Citation Nr: 19142738 Decision Date: 06/03/19 Archive Date: 06/03/19 DOCKET NO. 17-58 553 DATE: June 3, 2019 ORDER Entitlement to service connection for Meniere's syndrome is denied. Entitlement to service connection for edema of the bilateral upper extremities is denied. Entitlement to service connection for hepatitis C is denied. Entitlement to service connection for trichinosis is denied. Entitlement to service connection for dermatitis of the fingernails is denied. Entitlement to service connection for short term memory loss is denied. Entitlement to an initial compensation evaluation for bilateral hearing loss and to an evaluation in excess of 10 percent disabling after December 17, 2014 is denied. Entitlement to an evaluation in excess of 30 percent disabling until July 11, 2012, and in excess of 60 percent disabling thereafter, for service-connected asthmatic bronchitis is denied. Entitlement to service connection for obstructive sleep apnea is reopened. Entitlement to service connection for an acquired psychiatric disorder is reopened. Entitlement to service connection for diabetes mellitus, type 2, is reopened. Entitlement to service connection for peripheral neuropathy of the bilateral upper and lower extremities is reopened. REMANDED Entitlement to service connection for obstructive sleep apnea is remanded. Entitlement to service connection for an acquired psychiatric disorder is remanded. Entitlement to service connection for diabetes mellitus, type 2, is remanded. Entitlement to service connection for erectile dysfunction is remanded. Entitlement to service connection for chronic kidney disease is remanded. Entitlement to service connection for peripheral neuropathy of the bilateral upper and lower extremities is remanded. Entitlement to service connection for edema of the bilateral lower extremities is remanded. Entitlement to a total disability rating based on individual unemployability is remanded. FINDINGS OF FACT 1. The Veteran does not have a current disability of Meniere's syndrome. 2. The Veteran does not have a current disability consisting of edema of the bilateral upper extremities. 3. The Veteran’s hepatitis C was not incurred in and is not otherwise related to his active service; his hepatitis C was not caused by or aggravated by any service-connected disability. 4. The Veteran does not have a current disability of trichinosis. 5. The Veteran does not have a current disability of dermatitis of the fingernails. 6. The Veteran does not have a current disability of short-term memory loss. 7. Prior to December 17, 2014, the Veteran’s hearing loss warranted assignment of Roman numeral designations of V for the right ear and I for the left ear; after December 17, 2014, the Veteran’s hearing loss warranted assignment of Roman numeral designations of VI for the right and left ears. 8. Prior to July 11, 2012, the Veteran’s service-connected asthmatic bronchitis resulted in FEV-1 of 58 percent of predicted and FEV-1/FVC of 59 percent and was treated with daily inhalational therapy, but not systemic corticosteroids; from July 11, 2012, his asthmatic bronchitis resulted in FEV-1 of 50 percent and FEV-1/FVC of 88 percent and was treated with daily inhalational therapy, but not systemic corticosteroids. 9. The evidence submitted since the most recent denial of the claim of entitlement to service connection for obstructive sleep apnea is new and material and raises a reasonable possibility of substantiating the claim. 10. The evidence submitted since the most recent denial of the claim of entitlement to service connection for an acquired psychiatric disorder is new and material and raises a reasonable possibility of substantiating the claim. 11. The evidence submitted since the most recent denial of the claim of entitlement to service connection for diabetes mellitus (type 2) is new and material and raises a reasonable possibility of substantiating the claim. 12. The evidence submitted since the most recent denial of the claim of entitlement to service connection for peripheral neuropathy of the bilateral upper and lower extremities is new and material and raises a reasonable possibility of substantiating the claim. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for Meniere's syndrome have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for entitlement to service connection for edema of the bilateral upper extremities have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for entitlement to service connection for hepatitis C have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for entitlement to service connection for trichinosis have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 5. The criteria for entitlement to service connection for dermatitis of the fingernails have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 6. The criteria for entitlement to service connection for short term memory loss have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 7. The criteria for entitlement to an initial compensation evaluation for bilateral hearing loss and to an evaluation in excess of 10 percent disabling after December 17, 2014 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.85, 4.86, Diagnostic Code 6100. 8. The criteria for entitlement to an evaluation in excess of 30 percent disabling prior to July 11, 2012, and in excess of 60 percent disabling thereafter, for service-connected asthmatic bronchitis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.96, 4.97, Diagnostic Code 6602. 9. The July 2012 rating decision denying the Veteran’s claims of entitlement to service connection for obstructive sleep apnea, an acquired psychiatric disorder, diabetes mellitus (type 2), and peripheral neuropathy of the bilateral upper and lower extremities is final. 38 U.S.C. § 7104 (West 2014); 38 C.F.R. §§ 20.1100, 20.1103 (2018). 10. As new and material evidence has been received, the claims of entitlement to service connection for obstructive sleep apnea, an acquired psychiatric disorder, diabetes mellitus (type 2), and peripheral neuropathy of the bilateral upper and lower extremities are reopened. 38 C.F.R. §3.156 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from October 1971 to January 1972, from October 1976 to October 1979, and from June 1981 to May 1984. The new and material evidence issues regarding sleep apnea, an acquired psychiatric disorder, diabetes mellitus (type 2), and peripheral neuropathy of the bilateral upper and lower extremities have been added to the claims on appeal because the RO denied reopening of those claims and, so, those claims are properly characterized as claims to reopen. However, new and material evidence has been received on each of those claims, so the claims are reopened and the underlying claims of entitlement to service connection are therefore also on appeal. Those claims must be remanded. The reasons and bases for reopening and the remand are discussed below. In the February 2018 Appellant’s Brief, the Veteran’s representative lists entitlement to service connection for hypertension as an issue on appeal. The claim was originally denied in a July 2012 Rating Decision. The Veteran did not appeal but filed a new claim in January 2013 that did not include a claim of entitlement to service connection for hypertension. That claim was adjudicated, and the Veteran appealed, resulting in the above-listed matters coming before the Board. However, the appealed claim did not include a hypertension claim. Therefore, a claim of entitlement to service connection for hypertension is not on appeal and is not listed above. The record contains evidence not yet considered by the agency of original jurisdiction (AOJ). The Veteran waived AOJ consideration of that evidence in February 2018. See February 2018 Appellant’s Brief (attaching AOJ waiver). Therefore, the Board may consider the merits of the claims on appeal. 38 C.F.R. § 20.1304(c). Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). 1. Entitlement to service connection for Meniere's syndrome The Veteran has not identified any evidence supporting his claim of entitlement to service connection for Meniere’s syndrome and has not reported any diagnosis by a competent medical professional. The Board has reviewed the available medical evidence and finds the evidence does not contain any indication that the Veteran has or has ever had Meniere’s syndrome. In addition to the treatment records that are silent for diagnosis of Meniere’s syndrome, the Veteran has undergone VA examinations to evaluate his ear complaints (including poor hearing acuity, ringing in the ears, and pain). The VA examinations do not contain a diagnosis of Meniere’s syndrome or any discussion of a past diagnosis of or symptoms of Meniere’s syndrome. See April 2012 VA Examination; February 2015 VA Examination. Consequently, the evidence is not in equipoise, but the greater weight of the evidence is against finding that the Veteran has a disability consisting of or characterized by Meniere’s syndrome. Gilbert, 1 Vet. App. at 53-56. Because the Board finds that the Veteran does not have a condition consisting of or characterized by Meniere’s syndrome, the criteria for establishing service connection have not been met. 38 C.F.R. § 3.303; Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) (“In the absence of proof of a present disability there can be no valid claim.”); 38 C.F.R. § 4.125(a); see also Gilpin v. West, 155 F.3d 1353, 1355 (Fed. Cir. 1998). Entitlement to service connection for Meniere’s syndrome, to include as secondary to service-connected disabilities, is denied. To the extent the Veteran’s claim for Meniere’s syndrome encompasses hearing loss, ringing or roaring in the ear, or other ear symptoms, any such symptoms found upon examination of the Veteran’s ears or otherwise established by the competent evidence of record have been contemplated within his ratings for his service-connected hearing loss and tinnitus conditions. The claim of entitlement to Meniere’s syndrome is denied. 2. Entitlement to service connection for edema of the bilateral upper extremities The available treatment records are against finding that the Veteran currently has edema of the bilateral upper extremities. See, e.g., November 2017 VA Progress Note (“No peripheral edema”); March 2015 VA Progress Note (“Edema of head, neck, upper or lower extremities: Not present.”). The Veteran has not identified any medical records or other evidence documenting that he has had edema of the bilateral upper extremities during the period on appeal. Because the Board finds that the Veteran does not have a condition consisting of or characterized by edema of the bilateral upper extremities, the criteria for establishing service connection have not been met. 38 C.F.R. § 3.303; Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) (“In the absence of proof of a present disability there can be no valid claim.”); 38 C.F.R. § 4.125(a); see also Gilpin v. West, 155 F.3d 1353, 1355 (Fed. Cir. 1998). Entitlement to service connection for edema of the bilateral upper extremities is denied. 3. Entitlement to service connection for hepatitis C The Veteran filed a January 2013 claim of entitlement to service connection for hepatitis C. The claim did not identify any in-service disease, injury, or events that are allegedly related to the current hepatitis C. Notably, the Veteran’s February 2018 Brief contains no discussion of his hepatitis C claim, though it addresses the issue of chronic kidney disease and diabetes mellitus, among others, and does not identify any in-service disease, injury, or event that might be related to his current hepatitis C. Review of the Veteran’s service treatment records reveals that the Veteran was not diagnosed with hepatitis C during his active service. See July 2004 VA Progress Note (noting that his VA physicians first diagnosed hepatitis C in March 2003). His service treatment records fail to document any other disease, injury, or event that may be associated with his hepatitis C. In the absence of a specific allegation by the Veteran and the lack of any apparent in-service disease, injury, or event that may be associated with his hepatitis C, the Veteran’s claim fails as the greater weight of the evidence is against finding that the in-service element of his claim has been established. The Veteran has not argued that his hepatitis C is secondary to any service-connected condition and the evidence does not reveal any apparent connection between his hepatitis C diagnosed in 2003 and any service-connected condition. Entitlement to service connection for hepatitis C is denied. 4. Entitlement to service connection for trichinosis The Veteran filed a January 2013 claim of entitlement to service connection for trichinosis. The claim did not identify any in-service disease, injury, or events that are allegedly related to an alleged current disability of trichinosis. Notably, the Veteran’s February 2018 Brief contains no discussion of his trichinosis claim, though it addresses the issue of chronic kidney disease and diabetes mellitus, among others, and does not identify any in-service disease, injury, or event that might be related to trichinosis. The greater weight of the evidence is against finding that the in-service element of the Veteran’s claim has been met. The Board also notes that the available treatment records are against finding that the Veteran currently has trichinosis. The Veteran has not identified any medical records or other evidence documenting that he has had trichinosis during the period on appeal. Because the Board finds that the Veteran did not have a condition consisting of or characterized by trichinosis, the criteria for establishing service connection have not been met. 38 C.F.R. § 3.303; Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) (“In the absence of proof of a present disability there can be no valid claim.”); 38 C.F.R. § 4.125(a); see also Gilpin v. West, 155 F.3d 1353, 1355 (Fed. Cir. 1998). Entitlement to service connection for trichinosis is denied. 5. Entitlement to service connection for dermatitis of the fingernails The Veteran has claimed entitlement to service connection for dermatitis of the fingernails but has not identified any evidence supporting the claim. The Veteran’s medical treatment records do not contain diagnoses of or indications that he has been treated for dermatitis of the fingernails. VA provided the Veteran an examination in connection with his claim. The September 2013 VA examiner noted that the only skin condition affecting the Veteran’s hands was an adverse reaction to poison ivy in August of 1987 that had resolved shortly thereafter. After examination, concluded that the Veteran does not have any visible skin conditions and did not have any onychomycosis (fingernail fungus) at the time of the examination. He further specifically noted that the Veteran’s fingernails were “within normal limits”, notwithstanding that the examiner indicated there was no such thing as dermatitis of the fingernails. September 2013 VA Examination. Consequently, the evidence is not in equipoise, but the greater weight of the evidence is against finding that the Veteran has a disability consisting of or characterized by dermatitis of the fingernails. Gilbert, 1 Vet. App. at 53-56. Because the Board finds that the Veteran does not have a condition consisting of or characterized by dermatitis of the fingernails, the criteria for establishing service connection have not been met. 38 C.F.R. § 3.303; Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) (“In the absence of proof of a present disability there can be no valid claim.”); 38 C.F.R. § 4.125(a); see also Gilpin v. West, 155 F.3d 1353, 1355 (Fed. Cir. 1998). The claim of entitlement to dermatitis of the fingernails is denied. 6. Entitlement to service connection for short term memory loss The Veteran has not identified any evidence or argument supporting his claim of entitlement to service connection for short term memory loss. An independent review of the record does not reveal evidence that suggests the Veteran has a disability characterized by short-term memory loss. See, e.g., February 2010 Feasibility Worksheet (failing to list memory loss or any such disorder among the Veteran’s disabilities); September 2014 Mental Disorders DBQ (failing to indicate the Veteran has symptoms of memory loss though such symptoms would be expected to be noted in a psychiatric evaluation); March 2008 VA Psychiatry Note (diagnosing schizophrenia, paranoid type, and noting his reports of fantastic stories, but failing to indicate any deficit in memory other than possible delusions/fabrications though such symptoms would be expected to be noted and reported in a psychiatric evaluation); May 2001 Case Development Sheet (“They pointed out that [the Veteran] had trouble understanding, remembering, etc., but I noticed no such difficulties. I found [the Veteran] to be articulate and a good historian.”). Consequently, the evidence is not in equipoise, but the greater weight of the evidence is against finding that the Veteran has a disability consisting of or characterized by short term memory loss. Gilbert, 1 Vet. App. at 53-56. Because the Board finds that the Veteran did not have a condition consisting of or characterized by short term memory loss, the criteria for establishing service connection have not been met. 38 C.F.R. § 3.303; Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) (“In the absence of proof of a present disability there can be no valid claim.”); 38 C.F.R. § 4.125(a); see also Gilpin v. West, 155 F.3d 1353, 1355 (Fed. Cir. 1998). Entitlement to service connection for short term memory loss is denied. Increased Ratings Disability evaluations are assigned to reflect levels of current disability. The appropriate rating is determined by the application of a schedule of ratings which is based on average impairment of earning capacity. Generally, the degrees of disability are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. 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. When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability, such doubt will be resolved in favor of the claimant. 38 C.F.R. § 4.3. When there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. In evaluating claims for increased ratings, VA must evaluate the veteran’s condition with a critical eye toward the lack of usefulness of the body or system in question. 38 C.F.R. § 4.10. VA has considered the level of the veteran’s impairment throughout the entire period on appeal, including the propriety of staged ratings. O’Connell v. Nicholson, 21 Vet. App. 89 (2007). In assigning disability ratings, the evaluation of the same disability under various diagnoses is to be avoided. See 38 C.F.R. § 4.14; Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994); see also VA Gen. Coun. Prec. 9–2004 (Sep. 17, 2004) (“[T]he key consideration in determining whether rating under more than one diagnostic code is in order is whether the ratings under different diagnostic codes would be based on the same manifestation of disability or whether none of the symptomatology upon which the separate ratings would be based is duplicative or overlapping.”). 7. Entitlement to an initial compensation evaluation for bilateral hearing loss and to an evaluation in excess of 10 percent disabling after December 17, 2014 Disability ratings for hearing loss generally must be based on objective audiometric testing of puretone threshold averages and controlled speech discrimination testing (Maryland CNC) by a state-licensed audiologist. 38 C.F.R. § 4.85(a). Under 38 C.F.R. § 4.85(d), the puretone threshold average is the sum of the puretone thresholds at 1000, 2000, 3000 and 4000 Hertz divided by four. These averages, together with the speech recognition ability, are combined pursuant to 38 C.F.R. § 4.85, Table VI, to obtain a Roman numeral designation. In some circumstances, the rating specialist may use Table VIa instead of Table VI. Specifically, Table VIa may be used where the examiner certifies that use of the speech discrimination test was not appropriate because of language difficulties, inconsistent speech discrimination scores, etc., or when indicated under the provisions of 38 C.F.R. § 4.86. See 38 C.F.R. § 4.85(c). Also, in cases presenting exceptional patterns of hearing impairment, a rating specialist may use Table VIa. 38 C.F.R. § 4.86. Exceptional patterns of hearing impairment include circumstances where the hearing thresholds are 55 decibels or more in each of the four frequencies from 1000 to 4000 Hertz or where a veteran has a hearing threshold of less than 30 decibels or less at 1000 Hertz and 70 decibels or more at 2000 Hertz. 38 C.F.R. § 4.86. On the authorized audiological evaluation in April 2012, pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 50 60 60 65 85 LEFT 45 55 50 55 50 The puretone averages (1000-4000 Hz) are, therefore, 68 decibels in the right ear and 53 decibels in the left ear. Speech audiometry revealed speech recognition ability of 72 percent in the right ear and of 100 percent in the left ear. The Veteran has an exceptional pattern of hearing in his right ear as the puretone threshold at each of the four specified frequencies (1000, 2000, 3000, and 4000 Hz) is 55 decibels or more, the higher of the Roman numeral designation using Tables VI and VIa will be used for the right ear, but not the left ear. See 38 C.F.R. § 4.86. Applying Table VI to the above findings, results in a Roman numeral designation of IV for the right ear and a Roman numeral designation of I for the left ear. Using Table VIa, the Roman numeral designation for the right ear is V. Using Roman numerals V and I and Table VII, the April 2012 VA Examination does not warrant awarding any compensable rating. See 38 C.F.R. § 4.85. On the authorized audiological evaluation in February 2015, pure tone thresholds, in decibels, were as follows:   HERTZ 500 1000 2000 3000 4000 RIGHT 50 60 55 55 75 LEFT 55 55 55 60 55 The puretone averages (1000-4000 Hz) are, therefore, 61 decibels in the right ear and 56 decibels in the left ear. Speech audiometry revealed speech recognition ability of 80 percent in the right ear and of 84 percent in the left ear. The Veteran has an exceptional pattern of hearing in his left ear as the puretone threshold at each of the four specified frequencies (1000, 2000, 3000, and 4000 Hz) is 55 decibels or more, the higher of the Roman numeral designation using Tables VI and VIa will be used for the left ear, but not the right ear. See 38 C.F.R. § 4.86. Applying Table VI to the above findings, results in a Roman numeral designation of IV for the right ear and a Roman numeral designation of II for the left ear. Using Table VIa, the Roman numeral designation for the left ear is IV. Using Roman numerals IV for the right ear and IV for the left ear and Table VII, the February 2015 VA Examination supports the award of a 10 percent rating. See 38 C.F.R. § 4.85. The record does not contain the results of any other audiological evaluations that meet the requirements the regulations for rating hearing disabilities. Therefore, the evidence did not support the award of a compensable initial rating. The first competent evidence supporting the award of a compensable rating was the February 2015 VA examination. The RO gave the Veteran the benefit of every doubt and awarded a 10 percent rating effective the date of his most recent application for increased benefits, December 17, 2014. This effective date predates the first evidence supporting the award of a compensable rating, so no earlier date for the award of the 10 percent rating is warranted. The assigned staged ratings are correct based on the available evidence and entitlement to any higher rating is denied. 8. Entitlement to an evaluation in excess of 30 percent disabling until July 11, 2012, and in excess of 60 percent disabling thereafter, for service-connected asthmatic bronchitis The Veteran filed a January 2011 claim seeking an increase in his 30 percent evaluation for service-connected asthmatic bronchitis. The RO denied the claim in a July 2012 Rating Decision. The Veteran did not appeal that decision, but instead filed a new claim of entitlement to an increased rating. The RO also denied that claim in an October 2013 Rating Decision. The Veteran appealed. During the pendency of the appeal, the RO issued a November 2017 Rating Decision assigning a 60 percent rating effective July 11, 2012, based on clear and unmistakable error in the October 2013 Rating Decision. The Veteran has continued his appeal, seeking ratings in excess of 30 percent prior to July 11, 2012, and in excess of 60 percent thereafter. The Veteran has not presented argument or evidence in support of his claim of entitlement to a higher rating. The Veteran’s asthmatic bronchitis is rated under diagnostic code 6602 (bronchial asthma). 38 C.F.R. § 4.97. Under DC 6602, a 30 percent rating is warranted for an FEV-1 of 56 to 70 percent predicted, or; FEV-1/FVC of 56 to 70 percent, or; daily inhalational or oral bronchodilator therapy, or; inhalational anti-inflammatory medication. A 60 percent rating is warranted for an FEV-1 of 40 to 55 percent predicted, or; FEV-1/FVC of 40 to 55 percent, or; at least monthly visits to a physician for required care of exacerbations, or; intermittent (at least three per year) courses of systemic (oral or parenteral) corticosteroids. A 100 percent rating is warranted for an FEV-1 of less than 40 percent predicted, or; FEV-1/FVC of less than 40 percent, or; more than one attack per week with episodes of respiratory failure, or; requires daily use of systemic (oral or parenteral) high dose corticosteroids or immuno-suppressive medications. Prior to July 11, 2012 The record contains the results of a September 2011 VA examination. The examiner noted asthma with symptoms including wheezing and shortness of breath. The examiner stated that the Veteran’s symptoms did not include cough that produces mucus or phlegm or coughing up blood, and had not resulted in anorexia, but did include shortness of breath of moderate severity while being active. The examiner noted daily attacks of asthma, but that the Veteran was able to function “fairly well but not normally” between attacks. The Veteran was treated with anmanex (inhalational therapy) twice per day and albuterol (bronchodilator) three times per day, and Symbicort (inhalational therapy) daily, all with good response. Pulmonary function tests (post-bronchodilator results) revealed an FEV-1 of 58 percent of predicted and FEV-1/FVC of 59 percent. See 38 C.F.R. § 4.96(d)(5) (“When evaluating based on PFT’s, use post-bronchodilator results in applying the evaluation criteria in the rating schedule unless the post-bronchodilator results were poorer than the pre-bronchodilator results. In those cases, use the pre-bronchodilator values for rating purposes.”). The examiner noted the results were abnormal. A DLCO test was needed because the restrictive component was unexpected and of unknown cause. The DLCO results showed decreased diffusing capacity. There was not any disparity between the results of the PFT and DLCO. Chest X-rays were abnormal with mild hyperinflation. The condition affected the Veteran’s usual occupation and daily activities by limiting him to a low level of exertion. VA treatment records prior to July 11, 2012, reflect symptoms and functional limitations that are consistent with those noted in the VA examination, but do not include other PFT results during the period. The PFT values meet the criteria for a 30 percent rating, but do not meet the criteria for any higher rating. The Veteran also used bronchodilator (daily) and inhalational therapy (multiple times daily). These treatments also meet the criteria for a 30 percent rating (e.g., daily inhalational or oral bronchodilator therapy), but do not meet the criteria for a higher rating (e.g., intermittent or daily use of systemic (oral or parenteral) corticosteroids.). The medical evidence is against awarding any rating in excess of 30 percent during the period on appeal prior to July 11, 2012. From July 11, 2012, to the Present The Veteran was again examined in September 2013. The VA examiner noted the use of inhalational bronchodilator therapy daily, inhalational anti-inflammatory medication daily, and several other inhaled medications (tiotropium, budesonide, formoterol, montelukast, albuterol/Proventil). The examiner noted that the Veteran arrived at the examination “having already taken his bronchodilator”, so pre- and post-bronchodilator comparisons were not possible. The examiner stated: “If there is an inaccuracy, it is to overestimate the veteran’s actual FEV-1, however he declined further testing to see whether a lower FEV-1 is in fact present.” PFT testing on July 11, 2012 revealed FEV-1 of 50 percent of predicted and an FEV-1/FVC of 88 percent. The examiner noted there had been no notable changes since the July 2012 testing. The examiner opined that the Veteran’s condition did not impact the Veteran’s ability to work. VA treatment records from July 11, 2012, to the present are consistent with the VA examiner’s findings (including the functional impact of and treatment for the Veteran’s service-connected asthmatic bronchitis). The treatment records do not include additional PFT results. The September 2013 VA examination supports the assignment of a 60 percent rating, but not higher. The FEV-1 of 50 percent, in particular, meets, but does not exceed, the criteria for a 60 percent rating. The daily inhalational therapy would only meet the criteria for a 30 percent rating. The record does not support finding that the Veteran uses systemic (oral or parenteral) corticosteroids (whether intermittently or daily). Therefore, the Veteran does not meet the criteria for a 100 percent rating, the only higher schedular rating available, and does not exhibit symptoms or functional impairments that otherwise exceed the criteria for a 60 percent rating. The medical evidence is against awarding any rating in excess of 60 percent from July 11, 2012, to the present. The Board notes that July 11, 2012, is the first date the medical evidence establishes entitlement to a higher rating. Pursuant to 38 C.F.R. § 3.400(o), the effective date for an increased rating cannot be earlier than the earliest date as of which it is factually ascertainable based on all evidence of record than an increase in disability occurred. Therefore, July 11, 2012, is the proper effective date for the increase in evaluation from 30 percent disabling to 60 percent disabling. Entitlement to an evaluation in excess of 30 percent disabling until July 11, 2012, and in excess of 60 percent disabling thereafter, for service-connected asthmatic bronchitis is denied. Reopening of claims for obstructive sleep apnea, an acquired psychiatric disorder, diabetes mellitus (type 2), and peripheral neuropathy The VA Regional Office (RO) originally denied the claims of entitlement to service connection for obstructive sleep apnea, an acquired psychiatric disorder, diabetes mellitus (type 2), and peripheral neuropathy of the bilateral upper and lower extremities in a July 2012 decision. The Veteran did not appeal that decision, so it is final. 38 U.S.C. § 7104 (West 2014); 38 C.F.R. §§ 20.1100, 20.1104 (2018). A final decision cannot be reopened unless new and material evidence is presented. 38 U.S.C. § 5108. The Secretary must reopen a finally disallowed claim when new and material evidence is presented or secured with respect to that claim. See Shade v. Shinseki, 24 Vet. App. 110, 113 (2010). Evidence is “new and material” if it (1) has not been previously submitted to agency decision makers; (2) relates to an unestablished fact necessary to substantiate the claim; (3) is neither cumulative nor redundant of evidence already of record at the time of the last prior final denial of the claim sought to be opened; and (4) raises a reasonably possibility of substantiating the claim. 38 C.F.R. § 3.156(a). The Veteran submitted a January 2013 claim to reopen in which he asserted entitlement to service connection for various disabilities, including obstructive sleep apnea, an acquired psychiatric disorder, diabetes mellitus (type 2), and peripheral neuropathy of the bilateral upper and lower extremities. The RO denied reopening of each of the claims. The RO determined that new and material evidence had not been submitted sufficient to reopen the claims. See November 2017 Statement of the Case. During the pendency of the appeal, the Veteran has submitted expert opinions and other evidence in support of his claims. See February 2018 Brief (discussing new evidence and establishing additional evidence tending to relate the claimed disabilities to the Veteran’s service-connected disabilities). As discussed with respect to each claim, the evidence is new and material evidence and relates to unestablished elements of his claims, so they will be reopened. 9. Entitlement to service connection for obstructive sleep apnea is reopened. The Veteran has submitted medical evidence supporting the theory that his service-connected asthmatic bronchitis has aggravated his obstructive sleep apnea. See February 2018 Appellant’s Brief (also attaching medical evidence indicating there is some interplay between asthma and obstructive sleep apnea). This evidence is new and material and raises a reasonable possibility of substantiating the claim. The claim is reopened. 10. Entitlement to service connection for an acquired psychiatric disorder is reopened. The Veteran argues that he is entitled to service connection for an acquired psychiatric disorder as secondary to his service-connected disabilities. See February 2018 Appellant’s Brief (“The Veteran should be awarded service connection for depression secondary to his service-connected asthmatic bronchitis, hearing loss, and tinnitus.”). In his brief, he cites to evidence added to the claims file that supports this theory. This evidence is new and material and raises a reasonable possibility of substantiating the claim. The claim is reopened. 11. Entitlement to service connection for diabetes mellitus, type 2 is remanded. The Veteran has submitted additional evidence since the prior final denial of his claim. The evidence submitted by the Veteran is new medical evidence indicating the Veteran’s service-connected asthmatic bronchitis has caused or aggravated his obstructive sleep apnea which has caused or aggravated his diabetes mellitus. February 2018 Appellant’s Brief (attaching and citing evidence added to the record since the most recent final denial of the claim). This evidence is new and material and raises a reasonable possibility of substantiating the claim. The claim is reopened. 12. Entitlement to service connection for peripheral neuropathy of the bilateral upper and lower extremities is reopened. The Veteran’s peripheral neuropathy claims are based on other disabilities not yet service-connected (e.g., diabetes mellitus). The new evidence linking the Veteran’s diabetes mellitus to his service-connected asthmatic bronchitis is material to the peripheral neuropathy claims as there is substantial evidence that the Veteran’s peripheral neuropathy is related to his diabetes. The claim is reopened. Duties to Notify and Assist The Veteran has not raised any specific issues with the duty to notify or duty to assist in regard to the claim decided above. 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). Therefore, the Board does not need to discuss VA’s compliance with the duties to notify and assist with respect to the claims decided above. REASONS FOR REMAND 1. Entitlement to service connection for obstructive sleep apnea is remanded. The Veteran has submitted medical evidence supporting the theory that his service-connected asthmatic bronchitis has aggravated his obstructive sleep apnea. See February 2018 Appellant’s Brief (also attaching medical evidence indicating there is some interplay between asthma and obstructive sleep apnea). Although the record contains a VA examination and nexus opinion obtained in connection with the claim denied in 2012, the opinion is inadequate. To resolve this matter on the merits, the Board requires an adequate VA opinion. Specifically, the VA examiner opined “[t]here is no cause and effect relationship between asthma and Obstructive Sleep Apnea,” but did not address whether the Veteran’s obstructive sleep apnea was aggravated by his service-connected asthma. May 2012 VA Examination; Allen v. Brown, 7 Vet. App. 439, 448-49 (1995) (holding that an opinion obtained regarding secondary service connection must address both causation and aggravation of the nonservice-connected condition); 38 C.F.R. § 3.310. An adequate opinion is necessary to decide the claim. See Allen, 7 Vet. App. at 448-49; Stefl v. Nicholson, 21 Vet. App. 120, 123-24 (2007); Barr v. Nicholson, 21 Vet. App. 303, 311-12 (2007). The Board must remand the claim for an opinion that adequately addresses the secondary service connection theory raised by the Veteran. 2. Entitlement to service connection for an acquired psychiatric disorder The Veteran argues that he is entitled to service connection for an acquired psychiatric disorder as secondary to his service-connected disabilities. See February 2018 Appellant’s Brief (“The Veteran should be awarded service connection for depression secondary to his service-connected asthmatic bronchitis, hearing loss, and tinnitus.”). He has not had a VA examination. The record contains evidence of multiple acquired psychiatric disorders. See February 2010 Feasibility Worksheet (including among the Veteran’s disabilities, PTSD, anxiety, and personality disorder NOS). The Veteran’s filings in this matter have also sought service connection for a personality disorder. See, e.g., January 2013 VA 21-4138 (“I would like to file for service connected disability for…atypical depression/personality disorder…”). In order to ensure there is sufficient medical evidence to decide the Veteran’s entire claim on the merits (including the nature and etiology of each of the Veteran’s acquired psychiatric disorders), remand is required to afford the Veteran a VA examination. See Clemons v. Shinseki, 23 Vet. App. 1, 9 (2009). The Board cannot make a fully-informed decision on the issue of entitlement to service connection for an acquired psychiatric disorder because no VA examiner has opined whether the Veteran’s current acquired psychiatric disorder(s) is/are related to his active service and/or was/have been caused or aggravated by his service-conneced disabilities. 3. Entitlement to service connection for diabetes mellitus, type 2 is remanded. There was a prior final decision on the issue of entitlement to service connection for diabetes mellitus in July 2012. The Veteran has since submitted additional evidence, particularly including the February 2018 Appellant’s Brief and evidence attached thereto. The AOJ denied reopening and did not consider the merits of the service connection claim; however, the Veteran has submitted new medical evidence indicating the Veteran’s service-connected asthmatic bronchitis has caused or aggravated his obstructive sleep apnea which has caused or aggravated his diabetes mellitus. February 2018 Appellant’s Brief (attaching and citing evidence added to the record since the most recent final denial of the claim). The evidence is sufficient to reopen the claim. 38 C.F.R. § 3.156. However, for the following reasons, remand is required prior to a decision on the merits. The Veteran argues that his obstructive sleep apnea “has contributed to and aggravates his…type II diabetes mellitus.” February 2018 Appellant’s Brief. The Veteran is not yet service-connected for obstructive sleep apnea, but that claim is being remanded for further development and readjudication. Because a decision on the remanded issue of entitlement to service connection for obstructive sleep apnea could significantly impact a decision on the issue of entitlement to service connection for diabetes mellitus, the issues are inextricably intertwined. A remand of the claim of entitlement to service connection for diabetes mellitus, type 2, is required. 4. Entitlement to service connection for chronic kidney disease is remanded. The Veteran argues that his obstructive sleep apnea “has contributed to and aggravates his…type II diabetes mellitus” which he argues “precipitated and permanently aggravates his chronic kidney disease.” See February 2018 Appellant’s Brief. The Veteran is not yet service-connected for obstructive sleep apnea or diabetes mellitus, but those claims are being remanded for further development and readjudication. Because a decision on the remanded issues of entitlement to service connection for obstructive sleep apnea and diabetes mellitus could significantly impact a decision on the issue of entitlement to service connection for chronic kidney disease, the issues are inextricably intertwined. A remand of the claim of entitlement to service connection for chronic kidney disease is required. 5. Entitlement to service connection for erectile dysfunction is remanded. The Veteran’s erectile dysfunction claim is based on other disabilities not yet service-connected (e.g., diabetes mellitus). Because a decision on the remanded issues of entitlement to service connection for obstructive sleep apnea and diabetes mellitus could significantly impact a decision on the issue of entitlement to service connection for erectile dysfunction, the issues are inextricably intertwined. A remand of the claim of entitlement to service connection for erectile dysfunction is required. 6. Entitlement to service connection for peripheral neuropathy of the bilateral upper and lower extremities is remanded. The Veteran’s peripheral neuropathy claims are based on other disabilities not yet service-connected (e.g., diabetes mellitus). Because a decision on the remanded issues of entitlement to service connection for obstructive sleep apnea and diabetes mellitus could significantly impact a decision on the issue of entitlement to service connection for peripheral neuropathy, the issues are inextricably intertwined. A remand of the claim of entitlement to service connection for peripheral neuropathy of the bilateral upper and lower extremities is required. 7. Entitlement to service connection for edema of the bilateral lower extremities The available treatment records occasional edema of the bilateral lower extremities during the appeal period. See, e.g., March 2015 Renal Inpatient Note (“LL trace edema”); March 2015 VA Progress Note (“Exam…Ext: 1+ LE edema bilat…”); March 2017 VA Podiatry Note (“Edema noted perimalleolar [ankle] b/l.”). The records indicate that this may be associated with the Veteran’s diabetes and/or chronic kidney disease. Because a decision on the remanded issues of entitlement to service connection for obstructive sleep apnea, diabetes mellitus, and/or chronic kidney disease could significantly impact a decision on the issue of entitlement to service connection for edema of the bilateral lower extremities, the issues are inextricably intertwined. A remand of the claim of entitlement to service connection for edema of the bilateral lower extremities is required. 8. Entitlement to a total disability rating based on individual unemployability The Veteran’s claim of entitlement to a TDIU is significantly based on his remanded service connection claims. Particularly because the additional examinations required will provide significant relevant evidence (whether the other remanded claims are granted or not), it is most appropriate to remand the TDIU claim. The TDIU claim is inextricably intertwined with the above-remanded claims, so remand is required for readjudication of the TDIU claim in light of the development and resolution of those claims. The matters are REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records for the period from October 2017 to the Present. 2. Send the Veteran a VA Form 21-8940 (Application for increased compensation based on unemployability) and request that he return the completed form to VA in a timely manner. 3. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s obstructive sleep apnea is at least as likely as not proximately due to his service-connected disabilities (particularly including his asthmatic bronchitis) or, if not, whether his obstructive sleep apnea is at least as likely as not aggravated beyond its natural progression by his service-connected disabilities (particularly including his asthmatic bronchitis). It would be helpful if the examiner commented on the areas of agreement and disagreement with the opinion of Homer Skaggs, M.D., and the medical literature he cited and as referenced in the February 2018 Appellant’s Brief. 4. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any acquired psychiatric disability. The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease. The examiner should also opine on whether it is at least as likely as not (1) proximately due to service-connected disability (including hearing loss and asthmatic bronchitis), or (2) aggravated beyond its natural progression by service-connected disability. In rendering the requested opinions, it would be helpful if the examiner commented on the areas of agreement and disagreement with the opinion of Heather Henderson-Galligan, Ph.D., HSPP, and the medical literature she cited all of which are referenced in the February 2018 Appellant’s Brief. 5. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of the Veteran’s diabetes mellitus, type 2. The examiner must opine whether his diabetes mellitus is at least as likely as not (1) proximately due to the Veteran’s obstructive sleep apnea, or (2) aggravated beyond its natural progression by obstructive sleep apnea. In rendering the requested opinions, it would be helpful if the examiner commented on the areas of agreement and disagreement with the opinion of Homer Skaggs, M.D., and the medical literature he cited and as referenced in the February 2018 Appellant’s Brief. 6. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of the Veteran’s chronic kidney disease. The examiner must opine whether his chronic kidney disease is at least as likely as not (1) proximately due to the Veteran’s diabetes mellitus, or (2) aggravated beyond its natural progression by diabetes mellitus. In rendering the requested opinions, it would be helpful if the examiner commented on the areas of agreement and disagreement with the opinion of Homer Skaggs, M.D., and the medical literature he cited all of which is referenced in the February 2018 Appellant’s Brief. 7. After reviewing the above opinions, determine whether any further opinions are needed to address the remaining claims. MICHELLE L. KANE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Kerry Hubers, Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.