Citation Nr: 20010792 Decision Date: 02/11/20 Archive Date: 02/10/20 DOCKET NO. 18-41 242 DATE: February 11, 2020 ORDER New and material evidence having been presented, the request to reopen the finally disallowed claim of service connection for a left knee disability is granted. New and material evidence having been presented, the request to reopen the finally disallowed claim of service connection for a right knee disability is granted. New and material evidence having been presented, the request to reopen the finally disallowed claim of service connection for a low back disability is granted Entitlement to service connection for a left knee disability, to include left knee patellofemoral pain syndrome and degenerative arthritis, is granted. Entitlement to service connection for a right knee disability, to include right knee patellofemoral pain syndrome and degenerative arthritis, is granted. Entitlement to service connection for a low back disability, degenerative arthritis of the lumbar spine, is granted. Entitlement to service connection for an acquired psychiatric disorder, variously diagnosed as unspecified anxiety disorder and posttraumatic stress disorder (PTSD), is granted. REMANDED Issue of entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. FINDINGS OF FACT 1. The evidence associated with the claims file since the RO’s December 2014 final disallowance of claims for service connection for a bilateral knee disability and low back disability relates to an unestablished fact and raises a reasonable possibility of substantiating the claims. 2. The evidence of record is at least in relative equipoise as to whether the Veteran’s current left knee disability is related to his active duty service. 3. The most probative evidence shows that the Veteran’s right knee disability is related to active duty service. 4. The most probative evidence shows that the Veteran’s low back disability is related to active duty service. 5. The most probative evidence shows that the Veteran’s acquired psychiatric disorder is related to active duty service. CONCLUSIONS OF LAW 1. The criteria for reopening the finally disallowed claims of service connection for a bilateral knee disability and low back disability have been met. 38 U.S.C. § §§ 5108, 7105 (2012); 38 C.F.R. § §§ 3.156, 20.1103 (2019). 2. The criteria for service connection for a left knee disability, to include left knee patellofemoral pain syndrome and degenerative arthritis, are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for service connection for a right knee disability, to include right knee patellofemoral pain syndrome and degenerative arthritis, are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for service connection for a low back disability, to include degenerative arthritis of the lumbar spine, are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 5. The criteria for service connection for an acquired psychiatric disorder, variously diagnosed as unspecified anxiety disorder and PTSD, are met. 38 U.S.C. §§ 1110, 1154(a), 5107(b); 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1970 to June 1972, as well as additional Reservist duty, to include service in the Republic of Vietnam. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from rating decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO). In December 2014, the RO denied service connection for, in relevant part, a bilateral knee disability and low back disability. The Veteran did not file a notice of disagreement (NOD) as to the claim of a left or right knee disability or the low back disability claim. The Veteran filed a new claim of entitlement to service connection for a left knee disability, a right knee disability, and a low back disability in December 2017. In a January 2018 rating decision, the RO denied both claims, citing that no new and material evidence had been provided. In March 2018, the RO denied the claim relating to an acquired psychiatric disorder. Regarding all claims listed above, a NOD was received in May 2018. A Statement of the Case (SOC) was issued in June 2018, and the Veteran filed his Substantive Appeal (via a VA Form 9) in July 2018. In January 2020 correspondence, the Veteran, through his representative, waived his hearing request and canceled a scheduled February 2020 hearing. Thus, his hearing request is deemed withdrawn. 38 C.F.R. § 20.704. New and Material Evidence In a December 2014 rating decision, the RO denied service connection for a right knee disability, a left knee disability, and a low back disability. Specifically, the RO denied the left knee claim based on a finding that although there was a record of in-service treatment for left knee joint pain and instability, no permanent residual or chronic disability was shown. The RO denied the right knee claim and low back claim based on a finding that there was no evidence to establish that the conditions occurred in or were caused by service. As noted above, the Veteran did not file a NOD as to the either of the three claims. As such, the December 2014 rating decision, as to these three issues, became final. In December 2017, the Veteran filed a request to reopen the claims of service connection for disabilities relating to his right knee, left knee, and low back. In a January 2018 rating decision, the RO denied the claims on the grounds of no new and material evidence. The Veteran appealed the decision and properly perfected his appeal of the claims. A claimant may reopen a finally adjudicated claim by submitting new and material evidence. 38 C.F.R. § § 3.156 (a). If new and material evidence is presented or secured with respect to a claim that has been disallowed, VA must reopen the claim and review the claim on the merits. 38 U.S.C. § § 5108. New evidence means existing evidence not previously submitted to agency decision makers. Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § § 3.156 (a). The threshold for determining whether new and material evidence raises a reasonable possibility of substantiating a claim is low. See Shade v. Shinseki, 24 Vet. App. 110 (2010). On review of the record the Board finds that new and material evidence has been submitted since the RO’s December 2014 rating decision. In this regard, the Board notes that the Veteran submitted, in relevant part, VA treatment records, a January 2017 VA examination report and, most notably, a September 2019 Independent Medical Examination report in which the examining physician provided a favorable nexus opinion. The Veteran also provided lay statements in which he claimed that he injured his knees and back during service as a result of his duties on a flight deck, which included standing and bending for prolonged periods of time. See July 2018 NOD; January 2018, May 2018, and August 2019 Statements in Support of Claim. This evidence is new as it was not of record at the time of the December 2014 rating decision. Additionally, the Board finds that the Veteran’s lay statements regarding an in-service onset and continuity of symptomatology relating to his bilateral knees and back and a VA examiner’s opinion relating his injuries to service to be material as it relates to an unestablished fact necessary to substantiate the claim. As such, the criteria to reopen the finally disallowed claims of service connection for a left knee disability, a right knee disability, and a low back disability are met. 38 U.S.C. § § 5108; 38 C.F.R. § § 3.156 (a). Service Connection Service connection is warranted where the evidence of record establishes that an injury or disease resulting in disability was incurred in active military service or, if preexisting, was aggravated thereby. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Generally, to establish service connection, there must be evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. See, e.g., Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may be granted for certain chronic diseases, including arthritis, if it established that such chronic disease manifested to a compensable degree within one year from separation from service. 38 U.S.C. §§ 1101, 1110, 1131; 38 C.F.R. §§ 3.307. 3.309. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C. §§ 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. Service may be granted for any disease diagnosed after service discharge, when the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). 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 appellant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 1. Entitlement to service connection for a left knee disability. The Veteran contends that he has a left knee which can be attributed to his period of active duty service. Specifically, the Veteran maintains that he injured his each of his knees as a result of standing on a hard deck for twelve hours a day, securing and launching aircraft, and hitting his knees on objects during service. See January 2018 and May 2018 Statements in Support of Claim. A service treatment record, dated in August 1971, reveals that the Veteran presented with complaints of a left knee injury after hitting a steel stake or ladder. An x-ray showed that the Veteran had weak lateral collateral ligaments and a left patellar contusion without joint effusion. A May 1972 Report of Medical Examination, conducted at separation, reveals a normal clinical evaluation of the lower extremities. An April 1974 Report of Medical History reveals that the Veteran denied having swollen or painful joints; cramps in his legs; broken bones; a bone, joint, or deformity; or a “trick” or locked knee. An April 1974 Report of Medical Examination, taken for the purpose of reservist duty, reveals a normal clinical evaluation of the Veteran’s lower extremities. An August 1975 Report of Medical History reveals that the Veteran denied having swollen or painful joints; cramps in his legs; broken bones; a bone, joint, or deformity; or a “trick” or locked knee. An August 1975 Report of Medical Examination, conducted at reenlistment, revealed a normal lower extremity evaluation. A March 2008 radiological report reveals that the Veteran had mostly lateral compartment pain, with mild effusion. A February 2014 VA treatment record shows a diagnosis of left knee moderate to advanced degenerative joint disease. A March 2014 VA treatment record reveals that the Veteran presented with complaints of bilateral knee pain. An April 2014 VA treatment record shows a diagnosis of moderate to advanced degenerative joint disease of the left knee. In January 2018, the Veteran was afforded a VA Knee and Lower Leg examination, at which time the examiner noted that the Veteran had patellofemoral pain syndrome and degenerative arthritis relating to the bilateral knees. At the time of the examination, the Veteran stated that the date of onset of his symptoms was in 1972 and that his bilateral knee conditions began as a result of flight deck bending, standing, and stooping for prolonged periods of time while stationed onboard the USS Hancock. The Veteran also stated that his condition had worsened. The examiner stated that the Veteran’s condition affected his ability to perform any occupational task due to his flare-ups and pain with prolonged standing and sitting. The examiner also opined that it was less likely than not that the Veteran’s left knee condition was related to service. The examiner rationed that while the Veteran had a documented injury in service, there were no further complaints of the left knee that would show that the Veteran continued to have chronic knee problems until 2008. The examiner also acknowledged that the Veteran was given an in-service diagnosis of a left knee contusion, but that it likely resolved. In an August 2019 Statement in Support of Claim, the Veteran’s sister (J.B.) reported that the Veteran had difficulty walking and riding in a car for prolonged periods of time. The Veteran’s sister also stated that the Veteran does not like to fly because of the difficulty that it poses to his knees and no longer participates in family softball games. In a September 2019 Independent Medical Evaluation Report, submitted by the Veteran, Dr. V.F. opined that it was at least as likely as not that the Veteran’s left knee disability was a result of service. Specifically, the examiner noted that the Veteran did not have any problems with his left knee prior to service and that the most likely initiating cause of his left knee condition occurred while in the Navy and that it began a process of degeneration which led to his current left knee arthritic condition. In providing such opinion, the examiner acknowledged the January 2018 VA examination and disagreed with the previous unfavorable opinion provided. The examiner stated that while the Veteran did not receive treatment for many years after service, his reason for doing so was due to his limited health insurance. Further, the examiner noted that the January 2018 examiner proposed no other cause for the Veteran’s ongoing left knee condition. In cases where there are two different medical opinions, such as in the instant case, the Board must assess the credibility and weight of all the evidence, including the medical evidence, to determine its probative value. Wilson v. Derwinski, 2 Vet. App. 614, 618. Here, in weighing the two opinions against one another, the Board determines that the evidence for and against the medical nexus question is in relative equipoise. In this regard, the opinions were as provided by medical professionals qualified to evaluate the Veteran’s left knee disability and who had the opportunity to examine the Veteran and review the available evidence. Giving the benefit of the doubt to the Veteran, the Board must resolve reasonable doubt in favor of the Veteran. Thus, the nexus element of service connection has been met. In summary, the Board finds that the evidence is in relative equipoise as to whether the Veteran’s current left knee disability is related to service. Accordingly, resolving doubt in favor of the Veteran, the Board finds that the criteria for service connection have been met, and the claim is granted. 2. Entitlement to service connection for a right knee disability The Veteran contends that he has a right knee disability which can be attributed to his period of active duty service. Specifically, the Veteran maintains that he injured his bilateral knees as a result of standing on a hard deck for twelve hours a day, securing and launching aircraft, and hitting his knees on objects during service. See January 2018 and May 2018 Statements in Support of Claim. In a May 1970 Report of Medical History, the Veteran denied having swollen or painful joints; cramps in his legs; broken bones; a bone, joint, or deformity; or a “trick” or locked knee. In a May 1970 Report of Medical History, the Veteran’s lower extremities were deemed clinically normal. A May 1972 Report of Medical Examination, conducted at separation, reveals a normal clinical evaluation of the lower extremities. An April 1974 Report of Medical History reveals that the Veteran denied having swollen or painful joints; cramps in his legs; broken bones; a bone, joint, or deformity; or a “trick” or locked knee. An August 1975 Report of Medical History reveals that the Veteran denied having swollen or painful joints; cramps in his legs; broken bones; a bone, joint, or deformity; or a “trick” or locked knee. An August 1975 Report of Medical Examination, conducted at reenlistment, revealed a normal lower extremity evaluation. A March 2008 radiological report reveals that the Veteran had minimal degenerative joint disease medial compartment and patellofemoral moderate degenerative joint disease sparing. A February 2014 VA treatment record shows that the Veteran had moderate to advanced degenerative joint disease in his right knee with moderate to advanced medial joint space narrowing and osteophytes. An April 2014 VA treatment record shows that the Veteran was diagnosed with moderate to advanced degenerative joint disease of the right knee. A March 2014 VA treatment record reveals that the Veteran presented with complaints of bilateral knee pain. A February 2018 VA treatment record shows that the Veteran was diagnosed with arthritis in his right knee. In an August 2019 Statement in Support of Claim, the Veteran’s sister (J.B.) reported that the Veteran had difficulty walking and riding in a car for prolonged periods of time. The Veteran’s sister also stated that the Veteran does not like to fly because of the difficulty that it poses to his knees and no longer participates in family softball games. In a September 2019 Independent Medical Evaluation Report, submitted by the Veteran, Dr. V.F. stated that the Veteran injured his right knee in service while working in minimal clearance areas which required frequent kneeling and bending and lifting heavy weights. The examiner also noted that the Veteran was treated on the ship and told to rest for a short period of time before returning back to work. The examiner also reported that the Veteran had right knee pain throughout his service until his honorable discharge. The examiner further opined that it was at least as likely as not that the Veteran’s right knee disability was a result of service. Specifically, the examiner noted that the Veteran did not have any problems with his right knee prior to service and that the most likely initiating cause of his right knee condition occurred while in the Navy and that it began a process of degeneration which led to his current right knee arthritic condition. Here, the Board finds the September 2019 Independent Medical Evaluation Report to be probative even though the Veteran’s service treatment records are silent as to treatment for a right knee injury or diagnosed disability. In this regard, however, the Veteran has stated that he injured his right knee in the same way during service that he injured his left knee and that he has shad worsening pain in his right knee since separation. When evaluating the Veteran’s lay statements in tandem with the September 2019 opinion, noting degenerative changes attributed to an in-service injury and/or trauma, the Board concludes that service connection is warranted. There are no other opinions of record to rebut this finding. Thus, resolving reasonable doubt in favor of the Veteran, service connection is warranted for a right knee disability. 3. Entitlement to service connection for a low back disability The Veteran contends that service connection is warranted for a low back disability. Specifically, the Veteran stated that he injured his back as a result of bending under a three-foot clearance for twelve hours a day for a period of six months, picking up aircraft tow bars, and securing seventy-five-pound aircraft nose wheels while in service. See January 2018 and May 2018 Statements in Support of Claim. The Veteran’s service treatment records are absent of any complaints, treatment, or diagnosis of a disorder relating to the Veteran’s back. Specifically, in a May 1970 Report of Medical History, the Veteran denied back trouble of any kind. In a May 1970 Report of Medical Examination, the Veteran’s spine was deemed clinically normal. A Report of Medical Examination, dated May 1972, conducted at separation, similarly reveals that the Veteran’s spine was deemed clinically normal. An April 1974 Report of Medical History reveals that the Veteran denied having recurrent back pain. An August 1975 Report of Medical History reveals that the Veteran denied having recurrent back pain. An August 1975 Report of Medical Examination, conducted at reenlistment, revealed a normal spinal evaluation. An August 2003 private treatment record reveals that the Veteran had mild narrowing of his L-4 and L-5 intervertebral disc spaces associated with degenerative changes, indicating chronicity. A February 2005 private treatment record reveals that the Veteran presented with complaints of intermittent aching and a stabbing pain in his back. The Veteran was assessed with mildly decreased lordosis. An April 2014 treatment record shows mild scoliosis with moderate disc degeneration throughout the lumbosacral spine. A November 2014 VA treatment record shows that the Veteran presented with complaints of right-sided lower back pain radiating down the back of his right leg. In February 2018, the Veteran was diagnosed with chronic low back pain. In an August 2019 Statement in Support of Claim, the Veteran’s sister (J.B.) reported that the Veteran had difficulty walking and riding in a car for prolonged periods of time. The Veteran’s sister also stated that the Veteran does not like to fly because of the difficulty that it poses to his back. In a September 2019 Independent Medical Evaluation Report, submitted by the Veteran, Dr. V.F. opined that it was at least as likely as not that the Veteran’s back disability was the result of service. Specifically, the examiner noted that the Veteran did not have any problems with his back prior to service. The examiner also reported that in August 1971, the Veteran injured his low back while working in minimal clearance areas which required frequent kneeling, bending, and lifting heavy weights. The examiner also noted that the Veteran was treated on the ship and told to rest for a short period and to get back to work. The examiner noted that the Veteran continued to have back pain throughout his service until his honorable discharge in 1972. The examiner further noted that since separation, the Veteran has continued to have progressively worsening low back and right leg pain. The examiner also noted that the Veteran’s treatment was limited for many years because he could not seek care due to his limited health insurance. Here, the Board finds the September 2019 Independent Medical Evaluation Report to be probative even though the Veteran’s service treatment records are silent as to complaints or treatment for a low back disorder. In this regard, however, the Veteran has stated that he injured his back partially in the same way during service that he injured his bilateral knees and that he has had worsening pain in his back since separation. When evaluating the Veteran’s lay statements in addition to the September 2019 opinion, noting degenerative changes attributed to an in-service injury and/or trauma, the Board concludes that service connection is warranted. There are no other opinions of record to rebut this finding. Thus, resolving reasonable doubt in favor of the Veteran, service connection is warranted for a low back disability. 4. Entitlement to service connection for an acquired psychiatric disorder The Veteran contends that service connection is warranted for an acquired psychiatric disorder Specifically, the Veteran stated that his PTSD started from the time that he entered into boot camp as a result of being quarantined during a spinal meningitis outbreak, viewing a horrific training film, and being stationed aboard a ship which caught fire and subsequently being told that the ship would explode. The Veteran also stated that he witnessed a jet crash, resulting in a pilot being ejected from the aircraft, as well as an aircraft hitting the back of the ship upon which he was stationed. As a result of such incidents, the Veteran stated that he has bad dreams and feelings of hopelessness. See January 2018 and May 2018 Statements in Support of Claim. The Veteran’s service treatment records are absent of any complaints, treatment, or diagnosis of a disorder relating to a psychiatric condition or disorder. Specifically, in a May 1970 Report of Medical History, the Veteran denied having depression or excessive worry, loss of memory or amnesia, frequent trouble sleeping, or nervous trouble of any sort. In a May 1970 Report of Medical Examination, the Veteran’s psychiatric evaluation was deemed normal. In a May 1972 Report of Medical Examination, the Veteran had a normal psychiatric clinical evaluation. An April 1974 Report of Medical History reveals that the Veteran denied having depression or excessive worry, loss of memory or amnesia, frequent trouble sleeping, or nervous trouble of any sort. An August 1975 Report of Medical History reveals that the Veteran denied having depression or excessive worry, loss of memory or amnesia, frequent trouble sleeping, or nervous trouble of any sort. An August 1975 Report of Medical Examination, conducted at reenlistment, revealed a normal psychiatric evaluation. Regarding a current diagnosis of PTSD or a psychiatric disorder according to the DSM criteria, there is competing medical evidence regarding a diagnosis for the Veteran. In a January 2018 PTSD DBQ, the examiner noted a sole diagnosis of an unspecified anxiety disorder, noting that the Veteran did not meet the diagnostic criteria for PTSD under DSM-V. The examiner did not provide an etiology opinion as to the unspecified anxiety disorder. In an August 2019 Statement in Support of Claim, the Veteran’s sister (J.B.) stated that the Veteran began to isolate himself and talk less once he returned from service. In an August 2019 Independent Medical Examination, a private licensed psychologist examined the Veteran via video-conference. Based on that examination, review of pertinent medical literature and diagnostic criteria under the DSM-V, and review of the Veteran’s claims file, it was his opinion that the Veteran has a diagnosis of PTSD. The doctor also reviewed the previous examinations and diagnosis of the Veteran, giving specific attention to the January 2018 VA examination. He disagreed with the January 2018 examiner’s finding that the Veteran did not have PTSD, noting that “there were several problems with the examination, including limited documentation in critical sections covering mental health and impairment and a failure to use any evidence-based assessment of PTSD symptoms.” The examiner stated that he utilized CAPS, which is the gold standard assessment for PTSD. The examiner noted that he has conducted regular VA compensation and pension examinations. The medical opinion regarding a current PTSD diagnosis is supported by well-reasoned rationale and review of the Veteran’s history. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The Board finds the August 2019 private psychologist is qualified to render such a diagnosis. In addition, the preponderance of the evidence supports that the Veteran has been exhibiting symptoms associated with PTSD. Thus, the Board finds that the Veteran has a current diagnosis of PTSD in accordance with the DSM-V criteria. Regarding an in-service stressor, the Veteran contends that he suffered several stressors while in service, to include witnessing bombs falling off of planes; crewmen being blown off the flight deck; fellow servicemen killed and sucked into a jet engine; and a plane crash. The Veteran also stated that he was blown down the deck by jet exhaust. An in-service stressor requires credible supporting evidence that the in-service stressor occurred. Here, the January 1971 deck logs reveal that a pilot indeed crashed into the water after being launched off a port catapult and that the pilot was missing. A June 1971 deck log reveals that there was a call from an unknown person stating that there was a bomb aboard the ship. The Board finds that such deck logs corroborate the Veteran’s account of the explosion and an in-service stressor is established. The third element, the link between the Veteran’s symptoms and the in-service stressor, has to be established by medical evidence. Here, the January 2018 examiner did not provide an etiological opinion. On the other hand, the August 2019 private psychologist provided a nexus between the Veteran’s symptoms and his in-service stressors, to specifically include witnessing the death of a fellow service-member and friend who was sucked into a jet engine and a plane crash which led to an on-board fire and nearly lit jet fuel storage tanks. Based on the examination, the examiner’s professional experience, and record review, it was his opinion that the Veteran’s traumatic stressors, identified above, were sufficient to cause his current PTSD. The Board finds this opinion to be highly probative. As such, the Board finds a medical nexus between the Veteran’s PTSD and the identified in-service stressors. The Board, thus, finds that the criteria for service connection for the Veteran’s acquired psychiatric disorder, variously diagnosed as an unspecified anxiety disorder and PTSD, have been met and entitlement to service connection is warranted. REASONS FOR REMAND The Veteran contends that he is unemployable due to his low back and knees. See October 2018 Veteran’s Application for Unemployability. Additionally, in a September 2019 Independent Medical Examination, a private physician expressed the opinion that the Veteran is unemployable due to his bilateral knee and back disabilities. Also, in an August 2019 Independent Medical Examination, a private physician opined that the Veteran’s psychiatric symptoms impacted his ability to maintain task persistence and pace, the ability to arrive to work on time, and the ability to work a regular schedule without excessive absences to a moderate/severe extent. In this decision, the Board grants service connection for a bilateral knee disability, a low back disability, and an acquired psychiatric disorder. As the Agency of Original Jurisdiction (AOJ) has yet to implement the favorable grants of service connection decided herein by the Board, a determination concerning the issue of TDIU would be premature at this time and is inextricably intertwined with the favorably decided issues that required action by the AOJ. Accordingly, a remand of the TDIU issue is warranted. Lastly, the Board also notes that the August 2019 examiner noted that the Veteran has been in receipt of Social Security Administration benefits since 2005. On remand, these outstanding records should be obtained and associated with the claims file. The matters are REMANDED for the following action: 1. Obtain the Veteran’s outstanding Social Security Administration records, as identified in an August 2019 Independent Medical Examination. 2. Once the AOJ implements the Board’s determinations regarding the issues of service connection for the disabilities awarded herein, re-ajudicate the issue of entitlement to a TDIU. If the determination remains adverse to the Veteran, furnish a supplemental statement of the case (SSOC) and afford the Veteran and his representative an opportunity to respond. Thereafter, the case should be returned to the Board for appellate review, if otherwise in order. DEBORAH W. SINGLETON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Department of Veterans Affairs 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.