Citation Nr: 20030485 Decision Date: 04/30/20 Archive Date: 04/30/20 DOCKET NO. 17-37 934 DATE: April 30, 2020 ORDER Entitlement to service connection for an acquired psychiatric disorder, to include adjustment disorder with disturbance of mood and secondary substance abuse disorder, is granted. New and material evidence having been received, the claim of entitlement to service connection for a thoracolumbar spine condition (claimed as back condition) is reopened. Entitlement to service connection for lumbosacral strain (claimed as back condition) is granted. New and material evidence having been received, the claim of entitlement to service connection for hypertension is reopened. Entitlement to service connection for hypertension, to include as secondary to an acquired psychiatric disorder, is granted. New and material evidence having been received, the claim of entitlement to service connection for flat feet (also claimed as bilateral foot condition) is reopened. Entitlement to service connection for flat feet (also claimed as bilateral foot condition) is granted. New and material evidence having been received, the claim of entitlement to service connection for diabetes mellitus type II is reopened. Entitlement to service connection for diabetes mellitus type II is granted. New and material evidence having been received, the claim of entitlement to service connection for hepatitis-C is reopened. New and material evidence not having been received, the claim of entitlement to service connection for glaucoma is not reopened. REMANDED Entitlement to service connection for a prostate disorder is remanded. Entitlement to service connection for hepatitis C (claimed as a liver condition) is remanded. FINDINGS OF FACT 1. The most probative evidence is at least in equipoise as to whether the Veteran’s acquired psychiatric disorder, adjustment disorder with disturbance of mood and secondary substance abuse disorder, had its onset during or is etiologically related to military service. 2. A September 1977 decision denied a claim of entitlement to service connection for a back injury. The Veteran did not file a Notice of Disagreement or submit new and material evidence within one year of such decision. 3. A March 2010 rating decision denied entitlement to service connection for hypertension, glaucoma, pes planus, diabetes mellitus type II, and hepatitis C. The Veteran did not file a Notice of Disagreement or submit new and material evidence within one year of such decision. 4. A May 2012 rating decision denied entitlement to service connection for diabetes mellitus type II and declined to reopen the claim of service connection for hepatitis C. The Veteran did not file a Notice of Disagreement or submit new and material evidence within one year of such decision. 5. New and material evidence has been received regarding the claims of service connection for a back disorder, hypertension, pes planus, diabetes mellitus type II, and hepatitis C. 6. New and material evidence has not been received regarding the claim of entitlement to service connection for glaucoma. 7. The most probative evidence is at least in equipoise as to whether the Veteran’s lumbosacral strain had its onset during or is etiologically related to military service. 8. The most probative evidence is at least in equipoise as to whether the Veteran’s hypertension is proximately due to or a result of his service-connected acquired psychiatric disorder. 9. The Veteran’s pre-existing flat feet increased in severity during service and is presumed aggravated by military service. 10. The most probative evidence is at least in equipoise as to whether the Veteran was exposed to herbicide agents while stationed at Korat Royal Thai Air Force Base; therefore, his diabetes mellitus type II is presumed to be related to service. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for an acquired psychiatric disorder have been met. 38 U.S.C. §§ 1110, 5107; 38 U.S.C. §§ 3.102, 3.303. 2. The September 1977 decision which denied entitlement to service connection for a back injury is final. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.104, 3.156 (b), 20.200. 3. The March 2010 rating decision which denied entitlement to service connection for hypertension, glaucoma, pes planus, diabetes mellitus type II, and hepatitis C is final. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.104, 3.156 (b), 20.200. 4. The May 2012 rating decision which declined to reopen the claims of service connection for diabetes mellitus type II and hepatitis C is final. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.104, 3.156 (b), 20.200. 5. New and material evidence has been received to reopen the claims of entitlement to service connection for a back condition, hypertension, pes planus, diabetes mellitus type II, and hepatitis C; therefore, those claims are reopened. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.104, 3.156 (a). 6. New and material evidence has not been received to reopen the claim of entitlement to service connection for glaucoma; therefore, that claim is not reopened. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.104, 3.156 (a). 7. The criteria for entitlement to service connection for lumbosacral strain have been met. 38 U.S.C. §§ 1110, 5107; 38 U.S.C. §§ 3.102, 3.303. 8. The criteria for entitlement to service connection for hypertension on a secondary basis to an acquired psychiatric disorder have been met. 38 U.S.C. §§ 1110, 5107; 38 U.S.C. §§ 3.102, 3.303. 9. The criteria for entitlement to service connection for flat feet (pes planus) (also claimed as bilateral foot condition) on the basis of aggravation have been met. 38 U.S.C. §§ 1110, 1153, 5107; 38 C.F.R. §§ 3.303, 3.306. 10. The criteria for entitlement to service connection for diabetes mellitus type II, to include as due to exposure to herbicide agents, have been met. 38 U.S.C. §§ 1110, 5107; 38 U.S.C. §§ 3.102, 3.303, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Air Force from August 1962 to May 1978. The Board thanks him for his service to the United States. These matters come before the Board of Veterans’ Appeals (Board) on appeal of a rating decision issued by the Department of Veterans Affairs (VA), and have been advanced on the Board’s docket pursuant to 38 U.S.C. § 7107. The Veteran testified before the undersigned during a hearing in September 2019. A transcript of the hearing is associated with the claims file. A brief explanation of the procedural background of these matters is necessary. A September 1977 rating letter informed the Veteran that his claim for service connection for a back injury was denied because he failed to report for a VA examination. The decision became final because the Veteran did not file a Notice of Disagreement or submit new and material evidence within one year. The Veteran’s claims of service connection for diabetes mellitus type II, glaucoma, hypertension, flat feet (pes planus), and hepatitis C were denied in a January 2010 rating decision. The denials were confirmed and continued in a March 2010 rating decision. The Veteran did not file a Notice of Disagreement or submit new and material evidence within one year of the March 2010 rating decision. 38 U.S.C. § 7105. Therefore, the decision became final. The Veteran filed a request to reopen his claim of service connection for diabetes mellitus type II and hepatitis C in June 2011. In May 2012, the agency of original jurisdiction (AOJ) issued a rating decision finding that new and material evidence had not been submitted, and declined to reopen the claim. This decision also became final. The Veteran filed a request to reopen his claims of service connection for diabetes mellitus type II and hepatitis-C in October 2014. In September 2015, the AOJ found that new and material evidence had not been submitted to reopen the claims. Within one year of the decision, in June 2016, the Veteran filed a request to reopen his claims of service connection for a back disorder, diabetes mellitus type II, hypertension, flat feet, glaucoma, hepatitis-C, and new claims of service connection for a prostate disorder and an acquired psychiatric disorder. The AOJ denied the claims for a prostate disorder and a psychiatric disorder, and found that new and material evidence had not been received regarding the other issues, in an August 2016 rating decision. This is the decision at issue on appeal. New and material evidence has been received to reopen the claims of service connection for a back condition, diabetes mellitus type II, hepatitis-C, flat feet, and hypertension. Therefore, those claims are reopened. See Hearing Transcript, September 2019; Medical Treatment – Non-Government Facility, January 2020. Regarding the Veteran’s claim for glaucoma, it was previously denied because no evidence showed a current diagnosis, an in-service occurrence, or a link between an in-service occurrence and a current diagnosis. 38 C.F.R. § 3.303. During the Veteran’s hearing, the attorney contended that a current glaucoma disability should be connected on a secondary basis to diabetes mellitus type II. However, the Board finds that new and material evidence has not been submitted regarding the claim of service connection for glaucoma. 38 C.F.R. § 3.156 (a). The Board observes that asserting a different theory of entitlement is considered to be a claim to reopen, rather than “new and material evidence” under applicable regulations. Boggs v. Peake, 520 F.3d 1330, 1336-37 (Fed. Cir. 2008). Even though the Veteran’s attorney asserted that glaucoma should be subject to service connection on a secondary basis to diabetes mellitus type II, he did not submit new and material evidence in support of this theory to the extent that the Board may reopen the claim. Neither VA treatment records nor private medical records reflect a current diagnosis of glaucoma. The Veteran’s private medical opinion did not diagnose the condition or discuss any potential nexus between glaucoma and military service. The attorney’s post-hearing brief made no argument as to the claim of service connection for glaucoma. Therefore, the claim is not reopened. The Board notes that the Veteran filed claims for several different acquired psychiatric disorders. However, applicable law provides that a claim for service connection for an acquired psychiatric disorder is not limited to a diagnosis named on a claims form, but instead must be considered for the functional impairment due to such mental disorder(s). See Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009). Accordingly, the Board has reframed the issue on appeal. Service Connection – Legal Criteria Service connection may be granted for a disability resulting from disease or injury incurred coincident with or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). Establishing direct service connection generally requires competent evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). A disability which is proximately due to or the result of a service-connected disease or injury shall be service-connected. 38 C.F.R. § 3.310 (a). Any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, will also be service-connected. 38 C.F.R. § 3.310 (b). 1. Entitlement to service connection for an acquired psychiatric disorder The Board finds that the most probative evidence reaches the level of equipoise as to whether the Veteran’s current psychiatric disorder had its onset during or is etiologically related to active military service. The Veteran’s DD Form 214 shows that his primary occupational specialty was a radio operator supervisor. Personnel records confirm that he worked in radio operations, including during the evacuations of Cambodia and South Vietnam, and that he volunteered to fly in two combat missions with the Operation College Eye Task Force, an airborne early-warning unit, between March and October 1971. Service medical records show that the Veteran sought treatment on several occasions for symptoms of anxiety and hyperventilation. For example, in December 1971, the Veteran sought treatment after feeling sudden onset of shortness of breath and tightness in his chest. He reported drinking heavily the previous night, and being hung over in the morning. The examiner diagnosed anxiety and hyperventilation, and prescribed valium. In February 1972, the Veteran again sought treatment for anxiety and hyperventilation. He reported being afraid of dying. The examiner assessed anxiety and prescribed more valium. The Veteran spoke to a social worker a few days later, who noted “multiple family problems.” The Veteran sought treatment for anxiety attacks several more times in service, including in June 1973, October 1973, January 1974, and August 1974. No psychiatric problems were detected on his separation examination, and the Veteran denied a history of depression or excessive worry. However, he did report a history of shortness of breath. The Veteran underwent a VA examination in August 2016. He reported having anxiety while flying in combat missions over Vietnam, and that he had a history of panic attacks in the 1990s. The examiner, a VA psychologist, determined that the Veteran’s current symptoms did not meet the criteria for a diagnosable mental disorder. The record reflects a medical opinion from Dr. Q.A.S. dated October 2019. She reviewed the claims file, interviewed the Veteran, and diagnosed adjustment disorder with disturbance of mood and secondary substance abuse disorder. She opined that the condition is directly related to active military service, including the Veteran’s experiences as a radio operator. She explained that he was forced to listen to constant reports of conflict and casualties, and that he was worried about making mistakes that might cost American lives. She stated that after his experiences aiding the evacuation of Saigon and Cambodia, he began to show a significant deterioration in behavior, ultimately leading to substance abuse and a court martial. She disputed the findings of the VA examiner, and contended that his review of the claims file was incomplete, based on his lack of discussion of personnel records showing evidence of severe behavioral changes. During his hearing, the Veteran testified, among other things, that he feared for his life during his two combat flights for Operation College Eye. He reported that the enemy had fired surface-to-air missiles at their airplane, and that the pilot was forced to perform evasive maneuvers. The Veteran’s attorney noted that service medical records showed reports of anxiety and hyperventilation. He challenged the qualifications of the VA examiner, because he believed it was a nurse practitioner who performed the mental health examination. After careful review of the record, the Board finds that the most probative evidence is at least in equipoise as to the claim of service connection for an acquired psychiatric disorder. Therefore, service connection is granted. Dr. Q.A.S. opined that the Veteran’s current adjustment disorder with disturbance of mood and secondary substance abuse disorder is directly related to his experience as a radio operator in military service, including during the evacuations of South Vietnam and Cambodia. As she reviewed the claims file, and provided a cogent and persuasive opinion, the Board affords her findings high probative weight. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Additionally, military personnel and medical records are consistent with the Veteran’s reports that he began to have anxiety after flying in combat missions with Operation College Eye. The Board notes that the Veteran sought treatment for an anxiety episode in December 1971, only a few months after his participation in the combat missions was recorded in a performance evaluation, and he continued to seek treatment for anxiety symptoms through at least 1974. Lastly, the Board notes that the VA examiner is a psychologist. See Cox v. Nicholson, 20 Vet. App. 563, 569 (2007). Notwithstanding such finding, as the Board is granting the benefit sought for this issue to the maximum extent allowed by law, the attorney’s challenge to the examiner’s qualifications is moot. The law is clear. Pursuant to the “benefit-of-the-doubt” rule, where there is “an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter,” the Veteran shall prevail upon the issue. 38 U.S.C. § 5107 (b). The Board finds that the most probative evidence, including Dr. Q.A.S.’s opinion and military personnel and medical records, is at least in equipoise regarding the claim of service connection for an acquired psychiatric disorder, diagnosed as adjustment disorder. Therefore, a grant of service connection is warranted. 2. Entitlement to service connection for a thoracolumbar spine condition (claimed as back condition) The Board finds that the most probative evidence reaches the level of equipoise as to whether the Veteran’s lumbar strain had its onset during or is etiologically related to military service. Therefore, service connection is granted. Service medical records show that the Veteran complained of lower back pain. In August 1968, the Veteran reported continuous pain in the lower back for two days. The clinician assessed a strained back and noted that the Veteran was participating in a weight reduction program. In December 1976, the Veteran’s out-processing examination showed a normal spine and musculoskeletal system. However, in the report of medical history, the Veteran endorsed recurrent back pain. The Veteran submitted a private medical opinion from Dr. M.F. dated January 2020. Dr. M.F. stated that the Veteran “complained of low back pain while in service and was treated many times with back exercises, heat, analgesics and muscle relaxants. His back pain has continued to the present time with back pain present on a daily basis with flare ups of more severe pain. He is limited in prolonged standing and sitting. Dr. M.F. identified his low back condition as “#5237”, a reference to the Diagnostic Code for lumbosacral strain, and noted “[i]t is as likely as not that his low back condition began in service and is, therefore, service-connected.” The Board concludes that the most probative evidence is at least in equipoise regarding the claim of entitlement to service connection for a back disorder. In reaching this determination, the Board affords high probative weight to service medical records, which show treatment for recurring back pain, and the medical opinion of Dr. M.F., who asserted that the Veteran’s current lumbar strain is related to the complaints of recurrent back pain in military service. Therefore, with the benefit of the doubt resolved in the Veteran’s favor, a grant of service connection for a low back disorder is warranted. See Gilbert, 1 Vet. App. at 55. 3. Entitlement to service connection for hypertension VA treatment records reflect a current diagnosis of hypertension, as confirmed by a primary care note in June 2017. The Veteran contends that his hypertension is proximately due to or a result of his acquired psychiatric disorder, which has herein been found to be connected to his military service. See 38 C.F.R. § 3.310. The Veteran submitted a medical opinion from Dr. M.F. dated September 2019. Dr. M.F. reviewed the claims file, and opined that it is as likely as not that the Veteran’s hypertension is secondary to his psychiatric disorder. He stated that there is a known relationship between mental health issues and the development of hypertension, and that numerous articles in the peer reviewed literature support such a relationship. He cited several articles in support of his findings. The Board finds that the most probative evidence reaches the level of equipoise as to whether the Veteran’s hypertension is proximately due to, or a result of, his service-connected acquired psychiatric disorder. In reaching this determination, the Board assigns high probative weight to Dr. M.F.’s medical opinion, which was given in consideration of his review of the claims file and his expertise as a medical professional. See Nieves-Rodriguez, 22 Vet. App. at 304. In sum, as the most probative evidence is at least in equipoise as to whether the Veteran’s hypertension is proximately due to or a result of hypertension, service connection is granted. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.310. 4. Entitlement to service connection for flat feet (also claimed as bilateral foot condition) The record shows that the Veteran’s pes planus pre-existed active duty service. As the most probative evidence reflects in-service worsening of the condition beyond its natural progression, service connection is warranted based on the presumption of aggravation. 38 C.F.R. § 3.102; 38 C.F.R. § 3.306. Every Veteran is presumed to be in sound condition when examined, accepted, and enrolled for service, except as to defects, infirmities, or disorders noted at the time of the examination, acceptance, and enrollment, or where clear and unmistakable evidence demonstrates that the injury or disease existed before acceptance and enrollment and was not aggravated by such service. 38 U.S.C. § 1111. The Federal Circuit has distinguished between those cases in which the preexisting condition is noted upon entry into service, and cases in which the preexistence of the condition must otherwise be established. See Wagner v. Principi, 370 F.3d 1089, 1096 (Fed. Cir. 2004). To be “noted” within the meaning of the presumption of soundness statute, the condition must be recorded in the entrance examination report. 38 U.S.C. § 1111; Crowe v. Brown, 7 Vet. App. 238, 245 (1994). History of pre-service existence of a disease does not constitute notation of such condition. Id. at 240. However, the disease need not be symptomatic at the time of the evaluation, so long as a diagnosis is provided. See Verdon v. Brown, 8 Vet. App. 529, 530 (1996). If a preexisting disorder is noted upon entry into service, the veteran may bring a claim for service-connected aggravation of that disorder. 38 U.S.C. § 1153. If the presumption of aggravation under section 1153 arises, the burden shifts to the government to show a lack of aggravation by establishing “that the increase in disability is due to the natural progress of the disease.” See Jensen v. Brown, 19 F.3d 1413, 1416 (Fed. Cir. 1994). The Veteran’s enlistment examination in August 1962 shows that pes planus was listed in the summary of defects and diagnoses. Therefore, the Board finds that pes planus was noted at induction, and the question is first whether there was any increase in disability during military service. See Crowe, 7 Vet. App. at 245. Service medical records do not show any symptoms or treatment of pes planus. However, the Veteran submitted a report from Dr. M.F. in January 2020, stating: “this Veteran was noted to have flat feet (pes planus) on his entrance into the Air Force. The demands of the service worsened his pes planus and bilateral foot pain. He did not receive any medical treatment for the pes planus while in service despite his foot pain. It is clear that the pes planus this Veteran had on entrance into the military was worsened by his basic training and duties in service.” Considering Dr. M.F.’s medical opinion, and affording the Veteran the benefit of the doubt, the Board finds that there was an increase in pes planus disability during active service. As such, the presumption of aggravation applies with respect to pes planus. See 38 U.S.C. § 1153. As the presumption of aggravation applies, it must be shown by clear and unmistakable evidence that such aggravation was due to the natural progress of the Veteran’s pes planus. Id.; see also VAOPGCPREC 3-03. In the instant case, the Board finds there is no clear and unmistakable evidence to indicate that the aggravation of the Veteran’s pes planus was due to the natural progress of the condition. Accordingly, service connection for pes planus based on the presumption of aggravation is warranted. 38 U.S.C. § 5107 (b). 5. Entitlement to service connection for diabetes mellitus type II The Board finds that the most probative evidence is at least in relative equipoise as to whether the Veteran was exposed to herbicide agents while stationed at Korat Royal Thai Air Force Base during the Vietnam era. Therefore, his diabetes mellitus type II is presumed to be related to exposure to herbicide agents. VA has determined that special consideration of exposure to herbicide agents on a factual basis should be extended to veterans whose duties placed them on or near the perimeters of certain Thailand military bases. As such, exposure to herbicide agents should be conceded on a facts-found or direct basis as shown by military occupational specialty, performance evaluations, or other credible evidence. See Parseeya-Picchione v. McDonald, 28 Vet. App. 171, 176-77 (2016). The Veteran’s DD Form 214 shows a primary military occupational specialty of radio operator supervisor and a secondary specialty of administrative specialist. Military personnel records, including records related to a court martial proceeding and specification of charges in 1975 and 1976, show that the Veteran was stationed at Korat air base during his military service. During the Veteran’s hearing testimony, he described the circumstances of his alleged exposure to herbicide agents while at Korat and Udorn Royal Thai Air Force Bases. Among other things, the Veteran reported that he set up radio equipment in areas outside the perimeter of the base that had been cleared with herbicide agents, and that his primary duty station was located close to the perimeter of the base. He claimed that he served at Korat for around 179 days and at Udorn from 90 to 179 days. The Board notes that service personnel records do not confirm any service at Udorn, but service at Korat is confirmed and his statements are consistent with the places, types and circumstances of the Veteran’s service as a radio operator supervisor. Dr. M.F. noted that the Veteran served at Thai air force bases, and opined that “if a service person was near the perimeter of these bases, it has been accepted that they were exposed to Agent Orange.” He noted that the Veteran currently takes oral medication to treat his diabetes and opined that his diabetes is at least as likely as not due to Agent Orange exposure. After careful review, the Board finds that the most probative evidence is at least in equipoise as to whether the Veteran was exposed to herbicide agents while stationed at Korat. Therefore, a grant of service connection for diabetes mellitus type II on a presumptive basis is applicable. 38 C.F.R. § 3.309. The Veteran testified that his occupational duties as a radio operator placed him in proximity to the base perimeter at Korat. He indicated that he went outside the perimeter to set up radio equipment, and that his primary duty station was located near the base perimeter. The Board notes that a veteran is considered competent to report on matters that are capable of ordinary observation, including the location of his duty station and the nature of his occupational duties. Layno v. Brown, 6 Vet. App. 465, 469 (1994). Accordingly, the Board will resolve reasonable doubt in the Veteran’s favor as to the question of exposure to herbicide agents. Considering the foregoing, service connection for diabetes mellitus is warranted.   REASONS FOR REMAND 1. Entitlement to service connection for a prostate condition is remanded. The Board finds that remand is warranted to procure a VA medical opinion discussing whether the Veteran’s prostate condition is etiologically related to military service. 38 U.S.C. § 5103A (d). The Veteran contends that his exposure to herbicide agents caused his benign prostatic enlargement with lower urinary tract symptoms, as shown by VA medical records dated June 2017. Prostatic enlargement is not listed among the conditions presumptively linked to herbicide agent exposure under 38 C.F.R. § 3.309. However, this does not preclude a Veteran from establishing service connection on a direct basis. Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). Accordingly, the Board finds that a VA medical opinion is necessary to determine the nature and etiology of the Veteran’s prostatic enlargement, and discuss a potential link between such condition and exposure to herbicide agents. 2. Entitlement to service connection for hepatitis C (claimed as a liver condition) is remanded. The Board has herein determined that new and material evidence has been submitted to reopen a claim of entitlement to service connection for hepatitis C. However, the Veteran has not waived jurisdiction of the AOJ, and for the Board to decide the claim presently would deny the Veteran the benefit of having one review of the claim at issue. See 38 U.S.C. § 7104; Bernard v. Brown, 4 Vet. App. 384, 390 (1993). Thus, to avoid prejudice to the Veteran, the claim must be remanded for consideration by the AOJ in the first instance. The matters are REMANDED for the following actions: 1. Please obtain a VA medical opinion from a suitably qualified clinician regarding the nature and etiology of the Veteran’s diagnosed prostatic enlargement with urinary tract symptoms. The examiner is asked to review the claims file, and to opine on the following: (a) Is it at least as likely as not that the Veteran’s prostatic enlargement with urinary tract symptoms began during or is etiologically related to military service, to include exposure to herbicide agents? (b) Is it at least as likely as not that the Veteran’s prostatic enlargement with urinary tract symptoms is proximately due to, a result, or aggravated by, a service-connected disability? If aggravation is present, the examiner should indicate, to the extent possible, the approximate level of prostate disability before the onset of the aggravation. A complete rationale should be provided for all opinions. The examiner is asked to discuss relevant medical and lay evidence, to include the diagnosis of prostatic enlargement with urinary tract symptoms within VA treatment records dated June 2017, and the Veteran’s contentions that herbicide exposure caused his prostate disorder, when rendering his or her opinion. 2. Readjudicate the reopened claim of entitlement to service connection for hepatitis-C, also claimed as a liver condition. If the benefit sought remains denied, furnish the Veteran and his representative with a Supplemental   Statement of the Case. Allow an appropriate period for response before returning the appeal to the Board. M. C. GRAHAM Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Reed, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.