Citation Nr: 18160966 Decision Date: 12/28/18 Archive Date: 12/28/18 DOCKET NO. 14-21 109 DATE: December 28, 2018 ORDER New and material evidence having been submitted, the claim for service connection for sleep apnea is reopened. Service connection for sleep apnea is granted. New and material evidence having been submitted, the claim for service connection for a bilateral foot disorder is reopened, and to this extent only, the appeal is granted. REMANDED Entitlement to service connection for a low back disorder is remanded. Entitlement to service connection for a right knee disorder is remanded. Entitlement to service connection for a left shoulder disorder, to include as due to a service-connected right shoulder disability, is remanded. Entitlement to service connection for a bilateral foot disorder is remanded. Entitlement to service connection for a left knee disorder, to include as secondary to a right knee disorder, is remanded. Entitlement to an acquired psychiatric disorder, to include major depressive disorder, psychosis, and alcohol dependence, is remanded. Entitlement to an evaluation in excess of 10 percent for tendonitis of the right hip is remanded. Entitlement to an evaluation in excess of 20 percent for residuals of a right shoulder injury is remanded. Entitlement to a total disability evaluation based upon individual unemployability due to service-connected disabilities (TDIU) is remanded. FINDINGS OF FACT 1. The claim for service connection for sleep apnea was previously considered and denied by the RO in a December 1997 rating decision. The Veteran did not appeal that decision or submit new and material evidence within one year. 2. The evidence received since the December 1997 rating decision is not cumulative of the evidence previously of record and relates to an unestablished fact necessary to substantiate the claim for service connection for sleep apnea. 3. The Veteran’s current sleep apnea is related to his military service. 4. The claim for service connection for a bilateral foot disorder was previously considered and denied by the Board in a November 1994 decision. The Veteran did not appeal that decision or file a motion to vacate, reconsider, or revise the decision based on clear and unmistakable error. 5. The evidence received since the final November 1994 Board decision is not cumulative of the evidence previously of record and relates to an unestablished fact necessary to substantiate the claim for service connection for a bilateral foot disorder. CONCLUSIONS OF LAW 1. The December 1997 rating decision that denied service connection for sleep apnea is final. 38 U.S.C. § 7105(c) (West 2012); 38 C.F.R. §§ 3.104, 3.156, 20.200, 20.202, 20.302, 20.1103 (2018). 2. The evidence received subsequent to the December 1997 rating decision is new and material, and the claim for service connection for sleep apnea is reopened. 38 U.S.C. § 5108 (West 2012); 38 C.F.R. § 3.156 (2018). 3. Sleep apnea was incurred in active service. 38 U.S.C. § 1110, 1131 (West 2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2018). 4. The November 1994 Board decision that denied service connection for a bilateral foot disorder is final. 38 U.S.C. §§ 7103, 7104, 7111, 7252, 7266 (West 2012); 38 C.F.R. §§ 20.100, 20.1104 (2018). 5. The evidence received subsequent to the November 1994 Board decision is new and material with regard to the claim for service connection for a bilateral foot disorder, and the claim is reopened. 38 U.S.C. § 5108 (West 2012); 38 C.F.R. 3.156 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty service from August 1979 to May 1989. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from November 2009, May 2010, and March 2012 rating decisions from the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a hearing before the undersigned Veterans Law Judge in April 2018. A transcript of that hearing has been associated with the claims file. The Veteran and his representative have not raised any issues with the duty to notify or duty to assist with regard to the issues decided herein. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). Service Connection Service connection may be established for disability resulting from personal injury suffered or disease contracted in line of duty in the active military, naval, or air service. 38 U.S.C. §§ 1110, 1131. That an injury or disease occurred in service is not enough; there must be chronic disability resulting from that injury or disease. If there is no showing of a resulting chronic condition during service, then a showing of continuity of symptomatology after service is required to support a finding of chronicity. 38 C.F.R. § 3.303(b). Service connection may also be granted for any injury or disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d). In order to reopen a claim which has been denied by a final decision, the claimant must present new and material evidence. 38 U.S.C. § 5108. New and material evidence means evidence not previously submitted to agency decisionmakers; which relates, either by itself or when considered with previous evidence of record, to an unestablished fact necessary to substantiate the claim; which is 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 which raises a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). To reopen a previously disallowed claim, new and material evidence must be presented or secured since the last final disallowance of the claim on any basis, including on the basis that there was no new and material evidence to reopen the claim since a prior final disallowance. See Evans v. Brown, 9 Vet. App. 273, 285 (1996). For purposes of reopening a claim, the credibility of newly submitted evidence is generally presumed. See Justus v. Principi, 3 Vet. App. 510, 513 (1992) (in determining whether evidence is new and material, “credibility” of newly presented evidence is to be presumed unless evidence is inherently incredible or beyond competence of witness). The United States Court of Appeals for Veterans Claims (Court) has held that the threshold for determining whether new and material evidence raises a reasonable possibility of substantiating a claim is “low.” See Shade v. Shinseki, 24 Vet. App. 110, 117 (2010). Furthermore, in determining whether this low threshold is met, VA should not limit its consideration to whether the newly submitted evidence relates specifically to the reason why the claim was last denied, but instead should ask whether the evidence could reasonably substantiate the claim were the claim to be reopened, to include by triggering the Secretary’s duty to assist. Id. at 118. A. Sleep Apnea The RO previously considered and denied the Veteran’s claim for service connection for sleep apnea in a December 1997 rating decision. In that decision, the RO noted that the service treatment records did not show any complaints of, treatment for, or diagnosis of sleep apnea. The Veteran was notified of that decision and of his appellate rights, but he did not appeal or submit new and material evidence within one year of the issuance of the decision. Therefore, the December 1997 rating decision is final. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.156 (b), 20.200, 20.201, 20.302, 20.1103. The Veteran later submitted a new claim for service connection for sleep apnea in September 2009. The evidence associated with the claims file since the December 1997 rating decision includes a March 2011 medical opinion indicating that the Veteran’s sleep apnea is related to his military service. Such evidence was not considered at the time of the December 1997 rating decision and relates to a previously unestablished fact. Therefore, the Board finds that new and material evidence has been received in order to reopen the Veteran’s claim for service connection for sleep apnea. 38 C.F.R. § 3.156(a). Turning to the merits of the claim, the Veteran’s service treatment records document reports of difficulty sleeping or a lack of sleep on several occasions, including during appointments in June 1981, July 1982, and June 1986. Sleep apnea was later reported as a diagnosis in the Veteran’s medical records in 1994 and 1996. In September 2009, the Veteran submitted a medical opinion from Dr. J.W. (initials used to protect privacy). Dr. J.W. stated that he had reviewed the Veteran’s military medical records and opined that, although it was difficult to determine the underlying etiology of the sleep difficulties during military service, it was not beyond the realm of possibility that it may be related to his subsequently diagnosed sleep apnea and/or his chronic sinus congestion. The Veteran was afforded a VA examination in connection with his claim in March 2010. The examiner diagnosed the Veteran with sleep apnea, but stated that, after a review of the medical records, he could not determine the etiology of the sleep apnea without resorting to speculation. He noted that the Veteran reported difficulty sleeping on multiple occasions while in the military, but also indicated that a sleep study had not been performed at that time. Thus, he could not determine whether the sleep apnea was caused by service without resorting to speculation. During a March 2011 VA medical appointment for sleep apnea, the treating doctor opined that the sleep disturbances that the Veteran reported during service were more likely than not due to undiagnosed sleep apnea. As such, she opined that the condition should be service connected. The Board finds that the medical opinions cited above permit application of the reasonable doubt doctrine. The Board finds that the opinions of Dr. J.W. and the March 2011 VA medical record place the evidence of record at least in equipoise as to whether the Veteran’s sleep apnea was caused by or related to his military service, particularly in light of the symptomatology documented in service. Accordingly, resolving all reasonable doubt in the appellant’s favor, the Board finds that service connection for the Veteran’s sleep apnea is warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. B. Bilateral foot disorder The Board denied the Veteran’s claim for service connection for a bilateral foot disorder in a November 1994 decision. Specifically, the Board found that the Veteran’s current foot disorders, including plantar fasciitis, degenerative arthritis of the left foot, and a calcaneal spur of the right foot, were not present in service and did not manifest within one year of separation from service. The Veteran did not appeal the November 1994 decision to the United States Court of Appeals for Veteran’s Claims or file a motion to vacate, reconsider, or revise the decision based on clear and unmistakable error. As such, the November 1994 Board decision became final. The Veteran later submitted a new claim for service connection for a bilateral foot disorder with submissions dated in December 2011 and January 2012. The evidence associated with the claims file since the November 1994 Board decision includes statements that the Veteran’s in-service toe nail issues caused difficulty walking and therefore may have caused his current foot disorders. Such evidence was not considered at the time of the November 1994 Board decision and relates to a previously unestablished fact. Therefore, the Board finds that new and material evidence has been received in order to reopen the Veteran’s claim for service connection for a bilateral foot disorder. 38 C.F.R. § 3.156(a). However, as will be discussed below, the Board finds that further development is necessary prior to rendering a decision on the merits of the underlying claims. REASONS FOR REMAND Right knee and low back disorders The Veteran has stated that he first injured his low back in service while unloading a tank. He also testified that he first injured his right knee in service after falling from a tank and while exercising on pavement. The Veteran was not afforded VA examinations in connection with his low back and right knee disorders. Therefore, the Board finds that a remand is necessary to provide him VA examinations in connection with these claims. Left knee and left shoulder disorders The Board also finds that further development is needed for the Veteran’s claims for service connection for left knee and left shoulder disorders. The Veteran has asserted that his left shoulder disorder is secondary to a service-connected right shoulder disability and that his left knee disorder is secondary to his right knee disorder. He has not been afforded VA examinations for either disorder. Based upon the Veteran’s testimony, the claims must be remanded to obtain VA examinations. Additionally, upon remand, the AOJ should ensure the proper notice has been issued to the Veteran with regard to secondary service-connection in connection with these claims. Acquired psychiatric disorder With regard to the Veteran’s acquired psychiatric disorder claim, the Board finds that the record contains differing opinions and testimony as to the etiology of the disorder. The VA medical records have discussed childhood trauma, his mother’s death, and possible pain in connection with the cause of the Veteran’s stress. An August 2011 disability benefits questionnaire (DBQ) submitted by the Veteran provided a positive nexus opinion for depression; however, this opinion was based upon the Veteran’s claim that he had witnessed soldiers shooting themselves, which had not previously been raised or discussed. A June 2014 VA examination diagnosed substance induced bipolar disorder, which the examiner then opined was due to the effects of acid and medications and not service-connected disabilities. In December 2017, the Veteran then stated that he saw someone kill himself while in service and reported that he had been captured and tortured during a field exercise. Due to the conflicting evidence of record, the Board finds that further development is necessary. The AOJ should contact the Veteran and clarify the basis of his acquired psychiatric claim and whether he is attempting to make a claim for posttraumatic stress disorder (PTSD). If the basis of the claim is the result of incidents during service, the AOJ should attempt to verify such events. An additional VA examination should be performed to determine what diagnoses are present and whether any diagnoses found were caused by the Veteran’s service and/or as a result of or aggravated by pain due to service-connected disabilities. Bilateral foot disorder The Veteran should be afforded a VA examination to determine the etiology of all of his current foot disorders. The examiner should specifically address the Veteran’s testimony that his in-service toe nail issues caused difficulties walking, which caused some of the foot disorders. Right hip and right shoulder disorders A remand is required for the Veteran’s right hip and right shoulder claims in light of a recent decision issued by the United States Court of Appeals for Veterans Claims (Court), Correia v. McDonald, 28 Vet. App. 158 (2016). In Correia, the Court concluded that 38 C.F.R. § 4.59 required VA examinations to include joint testing for pain on both active and passive range of motion, as well as with weight-bearing and nonweight-bearing. The Court further found that, if possible, the VA examiner should also include range of motion measurements of the opposite undamaged joint. Thus, while the Veteran was afforded VA examinations in June 2014 for his right hip and right shoulder disabilities, these examinations do not satisfy the requirements under Correia in order for the Board to properly evaluate the disorders. As such, an additional VA examination is required in this case. TDIU The Board further finds that the Veteran’s TDIU claim is inextricably intertwined with the claims being remanded herein, as these claims could affect the outcome of the TDIU claim. For this reason, these issues must be resolved prior to resolution of the claim for TDIU. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (noting that the prohibition against the adjudication of claims that are inextricably intertwined is based upon the recognition that claims related to each other should not be subject to piecemeal decision-making or appellate litigation). Accordingly, a remand is required for the AOJ to adjudicate the inextricably intertwined issues. Accordingly, the case is REMANDED for the following action: 1. The AOJ should request that the Veteran provide the names and addresses of any and all health care providers who have provided treatment for his low back, right knee, left shoulder, left knee, bilateral foot, acquired psychiatric disorder, right hip, and right shoulder disorders. After acquiring this information and obtaining any necessary authorization, the AOJ should obtain and associate these records with the claims file. Any outstanding VA medical records should also be obtained and associated with the claims file. 2. The AOJ should contact the Veteran for clarification regarding his acquired psychiatric disorder. Specifically, the AOJ should clarify whether he is claiming service connection for PTSD. If the Veteran is claiming PTSD, the AOJ should take all appropriate steps to verify the Veteran’s claimed stressors, to include verification of all in-service incidents as described by the Veteran in his December 2017 statement. 3. The AOJ should send the Veteran a notice letter in connection with his claims for service connection for a left shoulder and a left knee disorder. The letter should (1) inform him of the information and evidence that is necessary to substantiate the claims; (2) inform him about the information and evidence that VA will seek to provide; and, (3) inform him about the information and evidence he is expected to provide. The letter should also explain how disability ratings and effective dates are determined. Specifically, the letter should notify the Veteran of the evidence necessary to substantiate the claims on both a direct and secondary basis. 4. After the above development has been completed, the Veteran should be afforded a VA examination to determine the nature and etiology of any left knee disorder that may be present. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran’s service treatment records, post-service medical records, and assertions. The examiner should note that the Veteran is competent to attest to matters of which he has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the appellant, the examiner should provide a fully reasoned explanation. The examiner should opine as to whether it is at least as likely as not that the Veteran has a current left knee disorder that is causally or etiologically related to his military service, to include any injury or symptomatology therein. The examiner should also opine as to whether it is at least as likely as not that the Veteran has a left knee disorder that is caused by or aggravated by his right knee disorder. (The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of a certain conclusion as it is to find against it.) A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Because it is important “that each disability be viewed in relation to its history [,]” 38 C.F.R. § 4.1, copies of all pertinent records in the appellant’s claims file, or in the alternative, the claims file, must be made available to the examiner for review. 5. After the above development has been completed, the Veteran should be afforded a VA examination to determine the nature and etiology of any left shoulder disorder that may be present. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran’s service treatment records, post-service medical records, and assertions. The examiner should note that the Veteran is competent to attest to matters of which he has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the appellant, the examiner should provide a fully reasoned explanation. The examiner should opine as to whether it is at least as likely as not that the Veteran has a current left shoulder disorder that is causally or etiologically related to his military service, to include any injury or symptomatology therein. The examiner should also opine as to whether it is at least as likely as not that the Veteran has a left shoulder disorder that is caused by or aggravated by his service-connected right shoulder disability. (The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of a certain conclusion as it is to find against it.) A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Because it is important “that each disability be viewed in relation to its history [,]” 38 C.F.R. § 4.1, copies of all pertinent records in the appellant’s claims file, or in the alternative, the claims file, must be made available to the examiner for review. 6. After the above development has been completed, the Veteran should be afforded a VA examination to determine the nature and etiology of any low back disorder that may be present. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran’s service treatment records, post-service medical records, and assertions. The examiner should note that the Veteran is competent to attest to matters of which he has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the appellant, the examiner should provide a fully reasoned explanation. The examiner should opine as to whether it is at least as likely as not that the Veteran has a current low back disorder that is causally or etiologically related to his military service, to include any injury or symptomatology therein. (The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of a certain conclusion as it is to find against it.) A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Because it is important “that each disability be viewed in relation to its history [,]” 38 C.F.R. § 4.1, copies of all pertinent records in the appellant’s claims file, or in the alternative, the claims file, must be made available to the examiner for review. 7. After the above development has been completed, the Veteran should be afforded a VA examination to determine the nature and etiology of any right knee disorder that may be present. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran’s service treatment records, post-service medical records, and assertions. The examiner should note that the Veteran is competent to attest to matters of which he has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the appellant, the examiner should provide a fully reasoned explanation. The examiner should opine as to whether it is at least as likely as not that the Veteran has a current right knee disorder that is causally or etiologically related to his military service, to include any injury or symptomatology therein. (The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of a certain conclusion as it is to find against it.) A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Because it is important “that each disability be viewed in relation to its history [,]” 38 C.F.R. § 4.1, copies of all pertinent records in the appellant’s claims file, or in the alternative, the claims file, must be made available to the examiner for review. 8. After the above development has been completed, the Veteran should be afforded a VA examination to determine the nature and etiology of any bilateral foot disorders that may be present. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran’s service treatment records, post-service medical records, and assertions. The examiner should note that the Veteran is competent to attest to matters of which he has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the appellant, the examiner should provide a fully reasoned explanation. The examiner should identify all current foot disorders. For each diagnosis identified, the examiner should opine as to whether it is at least as likely as not that the disorder is causally or etiologically related to his military service, to include any injury or symptomatology therein. The examiner should specifically address the Veteran’s testimony that his in-service toe nail issues caused difficulty walking, which then caused his current foot disorders. (The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of a certain conclusion as it is to find against it.) A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Because it is important “that each disability be viewed in relation to its history [,]” 38 C.F.R. § 4.1, copies of all pertinent records in the appellant’s claims file, or in the alternative, the claims file, must be made available to the examiner for review. 9. After the above development has been completed, the Veteran should be afforded a VA examination to determine the nature and etiology of any acquired psychiatric disorder that may be present. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed, but should include psychological testing, including PTSD sub scales. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran’s service treatment and personnel records, post-service medical records, lay statements and assertions, and information pertaining to the claimed in-service stressor. The examiner should note that the Veteran is competent to attest to matters of which he has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the appellant, the examiner should provide a fully reasoned explanation. The examiner should identify all current psychiatric disorders. In so doing, the examiner should consider the diagnoses of record and the results of any testing performed. For each disorder identified other than PTSD, the examiner should state whether it is at least as likely as not that the disorder manifested in service or is otherwise causally or etiologically related to the Veteran’s military service. The examiner should also opine as to whether it is at least as likely as not that the Veteran has a current acquired psychiatric disorder that is caused by or aggravated by his service-connected disabilities, to include any associated pain. Regarding PTSD, the AOJ should provide the examiner with a summary of any verified in-service stressors, and the examiner must be instructed that only these events or any stressors related to fear of hostile military or terrorist activity may be considered for the purpose of determining whether exposure to an in-service stressor has resulted in PTSD. The examiner should determine whether the diagnostic criteria to support the diagnosis of PTSD have been satisfied. If the PTSD diagnosis is deemed appropriate, the examiner should then comment upon the link between the current symptomatology and any verified in-service stressor. (The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of a certain conclusion as it is to find against it.) A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Because it is important “that each disability be viewed in relation to its history [,]” 38 C.F.R. § 4.1, copies of all pertinent records in the appellant’s claims file, or in the alternative, the claims file, must be made available to the examiner for review. 10. After the above development has been completed, the Veteran should be afforded a VA examination to determine the severity and manifestations of his service-connected right shoulder disability. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. The examiner is requested to review all pertinent records associated with the claims file. The examiner should note that the Veteran is competent to attest to factual matters of which he has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. The examiner should report all signs and symptoms necessary for rating the Veteran’s service-connected right shoulder disabilities under the rating criteria. In particular, the examiner should provide the range of motion in degrees and test the Veteran’s range of motion in active motion, passive motion, weight-bearing, and nonweight-bearing for both the right and left shoulders. If the examiner is unable to conduct the required testing or concludes that the required testing is not necessary in this case, he or she should clearly explain so in the report. The examiner should also indicate whether the presence of objective pain, excess fatigability, incoordination, or weakness and/or flare-ups result in limitation of the right arm to shoulder level, midway between the side and shoulder level, or to 25 degrees from the side. The examiner should also indicate whether there is any form of ankyloses or impairment of the humerus, such as malunion, recurrent dislocation at the scapulohumeral joint, fibrous union, nonunion (false flail joint), and loss of head (flail shoulder). He or she should also indicate whether there is any impairment of the clavicle or scapula, such as malunion, nonunion with or without loose motion, or dislocation. The presence of objective evidence of pain, excess fatigability, incoordination, and weakness should also be noted, as should any additional disability, including additional limitation of motion, due to these factors. A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Because it is important “that each disability be viewed in relation to its history [,]” 38 C.F.R. § 4.1, copies of all pertinent records in the appellant’s claims file, or in the alternative, the claims file, must be made available to the examiner for review. 11. After the above development has been completed, the Veteran should be afforded a VA examination to determine the severity and manifestation of his service-connected right hip disability. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. The examiner is requested to review all pertinent records associated with the claims file. The examiner should note that the Veteran is competent to attest to matters of which he has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the appellant, the examiner should provide a fully reasoned explanation. The examiner should report all signs and symptoms necessary for rating the Veteran’s right hip disability under the rating criteria. In particular, the examiner should provide the range of motion in degrees and test the Veteran’s range of motion in active motion, passive motion, weight-bearing, and nonweight-bearing, for both the right and left hips. If the examiner is unable to conduct the required testing or concludes that the required testing is not necessary in this case, he or she should clearly explain so in the report. The presence of objective evidence of pain, excess fatigability, incoordination, and weakness should also be noted, as should any additional disability, including additional limitation of motion, due to these factors. The examiner should also state whether there is any form of ankylosis, flail joint, or impairment of the femur. A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Because it is important “that each disability be viewed in relation to its history [,]” 38 C.F.R. § 4.1, copies of all pertinent records in the appellant’s claims file, or in the alternative, the claims file, must be made available to the examiner for review. 12. After completing these actions, the AOJ should conduct any other development as may be indicated by a response received as a consequence of the actions taken in the preceding paragraphs. Further development may include affording the Veteran a VA examination and/or obtaining a medical opinion in connection with the claim for TDIU. J.W. ZISSIMOS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD B. Rideout-Davidson, Counsel