Citation Nr: 18160864 Decision Date: 12/28/18 Archive Date: 12/27/18 DOCKET NO. 14-19 037 DATE: December 28, 2018 ORDER Entitlement to a rating of 100 percent for posttraumatic stress disorder (PTSD) is granted. The appeal as to the claim of entitlement to service connection for diabetes mellitus type II is dismissed. The appeal as to the claim of entitlement to service connection for arthritis and joint pain is dismissed. The appeal as to the claim of entitlement to service connection for loss of testicle is dismissed. The appeal as to the claim of entitlement to an evaluation in excess of 10 percent for laceration with retained foreign bodies, status post laparotomy and resection ileum, is dismissed. The appeal as to the claim of entitlement to an evaluation in excess of 10 percent for abdominal scars and scar, right testicle, is dismissed. The appeal as to the claim of entitlement to a compensable rating for fragment wound, right arm, is dismissed. The appeal as to the claim of entitlement to a compensable rating for fragment wound, right ankle, is dismissed. The appeal as to the claim of entitlement to a compensable rating for fragment wound, left thigh, is dismissed. REMANDED Entitlement to service connection for a lumbar spine disability is remanded. Entitlement to service connection for bilateral hearing loss is remanded. Entitlement to service connection for a male reproductive condition is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. FINDINGS OF FACT 1. For the entire period on appeal, the Veteran’s service-connected PTSD has resulted in total occupational and social impairment. 2. At the time of the Veteran’s March 2018 hearing, prior to the promulgation of a decision by the Board, the Board received notification from the Veteran that a withdrawal of his appeal with respect to the issue of entitlement to service connection for diabetes mellitus type II is requested. 3. At the time of the Veteran’s March 2018 hearing, prior to the promulgation of a decision by the Board, the Board received notification from the Veteran that a withdrawal of his appeal with respect to the issue of entitlement to service connection for arthritis and joint pain is requested. 4. At the time of the Veteran’s March 2018 hearing, prior to the promulgation of a decision by the Board, the Board received notification from the Veteran that a withdrawal of his appeal with respect to the issue of entitlement to service connection for loss of testicle is requested. 5. At the time of the Veteran’s March 2018 hearing, prior to the promulgation of a decision by the Board, the Board received notification from the Veteran that a withdrawal of his appeal with respect to the issue of entitlement to an evaluation in excess of 10 percent for laceration with retained foreign bodies, status post laparotomy and resection ileum, is requested. 6. At the time of the Veteran’s March 2018 hearing, prior to the promulgation of a decision by the Board, the Board received notification from the Veteran that a withdrawal of his appeal with respect to the issue of entitlement to an evaluation in excess of 10 percent for abdominal scars and scar, right testicle, is requested. 7. At the time of the Veteran’s March 2018 hearing, prior to the promulgation of a decision by the Board, the Board received notification from the Veteran that a withdrawal of his appeal with respect to the issue of entitlement to a compensable rating for fragment wound, right arm, is requested. 8. At the time of the Veteran’s March 2018 hearing, prior to the promulgation of a decision by the Board, the Board received notification from the Veteran that a withdrawal of his appeal with respect to the issue of entitlement to a compensable rating for fragment wound, right ankle, is requested. 9. At the time of the Veteran’s March 2018 hearing, prior to the promulgation of a decision by the Board, the Board received notification from the Veteran that a withdrawal of his appeal with respect to the issue of entitlement to a compensable rating for fragment wound, left thigh, is requested. CONCLUSIONS OF LAW 1. The criteria for an initial 100 percent evaluation for PTSD have been met for the entire period on appeal. 38 U.S.C. 1155 (2012); 38 C.F.R. 4.130, Diagnostic Code 9411 (2017). 2. The criteria for withdrawal of the appeal by the Veteran have been met with respect to the issue of entitlement to service connection for diabetes mellitus type II. 38 U.S.C. § 7105(d)(5) (2012); 38 C.F.R. § 20.204 (2017). 3. The criteria for withdrawal of the appeal by the Veteran have been met with respect to the issue of entitlement to service connection for arthritis and joint pain. 38 U.S.C. § 7105(d)(5) (2012); 38 C.F.R. § 20.204 (2017). 4. The criteria for withdrawal of the appeal by the Veteran have been met with respect to the issue of entitlement to service connection for loss of testicle. 38 U.S.C. § 7105(d)(5) (2012); 38 C.F.R. § 20.204 (2017). 5. The criteria for withdrawal of the appeal by the Veteran have been met with respect to the issue of entitlement to an evaluation in excess of 10 percent for laceration with retained foreign bodies, status post laparotomy and resection ileum. 38 U.S.C. § 7105(d)(5) (2012); 38 C.F.R. § 20.204 (2017). 6. The criteria for withdrawal of the appeal by the Veteran have been met with respect to the issue of entitlement to an evaluation in excess of 10 percent for abdominal scars and scar, right testicle. 38 U.S.C. § 7105(d)(5) (2012); 38 C.F.R. § 20.204 (2017). 7. The criteria for withdrawal of the appeal by the Veteran have been met with respect to the issue of entitlement to a compensable rating for fragment wound, right arm. 38 U.S.C. § 7105(d)(5) (2012); 38 C.F.R. § 20.204 (2017). 8. The criteria for withdrawal of the appeal by the Veteran have been met with respect to the issue of entitlement to a compensable rating for fragment wound, right ankle. 38 U.S.C. § 7105(d)(5) (2012); 38 C.F.R. § 20.204 (2017). 9. The criteria for withdrawal of the appeal by the Veteran have been met with respect to the issue of entitlement to a compensable rating for fragment wound, left thigh. 38 U.S.C. § 7105(d)(5) (2012); 38 C.F.R. § 20.204 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Board notes that the appeal for entitlement to an evaluation in excess of 30 percent for PTSD has not been formally certified to the Board. See VA Form 8, Certification of Appeal, dated in July 2015. However, a review of the record reveals that the Veteran submitted a timely substantive appeal in February 2013, following the issuance of the January 2013 statement of the case. In light of the perfected appeal as to the issue of entitlement to an evaluation in excess of 30 percent for PTSD, the Board will take jurisdiction of the issue and has included it as an issue on appeal. The Veteran served on active duty in the United States Marine Corps from June 1968 to June 1972. During his period of service, the Veteran earned the Purple Heart Medal with one star, Combat Action Ribbon, National Defense Service Medal, Vietnamese Service Medal with one star, Vietnamese Campaign Medal, Vietnamese Cross of Gallantry, Marksman Pistol Badge, and Marksman Rifle Badge. Disability ratings are determined by evaluating the extent to which a Veteran’s service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities. See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. If two ratings are potentially applicable, the higher rating will be assigned if the disability more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. See 38 C.F.R. § 4.3. PTSD is evaluated under a general rating formula for mental disorders. See 38 C.F.R. § 4.130, Diagnostic Code 9411. Under the applicable diagnostic criteria, a 30 percent rating is granted for occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events). A 50 percent rating is warranted where there is occupational and social impairment with reduced reliability and productivity due to such symptoms as: 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; difficulty in establishing and maintaining effective work and social relationships. A 70 percent rating is warranted where there is occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: 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. A 100 percent rating is warranted where there is total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. The use of the term “such as” in the general rating formula for mental disorders in 38 C.F.R. § 4.130 demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list, but rather are to serve as examples of the type and degree of symptoms, or their effects, that would justify a particular rating. See Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). It is not required to find the presence of all, most, or even some, of the enumerated symptoms recited for particular ratings. Id. The use of the phrase “such symptoms as,” followed by a list of examples, provides guidance as to the severity of the symptoms contemplated for each rating, in addition to permitting consideration of other symptoms particular to each veteran and disorder, and the effect of those symptoms on his/her social and work situation. Id. In Vazquez-Claudio v. Shinseki, 713 F.3d 112 (Fed. Cir. 2013), the Federal Circuit stated that “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.” It was further noted that “§ 4.130 requires not only the presence of certain symptoms but also that those symptoms have caused occupational and social impairment in most of the referenced areas.” The Veteran’s entire history is to be considered when making disability evaluations. 38 C.F.R. § 4.1. If, as here, there is disagreement with the initial rating assigned following a grant of service connection, separate ratings can be assigned for separate periods of time, based upon the facts found. Fenderson v. West, 12 Vet. App. 119, 125-26 (1999). See also AB v. Brown, 6 Vet. App. 35 (1993) (a claim for an original rating remains in controversy when less than the maximum available benefit is awarded); Hart v. Mansfield, 21 Vet. App. 505 (2007). The Veteran appeared for a VA PTSD examination in May 2010. The Veteran reported that he began to avoid his wife, children, and grandchildren. He further reported that he isolated himself by going into the bedroom, shutting the door, and watching television. He denied a history of suicide attempts, violence, or assaultive behavior. The Veteran stated that he began to observe an increase in symptoms two and a half years prior to examination. The Veteran indicated that he blacked out due to drinking and got into a fight, which resulted in him losing half his ear. He quit drinking after this incident. Upon examination, the examiner observed that the Veteran was clean and neatly dressed in “bizarre clothes.” The Veterans’ psychomotor activity was unremarkable and his speech was clear and coherent. He was cooperative toward the examiner. The Veteran’s affect was constricted and mood was anxious. There was no evidence to suggest difficulty with attention and concentration during the evaluation. The Veteran was oriented to person, time, and place. His thought content was unremarkable. There were no reports of delusions. The Veteran’s judgment and insight were intact. The Veteran reported sleep impairment. He indicated that he would sleep soundly once asleep; however, he had problems initiating sleep. After taking medication, he noted that he may fall asleep within 30 minutes; however, it would sometimes take hours to fall asleep. The Veteran also reported nightmares, though he did not remember them. He further reported that he has stopped breathing during his nightmares. The examiner noted that the Veteran experienced auditory hallucinations, which included hearing the voice of a friend killed in Vietnam. The Veteran experienced passive suicidal thoughts with no plan or intent. His memory was normal. The examiner documented symptoms of difficult memories, nightmares, sweating in response to cues, inability to participate in conversations related to his military experiences, avoidance of crowded situations, anhedonia, feelings of detachment, restricted affect, sleep disturbance, irritability, exaggerated startle response anger dyscontrol, and difficulty in concentration. The Veteran was able to maintain minimum personal hygiene and was capable of managing his financial affairs. He was employed at the time of the examination and reported that he had lost less than a week from work in the previous 12-month period due to his disability. The Veteran reported leaving one day of work due to suicidal thoughts. The examiner diagnosed alcohol dependence, full sustained remission. A June 2011 psychiatric/psychological impairment questionnaire completed by Dr. M. D. was associated with the Veterans’ record in September 2011. The examiner diagnosed PTSD. She determined that the Veteran’s prognosis was fair with continued trauma-focused treatment. The examiner identified symptoms that included deficiencies in family relations, deficiencies in mood, deficiencies in work or school, difficulty in adapting to stressful circumstances, intrusive recollections of a traumatic experience, compulsive suicidal ideations, exaggerated startle response, avoidance of crowds/public situations, and isolation from family when distressed by intrusive thoughts. The examiner indicated that the Veteran was markedly limited in his ability to interact appropriately with the general public, respond appropriately to changes in the work setting, and be aware of normal hazards and take appropriate precautions. The Veteran was moderately limited in his ability to maintain attention and concentration for extended periods, work in coordination with or proximity to others without being distracted by them, complete a normal work week without interruptions from psychologically based symptoms and to perform at a consistent pace without an unreasonable number and length of rest periods, and travel to unfamiliar places or use public transportation. The examiner further indicated that the Veteran was mildly limited in his ability to sustain ordinary routine without supervision, accept instructions and respond appropriately to criticism from supervisors, get along with coworkers or peers without distracting them or exhibiting behavioral extremes, maintain socially appropriate behavior and to adhere to basic standards of neatness and cleanliness, perform activities within a schedule, maintain regular attendance, and be punctual within customary tolerance. There was no evidence of limitation in his ability to remember locations and worklike procedures nor ability to set realistic goals or make plans independently. The Veteran’s disability was noted to likely produce “good days” and “bad days.” The examiner noted that the Veteran’s disability would cause him to be absent from work about three days a month, as he would leave before the end of his shift due to suicidal thoughts. The examiner further indicated that the Veteran would not be capable of performing full-time competitive work due to his symptoms. The Veteran and his spouse testified at a Travel Board hearing before the undersigned Veterans Law Judge (VLJ) in March 2018. The Veteran reported experiencing night terrors, depression, and suicidal thoughts associated with his PTSD. He indicated that he had previously been hospitalized in 2016 for suicidal ideations. The Veteran’s spouse stated that the Veteran would sometimes experience visual hallucinations, reporting that he would see “a bunch of dead bodies” coming toward him. The Veteran also reported anger issues toward family members, lack of concern for personal care, agitation, difficulty concentrating, poor memory, and isolation. The Veteran’s spouse stated that the Veteran only wants to sleep, sometimes sleeping between 12 to 18 hours a day. She also stated that she had to bathe him, give him medication, and clean him after he goes to the bathroom, as he is unable to maintain his hygiene on his own. The Veteran reported that he has no interests or hobbies beyond his adult coloring book, and stated that he does not have any friends. The Veteran furthered stated that he had to retire from his employment due to his lack of concentration and his ability to harm others. The medical evidence also includes VA treatment records showing psychiatric treatment and symptoms that were not inconsistent with those recorded in the examination reports. With resolution of reasonable doubt in the favor of the Veteran, the Board finds that the Veteran’s PTSD has resulted in total occupational and social impairment for the entire period on appeal. Each of the VA examiners found the Veteran had roughly consistent symptomatology. The Veteran has consistently reported visual and auditory hallucination; irritability; social isolation; depressed mood; suicidal ideation; angry outbursts; poor concentration; lack of focus; nightmares; inability to initiate sleep; flashbacks; avoidance of people, places, and things that would remind him of his trauma; distancing; exaggerated startle response; avoidance of crowds; memory loss; and difficulty maintaining personal hygiene. Additionally, the Veteran reported that he had to leave his employment due suicidal ideations and poor concentration. Further, the Veteran has reported difficulty with familial and interpersonal relationships. He stated that he isolates himself from his family and does not have any friends. The Veteran has reported hospitalization for his PTSD symptomatology. Accordingly, the Board finds that his symptoms more closely approximate a 100 percent rating for PTSD during the entire appeal period. This 100 percent evaluation is a full grant of the benefits on appeal. As such, any consideration of higher ratings is not relevant. The Board acknowledges that the results of the VA examinations, the symptoms described in the VA examination reports, and the VA treatment records do not indicate that the Veteran has experienced all the symptoms associated with a 100 percent rating for PTSD. However, the symptoms enumerated under the schedule for rating mental disorders are not intended to constitute an exhaustive list, but serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular disability rating. Mauerhan, supra. Thus, the Board finds that there is total occupational and social impairment sufficient to warrant a 100 percent rating for the entire period on appeal, even though all the specific symptoms listed for a 100 percent rating are not manifested. Therefore, resolving reasonable doubt in favor of the Veteran, the Board finds that the preponderance of the evidence supports the assignment of a 100 percent rating for PTSD for the entire period on appeal. 38 U.S.C. 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Withdrawn Claims The Board may dismiss any appeal which fails to allege specific error of fact or law in the determination being appealed. 38 U.S.C. § 7105 (2012). An appeal may be withdrawn as to any or all issues at any time before the Board promulgates a decision. 38 C.F.R. § 20.204 (2017). Such withdrawal may be made by the Veteran or by his or her authorized representative and, unless done on the record at a hearing, it must be in writing. 38 C.F.R. § 20.204(a). The Veteran perfected an appeal in the matters of entitlement to service connection for diabetes mellitus type II, arthritis and joint pain, loss of testicle, and increased evaluations for service-connected laceration with retained foreign bodies, status post laparotomy and resection ileum; abdominal scars and scar, right testicle; fragment wound, right arm; fragment wound, right ankle; and fragment wound, left thigh. At his March 2018 Board hearing, the Veteran withdrew these claims on the record. Because the Veteran explicitly withdrew the claims of entitlement to service connection for diabetes mellitus type II, arthritis and joint pain, loss of testicle, and increased evaluations for service-connected laceration with retained foreign bodies, status post laparotomy and resection ileum; abdominal scars and scar, right testicle; fragment wound, right arm; fragment wound, right ankle; and fragment wound, left thigh, there remain no allegations of errors of fact or law for appellate consideration with regard to these claims. Accordingly, the Board does not have jurisdiction to review the appeal of these issues and they are dismissed. REASONS FOR REMAND Lumbar Spine The Board notes that the Veteran has not been afforded a VA examination with respect to his current claim for service connection for a lumbar spine disability. VA’s duty to assist includes providing a medical examination when it is necessary to make a decision on a claim. 38 U.S.C. § 5103A(d) (2012); 38 C.F.R. § 3.159 (2017). Such development is necessary if the information and evidence of record does not contain sufficient competent medical evidence to decide the claim, but (1) contains competent evidence of diagnosed disability or symptoms of disability, (2) establishes that the Veteran suffered an event, injury or disease in service, or has a presumptive disease during the pertinent presumptive period, and (3) indicates that the claimed disability may be associated with the in-service event, injury, or disease, or with another service-connected disability. 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79, 83-86 (2006). The Veteran contends that he experienced back pain in service as a result of jumping out of helicopters with heavy backpacks. He contends that his back pain has continued since separation from service. A review of the Veteran’s treatment records shows a current diagnoses of lumbosacral degenerative disc disease, lumbosacral neuritis NOS, and lumbago. As such, the Board finds that a remand for examination is warranted to ascertain whether his current lumbar spine condition is etiologically related to his active duty service. See McLendon, supra. Bilateral Hearing Loss Regarding the Veteran’s bilateral hearing loss disability, the Veteran appeared for a VA hearing loss examination in August 2011. The Veteran reported two in-service acoustic trauma exposures, including grenade detonation and a booby trap detonation near his right side. The examiner documented mild to severe loss at 250 Hz to 1000 Hz, rising to a moderate to moderately severe mixed hearing loss at 2000 Hz to 8000 Hz in the right ear. Hearing was within normal limits at 250 Hz to 8000 Hz, with a mild sensorineural hearing loss at 500 Hz only in the left ear. Speech audiometry revealed speech recognition ability of 80 percent in the right ear and of 94 in the left ear. The examiner diagnosed mixed hearing loss in the right ear and noted that the hearing loss was not disabling for VA purposes pursuant to 38 C.F.R. § 3.385. The examiner opined that it was less likely than not that the Veteran’s right ear hearing loss was caused by or the result of military noise exposure. The examiner further opined that it was at least as likely as not that the Veteran’s left ear hearing loss was caused by or the result of military noise exposure. In support of her opinions, the examiner indicated that the Veteran showed normal hearing in both ears at the time of enlistment in 1968. At separation, the left ear showed threshold shifts of greater than 10 dB at isolate frequencies and no significant change in the right ear hearing in 1972. As it related to the right ear, the examiner cited to a 2005 Institute of Medicine study on Military and Noise exposure which stated that there was no scientific evidence to support delayed onset of noise induced hearing loss. The examiner further noted that the Veteran has an 18-year civilian work history that may be a contributing factor in his current hearing loss. The Board finds the August 2011 opinion to be inadequate, as the opinion appear to be internally inconsistent. Though acoustic trauma was conceded and right ear hearing loss diagnosed, the examiner opined that the Veteran’s civilian work history contributed to his current hearing loss. The examiner failed to provide sufficient rationale for this opinion. Further, the examiner failed to address a notation on the Veteran’s November 1969 “replacement physical” indicating “hard of hearing in right ear.” Additionally, the examiner opined that it was at least as likely as not that the Veteran’s left ear hearing loss was caused by or the result of military noise exposure; however, the examiner determined that the Veteran’s left ear hearing was within normal limits. In light of these deficiencies, the Board finds that a remand is necessary to provide the Veteran with a new VA examination and opinion relating to his claim for service connection for bilateral hearing loss. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Male Reproductive Condition The Veteran contends that he suffers from a male reproductive condition as a result of his PTSD medication. The Veteran appeared for a genitourinary examination in June 2011. The Veteran stated that he began to notice an inability to obtain or maintain an erection after beginning medication for the treatment of PTSD. He was prescribed Cialis, which did not work. The examiner diagnosed erectile dysfunction. The examiner noted that the most likely etiology was medication. Despite noting this finding, the examiner opined that the Veteran’s male reproductive condition was less likely as not caused by or aggravated by his PTSD, as there was no documented evidence in the medical literature to substantiate a claim that PTSD caused or permanently aggravated erectile dysfunction. The Board finds the June 2011 opinion to be inadequate, as the opinion appears to be internally inconsistent. Although the examiner opined that the Veteran’s male reproductive condition was less likely as not caused by or aggravated by his PTSD, the opinion appears to be inconsistent with the examiner’s finding that the Veteran’s male reproductive condition was caused by his PTSD medication. Thus, the Board finds that a remand is necessary to obtain an addendum opinion relating to his claim for service connection for a male reproductive condition, to include as secondary to his service-connected PTSD. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). TDIU VA will grant a total rating for compensation purposes based on unemployability when the evidence shows that the Veteran is precluded, by reason of his service- connected disabilities, from obtaining and maintaining substantially gainful employment consistent with his education and occupational experience. 38 C.F.R. §§ 3.340, 3.341, 4.16. Total disability ratings for compensation based on individual unemployability 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 as a result of two or more 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 C.F.R. §§ 3.340, 3.341, 4.16(a). 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). Consideration may be given to the Veteran’s education, special training, and previous work experience, but not to his age or to the impairment caused by nonservice-connected disabilities. See 38 C.F.R. §§ 3.341, 4.16, 4.19; see also Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). The evidence shows that the Veteran is currently service-connected for PTSD, which is rated as 100 percent disabling by this decision; tinnitus, which is rated as 10 percent disabling; laceration with retained foreign bodies, status post laparotomy and resection ileum, which is rated as 10 percent disabling; abdominal scars and scar, right testicle, which is rated as 10 percent disabling; fragment wound, right arm, which is rated as noncompensable; fragment wound, right ankle, which is rated as noncompensable; and fragment wound, left thigh, which is rated as noncompensable. The claim for TDIU cannot be dismissed as moot despite the Veteran already having an overall total rating. Bradley v. Peake, 22 Vet. App. 280 (2008). Rather, the Board must look at the evidence to see whether, excluding the disorder for which a 100 percent rating is in effect, the Veteran has additional service connected disorders which are productive of unemployability. As such, the issue of entitlement to a TDIU is remanded because the issue is inextricably intertwined with the service-connection claims being remanded. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (holding that all issues “inextricably intertwined” with issues certified for appeal are to be identified and developed prior to appellate review). The matters are REMANDED for the following action: 1. Schedule the Veteran for VA examinations with the appropriate examiner(s) to address the nature and etiology of his lumbar spine, bilateral hearing loss, and male reproductive disabilities. The examiner(s) must review pertinent documents in the Veteran’s claims file in conjunction with the examinations. This must be noted in the examination reports. Any studies, tests, and evaluations deemed necessary by the examiner(s) should be performed. (a.) With regard to a lumbar spine disability, the examiner must state whether it is at least as likely as not (a 50 percent probability or greater) that the Veteran’s current lumbar spine condition had its onset in service or is otherwise etiologically related to active service. The examiner’s attention is directed to the March 2012 private treatment records indicating diagnoses of lumbosacral degenerative disc disease, lumbosacral neuritis NOS, and lumbago. In providing this opinion, the examiner is reminded that the Veteran is competent to report continuous symptoms of back pain since service. (b.) With regard to the bilateral hearing loss claim, the examiner should clearly identify any bilateral hearing loss that may be present. Then, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that a current hearing loss disability was incurred in service or are otherwise medically related to service, to include noise exposure therein. In providing this opinion, the examiner is reminded that military acoustic trauma has been conceded. It should be noted that the absence of in-service evidence of a hearing disability during service is not always fatal to a service connection claim. Evidence of a current hearing loss disability and a medically sound basis for attributing that disability to service may serve as a basis for a grant of service connection for hearing loss where there is credible evidence of acoustic trauma due to significant noise exposure in service, post-service audiometric findings meeting the regulatory requirements for hearing loss disability for VA purposes, and a medically sound basis upon which to attribute the post-service findings to the injury in service. (c.) With regard to the male reproductive condition claim, the examiner should provide an opinion as to it is at least as likely as not (a 50 percent probability or greater) that the Veteran’s claimed male reproductive condition had its onset in service or is otherwise etiologically related to active service, or was caused or aggravated by his service-connected PTSD, to include PTSD medication. In providing this opinion, the examiner is asked to discuss the June 2011 examiner’s determination that the etiology of the Veteran’s male reproductive condition was most likely medication. The examiner is also asked to address the research article submitted by the Veteran’s representative in March 2018. 2. Thereafter, adjudicate the inextricably intertwined claim for a TDIU. A. S. CARACCIOLO Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Joseph, Associate Counsel