Citation Nr: 21003621 Decision Date: 01/22/21 Archive Date: 01/22/21 DOCKET NO. 19-34 841 DATE: January 22, 2021 ORDER The request to reopen the claim of service connection for a nervous disorder is granted. The request to reopen the claim of service connection for hypertension, claimed as high blood pressure, is granted. Entitlement to service connection for hypertension is granted. Entitlement to service connection for a heart disorder is denied. Entitlement to service connection for a cervical spine disorder is denied. Entitlement to an evaluation in excess of 30 percent for infectious hepatitis with schistosomiasis is denied. REMANDED Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), is remanded. Entitlement to service connection for a gastrointestinal disorder is remanded. Entitlement to service connection for hearing loss is remanded. Entitlement to service connection for tinnitus is remanded. Entitlement to service connection for a right shoulder disorder is remanded. Entitlement to service connection for a left shoulder disorder is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. Entitlement to Dependents’ Educational Assistance (DEA) benefits under Chapter 35 is remanded. FINDINGS OF FACT 1. In an August 2009 rating decision, the Veteran was denied service connection for a nervous condition because the evidence did not show the presence of a clinically diagnosed condition or that the condition was incurred in service or aggravated by an event during service. The Veteran was informed of the decision and did not appeal, nor was new and material evidence received within a year of the decision. 2. In an August 2009 rating decision, the Veteran was denied entitlement to service connection for hypertension, claimed as high blood pressure, because the evidence did not show that the condition was incurred in service or diagnosed within one year of discharge. The Veteran was informed of the decision and did not appeal, nor was new and material evidence received within a year of the decision. 3. In April 2018, the Veteran submitted an opinion from a private physician indicating he has a psychiatric disorder related to service and hypertension due to in-service herbicide exposure. This evidence is relevant and probative as to the possibility that the Veteran has a psychiatric condition and hypertension related to an event during service. 4. The Veteran’s hypertension is related to presumed herbicide exposure during service in Vietnam. 5. The Veteran does not have a currently diagnosed heart disorder that is causally or etiologically related to any disease, injury, or incident during service, including exposure to herbicide agents, or that had its onset within one year of discharge. 6. The Veteran does not have a currently diagnosed cervical spine disorder that is causally or etiologically related to any disease, injury, or incident during service or that had its onset within one year of discharge. 7. The Veteran’s hepatitis with schistosomiasis is asymptomatic and without sequelae; there has been no symptoms of daily fatigue, malaise, and anorexia, with minor weight loss and hepatomegaly, or incapacitating episodes as defined by statute having a total duration of at least four weeks, but less than six weeks, during the past 12-month period. CONCLUSIONS OF LAW 1. The August 2009 rating decision is final. 38 U.S.C. § 7105(c) (2012); 38 C.F.R. §§ 20.302, 20.1103 (2019). 2. Evidence received since the August 2009 rating decision is new and material and the claim for service connection for a nervous disorder is reopened. 38 U.S.C. §§ 5103A, 5107, 5108 (2012); 38 C.F.R. § 3.156(a) (2019). 3. Evidence received since the August 2009 rating decision is new and material and the claim for service connection for hypertension, originally claimed as high blood pressure, is reopened. 38 U.S.C. §§ 5103A, 5107, 5108 (2012); 38 C.F.R. § 3.156(a) (2019). 4. The criteria for service connection for hypertension have been met. 38 U.S.C. §§ 1110, 1112, 1131, 1137, 1116, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309(e) (2019). 5. The criteria for service connection for a heart disorder are not met. 38 U.S.C. §§ 1101, 1110, 1112, 1116, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2019). 6. The criteria for service connection for a cervical spine disorder are not met. 38 U.S.C. §§ 1101, 1110, 1112, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2019). 7. The criteria for a rating in excess of 30 percent for hepatitis with schistosomiasis are not met. 38 U.S.C. §§ 5107, 5110 (2012); 38 C.F.R. §§ 3.102, 4.114, Diagnostic Codes (DCs) 7345-7324 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1964 to July 1966. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a January 2019 rating decision. The Board has recharacterized the psychiatric claim to be broader in scope. See Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009). I. New and Material Evidence Whether new and material evidence has been submitted to reopen claims of service connection for a nervous disorder and hypertension. By an August 2009 rating decision, claims of service connection for a nervous disorder and hypertension, claimed as high blood pressure, were denied. The RO found that the evidence did not show the presence of a clinically diagnosed nervous condition or that such condition was incurred in service or aggravated by an event during service. The RO also found that the evidence did not show that hypertension, claimed as high blood pressure, was incurred in service or diagnosed within one year of discharge. The Veteran was notified of the decision by a September 2009 letter, which was mailed to the then current mailing address of record. Thereafter, nothing further regarding these claims was received until the present claims to reopen in June 2018. No new evidence or notice of disagreement (NOD) was received by VA within one year of the issuance of the August 2009 rating decision. As the Veteran did not appeal the decision, that rating decision is final. See 38 U.S.C. § 7105; 38 C.F.R. §§ 20.302, 20.1103. Thereafter, in April 2018, the Veteran submitted an opinion from a private physician indicating he has a psychiatric disorder related to service and hypertension due to in-service herbicide exposure. Then, in June 2018, the Veteran filed a new claim of entitlement to service connection for psychiatric conditions and hypertension. As the newly submitted evidence is relevant and probative as to the possibility that the Veteran has a psychiatric condition and hypertension related to service, the Board finds that new and material evidence has been submitted so that the previously denied claims of service connection are reopened. See 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). II. Service Connection Legal Criteria Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. A veteran seeking compensation under these provisions must establish three elements: “(1) the existence of a present 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.” Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). In addition, for veterans exposed to an herbicide agent, such as Agent Orange, during active service, certain diseases shall be service connected if the requirements of 38 C.F.R. § 3.307(a)(6) are met. 38 C.F.R. § 3.309(e). VA laws and regulations provide that a veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the Vietnam war shall be presumed to have been exposed to an herbicide agent, unless there is affirmative evidence to the contrary. 38 U.S.C. § 1116(a)(3); 38 C.F.R. § 3.307(a)(6)(iii). Furthermore, certain chronic diseases are presumed to be incurred in or aggravated by service if manifest to a compensable degree within one year of separation from service. See 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309(a); Fountain v. McDonald, 27 Vet. App. 258 (2015). Service connection for hypertension. The Veteran contends that he has hypertension due to service. The Veteran’s service personnel records show that he served in Vietnam and, therefore, he is presumed to have been exposed to herbicides during such service. See 38 U.S.C. § 1116(f); 38 C.F.R. § 3.307(a)(6)(iii). The Veteran’s post-service VA treatment records show that he was diagnosed with hypertension as early as October 2007. The Board notes that, while hypertension is not recognized as a presumptive condition due to herbicide exposure, the National Academy of Sciences (NAS) has indicated that there is sufficient evidence of an association between hypertension and herbicide exposure. The NAS moved hypertension to the category of “sufficient” evidence of an association from its previous classification in the “limited or suggestive” category. The sufficient category indicates that there is enough epidemiologic evidence to conclude that there is a positive association. See Hypertension Upgraded in Latest Biennial Review of Research on Health Problems in Veterans That May Be Linked to Agent Orange Exposure During Vietnam War: Update November 15, 2018; see also 38 C.F.R. § 3.309. While the NAS evidence does not provide for a definitive association between herbicides and hypertension, it does provide positive evidence regarding said association. When there is reasonable doubt, such shall be resolved in the Veteran’s favor. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. As such, and mindful of the laws and regulations, after resolving reasonable doubt in favor of the Veteran, the Board finds that service connection for hypertension is warranted. Service connection for a heart disorder. The Veteran is seeking service connection for a heart disorder. In an April 2018 statement, he reported having an ischemic heart condition due to in-service herbicide exposure. As noted above, the Veteran’s service personnel records show that he served in Vietnam. His service treatment records do not include reports of, or treatment for, a heart condition. In a July 1966 report of medical history, the Veteran denied experiencing pain or pressure in chest. The Veteran’s July 1966 separation examination was marked normal for the heart and nothing relevant was noted or reported. In April 2018, the Veteran submitted a statement from a private physician, Dr. Quesada. Dr. Quesada stated that the Veteran experiences episodes of palpitations, diaphoresis, and chest tightness. The examiner noted that the Veteran was exposed to herbicides in Vietnam. The Veteran’s post-service VA treatment records do not include reports of, or treatment for, a heart disorder. The Veteran was afforded a heart examination in October 2018. The examiner reviewed the Veteran’s claims file. The examiner found that the Veteran does not have a heart disorder. She explained that the Veteran’s treatment records do not show a diagnosed heart condition. She also explained that a March 2015 stress test was negative for ischemia and that an August 2018 echocardiogram showed adequate ejection fraction and no evidence of a heart condition. The examiner further explained that the medical records do not indicate the presence of ischemic heart disease, obstructive coronary artery disease, or a history of cardiac surgeries or revascularization procedures. The Board finds that the Veteran does not have a heart condition due to service, to include as due to herbicide exposure. The evidence shows that he was exposed to herbicide during service. However, the October 2018 VA examiner’s finding that the Veteran has not had a heart disorder during the appeal period is clear and unequivocal and is based on the relevant information, including the Veteran’s statements, service treatment records, and post-service medical records. In addition, the examiner’s explanations are logical and follow from the facts and information given. See Monzingo v. Shinseki, 26 Vet. App. 97, 105-06 (2012); Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Thus, her conclusion that the Veteran does not have a heart disorder is highly persuasive and probative evidence. The examiner explained that a heart diagnosis was not made during the examination and the diagnostic records on file do not indicate the presence of ischemic heart disease, coronary artery disease, or another heart condition. Thus, the evidence does not establish the current disability element for a heart disorder at the time the claim was filed or at any time during its pendency. See Romanowsky v. Shinseki, 26 Vet. App. 289, 293 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). While the Veteran believes that he has a heart disorder that is related to service, this is a complex medical question outside the competence of a non-medical expert to determine. This question involves complex medical matters requiring expert consideration and cannot be considered within the competence of a non-expert lay witness. Thus, the Veteran, as a lay person, has not established the competence to diagnosis a heart disorder. See Fountain, 27 Vet. App. at 274-75; Monzingo, 26 Vet. App. at 106. The Board notes that Dr. Quesada reported the presence of relevant heart symptoms and indicated that they are related to in-service herbicide exposure. However, he did not report a specific diagnosis or explained why he found that the Veteran has a heart disorder. Therefore, these statements are outweighed by the findings of the VA examiner because she provided a thorough rationale for her conclusion that the Veteran does not have a heart disorder. See Nieves-Rodriguez, 22 Vet. App. at 295; Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (“[A]medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions”). Accordingly, there is insufficient evidence to establish that the Veteran has a heart disorder that is causally or etiologically related to any disease, injury, or incident during service, to include herbicide exposure, or that had its onset within one year of discharge. Therefore, as the evidence is not at least in equipoise, the benefit-of-the-doubt doctrine is not applicable and service connection for this claimed disorder is not warranted. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Although the Board is remanding other claims for additional development, remand is not necessary for this issue, as there is no reasonable possibility that further assistance would substantiate the claim. See 38 C.F.R. § 3.159(d). Service connection for a cervical spine disorder. The Veteran is seeking service connection for a cervical spine disorder. The Veteran’s service treatment records do not include reports of, or treatment for, a cervical spine condition. In a July 1966 report of medical history, the Veteran denied experiencing arthritis. The Veteran’s July 1966 separation examination was marked normal for the spine and nothing relevant was noted or reported. As noted above, in April 2018, the Veteran submitted a statement from a private physician, Dr. Quesada. However, Dr. Quesada did not report the presence of complaints, treatment, or diagnosis of a cervical spine disorder. The Veteran’s post-service VA treatment records also do not include complaints of, or treatment for, a cervical spine disorder. The Board finds that the Veteran does not have a currently diagnosed cervical spine disorder that is causally or etiologically related to any disease, injury, or incident during service or that had its onset within one year of discharge. The Veteran’s service treatment records do not include any relevant reports of, or treatment for, a cervical spine condition. He has not explained why he relates a cervical spine condition to service or reported that it had its onset within one year of discharge from service. While the Veteran has not been afforded an examination in regard to this claim, a mere conclusory claim that a current condition is related to service is insufficient to require the Secretary to provide an examination. See Waters v. Shinseki, 601 F.3d 1274, 1278 (2010) (distinguishing cases where only a conclusory generalized statement is provided by the veteran and rejecting the theory that medical examinations are to be routinely and virtually automatically provided to all veterans in disability cases involving nexus issues). Therefore, the Board finds that a VA examination or opinion is not warranted for this claim. While the Veteran is competent to report symptoms, for example pain or limited motion of the cervical spine, he has not done so in statements submitted to VA or his treatment providers. Though he believes that he has a cervical spine disorder that is related to service, this is a complex medical question outside the competence of a non-medical expert to determine. This question involves complex medical matters requiring expert consideration and cannot be considered within the competence of a non-expert lay witness. Thus, the Veteran, as a lay person, has not established the competence to diagnosis a cervical spine disorder related to service. See Fountain, 27 Vet. App. at 274-75; Monzingo, 26 Vet. App. at 106. Accordingly, there is insufficient evidence to establish that the Veteran currently has a cervical spine disorder that is causally or etiologically related to any disease, injury, or incident during service or that had its onset within one year of discharge. Therefore, as the evidence is not at least in equipoise, the benefit-of-the-doubt doctrine is not applicable and service connection for this claimed disorder is not warranted. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Although the Board is remanding other claims for additional development, remand is not necessary for this issue, as there is no reasonable possibility that further assistance would substantiate the claim. See 38 C.F.R. § 3.159(d). III. Increased Rating Legal Criteria Ratings are based on a schedule of reductions in earning capacity from specific injuries or combination of injuries. The ratings shall be based, as far as practicable, upon the average impairments of earning capacity resulting from such injuries in civil occupations. 38 U.S.C. § 1155. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1. A rating in excess of 30 percent for infectious hepatitis with schistosomiasis. The Veteran’s infectious hepatitis with schistosomiasis is rated under DC 7345-7324. Under DC 7345, a non-compensable rating is assigned for non-symptomatic; a 10 percent rating is assigned for intermittent fatigue, malaise, and anorexia or incapacitating episodes (with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain) having a total duration of at least one week, but less than two weeks during a 12-month period; a 20 percent rating is assigned for daily fatigue, malaise, and anorexia (without weight loss or hepatomegaly), requiring dietary restriction or continuous medication, or; incapacitating episodes (with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain) having a total duration of at least two weeks, but less than four weeks, during the past 12-month period; a 40 percent rating is assigned for symptoms of daily fatigue, malaise, and anorexia, with minor weight loss and hepatomegaly, or; incapacitating episodes (with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain) having a total duration of at least four weeks, but less than six weeks, during the past 12-month period; a 60 percent rating is assigned evaluation is warranted for daily fatigue, malaise, and anorexia, with substantial weight loss (or other indication of malnutrition), and hepatomegaly or; incapacitating episodes (with symptoms, such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain) having a total duration of at least six weeks during the past 12-month period, but not occurring constantly; and the highest rating of 100 percent is warranted for near-constant debilitating symptoms (such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain). 38 C.F.R. § 4.114, DC 7345. Note (1) states evaluate sequelae, such as cirrhosis or malignancy of the liver, under an appropriate diagnostic code, but do not use the same signs and symptoms as the basis for evaluation under DC 7354 and under a diagnostic code for sequelae (See §4.14.). Id. Note (2) states that, for purposes of evaluating conditions under DC 7345, “incapacitating episode” means a period of acute signs and symptoms severe enough to require bed rest and treatment by a physician. Id. Note (3) stages Hepatitis B infection must be confirmed by serologic testing in order to evaluate it under diagnostic code 7345. Id. However, as certain coexisting diseases found under 38 C.F.R. § 4.114 do not lend themselves to distinct and separate disability evaluations without violating the fundamental principle relating to pyramiding, ratings under DCs 7301 to 7329, inclusive, 7331, 7342, and 7345 to 7348, inclusive, will not be combined with each other. See 38 C.F.R. § 4.14. Instead, a single evaluation is assigned under the DC which reflects the predominant disability picture, with elevation to the next higher evaluation where the severity of the overall disability warrants such evaluation. In this case, the Veteran’s disability rating is assigned under DC 7324 for hepatitic distomiasis. Under DC 7324, a noncompensable rating is assigned for mild or no symptoms; a 10 percent rating is assigned for moderate symptoms; and a 30 percent rating is assigned for severe symptoms. 38 C.F.R. § 4.114, DC 7324. For the purposes of evaluating these disabilities, moderate is “tending toward the mean or average amount or dimension” and “severe” is “of a great degree.” See www.merriam-webster.com/dictionary/moderate; www.merriam-webster.com/dictionary/severe. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3. Analysis The Veteran is seeking a higher rating for this disability. He is currently receiving the maximum schedular rating under DC 7324. The Veteran was afforded a VA examination for infectious intestinal conditions in September 2018. The examiner noted that the Veteran has been granted service-connection for a history of parasitic infection of the intestines since November 1966. The Veteran denied experiencing symptoms or recurrence of the condition. The examiner denied the presence of signs or symptoms of an infectious intestinal condition, weight loss, and malnutrition. The Veteran was afforded an examination for hepatitis, cirrhosis, and other liver conditions in May 2019. The examiner reported a diagnosis of infectious hepatitis with schistosomiasis mansoni, resolved. The examiner also reported that the Veteran and his wife stated that his liver is fine. The examiner denied the presence of signs or symptoms related to this condition, incapacitating episodes, or other pertinent findings, complications, or conditions. The examiner also denied that the condition results in functional impairment. The examiner concluded that Veteran no longer receives active treatment, there is no longer schistosomiasis in his system, he is asymptomatic, and the condition has resolved. The Board finds that a higher rating is not warranted under DC 7345 or other analogous criteria. In this regard, the September 2018 and May 2019 examiners both found that the Veteran’s hepatitis and related infectious intestinal condition have resolved without sequelae and do not result in signs, symptoms, weight loss, malnutrition, or incapacitating episodes. Instead, both examiners found that the conditions have resolved and are now asymptomatic. Thus, the preponderance of the evidence is against claim. The benefit of the doubt doctrine is not applicable, and a higher rating is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3. Although the Board is remanding other claims for additional development, remand is not necessary for this issue as there is no reasonable possibility that further assistance would substantiate the claim. See 38 C.F.R. § 3.159(d). REASONS FOR REMAND Service connection for an acquired psychiatric disorder, to include PTSD. The Veteran contends that he has a psychiatric disorder due to service. In an April 2018 statement, he reported having nightmares and flashbacks related to Vietnam service. In a June 2018 claim form, he requested service connection for cognitive disorder, anxiety, depression, and PTSD. In a January 2019 statement, he reported being under enemy fire during service in Vietnam. In September 2012, the Veteran was seen by a VA psychiatrist. The psychiatrist diagnosed the Veteran with early symptoms of dementia. In April 2018, the Veteran submitted a statement from Dr. Quesada. He stated that the Veteran has an anxiety disorder secondary to service. The Veteran was afforded a VA psychiatric examination in July 2018. The examiner noted a diagnosis of depressive disorder but found that it is not related to service. First, it is unclear whether the Veteran’s claims file contains his complete service personnel records for his period of service. As they may contain information pertinent to the claim (e.g. duty assignments and military occupational specialities (MOS) in Vietnam) a remand is required to obtain them. Next, as indicated above, the Veteran reported in-service stressors associated with his Vietnam service. A remand is required to allow VA to attempt to corroborate the Veteran’s reported stressors, to include contacting the Joint Service Records Research Center (JSRRC) to obtain any corroborating information. Finally, in light of the missing records and the necessary development, the Veteran should be afforded another examination and opinion in regard to this claim. Service connection for hearing loss and tinnitus. The Veteran is seeking service connection for hearing loss and tinnitus on the basis of in-service noise exposure. As indicated above it is unclear whether the Veteran’s complete service personnel records have been obtained. As they may contain information regarding the Veteran’s duty assignments and other potential MOS, other than wireman listed on the DD 214, showing noise exposure, a remand is also required to obtain them with regard to these claims. While a September 2018 VA audiological examination is of record, this examination does not provide a sufficient basis upon which to decide the claims. Notably, it is essential that each disability be viewed in relation to its history and as indicated there are missing records. Moreover, the examiner’s conclusions are internally inconsistent. The examiner opined hearing loss and tinnitus were not related to service and yet indicated hearing loss was due to combination of aging process and noise exposure. Thus, a remand is necessary to afford the Veteran another examination for these claims. Service connection for a gastrointestinal disorder. The Veteran is seeking service connection for a gastrointestinal disorder. The Veteran’s service treatment records include a finding that his intestines could be affected by his service-connected hepatitis and schistosomiasis. In September 2016, the Veteran underwent an endoscopy at a VA facility. The treating physician reported diagnoses of diaphragmatic hernia, esophagitis, chronic gastritis, and duodenitis. In April 2018, the Veteran submitted a statement from Dr. Quesada. He stated that the Veteran has gastritis, hiatal hernia with esophagitis, and duodenitis secondary to service. He did not provide a rationale for these conclusions. The Board cannot make a fully-informed decision on this issue because the Veteran has not been afforded an examination to determine that nature of his gastorinestinal disorders. Moreover, no VA examiner has opined whether any gastrointestinal disorders diagnosed during the appeal period were incurred in service or caused or aggravated by the service-connected hepatitis and schistosomiasis. See McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). Service connection for right and left shoulder disorders. The Veteran is seeking service connection for right and left shoulder disorders. The Veteran’s post-service VA treatment records indicate that he has at least reported experiencing left shoulder symptoms, to include left distal clavicle dislocation and pain. There was also some limited motion noted of the left shoulder. The Veteran has not been afforded an examination in regard to these claims. On remand, the Veteran should be afforded an examination to determine the nature and etiology of any right and left shoulder disorders diagnosed during the appeal period, to include pain resulting in functional impairment. See McLendon, 20 Vet. App. at 81; See also Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir., 2018). Entitlement to a TDIU and DEA. The Veteran is seeking a TDIU and DEA. In a July 2018 TDIU application, in pertinent part, the Veteran reported becoming too disabled to work in 2004 due to hypertension and psychiatric conditions. In a June 2019 TDIU application, the Veteran also reported being unable to work due to hearing loss and tinnitus. As the award of service connection for hypertension has yet to be implemented and assigned an evaluation, and as a decision on the remanded service connection claims could significantly impact a decision on the claims for TDIU and DEA, they are inextricably intertwined, and a remand is required. In addition, on remand the RO should obtain information from the Veteran’s last employer, the US Postal Service and an opinion to assess the functional impairments, if any, of the Veteran’s disabilities. The matters are REMANDED for the following action: 1. Obtain the Veteran’s complete service personnel records, to include all documents pertaining to foreign service, units and bases of assignment, duties performed, and MOS. Document all requests for information as well as all responses in the claims file. 2. Notify the Veteran that he may submit lay statements from himself and from other individuals who have first-hand knowledge, and/or were contemporaneously informed of all claimed in-service stressor events. The Veteran should be provided an appropriate amount of time to submit this lay evidence. 3. Once those procedures have been completed, take appropriate measures to verify all of the Veteran’s claimed stressors during his service, to include being under enemy fire during service in Vietnam, including through the JSRRC. All documentation sent and received regarding this request must be associated with the claims file. 4. Send a VA Form 21-4192 to the Veteran’s most recent employer, the US Postal Service, and send a copy of VA Form 21-4192 to the Veteran for him to request the form be completed and returned by the employer. 5. After completing the records development indicated above, including after the Veteran’s reported stressors have been developed, schedule the Veteran for an examination by an appropriate medical professional to determine the nature and etiology of his psychiatric disorders. The entire claims file should be reviewed by the examiner. Thereafter, the examiner is asked to: (a) identify all of the Veteran’s psychiatric disorders. (b) If PTSD is diagnosed, provide an opinion as to whether it is at least as likely as not the result of any verified in-service stressor, to include hostile military activity during service in Vietnam. (c) For each currently diagnosed psychiatric disorder other than PTSD, the examiner should provide an opinion as to whether it is at least as likely as not that any such disorder had its onset during service or is otherwise related to an in-service event, disease, or injury service, to include service in Vietnam. A rationale should be provided for opinions expressed. In rendering this opinion, the examiner must address the private physician opinion submitted in April 2018. 6. After completing the records development indicated above, schedule the Veteran for a VA examination to be conducted by an audiologist to determine the nature and etiology of the hearing loss and tinnitus. The entire claims file should be reviewed by the examiner. The examiner should address the following: (a) whether there is right or left ear hearing loss for VA purposes under 38 C.F.R. § 3.385. (b) For any diagnosed hearing loss, state whether it is at least as likely as not that it had its onset during service, within one year of discharge from service, or is otherwise related to service, to include in-service noise exposure. (c) State whether it is at least as likely as not that tinnitus had its onset during service or is otherwise related to service, to include in-service noise exposure. Please provide the complete rationale for all opinions expressed. In rendering this opinion, the examiner must address the private physician opinion submitted in April 2018. The examiner is notified that the absence of hearing loss disability in service is not in and of itself sufficient basis for a negative opinion. Finally, the examiner is also advised that the Veteran is competent to report his symptoms and history, and such reports must be acknowledged and considered in formulating any opinion. 7. After completing the records development indicated above, schedule the Veteran for an examination by an appropriate medical professional to determine the nature and etiology of any right and left shoulder disorders. The entire claims file should be reviewed by the examiner. Thereafter, the examiner is asked to: (a) identify all of the Veteran’s right and left shoulder disorders. (b) If a diagnosis cannot be provided but the Veteran’s condition manifests in symptoms that cause functional impairment, then the examiner should consider them a “disability” for the purpose of providing the requested opinion(s) below. (c) State whether any currently diagnosed left or right shoulder disorder at least as likely as not had its onset during service or is otherwise related to an in-service event, disease, or injury. A rationale should be provided for opinions expressed. In providing the requested opinion, consider the Veteran’s description of his in-service injury and symptoms as well as his post-service symptoms. 8. After completing the records development indicated above, schedule the Veteran for an examination by an appropriate medical professional to determine the nature and etiology of any gastrointestinal disorders. The entire claims file should be reviewed by the examiner. Thereafter, the examiner is asked to: (a) identify all of the Veteran’s gastrointestinal disorders. (b) State whether each disorder is at least as likely as not that each disorder had its onset during service or is otherwise related to an in-service event, disease, or injury. (c) State whether each disorder is at least as likely as not that each disorder is at least as likely as not caused or aggravated beyond the natural progress of the disease by the service connected infectious hepatitis with schistosomiasis. A rationale should be provided for opinions expressed, including addressing the private physician opinion submitted in April 2018. 9. After completing all of the above development, obtain an opinion from an appropriate clinician regarding the functional limitations on employability caused by the Veteran’s service-connected infectious hepatitis with schistosomiasis and hypertension. The need for another clinical evaluation is left to the discretion of the medical professional rendering the opinion. A complete copy of the claims file must be made available to the examiner and the examination report should specifically state that a review of the record was conducted. After a thorough review of the medical and lay evidence of record, the examiner should discuss the functional effects of the Veteran’s service-connected disabilities on his ability to perform the physical and mental acts, as appropriate, required to sustain substantially gainful employment consistent with his education and occupational experience. This discussion should include both sedentary and non-sedentary labor. The examiner must address the private physician opinion submitted in April 2018. The examiner should provide a complete rationale for all opinions provided. If an opinion cannot be provided without to resorting to mere speculation, the examiner should identify all medical and lay evidence considered in this conclusion, fully explain why this is the case and identify what additional evidence (if any) would allow for a more definitive opinion. 10. Thereafter, including implementing the award of service connection for hypertension and assigning an evaluation, readjudicate the claims. If upon completion of the above action, the issues remain denied, the case should be returned to the Board after compliance with appellate procedures. K. L. WALLIN Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Jimerfield 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.