Citation Nr: 19132082 Decision Date: 04/25/19 Archive Date: 04/24/19 DOCKET NO. 06-11 365 DATE: April 25, 2019 ORDER Severance of service connection for posttraumatic stress disorder (PTSD) was not proper and is restored. The appeal to reopen service connection for PTSD is dismissed as moot. New and material evidence has been received to reopen the claim of service connection for an acquired psychiatric disorder other than PTSD. New and material evidence has been received to reopen the claim of service connection for hepatitis C. New and material evidence has been received to reopen the claim of service connection for a left leg disability. New and material evidence has been received to reopen the claim of service connection for a right leg disability. New and material evidence has been received to reopen the claim of service connection for a left ankle disability. New and material evidence has been received to reopen the claim of service connection for a right ankle disability. New and material evidence has been received to reopen the claim of service connection for a traumatic brain injury (TBI). Entitlement to service connection for a left shoulder disability is denied. Entitlement to service connection for a right shoulder disability is denied. Entitlement to service connection for a chest shrapnel wound injury is denied. Entitlement to service connection for neck disability is denied. REMANDED Entitlement to service connection for a left leg disability is remanded. Entitlement to service connection for a right leg disability is remanded. Entitlement to service connection for a left ankle disability is remanded. Entitlement to service connection for a right ankle disability is remanded. Entitlement to service connection for a TBI is remanded. Entitlement to service connection for headaches is remanded. Entitlement to service connection for thoracolumbar spine disability is remanded. Entitlement to service connection for a left knee disability is remanded. Entitlement to service connection for a right knee disability is remanded. Entitlement to service connection for hepatitis C is remanded. Entitlement to service connection for an acquired psychiatric disorder other than PTSD is remanded. Entitlement to a TDIU is remanded. FINDINGS OF FACT 1. The award of service connection for PTSD was not clearly and unmistakably erroneous. 2. The restoration of service connection for PTSD renders moot the issue of reopening service connection for PTSD. 3. An unappealed August 2005 rating decision denied service connection for major depressive disorder. 4. Evidence received more than one year since the August 2005 rating decision denying service connection for major depressive disorder, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim of service connection for major depressive disorder, and raises a reasonable possibility of substantiating the claim. 5. An unappealed September 2006 rating decision denied service connection for hepatitis C. 6. Evidence received more than one year since the September 2006 rating decision denying service connection for hepatitis C, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim of service connection for hepatitis C, and raises a reasonable possibility of substantiating the claim. 7. An unappealed August 2008 rating decision denied service connection for a TBI. 8. An unappealed October 2009 Board decision denied service connection for a left leg, right leg, left ankle and right ankle disability. 9. Evidence received more than one year since the August 2008 rating decision denying service connection for a TBI, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim of service connection for a TBI, and raises a reasonable possibility of substantiating the claim. 10. Evidence received since the October 2009 Board decision denying service connection for a left leg, right leg, left ankle and right ankle disability, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim of service connection for a left leg, right leg, left ankle and right ankle disability, and raises a reasonable possibility of substantiating the claim. 11. A left shoulder disability did not have its onset in service and is not otherwise related to service. 12. A right shoulder disability did not have its onset in service and is not otherwise related to service. 13. There is no competent evidence of a chest shrapnel wound injury during or just prior to the pendency of the claim. 14. There is no competent evidence of a neck disability during or just prior to the pendency of the claim. CONCLUSIONS OF LAW 1. The criteria for restoration of service connection are met. 38 U.S.C. §§ 1110, 5104, 5112; 38 C.F.R. §§ 3.105, 3.303. 2. The appeal concerning reopening service connection for PTSD is dismissed as moot. 38 U.S.C. § 7105(d)(5). 3. The August 2005 rating decision denying the claim for service connection for major depressive disorder is final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. 4. New and material evidence has been received to reopen the claim of service connection for an acquired psychiatric disorder other than PTSD. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 5. The September 2006 rating decision denying the claim for service connection for hepatitis C is final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. 6. New and material evidence has been received to reopen the claim of service connection for hepatitis C. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 7. The August 2008 rating decision denying the claim for service connection for a TBI is final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. 8. The October 2009 Board decision denying the claims for service connection for a left leg, right leg, left ankle and right ankle disability is final. 38 U.S.C. § 7104; 38 C.F.R. § 20.1100. 9. New and material evidence has been received to reopen the claim of service connection for a left leg disability. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 10. New and material evidence has been received to reopen the claim of service connection for a right leg disability. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 11. New and material evidence has been received to reopen the claim of service connection for a left ankle disability. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 12. New and material evidence has been received to reopen the claim of service connection for a right ankle disability. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 13. New and material evidence has been received to reopen the claim of service connection for a TBI. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 14. The criteria for entitlement to service connection for a left shoulder disability have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 15. The criteria for entitlement to service connection for a right shoulder disability have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 16. The criteria for entitlement to service connection for a chest shrapnel wound injury have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 17. The criteria for entitlement to service connection for a neck disability have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from August 2003 to September 2004, including prior active duty for training from August 2001 to December 2001. His active duty included service in Afghanistan from March 2004 to June 2004. These matters come before the Board of Veterans’ Appeals (Board) on appeal from August 2005, February 2010 and July 2013 rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO). These matters were previously before the Board in October 2009 and November 2010 when they were remanded for additional development. In February 2019, the Veteran withdrew his pending Board hearing request. Service Connection Service connection will be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999); Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd per curiam, 78 F. 3d 604 (Fed. Cir. 1996) (table decision). Service connection may be established for disability that is proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310(a). Further, a disability which is aggravated by a service-connected disability may be service-connected to the degree that the aggravation is shown. 38 C.F.R. § 3.310; El-Amin v. Shinseki, 26 Vet. App. 136 (2013); Allen v. Brown, 7 Vet. App. 439 (1995). Generally, when a claim is disallowed, it may not be reopened and allowed, and a claim based on the same factual basis may not be considered. 38 U.S.C. § 7105. However, a claim on which there is a final decision may be reopened if new and material evidence is submitted. 38 C.F.R. § 5108. “New” evidence means existing evidence not previously submitted to agency decisionmakers. “Material” evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). In determining whether evidence is “new and material,” the credibility of the new evidence must be presumed. Justus v. Principi, 3 Vet. App. 510 (1992). The provisions of 38 U.S.C. § 5108 require a review of all evidence submitted by or on behalf of a claimant since the last final denial on any basis to determine whether a claim must be reopened. See Evans v. Brown, 9 Vet. App. 273 (1996). 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, 121 (2010). Moreover, in determining whether this low threshold is met, consideration need not be limited to consideration of whether the newly submitted evidence relates specifically to the reason why the claim was last denied, but instead one should ask whether the evidence could reasonably substantiate the claim to be reopened, either by triggering VA’s duty to assist or through consideration of an alternative theory of entitlement. Id. at 118. 1. Whether the severance of service connection for PTSD was proper. The Veteran asserts that VA improperly severed service connection for PTSD. Once service connection has been granted, it can only be severed where the evidence establishes that the grant was clearly and unmistakably erroneous (the burden being on the Government), and only where certain procedural safeguards have been met. Stallworth v. Nicholson, 20 Vet. App. 482, 487 (2006); Daniels v. Gober, 10 Vet. App. 474, 478 (1997). Severance of service connection based on any standard less than that set forth in 38 C.F.R. § 3.105(d) is erroneous as a matter of law. Stallworth, 20 Vet. App. at 488; Graves v. Brown, 6 Vet. App. 166, 170 (1994); see also Baughman v. Derwinski, 1 Vet. App. 563, 566 (1991). The United States Court of Appeals for Veterans Claims (Court) has stated that clear and unmistakable error is a very specific and rare kind of error. It is the kind of error of fact or law that, when called to the attention of reviewers, compels the conclusion, to which reasonable minds could not differ, that the results would be manifestly different but for the error. See Fugo v. Brown, 6 Vet. App. 40, 43 (1993). To warrant revision of a decision on the ground of clear and unmistakable error in a severance of service connection case, there must have been an error in the adjudication of the appeal that, had it not been made, would have manifestly changed the outcome, i.e., whether, based on the current evidence of record, a grant of service connection would be clearly and unmistakably erroneous. See Stallworth, 20 Vet. App. at 488. In this case, the RO severed service connection for PTSD on the basis that the Veteran possessed no combat decorations or awards, and there was no credible supporting evidence of an in-service stressor. The Veteran’s primary theory of entitlement to service connection for PTSD was that he was injured by an improvised explosive device (IED) and exposed to combat while stationed in Afghanistan. See, e.g., March 2006 VA PTSD examination. The March 2006 rating decision that awarded service connection for PTSD did so after conceding combat due to the Veteran’s military occupational specialty (infantryman), and a positive March 2006 VA examination opinion that the Veteran’s PTSD symptoms were related to his injury and combat service in Afghanistan. The Veteran’s DD Form 214 reflected his decorations and awards included a Combat Infantryman Badge, denoting combat. His DD Form 214 also stated that during the period the Veteran was stationed in Afghanistan, he was in an imminent danger pay area for contingency operations in Afghanistan. Notably, the March 2006 rating decision did not concede the Veteran was injured by an IED. The February 2010 rating decision that severed service connection for PTSD did so on the basis of no credible stressor, and because there were no decorations or awards denoting combat. In support of this finding, it was noted that a DD Form 215 corrected the DD Form 214, deleting the Combat Infantryman Badge. Significantly, the February 2010 rating decision did not address the fact the Veteran’s DD Form 214 reflects he was in an imminent danger pay area for contingency operations. Moreover, while there are no decorations or awards denoting combat, the Veteran’s report of being exposed to combat is consistent with the circumstances of his service and his military occupational specialty as an infantryman. 38 U.S.C. § 1154. Given this favorable evidence, along with the positive March 2006 VA examination opinion, the Board finds that the onerous standard necessary to demonstrate a clear and unmistakable error in awarding service connection is not met. In other words, reasonable minds could differ on whether to afford the Veteran the benefit of the doubt to assess whether the Veteran warranted service connection for PTSD. Thus, severance was not proper, and service connection for PTSD is restored. 2. Whether new and material evidence has been received to reopen service connection for PTSD. As the Board has restored service connection for PTSD, the appeal to reopen a claim for service connection for PTSD is dismissed as moot, as the benefit sought on appeal has been fully granted. Thus, because there remains no case or controversy to resolve, the appeal is dismissed. 38 U.S.C. § 7105(d)(5). 3. Whether new and material evidence has been received to reopen service connection for major depressive disorder. Historically, an unappealed August 2005 rating decision denied the Veteran’s claim of service connection for major depressive disorder, based on lack of a nexus to service. No additional evidence pertinent to this issue was associated with the claims file within the one-year appeal period. See 38 C.F.R. § 3.156(b); Bond v. Shinseki, 659 F.3d 1362 (Fed. Cir. 2011); see also Buie v. Shinseki, 24 Vet. App. 242, 251-52 (2010). Accordingly, the August 2005 rating decision is final. 38 U.S.C. § 7105; 38 C.F.R. §§ 20.200, 20.202, 20.1103. The instant claim for service connection for major depressive disorder was received in February 2013. Evidence received more than one year since the August 2005 rating decision includes a March 2014 VA PTSD examination report indicating the Veteran’s PTSD symptoms included a depressed mood, among other symptoms. This evidence is new, in that it was not previously of record at the time of the August 2005 rating decision. Additionally, the newly submitted evidence is not cumulative or redundant of evidence already of record. Given the standard set forth in Shade, outlined above, the Board finds that the additional evidence is new and material within the meaning of 38 C.F.R. § 3.156, warranting reopening of the claim of service connection for major depressive disorder as such evidence presents an alternative theory of entitlement to service connection for major depressive disorder on a secondary basis. 38 C.F.R. § 3.310. 4. Whether new and material evidence has been received to reopen service connection for hepatitis C. Historically, an unappealed September 2006 rating decision denied the Veteran’s claim of service connection for hepatitis C, based on lack of a nexus to service. No additional evidence pertinent to this issue was associated with the claims file within the one-year appeal period. See 38 C.F.R. § 3.156(b); Bond v. Shinseki, 659 F.3d 1362 (Fed. Cir. 2011); see also Buie v. Shinseki, 24 Vet. App. 242, 251-52 (2010). Accordingly, the September 2006 rating decision is final. 38 U.S.C. § 7105; 38 C.F.R. §§ 20.200, 20.202, 20.1103. The instant claim for service connection for hepatitis C was received in February 2013. Since the September 2006 rating decision, the Veteran submitted additional evidence, including a May 2013 hepatitis C risk factor letter stating he was accidentally exposed to blood by helping wounded people during his service in Afghanistan. This evidence is new, in that it was not previously of record at the time of the September 2006 rating decision. Additionally, the newly submitted evidence is not cumulative or redundant of evidence already of record. Given the standard set forth in Shade, outlined above, the Board finds that the additional evidence is new and material within the meaning of 38 C.F.R. § 3.156, warranting reopening of the claim of service connection for hepatitis C. 5. Whether new and material evidence has been received to reopen service connection for a TBI. Historically, an unappealed August 2008 rating decision denied the Veteran’s claim for service connection for a TBI, essentially based on finding there was no evidence of such disability. No additional evidence pertinent to this issue was associated with the claims file within the one-year appeal period. See 38 C.F.R. § 3.156(b); Bond v. Shinseki, 659 F.3d 1362 (Fed. Cir. 2011); see also Buie v. Shinseki, 24 Vet. App. 242, 251-52 (2010). Accordingly, the August 2008 rating decision is final. 38 U.S.C. § 7105; 38 C.F.R. §§ 20.200, 20.202, 20.1103. The instant claim for service connection for a TBI was received in February 2013. Evidence added to the record since the August 2008 rating decision includes a March 2014 VA PTSD examination report that opined the Veteran “sustained physical and likely brain injury as the result of the IED explosion while in Afghanistan.” It was also stated that it could not be determined if a formal diagnosis of TBI/cognitive impairment has occurred. This evidence is new, in that it was not previously of record at the time of the August 2008 Board decision. Additionally, the newly submitted evidence is not cumulative or redundant of evidence already of record. Given the standard set forth in Shade, outlined above, the Board finds that the additional evidence is new and material within the meaning of 38 C.F.R. § 3.156, warranting reopening of the claim of service connection for a TBI. 6. Whether new and material evidence has been received to reopen service connection for a left leg disability. 7. Whether new and material evidence has been received to reopen service connection for a right leg disability. 8. Whether new and material evidence has been received to reopen service connection for a left ankle disability. 9. Whether new and material evidence has been received to reopen service connection for a right ankle disability. Historically, an August 2005 rating decision denied the Veteran’s claims for service connection for a left leg, right leg, left ankle, and right ankle disability, essentially based on findings that there was no evidence of such disabilities. An October 2009 Board decision also denied the Veteran’s appeal seeking service connection for a left leg, right leg, left ankle, and right ankle disability for lack of current disability. The Veteran did not appeal that decision to the Court or request reconsideration, and it is therefore final. 38 U.S.C. § 7104; 38 C.F.R. § 20.1100. The instant claim for service connection for a left leg, right leg, left ankle, and right ankle disability was received in February 2013. Evidence added to the record since the October 2009 Board decision includes a February 2014 VA Form 119 (Report of Contact) indicating that the Veteran’s ankles and legs limit heavy lifting, carrying, pushing, pulling, climbing, stooping, kneeling, crouching and crawling. Saunders v. Wilkie, 886 F.3d 1356 (2018) (holding that pain resulting in functional impairment constitutes a disability as contemplated by 38 U.S.C. § 1110, even in the absence of a presently-diagnosed condition). This evidence is new, in that it was not previously of record at the time of the October 2009 Board decision. Additionally, the newly submitted evidence is not cumulative or redundant of evidence already of record. Given the standard set forth in Shade, outlined above, the Board finds that the additional evidence is new and material within the meaning of 38 C.F.R. § 3.156, warranting reopening of the claim of service connection for a left leg, right leg, left ankle and right ankle disability. 10. Entitlement to service connection for a left shoulder disability. 11. Entitlement to service connection for a right shoulder disability. The evidence of record includes the Veteran’s complaint of shoulder pain, including lifting his arms above his shoulders. See February 2014 VA Form 119. Although there is no evidence of a specific disability of either shoulder, such complaint of pain with resulting functional impairment constitutes a disability for purposes of this appeal. Saunders, supra. The Veteran has not asserted, nor does the evidence so indicate, that his left and right shoulder disability had their onset in service or are otherwise related to service. Indeed, the Veteran has proffered no theory of entitlement to service connection for these disabilities. Notably, there is no indication of any complaints, findings, treatment, or diagnosis relating to either shoulder during service or within one year of separation, and the Veteran has not indicated otherwise. Indeed, on his August 2004 Report of Medical History at service separation, he denied any shoulder problems and clinical evaluation of the upper extremities was normal. The earliest indication of shoulder complaints was in March 2013, over 8 years after his discharge from service. Even upon a liberal reading of the evidence, there is otherwise no indication of a nexus to service, and it is not asserted that these disabilities are related to (caused and/or aggravated by) a service-connected disability. As such, the Board analysis of the Veteran’s claim is limited to the theory advanced (or not advanced as in this case) by the Veteran. See Robinson v. Mansfield, 21 Vet. App. 545, 553 (2008) (concluding “that the Board is not required sua sponte to raise and reject ‘all possible’ theories of entitlement in order to render a valid opinion” and “commits error only in failing to discuss a theory of entitlement that was raised either by the appellant or by the evidence of record.”), aff’d sub nom. Robinson v. Shinseki, 577 F.3d 1355, 1361 (Fed. Cir. 2009) (stating that “[w]here a fully developed record is presented to the Board with no evidentiary support for a particular theory of recovery, there is no reason for the Board to address or consider such a theory”). On the basis of this record, the evidence does not indicate a nexus to service or to a service-connected disability. Therefore, the claims are denied. See 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. § 3.102,3.303; see also Fagan v. Shinseki, 573 F.3d 1282, 1287-88 (Fed. Cir. 2009). 12. Entitlement to service connection for a chest shrapnel wound injury. In the absence of proof of a current disability, there can be no valid claim. Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Based on the competent evidence of record, the Board finds that the preponderance of the evidence is against the claim of entitlement to service connection for a chest shrapnel wound injury, under any theory of entitlement, as there is no indication of current diagnosis of such disability at any point just prior to and since the filing of his claim. The Veteran asserts that in June 2004, while stationed in Afghanistan, he was wounded by an IED, sustaining a shrapnel injury to the chest. See, e.g., August 2005 A.D., D.O. private medical report. June 2014 service treatment records revealed laboratory results indicating the Veteran was hepatitis C positive. June 2014 service treatment records show the Veteran was medevaced from Afghanistan for elevated liver function tests. In July 2014, he was placed on temporary physical profile for elevated liver function tests and possible hepatitis. August 2004 report of medical assessment noted the Veteran was returned to the continental United States due to acute hepatitis, and the Veteran reported drinking alcohol; he denied other problems. The August 2004 separation report of medical examination revealed palpable snapping rib at the costal sternal junction with slight tenderness; the diagnosis included costosternal irregularity. On August 2004 separation report of medical history, the Veteran denied pain or pressure in the chest. Post-service treatment records include January 2005 normal x-rays of the chest. August 2005 VAX revealed negative chest x-rays. In this case, the Board must deny the claim for service connection for a chest shrapnel wound injury due to the absence of proof of current disability. While the Veteran has asserted he was medevaced due to a shrapnel injury to the chest from an IED while stationed in Afghanistan, his report is not credible, as the contemporaneous evidence shows he was medevaced for elevated liver function tests. Moreover, there is no other evidence of a shrapnel injury to the chest. In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable in the instant appeal, and the claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 13. Entitlement to service connection for neck disability. In the absence of proof of a current disability, there can be no valid claim. Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Based on the competent evidence of record, the Board finds that the preponderance of the evidence is against the claim of entitlement to service connection for a neck disability, under any theory of entitlement, as there is no indication of current diagnosis of a neck disability at any point just prior to and since the filing of his claim. To the extent the Veteran may have endorsed neck pain during the appeal period, which he is competent to report, the record is negative for any evidence of functional impairment of earning capacity due to such pain during the appeal period. See Saunders, supra; February 2014 VA Form 119. In this case, the Board must deny the claim for service connection for a neck disability due to the absence of proof of current disability. In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable in the instant appeal, and the claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). REASONS FOR REMAND 14. Entitlement to service connection for a left leg disability. 15. Entitlement to service connection for a right leg disability. 16. Entitlement to service connection for a left ankle disability. 17. Entitlement to service connection for a right ankle disability. 18. Entitlement to service connection for a TBI. As discussed above, the Board has reopened the claims for service connection for left leg, right leg, left ankle, and right ankle disabilities, along with service connection for a TBI. However, as the RO has not adjudicated the merits of the service connection claims in the first instance, the Board must remand the claims so that this may be accomplished. See Bernard v. Brown, 4 Vet. App. 384 (1993). 19. Entitlement to service connection for headaches. Additionally, because the Veteran’s headaches claim is inextricably intertwined with the TBI claim remaining on appeal, appellate consideration of entitlement to service connection for headaches is deferred pending resolution of the TBI claim. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991); see also Tyrues v. Shinseki, 23 Vet. App. 166, 177 (2009) (en banc) (explaining that claims are inextricably intertwined where the adjudication of one claim could have a significant impact on the adjudication of another claim). 20. Entitlement to service connection for thoracolumbar spine disability is remanded. 21. Entitlement to service connection for a left knee disability. 22. Entitlement to service connection for a right knee disability. The evidence of record includes a February 2014 VA Form 119 stating the Veteran’s knees limit heavy lifting, carrying, pushing, pulling, climbing, stooping, kneeling, crouching and crawling. In addition, post-service treatment records reflect complaints of low back pain. Although there is no evidence of a specific disability of either knee or the low back, such complaints of pain with resulting functional impairment constitutes a disability for purposes of this appeal. Saunders, supra. While the Veteran asserts that his knees and low back were injured during an IED explosion while stationed in Afghanistan, of which there is no credible evidence, he also asserts that such disabilities are due to lifting and carrying heavy objects on his back (e.g., combat load equipment, ruck sacks, etc.). See June 2005 VA Form 21-4138. The Board finds that the “low threshold” requirement under McLendon v. Nicholson, 20 Vet. App. 79 (2006) is met, and the Veteran should be afforded a VA examination to determination the nature and etiology of his disabilities. 23. Entitlement to service connection for hepatitis C is remanded. Treatment records show the Veteran’s statement he began using illegal substances, including IV drug use, while stationed in Afghanistan. As noted above, in a May 2013 hepatitis C risk factor letter, the Veteran stated he had accidental exposure to blood by helping wounded people. Inasmuch as it is conceded the Veteran had combat exposure during service, and exposure to blood by helping the wounded would be consistent with the circumstances of his combat service, the Board finds that an opinion should be secured as to the etiology of the Veteran’s hepatitis C. 24. Entitlement to service connection for an acquired psychiatric disorder other than PTSD is remanded. An examination is needed to determine whether the Veteran has an acquired psychiatric disorder secondary to his PTSD. 25. Entitlement to TDIU is remanded. Additionally, because the Veteran’s TDIU claim is inextricably intertwined with the claims remaining on appeal, appellate consideration of entitlement to a TDIU rating is deferred pending resolution of the remaining claims on appeal. See Harris, supra. Outstanding treatment records should also be secured. The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records. 2. Obtain any outstanding relevant private treatment records. 3. Then schedule the Veteran for a VA examination to determine the nature and etiology of any current thoracolumbar, right knee, and left knee disabilities. The claims file, including a copy of this remand, must be provided to the examiner in conjunction with the requested opinion. All indicated tests and studies should be conducted, and all findings reported in detail. The examiner is asked to address the following: (a) Provide a diagnosis for any thoracolumbar, right knee, or left knee disability found. If no such disability is diagnosed, the examiner must indicate whether the Veteran’s reported low back, right knee, or left knee pain causes any functional impairment. See February 2014 VA Form 119. (b) For any thoracolumbar, right knee, or left knee disability/functional impairment diagnosed, please opine as to whether it is at least as likely as not (50 percent or greater probability) that such disability/functional impairment had its onset or is otherwise related to the Veteran’s active service, to include as a result of an injury from the cumulative impact of lifting and carrying heavy objects on his back (combat load equipment, ruck sacks, etc.) due to his military occupational specialty as an infantryman. A complete rationale should be given for all opinions and conclusions expressed. If unable to provide a medical opinion, provide a statement as to whether there is any additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. 4. Secure a VA opinion as to the etiology of the Veteran’s hepatitis C. No physical examination is necessary unless the examiner determines otherwise. The claims file should be made available to and reviewed by the examiner in conjunction with providing the request opinion/conducting the examination. Following consideration of the evidence of record, the examiner is asked to address the following: (a) Is it at least as likely as not (50 percent or greater probability) that the Veteran’s hepatitis C had its onset in service? (b) Is it at least as likely as not (50 percent or greater probability) that the Veteran’s hepatitis C is otherwise related to service, to specifically include as due to conceded exposure to blood while engaged in combat in Afghanistan. Please discuss the Veteran’s history of IV drug use. A complete rationale should be given for all opinions and conclusions expressed. If unable to provide a medical opinion, provide a statement as to whether there is any additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. 5. Schedule the Veteran for a VA psychiatric examination. The claims file and a copy of this remand must be made available to the examiner for review. After examining the Veteran and reviewing the record, the examiner is asked to address the following: (a) Please identify all current psychiatric diagnoses other than PTSD present since February 2013. (b) For each disability other than any substance abuse disorder so diagnosed, please indicate whether it is at least as likely as not (probability of 50 percent or greater) that such disorder: i. had its onset in service or is otherwise related to combat service; ii. is proximately due to his service-connected disabilities, to include his service-connected PTSD; or iii. has been aggravated (worsened beyond natural progression) by his service-connected disabilities, to include his service-connected PTSD. (c) If a substance abuse disorder is diagnosed, please indicate whether it is at least as likely as not (probability of 50 percent or greater) that such disorder: i. is proximately due to his service-connected disabilities, to include his service-connected PTSD; or ii. has been aggravated (worsened beyond natural progression) by his service-connected disabilities, to include his service-connected PTSD. All opinions should be accompanied by a clear rationale. If the examiner cannot answer without resorting to speculation, he or she should explain why it should be speculative to respond. 6. Then readjudicate the issues on appeal, including service connection for a left leg, right leg, left ankle, and right ankle disability, as well as service connection for TBI, on the merits. If the benefits sought on appeal remain denied, issue the Veteran and his representative a Supplemental Statement of the Case and provide the Veteran and his representative an opportunity to respond. S. BUSH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Marley, Counsel