Citation Nr: 20021518 Decision Date: 03/26/20 Archive Date: 03/26/20 DOCKET NO. 17-45 246 DATE: March 26, 2020 ORDER Entitlement to an effective date earlier than May 30, 2015, for the grant of service connection for tinnitus is denied. Entitlement to an initial disability rating in excess of 10 percent for tinnitus is denied. Entitlement to service connection for bilateral flat feet is granted. Entitlement to service connection for left heel spur as secondary to bilateral plantar fasciitis by way of causation is granted. Entitlement to a total disability rating based on individual unemployability (TDIU) effective March 25, 2016, is granted, subject to the laws and regulations governing the payment of monetary benefits. REMANDED Entitlement to increased disability ratings for posttraumatic stress disorder (PTSD) with depression, anxiety, and alcohol dependence, formerly rated as adjustment disorder with anxiety, rated as 70 percent disabling since May 30, 2015, and 30 percent disabling prior to May 30, 2015, is remanded. Entitlement to increased disability ratings for lumbar spine strain, rated as 20 percent disabling since August 11, 2014, and 10 percent disabling prior to August 11, 2014, is remanded. Entitlement to a disability rating in excess of 10 percent for right ankle strain is remanded. Entitlement to a disability rating in excess of 10 percent for bilateral planter fasciitis is remanded. Entitlement to increased disability ratings for allergic rhinitis, rated as 10 percent disabling since May 30, 2015, and zero percent disabling prior to May 30, 2015, is remanded. Entitlement to increased disability ratings for tinea versicolor, rated as 30 percent disabling since May 30, 2015, and 10 percent disabling prior to May 30, 2015, is remanded. Entitlement to a compensable disability rating for right hallux valgus with metatarsal primus varus and bunions is remanded. Entitlement to a compensable disability rating for left hallux valgus with metatarsal primus varus and bunions is remanded. Entitlement to a compensable disability rating for right hammertoe of the third toe is remanded. Entitlement to a compensable disability rating for left hammertoe of the third toe is remanded. Entitlement to service connection for a left wrist disability is remanded. Entitlement to service connection for hearing loss is remanded. Entitlement to service connection for asthma, to include secondary to allergic rhinitis, is remanded. Entitlement to service connection for gastroesophageal reflux disease (GERD) is remanded. Entitlement to service connection for osteopenia is remanded. Entitlement to service connection for a right hip disability, to include as due to an undiagnosed illness, is remanded. Entitlement to service connection for a left hip disability, to include as due to an undiagnosed illness, is remanded. Entitlement to service connection for a right knee disability, to include as due to an undiagnosed illness, is remanded. Entitlement to service connection for a left knee disability, to include as due to an undiagnosed illness, is remanded. Entitlement to service connection for a left ankle disability, to include as due to an undiagnosed illness, is remanded. Entitlement to service connection for a right foot disability – to include degenerative arthritis, fibromatosis, and heel spur; and as secondary to service-connected bilateral flat feet, left heel spur, bilateral plantar fasciitis, bilateral hallux valgus, and bilateral hammertoes – is remanded. Entitlement to service connection for a left foot disability – to include degenerative arthritis and fibromatosis and as secondary to service-connected bilateral flat feet, left heel spur, bilateral plantar fasciitis, bilateral hallux valgus, and bilateral hammertoes – is remanded. REFERRED The issues of entitlement to an earlier effective date for the assignment of a 10 percent rating for bilateral plantar fasciitis and an earlier effective date for the grant of service connection for a right ankle disability, bilateral hallux valgus, and bilateral hammertoes were raised in a March 2016 statement and are referred to the Agency of Original Jurisdiction (AOJ) for appropriate action. FINDINGS OF FACT 1. A RO granted service connection for tinnitus effective May 30, 2015, in a January 2016 rating decision. 2. On May 30, 2015, the Veteran expressed an intent to file a claim for compensation benefits. 3. On August 24, 2015, a RO received the Veteran’s application form claiming service connection for tinnitus. 4. There was no formal claim for service connection for tinnitus in particular or an intent to file a claim for compensation benefits in general presented prior to May 30, 2015. 5. The Veteran is receiving the maximum schedular rating for tinnitus. 6. The weight of evidence shows that the Veteran had bilateral flat feet and still has this disability. 7. The weight of evidence shows that the left heel spur was caused by the service-connected bilateral plantar fasciitis. 8. The weight of evidence shows that the Veteran stopped working on March 24, 2016. 9. Since March 25, 2016, the Veteran has been service-connected for a psychiatric disorder, tinea versicolor, allergic rhinitis, tinnitus, lumbar spine strain, right ankle strain, and various foot disabilities. 10. Since March 25, 2016, the service-connected disabilities have been rated 90 percent disabling, with the psychiatric disorder rated as 70 percent disabling. 11. The weight of evidence shows that since March 25, 2016, the service-connected disabilities rendered him unemployable from performing all forms of substantially gainful employment that are consistent with his education and occupational experience. CONCLUSIONS OF LAW 1. The criteria for entitlement to an effective date earlier than May 30, 2015, for the grant of service connection for tinnitus have not been met. 38 U.S.C. §§ 5103, 5103A, 5107, 5110 (2012); 38 C.F.R. § 3.400 (2019). 2. The criteria for entitlement to a disability rating in excess of 10 percent for tinnitus have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102. 3.159, 4.87, Diagnostic Code 6260 (2019). 3. The criteria for entitlement to service connection for bilateral flat feet have been met. 38 U.S.C. §§ 1110, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303(a) (2019). 4. The criteria for entitlement to service connection for left heel spur as secondary to bilateral plantar fasciitis have been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.310 (2019). 5. The criteria for entitlement to TDIU since March 25, 2016, have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.16, 4.19 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from April 2004 to November 2012. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a January 2016 rating decision of a Department of Veterans Affairs (VA) regional office (RO). In January 2019, the RO received the Veteran’s formal TDIU claim in which he asserts that he is unemployed because of his plantar fasciitis, lumbar back strain, and psychiatric disorder. Since entitlement to TDIU is not a separate claim for benefits, but rather involves an attempt to obtain an appropriate rating for a disability or disabilities, it is part of the initial adjudication of a claim for increase. See Rice v. Shinseki, 22 Vet. App. 447, 453 (2009). In the January 2016 rating decision, the RO reclassified the psychiatric disorder from adjustment disorder with anxiety to PTSD, anxiety, and alcohol dependence and assigned a 70 percent disability rating for the disorder effective May 30, 2015, the date of intent to file a claim for compensation. The psychiatric disorder was rated 30 percent disabling from September 26, 2013, to May 29, 2015. In March 2016, the Veteran filed a notice of disagreement with the assignment of the 70 percent disability rating and the effective date of that rating. Pursuant to Hart v. Mansfield, 21 Vet. App. 505 (2007), the Board must consider the state of the disability from the time period one year before the claim was filed until VA makes a final decision on the claim. As such, the Board has jurisdiction over the issue of entitlement to a rating in excess of 30 percent for the psychiatric disorder prior to May 30, 2015. In a July 2017 rating decision, a RO assigned a 20 percent disability rating for lumbar spine strain effective August 11, 2014, the date of claim. The lumbar spine disability was rated 10 percent disabling prior to August 11, 2014. In August 2017, the Veteran’s counsel filed a notice of disagreement with the assignment of the 20 percent disability rating and the effective date of that rating. Regardless of whether the counsel filed a notice of disagreement, the claim remains in appellate status as this rating is not the maximum rating available for this disability. See AB v. Brown, 6 Vet. App. 35 (1993). Pursuant to Hart, the Board has jurisdiction over the issue of entitlement to a rating in excess of 10 percent for the lumbar spine disability prior to August 11, 2014. In the July 2017 rating decision, the RO assigned a 10 percent disability rating for allergic rhinitis effective May 30, 2015, the date of intent to file a claim for compensation. The allergic rhinitis was rated zero percent disabling prior to May 30, 2015. In August 2017, the Veteran’s counsel filed a notice of disagreement with the assignment of the 10 percent disability rating and the effective date of that rating. The claim remains in appellate status as this rating is not the maximum rating available for this disability. See AB v. Brown, 6 Vet. App. 35 (1993). Pursuant to Hart, the Board has jurisdiction over the issue of entitlement to a compensable rating for allergic rhinitis prior to May 30, 2015. In the July 2017 rating decision, the RO assigned a 30 percent disability rating for tinea versicolor effective May 30, 2015, the date of intent to file a claim for compensation. The skin disability was rated 10 percent disabling prior to May 30, 2015. In August 2017, the Veteran’s counsel filed a notice of disagreement with the assignment of the 30 percent disability rating and the effective date of that rating. The claim remains in appellate status as this rating is not the maximum rating available for this disability. Pursuant to Hart, the Board has jurisdiction over the issue of entitlement to a rating in excess of 10 percent for tinea versicolor prior to May 30, 2015. The Veteran’s service treatment records show that in September 2008 the assessment was rule out possible asthma attack from dust allergies. In Schroeder v. West, 212 F.3d 1265, 1271 (Fed. Cir. 2000), the United States Court of Appeals for the Federal Circuit (the Federal Circuit) held that VA’s duty to assist attaches to the investigation of all possible causes of a current disability, including those unknown to the claimant. Pursuant to Schroeder, the Board will consider whether asthma is secondary to allergic rhinitis. Regarding the feet, the medical evidence shows diagnoses of bilateral flat feet, heel spurs, and bilateral degenerative arthritis. The Veteran is also claiming service connection for fibromatosis. A May 2014 VA examination report reveals that the left heel spur was caused by service-connected plantar fasciitis. Pursuant to Schroeder, the Board will consider whether the foot disabilities are secondary to the various service-connected foot disabilities. As noted in the findings of fact and conclusions of law, the Board is granting service connection for bilateral flat feet and a left heel spur. The Board is also remanding the issues of service connection for the remaining foot disabilities that are not already service connected for further development. In an August 2015 statement with his formal claim, the Veteran claimed joint pains involving the hips, knees, ankles, and feet. The Veteran served in the Southwest Asia theater of operations. Pursuant to Schroeder, the Board will consider whether the orthopedic disabilities of the lower extremities are an undiagnosed illness. In January 2019, the Veteran’s counsel submitted additional evidence and waived initial consideration of the evidence by the agency of original jurisdiction. VA’s duties to notify and assist claimants in substantiating a claim for VA benefits are found at 38 U.S.C. §§ 5100, 5102, 5103, 5103A, 5107, 5126 and 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a). Neither the Veteran nor his counsel has raised any issues with the duty to notify or duty to assist. Scott v. McDonald, 789 F.3d 1375 (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 duty to assist argument). 1. Entitlement to an effective date earlier than May 30, 2015, for the grant of service connection for tinnitus. Governing law and regulations The assignment of effective dates of awards is generally governed by 38 U.S.C. § 5110 and 38 C.F.R. § 3.400. Unless specifically provided otherwise, the effective date of an award of compensation based on an original claim shall be fixed in accordance with facts found but shall not be earlier than the date of receipt of application therefor. See 38 U.S.C. § 5110(a). The implementing VA regulation provides that the effective date of an award of compensation based on an original claim filed over a year after active service will be the date of receipt of the claim or the date entitlement arose, whichever is later. See 38 C.F.R. § 3.400(a). A claimant may indicate an intent to file a claim for benefits by submitting an intent to file a claim to VA. Upon receipt of the intent to file a claim, VA will furnish the claimant with the appropriate application form prescribed by the Secretary. If VA receives the application form within one year of receipt of the intent to file a claim, VA will consider the completed claim filed as of the date the intent to file a claim was received. 38 C.F.R. § 3.155(b) (2019). An oral statement of intent to file a claim will be accepted if it is directed to a VA employee designated to receive such a communication, the VA employee receiving this information follows the provisions set forth in 38 C.F.R. § 3.217 (2019), and the employee documents the date VA received the claimant’s intent to file a claim in the claimant’s records. 38 C.F.R. § 3.155(b)(1)(iii) (2019). An intent to file a claim must identify the general benefit (for example, compensation) but need not identify the specific benefit claimed or any medical conditions on which the claim is based. 38 C.F.R. § 3.155(b)(2) (2019). Analysis On May 30, 2015, the Veteran expressed an intent to file a claim for compensation benefits. In a June 1, 2015, letter to the Veteran, the RO noted that he indicated an intent to file for compensation benefits on May 30, 2015, and provided him an application. On August 24, 2015, a RO received the Veteran’s application form claiming service connection for tinnitus. In the January 2016 rating decision, the RO granted service connection for tinnitus effective May 30, 2015. A review of the claims file reveals that there was no formal claim for service connection for tinnitus or intent to file a claim for compensation presented prior to May 30, 2015. Neither the Veteran nor his counsel has identified any document dated prior to May 30, 2015, indicating an intent to claim service connection for tinnitus in particular or any intent to file a claim for compensation in general prior to May 30, 2015. In short, for the reasons and bases set forth above, the Board concludes that the most credible and probative evidence weighs strongly against a finding that an effective date earlier than May 30, 2015, for the grant of service connection for tinnitus is warranted. Therefore, the preponderance of the evidence is against the claim, and it is denied. 2. Entitlement to an initial rating in excess of 10 percent for tinnitus Governing law and regulations Ten percent is the maximum schedular rating for tinnitus. 38 C.F.R. § 4.87, Diagnostic Code 6260. Effective on June 13, 2003, Diagnostic Code 6260 for tinnitus was revised to clarify existing VA practice that only a single 10 percent evaluation is assigned for “recurrent” tinnitus, whether the sound is perceived as being in one ear, both ears, or in the head. 38 C.F.R. § 4.87, Note (2); 68 Fed. Reg. 25822 (June 2003); see also Smith v. Nicholson, 451 F.3d 1344 (Fed. Cir. 2006). Analysis In the January 2016 rating decision, the RO granted service connection for tinnitus effective May 30, 2015, and assigned a 10 percent disability rating effective that same date. The Veteran is receiving the maximum schedular rating for tinnitus. Thus, a higher schedular rating is not warranted. Under these circumstances, the disposition of this claim is based on the law, and not the facts of the case, and the claim for an increased schedular rating must be denied based on a lack of entitlement under the law. See Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). 3. Entitlement to service connection for bilateral pes planus Governing law and regulations Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service, even if the disability was initially diagnosed after service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Notwithstanding the above, service connection may be granted for disability shown after service, when all the evidence, including that pertinent to service, shows that it was incurred or aggravated in service. 38 C.F.R. § 3.303(a). To establish service connection for a claimed disorder, there must be (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999). Analysis May 2014 and July 2017 VA examination reports reveal a diagnosis of bilateral flat feet. Thus, there is a current diagnosis of that disability. The service treatment records show that on an April 2004 entrance examination the arches were normal. In July 2010, the assessment was flat foot. In June 2011, it was noted that the Veteran had a low arch. A July 2011 foot examination revealed fallen arches. Given the evidence of bilateral flat feet in service, the weight of evidence shows that the Veteran had bilateral flat feet in service and that he still has this disability. Service connection is in order for bilateral pes planus. 38 U.S.C. §§ 1110, 5107. The benefit sought on appeal is accordingly allowed. 4. Entitlement to service connection for left heel spur Governing law and regulations A disability that is proximately due to or the result of a service-connected disease or injury shall be service connected. When service connection is thus established for a secondary disorder, the secondary disorder shall be considered a part of the original condition. 38 C.F.R. § 3.310(a). To establish service connection for a claimed disability on a secondary basis, there must be (1) medical evidence of a current disability; (2) a service-connected disability; and (3) medical evidence of a nexus between the service-connected disease or injury and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). Analysis The May 2014 VA examiner diagnosed left heel spur. Service connection is in effect for bilateral plantar fasciitis. Wallin elements (1) and (2), current disability and a service-connected disability, are met. With regard to Wallin element (3), medical nexus, the May 2014 VA examiner stated that it is at least as likely as not that the left heel spur was caused by the service-connected chronic plantar fasciitis. The examiner’s rationale was that heel spurs are the result of chronic plantar fasciitis. The weight of evidence shows that the left heel spur was caused by the service-connected bilateral plantar fasciitis Therefore, service connection by means of causation is in order. 38 U.S.C. §§ 1110, 5107. 5. Entitlement to TDIU Governing law and regulations TDUI may be assigned where the schedular rating is less than total, when it is found that the disabled person is unable to secure or follow a substantially gainful occupation without regard to advancing age as a result of a single service-connected disability ratable at 60 percent or more, or as a result of two or more disabilities, provided at least one disability is ratable at 40 percent or more, and there is sufficient additional service-connected disability to bring the combined rating to 70 percent or more. 38 C.F.R. §§ 3.340, 3.341, 4.16(a). For a veteran to prevail on a claim for a total compensation rating based on individual unemployability, the record must reflect some factor, which takes this case outside the norm. The simple fact that a claimant is currently unemployed or has difficulty obtaining employment is not enough. A high rating in itself is recognition that the impairment makes it difficult to obtain or keep employment, but the ultimate question is whether a veteran is capable of performing the physical and mental acts required by employment, not whether he can find employment. Van Hoose v. Brown, 4 Vet. App. 361 (1993) (A high rating is recognition that the impairment makes it difficult to obtain or keep employment.). Age cannot be considered as a factor in evaluating a service-connected disability. Unemployability associated with advancing age or intercurrent disability cannot be used as a basis for a total disability rating. 38 C.F.R. § 4.19. Analysis There is conflicting evidence regarding the date that the Veteran stopped working. In January 2019, the RO received the Veteran’s formal TDIU claim that was signed in July 2017. The Veteran reported that he last worked on March 24, 2016, and that at his last job he earned $3,200 a month. He stated that he became too disabled to work on April 1, 2016. A March 8, 2016, VA treatment record reveals that the Veteran had not worked since two and half weeks and that he quit his job to keep from being fired due to anxiety, anger, and irritability. The Social Security Administration earnings statement shows that he earned approximately $6500 in 2016. Given that he reported earning $3,200 a month at his last job, the earnings statement is evidence that the Veteran worked in March 2016 because he earned more than $6,400 in 2016. Based on the earnings statement and the formal TDIU claim, the weight of evidence shows that the Veteran stopped working on March 24, 2016. Given that the Veteran stopped working on March 24, 2016, six days prior to the date he claims he was too disabled to work, the Board will consider whether his service-connected disabilities rendered him unemployable from performing all forms of substantially gainful employment that are consistent with his education and occupational experience since March 25, 2016, the day after he stopped working. Since March 25, 2016, the Veteran has been service-connected for a psychiatric disorder, tinea versicolor, allergic rhinitis, tinnitus, lumbar spine strain, right ankle strain, and various foot disabilities. Since March 25, 2016, the service-connected disabilities have been rated 90 percent disabling, with the psychiatric disorder rated as 70 percent disabling. This makes him eligible for consideration under 38 C.F.R. § 4.16(a) since March 25, 2016. In his formal TDIU claim, the Veteran reported that he worked as an aviation mechanic prior to March 25, 2016. He stated that he had two years of college and that after he became too disabled to work, he completed additional education or training in aviation maintenance in January 2017. A November 2015 VA PTSD examination report shows that the examiner determined that the Veteran has an occupational and social impairment due to mild or transient symptoms that decrease work efficiency and ability to perform occupational tasks only during periods of significant stress or that symptoms are controlled by medication. The examiner, however, also noted that the Veteran has the following: impaired impulse control, such as unprovoked irritability with periods of violence; difficulty in adapting to stressful circumstances, including work or worklike setting; and difficulty in establishing and maintaining effective work and social relationships. The examiner stated that the Veteran was able to work, but that his mental health issues cause significant distress in all areas of his life. The examiner added that the psychiatric disorder negatively impacts his employment because he is not always able to go to work and because his disorder impairs his ability to be around people. A July 2016 psychological evaluation for Social Security disability purposes shows that his ability to interact effectively with peers is affected by his psychiatric disorder. A July 2017 VA spine examination report reveals that the impact on the Veteran’s ability to work from the lumbar spine disability is difficulty with bending and lifting. A July 2017 VA foot examination report reflects that the impact on the Veteran’s ability to work from the bilateral foot disabilities is difficulty with walking. July 2017 VA examination reports show that there was no impact on the Veteran’s ability to work from the right ankle disability, allergic rhinitis, and skin disability. A November 2018 review PTSD disability benefits questionnaire shows that the psychologist determined that the Veteran has an occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, and mood. The psychologist noted that the Veteran has the following: suicidal ideation; difficulty in adapting to stressful circumstances, including work or worklike setting; and an inability to establish and maintain effective relationships. The psychologist stated that the Veteran cannot sustain stress from a competitive work environment or be expected to engage in gainful activity due to his PTSD. In a November 2018 residual functional capacity evaluation, the psychologist who prepared the review PTSD disability benefits questionnaire stated that the Veteran would miss three or more days of work a month due to mental problems. The psychologist added that he would need to leave work early three or more days a month because of mental problems. As to trouble concentrating and focusing to complete simple repetitive tasks, the psychologist indicated that the Veteran would not stay focused for at least seven hours in an eight-hour workday for three or more days a month. Regarding normal pressures and constructive criticisms of a job, more than once a month he would respond in an angry manner but would not actually become violent. In a November 2018 statement, a private physician noted that the Veteran had to leave his job after an argument with a supervisor because of an inability to get along with coworkers. The Veteran reported that he had continuous problems being able to focus and losing his temper. The doctor stated that the Veteran would miss three or more days of work or need to leave early three or more days per month due to the various service-connected disabilities. The doctor stated that the combined effects caused by the various service-connected disabilities, to include the side effects caused by medications used to treat these disabilities, impact his ability to stay focused. The doctor stated that more than three days a month the Veteran would not be able to stay focused to complete simple repetitive tasks seven hours out of an eight-hour workday. The Veteran reported that his medications make him feel dizzy, drowsy, and sleepy, and affect his ability to focus or concentrate on tasks. The doctor opined that it is more likely than not that the Veteran is unable to maintain substantially gainful employment due to the combined effects caused by his service-connected disabilities, to include side effects caused by medications to treat such disabilities. The Board places great weight on the findings of impaired impulse control, difficulty in adapting to stressful circumstances, inability to establish and maintain effective relationships, and suicidal ideation found on evaluations before or after the Veteran stopped working and on the physical impairments from the lumbar spine and foot disabilities noted in the July 2017 VA examination reports. The Board also places great weight on the findings of the private psychologist and medical doctor regarding inability to concentrate and handling the normal pressures and constructive criticisms of a job. The Board also gives great weight on the November 2018 opinion of the private doctor regarding the combined effects of the service-connected disabilities, to include side effects from taking medications to treat these disabilities. Based on the above, the weight of evidence shows that since March 25, 2016, the service-connected disabilities rendered him unemployable from performing all forms of substantially gainful employment that are consistent with his education and occupational experience. Accordingly, entitlement to TDIU since March 25, 2016, in order. REASONS FOR REMAND The Veteran has applied for Social Security disability benefits. The RO should obtain all records pertaining to his disability claim. The RO last obtained VA treatment records in August 2014. The RO should obtain all records from the VA North Texas Health Care System from August 2014 to the present. Given that the Veteran is now unemployed and was last examined for his psychiatric disorder in November 2015, a new VA examination is necessary. The July 2017 VA spine examination report reveals that passive range of motion and non-weight-bearing testing was not performed because the standards for measuring passive range of motion and non-weight-bearing have not been established. Given the passage of time, another VA examination is warranted to determine whether it is now possible to measure passive range of motion and pain on non-weight-bearing. At an August 2016 examination for Social Security disability benefits purposes, the Veteran reported that he underwent a separation examination and that examining doctor thought he had asthma. The Veteran’s separation examination is not of record. The RO obtained service treatment records prior to separation from service. The RO should obtain any additional service treatment records, to include his separation examination. The service treatment records reveal that the Veteran suffered a left ankle sprain in December 2004. A July 2017 VA examination report reflect that he complained of left ankle pain but that a left ankle disability was not diagnosed. Given the passage of time, another examination is warranted to determine whether he has a current left ankle disability related to service. The service treatment records reveal that in September 2008 the assessment was rule out possible asthma attack from dust allergies. A VA examination is necessary to determine whether the asthma is related to service or secondary to service-connected allergic rhinitis. The service treatment records show that the Veteran had left knee pain in March 2005 and that he sprained his left wrist in April 2006. VA treatment records, however, reveal that in July 2013 the Veteran suffered a left wrist injury. July 2013 X-rays of the left wrist revealed a fracture. August 2013 X-rays of the left wrist also revealed osteopenia and degenerative changes. A VA examination is required to determine whether he has left wrist and knee disabilities related to service and whether his osteopenia is related to service. A VA examination is warranted to determine whether the Veteran has bilateral hip and right knee disabilities related to service. The service treatment records reveal that in August 2005 the Veteran suffered a contusion of the left great toe. A right heel spur was diagnosed in service but was not found on in-service X-rays or at the May 2014 VA examination. A VA examination is necessary to determine the nature and etiologies of any foot disabilities not currently service connected, to include whether they are secondary to the service-connected disabilities. A February 2013 VA treatment record reveals that the Veteran reported having had heartburn and GERD for a year. He left service in November 2012. A VA examination is warranted to determine whether the GERD is related to service. The matters are REMANDED for the following action: 1. Ask the Veteran to identify all treatment for his psychiatric disorder, lumbar spine disability, ankle disabilities, foot disabilities, a skin disability, hearing loss, asthma, allergic rhinitis, GERD, hip disabilities, knee disabilities, a left wrist disability, and osteopenia. Obtain the Veteran’s VA treatment records from the VA North Texas Health Care System from August 2014 to the present. 2. Obtain the Veteran’s federal records from the Social Security Administration pertaining to his claim for disability benefits. Document all requests for information as well as all responses in the claims file. 3. Obtain the Veteran’s complete service treatment records, to include his separation examination. 4. After the development in 1 through 3 is completed, schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected PTSD with depression, anxiety, and alcohol dependence. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. The examiner must attempt to elicit information regarding the severity, frequency, and duration of symptoms. To the extent possible, the examiner should identify any symptoms and social and occupational impairment due to his service-connected PTSD with depression, anxiety, and alcohol dependence alone. 5. After the development in 1 through 3 is completed, schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected lumbar spine strain. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. In so doing, the examiner must test the Veteran’s active motion, passive motion, and pain with weight-bearing and without weight-bearing. If it is not possible to provide a specific measurement without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). In so doing, the examiner must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. If it is not possible to provide a specific measurement based on direct observation, the examiner should provide an estimate, if at all possible, of the additional impairment due to flare-ups based on the other evidence of record and the Veteran’s statements. If it is not possible to provide a specific measurement without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). 6. After the development in 1 through 3 is completed, schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any left wrist disorder, osteopenia, and any symptomatology involving both hips, both knees, and the left ankle. The examiner should offer an opinion as to the etiology of the symptom of any discomfort involving both hips, both knees, and the left ankle, to include commenting on whether it is attributable to a known clinical diagnosis. If that examiner cannot identify a disease or disability which causes the reported symptoms, the examiner should so state. The examiner should be made aware of the left wrist injury in July 2013 as documented in the VA treatment records. For any left wrist disability, the examiner should specifically opine on whether it is at least as likely as not that such a disability is related to an in-service injury, event, or disease, including the left wrist sprain in April 2006. The examiner should specifically opine on whether it is at least as likely as not that osteopenia is related to an in-service injury, event, or disease. If a disease or disability is identified regarding the left ankle, the examiner should specifically opine on whether it is at least as likely as not that such a disability is related to an in-service injury, event, or disease, including the left ankle sprain in December 2004 and exposure to environmental hazards during service in the Persian Gulf region. If a disease or disability is identified regarding the left knee, the examiner should specifically opine on whether it is at least as likely as not that such a disability is related to an in-service injury, event, or disease, including the left knee pain in March 2005 and exposure to environmental hazards during service in the Persian Gulf region. If a disease or disability is identified regarding either hip or the right knee, the examiner should specifically opine on whether it is at least as likely as not that such a disability is related to an in-service injury, event, or disease, including exposure to environmental hazards during service in the Persian Gulf region. 7. After the development in 1 through 3 is completed, schedule the Veteran for an examination by an appropriate clinician to determine the natures and etiologies of the right heel spur, bilateral fibromatosis, degenerative arthritis of the feet, and any other foot disability not currently service connected. The examiner must opine whether it is at least as likely as not that that the Veteran has a right heel spur. If he has a right heel spur, the examiner must opine whether it is at least as likely as not that that the disorder is related to an in-service injury, event, or disease, including in-service treatment for right heel spur. The examiner must opine whether it is at least as likely as not that that the Veteran has fibromatosis of either foot. If he has fibromatosis, the examiner must opine whether it is at least as likely as not that that the disorder is related to an in-service injury, event, or disease, including in-service treatment for the feet. For degenerative arthritis of the feet, the examiner must opine whether it is at least as likely as not that that the disorder is related to an in-service injury, event, or disease, including in-service treatment for the feet. For any other current disability other than bilateral flat feet, left heel spur, bilateral plantar fasciitis, bilateral hallux valgus, and bilateral hammertoes, the examiner must opine whether it is at least as likely as not that that the disorder is related to an in-service injury, event, or disease, including in-service treatment for the feet. For any right heel spur, fibromatosis, degenerative arthritis of the feet, and any other current disability other than bilateral flat feet, left heel spur, bilateral plantar fasciitis, bilateral hallux valgus, and bilateral hammertoes, the examiner must opine on whether it is at least as likely as not that the disorder was (1) caused by or (2) aggravated by the service-connected bilateral flat feet, left heel spur, bilateral plantar fasciitis, bilateral hallux valgus, or bilateral hammertoes. If the examiner finds that a disorder was aggravated by bilateral flat feet, left heel spur, bilateral plantar fasciitis, bilateral hallux valgus, or bilateral hammertoes, then the examiner should quantify the degree of aggravation. 8. After the development in 1 through 3 is completed, schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of asthma. The examiner must opine whether it is at least as likely as not that the disorder is related to an in-service injury, event, or disease, including in-service treatment for possible asthma attack from dust allergies in September 2008. The examiner must opine on whether it is at least as likely as not that asthma was (1) caused by or (2) aggravated by the service-connected allergic rhinitis. If the examiner finds that asthma was aggravated by allergic rhinitis, then the examiner should quantify the degree of aggravation. 9. After the development in 1 through 3 is completed, schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of GERD. The examiner must opine whether it is at least as likely as not that the disorder is related to an in-service injury, event, or disease. 10. After the development in 1 through 9 is completed, the RO should undertake any necessary development on the issues of increased ratings for right ankle sprain, bilateral foot disabilities, tinea versicolor, and allergic rhinitis, and service connection for hearing loss as warranted by any additional evidence of record. 11. After development above has been completed, the RO should readjudicate the Veteran’s claims with consideration of secondary service connection. If any claim remains denied, the Veteran should be issued a supplemental statement of the case, with a copy to his counsel, and afforded an opportunity to respond. MICHAEL LANE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Cherry, 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.