Citation Nr: 20004827 Decision Date: 01/21/20 Archive Date: 01/21/20 DOCKET NO. 17-25 111 DATE: January 21, 2020 ORDER New and material evidence has been received sufficient to reopen a previously denied claim of service connection for an acquired psychiatric disorder characterized as depression, the appeal is granted to this extent only. New and material evidence has been received sufficient to reopen a previously denied claim of service connection for lumbar spine disorder, the appeal is granted to this extent only. Entitlement to service connection for a left ankle disorder is denied. Entitlement to service connection for bilateral numbness of the feet is denied. Entitlement to service connection for bilateral knee disorders is denied. Entitlement to service connection for bilateral hip disorders is denied. Entitlement to an increased initial disability evaluation in excess of 10 percent for right-shin splints is denied. Entitlement to an increased initial disability evaluation in excess of 10 percent for left-shin splints is denied. REMANDED Entitlement to service connection for an acquired psychiatric disorder, to include depression, is remanded. Entitlement to service connection for lumbar spine disorder is remanded. Entitlement to an increased disability evaluation in excess of 10 percent for sinusitis, to include allergic rhinitis, is remanded. FINDINGS OF FACT 1. A June 2009 rating decision denied service connection for depression, as secondary to service-connected bilateral shin splints, the Veteran received notice of the decision and she did not file a timely appeal. 2. Evidence received since the June 2009 rating decision is not cumulative, it relates to an unestablished fact necessary to substantiate the claim and it raises a reasonable possibility of substantiating the claim. 3. A June 2009 rating decision denied service connection for lumbar spine disorder, as secondary to service-connected bilateral shin splints, the Veteran received notice of the decision and she did not file a timely appeal. 4. Evidence received since the June 2009 rating decision is not cumulative, it relates to an unestablished fact necessary to substantiate the claim and it raises a reasonable possibility of substantiating the claim. 5. A chronic left ankle disorder was not shown in service, any current disorder was not shown to be related to service or service-connected disability, any arthritis was first shown more than 1 year after service separation. 6. Bilateral numbness of the feet was not shown in service and is not currently clinically established. 7. Chronic bilateral knee disorders were not shown in service, any current knee disorder is not shown to be related to service or service-connected disability, any arthritis was first shown more than 1 year following service separation. 8. Chronic bilateral hip disorders were not shown in service, any current hip disorder is not shown to be related to service or service-connected disability, any arthritis was first shown more than 1 year following service separation. 9. The objective medical evidence shows during the period on appeal right-shin splints did not more closely approximate malunion of the tibia and fibula with moderate knee or ankle disability, malunion of the tibia and fibula with marked knee or ankle disability or nonunion of the tibia and fibula with loose motion, requiring a brace. 10. The objective medical evidence shows during the period on appeal left-shin splints did not more closely approximate malunion of the tibia and fibula with moderate knee or ankle disability, malunion of the tibia and fibula with marked knee or ankle disability or nonunion of the tibia and fibula with loose motion, requiring a brace. CONCLUSIONS OF LAW 1. The June 2009 denial of the claim of service connection for depression, to include as secondary to service-connected bilateral shin splints, is final. 38 U.S.C. § 7104 (2012); 38 C.F.R. §§ 3.156, 20.1100 (2018). 2. New and material evidence has been received to reopen the previously denied claim of service connection for an acquired psychiatric disorder, characterized as depression, as secondary to service-connected bilateral shin splints. 38 U.S.C. §§ 5103, 5103A, 5107, 5108 (2012); 38 C.F.R. § 3.156 (2018). 3. The June 2009 denial of the claim of service connection for lumbar spine disorder, as secondary to service-connected bilateral shin splints, is final. 38 U.S.C. § 7104 (2012); 38 C.F.R. §§ 3.156, 20.1100 (2018). 4. New and material evidence has been received to reopen the previously denied and final claim of service connection for lumbar spine disorder, as secondary to service-connected bilateral shin splints. 38 U.S.C. §§ 5103, 5103A, 5107, 5108 (2012); 38 C.F.R. § 3.156 (2018). 5. The criteria for service connection for a left ankle disorder have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310 (2018). 6. The criteria for service connection for numbness of the feet have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.310 (2018). 7. The criteria for service connection for bilateral knee disorders have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310 (2018). 8. The criteria for service connection for bilateral hip disorders have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310 (2018). 9. The criteria for an increased initial disability evaluation in excess of 10 percent for right-shin splints are not met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.3, 4.7, 4.71a, Diagnostic Code 5262 (2018). 10. The criteria for an increased initial disability evaluation in excess of 10 percent for left-shin splints are not met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.3, 4.7, 4.71a, Diagnostic Code 5262 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service in the United States Marine Corps from March 2001 to March 2003. In October 2019, the Veteran and her mother testified at a videoconference Board hearing before the undersigned Veterans Law Judge. A transcript of that hearing is of record. 1. Whether new and material evidence has been received sufficient to reopen a claim for an acquired psychiatric disorder, characterized as depression. 2. Whether new and material evidence has been received sufficient to reopen a claim for lumbar spine disorder. In general, rating decisions that are not timely appealed are final. 38 U.S.C. § 7105; 38 C.F.R. §§ 20.1103, 20.1105. Pursuant to 38 U.S.C. § 5108, a finally disallowed claim may be reopened when new and material evidence is presented or secured to that claim. New evidence is evidence not previously submitted to agency decision makers. Material evidence means existing evidence which, 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. The credibility of the evidence is presumed and the threshold for submission is low. Justus v. Principi, 3 Vet. App. 510, 513 (1992); Shade v. Shinseki, 24 Vet. App. 110, 117-18 (2010). The Board notes in its review of the record that the last final decision denying the claim for service connection for depression and for lumbar spine disorder is in June 2009. A notification letter for both denials was sent to the Veteran a day later. The Veteran did not appeal the decision within one year of receiving notification and the decision became final. The Veteran submitted in August 2016 a Statement in Support of Claim and a statement accompanying her Notice of Disagreement indicating her desire that each claim be reopened. A May 2017 Statement of the Case (SOC) reopened the claim for service connection for depression on the submission of evidence which the Agency of Original Jurisdiction (AOJ) considered new and material. A second SOC in May 2017 denied the claim for service connection for lumbar spine disorder for lack of new and material evidence, but, in addressing the merits of the claim at some length, in effect reopened the claim. Regardless of a decision by the AOJ to reopen or its reopening by a discussion of the merits, the Board must make its own determination, as this in turn establishes the Board’s jurisdiction to reach the underlying claim and to adjudicate the claim de novo. See Woehlaert v. Nicholson, 21 Vet. App. 456, 460-61 (2007) (citing Barnett v. Brown, 83 F.3d 1380, 1383 (Fed. Cir. 1996), aff’g, 8 Vet. App. 1 (1995)). On this basis and looking to the original decision denying the claims in June 2009, new and material evidence would consist of medical evidence showing a diagnosed disability or treatment for depression or that it is related to the service-connected bilateral shin splints, and medical evidence showing lumbar spine disorder is related to active service. Since the June 2009 rating decision, the record now includes an October 2016 VA examination for mental disorders and an October 2011 VA examination for lumbar spine disorder. The Board finds this evidence was not of record at the time of the rating decision and is therefore new. Moreover, it is material, as it provides information possibly supporting the Veteran’s assertions and thereby presents a reasonable possibility of substantiating the claim. The evidence is neither cumulative nor redundant of the evidence previously of record and it is pertinent to the issues on which the Veteran’s claim will turn. For these reasons, the claims are reopened. Service Connection Service connection may be established for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110. Service connection may be presumed for certain diseases, including arthritis, that are manifested to a compensable degree within 1 year following separation from qualifying service. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. Service connection may be granted for any disability that is proximately due to, the result of, or aggravated by a service-connected disability.38 C.F.R. § 3.310. 3. Entitlement to service connection for a left ankle disorder. 4. Entitlement to service connection for bilateral numbness of the feet. 5. Entitlement to service connection for bilateral knee disorders. 6. Entitlement to service connection for bilateral hip disorders. The record reveals that the Veteran has been service connected for migraines, rated 30 percent disabling; left shin splints, rated 10 percent disabling; right shin splints, rated 10 percent disabling; tinnitus, rated 10 percent disabling; allergic rhinitis, rated 10 percent disabling; and bilateral hearing loss rated noncompenably disabling. Review of the service treatment records reveals no complaints, findings, or diagnoses of a left ankle disorder, numbness of the feet, bilateral knee or hip impairment. At the time of examination from service, multiple problems were listed, but the Veteran specifically denied foot problems, knee, hip, or ankle problems, arthritis, and bone or joint deformity. She did report swollen or painful joints, but further elaboration is not on file. Post-service treatment records reveal pertinent complaints first recorded several years after service. As to foot numbness while it is complained of, there are no clinical findings made. Thus, while there are complaints, no functional impairment has been attributed to the complaints, and as such there is no disability manifested by these complaints of numbness to service connect. To the extent impairment of the left ankle, knees and hips are shown. The objective evidence fails to show that any of these disorders are related to service. As pertinent, the file contains negative opinions, without positive findings. Where appropriate the disorders have been found unrelated to service or to any service-connected disability, to include shin splints. Moreover, to the extent there was arthritis found in any of these joints, the first manifestation of arthritis was several years following separation from active service and it has not been otherwise attributed to service or to service-connected disability. As the evidence preponderates against these claims, they must be denied. 38 U.S.C. §5107. Increased Schedular Ratings Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (rating schedule), found in 38 C.F.R. Part 4. When a reasonable doubt arises regarding the degree of disability, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. 38 C.F.R. § 4.7. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Additionally, it is possible for a veteran to be awarded separate percentage evaluations for separate periods (staged ratings), based on the facts. See Fenderson v. West, 12 Vet. App. 119, 126–27 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). The rating schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of, or incident to, military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.1 (2018). In considering the severity of a disability, it is essential to trace the medical history of the veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41; Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Consideration of the whole-recorded history is necessary so that a rating may accurately reflect the elements of disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Where an increase in the disability rating is at issue, the present level of the veteran’s disability is the primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994).   3. Entitlement to an increased initial disability evaluation in excess of 10 percent for right-shin splints. 4. Entitlement to an increased initial disability evaluation in excess of 10 percent for left-shin splints. An October 2005 rating decision granted service connection for right and left-shin splints at a 10 percent disability evaluation for each. Both disorders are rated under Diagnostic Code 5262. The Board further notes in passing that these claims were addressed and the evidence below was considered in the most recent adjudication by the AOJ in its December 2018 Supplemental Statement of the Case (SSOC). The evidence and analysis for the issues of entitlement to an increased rating for right and left-shin splints are largely similar and, at times, the Board may refer to the disorders as bilateral shin splints. Under Diagnostic Code 5262, a 10 percent disability rating is warranted for malunion of the tibia and fibula with slight knee or ankle disability; a 20 percent disability rating is warranted for malunion of the tibia and fibula with moderate knee or ankle disability; a 30 percent disability rating is warranted for malunion of the tibia and fibula with marked knee or ankle disability; and a maximum schedular 40 percent disability rating is warranted for nonunion of the tibia and fibula with loose motion, requiring a brace. 38 C.F.R. § 4.71a, Diagnostic Code 5262. In an effort to afford the Veteran the highest possible rating, the Board has also considered whether any other rating criteria are applicable. The assignment of a particular diagnostic code is “completely dependent on the facts of a particular case.” Butts v. Brown, 5 Vet. App. 532, 538 (1993). One diagnostic code may be more appropriate than another based on such factors as an individual’s relevant medical history, the current diagnosis and demonstrated symptomatology. See Pernorio v. Derwinski, 2 Vet. App. 625, 629 (1992). Thus, the Board has considered the propriety of assigning a higher or separate rating under another diagnostic code. See Tedeschi v. Brown, 7 Vet. App. 411, 414 (1995). However, for the reasons discussed below, possibly related or analogous diagnostic codes, appearing with Diagnostic Code 5262 in the range of diagnostic codes of 5256 through 5263 for knee and leg disorders, are not conceivably applicable, as the medical evidence of record does not indicate reports, complaints, treatment, or diagnoses of knee ankylosis (Diagnostic Code 5256), knee-subluxation or lateral instability (5257), dislocated knee cartilage (5258), or genu recurvatum (back bending knee) (5263). The range of motion findings for flexion and extension addressed in Diagnostic Codes 5260 and 5261, although such findings are made in the June 2018 VA examination for knee and lower-leg conditions, first, belong more properly to the determination of the Veteran’s claims of service connection for right and left-knee disorders. Second, the findings are relevant when considered in conjunction with the June 2018 VA examiner’s findings pertaining to shin splints, discussed below, regarding which she comments that shin splints, although diagnosed in 2001, are now “resolved” and there is no evidence of chronicity of shin splints on that day’s examination. Looking to the record, it also contains a June 2018 VA examination for ankle conditions, in which the VA examiner first found the Veteran has bilateral shin splints and further found they do not affect the range of motion of the ankle of the range of motion of the knee. She further commented, “X-rays on the day of exam were not clinically indicated. Veteran had no pain or tenderness along entire length of anterior tibia confirming no recent medial tibial stress or shin splints.” In opining negatively as to secondary causation of left-ankle disorder due to shin splints, the June 2018 VA examiner stated the following regarding the Veteran’s shin splints: Shin splints were diagnosed bilaterally while veteran was in boot camp. This is a common ailment in athletes who train too fast and in military recruits who abruptly increase their level of activity. Shin splints or Medial Tibial stress syndrome is an inflammation of the muscles, tendons and bone tissue which causes diffuse pain along the length of the tibial shaft; there is no focal bony swelling or tenderness. With rest, it usually heals within days or weeks. Conversely, a focal, palpable area of tenderness is present in most patients with a stress fracture of the tibia. This will heal within 6 months. The veteran has neither today. She had no pain along the tibial shaft. She had normal leg X-rays on 7/27/2001 and 2/2009. There is no medical literature that suggests a history of shin splints will cause ankle injury or osteoarthritis in the foot. Medical Source: UPTODATE: 1.Beck BR. Tibial stress injuries. An aetiological review for the purposes of guiding management. Sports Med 1998; 26:265.2.Niva MH, Kiuru MJ, Haataja R, Pihlajamäki HK. Bone stress injuries causing exercise-induced knee pain. Am J Sports Med 2006; 34[.] The same VA examiner conducted the June 2018 VA examination for knee and lower-leg conditions, in which, once again, she found the Veteran has bilateral shin splints and further found they do not affect the range of motion of the ankle of the range of motion of the knee. As already stated, she commented: “Shin splints diagnosed bilaterally in 2001 – resolved” and added, “No evidence of chronicity of shin splints today on exam.” She opined negatively as to secondary causation of left-knee disorder due to shin splints and re-stated the first eight sentences of the left-ankle opinion rationale, above, adding the following: There is no medical literature that suggests a history of shin splints will cause chondromalacia or ACL [anterior cruciate ligament] tears. Medical Source: UPTODATE: 1.Beck BR. Tibial stress injuries. An aetiological review for the purposes of guiding management. Sports Med 1998; 26:265.2.Niva MH, Kiuru MJ, Haataja R, Pihlajamäki HK. Bone stress injuries causing exercise-induced knee pain. Am J Sports Med 2006; 34 (pg. 356). MRI in 9/2016 showed no meniscus tear; minimal fibrous tearing of ACL and chondromalacia-(degeneration of cartilage under knee cap)[.] It is more likely that the veteran’s knee conditions are related to falls occurred after service, aging and wear and tear as she uses stairs at work for exercise. Medical resource: UPTODATE; chondromalacia patella[.]   Other Considerations The Veteran’s representative has asserted at the October 2019 Board hearing that the symptoms of Veteran’s shin splints are of a severity as not to be properly reflected in the rating criteria of Diagnostic Code 5262. The Veteran testified that she experiences aching pain down to the bone; her walking distance is therefore limited; she is forced to sit due to pain; pain is exacerbated in cold weather and rainy weather; icing, wrapping and pain medications are ineffective; her activities of daily living are limited; and the Veteran testified “[i]t’s hard to go to work” and it is becoming harder, but she further testified that she works through it. The Veteran’s representative stated at the hearing that extra-schedular consideration is applicable because the Veteran’s 10 percent for each shin splint “is the maximum” available to her under Diagnostic Code 5262. This is not correct. A set forth above, there are 20 percent, 30 percent and 40 percent evaluations available, depending, of course, on the sufficiency of the medical evidence in the record. Consideration of an extraschedular rating requires a three-step inquiry. The first question is whether the schedular rating criteria adequately contemplate the veteran’s disability picture. If the schedular evaluation does not contemplate the level of disability and symptomatology shown and is found inadequate, then the second inquiry is whether the exceptional disability picture exhibits other related factors, such as marked interference with employment or frequent periods of hospitalization. See Thun v. Peake, 22 Vet. App. 111 (2008). The first Thun element compares a claimant’s symptoms to the rating criteria, while the second addresses the resulting effects of those symptoms. Thus, the first and second Thun elements, although interrelated, involve separate and distinct analyses. Yancy v. McDonald, 27 Vet. App. 484, 495 (2016). If the veteran’s disability picture satisfies the requirements of the second inquiry, then the third step is to refer the case to the Director of Compensation Service to determine whether an extraschedular rating is warranted. See Thun, 22 Vet. App. 111. See also 38 C.F.R. § 321 (b)(1). To summarize, the foregoing assertions made during the hearing raise the questions of whether the Veteran’s disability picture is more nearly approximated by the criteria of the assigned rating under the diagnostic code and whether the overall disability picture is otherwise exceptional or unusual when looking to other related factors. In regard to the first element, comparison of the Veteran’s symptoms and associated functional impairment does not show that the rating criteria are inadequate to describe his disability picture. The Board notes briefly that the October 2005 rating decision granted service connection for each shin splint and a 10 percent disability evaluation was assigned for painful or limited motion of a major joint or group of minor joints. As explained in the rating decision, “painful or limited motion” is not specifically listed in the rating schedule and such a rating was therefore rendered as being analogous to a disability for which not only the functions affected, but the anatomical localization and symptoms, are closely related. Even though such evaluation criteria are found outside Diagnostic Code 5262, nonetheless “painful or limited motion” address the very symptoms to which the Veteran has testified: Pain and pain on movement, thereby limiting movement. However, the Veteran does not otherwise assert and the medical evidence does not indicate that there is a malunion of the tibia and fibula with moderate knee or ankle disability or marked disability in those joints, nor is there evidence of a nonunion of the tibia and fibula, all of which would be the bases of higher evaluations under Diagnostic Code 5262. For example, the June 2018 VA examination for ankle conditions and knee and lower leg conditions both contain findings that the Veteran’s shin splints do not affect the range of motion of either ankles or knees. As already stated, higher evaluations under Diagnostic Code 5262 are based specifically on the degree of severity of the effect of shin splints on the ankles or knees. The record in fact offers no findings to indicate that the schedular rating criteria do not adequately contemplate the level of disability and symptomatology of the veteran’s shin splints. Consequently, the inquiry of consideration of the availability of extra-schedular consideration need not continue further. However, at this point the Board will emphasize that consideration of whether the Veteran’s disability picture is adequately contemplated by the rating criteria is very much informed by the overarching fact that the Veteran has not offered evidence and did not testify to the cessation of or marked interference with her employment due to the symptoms of shin splints. Although such a finding more properly belongs to the continuation of consideration for referral to the Director of Competence Service for extra-schedular consideration, nonetheless, as stated above, the Veteran testified she works through pain and discomfort and has offered no evidence of frequent periods of hospitalization. Based on the evidence of record, the Veteran’s symptoms of shin splints are reasonably contemplated by the Diagnostic Code 5292. The threshold issue under Thun is thus not met and further consideration of an extraschedular rating is not warranted. For the foregoing reasons and based on the objective medical evidence, the Board finds a preponderance of evidence is against the claim for an increased disability rating in excess of 10 percent for right-shin splints and left-shin splints. The Board has considered the benefit-of-the-doubt doctrine; however, the Board does not perceive an approximate balance of positive and negative evidence. As the preponderance of the evidence is against the claim, the doctrine is not applicable and the claim must be denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 4.3. REASONS FOR REMAND 1. Entitlement to service connection for an acquired psychiatric disorder, to include depression. The evidence of record shows an October 2016 VA examination for mental disorders, in which an opinion is rendered only addressing depressive disorder as secondary to bilateral tinnitus. Because the lengthy record of treatment for this disorder indicates that the Veteran has asserted at different times several bases of secondary causation, a VA examination with an opinion or opinions addressing secondary causation due to any service-connected disability is warranted for the Board to proceed properly to a determination of the claim. See McLendon v. Nicholson, 20 Vet. App. 79, 81-83 (2006). See also 38 U.S.C. § 5103A (d)(2); 38 C.F.R. § 3.159 (c)(4)(i). 2. Entitlement to service connection for lumbar spine disorder. The evidence of record shows a VA examination for lumbar spine disorder only from October 2011. However, the October 2011 VA examiner, although able to diagnose the disorder, was unable to offer an opinion regarding service connection, as “no records [were] available for review.” Once again, there is insufficient competent medical evidence on file, particularly regarding an opinion or opinions for direct and secondary service connection, for a determination of the claim. See McLendon at 81-83 (2006). See also 38 U.S.C. § 5103A (d)(2); 38 C.F.R. § 3.159 (c)(4)(i). Remand for a VA examination and opinions is therefore necessary. 3. Entitlement to an increased disability evaluation in excess of 10 percent for sinusitis, to include allergic rhinitis. The evidence of record for this claim contains a January 2016 VA examination for sinusitis, well preceding the period on appeal. However, even if considered, the record would remain insufficient for competent medical evidence on file of current findings reflecting the nature, extent and current severity of the Veteran’s disability for a determination of the claim, particularly so, as a VA primary care note in May 2018 has noted its diagnostic impression “[p]aranasal sinus disease, especially confluent within the ethmoids,” suggesting possibly complex developments of this disorder. Once again, under McLendon, a VA examination is required for current findings for the proper and fair determination of this claim. The matters are REMANDED for the following action: 1. Contact the Veteran and her representative for information pertaining to any current treatment for an acquired psychiatric disorder, to include depression, for lumbar spine disorder and for sinusitis, to include allergic rhinitis, at any VA facility and by any private treatment provider. Obtain any records of the above treatments not yet associated with the claims file and associate them with the claims file. The assistance of the Veteran and/or her representative should be requested in obtaining any records of recent treatment as indicated. All attempts to obtain records should be documented in the claims file. 2. After all additional records have been obtained and associated with the claims file, but whether or not records are obtained, arrange for examinations conducted by VA examiners with appropriate specialties for producing findings for an acquired psychiatric disorder, to include depression, for lumbar spine disorder and for sinusitis, to include allergic rhinitis. The complete electronic claims file must be made available to the examiners in conjunction with the examinations. The examiners should detail all findings. The examiners are requested to provide, based on appropriate testing, findings and diagnoses as to the nature, and etiology of an acquired psychiatric disorder, to include depression, and for lumbar spine disorder, and determine the nature and severity of the service-connected nasal pathology. The examiner for an acquired psychiatric disorder, to include depression, is further requested to render opinions addressing the following: (a) Whether it is at least as likely as not (a 50 percent or more probability) or less likely than not (less than a 50 percent probability) that an acquired psychiatric disorder, to include depression, is caused by an event, injury or illness during active service. (b) Whether it is at least as likely as not (a 50 percent or more probability) or less likely than not (less than a 50 percent probability) that an acquired psychiatric disorder, to include depression, is proximately due to, the result of or made worse beyond its natural progression (secondarily caused) by any of the Veteran’s service-connected disorders. Each opinion must be supported by a rationale explaining the reasons for the conclusions of the opinion, with reference to findings on examination, clinical findings in the record and/or reference to accepted medical literature. The examiner for lumbar spine disorder is requested to render opinions addressing the following: (a) Whether it is at least as likely as not (a 50 percent or more probability) or less likely than not (less than a 50 percent probability) that lumbar spine disorder is caused by an event, injury or illness during active service. (b) Whether it is at least as likely as not (a 50 percent or more probability) or less likely than not (less than a 50 percent probability) that lumbar spine disorder is proximately due to, the result of or made worse beyond its natural progression (secondarily caused) by service-connected right and left-shin splints or any of the Veteran’s other service-connected disorders. Each opinion must be supported by a rationale explaining the reasons for the conclusions of the opinion, with reference to findings on examination, clinical findings in the record and/or reference to accepted medical literature. All examiners are also requested to comment on all opinions in the record, as well as to acknowledge, address, consider, and discuss all lay evidence of the Veteran, to include her reports to treatment providers, as they appear throughout the record, as well as all lay evidence of other persons, as it pertains to an acquired psychiatric disorder, to include depression, to lumbar spine disorder and to sinusitis, to include allergic rhinitis. 3. After completing the above development and any other indicated development, readjudicate the claims in accordance with applicable provisions. MICHAEL D. LYON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board P. Franke, Associate 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.