Citation Nr: 19127582 Decision Date: 04/10/19 Archive Date: 04/09/19 DOCKET NO. 16-39 094 DATE: April 10, 2019 ORDER Entitlement to service connection for peripheral arterial disease (PAD) of the bilateral lower extremities is granted. Entitlement to service connection for a bilateral leg condition other than PAD is denied. Entitlement to service connection for bilateral hearing loss is denied. Entitlement to service connection for a respiratory condition is denied. Entitlement to an initial compensable rating for scars associated with ischemic heart disease (IHD), status post coronary bypass graft, is denied. Entitlement to an effective date prior to July 17, 2012, for the award of service connection for IHD, status post coronary artery bypass, graft is denied. Entitlement to an effective date prior to July 17, 2013, for the award of service connection for bilateral eye residual corneal scarring/haze, status post pterygium removal (“bilateral eye disability”), is denied. Entitlement to a total disability based on individual unemployability by reason of service-connected disabilities (TDIU), for the period of appeal from March 29, 2017, is dismissed. REMANDED Entitlement to service connection for a back condition is remanded. Entitlement to service connection for a bilateral hip condition is remanded. Entitlement to service connection for a sleeping condition is remanded. Entitlement to service connection for high blood pressure is remanded. Entitlement to service connection for enlarged prostate is remanded. Entitlement to service connection for an acquired psychiatric disorder is remanded. Entitlement to an initial rating in excess of 10 percent for IHD, status post coronary artery bypass, for the period of appeal prior to March 29, 2017, is remanded. Entitlement to an initial compensable rating for the bilateral eye disability, and in excess of 10 percent from March 29, 2017, is remanded. Entitlement to a TDIU for the period of appeal prior to March 29, 2017, is remanded. FINDINGS OF FACT 1. The Veteran has a current diagnosis of PAD of the bilateral lower extremities, and the evidence is in equipoise on whether it is etiologically related to service. 2. The Veteran does not have a diagnosis of a bilateral leg condition other than PAD. 3. The Veteran does not have a diagnosis of hearing loss in the left ear or right ear. 4. The Veteran does not have a diagnosis of a respiratory condition. 5. For the entire period of appeal, the scars associated with the IHD are linear and stable, and do not result in pain, limited motion, or other functional impairment. 6. The Veteran filed claims for service connection for IHD and the bilateral eye disability on July 17, 2013. 7. The earliest date of claim for service connection for IHD (July 17, 2013) is later than the date the disability arose (sometime prior to December 2000). 8. The earliest date of claim for service connection for the bilateral eye disability (July 17, 2013) is later than the date the disability arose (as early as 1971). 9. There is no rating decision that addressed service connection for IHD or the bilateral eye disability prior to the June 2014 rating decision on appeal, and no prior formal or informal correspondence from the Veteran can be reasonably construed as a claim for service connection for IHD or a bilateral eye disability. 10. There is no rating decision issued between September 25, 1985, and May 3, 1989, that denied service connection for IHD. 11. For the period of appeal from March 29, 2017, the Veteran has not had a “less than total” rating. CONCLUSIONS OF LAW 1. The criteria for service connection for PAD of the bilateral lower extremities are met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304. 2. The criteria for service connection for a bilateral leg condition other than PAD are not met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304. 3. The criteria for service connection for bilateral hearing loss are not met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304. 4. The criteria for service connection for a respiratory condition are not met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304. 5. The criteria for an initial compensable rating for scars associated with IHD are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.118, Diagnostic Code 7805. 6. The criteria for the assignment of an effective date earlier than July 17, 2012, for the grant of service connection for IHD, status post coronary artery bypass, are not met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. §§ 3.155(a), 3.400, 3.816. 7. The criteria for the assignment of an effective date earlier than July 17, 2013, for the grant of service connection for the bilateral eye disability are not met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. §§ 3.155(a), 3.400. 8. The assignment of a 100 percent combined schedular evaluation for the service-connected IHD from March 29, 2017, renders the TDIU appeal moot for this period of appeal, so no question of fact or law remains to be decided. 38 U.S.C. § 7104; 38 C.F.R. § 4.16(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the Marine Corps from August 1968 to June 1970. His decorations include a Vietnam Service Medal and a Republic of Vietnam Cross of Gallantry with palm and frame. Service Connection To prevail on a direct service connection claim, there must be competent evidence of (1) a current disability, (2) in-service incurrence or aggravation of a disease or injury, and (3) a nexus between the in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). A disability may be service connected on a secondary basis if it is proximately due to or the result of a service-connected disease or injury; or, if it is aggravated beyond its natural progress by a service-connected disease or injury. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.310(a), (b). 1. Service connection for PAD. The Veteran contends that he was exposed to Agent Orange during service in Vietnam, which caused his PAD of the bilateral lower extremities. See the November 2017 statement. The medical evidence shows that the Veteran was diagnosed with PAD of the bilateral lower extremities sometime between 2008 and 2012. Private treatment records indicate that in November 2008, the Veteran had three procedures, including a bilateral percutaneous transluminal coronary angioplasty and stenting of the iliac arteries. A March 2014 VA examination indicates that the Veteran was diagnosed with PAD in 2008, and a March 2017 VA examination indicates that the Veteran was diagnosed with peripheral vascular/arterial disease in 2012. Thus, the current disability requirement for service connection for PAD of the bilateral lower extremities is satisfied. If a Veteran was exposed to an “herbicide agent,” such as Agent Orange, used in support of the United States and allied military operations in the Republic of Vietnam from January 9, 1962, to May 7, 1975, then, absent affirmative evidence to the contrary, certain diseases, including ischemic heart disease (IHD), will be presumptively service connected even if there is no record of the disease in service. 38 U.S.C. §§ 1110, 1116, 1131; 38 C.F.R. §§ 3.307(a)(6), (d), 3.309(e). Here, the Veteran had service in Vietnam, but PAD is not among the diseases eligible for presumptive service connection. Rather, peripheral manifestations of arteriosclerosis, such as peripheral vascular disease, is not a form of IHD. See 38 C.F.R. § 3.309(e), Note 2. As such, presumptive service connection for tongue cancer is not warranted. However, for disabilities not presumed by regulation to be due Agent Orange exposure, the Veteran may still establish service connection by showing that any such disability is, in fact, directly and causally linked to Agent Orange exposure, or any other incident or injury in service. See Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994). In this case, the Veteran has submitted a medical opinion from Dr. H.S. in support of his claim. In an August 2016 letter, Dr. H.S., a physician with a family practice and previous emergency room experience, indicated that he reviewed the Veteran’s complete claims file, and concluded that the Veteran’s service-connected IHD and the PAD had a common etiology of the Veteran’s exposure to Agent Orange. Dr. H.S. explained that IHD is often referred to as “hardening of the arteries,” which was caused by a buildup of plaque in the arteries within the heart. The plaque buildup resulted in the heart not getting enough oxygen, which resulted in decreased heart function and lowered blood flow to the body. Progressive narrowing of the arteries due to atherosclerosis often subsequently affected many areas of the body. One such complication is PAD and/or vascular disease, which is a narrowing of arteries in the lower extremities due to atherosclerosis. Dr. H.S. noted that the March 2014 VA examination report indicated that the Veteran had peripheral arterial and vascular diseases that had been present for many years, including a right femoral to left femoral artery bypass graft (in 2013). Dr. H.S. further explained that that there was a high prevalence of vascular disease among veterans exposed to Agent Orange, and that chemicals in Agent Orange have been shown to contribute to the development of inflammatory diseases such as atherosclerosis. Three journal articles were submitted as support for his contentions including one from Arteriosclerosis, Thrombosis, and Vascular Biology about the development of vascular inflammation and promotion of atherosclerosis in mice; one from Journal of Preventative Medicine & Public Health about Agent Orange exposure and prevalence of diseases in Korean Vietnam veterans; and results of a National Health and Nutrition Examination Survey, 1999-2000 regarding the prevalence and risk factors for PAD in the United States. The Board finds Dr. H.S.’s opinion to be competent and credible, and as such, entitled to significant probative weight. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994). The opinion was rendered based on review of the Veteran’s claims file, subject matter expertise, and citations to peer-reviewed medical literature. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008) (holding that it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion). The Board acknowledges that the March 2017 VA examiner found that the Veteran’s PAD was less likely than not related to his HID, status post coronary bypass graft. The examiner indicated that the bypass grafts were taken from areas that were not near the femoral arteries, and that it was unlikely that the femoral artery was damaged during the angioplasty. The examiner also noted that the Veteran had a number of risk factors, including being male, a smoker, hypertension, hypolipidemia, atherosclerosis, and increasing age. However, under the “benefit-of-the- doubt” rule, where there exists “an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter,” the Veteran shall prevail upon the issue. Ashley v. Brown, 6 Vet. App. 52, 59 (1993). In this case, the Board finds that there is “an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter.” As such, this is a situation where the benefit of the doubt rule applies. Ashley, 6 Vet. App. at 59; 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Resolving all reasonable doubt in the Veteran’s favor, the Board finds that the Veteran’s PAD of the bilateral lower extremities was caused by exposure to herbicides, including Agent Orange, and the claim of entitlement to service connection for PAD of the bilateral lower extremities is granted. 38 U.S.C. §§ 1110, 5107; see generally Gilbert v. Derwinski, 1 Vet. App. 49 (1990); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001). 2. Service connection for a bilateral leg condition other than PAD, bilateral hearing loss, and a respiratory condition. The Board finds that the probative evidence of record does not establish that the Veteran has current diagnoses of a leg condition other than PAD, hearing loss in either ear, or a respiratory condition. Private treatment records associated with the claims file note several heart-related diagnoses and procedures, but are silent for complaints, diagnoses, or treatment of a leg condition other than PAD, hearing loss in either ear, or a respiratory condition. Similarly, VA treatment records associated with the claims file, dated from November 2004 to March 2018, are silent for complaints, diagnoses, or treatment of a leg condition other than PAD, hearing loss in either ear, or a respiratory condition. In short, there is simply no evidence of diagnoses of a leg condition other than PAD, hearing loss in either ear, or a respiratory condition, or complaints of relevant symptom in more than 12 years’ worth of medical evidence. The only evidence of record indicating that the Veteran has diagnoses of a leg condition other than PAD, hearing loss in either ear, or a respiratory condition are the Veteran’s own statements. The Board does not doubt the Veteran is sincere in his belief that the claimed leg condition other than PAD, hearing loss, and respiratory condition are related to his service. However, as a lay person, the Veteran’s statements cannot be used to make diagnoses. The diagnosis and etiology of leg condition other than PAD, hearing loss, or a respiratory condition go beyond a simple and immediately observable cause-and-effect relationship and requires medical knowledge to review and interpret clinical tests. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007) (explaining in footnote 4 that a Veteran may be competent to provide a diagnosis of a simple condition such as a broken leg, but not competent to provide evidence as to more complex medical questions). As such, the Board finds little probative value in the Veteran’s statements with regard to establishing service connection. In sum, the weight of the competent and credible evidence of record weighs against the claims for service connection for a leg condition other than PAD, bilateral hearing loss, and a respiratory condition. As the preponderance of the evidence is against the claims, the benefit-of-the-doubt doctrine does not apply. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Accordingly, service connection for a leg condition other than PAD, bilateral hearing loss, and a respiratory condition is not warranted. Increased Ratings Disability evaluations are determined by the application of VA’s Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and the residual conditions in civil occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(a), 4.1. Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the veteran working or seeking work. 38 C.F.R. § 4.2. All reasonable doubt will be resolved in the claimant’s favor. 38 C.F.R. § 4.3. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7. 3. Increased rating for scars associated with IHD. The Veteran is service-connected for scars associated with IHD, status post coronary bypass graft, rated as noncompensable from July 17, 2013, under Diagnostic Code 7805. Under this diagnostic code, scars are rated based on limitation of function of the part affected. In a March 2014 VA examination, the examiner indicated that the Veteran’s scars were not painful and/or unstable, nor was the total area of all related scars 39 square centimeters (cm) (6 square inches) or greater. In a March 2017 VA examination, the Veteran was noted to have a vertical chest scar that was 22 cm long and 0.1 cm wide. He also had a scar on his right groin that was 5.25 cm long and 0.1 cm wide, and a scar on his left groin that was 6 cm long and 0.1 cm wide. None of the scars were found to be painful and/or unstable, or having a total area of equal to or greater than 39 square cm. In evaluating the Diagnostic Codes potentially applicable to the Veteran’s scars, the Board notes that Diagnostic Code 7800 does not apply because the Veteran’s scars are not on his head, face, or neck. Diagnostic Code 7801 does not apply because the Veteran’s scars are neither deep nor nonlinear. Diagnostic Code 7802 does not apply because the Veteran’s scars are linear. Diagnostic Code 7804 does not apply because the Veteran’s scars are stable and not painful. Thus, with Diagnostic Codes 7800 to 7804 excluded, Diagnostic Code 7805 applies, which contemplates the ratings of “other” scars, which are to be rated based on limitation of function of the part affected. The Veteran is not entitled to a compensable rating under this diagnostic code because he has suffered no functional impairment (such as limitation of motion) as a result of his scars, nor does the Veteran so contend. Because the preponderance of the evidence weighs against the claim, the benefit of the doubt doctrine is not for application. Gilbert v. Derwinski, 1 Vet. App. 49, 53-54 (1990). 4. Entitlement to a TDIU from March 29, 2017. TDIU may be assigned where the schedular rating is less than total, when the disabled person is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities. 38 C.F.R. § 4.16(a). In this case, the RO awarded a 100 percent schedular rating for the IHD effective from March 29, 2017. Thus, due to the award of a total rating for IHD, the Veteran has been in receipt of a total (100 percent) schedular rating since March 29, 2017. Accordingly, the Board finds that the grant of a total rating for IHD from March 29, 2017, which results in the Veteran having a “total” (100 percent) rating, renders the TDIU claim moot for this period of appeal, and it must be dismissed. See Green v. West, 11 Vet. App. 472, 276 (1998) (holding that, if a 100 percent schedular rating is granted, a veteran is not also entitled to TDIU for the same period). The Board is cognizant of the decision of the U.S. Court of Appeals for Veterans Claims (Court) in Bradley v. Peake, 22 Vet. App. 280 (2008), in which the Court held that, although no additional disability compensation may be paid when a total schedular disability rating is already in effect, a separate award of TDIU predicated on a single disability may form the basis for an award of special monthly compensation. In Bradley, the Court held that there could be a situation where a veteran has a schedular total rating for a particular service-connected disability, and could establish a TDIU rating for another service-connected disability in order to qualify for special monthly compensation (SMC) under 38 U.S.C. § 1114(s) by having an additional disability of 60 percent or more (housebound rate). See Bradley v. Peake, 22 Vet. App. 280 (2008), 38 U.S.C.A. § 1114 (s). Thus, Bradley made it such that even with the assignment of a total schedular rating, the issue of TDIU was potentially not moot. However, having reviewed Bradley, the Board concludes that the facts of that case are sufficiently differentiable from the facts of this case such that the holding in Bradley is inapplicable and the Veteran’s TDIU claim is in fact moot. Specifically, in the veteran in Bradley was in receipt of a 100 percent schedular rating for service connected disabilities other than his PTSD, which was rated at 70 percent. As such, the Court concluded that the PTSD on its own could potentially result in a TDIU in and of itself. Here, however, the Veteran’s only service-connected disabilities aside from IHD are scars associated with the IHD (rated as noncompensable) and the bilateral eye disability rated as 10 percent disabling, and there is no suggestion that the Veteran’s scars or eye disability interfere in any way with his employability. Simply put, aside from IHD, the Veteran does not currently have any service-connected disabilities, which are evaluated as less than total, that have been suggested to cause any unemployability. As such, Bradley is inapplicable, and the grant of a total schedular rating for IHD from March 29, 2017, renders the TDIU claim moot for this period of the appeal. Effective Dates In general, the effective date of an award of disability compensation, in conjunction with a grant of entitlement to service connection, shall be the day following separation from active service or the date entitlement arose if the claim is received within one year of separation from service; otherwise, the effective date shall be the date of receipt of the claim, or the date entitlement arose, whichever is later. 38 U.S.C. § 5110; 38 C.F.R. § 3.400(b)(2)(i). The law grants a period of one year from the date of the notice of the result of the initial determination for initiating an appeal by filing a notice of disagreement; otherwise, that determination becomes final and is not subject to the revision on the same factual basis in the absence of clear and unmistakable error (CUE). 38 U.S.C. § 7105; 38 C.F.R. § 3.105(a). 5. Earlier effective date for the award of service connection for IHD. IHD is included as a presumptive herbicide-related disease under 38 C.F.R. § 3.309(e), which was made effective by VA as of August 31, 2010. See 75 Fed. Reg. 53,702 (August 31, 2010). Effective dates of awards of IHD under 38 C.F.R. § 3.309(e) are governed by the Nehmer provisions. See 75 Fed. Reg. at 53,203. See also Nehmer v. United States Veterans Administration, 712 F. Supp. 1404 (N.D. Cal. 1989) (Nehmer I); Nehmer v. United States Veterans Administration, 32 F. Supp. 2d. 1175 (N.D. Cal. 1999) (Nehmer II); Nehmer v. Veterans Administration of the Government of the United States, 284 F.3d 1158 (9th Cir. 2002) (Nehmer III). The Veteran is a Nehmer class member because he is a Vietnam veteran who has a covered herbicide disease. 38 C.F.R. § 3.816(b)(1)(i). The Nehmer regulation provides for situations where the effective date can be earlier than the date of the liberalizing law, assuming a “Nehmer class member” has been granted compensation for a covered herbicide disease. Either (1) VA denied compensation for the same covered herbicide disease in a decision issued between September 25, 1985, and May 3, 1989; or (2) the class member’s claim for disability compensation for the covered herbicide disease was either pending before VA on May 3, 1989, or was received by VA between May 3, 1989, and the effective date of the statute or regulations establishing a presumption of service connection for the covered disease (here August 31, 2010). In these situations, the effective date of the award will be the later of the date such claim was received by VA or the date the disability arose. See 38 C.F.R. § 3.816. The question for the Board is whether the evidence of record contains any formal or informal claim for benefits for service connection for IHD prior to July 17, 2012, the effective date for the award of service connection. The Board finds that there is no prior formal or informal claim for benefits for service connection for ischemic heart disease pending before VA prior to July 12, 2012. Rather, the Veteran did not submit a claim for service connection for ischemic heart disease until July 13, 2013. The June 2014 rating decision, which granted service connection for IHD, status post coronary bypass graft, explained that the effective date was one year prior to the date VA received the Veteran’s claim. The rating decision noted that when a claim of service connection is received more than one year after a change in law, and all the requirements are met for a grant on the date of the change in law, the effective date is one year prior to the date is one year prior ot the date VA received the claim. Regarding the proper effective date for service connection for IHD under the Nehmer provisions, the Board finds that the Veteran was not denied compensation for ischemic heart disease between September 25, 1985, and May 3, 1989; his claim for service connection was not pending before VA on May 3, 1989 or received by VA between that date and July 17, 2013; and his claim was not received within one year from the date of his separation from service. In sum, the Veteran was not denied service connection for IHD between September 25, 1983, and May 3, 1989, and did not have a claim for service connection for ischemic heart disease pending prior to July 2013. As such, the provisions governing a possible earlier effective date for service connection, as afforded to Nehmer class members, are inapplicable here. Accordingly, the preponderance of the evidence is against an earlier effective date for the grant of service connection for IHD. Because the preponderance of the evidence is against the claim for an earlier effective date, the benefit of the doubt doctrine is not for application. See Gilbert v. Derwinski, 1 Vet. App. 49, 53-54 (1990). 6. Earlier effective date for the award of service connection for the bilateral eye disability. The Board finds that the earliest effective date for the award of service connection is October 15, 2012. See 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400(q) and (r). The Board has reviewed the record to determine whether an informal claim of service connection for a left eye disability was filed prior to October 15, 2012, that can be construed as an informal or formal claim for compensation benefits for a left eye disability and was not adjudicated in the September 1967, February and July 1985, and September 2002 rating decisions, but finds that there is no such document in the claims file. See 38 C.F.R. §§ 3.151, 3.155; Rudd v. Nicholson, 20 Vet. App. 296 (2006) (holding that a freestanding claim for effective date earlier than the date on which the claim was received, impermissibly attempts to vitiate the rule of finality). The Veteran has argued that an effective date in 1967 should be assigned because he was granted service connection then. However, as noted above, the RO granted service connection for the left eye disability in June 1967 for vocational rehabilitation purposes only, and not for compensation purposes. Accordingly, under the applicable regulations, October 15, 2012, is the earliest date for the award of service connection for the left eye disability absent an appeal of whether CUE was committed in a prior rating decision. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. Because the preponderance of the evidence is against the claim for an earlier effective date, the benefit of the doubt doctrine is not for application. See Gilbert v. Derwinski, 1 Vet. App. 49, 53-54 (1990). REASONS FOR REMAND 1. Entitlement to service connection for a back condition, bilateral hip condition, sleeping condition, and enlarged prostate are remanded. The Veteran was denied entitlement to service connection for a back condition, bilateral hip condition, sleeping condition, and enlarged prostate in a February 2015 rating decision. With regard to the claim for a back condition, the rating decision noted that there was no evidence of a connection or link between any in-service injury or disease and any current disability. With regard to the claims for a bilateral hip condition, sleeping condition, and enlarged prostate, the rating decision noted that the evidence did not show current diagnoses of these disabilities. The Veteran was not afforded VA examinations for any of claimed disabilities. VA treatment records, however, show symptoms, diagnoses, and/or treatment relevant to these claimed disabilities. Specifically, the Veteran was noted to have an enlarged prostate in March 2005; in March 2013, he was noted to have a history of degenerative disc disease of the lumbar spine; in July 2014, he was noted to a previous prescription for Ambien; and in September 2016, he was noted ot have hip pain. As such, the Board lacks sufficient medical evidence to render a decision on these issues, and VA examinations are warranted. See McLendon v. Nicholson, 20 Vet. App. 79 (2006), 38 U.S.C. § 5103A(d). 2. Entitlement to service connection for high blood pressure. Private treatment records clearly establish that the Veteran has a diagnosis of hypertension (high blood pressure). It is unclear, however, whether the hypertension is related to the service-connected IHD, to include whether the hypertension was caused or aggravated by the IHD. As such, the Board lacks sufficient medical evidence to render a decision on this issue, and a VA examination is warranted. See McLendon v. Nicholson, 20 Vet. App. 79 (2006), 38 U.S.C. § 5103A(d). 3. Entitlement to service connection for an acquired psychiatric disorder is remanded. In July 2016, Dr. H.H., a psychologist, completed a mental disorders disability benefits questionnaire (DBQ). She found that the Veteran had a diagnosis of depressive disorder due to his medical conditions, with symptoms including depressed mood, anxiety, suspiciousness, near-continuous panic or depression affecting the ability to function appropriately, chronic sleep impairment, mild memory loss, impairment of short and long term memory, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty adapting to stressful circumstances including work, inability to establish and maintain effective relationships, suicidal ideation, neglect of personal appearance and hygiene, and intermittent inability to perform activities of daily living including maintenance of minimal personal hygiene. Dr. H.H. opined that the depressive disorder caused occupational and social impairment with deficiencies in most areas. The Board finds the DBQ by Dr. H.H. to be insufficient for adjudication purposes, as it did not contain adequate discussion of contradicting evidence or rationale to explain the conclusions. For instance, VA depression screenings dated in November 2006, June 2010, November 2011, March 2013, April 2014, April 2015, April 2016, and July 2017 are all negative. As such, the Veteran should be afforded a VA psychiatric examination to determine whether any acquired psychiatric disorder is related to service, to include as secondary to service-connected disabilities. 4. Increased rating for IHD prior to March 29, 2017, is remanded. The disability rating assigned to the service connection claim for PAD granted herein, as well as the outcome of the remanded claim for service connection for high blood pressure, may affect the rating for IHD. Consideration of entitlement to a TDIU prior to March 29, 2017, must therefore be deferred until the intertwined issues are resolved or prepared for appellate consideration. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). 5. Increased rating for the bilateral eye disability is remanded. The Veteran was most recently examined for the bilateral eye disability in March 2017. The VA examination diagnosed central corneal opacity bilaterally and status post pterygium removal bilaterally with residual corneal scarring/haze. VA treatment records dated in July 2017 indicate that the Veteran reported having “some vision changes.” He had a full vision evaluation in August 2017, and was found to have mild cataracts with moderate visual significance in the right eye. He was referred for cataract surgery in the right eye. It is unclear whether the cataracts are related to the service-connected bilateral eye disability. It is also unclear whether the cataracts are solely responsible for the Veteran’s reported vision changes. As such, due to evidence of potentially worsening symptomatology, the Board finds a new VA examination is necessary. 6. Entitlement to a TDIU prior to March 29, 2017 is remanded. Any decision on the service connection claims and increased rating claims being remanded herein, as well as the service connection claim granted herein, may affect the claim for a TDIU prior to March 29, 2017. Consideration of entitlement to a TDIU prior to March 29, 2017, must therefore be deferred until the intertwined issues are resolved or prepared for appellate consideration. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). The matters are REMANDED for the following action: 1. Schedule the Veteran for appropriate VA examinations to determine the nature and likely etiology of any current back, bilateral hip, sleeping, and/or prostate conditions. The entire claims file, including a copy of this REMAND, must be reviewed by the examiner in conjunction with the examination. All indicated studies, tests, and evaluations deemed necessary should be performed. All relevant diagnoses should be noted. For each diagnosis, the examiner(s) should provide medical opinions on whether it is as likely as not (50 percent or greater probability) that the diagnosis is related to service. A thorough rationale should be provided for all opinions expressed. If any requested medical opinion cannot be given, the examiner should state the reason(s) why. 2. Schedule the Veteran for a VA hypertension examination to determine the nature and likely etiology of any current hypertension. The entire claims file, including a copy of this REMAND, must be reviewed by the examiner in conjunction with the examination. All indicated studies, tests, and evaluations deemed necessary should be performed. All relevant diagnoses should be noted. For each diagnosis, the examiner(s) should provide medical opinions on whether it is as likely as not (50 percent or greater probability) that the diagnosis is related to service, to include whether it is at least as likely as not that any current diagnosis of hypertension was caused by or aggravated beyond the normal progression (chronically worsened) by the Veteran’s service-connected IHD. A thorough rationale should be provided for all opinions expressed. If any requested medical opinion cannot be given, the examiner should state the reason(s) why. 3. Schedule the Veteran for a VA psychiatric examination to determine the current nature and likely etiology of any diagnosed acquired psychiatric disorder(s). The entire claims file, including a copy of this REMAND, must be reviewed by the examiner in conjunction with the examination. All indicated studies, tests, and evaluations deemed necessary should be performed. For any diagnosed acquired psychiatric disorder, to include depressive disorder, the examiner should provide an opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that the disorder was incurred in or aggravated by military service, to include whether it is at least as likely as not that any current acquired psychiatric disorder was caused by or aggravated beyond the normal progression (chronically worsened) by the Veteran’s service-connected disabilities. The examiner should clearly outline the rationale for any opinion expressed. If any requested medical opinion cannot be given, the examiner should state the reason(s) why. 4. Schedule the Veteran for a VA eye examination to determine the severity of his bilateral eye disability. The entire claims file, including a copy of this REMAND, must be reviewed by the examiner in conjunction with the examination. All indicated studies, tests, and evaluations deemed necessary should be performed. The examiner should identify all symptoms attributable to the Veteran’s eye disability, to include consideration and discussion of the bilateral cataracts, and comment on their severity. The examiner should also describe the functional impact of the Veteran’s eye disability. The examiner should clearly outline the rationale for any opinion expressed. If any requested medical opinion cannot be given, the examiner should state the reason(s) why. 5. After completing all indicated development, and any additional development deemed necessary, readjudicate the claims in light of all the evidence of record. If any benefit sought on appeal remains denied, then a fully responsive SSOC should be furnished to the Veteran and his representative, and they should be afforded a reasonable opportunity for response. KRISTI L. GUNN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD N. Nelson, Counsel