Citation Nr: 20028826 Decision Date: 04/24/20 Archive Date: 04/24/20 DOCKET NO. 16-58 462A DATE: April 24, 2020 ORDER New and material evidence having been received, the claim for entitlement to service connection for hepatitis C is reopened; to this extent only, the claim is granted. New and material evidence having been received, the claim for entitlement to service connection for a low back disability is reopened. Entitlement to service connection for a low back disability, diagnosed as lumbar spine disc space narrowing at L1-L2 and L5-S1, is granted. For the evaluation period prior to November 28, 2017, entitlement to a rating in excess of 10 percent for headaches is denied. For the evaluation period from November 28, 2017 through December 6, 2017, entitlement to a rating of 50 percent (the maximum schedular rating) for headaches is granted, subject to regulations governing the payment of monetary awards. REMANDED Entitlement to service connection for hepatitis C is remanded. Entitlement to a compensable rating for right knee scar is remanded. Entitlement to a compensable rating for left knee scar is remanded. Entitlement to a rating in excess of 10 percent for right knee shell fragment wound residuals is remanded. Entitlement to a rating in excess of 10 percent for left knee shell fragment wound residuals is remanded. Entitlement to an initial rating in excess of 10 percent for left cervical spine shell fragment wound degenerative changes is remanded. Entitlement to a rating in excess of 10 percent for glaucoma is remanded. Entitlement to a rating in excess of 30 percent for right eye cataract is remanded. Entitlement to a rating in excess of 50 percent for posttraumatic stress disorder (PTSD) with traumatic brain injury (TBI) is remanded. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU rating) is remanded. FINDINGS OF FACT 1. A January 2013 Board decision denied entitlement to service connection for hepatitis C; the Veteran did not file an appeal to the United States Court of Appeals for Veterans Claims (Court), and his February 2014 motion alleging clear and unmistakable error (CUE) in the January 2013 Board decision with regard to that issue was dismissed in a December 2015 Board decision. 2. Additional evidence received since the January 2013 Board decision is not cumulative or redundant of the evidence of record at the time of that decision, relates to an unestablished fact necessary to substantiate the claim for service connection for hepatitis C, and raises a reasonable possibility of substantiating the claim. 3. A February 2011 Board decision denied entitlement to service connection for a low back disability; the Veteran did not file an appeal to the Court. 4. Additional evidence received since the February 2011 Board decision is not cumulative or redundant of the evidence of record at the time of that decision, relates to an unestablished fact necessary to substantiate the claim for service connection for a low back disability, and raises a reasonable possibility of substantiating the claim. 5. The Veteran’s lumbar spine disc space narrowing at L1-L2 and L5-S1 was incurred during his active service. 6. For the evaluation period prior to November 28, 2017, the Veteran’s headaches were shown to have been manifested by non-prostrating headache pain; his headaches were not shown to have been manifested either by characteristic prostrating attacks occurring at least once a month on average or by completely prostrating and prolonged attacks of headache pain productive of severe economic inadaptability at any time during this period. 7. For the evaluation period from November 28, 2017 through December 6, 2017, the Veteran’s headaches were shown to have been manifested by very frequent completely prostrating and prolonged attacks of headache pain productive of severe economic inadaptability; the schedular diagnostic criteria encompass all symptoms and related functional impairment of his headaches disability shown during the evaluation period considered. CONCLUSIONS OF LAW 1. The January 2013 Board decision denying entitlement to service connection for hepatitis C is final. 38 U.S.C. § 7104 (2012); 38 C.F.R. § 20.1100 (2018). 2. New and material evidence has been received to reopen the Veteran’s claim for entitlement to service connection for hepatitis C. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 3. The February 2011 Board decision denying entitlement to service connection for a low back disability is final. 38 U.S.C. § 7104 (2012); 38 C.F.R. § 20.1100 (2018). 4. New and material evidence has been received to reopen the Veteran’s claim for entitlement to service connection for a low back disability. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 5. The criteria for entitlement to service connection for a low back disability, diagnosed as lumbar spine disc space narrowing at L1-L2 and L5-S1, have been met. 38 U.S.C. §§ 1110, 1154(b), 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 6. For the evaluation period prior to November 28, 2017, a rating in excess of 10 percent for headaches is not warranted. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.124a, Diagnostic Code (DC) 8100. 7. For the evaluation period from November 28, 2017 through December 6, 2017, a rating of 50 percent (the maximum schedular rating) for headaches is warranted. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.124a, DC 8100. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1966 to May 1971. The Veteran previously was represented in this appeal by a Veterans Service Organization, namely Disabled American Veterans (DAV). However, in an April 2019 written statement, the Veteran indicated that he was revoking DAV’s representation. Thereafter, the record does not contain any executed form (either a VA Form 21-22 or a VA Form 21-22a) appointing a valid representative in the current appeal. Consequently, the Board will proceed with the understanding that the Veteran is appearing pro se. The Veteran is hereby advised that he is permitted to appoint a valid representative at any time. In November 2019, a videoconference hearing was held before the undersigned Veterans Law Judge, and a transcript of the hearing is associated with the record. From the date of the hearing, the record was held open for 60 days in order to allow for the submission of additional evidence for consideration. Additional evidence was submitted by the Veteran later in November 2019 and will be considered by the Board in adjudicating this appeal. See 38 C.F.R. § 20.1304 (2018). Reopening Service Connection Claims Generally, a claim which has been denied may not thereafter be reopened and allowed based on the same record. 38 U.S.C. §§ 7104, 7105 (2012). However, pursuant to 38 U.S.C. § 5108, if new and material evidence is presented or secured with respect to a claim which has been disallowed, the VA Secretary shall reopen the claim and review the former disposition of the claim. New evidence is defined as existing evidence not previously submitted to agency decision makers. Material evidence is defined as existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. 38 C.F.R. § 3.156(a). 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. Id. In determining whether evidence is new and material, the credibility of the new evidence must be presumed. Fortuck v. Principi, 17 Vet. App. 173, 179-80 (2003); Justus v. Principi, 3 Vet. App. 510, 513 (1992). 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, 117 (2010). Furthermore, in determining whether this low threshold is met, VA should not limit its consideration to whether the newly received evidence relates specifically to the reason why the claim was last denied, but instead should ask whether the evidence could reasonably substantiate the claim were the claim to be reopened, either by triggering VA’s duty to assist or through consideration of an alternative theory of entitlement. Shade, 24 Vet. App. at 118. If the Board determines that the evidence submitted is both new and material, it must reopen the case and evaluate the claim in light of all the evidence. Justus, 3 Vet. App. at 512. Such evidence is presumed to be credible for the purpose of determining whether the case should be reopened; once the case is reopened, the presumption as to the credibility no longer applies. Id. at 513. 1. Whether new and material evidence has been received to reopen a claim for entitlement to service connection for hepatitis C. A claim for service connection for hepatitis C was initially denied by the Agency of Original Jurisdiction (AOJ) in an August 2005 rating decision. The Veteran timely appealed that rating decision, and a January 2013 Board decision denied entitlement to service connection for hepatitis C on the basis that the evidence did not show a nexus between the Veteran’s current diagnosis of hepatitis C and his military service. The Veteran was notified of the decision, and his rights to appeal were explained. 38 C.F.R. § 20.1100 (2018). The Veteran did not appeal the decision to the Court, and his February 2014 motion alleging CUE in the January 2013 Board decision with regard to that issue was dismissed in a December 2015 Board decision. The evidence received since the January 2013 Board decision includes the Veteran’s November 2019 Board hearing testimony (alleging his belief that his current hepatitis C is related to jet injector inoculations during his military service and to his exposure to the blood of wounded soldiers during his combat service) and a treatise article submitted by the Veteran in November 2019 (which discussed the discontinuation of jet injector inoculations by the Department of Defense due to safety concerns). This evidence was not before adjudicators when the Veteran’s claim was previously denied by the Board in January 2013, and it is not cumulative or redundant of the evidence of record at the time of that decision. It also relates to an unestablished fact necessary to substantiate the claim for service connection for hepatitis C, and raises a reasonable possibility of substantiating the claim. Accordingly, the claim is reopened. 2. Whether new and material evidence has been received to reopen a claim for entitlement to service connection for a low back disability. A claim for service connection for a low back disability was initially denied by the AOJ in a June 2003 rating decision. The Veteran timely appealed that rating decision; after an April 2005 Board decision denied the claim, the Court issued an Order that vacated the April 2005 Board decision with regard to that issue, and remanded that matter for readjudication consistent with instructions outlined in a March 2006 Joint Motion for Remand by the parties. Thereafter, a February 2011 Board decision denied entitlement to service connection for a low back disability on the basis that the evidence did not show a nexus between the Veteran’s current diagnosis of a low back disability and his military service. The Veteran was notified of the decision, and his rights to appeal were explained. 38 C.F.R. § 20.1100 (2018). The Veteran did not appeal the decision to the Court. The evidence received since the February 2011 Board decision includes the report of a May 2017 VA lumbar spine examination, which noted a diagnosis for the Veteran of lumbar spine disc space narrowing at L1-L2 and L5-S1 with a date of diagnosis in 1967, and the onset and course of the condition was described as follows: “Flipped over jeep and hurt back in 1967. Low back pain getting worse. Pain worse while driving, sitting on a couch, sleeping[,] or lying down. Intense type of pain.” Additionally, in an accompanying May 2017 medical opinion, the VA examiner opined: “Trauma from flipping of van [Jeep] can cause narrowing of lumbar spine spaces.” This evidence was not before adjudicators when the Veteran’s claim was previously denied by the Board in February 2011, and it is not cumulative or redundant of the evidence of record at the time of that decision. It also relates to an unestablished fact necessary to substantiate the claim for service connection for a low back disability, and raises a reasonable possibility of substantiating the claim. Accordingly, the claim is reopened. Service Connection Claim Entitlement to service connection requires evidence of three elements: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship or nexus between the current disability and the disease or injury incurred or aggravated during active service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). 3. Entitlement to service connection for a low back disability. The Veteran contends that he currently has a low back disability which began during his military service and has continued to the present. The medical evidence of record, including a May 2017 VA lumbar spine examination report, shows that the Veteran has a current diagnosis of lumbar spine disc space narrowing at L1-L2 and L5-S1. The Veteran’s service treatment records (STRs) document the following pertinent findings. On a March 1971 Report of Medical History, he indicated “Yes” to whether he had a history of back trouble of any kind. Thereafter, an April 1971 STR noted that he had had an accident in a Jeep three years ago. Three and a half weeks later, an April 1971 STR noted that he was tender over the right anterior superior iliac crest, and it was also noted that he had a history of trauma in this region; x-rays of his pelvis taken on that same date in April 1971 showed no fractures. The Veteran’s DD Form 214 confirms his receipt of the Combat Infantryman Badge (CIB), and his DD Form 215 confirms his receipt of the Purple Heart. This evidence verifies the Veteran’s combat service and any events consistent with such service. See 38 U.S.C. § 1154(b). Post-service, at a June 2007 VA lumbar spine examination, the Veteran was diagnosed with mild lumbar spine strain “without any functional limitation whatsoever.” It was noted that x-rays of his lumbar spine on that date also showed some degenerative disc changes with disc space narrowing at L1-L2 and L5-S1. The Veteran reported that during his service in 1967, he was riding in a Jeep when it hit a pothole, flipped over, and tossed him out, and he stated that he injured his back (as well as his head and neck) during this incident. He also reported that he was involved in a rocket attack in Vietnam in 1971 during which he injured his back (as well as his head and knees). The VA examiner noted the pertinent March 1971 and April 1971 STRs outlined above, but also noted that there were no STRs documenting any back injuries for the Veteran. The VA examiner provided the following opinion: “If asked directly if the back complaints he is having today are related to a 1971 injury to his anterior superior iliac spine, I do not believe so. I do not think that they are related whatsoever. I do not see any documentation in his [STRs] for any of his claimed injuries to have occurred, so it is my opinion that his present condition is not at least as likely as not related to service. He has no residuals whatsoever and an essentially negative back examination today.” As outlined above, at a May 2017 VA lumbar spine examination, the Veteran was diagnosed with lumbar spine disc space narrowing at L1-L2 and L5-S1. His date of diagnosis was noted to be 1967 (i.e., during his military service), and the onset and course of the condition was described as follows: “Flipped over jeep and hurt back in 1967. Low back pain getting worse. Pain worse while driving, sitting on a couch, sleeping[,] or lying down. Intense type of pain.” Additionally, in an accompanying May 2017 medical opinion, the VA examiner opined: “Trauma from flipping of van [Jeep] can cause narrowing of lumbar spine spaces.” At his November 2019 Board hearing, the Veteran testified that he first injured his back in service during the Jeep accident in 1967 and then reinjured his back during the rocket attack in 1971. The Board finds that the Veteran’s history of experiencing trauma to his back during service is competent and credible, as it is consistent with the circumstances of his service. It is also supported by the STRs documenting his history of a Jeep accident in service and the history of trauma to his right anterior superior iliac crest region. The Board also finds that the favorable medical opinion provided by the May 2017 VA examiner, which tends to link the Veteran’s currently diagnosed lumbar spine disc space narrowing at L1-L2 and L5-S1 to his military service, is supported by an adequate rationale for the conclusion reached, as this rationale took into account the pertinent circumstances of his service (to include the in-service Jeep accident and his back trauma). Even when considering the unfavorable medical opinion provided by the VA examiner in June 2007, the Board finds that the evidence currently of record is at least in equipoise that the Veteran’s current lumbar spine disc space narrowing at L1-L2 and L5-S1 was incurred during his active service. In light of the foregoing and after resolving all doubt in the Veteran’s favor, the Board concludes that service connection for a low back disability, diagnosed as lumbar spine disc space narrowing at L1-L2 and L5-S1, is warranted on a direct basis. 38 U.S.C. §§ 1110, 1154(b), 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). [The Board finds that the instant decision applies to – and resolves – all pending claims of service connection for a low back disability, however diagnosed. See Clemons v. Shinseki, 23 Vet. App. 1, 5-6 (2009).] Increased Rating Claim Generally, disability evaluations are determined by the application of a schedule of ratings, which is based on the average impairment of earning capacity caused by a given disability. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability more closely approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3. In evaluating the severity of a particular disability, it is essential to consider its history. 38 C.F.R. § 4.1; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary importance. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Separate “staged” ratings may be assigned for separate periods of time based on the facts found. Hart v. Mansfield, 21 Vet. App. 505 (2007). 4. Entitlement to a rating in excess of 10 percent (prior to November 28, 2017) for headaches. 5. Entitlement to a rating of 50 percent (from November 28, 2017 through December 6, 2017) for headaches. The Veteran filed the instant claim for an increased rating for his headaches in February 2012. Therefore, for purposes of this appeal, the evaluation period begins in February 2011 (i.e., one year prior to the date of claim). The March 2013 rating decision on appeal continued the 10 percent rating already assigned for the Veteran’s headaches under DC 8100. Thereafter, a March 2018 rating decision granted an increased 50 percent rating for headaches under DC 8100, effective December 7, 2017 (i.e., the date that a November 28, 2017 VA headaches examination report was signed by the examining physician). The Board notes that a 50 percent rating is the highest schedular rating available under DC 8100 and therefore represents a total grant of benefits sought on appeal for this disability as of December 7, 2017, and thus the Veteran’s claim for a higher schedular rating is moot as of that date. See AB v. Brown, 6 Vet. App. 35 (1993). DC 8100 provides the following ratings for migraines. A 10 percent rating is warranted for migraines with characteristic prostrating attacks averaging one in two months over the last several months. A 30 percent rating is warranted for migraines with characteristic prostrating attacks occurring on an average of once a month over the last several months. A 50 percent rating is warranted for migraines with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. 38 C.F.R. § 4.124a, DC 8100. The phrase “completely prostrating” (which is required for a 50 percent rating) is defined as “completely … lacking in vitality or will” and “powerless to rise.” See Johnson v. Wilkie, 30 Vet. App. 245 (2018). The Court has indicated this phrase means the headaches “must render the veteran entirely powerless.” Id. at 253 (emphasis in original). This differs from “characteristic prostrating” (which is required for a 30 percent rating), which means that the migraine attacks “typically produce powerlessness or a lack of vitality.” Further, prolonged has been defined as “to lengthen in time: extend duration: draw out: continue, protract.” Id. “[P]roductive of severe economic inadaptability” has been defined as either “‘producing’ or ‘capable of producing’ severe economic inadaptability.” Id. (citing Pierce v. Principi, 18 Vet. App. 440 (2004)). For the evaluation period prior to November 28, 2017, the Veteran’s headaches were shown to have been manifested by non-prostrating headache pain, as shown by the evidence of record (including the reports of VA headaches examinations in November 2012, September 2016, and May 2017). In addition, the aforementioned evidence of record shows that his headaches were not shown to have been manifested either by characteristic prostrating attacks occurring at least once a month on average or by completely prostrating and prolonged attacks of headache pain productive of severe economic inadaptability at any time during this period (as all three of the aforementioned VA headaches examination reports noted that he had no characteristic prostrating attacks and that his headaches had no impact on his ability to work). For the evaluation period from November 28, 2017 through December 6, 2017, the Veteran’s headaches were shown to have been manifested by very frequent completely prostrating and prolonged attacks of headache pain productive of severe economic inadaptability, as shown by the evidence of record (including the report of a November 28, 2017 VA headaches examination, which noted that he had characteristic prostrating attacks and very prostrating and prolonged attacks productive of severe economic inadaptability, and that his headaches impacted his ability to work as follows: “The frequency of prostrating attacks is more than once per month productive of economic inadaptability[.]”). Accordingly, the Board finds that for the Veteran’s headaches, a rating in excess of 10 percent is not warranted at any time during the evaluation period prior to November 28, 2017, and that a 50 percent rating is warranted during the evaluation period from November 28, 2017 through December 6, 2017. See 38 C.F.R. § 4.124a, DC 8100; see also Francisco, 7 Vet. App. at 55, 58; see also Hart, 21 Vet. App. at 505. As noted above, a 50 percent rating is the highest schedular rating available under DC 8100 (and such rating was already in effect as of December 7, 2017). The Board finds that the schedular diagnostic criteria encompass all symptoms and related functional impairment of the Veteran’s headaches disability shown during the evaluation period considered, and the Veteran has not contended otherwise. REASONS FOR REMAND 1. Entitlement to service connection for hepatitis C. The Veteran contends that his current hepatitis C is related to his military service, to include as a result of receiving jet injector inoculations therein and as a result of his alleged exposure to the blood of wounded soldiers during his combat service. As noted above, the Veteran’s combat service has been verified by his confirmed receipt of the CIB and the Purple Heart. See 38 U.S.C. § 1154(b). At a February 2011 VA hepatitis examination, it was noted that the Veteran did not have exposure to blood from another individual during his military service. The VA examiner opined that it was less likely than not that the Veteran’s currently diagnosed hepatitis C was related to bleeding from his in-service knee, shoulder, and scalp injuries. For rationale, the VA examiner noted: “[T]hese lesions were treated soon after he got medical attention without any contamination and the wounds healed well within a few weeks and there was no exposure to blood from other Veterans while in the military service.” The medical evidence of record documents that the Veteran received VA treatment for hepatitis C during the current appeal period, specifically in 2016. At his November 2019 Board hearing, he testified with regard to his belief that his current hepatitis C is related to jet injector inoculations during his military service and to his exposure to the blood of wounded soldiers during his combat service. Thereafter, in November 2019, he submitted a treatise article which discussed the discontinuation of jet injector inoculations by the Department of Defense due to safety concerns. On remand, after any outstanding treatment records have been associated with the claims file, an examination with medical opinion should be scheduled to determine whether the Veteran’s current hepatitis C is related to his military service. The examiner should give specific consideration to the Veteran’s verified combat service and his alleged exposure to the blood of wounded soldiers during such combat service, and to his allegations of contracting the virus through jet injector inoculations during his service. 2. Entitlement to a compensable rating for right knee scar. 3. Entitlement to a compensable rating for left knee scar. 4. Entitlement to a rating in excess of 10 percent for right knee shell fragment wound residuals. 5. Entitlement to a rating in excess of 10 percent for left knee shell fragment wound residuals. 6. Entitlement to an initial rating in excess of 10 percent for left cervical spine shell fragment wound degenerative changes. 7. Entitlement to a rating in excess of 10 percent for glaucoma. 8. Entitlement to a rating in excess of 30 percent for right eye cataract. 9. Entitlement to a rating in excess of 50 percent for PTSD with TBI. The Veteran contends that he is entitled to higher ratings for his service-connected right knee scar, left knee scar, right knee shell fragment wound residuals, left knee shell fragment wound residuals, left cervical spine shell fragment wound degenerative changes, glaucoma, right eye cataract, and PTSD with TBI. Regarding the Veteran’s eye disabilities specifically, VA treatment records during the appeal period (including in June 2014, September 2014, and June 2017) refer to scanned visual field reports in VistA Imaging; however, these visual field reports are not currently viewable in the claims file. In addition, the reports of the Veteran’s VA eye examinations in April 2015 and May 2017 note that the Veteran underwent Goldmann visual field testing in conjunction with both of those examinations; however, the graphical charts showing the results of such testing are not currently in the claims file. In addition, the record reflects that the Veteran was most recently afforded VA examinations for his right knee scar and his left knee scar in November 2018; for his right knee shell fragment wound residuals and his left knee shell fragment wound residuals in November 2018; for his left cervical spine shell fragment wound degenerative changes in November 2012; for his glaucoma and right eye cataract in May 2017; and for his PTSD with TBI in November 2017 (with focus on his TBI symptoms) and in December 2017 (with focus on his psychiatric symptoms). Thereafter, at his November 2019 Board hearing, the Veteran testified that all of the conditions for which he was seeking increased ratings “are deteriorating” and “getting worse[.]” He also provided specific testimony regarding the current symptoms of each such disability. On remand, after all outstanding treatment records have been associated with the claims file, new examinations should be scheduled in order to ascertain the current level of severity of each disability remaining on appeal for which the Veteran seeks an increased rating, as there is an indication that the current record does not adequately reflect the severity of these conditions. In addition, for the Veteran’s right knee shell fragment wound residuals, left knee shell fragment wound residuals, and left cervical spine shell fragment wound degenerative changes, the examiner(s) should provide a medical opinion addressing any functional impairment (including the degree(s) of any additional range of motion loss) caused by flare-ups of each such disability. See Mitchell v. Shinseki, 25 Vet. App. 32, 43-44 (2011). If an examiner opines that he or she cannot offer an opinion as to additional functional loss during flare-ups without resorting to speculation based on the fact that the examination was not performed during a flare-up, then the examiner must “elicit relevant information as to the [V]eteran’s flares or ask him to describe the additional functional loss, if any, he suffered during flares and then estimate the [V]eteran’s functional loss due to flares based on all the evidence of record, including the [V]eteran’s lay information, or explain why [he or] she could not do so.” See Sharp v. Shulkin, 29 Vet. App. 26 (2017). Furthermore, for the Veteran’s glaucoma and right eye cataract, the examiner should give consideration to all applicable rating criteria, as during the pendency of the instant appeal and since the Veteran’s last VA eye examination in May 2017, VA revised the criteria for rating disabilities of the organs of special sense (including eyes), effective May 13, 2018. See 83 Fed. Reg. 15,321-322 (Apr. 10, 2018). 10. Entitlement to a TDIU rating. The Board notes that, although the Veteran initially indicated at his November 2019 Board hearing that he wished to withdraw the issue of entitlement to a TDIU rating, he affirmed later in the hearing that he wanted the TDIU rating issue to remain on appeal. Because a decision on the other remanded issues could significantly impact a decision on the TDIU rating issue, the issues are inextricably intertwined. A remand of the TDIU claim is required. See Harris v. Derwinski, 1 Vet. App. 181 (1991). The matters are REMANDED for the following actions: 1. Ask the Veteran to complete a VA Form 21-4142 for all private providers who have treated him for any of the claimed disabilities remaining on appeal at any time during the appeal period. Make two requests for the authorized records from each identified provider, unless it is clear after the first request that a second request would be futile. 2. Obtain the Veteran’s VA treatment records for the period from October 2018 to the present, as well as viewable copies of the visual field reports noted in the June 2014, September 2014, and June 2017 VA treatment records outlined above and the graphical charts showing the results of the Veteran’s Goldmann visual field testing at his April 2015 and May 2017 VA eye examinations. Any negative search result should be noted in the record and communicated to the Veteran. 3. After all requested records have been associated with the claims file, schedule the Veteran for examinations by appropriate clinicians to determine the nature and etiology of his hepatitis C, and to determine the current severity of his service-connected right knee scar, left knee scar, right knee shell fragment wound residuals, left knee shell fragment wound residuals, left cervical spine shell fragment wound degenerative changes, glaucoma, right eye cataract, and PTSD with TBI. The electronic claims file must be made available to the examiners for review in conjunction with the examinations. All necessary tests should be performed, and the results reported. (a.) For the Veteran’s hepatitis C: The examiner must provide an opinion as to whether it is at least as likely as not that such disability began during the Veteran’s active service (or within one year of service discharge), or is otherwise related to any incident of his military service (with specific consideration given to his verified combat service and his alleged exposure to the blood of wounded soldiers during such combat service, and to his allegations of contracting the virus through jet injector inoculations during his service). (b.) For the Veteran’s service-connected right knee scar and left knee scar: All pertinent symptomatology and findings must be reported in detail. Any appropriate Disability Benefits Questionnaire (DBQ) should be filled out for this purpose, if possible. (c.) For the Veteran’s service-connected right knee shell fragment wound residuals, left knee shell fragment wound residuals, and left cervical spine shell fragment wound degenerative changes: All pertinent symptomatology and findings must be reported in detail. Any appropriate DBQs should be filled out for this purpose, if possible. The examiner(s) should provide a medical opinion addressing any functional impairment (including the degree(s) of any additional range of motion loss) caused by the Veteran’s reported flare-ups of these disabilities. If the examiner(s) opines that he or she cannot offer an opinion as to additional functional loss during flare-ups without resorting to speculation based on the fact that the examination was not performed during a flare-up, then the examiner must elicit relevant information as to the Veteran’s flares or ask him to describe the additional functional loss, if any, he suffered during flares and then estimate the Veteran’s functional loss due to flares based on all of the evidence of record, including the Veteran’s lay information, or explain why he or she cannot do so. (d.) For the Veteran’s service-connected glaucoma and right eye cataract: All pertinent symptomatology and findings must be reported in detail. Any appropriate DBQ should be filled out for this purpose, if possible. The examiner should consider all applicable rating criteria during the appeal period (including the versions of the eye rating criteria effective prior to and since May 13, 2018). (e.) For the Veteran’s service-connected PTSD with TBI: All pertinent symptomatology and findings must be reported in detail. Any appropriate DBQs should be filled out for this purpose, if possible. (f.) Schedule the Veteran for the appropriate VA examination to determine the level of functional impairment his service-connected disabilities have on his ability to obtain and retain substantially gainful employment. After reviewing the file, the Veteran’s educational and occupational history and examination findings, the examiner should provide an opinion addressing what functional impairment the Veteran’s service-connected disabilities have on his ability to perform occupational tasks. A complete rationale for all opinions must be provided. If the clinician(s) cannot provide a requested opinion without resorting to speculation, it must be so stated, and the clinician(s) must provide the reasons why an opinion would require speculation. The clinician(s) must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the clinician(s) must indicate whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular clinician. 4. Thereafter, review the record, ensure that all development is completed (and arrange for any further development suggested by additional evidence received), and readjudicate the claims on appeal for entitlement to service connection for hepatitis C and for entitlement to higher ratings for right knee scar, left knee scar, right knee shell fragment wound residuals, left knee shell fragment wound residuals, left cervical spine shell fragment wound degenerative changes, glaucoma, right eye cataract, and PTSD with TBI – followed by readjudication of the issue of entitlement to a TDIU rating (in light of the outcome of the other claims on appeal). If any benefit sought on appeal remains denied, in whole or in part, a Supplemental Statement of the Case must be provided to the Veteran. After the Veteran has had an adequate opportunity to respond, the appeal must be returned to the Board for appellate review. C. CRAWFORD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board L. B. Yantz, Counsel The Board’s decision in this case is binding only with respect to the instant matters decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303 (2018).