Citation Nr: 18158135 Decision Date: 12/14/18 Archive Date: 12/14/18 DOCKET NO. 08-26 497 DATE: December 14, 2018 ORDER Entitlement to service connection for treatment purposes under 38 U.S.C. Chapter 17 for asthma is denied. Entitlement to service connection for treatment purposes under 38 U.S.C. Chapter 17 for head injury is denied. Entitlement to an initial 10 percent rating, but no higher, for laceration scar, right wrist is granted. REMANDED Entitlement to service connection for treatment purposes under 38 U.S.C. Chapter 17 for gastroesophageal reflux disorder (GERD) is remanded. Entitlement to service connection for treatment purposes under 38 U.S.C. Chapter 17 for residuals of a fall to include a back injury; hand injury; and feet injury is remanded. Entitlement to service connection for treatment purposes under 38 U.S.C. Chapter 17 for an acquired psychiatric disorder, claimed as posttraumatic stress disorder (PTSD) is remanded. FINDINGS OF FACT 1. The Veteran’s asthma was not caused by or aggravated by active service. 2. The Veteran does not have current residuals of TBI. 3. For the entire period on appeal, the Veteran had a painful, superficial laceration scar, right wrist. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for treatment purposes under 38 U.S.C. Chapter 17 for asthma have not been met. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for entitlement to service connection for treatment purposes under 38 U.S.C. Chapter 17 for head injury have not been met. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for an initial 10 percent rating, but no higher, for laceration scar, right wrist, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.118, DCs 7801-7805 (prior to and from October 23, 2008). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had honorable active service from August 1977 to October 1, 1981. The Veteran had a second period of active service from October 2, 1981 to May 1986, and was discharged under other than honorable conditions due to “Misconduct- Commission of a Serious Offense.” The Board has recharacterized the claim for service connection for treatment purposes for PTSD to include other acquired psychiatric disorders. Clemons v. Shinseki, 23 Vet. App. 1 (2009) (holding that even though a veteran may only seek service connection for PTSD, the claim “cannot be limited only to that diagnosis, but must rather be considered a claim for any mental disability that may be reasonably encompassed”). Service Connection Applicable law provides that service connection will be granted if it is shown that the Veteran suffers from disability resulting from an injury suffered or disease contracted in line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty, in the active military, naval, or air service. 38 U.S.C. §§ 1131; 38 C.F.R. § 3.303. The health-care and related benefits authorized by chapter 17 of title 38 U.S.C. shall be provided to certain former service persons with administrative discharges under other than honorable conditions for any disability incurred or aggravated during active military, naval, or air service in line of duty. 38 C.F.R. § 3.360(a). With certain exceptions such benefits shall be furnished for any disability incurred or aggravated during a period of service terminated by a discharge under other than honorable conditions. Specifically, they may not be furnished for any disability incurred or aggravated during a period of service terminated by a bad conduct discharge or when one of the bars listed in § 3.12(c) applies. 38 C.F.R. § 3.360(b). In making determinations of health-care eligibility the same criteria will be used as is now applicable to determinations of service incurrence and in line of duty when there is no character of discharge bar. 38 C.F.R. § 3.360(c). In this case, the VA determined that the Veteran’s discharge for the period of active service from October 1981 to May 1986 was considered to be under other than honorable conditions dishonorable for VA purposes, pursuant to 38 C.F.R. § 3.12 (d)(4), but that the Veteran was entitled to health care under 38 C.F.R. Chapter 17 for any disabilities determined to be service-connected based on service from October 1987 to July 1989. 1. Entitlement to service connection for treatment purposes under 38 U.S.C. Chapter 17 for asthma The Veteran contends that his asthma is due to his military service to include “cleaning and gutting out buildings full of asbestos.” See Veterans Application for Compensation. The Veteran’s service treatment records fail to include a diagnosis of asthma; however, they do include a diagnosis of an upper respiratory infection in September 1978 and again in July 1980. These assessments were made during the Veteran’s period of honorable service. Additionally, during the Veteran’s second period of service, he was diagnosed with upper respiratory infections in January 1983, December 1983 and May 1984. A January 1983 asbestos survey reflects that the Veteran was exposed to asbestos during service. Post service treatment records reflect a diagnosis of upper respiratory infection in December 1993, February 2002, December 2004, and March 2009. An inhaler was prescribed in October 2006. Asthma was diagnosed in September 2006, September 2007, August 2008, and February 2010. The September 2007 and August 2008 diagnoses were accompanied by a diagnosis of chronic obstructive pulmonary disease (COPD). The Veteran was afforded a VA examination in May 2017. The Veteran was diagnosed with asthma and COPD. The examiner opined that the Veteran’s asthma and COPD were not caused by the Veteran’s upper respiratory infection. The examiner noted that the Veteran has no proof of asbestosis or any other claimed etiology. In an October 2017 addendum opinion by the same VA examiner, the examiner noted that the Veteran is a “69 pack a year smoker” and while the Veteran might have been exposed to asbestos, there is no indication of this on the Veteran’s chest x-ray. The examiner stated that upper respiratory infections have never been considered to cause any lung disease. The examiner noted that upper respiratory infections involve the nose, sinuses, and throat and the lungs are involved with the lower respiratory conditions. The examiner further opined that smoking was the cause of the Veteran’s current potentially moderately severe lung condition. The examiner stated that his opinion was based on the Veteran’s admitted smoking history, 35 years of medical practice, and discussing this case with another physician. Based on a review of the evidence, the Board finds that service connection for treatment purposes under 38 U.S.C. Chapter 17 for asthma is not warranted. The only medical opinion of record, shows that the Veteran’s asthma is not related to his military service. As the opinion was formed after interviewing and examining the Veteran, and was based on medical expertise, the Board accords it great probative value. In addition, the examiner provided an etiology that linked the Veteran’s asthma and COPD to the Veteran’s history of smoking. It is also uncontradicted. No medical professional has provided any opinion indicating that the Veteran has asthma that is related to his military service. The overall evidence of record as discussed above weighs against a finding of asthma being associated with the Veteran’s active duty. Although lay persons are competent to provide opinions on some medical issues, see Kahana at 435, as to the specific issue in this case, the etiology of asthma falls outside the realm of common knowledge of a lay person. See Jandreau at 1377 n.4. The Veteran’s own assertions as to etiology have no probative value. Without competent and credible evidence of an association between asthma and the Veteran’s active duty, service connection for treatment purposes is not warranted. Based on this evidentiary posture, the Board concludes that the preponderance of the evidence is against the Veteran’s claim for service connection for treatment purposes under 38 U.S.C. Chapter 17 for asthma. As the preponderance of the evidence is against this issue, the benefit-of-the-doubt rule does not apply, and the Veteran’s claim is denied. See 38 U.S.C. §5107. 2. Entitlement to service connection for treatment purposes under 38 U.S.C. Chapter 17 for head injury In an undated correspondence, the Veteran alleges that he sustained a traumatic brain injury (TBI) in 1979, when he was involved in a motor vehicle accident. He stated that he went through the car’s windshield and landed on the street. He was knocked out and was treated at the NAS Jacksonville Hospital. The service treatment records confirm that the Veteran was in a motor vehicle accident in which he sustained trauma to his head and chest. The accident occurred in December 1980 (not 1979). Nonetheless, the accident occurred during a period of honorable service. The service treatment records also reflect that the Veteran sustained facial trauma when he was punched in the face by his brother-in-law in April 1985. This occurred during a period of service in which the Veteran was discharged under other than honorable conditions. However, in this case, the primary impediment to a grant of service connection for treatment purposes is the absence of evidence of a current disability. Here, the greater weight of the competent and credible evidence indicates that the Veteran has not been found to have TBI residuals at any time during the appeal period. The Veteran was afforded a VA examination in December 2017. The examiner indicated that the Veteran does not have or has ever had a traumatic brain injury or any residuals of a TBI. During the examination, the Veteran expressed that he was in a car accident where he collided with another vehicle. The Veteran stated that he lost consciousness. The Veteran indicated that after the incident, he started experiencing headaches. Assessment of the Veteran’s cognitive impairment revealed normal judgment with no complaints of problems with memory, attention, concentration, or executive function. Social interaction was routinely appropriate and orientation, motor activity, and visual-spatial orientation were all normal. The Veteran was able to communicate well with spoken and written language and his level of consciousness was normal. The examiner expressed that there is no diagnosis of TBI rendered because objective evidence in the Veteran’s service treatment records (STRs) do not support the diagnosis. The examiner noted that a TBI diagnosis requires a trauma to the brain that results in loss or alteration in consciousness, amnesia, or immediate neurological deficits or symptoms, none of which was evident in the Veteran’s service treatment record. The examiner stated that, even if the Veteran sustained a TBI in the 1980 incident, there is no evidence of residual TBI symptoms. The examiner opined that although the Veteran reports onset of chronic headaches after the 1980 auto accident, the evidence in his available records do not support the Veteran’s statements. The examiner noted that the available post military treatment record was negative for evidence of chronic headaches. The examiner expressed that not all head injuries affect the brain, therefore, although evidence showed that the Veteran sustained injury to his head during active duty service, there is no evidence to support that the injuries led to brain injury (TBI) hence the lack of a TBI diagnosis in the TBI disability. The Board finds that service connection for treatment purposes is not warranted in this case. The most probative evidence of record demonstrates that there is no current disability - no residuals of a TBI. The Veteran is competent to report headaches, but these complaints are not equivalent to a diagnosis of TBI. The Veteran does not have the medical expertise to make such a diagnosis as it is not capable of lay observation. Moreover, the VA examiner did not find sufficient clinical evidence to warrant a current diagnosis of TBI or residuals thereof. The examination report is unrebutted by any other medical evidence to the contrary. Accordingly, the Board has no basis on which to award service connection for treatment purposes for these symptoms Accordingly, the preponderance of the evidence is against the claim, and there is no reasonable doubt to be resolved. 38 U.S.C. § 5107(b). 3. Entitlement to an initial compensable evaluation for laceration scar, right wrist prior to May 17, 2017 and a rating greater than 10 percent thereafter This scar was initially rated as noncompensable under Diagnostic Code 7805, effective March 3, 2008. Subsequently, the RO granted a separate rating of 10 percent under Diagnostic Code 7804, effective May 17, 2017. See February 2018 rating decision. Skin disabilities are rated under 38 C.F.R. § 4.118. During the pendency of this appeal, the criteria for evaluating disabilities of the skin were revised, effective October 23, 2008. The new rating criteria for evaluation of scars are applicable only to claims received by VA on or after October 23, 2008, absent specific request for consideration under the revised code. See 73 Fed. Reg. 54708 (Sept. 23, 2008). The date of claim here was March 2008 and review under the revised criteria has not been requested expressly. Nevertheless, since the Veteran’s claim was pending at the time of the regulatory amendments, he is entitled to the application of the criteria that are the most favorable to his claim, for the period during which both could apply. See VAOPGCPREC 3-2000 (2000); 65 Fed. Reg. 33422 (2000); Rodriguez v. Peake, 511 F.3d 1147 (Fed. Cir. 2008). A new regulation applies, if at all, only to the period beginning with the effective date of the new regulation. See 38 U.S.C. § 5110(g); Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003); 38 C.F.R. § 3.114. DC 7800 addresses scarring of the head, face, or neck and does not apply to the right wrist scar. DC 7802 provides a 10 percent evaluation for scars with an area of 144 square inches (929 square centimeters) or greater; there is no evidence or contention that the Veteran’s scar meets these criteria. Therefore, DCs 7800 and 7802 will not be further discussed. Prior to October 23, 2008, DC 7801 was characterized as scars, other than on the head, face, or neck, that are deep or that cause limited motion. A 10 percent rating was warranted where the scar area or areas exceeded 6 square inches (39 square centimeters). A 20 percent rating was warranted where the scar area or areas exceeded 12 square inches (77 square centimeters). A 30 percent rating was warranted where the scar area or areas exceeded 72 square inches (465 square centimeters) and a 40 percent rating was warranted where the scar area or areas exceeded 144 square inches (929 square centimeters). Note (1) indicated that scars in widely separated areas, as on two or more extremities or on anterior and posterior surfaces of the extremities or trunk, would be separately rated and combined in accordance with § 4.25. Note (2) explained that a deep scar is one associated with underlying soft tissue damage. 38 C.F.R. § 4.118, DC 7801. From October 23, 2008, the title of DC 7801 was revised to “[b]urn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are deep and nonlinear.” The rating criteria were revised to provide a 10 percent rating where the scar area or areas is at least 6 square inches (39 square centimeters) but less than 12 square inches (77 square centimeters). A 20 percent rating is warranted where the scar area or areas is at least 12 square inches (77 square centimeters) but less than 72 square inches (465 square centimeters). A 30 percent rating is warranted where the scar area or areas is at least 72 square inches (465 square centimeters) but less than 144 square inches (929 square centimeters. A 40 percent rating is warranted where the scar area or areas is 144 square inches (929 square centimeters) or greater. Former Note (2) was moved to Note (1). As it relates to the extremities, Note (2) was revised to state that if multiple qualifying scars are present, or if a single qualifying scar affects more than one extremity, or a single qualifying scar affects one or more extremities, assign a separate evaluation for each affected extremity based on the total area of the qualifying scars that affect that extremity. Combine the separate evaluations under § 4.25. Qualifying scars are scars that are nonlinear, deep, and are not located on the head, face, or neck. Prior to October 23, 2008, DC 7803 provided a 10 percent rating for superficial, unstable scars. Note (1) indicated an unstable scar was one where, for any reason, there was frequent loss of covering of the skin over the scar. Note (2) indicated a superficial scar was one not associated with underlying soft tissue damage. DC 7803 was removed, effective October 23, 2008. Prior to October 23, 2008, DC 7804 provided a 10 percent rating for a superficial scar that was painful on examination. From October 23, 2008, DC 7804 was revised to provide a 10 percent rating for one or two scars that are unstable or painful. A 20 percent rating is warranted for three or four scars that are unstable or painful. A 30 percent rating is warranted for five or more scars that are unstable or painful. Note (1) explains that an unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. Note (2) provides that if one or more scars are both unstable and painful, 10 percent should be added to the evaluation that is based on the total number of unstable or painful scars. Note (3) states that scars evaluated under DCs 7800, 7801, 7802, or 7805 may also receive an evaluation under DC 7804, when applicable. Prior to October 23, 2008, DC 7805 provided that scars, other, could be rated based on limitation of function of the affected part. Similarly, from October 23, 2008, DC 7805 provides that any disabling effects not considered in a rating provided under DCs 7800-7804 can be considered under another appropriate DC. The Veterans VA treatment record dated November 2007 note that the Veteran had pain on the right wrist because he cut himself on the wrist. The examiner noted that the Veteran has evidence of a scar on the flexor side of right wrist and that there is full range of motion. The Veteran had discomfort during extreme flexion. The Veteran was afforded a VA examination in November 2009. The examiner stated that the scars are superficial and are unlikely to be causing any complications of arthritis or limitations of motions by themselves. The examiner reported that most of the symptoms that the Veteran is experiencing to include flare ups are symptoms of arthritis in the wrist. In a December 2009 treatment note, the Veteran had some old scars on the wrist but no nodules or deformities were noted. In an April 2010 Statement in Support of Claim, the Veteran expressed that during his November 2009 examination, the Veteran was taking pain medication for his wrist and therefore his wrist pain and movement were affected by his medication. The Veteran was afforded a VA examination in May 2017. The examiner indicated that the Veteran’s right wrist scar was painful. The examiner noted that the Veteran does not have any scars of the trunk or extremities that are unstable with frequent loss of covering of skin over the scar. The examiner noted that none of the scars are due to burns. The examiner noted that the Veteran has a linear scar measured at 6 cm. The examiner reported that the Veteran does not have any superficial non-liner scars or deep non-linear scars. The examiner noted that none of the Veteran’s scars result in limitation of function. Based on the above evidence, and resolving any doubt in favor of the Veteran, the Board finds that an initial 10 percent rating, but no higher, under Diagnostic Code 7804 is warranted for the entire period on appeal, based on evidence of a painful, superficial scar. The Board notes that the Veteran is competent to report pain, as that is a lay-observable symptom. In addition, the Veteran indicated that he was taking pain medication for his wrist during the November 2009 VA examination. Furthermore, the November 2009 examiner stated that the Veteran’s wrist scar was superficial. As noted above, prior to October 23, 2008, DC 7804 provided a 10 percent rating for a superficial scar that was painful on examination. Resolving any doubt in favor of the Veteran, the Board finds that a rating of 10 percent under Diagnostic Code 7804 is therefore warranted. However, prior to October 23, 2008, a rating in excess of 10 percent under Diagnostic Code 7804 is not warranted, as there is no evidence that the scar was unstable during that period. Similarly, the Veteran does not meet the criteria for a separate rating under any other relevant Diagnostic Code, as there is no objective evidence that his scar was deep, nonlinear, or unstable or that it caused limitation of motion. Rather, the relevant VA examinations describe the scar as stable, superficial and linear. See 38 C.F.R. § 4.118 Diagnostic Codes 7801-7803(2008 & 2017). Diagnostic Code 7805 is not for application as there is no indication of disabling effects not considered under the relevant Diagnostic Codes. Finally, the weight of the evidence does not support higher ratings under Diagnostic Codes 7801 and 7804, as the Veteran is service-connected for only one scar and the scar area is less than 77 square centimeters. In sum, the Veteran is entitled to a higher rating of 10 percent under Diagnostic Code 7804 for his right wrist scar for the entire period on appeal. However, a higher rating under Diagnostic Code 7804 or separate ratings under other applicable Diagnostic Codes are not warranted for the entire period on appeal as the evidence fails to show entitlement to higher ratings. Finally, all potentially applicable diagnostic codes have been considered, and the Veteran is not entitled to a rating in excess of the rating already assigned. See Schafrath v. Derwinski, 1 Vet. App. 589, 593(1991). REASONS FOR REMAND 1. Entitlement to service connection for treatment purposes under 38 U.S.C. Chapter 17 for gastroesophageal reflux disorder (GERD) is remanded. Unfortunately, the Veteran’s appeal for entitlement to service connection for treatment purposes for GERD must be remanded for further development. Although the Board sincerely regrets the additional delay, it is necessary to ensure that there is a complete record upon which to decide the Veteran’s appeal for this issue so that he is afforded every possible consideration. Although the service treatment records fail to include a diagnosis of GERD, they do include a diagnosis of gastritis in September 1978. This assessment was made during the Veteran’s period of honorable service. Additionally, in the Veteran’s second period of service, he was assessed with enteritis in February 1983. Post service treatment records reflect that in March 2008, the Veteran had a history of GERD. A July 2008 treatment report reflects that the Veteran requested aspirin for an unrelated condition because his doctor told him that ibuprofen would aggravate his GERD. The Veteran was afforded a VA examination in May 2017. The examiner indicated that the Veteran’s GERD was less likely than not related to service. The examiner expressed that gastritis presents symptoms below the diaphragm and GERD presents above the diaphragm, so it would not be possible to confuse the two conditions. The examiner noted that “the same could be said for enteritis, which showed up after the Veteran’s honorable service was over.” The Board finds the May 2017 VA opinion is inadequate as there is very little rationale to accompany the opinion reached. In addition, the examiner based his opinion for enteritis on the fact that the Veteran’s enteritis showed up after the Veteran’s honorable service. However, as the Veteran may be entitled to service connection for treatment purposes, the examiner’s statements regarding the timeframe of when the Veteran was diagnosed with enteritis is of no importance. Because the May 2017 VA opinion failed to provide an adequate opinion discussing the etiology of the Veteran’s GERD, a new VA examination and medical opinion is required. 2. Entitlement to service connection for treatment purposes under 38 U.S.C. Chapter 17 for residuals of a fall to include a back injury; hand injury; and feet injury is remanded. The RO acknowledged that the Veteran incurred each of these injuries during service. In April 1981, the Veteran sustained an injury to his left thumb when he struck it with a hammer. In July 1981, the Veteran sustained trauma to his left hand when it was crushed against a tree. In May 1982, the Veteran dropped an outboard motor on the tip of his left fourth (ring) finger. He sustained a fracture at the terminal tuft. In October 1982, the Veteran lacerated his right forearm when he fell onto sheet metal. The laceration became infected. In October 1982, the Veteran was assessed with post spinal back pain after undergoing a spinal tap in conjunction with a vasectomy. Post service treatment records reflect complaints of back pain in January 2008. March 2008 x-rays of the back revealed disc narrowing of 75 percent at L5-S1. Back pain and hand pain were also noted in February 2010. In July 1996, the Veteran reported arthritis in his hands and wrists. In an October 2017 VA addendum opinion, the examiner opined that as the Veteran injured his back twice on active duty, and as the Veteran expressed that his back pain was much worse after the second back injury in October 1982, the Veteran should be service connected for treatment purposes. The Veteran was afforded another VA addendum opinion in November 2017. The examiner opined that the Veteran’s back disability is less likely than not incurred in or caused by the Veteran’s motor vehicle accident in December 1980; back pain status post spinal tap in September 1982; and/or fall on sheet metal in October 1982 during service. The examiner expressed that there is no nexus between the Veteran’s s inservice injuries and his current back disability. The examiner expressed that there is no objective medical records or medical literature evidence to indicate otherwise. The examiner indicated that there was no causal pathophysiologic relationship. The examiner opined that the Veteran’s greatest risk factor for his back disability was his age. Regrettably, the Board finds both the October 2017 and November 2017 VA opinions are inadequate as there is very little rationale to accompany the opinions reached. The October 2017 VA examiner’s opinion, although positive, failed to provide an adequate rationale regarding why the Veteran’s first back injury during honorable service was not the cause of the Veteran’s current back disability. The November 2017 VA examiner’s opinion was inadequate due to conclusory rationale. Although the examiner expressed that the Veteran’s back disability is age-related, the explanatory rationale is inadequate and ultimately conclusory. Specifically, the examiner simply notes that, “there is no nexus” between the Veteran’s motor vehicle accident in December 1980; back pain status post spinal tap in September 1982; and/or fall on sheet metal in October 1982 during service, and the Veteran’s current back diagnosis, and that there “was no causal pathophysiologic relationship.” This opinion does not consider or discuss the Veteran’s contentions or in-service back injuries. In light of the above, the Board finds these opinions inadequate for rating purposes and a remand is necessary to obtain a new VA examination. 3. Entitlement to service connection for treatment purposes under 38 U.S.C. Chapter 17 for an acquired psychiatric disorder, claimed as posttraumatic stress disorder (PTSD) is remanded. The Board notes that the Veteran underwent a psychiatric examination in February 1985. The Veteran had an adjustment disorder with depressed mood, marital discord, and alcohol abuse in partial remission. The report states that the Veteran’s psychiatric disability was due to the Veteran’s wife telling him that she wanted a divorce. The VA examiner should note that this incident occurred during a period of service in which the Veteran was discharged under other than honorable conditions. An April 2014 correspondence from W.H. (Advanced Peer Specialist) reflects that he met with the Veteran in September 2013 and that the Veteran was accepted as a member of a PTSD group. Additionally, an April 2007 correspondence from J.H. (Staff Psychotherapist at the Texas Department of Criminal Justice) reflects that the Veteran has been under J.H.’s care for several months to develop coping skills for anger, stress, and depression. The Veteran was afforded a VA examination in December 2017. The examiner indicated that the Veteran does not have a diagnosis of PTSD. The examiner indicated that the Veteran’s only mental health diagnosis at the present time is Other Specified Personality Disorder. The examiner expressed that the Veteran fails to have any psychiatric disability to include depression and PTSD that is incurred in or caused by the head injury; motor vehicle accident during service. Regardless, the examiner did not discuss the prior psychiatric diagnoses to include depression that were given during the relevant appeal period. For VA purposes, a current disability exists when a claimant has a disability at the time a claim is filed or at some point during the pendency of that claim. McLain v. Nicholson, 21 Vet. App. 319, 321 (2007). As a result, medical clarification to determine whether the Veteran’s prior diagnoses are related to service or a service-connected disability is still necessary to comply with 38 C.F.R. § 3.159 (c)(4). The matters are REMANDED for the following action: 1. The Veteran should be afforded a VA examination for the purpose of determining the nature and etiology of the Veteran’s GERD. The claims file must be made available to the examiner for review in connection with the examination. Following a review of the relevant evidence, to include the claims file, service treatment records, post-service treatment records; a history obtained from the Veteran, the clinical evaluation, and any tests that are deemed necessary, the examiner should opine whether it is at least as likely as not (a 50 percent or greater probability) that any disability began during or is causally related to service, to include as due to the gastritis assessed in September 1981 and the enteritis assessed in February 1983. The examiner is advised that the Veteran is competent to report injuries and symptoms and that his reports must be considered in formulating the requested opinion. 2. The Veteran should be afforded a VA orthopedic examination for the purpose of determining the nature and etiology of the Veteran’s back disability. The claims file must be made available to the examiner for review in connection with the examination. Following a review of the relevant evidence, to include the claims file, service treatment records, post-service treatment records; a history obtained from the Veteran, the clinical evaluation, and any tests that are deemed necessary, the examiner should opine whether it is at least as likely as not (a 50 percent or greater probability) that any back disability began during or is causally related to service. The examiner is advised that the Veteran is competent to report injuries and symptoms and that his reports must be considered in formulating the requested opinion. 3. The Veteran should be afforded a VA psychiatric examination for the purpose of determining the nature and etiology of the Veteran’s psychiatric disability. The claims file must be made available to the examiner for review in connection with the examination. Following a review of the relevant evidence, to include the claims file, service treatment records, post-service treatment records; a history obtained from the Veteran, the clinical evaluation, and any tests that are deemed necessary, the examiner should opine whether it is at least as likely as not (a 50 percent or greater probability) that any psychiatric disability (to include PTSD) began during or is causally related to service, to include as due to a December 1980 motor vehicle accident. The examiner is advised that the Veteran is competent to report injuries and symptoms and that his reports must be considered in formulating the requested opinion. The examiner is also advised that for VA purposes, a current disability exists when a claimant has a disability at the time a claim is filed or at some point during the pendency of that claim. LESLEY A. REIN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M.D.