Citation Nr: 18158468
Decision Date: 12/17/18	Archive Date: 12/17/18

DOCKET NO. 15-20 309
DATE:	December 17, 2018
ORDER
The appeal seeking to reopen a claim of service connection for aortic sclerosis is granted.
The appeal seeking to reopen a claim of service connection for polyneuropathy is granted.
Service connection for diabetic neuropathy is granted. 
From August 10, 2011, an increased evaluation of 50 percent for a mood disorder with major depressive features is granted. 
A total disability rating due to individual unemployability (TDIU) is granted.
REMANDED
1. Entitlement to service connection for a heart condition is remanded.
2. Entitlement to an increased initial evaluation greater than 50 percent for a mood disorder with major depressive features is remanded. 
3. The appeal seeking to reopen a claim of service connection for hypertension is remanded.
4. Entitlement to an increased evaluation for service-connected hemorrhoids is remanded.
5. Entitlement to an increased evaluation for service-connected impotence is remanded.
6. Entitlement to an increased evaluation for residuals of prostate cancer, status post radical retropublic prostatectomy is remanded.
7. Entitlement to an increased evaluation for hypertensive nephrosclerosis and diabetic nephropathy with proteinuria, associated with diabetes mellitus, type II, is remanded.
8. Entitlement to an increased evaluation for service-connected burn scars on the legs is remanded.
9. Entitlement to an increased evaluation for service-connected fungal infections of the feet and ears is remanded.
FINDINGS OF FACT
1. A December 2010 rating decision denied service connection for aortic sclerosis and the Veteran was notified of the decision. The Veteran did not appeal the decision and new and material evidence was not submitted within a year after the decision. Therefore, the decision is final.
2. Evidence received since the December 2010 rating decision is relevant and probative as to the issue of service connection aortic sclerosis. 
3. A June 2010 rating decision denied service connection for polyneuropathy and the Veteran was notified of the decision. The Veteran did not appeal the decision and new and material evidence was not submitted within a year after the decision. Therefore, the decision is final.
4. Evidence received since the June 2010 rating decision is relevant and probative as to the issue of service connection for polyneuropathy. 
5. The Veteran’s diabetic neuropathy is proximately due to his service-connected diabetes mellitus, type II. 
6. From August 10, 2011, the Veteran’s mood disorder caused occupational and social impairment with reduced reliability and productivity due to symptoms of anxious moods, emotional lability and irritability, disturbances of motivation and mood, and difficulty in maintaining social relationships. 
7. The Veteran was precluded from obtaining and maintaining regular and substantially gainful employment because of his service-connected disabilities. 
CONCLUSIONS OF LAW
1. The December 2010 rating decision is final. 38 U.S.C. § 7105(c) (2012); 38 C.F.R. §§ 20.302, 20.1103 (2017).
2. The evidence received since the December 2010 rating decision, which denied service connection for aortic sclerosis, is new and material, and the claim is reopened. 38 U.S.C. §§ 5108, 7105 (2012); 38 C.F.R. § 3.156 (2017). 
3. The June 2010 rating decision is final. 38 U.S.C. § 7105(c) (2012); 38 C.F.R. §§ 20.302, 20.1103 (2017).
4. The evidence received since the June 2010 rating decision, which denied service connection for polyneuropathy, is new and material, and the claim is reopened. 38 U.S.C. §§ 5108, 7105 (2012); 38 C.F.R. § 3.156 (2017). 
5. The criteria for secondary service connection for diabetic neuropathy are met.  38 U.S.C. §§ 1110, 1131, 5107(b) (2017); 38 C.F.R. §§ 3.102, 3.310(a) (2012).
6. From August 10, 2011, an increased evaluation of 50 percent is warranted for the Veteran’s mood disorder with major depressive features.  38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2017); 38 C.F.R. §§ 3.159, 4.7, 4.124(a), 4.130, Diagnostic Code (DC) 9434 (2012).
7. A schedular TDIU rating is warranted. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.340, 3.341, 4.15, 4.16 (2017). 
REASONS AND BASES FOR FINDINGS AND CONCLUSIONS
The Veteran honorably served in the United States Navy for over 22 years on active duty from September 1943 to August 1966. He died in September 2013. The appellant is his surviving spouse. 
As a Veteran of World War II, the Korean War, peacetime, and the Vietnam War, the Board recognizes and is truly grateful for the long and distinguished service the Veteran gave to this country. 
This matter is before the Board of Veterans’ Appeals (Board) on appeal from March 2012, November 2012, and September 2015 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in Jackson, Mississippi. 
The Board notes there is an outstanding Motion to Advance on the Docket (AOD) pending. In support of the motion, the representative stated that the appellant is of advanced age, supported by documentation in the claims file indicating that the appellant is over 75 years of age. In light of this information, the undersigned Veterans Law Judge grants the motion to advance this appeal on the Board’s docket based upon advanced age. 38 C.F.R. § 20.900 (c) (“advanced age” is defined as 75 or more years of age). Accordingly, this appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.900 (c); 38 U.S.C. § 7107 (a)(2). 
In October 2013, the appellant filed an application for dependency and indemnity compensation and submitted a statement that she would like to keep the Veteran’s appeal open. See October 2013 Appellant’s Application for Dependency and Indemnity Compensation (VA Form 21-534); October 2013 Statement in Support of Claim (VA form 21-4138). This application and statement were considered by the RO to be a request for substitution. See 38 C.F.R. § 3.1010 (c)(2); October 2013 Deferred Rating Decision (characterizing this as a claim for substitution). The appellant has been awarded dependency and indemnity compensation as the Veteran’s surviving spouse. See October 2013 Rating Decision. Although the record does not reflect independent notice that the RO found the appellant to be an appropriate substitute, the discussion of substitution and subsequent adjudication on the merits of the claims in a May 2015 statement of the case was an implicit ruling by the AOJ on the suitability of the appellant as a substitute. See May 2015 Statement of the Case. Based on the foregoing, the Board finds that the appellant is a valid substitute and will step into the Veteran’s shoes. 
This decision splits the issue of entitlement to an increased initial evaluation into two issues: (1) entitlement to an increased initial evaluation greater than 30 percent and (2) entitlement to an increased initial evaluation greater than 50 percent. This permits a grant of an increased initial evaluation, to which the evidence of record shows the Veteran was entitled, without the delay of awaiting additional adjudication relating to whether he was entitled to an initial evaluation greater than 50 percent. See Locklear v. Shinseki, 24 Vet. App. 311 (2011) (splitting a claim generally is within VA’s discretion). 
The Board also notes that the Veteran made his claim for service connection for a “heart disease,” due to herbicide agent exposure, but the RO proceeded to adjudicate this as a request to reopen a prior final denial on the issue of service connection for aortic sclerosis. See March 2013 Veteran’s Supplemental Claim for Compensation (VA Form 21-536b); September 2015 Rating Decision. While aortic sclerosis would certainly be encompassed by the term “heart disease,” it is not the only condition for which the Veteran may have been seeking service connection. Notably, on the same form, the Veteran indicated that he treated at the VA Medical Center in Jackson, but there does not appear to have been records associated with the file relevant to this request. Therefore, the Board will broadly construe the claim for service connection for heart disease as a claim for service connection for a heart condition, to include a claim for aortic sclerosis. Clemons v. Shinseki, 23 Vet. App. 1, 6 (2009) (holding that the board must consider any disability that “may reasonably be encompassed by” the description of the claim and symptoms or other submitted information.). This means that this is partially an appeal to reopen and partially a new and distinct claim. This issue has been characterized accordingly. 
With respect to the portion of this claim that is an appeal to reopen the prior final denial for service connection of aortic sclerosis, the Board finds that the appropriate rating decision from which this appeal arose was actually the November 2012 rating decision. This is because approximately two months after the denial, the Veteran submitted his claim for service connection for heart disease. This reflected an expression of disagreement with and a desire to contest the results of the determination that he was not entitled to service connection for aortic sclerosis. 
Although the RO reopened the Veteran’s claims of service connection for neuropathy and aortic sclerosis, the question of whether new and material evidence has been received to reopen this claim must be addressed in the first instance by the Board because the issue goes to the Board’s jurisdiction to reach the underlying claim and adjudicate it on a de novo basis. See Jackson v. Principi, 265 F.3d 1366 (Fed. Cir. 2001); Barnett v. Brown, 83 F.3d 1380 (Fed. Cir. 1996). If the Board finds that no such evidence has been offered, that is where the analysis must end; hence, what the RO may have determined in this regard is irrelevant. Barnett, 83 F.3d at 1383. The Board has characterized the claims accordingly.

General Legal Considerations
When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the appellant. It is the policy of VA to administer the law under a broad interpretation, consistent with the facts in each case with all reasonable doubt to be resolved in favor of the appellant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990).
The Board has reviewed all the evidence in the claims file, with an emphasis on the evidence relevant to these appeals. Although the Board has an obligation to provide reasons and bases supporting its decision, there is no need to discuss, in detail, every piece of evidence of record. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). The Board will summarize the relevant evidence as appropriate and the analysis will focus on what the evidence shows, or fails to show, as to the claim.

Reopening for Aortic Sclerosis and Neuropathy
I.	Legal Criteria
Generally, when a claim is disallowed, it may not be reopened and allowed unless new and material evidence is submitted. 38 U.S.C. §§ 7104. “New” evidence means 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).
To decide whether evidence is material, VA must consider whether the new evidence could, if the claim were reopened, reasonably result in substantiation of the claim. Shade v. Shinseki, 24 Vet. App. 110, 118 (2010). Thus, evidence is new if it has not been previously submitted to agency decisionmakers and is material if, when considered with the evidence of record, it would at least trigger VA’s duty to assist by providing a medical opinion, which might raise a reasonable possibility of substantiating the claim. Id. The requirement of new and material evidence raising a reasonable possibility of substantiating the claim is a low threshold, and the phrase “raises a reasonable possibility of substantiating the claim” is to be viewed as “enabling rather than precluding reopening.” Id. at 121.
II.	Aortic Sclerosis: Factual Background and Legal Analysis
The RO previously adjudicated the Veteran’s claim for service connection for aortic sclerosis in a December 2010 rating decision. In this decision, the RO denied the Veteran’s claim, in part, because it concluded that there was no causal relationship (a “nexus”) to naval service and because the evidence did not demonstrate a diagnosis of a condition for which VA has created a presumptive nexus. See December 2010 Rating Decision. The Veteran did not appeal that decision and the record does not reflect that there was new and material evidence submitted within one year of the rating decision. Therefore, the December 2010 rating decision became final. 38 U.S.C. § 7105; 38 C.F.R. § 3.156.
However, the Veteran’s death certificate has revealed a potential relationship between the service-connected nephrosclerosis and the Veteran’s cardiac functioning. See September 2013 Veteran’s Certificate of Death (listing nephrotic syndrome and cardiopulmonary arrest as a cause of death); see also January 2012 VA Examination by H.M., P.A. (“hypertension may very well be the byproduct of his diagnosed diabetic nephropathy”). This means that VA’s duty to assist was triggered because a new medical opinion on secondary service connection was necessary. See McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006); see also Waters v. Shinseki, 601 F.3d 1274 (Fed. Cir. 2010); 38 C.F.R. § 3.159(c)(4)(i). Considering this new and material evidence, reopening is warranted. 38 C.F.R. § 3.156(a); see Shade, 24 Vet. App. at 121. 
III.	Neuropathy: Factual Background and Legal Analysis
The RO previously adjudicated the Veteran’s claim for service connection for neuropathy in a June 2010 rating decision. In this decision, the RO denied the Veteran’s claim because he had no diagnosis of neuropathy. See June 2010 Rating Decision. The Veteran did not appeal that decision and the record does not reflect that there was new and material evidence submitted within one year of the rating decision. Therefore, the June 2010 rating decision became final. 38 U.S.C. § 7105; 38 C.F.R. § 3.156.
However, since that time the RO has added medical records from Jackson VA Medical Center that indicates that the Veteran had diabetic neuropathy. See September 2015 Jackson VA Medical Center Records (dated September 2013).  This is new because it had not yet been seen by an adjudicator in addressing this issue and material because it raises a reasonable possibility of substantiating the claim. Considering this new and material evidence, reopening is warranted. 38 C.F.R. § 3.156(a); Shade v. Shinseki, 24 Vet. App. 110, 121 (2010). 

Service Connection for Neuropathy 
I.	Legal Criteria
Establishing secondary service connection requires evidence of: (1) a current disability (for which secondary service connection is sought); (2) a service-connected disability; and (3) that the current disability was either caused or aggravated by the service-connected disability. 38 C.F.R. § 3.310(a); see also Allen v. Brown, 7 Vet. App. 439 (1995).
II.	Factual Background and Legal Analysis
Medical records admitted into the record after the relevant statement of the case (SOC) indicate that the Veteran was prescribed gabapentin for his diabetic neuropathy. See September 2015 Jackson VA Medical Center Records (dated September 2013). This provides competent and credible evidence that the Veteran had a current disability that was proximately caused by the Veteran’s service-connected diabetes mellitus, type II. Although entitled to AOJ review of this evidence prior to a Board decision, see 38 U.S.C. § 7104(a), the award of service connection represents a full grant of the benefit sought and is nonprejudicial to the appellant. See Padgett v. Peake, 22 Vet. App. 159 (2008) (holding that there remains no controversy after a grant of service connection for accrued benefits purposes). 

 Increased Evaluation for Depression
I.	Legal Criteria
Disability evaluations are determined by the application of a schedule of ratings, which is based on average impairment of earning capacity caused by the given disability. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4.
When a question arises as to which of two ratings applies under a particular diagnostic code, the higher rating is assigned if the disability more closely approximates the criteria for the higher rating. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining, including degree of disability, is to be resolved in favor of the appellant. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3. 
In this case, the Veteran’s psychological disorders were rated as 30 percent disabling under the General Rating Formula for Mental Disorders (General Formula). 
A 50 percent evaluation is warranted for occupational and social impairment with reduced reliability and productivity. This may have been due to such symptoms as, for example: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. Id.
A 70 percent evaluation is warranted for occupational and social impairment, with deficiencies in most areas (such as work, school, family relations, judgment, thinking, or mood). This may have been due to such symptoms as, for example: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately, and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships. Id.
The list of symptoms in the General Formula is not intended to constitute an exhaustive list, but provides examples of the type and degree of symptoms, or their effects, that would justify a particular rating. Mauerhan v. Principi, 16 Vet. App. 436 (2002). However, a Veteran may only qualify for a given disability rating under § 4.130 by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration. Vazquez-Claudio v. Shinseki, 713 F.3d 112 (Fed. Cir. 2013). 
As relevant to this case, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), states that it was recommended that the use of Global Assessment of Functioning (GAF) scores be dropped for several reasons, including their conceptual lack of clarity and questionable psychometrics in routine practice. The Board recognizes the Court’s holding in Carpenter v. Brown, 8 Vet. App. 240, 242 (1995) regarding the importance of GAF scores, however, because the medical community has, since that time, determined that GAF scores are an unreliable measure of a psychiatric disability, the Board assigns the GAF scores mentioned in the record little probative value in and of themselves and has, instead, focused its analysis on the Veteran’s symptoms. See also Golden v. Shulkin, 29 Vet, App. 221 (2018).
II.	Factual Background and Legal Analysis
The Board finds that the Veteran’s mood disorder with major depressive features caused occupational and social impairment that best equated to a 50 percent rating as of the date of his claim, August 10, 2011, because the medical evidence of record reflects that the Veteran was at times emotional labile, had difficulties maintaining social relationships, had disturbances of motivation and mood, and had difficulty in performing more complex psychological tasks. 
The Veteran was evaluated by psychological examiners on two occasions. At his September 2011 examination, the Veteran reported symptoms of feeling down and some disturbances of motivation, occasional feelings of hopelessness, sleep disturbances, emotional lability and getting mad over little things. See September 2011 VA Examination (Mental Health) by J.R., M.D. He reported that he did not have any contact with his step-son and this bothered him, but that he also had a fairly stable relationship with his wife of then-20 years and had good friendships with members of his church, which he attended fairly regularly. Id. The examiner opined that no symptoms were severe enough to interfere with occupational or social functioning or require continuous medication. Id. This opinion cannot be assigned significant probative weight because it did not adequately take into account the Veteran’s competent and credible statements of reduced motivation, disturbances of mood, and difficulty with at least one social relationship. See Dalton v. Nicholson, 21 Vet. App. 23, 39-40 (2007).  
At his June 2012 examination, the Veteran reported symptoms and showed clinical signs of difficulty concentrating on complex tasks like multiplication, anxious mood, reduced motivation to attend social functions and do leisure activities, sleep disturbances and a labile affect. See June 2012 Private Psychological Examination Report by A.F., Ph.D. At this appointment, the examiner reported that the Veteran had “moderate difficulty in social, occupational, or school functioning.” Id. 
At this appointment the examiner provided many opinions, some of which are internally inconsistent with each other and the results of his mental status examination. When presented with a questionnaire that most nearly approximates the applicable General Rating Formula for Mental Disorders, the examiner opined that the Veteran would have occupational and social impairment with reduced reliability and productivity. Id. The Board assigns significant probative value to this assessment because it is most consistent with the reported symptoms and clinical signs that the Veteran showed on both examinations. 
However, in addition to this opinion, the examiner also provided opinions such as concluding that the Veteran would frequently decompensate if subjected to work-place pressures and would have difficulty making independent decisions, which suggests an occupational and social impairment with deficiencies in most areas. Id.; see also 38 C.F.R. § 4.130. These opinions are contrasted with the Veteran’s abilities to socialize with friends, attend church, think and speak logically and sequentially, demonstrate good insight and judgment, and play poker. See June 2012 Private Psychological Examination Report by A.F., Ph.D. Such activities indicate that the Veteran could deal with a greater level of psychological pressure than opined and was capable of making decisions for himself. Therefore, the Board cannot assign these opinions significant probative weight. 
A 70 percent rating is not warranted because the Veteran’s mood disorder with major depressive features did not result in deficiencies in most areas of his life. While he reported difficulty in maintaining a relationship with his step-son, he also indicated that he had a stable marriage with his wife and that he had friends at his church. The Veteran was capable of playing poker and cooking, which indicates that he was psychologically capable of functioning independently. There is no indication in the record that the Veteran was suicidal.
In assigning the rating back to the initial application date, the Board notes that an addendum opinion was obtained to resolve the inconsistency between the two conflicting opinions (and the GAF scores therein) discussed above. As to GAF scores, the addendum opinion concluded that the Veteran’s GAF score should be revised to reflect a score of 58. See February 2018 VA Addendum Opinion by R. L., M.D. Although these numeric scores themselves are of little value independent of their reports, the addendum opinion as a whole reflects that the addendum clinician believed that the Veteran’s level of functioning was the same through the entire claim period. 
The Board acknowledges the Veteran’s competent and credible reports of symptoms during his examinations and appreciates his diligent efforts to describe these symptoms while living with significant disability. These lay statements are consistent with the medical evidence of record and the assigned rating. 

Total Disability Ratings Due to Individual Unemployability (TDIU)
I.	Legal Criteria
It is the established policy of VA that all veterans who are unable to obtain and maintain a substantially gainful occupation because of service-connected disabilities shall be rated as totally disabled. 38 U.S.C. § 1155; 38 C.F.R. § 4.16. 
Entitlement to a TDIU rating requires that service-connected disabilities cause an impairment severe enough that the Veteran was precluded from obtaining and maintaining a substantially gainful occupation. 38 C.F.R. § 3.340. Substantially gainful employment is defined as work that is more than marginal and permits the individual to earn a living wage. Moore v. Derwinski, 1 Vet. App. 356 (1991). The central inquiry is whether the Veteran’s service-connected disabilities alone are of sufficient severity to produce unemployability. Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). In making this determination, consideration may be given to the veteran’s level of education, special training, and previous work experience, but not to age or to the impairment caused by nonservice-connected disabilities. See 38 C.F.R. §§ 3.341, 4.16, 4.19.
A schedular TDIU rating may be assigned where the schedular rating is less than total, when it is found that the disabled person is unable to secure or follow a substantially gainful occupation as a result of a single service-connected disability ratable at 60 percent or more; or if there are two or more service-connected disabilities, provided at least one disability is ratable at 40 percent or more, and there is sufficient additional service-connected disability to bring the combined rating to 70 percent or more. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.16(a). 
II.	Factual Background and Legal Analysis
Service connection was established for depressive disorder, now rated 50 percent disabling from August 2011; hypertensive nephrosclerosis and diabetic nephropathy, rated 30 percent disabling from January 2010; type II diabetes mellitus, rated 20 percent disabling from April 1994; residuals of prostate cancer, status post radical retropublic prostatectomy rated 10 percent disabling from January 2010. The Veteran was service-connected for other disabilities, currently at a noncompensable rating. Although the Veteran had no single rating that met the requirements for a schedular TDIU award, he met the schedular requirements when considering his depressive disorder, hypertensive nephrosclerosis and diabetic nephropathy, and his type II diabetes mellitus as a single disability arising from a common cause. See 38 C.F.R. § 4.16; see also December 2011 Rating Decision (awarding service connection for depressive disorder as secondary to diabetes mellitus, type II). Because the Veteran has a single service-connected disability rated at greater than 60 percent for TDIU purposes, the ratings requirements for a schedular TDIU rating is met. 38 C.F.R. § 4.16(a). Therefore, the remaining issue is whether Veteran is unable to obtain and maintain a substantially gainful occupation due to his service-connected disabilities.
In terms of the Veteran’s educational and vocational background, the Veteran reported a 10th grade education with a general equivalency degree (GED) later obtained while in service. See July 2012 Vocational Expert Report and Opinion by S.B., Ph.D. The Veteran was in active service for over 22 years. See Veteran’s Report of Transfer or Discharge (DD Form 214). Thereafter he worked as a security guard until he retired in 1979. See July 2012 Vocational Expert Report and Opinion by S.B., Ph.D. 
The Board acknowledges that various medical examiners opined that the Veteran had little to no work-related functional impairments due to his service-connected disabilities. See, e.g., September 2011 VA Examination (Diabetes) by T.S., M.D. One examiner opined that the Veteran’s kidney disorder did not affect his ability to “work at physical or sed[en]tary jobs.” See January 2012 VA Examination (Kidneys) by B.P., M.D., which the Board finds means that the Veteran’s service-connected kidney disorders did not prevent him from engaging in sedentary work.
Psychologically, a VA examiner opined that the Veteran’s mood disorder did not interfere with his occupational functioning. See September 2011 VA Examination (Mental Health) by J.R., M.D. This opinion cannot be assigned significant probative weight because it did not adequately take into account the Veteran’s competent and credible statements of reduced motivation, disturbances of mood, and difficulty with at least one social relationship. See Dalton v. Nicholson, 21 Vet. App. 23, 39-40 (2007).
The Veteran’s private psychological examiner’s opinion was that the Veteran would miss more than three days a month of work and that the Veteran’s depression at the time “significantly limit[ed] his ability to interact effectively with coworkers, the general public, or supervision. He [was] likely to be hypersensitive to demands placed upon him, [would] have [had] difficulty concentrating and persisting in tasks, and/or making independent decisions with respect to tasks assigned to him. He [would] have [had] difficulty dealing with more than minimal levels of stress with environments that [were] high paced.” See June 2012 Private Psychological Examination Report by A.F., Ph.D. This opinion can only be granted partial probative weight due to the internal inconsistencies addressed in greater detail above.  However, the Board is particularly persuaded by the portions of the opinion addressing the likely missed work time and difficulty concentrating on and persisting in tasks, in large part because these conclusions are consistent with the Veteran’s symptoms decreased motivation, emotional lability, and difficulty concentrating on the task of multiplication on his mental status examination. Id. Therefore, these portions of the opinion are accorded significant probative weight. 
The Veteran also submitted an opinion from a vocational expert that, in pertinent part, reported that the Veteran would be unemployable in light of his educational and vocational background when considering the Veteran’s limitation to sedentary work tasks and “inability to sustain” mental-related work activities. See July 2012 Vocational Expert Report and Opinion by S.B., Ph.D. The Board assigns this opinion on employability significant probative weight because, as a doctor of vocational rehabilitation, the vocational expert is competent to provide this opinion. It is also persuasive because of the extent of the consistency with the greater than sedentary physical nature of the Veteran’s only vocational experience after service, as well as his educational attainment level. Id.; see also U.S. DEP’T OF LABOR, DICTIONARY OF OCCUPATIONAL TITLES (1999) (classifying security guards as a light occupation, with significant amounts of standing and walking);  OFFICE OF MGMT. AND BUDGET, STANDARD OCCUPATIONAL CLASSIFICATION MANUAL (2018) (describing required occupational activities of patrolling and guarding);  Occupational Information Network, Summary Report for Security Guards, O*NETONLINE.COM, https://www.onetonline.org/link/summary/33-9032.00 (last visited September 27, 2018) (describing required activities of walking, standing, blocking). 
Considering the foregoing, the Board finds that the evidence is at least evenly balanced for and against (“in relative equipoise”) a finding that the Veteran’s service-connected disabilities reduce his occupational functioning to such an extent as to make him unable to obtain and maintain substantially gainful employment. Therefore, all reasonable doubt has been resolved in his favor and a TDIU rating is granted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990).  
REASONS FOR REMAND
1. Entitlement to service connection for a heart condition is remanded.
As discussed in greater detail above, the Veteran submitted a claim for service connection for heart disease, but this claim was only partially adjudicated by the RO. Further, the death certificate has revealed a potential relationship between the Veteran’s service-connected nephrosclerosis to his cardiac functioning. See September 2013 Veteran’s Certificate of Death (listing nephrotic syndrome and cardiopulmonary arrest as a cause of death); see also January 2012 VA Examination by H.M., P.A. (“hypertension may very well be the byproduct of his diagnosed diabetic nephropathy”). This means that VA’s duty to assist was triggered because a new medical opinion on secondary service connection was necessary. See McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006); see also Waters v. Shinseki, 601 F.3d 1274 (Fed. Cir. 2010); 38 C.F.R. § 3.159(c)(4)(i). Lastly, in the Veteran’s claim application, he indicated that he was treating his heart condition at the Jackson VA Medical, but no records were received into the file relating to this claim. 38 U.S.C. § 5103A (c) (2014); see also Bell v. Derwinski, 2. Vet. App. 611 (1992) (VA medical records are in constructive possession of the agency, and must be obtained if the material could be determinative of the claim).
Accordingly, a remand is required to obtain VA medical records and obtain an opinion regarding the relationship between the Veteran’s heart condition(s) and his service-connected hypertensive nephrosclerosis and diabetic nephropathy. 
2. Entitlement to an increased initial evaluation greater than 50 percent for a mood disorder with major depressive features is remanded. 
While this issue was already on appeal, the Veteran also submitted a claim for an increased evaluation for service-connected depressive disorder. See March 2013 Veteran’s Supplemental Claim for Compensation (VA Form 21-526b). In this claim, he indicated that he was getting treatment at the Jackson VA Medical, but no records were received into the file relating to this claim. 38 U.S.C. § 5103A (c) (2014); see also Bell v. Derwinski, 2. Vet. App. 611 (1992) (VA medical records are in constructive possession of the agency, and must be obtained if the material could be determinative of the claim). Accordingly, a remand is required to obtain VA medical records.
3. The appeal seeking to reopen a claim of service connection for hypertension is remanded.
4. Entitlement to an increased evaluation for service-connected hemorrhoids is remanded.
5. Entitlement to an increased evaluation for service-connected impotence is remanded.
6. Entitlement to an increased evaluation for residuals of prostate cancer, status post radical retropublic prostatectomy is remanded.
7. Entitlement to an increased evaluation for hypertensive nephrosclerosis and diabetic nephropathy with proteinuria, associated with diabetes mellitus, type II, is remanded.
8. Entitlement to an increased evaluation for service-connected burn scars on the legs is remanded.
9. Entitlement to an increased evaluation for service-connected fungal infections of the feet and ears is remanded.
Issues three through nine listed immediately above were denied in a March 2012 Rating Decision. The Veteran soon after appealed these issues in a March 2012 notice of disagreement, but a statement of the case has not yet been issued. The Board acknowledges that the representative in his later notice of disagreement did not include these issues, see July 2012 Notice of Disagreement; however, neither the Veteran nor the representative withdrew the appeals listed above. Similarly, the representative only addressed the issues of an increased evaluation for a mood disorder with major depressive features and TDIU in his motion to substitute the appellant. See November 2013 Motion for Substitution. However, the appellant had already submitted a request for substitution and her submissions were not so limited. See October 2013 Appellant’s Application for Dependency and Indemnity Compensation (VA Form 21-534); October 2013 Statement in Support of Claim (VA form 21-4138). Accordingly, the Board finds that these appeals are still pending and remand pursuant to Manlincon v. West, 12 Vet. App. 238, 240-41 (1999), is necessary.
The matters are REMANDED for the following action:
1. Obtain the Veteran’s VA treatment records for the period from October 2012 to September 2013.
2. After completion of directive one, provide the entire record to an appropriate clinician to determine the nature and cause of the Veteran’s heart condition(s). Based on the factual evidence of record, the clinician must provide an opinion that responds to the following:
(a.) Please identify the Veteran’s heart condition(s) by diagnosis(es). 
(b.) For EACH of the diagnosed heart conditions(s), is it at least as likely as not (defined as a 50% or better probability) that the Veteran’s heart condition(s) was incurred in active military service, to include herbicide agent exposure*?
*By virtue of the Veteran’s service in the Republic of Vietnam during the Vietnam War, herbicide agent exposure must be presumed. 
(c.) Is it at least as likely as not (defined as a 50% or better probability) that the Veteran’s heart condition(s) was proximately caused by or aggravated by Veteran’s service-connected hypertensive nephrosclerosis and diabetic nephropathy?
The clinician is advised that AGGRAVATION is defined as a permanent increase in severity of the disability beyond its natural progression.
Detailed rationale and reasoning for all opinions and conclusions provided is required BY LAW. Providing an opinion without a thorough explanation will delay processing of the claim and may result in a clarification being requested.
If it is not possible to provide any of the requested information, the examiner must state whether this is because of a deficiency in the state of general medical knowledge (that is, no one could respond, given medical science and the known facts), a deficiency in the record (that is, additional facts are required), or the examiner (that is, the examiner does not have the required knowledge or training).
If the examiner cannot provide answers because further information or diagnostic studies are required, all reasonable steps to obtain this information should be exhausted before concluding that the answer cannot be provided.
3. Send the appellant and her representative a statement of the case that addresses the issue of reopening a claim of service connection for hypertension; entitlement to an increased evaluation for service-connected hemorrhoids; entitlement to an increased evaluation for service-connected impotence; entitlement  to an increased evaluation for residuals of prostate cancer; entitlement to an increased evaluation for hypertensive nephrosclerosis and diabetic nephropathy; entitlement to an increased evaluation for service-connected burn scars on the legs; entitlement to an increased evaluation for service-connected fungal infections of the feet and ears.
[CONTINUED ON THE NEXT PAGE]
 

If the appellant perfects an appeal by submitting a timely VA Form 9, the issues should be returned to the Board for further appellate consideration.

 
VICTORIA MOSHIASHWILI
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	S. Lambert, Associate Counsel