain a new examination to determine the current severity of the Veteran’s service-connected lumbar spine disability, prior to readjudicating the issue of appropriate evaluations for the lumbar spine disability considering all available evidence. 5. Entitlement to an evaluation in excess of 20 percent for service-connected Scheuermann's disease is remanded. The Veteran was most recently afforded a VA cervical spine examination in August 2015. However, the Veteran’s medical treatment records reflect that he underwent cervical spine surgery in June 2015, and was required to remain in a neck brace day and night through August 2015. The Board further notes that he was awarded a temporary total disability rating for convalescence from this surgery through November 2015. As such, the August 2015 VA examination is not an accurate depiction of the current severity of the Veteran’s cervical spine disability, and a new examination is necessary. 6. Entitlement to a TDIU is remanded. The TDIU issue is intertwined with the above remanded issues and is also remanded at this time. See Henderson v. West, 12 Vet. App. 11, 20 (1998); Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination with an appropriate clinician to determine whether the headaches are related to the Veteran’s military service. The claims file must be made available to and be reviewed by the examiner in conjunction with the examination. Following review of the claims file and examination of the Veteran, the examiner should opine whether it is at least as likely as not (50 percent or greater probability) that the headaches began in or is otherwise caused by the Veteran’s active service. The examiner should address the Veteran’s lay statements regarding continuity of symptomatology since onset and/or since discharge from service. The examiner should address any other pertinent evidence of record, including the May 2013 VA treatment records reflecting complaints of chronic headaches. All findings must be reported in detail and all opinions must be accompanied by a clear rationale. If any of the above issues cannot be resolved without resorting to speculation, then a detailed medical explanation as to why this is so must be provided. 2. Schedule the Veteran for an examination with an appropriate clinician to determine whether any current skin condition is related to the Veteran’s military service. The claims file must be made available to and be reviewed by the examiner in conjunction with the examination. Following review of the claims file and examination of the Veteran, the examiner should identify all skin conditions currently found. For each skin condition identified, the examiner should opine whether it is at least as likely as not (50 percent or greater probability) that the disability began in or is otherwise caused by the Veteran’s active service. The examiner should address the Veteran’s lay statements regarding continuity of symptomatology since onset and/or since discharge from service. The examiner should address any other pertinent evidence of record, including the Veteran’s May 2011 written statement reporting that he incurred burns from a series of x-rays. The examiner should also address whether any current diagnosis of skin cancer likely resulted from exposure to radio frequency waves while in service. All findings must be reported in detail and all opinions must be accompanied by a clear rationale. If any of the above issues cannot be resolved without resorting to speculation, then a detailed medical explanation as to why this is so must be provided. 3. Schedule the Veteran for an examination with an appropriate clinician to determine whether any current psychiatric disorder is related to the Veteran’s military service. The claims file must be made available to and be reviewed by the examiner in conjunction with the examination. Following review of the claims file and examination of the Veteran, the examiner should identify all psychiatric disorders currently found. For each disorder identified, the examiner should opine whether it is at least as likely as not (50 percent or greater probability) that the disorder began in or is otherwise caused by the Veteran’s active service. The examiner should also opine whether it is at least as likely as not (50 percent or greater probability) that each disorder is (a) caused by; or (b) aggravated (i.e., worsened beyond the normal progression of the disease) by any of the Veteran’s service-connected disabilities. If aggravation is found, the examiner must attempt to establish a baseline level of severity of the disorder prior to aggravation by the service-connected disabilities. Please note, causation and aggravation are separate concepts and must be addressed independently. In responding to the above questions, the examiner should address the Veteran’s lay statements regarding continuity of symptomatology since onset and/or since discharge from service. The examiner should address any other pertinent evidence of record, including the July 2010 and July 2013 diagnoses of major depressive disorder and mood disorder, respectively, in the Veteran’s VA treatment records. All findings must be reported in detail and all opinions must be accompanied by a clear rationale. If any of the above issues cannot be resolved without resorting to speculation, then a detailed medical explanation as to why this is so must be provided. 4. Schedule the Veteran for an examination with an appropriate clinician to determine the current severity of the Veteran’s service-connected lumbar spine disability. The thoracolumbar spine should be tested in both active and passive motion, in weight-bearing and non weight-bearing. If the examiner is unable to conduct the required testing or concludes that the required testing is not necessary in this case, he or she should clearly explain why that is so. The examiner should describe any pain, weakened movement, excess fatigability, instability of station and incoordination present. The examiner should also state whether the examination is taking place during a period of flare-up. If not, the examiner should ask the Veteran to describe the flare-ups he experiences, including: frequency, duration, characteristics, precipitating and alleviating factors, severity and/or extent of functional impairment he experiences during a flare-up of symptoms and/or after repeated use over time. Based on the Veteran’s lay statements and the other evidence of record, the examiner should provide an opinion estimating any additional degrees of limited motion caused by functional loss during a flare-up or after repeated use over time. If the examiner cannot estimate the degrees of additional range of motion loss during flare-ups or after repetitive use without resorting to speculation, the examiner should 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). 5. Schedule the Veteran for an examination with an appropriate clinician to determine the current severity of the Veteran’s service-connected Scheuermann’s disease. The cervical spine should be tested in both active and passive motion, in weight-bearing and non weight-bearing and, if possible. If the examiner is unable to conduct the required testing or concludes that the required testing is not necessary in this case, he or she should clearly explain why that is so. The examiner should describe any pain, weakened movement, excess fatigability, instability of station and incoordination present. The examiner should also state whether the examination is taking place during a period of flare-up. If not, the examiner should ask the Veteran to describe the flare-ups he experiences, including: frequency, duration, characteristics, precipitating and alleviating factors, severity and/or extent of functional impairment he experiences during a flare-up of symptoms and/or after repeated use over time. Based on the Veteran’s lay statements and the other evidence of record, the examiner should provide an opinion estimating any additional degrees of limited motion caused by functional loss during a flare-up or after repeated use over time. If the examiner cannot estimate the degrees of additional range of motion loss during flare-ups or after repetitive use without resorting to speculation, the examiner should 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). M. HYLAND Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD K. Josey, Associate Counsel