Citation Nr: 18158091 Decision Date: 12/14/18 Archive Date: 12/14/18 DOCKET NO. 17-12 568 DATE: December 14, 2018 ORDER Service connection for bilateral shoulder disorders is denied. Service connection for bilateral knee disorders is denied. Service connection for sleep apnea is denied. Service connection for tinnitus is denied. An evaluation in excess of 20 percent for degenerative joint disease (DJD) of the lumbar spine with intervertebral disc syndrome (IVDS) is denied. An evaluation in excess of 10 percent for peripheral neuropathy of the right lower extremity is denied. An evaluation in excess of 10 percent for peripheral neuropathy of the left lower extremity is denied. REMANDED Entitlement to service connection for a cervical spine disorder is remanded. Entitlement to service connection for bilateral hip disorders, to include osteoarthritis, is remanded. Entitlement to service connection for bilateral ankle disorders is remanded. Entitlement to service connection for bilateral foot disorders is remanded. Entitlement to service connection for hypertension is remanded. Entitlement to service connection for a gastrointestinal disorder, to include gastritis and/or gastroesophageal reflux disease (GERD), is remanded. Entitlement to service connection for headaches, to include as secondary to service-connected disabilities, is remanded. Entitlement to specially adapted housing and/or a special home adaptation grant is remanded. Entitlement to an initial evaluation in excess of 70 percent for generalized anxiety disorder with alcohol use disorder in remission is remanded. Entitlement to an effective date prior to April 29, 2014, for the award of service connection for generalized anxiety disorder with alcohol use disorder in remission is remanded. FINDINGS OF FACT 1. The Veteran does not have current disabilities of sleep apnea, either knee or either shoulder. 2. The Veteran’s tinnitus did not have onset during service or within one year of separation from service and was not caused by service. 3. Throughout the appeal period, the Veteran’s thoracolumbar spine is not shown to be ankylosed nor shown to be limited to 30 degrees or less in forward flexion; although he has IVDS, he has not had least 4 weeks of incapacitating episodes in a 12 month period. 4. The Veteran’s peripheral neuropathy of the bilateral lower extremities more closely approximate to mild incomplete paralysis of the sciatic nerves throughout the appeal period. CONCLUSIONS OF LAW 1. The criteria for service connection for bilateral shoulder disorders are not met. 38 U.S.C. §§ 1110, 1131, 1154, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for bilateral knee disorders are not met. 38 U.S.C. §§ 1110, 1131, 1154, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for service connection for sleep apnea are not met. 38 U.S.C. §§ 1110, 1131, 1154, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for service connection for tinnitus are not met. 38 U.S.C. §§ 1110, 1112, 1131, 1154, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 5. The criteria for an evaluation in excess of 20 percent for DJD of the lumbar spine with IVDS are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5242, 5243. 6. The criteria for an evaluation in excess of 10 percent for peripheral neuropathy of the right lower extremity are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.124a, Diagnostic Code 8520. 7. The criteria for an evaluation in excess of 10 percent for peripheral neuropathy of the left lower extremity are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.124a, Diagnostic Code 8520. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty service from February 1974 to June 1979. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from June 2015, April 2016, March 2017, and March 2018 rating decisions by a Department of Veterans Affairs (VA) Regional Office (RO). Service Connection Claims Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). “To establish a right to compensation for a present disability, a Veteran must show: “(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service”—the so-called “nexus” requirement.” Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Sleep Apnea, Bilateral Knee, and Bilateral Shoulder Claims Turning to the evidence of record, the Board has reviewed the VA treatment records and other private treatment records associated with the claims file. Those records do not demonstrate that the Veteran has any complaints of, treatment for, or diagnosis of any sleep apnea disorder. Likewise, those records do not demonstrate that the Veteran has any bilateral shoulder problems at any time during the appeal period. After review of this evidence, the Board must conclude that the evidence of record at this time does not demonstrate any sleep apnea or bilateral shoulder disabilities at this time. Furthermore, although the Veteran’s VA treatment records demonstrate complaints of knee pain in 2004 through 2006, the Veteran’s most recent VA treatment records—particularly those records from throughout the appeal period since filing his claim for service connection in February 2016—do not demonstrate any complaints of, treatment for, or diagnosis of any bilateral knee pain or disorders. Thus, although it appears that the Veteran had some bilateral knee pain complaints in the past, it appears that such complaints following a motor vehicle accident resolved and the evidence of record does not demonstrate any current bilateral knee disabilities at this time. Accordingly, as there are no current disabilities for sleep apnea, bilateral shoulder, and bilateral knee claims at this time, those claims must be denied at this time based on the evidence of record. See 38 C.F.R. §§ 3.102, 3.303; McClain v. Nicholson, 21 Vet. App. 319 (2007) (the requirement that a current disability be present is satisfied “when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim . . . even though the disability resolves prior to the Secretary's adjudication of the claim.”); Brammer v. Derwinski, 3 Vet. App. 223 (1995) (Congress specifically limited entitlement for service-connected disease or injury to cases where such incidents had resulted in a disability). Tinnitus Claim Certain chronic diseases, including tinnitus (organic disease of the nervous system), may be presumed to have been incurred in or aggravated by service if manifest to a compensable degree within one year of discharge from service, even though there is no evidence of such disease during service. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309(a). Tinnitus is a condition that can be competently diagnosed by a layperson. Accordingly, the Board finds that the evidence of record demonstrates a current disability and the first element of service connection has been met in this case. A review of the Veteran’s service treatment records does not demonstrate any complaints of, treatment for, or diagnosis of ringing in the ears or tinnitus during military service; in fact, the first evidence of any complaints of tinnitus are in a February 2005 VA treatment record, many years after discharge from service. See Maxson v. West, 12 Vet. App. 453 (1999), aff'd, 230 F.3d 1330 (Fed. Cir. 2000) (a significant lapse in time between service and post-service medical treatment may be considered as part of the analysis of a service connection claim, which weighs against the claim). Additionally, the Veteran’s Form DD-214 documents that his military occupational specialty (MOS) was an administrative specialist—unit orderly room. The Board notes that this MOS is not suggestive of significant noise exposure, as it is an administrative position. Also, the Veteran has not asserted or contended at any time during the appeal period that his tinnitus is the result of any noise exposure that he suffered during military service. Furthermore, although the record shows that the Veteran was involved in a motor vehicle accident during military service in November 1977 there is no indication that this resulted in any complaints of tinnitus or any injury involving his hearing anatomy. Finally, the Board does reflect that the Veteran stated in a July 2008 VA treatment record that he has “tinnitus all the time when he is depressed,” and the record does reflect that the Veteran is service connected for a psychiatric disorder at this time. Although the Board acknowledges the Veteran has stated that he believes there is some connection between his depression and tinnitus, the Board notes that he is not competent to render any such a medical opinion and he has not otherwise submitted any evidence to support his belief that there is a relationship between his tinnitus and his service-connected psychiatric disorder. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007); see also Jones v. West, 12 Vet. App. 383, 385 (1999) (where the determinative issue is one of medical causation or a diagnosis, only those with specialized medical knowledge, training, or experience are competent to provide evidence on the issue). Thus, the Board finds that a remand is not necessary at this time in order to obtain a VA examination and medical opinion respecting those assertions. See McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006); see also Waters v. Shinseki, 601 F.3d 1274 (Fed. Cir. 2010); Colantonio v. Shinseki, 606 F.3d 1378 (Fed. Cir. 2010). In short, service connection for tinnitus must be denied at this time as there is no evidence of an in-service disease, injury, or event on which a finding of service connection can be predicated in this case. The evidence does not demonstrate that the Veteran’s tinnitus was incurred in service or within one year of military service, nor has the Veteran otherwise asserted some other in-service disease, injury, or event in service which resulted in his tinnitus. Increased Rating Claims Disability ratings are determined by applying the criteria set forth in the VA’s Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The basis of disability evaluations 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. In determining the severity of a disability, the Board is required to consider the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the Veteran, as well as the entire history of the Veteran’s disability. 38 C.F.R. §§ 4.1, 4.2; Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). If the disability more closely approximates the criteria for the higher of two ratings, the higher rating will be assigned; otherwise, the lower rating is assigned. 38 C.F.R. § 4.7. It is not expected that all cases will show all the findings specified; however, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances. 38 C.F.R. § 4.21. In deciding this appeal, the Board has considered whether separate ratings for different periods of time, based on the facts found, are warranted, a practice of assigning ratings referred to as “staging the ratings.” See Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2008). In determining the appropriate evaluation for musculoskeletal disabilities, particular attention is focused on functional loss of use of the affected part. Under 38 C.F.R. § 4.40, functional loss may be due to pain, supported by adequate pathology and evidenced by visible behavior on motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. Under 38 C.F.R. § 4.45, factors of joint disability include increased or limited motion, weakness, fatigability, or painful movement, swelling, deformity or disuse atrophy. Under 38 C.F.R. § 4.59, painful motion is an important factor of joint disability and actually painful joints are entitled to at least the minimum compensable rating for the joint. Where functional loss is alleged due to pain upon motion, the provisions of 38 C.F.R. § 4.40 and § 4.45 must be considered. DeLuca v. Brown, 8 Vet. App. 202, 207-08 (1995). Within this context, a finding of functional loss due to pain must be supported by adequate pathology, and evidenced by the visible behavior of the claimant. Johnston v. Brown, 10 Vet. App. 80, 85 (1997). Pain itself does not rise to the level of functional loss as contemplated by § 4.40 and § 4.45, but may result in functional loss only if it limits the ability to perform the normal working movements of the body with normal excursion, strength, coordination or endurance. Mitchell v. Shinseki, 25 Vet. App. 32, 43 (2011). Ankylosis is stiffening or fixation of a joint as the result of a disease process, with fibrous or bony union across the joint. Dinsay v. Brown, 9 Vet. App. 79, 81 (1996). The Veteran filed his claim for increased evaluation of his lumbar spine and associated peripheral neuropathy disabilities on April 22, 2014; thus, in conjunction with this decision, the Board has focused on evidence since April 22, 2013 to determine whether it is factually ascertainable that his disability increased in severity during that period. See 38 C.F.R. § 3.400(o). Throughout the appeal period, the Veteran has been assigned a 20 percent evaluation for his lumbar spine disability under Diagnostic Code 5242. Diagnostic Code 5242 refers the rater to the General Rating Formula for Diseases and Injuries of the Spine, which provides a 10 percent evaluation for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; a combined range of motion of the thoracolumbar spine than 120 degrees but not greater than 235 degrees; muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. A 20 percent evaluation for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees, a combined range of motion of the thoracolumbar spine not greater than 120 degrees, or muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour, such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent evaluation requires evidence of forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent evaluation is warranted for unfavorable ankylosis of the entire thoracolumbar spine. See 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine. For VA compensation purposes, normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion. Id. at Note (2). For VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. Id. at Note (5). Alternatively, the Veteran’s lumbar spine disability may be evaluated under the Formula for Rating IVDS Based on Incapacitating Episodes, which assigns a 10 percent evaluation with incapacitating episodes having a total duration of at least one week but less than 2 weeks during the past 12 months. A 20 percent evaluation may be assigned with incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months. A 40 percent evaluation may be assigned with incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months. A 60 percent evaluation may be assigned for intervertebral disc syndrome with incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. See 38 C.F.R. § 4.71a, Diagnostic Code 5243, Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. An incapacitating episode is a period of acute signs and symptoms due to intervertebral disc syndrome that requires bedrest prescribed by a physician and treatment by a physician. Id. at Note (1). Finally, with respect to the Veteran’s peripheral neuropathy associated with his lumbar spine disability, each lower extremity is noted as being 10 percent disabling under Diagnostic Code 8520 throughout the appeal period. Under Diagnostic Code 8520, which rates injuries to the sciatic nerve, a 10 percent rating is warranted for a mild incomplete paralysis. Moderate incomplete paralysis warrants a rating of 20 percent. Moderately severe incomplete paralysis warrants a 40 percent evaluation. Severe incomplete paralysis, with marked muscular atrophy, warrants a 60 percent evaluation. And finally, complete paralysis, defined as: the foot dangles and drops, no active movement possible of muscles below the knee, or flexion of the knee weakened or (very rarely) lost, warrants an 80 percent evaluation. See 38 C.F.R. § 4.124a, Diagnostic Code 8520. Turning to the evidence of record, the Veteran is shown to have continued VA treatment for his lower back pain, including management of his medication and care of his TENS unit, throughout the appeal period. The physical examination of the Veteran’s lumbar spine in those treatment records does not demonstrate any flexion to 30 degrees or less, or any evidence of ankylosis of the thoracolumbar spine. Likewise, the Veteran is noted to have peripheral neuropathy of the bilateral lower extremities in those treatment records, although no formal assessment of the severity of those disabilities is noted in those records. In April 2015, the Veteran underwent a VA examination of his lumbar spine and associated peripheral neuropathy disabilities, at which time he was diagnosed with degenerative joint disease of the lumbar spine with IVDS. The Veteran reported aching and tightness in his lower back when lifting more than 10 pounds; he also had aching in his lower back that radiated across his gluteal and down his legs sporadically when bending. He took pain medications for multiple musculoskeletal disorders. The Veteran denied any flare-ups of his lumbar spine disability. On examination, the Veteran had flexion to 90 degrees, extension to 30 degrees, bilateral lateral flexion to 30 degrees, and bilateral lateral rotation to 30 degrees, without any evidence of pain during range of motion testing; the Veteran’s range of motion was unchanged after repetitive testing and the examiner indicated that the Veteran did not have any additional limitation of motion or functional impairment due to repeated/repetitive motion testing; the examiner specifically noted that pain, weakness, fatigability, and incoordination did not significantly limit the Veteran’s functional abilities. The Veteran did not have any evidence of localized tenderness or pain on palpitation, or any guarding or muscle spasms of the thoracolumbar spine during the examination. His muscle strength, reflex, and sensory testing were all normal without any evidence of muscle atrophy. The examiner noted that the Veteran had IVDS, although he did not have any episodes of physician-prescribed bedrest or incapacitating episodes within the last 12-month period. The Veteran did not need to use any assistive devices due to his lumbar spine disability and the examiner found that the Veteran’s lumbar spine disability did not impact his ability to work. Respecting the peripheral neuropathy disabilities, the examiner noted that the Veteran was diagnosed with asymptomatic peripheral neuropathy of his bilateral lower extremities. The Veteran was noted to have complaints of cramping, tingling and occasional numbness in his legs and feet, which caused more discomfort at night. The Veteran reported mild numbness and paresthesias and/or dysesthesias of the bilateral lower extremities, but denied constant or intermittent pain. On examination, the examiner noted that muscle strength, reflex, and sensory testing were all normal without any evidence of muscle atrophy or trophic changes. The Veteran’s gait was normal. After neurological testing, the examiner found that the Veteran had mild incomplete paralysis of his bilateral sciatic nerves; however, the Veteran’s bilateral external popliteal (common peroneal), musculocutaneous (superficial peroneal), anterior tibial (deep peroneal), internal popliteal (tibial), posterior tibial, anterior crural (femoral), internal saphenous, obturator, external cutaneous of the thigh, and ilio-inguinal nerves were all unaffected or normal. The Veteran did not use any assistive devices due to his bilateral neurological disorders of his lower extremities and the examiner found that those disabilities did not impact his ability to work. Based on the foregoing evidence, the Board finds that an evaluation higher than 20 percent for the lumbar spine is not warranted in this case. The evidence does not demonstrate that the Veteran’s thoracolumbar spine was ankylosed at any time during the appeal period, as noted by range of motion; likewise, the Veteran’s forward flexion of his thoracolumbar spine was not limited to 30 degrees or less at any time during the appeal period. Finally, although the Veteran had IVDS, there is no evidence of any physician-prescribed bedrest at any time during the appeal period, and certainly no evidence of at least 4 weeks of incapacitating episodes during the appeal period. A higher evaluation under Diagnostic Codes 5242 and 5243 is therefore not warranted during the appeal period, and the Veteran’s claim for increased evaluation of his lumbar spine disability must be denied at this time based on the evidence of record. See 38 C.F.R. §§ 4.7, 4.71a, Diagnostic Codes 5242, 5243. Turning to the bilateral neurological disabilities, the Board acknowledges the Veteran’s complaints regarding neurological symptomatology, although he lacks the medical knowledge and expertise to render a medical opinion regarding the severity of his neurological condition in this case. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis); see also Jones v. West, 12 Vet. App. 383, 385 (1999) (where the determinative issue is one of medical causation or a diagnosis, only those with specialized medical knowledge, training, or experience are competent to provide evidence on the issue). Rather, the April 2015 VA examiner contemplated the Veteran’s lay statements regarding symptomatology along with physical and neurological examination of the Veteran. After such contemplation and examination, he found that the Veteran’s peripheral neuropathy disabilities were most closely approximate to mild incomplete paralysis of his sciatic nerves throughout the appeal period. There is no evidence to refute this finding, it is consistent with the other evidence of record, and it is the most probative evidence of record in this case. Such findings is commensurate with a 10 percent evaluation under Diagnostic Code 8520, and therefore the Board must also deny evaluations in excess of 10 percent for the Veteran’s peripheral neuropathy of the bilateral lower extremity disabilities at this time based on the evidence of record. See 38 C.F.R. §§ 4.7, 4.124a, Diagnostic Code 8520. In reaching the above conclusions, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claims, that doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. REASONS FOR REMAND Initially, with respect to the increased evaluation and earlier effective date claims for the Veteran’s psychiatric disability, the Board reflects that service connection was awarded for that disability in a March 2017 rating decision, at which time the Agency of Original Jurisdiction (AOJ) assigned a 70 percent evaluation, effective April 29, 2014. The Veteran timely submitted a Notice of Disagreement, VA Form 21-0958, with that decision in November 2017. As of this decision, no statement of the case has been issued with respect to those issues, and therefore, those claims are remanded in order for such to be accomplished. See Manlincon v. West, 12 Vet. App. 238 (1999); see also 38 C.F.R. § 19.9(c). The Veteran’s service treatment records document bilateral ankle injuries during service, as well as a motor vehicle accident in November 1977 which resulted in multiple facial lacerations. The Veteran’s lumbar spine disability is already service connected. The evidence of record currently demonstrates bilateral foot/ankle pain, cervical spine/neck pain, and osteoarthritis of the bilateral hips. The Board finds that the low threshold for obtaining VA examinations in this case regarding direct and secondary service connection for the cervical spine, bilateral foot/ankle, and bilateral hip disorders has been met in this case, and a remand in order for such to be accomplished is necessary at this time. See 38 U.S.C. § 5103A(d); McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). Likewise, the Veteran is currently shown to have hypertension and he was noted as having borderline hypertension during military service. In light of these facts, the Board also finds that the low threshold for obtaining a VA examination regarding the Veteran’s hypertension is necessary at this time and that claim is also remanded. See Id. Respecting the Veteran’s headache claim, the Board reflects that the Veteran and his representative have submitted a January 2018 private medical opinion from Dr. H.S., which indicated that the Veteran’s psychiatric and back disabilities, along with some of his nonservice-connected disabilities, either cause or aggravate the Veteran’s headaches. The Board finds that this opinion is not adequate to grant the claim at this time, although it does raise a secondary theory of entitlement. As no VA examination has been afforded to the Veteran, a remand is necessary in order for such to be accomplished at this time. See Id. Lastly, the evidence demonstrates that the Veteran has been treated for questionable gastritis and then ultimately abdominal pain with GERD in his VA treatment records; the Veteran’s service treatment records additionally document that he was treated with gastritis during military service. The Board finds that the low threshold for obtaining a VA examination and medical opinion with respect to that claim has also been met and that claim is also remanded in order for such to be accomplished at this time. See Id. The specially adapted housing/special home adaptation grant claim is intertwined with the above remanded claims and must also be remanded at this time. See Henderson v. West, 12 Vet. App. 11, 20 (1998); Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). Finally, on remand, the Board also finds that any outstanding VA treatment records should also be obtained. See 38 U.S.C. § 5103A(b), (c); 38 C.F.R. § 3.159(b); see also Sullivan v. McDonald, 815 F.3d 786 (Fed. Cir. 2016) (where the Veteran “sufficiently identifies” other VA medical records that he or she desires to be obtained, VA must also seek those records even if they do not appear potentially relevant based upon the available information); Bell v. Derwinski, 2 Vet. App. 611 (1992). The matters are REMANDED for the following action: 1. Furnish to the Veteran and his representative a statement of the case with regard to the claims of increased initial evaluation in excess of 70 percent for the Veteran’s generalized anxiety disorder with alcohol use disorder in remission, and an effective date prior to April 29, 2014, for the award of service connection for that disability. The issues should be returned to the Board only if a timely substantive appeal is received. 2. Obtain any and all VA treatment records not already associated with the claims file from the Salisbury and Fayetteville VA Medical Centers, or any other VA medical facility that may have treated the Veteran and associate those documents with the claims file. 3. Ensure that the Veteran is scheduled for a VA orthopedic examination with an appropriate examiner in order to determine whether cervical spine, bilateral hip, bilateral ankle, or bilateral foot disorders that are related to service or secondary to his service-connected lumbar spine disability. The claims folder must be made available to and be reviewed by the examiner. All tests deemed necessary should be conducted and the results reported in detail. Following examination of the Veteran and review of the claims file, the examiner must specifically state any cervical spine, bilateral hip, bilateral ankle and bilateral foot disorders found, to include any arthritic conditions thereof. Then, the examiner must opine whether it is at least as likely as not (50 percent or greater probability) that any current disorders of the cervical spine, bilateral hips, bilateral ankles, and/or bilateral feet found either began in or are otherwise related to his miliary service, to include the noted November 1977 motor vehicle accident therein. Next, for any orthopedic disorder found above that is not found to be directly related to military service, the examiner must opine whether such orthopedic disorders at least as likely as not are (a) caused by; or, (b) aggravated (i.e., chronically worsened) by the Veteran’s service-connected lumbar spine disability, to include any abnormal gait or weightbearing as a result of that disability. The examiner is reminded that he or she must address both prongs (a) and (b) above. In addressing the above, the examiner should consider any of the Veteran’s lay statements regarding symptomatology during service and any continuity of symptomatology since discharge and/or since onset. The examiner should also consider any other pertinent evidence of record, as appropriate. All findings should be reported in detail and all opinions must be accompanied by a clear rationale. 4. Ensure that the Veteran is scheduled for a VA examination in order to determine whether his hypertension is due to his military service or his service-connected psychiatric disability. The claims file must be made available to and be reviewed by the examiner in conjunction with the examination. All tests deemed necessary should be conducted. After review of the claims file and examination of the Veteran, the examiner should state whether the Veteran’s current hypertension at least as likely as not (50 percent or greater probability) began in service or within one year of discharge therefrom, or is otherwise the result of military service. Specifically, the examiner should consider any noted blood pressure readings in service, or within one year after discharge therefrom, as well as the notation of borderline hypertension therein. The examiner should address whether any readings and the notation of borderline hypertension during service are initial manifestations of the Veteran’s hypertension. Next, if the examiner determines that the Veteran’s hypertension is not directly related to service, the examiner should also opine whether any hypertension at least as likely as not was either (a) caused by; or, (b) aggravated (i.e., chronically worsened) by the Veteran’s service-connected psychiatric disability. The examiner must provide an individual opinion and rationale for each of the above requested (a) and (b) opinions. In addressing the above, the examiner should address any of the Veteran’s lay statements regarding symptomatology during service and any continuity of symptomatology since discharge and/or since onset. The examiner should also consider any other pertinent evidence of record, as appropriate. All findings should be reported in detail and all opinions must be accompanied by a clear rationale. 5. Ensure that the Veteran is scheduled for a VA examination to determine whether his headaches are related to military service or his service-connected disabilities. The claims folder must be made available to and be reviewed by the examiner. All tests deemed necessary should be conducted and the results reported in detail. After review of the claims file and examination of the Veteran, the examiner should opine whether his headaches more likely, less likely, or at least as likely as not (50 percent or greater probability) is a result of military service, to include any treatment for headaches therein, as well as any head trauma as a result of his November 1977 motor vehicle accident therein. Next, if the examiner finds that the Veteran’s headaches are not the result of military service, the examiner must opine whether his headaches are at least as likely as not (a) caused by; or, (b) aggravated (i.e., chronically worsened) by the Veteran’s service-connected lumbar spine and psychiatric disabilities. The examiner should address private physician, Dr. H.S.’s January 2018 medical opinion. The examiner is reminded that he or she must address both prongs (a) and (b) above. In addressing the above, the examiner should address any of the Veteran’s lay statements regarding symptomatology during service and any continuity of symptomatology since discharge and/or since onset. The examiner should also consider any other pertinent evidence of record, as appropriate. All findings should be reported in detail and all opinions must be accompanied by a clear rationale. 6. Ensure that the Veteran is scheduled for a VA orthopedic examination with an appropriate examiner in order to determine whether any gastrointestinal disorder, to include GERD, is related to service. The claims folder must be made available to and be reviewed by the examiner. All tests deemed necessary should be conducted and the results reported in detail. Following examination of the Veteran and review of the claims file, the examiner must specifically state any gastrointestinal disorders found, to include GERD. Then, the examiner must opine whether it is at least as likely as not (50 percent or greater probability) that any current gastrointestinal disorders, including GERD, began in or are otherwise related to his miliary service, to include the treatment for gastritis therein. In addressing the above, the examiner should address any of the Veteran’s lay statements regarding symptomatology during service and any continuity of symptomatology since discharge and/or since onset. The examiner should also consider any other pertinent evidence of record, as appropriate. All findings should be reported in detail and all opinions must be accompanied by a clear rationale. JAMES G. REINHART Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Peters, Counsel