Citation Nr: 21004954 Decision Date: 01/28/21 Archive Date: 01/28/21 DOCKET NO. 17-57 870 DATE: January 28, 2021 ORDER New and material evidence has not been received to reopen a claim of entitlement to service connection for back pain and the appeal is denied. New and material evidence has not been received to reopen a claim of entitlement to service connection for chest pain, to include sinus ventricular tachycardia, and the appeal is denied. New and material evidence has not been received to reopen a claim of entitlement to service connection for residuals of asbestos exposure, and the appeal is denied. New and material evidence has been received to reopen a claim of entitlement to service connection for a psychiatric disability, to include schizophrenia, and to that extent only, the appeal is granted. Entitlement to service connection for sleep apnea is denied. Entitlement to an effective date prior to April 7, 2015, for an increased rating of 10 percent for left eye macular lesion with scotoma, is denied. REMANDED Entitlement to service connection for a psychiatric disability, to include schizophrenia, is remanded. Entitlement to service connection for a forehead scar, to include as secondary to traumatic brain injury (TBI) and post-traumatic headaches, is remanded. Entitlement to a rating higher than 10 percent for post-traumatic headaches with migraine features is remanded. Entitlement to a rating higher than 10 percent for a left eye macular lesion with scotoma is remanded. Entitlement to a rating higher than 0 percent for a traumatic brain injury (TBI) is remanded. Entitlement to a rating higher than 0 percent for a fractured great right toe is remanded. FINDINGS OF FACT 1. Service connection for back pain and chest pain/sinus ventricular tachycardia disabilities, was denied in a May 1999 Agency of Original Jurisdiction (AOJ) rating decision and the Veteran did not perfect an appeal or submit new and material evidence within one year. 2. The evidence received since the May 1999 rating decision is either cumulative or redundant, does not relate to unestablished facts necessary to substantiate the claims, and does not raise a reasonable possibility of substantiating the claims of entitlement to service connection for back pain and chest pain/sinus ventricular tachycardia disabilities. 3. Service connection for residuals of asbestos exposure was denied in a February 2005 Agency of Original Jurisdiction (AOJ) rating decision and the Veteran did not perfect an appeal. 4. The evidence received since the February 2005 rating decision is either cumulative or redundant, does not relate to unestablished facts necessary to substantiate the claim, and does not raise a reasonable possibility of substantiating the claim of entitlement to service connection for residuals of asbestos exposure. 5. Service connection for a psychiatric disability, was denied in a June 2009 Agency of Original Jurisdiction (AOJ) rating decision and the Veteran did not perfect an appeal or submit new and material evidence within one year. 6. The evidence received since the June 2009 rating decision is neither cumulative nor redundant, relates to unestablished facts necessary to substantiate the claim, and raises a reasonable possibility of substantiating the claim of entitlement to service connection for a psychiatric disability. 7. The preponderance of the competent and credible evidence of record is against a finding that the Veteran’s sleep apnea is related to active service. 8. Prior to April 7, 2015, it was not factually ascertainable that the Veteran’s left eye disability warranted a rating in excess of 0 percent. CONCLUSIONS OF LAW 1. As new and material evidence has not been received, the claim for service connection for a back pain disability is not reopened. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 2. As new and material evidence has not been received, the claim for service connection for a chest pain disability is not reopened. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 3. As new and material evidence has not been received, the claim for service connection for residuals of asbestos exposure is not reopened. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 4. New and material evidence has been received to reopen a claim of entitlement to service connection for a psychiatric disability. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 5. The criteria for entitlement to service connection for sleep apnea have not been met. 38 U.S.C. §§ 1110, 1131, 1132, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303. 6. The criteria for an effective date prior to April 7, 2015, for the assignment of a 10 percent rating for left eye disability have not been met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. §§ 3.102, 3.400. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from April 1988 to April 1998. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from August 2015 and May 2016 rating decisions from the Department of Veterans Affairs (VA) Regional Office (RO). In July 2019, the Board remanded the case for further development. New and Material Evidence Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. VA rating decisions and Board decisions that are not timely appealed are final. 38 U.S.C. §§ 7104, 7105; 38 C.F.R. § 20.1103. A finally disallowed claim may be reopened when new and material evidence is presented or secured with respect to that claim. 38 U.S.C. § 5108. New evidence is defined as evidence not previously submitted to agency decision-makers. Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). An adjudicator must follow a two-step process in evaluating a previously denied claim. First, the adjudicator must determine whether the evidence added to the record since the last final decision is new and material. If new and material evidence is presented or secured with respect to a claim that has been finally denied, the claim will be reopened and decided upon the merits. Once it has been determined that a claimant has produced new and material evidence, the adjudicator must evaluate the merits of the claim in light of all the evidence, both new and old, after ensuring that the VA’s statutory duty to assist the appellant in the development of a claim has been fulfilled. 38 U.S.C. § 5108; Elkins v. West, 12 Vet. App. 209 (1999); Vargas-Gonzalez v. West, 12 Vet. App. 321 (1999). The claim to reopen does not require the submission of new and material evidence as to each previously unproven element of a claim for that claim to be reopened. Shade v. Shinseki, 24 Vet. App. 110 (2010). For the purpose of establishing whether new evidence is material, the credibility of the new evidence, although not its weight, is presumed. Justus v. Principi, 3 Vet. App. 510 (1992). 1. Whether new and material evidence has been received to reopen a claim of entitlement to service connection for back pain Service connection for a back disability was denied in a May 1999 Agency of Original Jurisdiction (AOJ) rating decision. The Veteran did not perfect an appeal, and the decision became final. The Veteran claimed that he had back pain during service. The service medical records show no complaints of any back pain or disability. In an April 1999 VA examination, the Veteran reported a minor lumbar strain with flare-ups in the past several years. On examination, the lumbar spine did not have any tenderness. The Veteran had a full range of motion. The examiner diagnosed a mild recurrent lumbar strain. The AOJ concluded that there was no evidence of any in-service treatment for a back disability, and there was no medical evidence of record which indicated that any current back disability occurred in or was caused by service. Evidence associated with the claims file since the May 1999 AOJ decision includes additional lay statements, VA and private treatment records, and Social Security Administration (SSA) records. The VA and private treatment records, and SSA records added to the claims file are new, but they are not material, as none of the treatment providers give any indication that the Veteran has a back disability that was caused by active duty service. All of the statements from the Veteran reiterate the previously considered assertion that he has a back disability related to service. Therefore, those statements merely reiterate contentions that were previously considered by the AOJ in the May 1999 decision. Thus, those statements are cumulative and are not material evidence. The Board finds the evidence added to the claims file since the May 1999 RO decision is cumulative or redundant of the evidence of record and does not raise a reasonable possibility of substantiating the claim. The evidence added to the record does not include any new competent evidence which suggests that the Veteran has a current diagnosis of a back disability that occurred in or was caused by service, which was the basis for the prior determination. The Veteran’s lay statements are redundant of the evidence previously considered, and the medical reports do not show a connection between any disability manifested by back pain and service. As the information provided in support of the application to reopen the claim for service connection for a back disability does not include new and material evidence, the appeal as to that issue remains denied and the claim is not reopened. 2. Whether new and material evidence has been received to reopen a claim of entitlement to service connection for chest pain, to include sinus ventricular tachycardia Service connection for a chest disability was denied in a May 1999 rating decision. The Veteran did not perfect an appeal, and the decision became final. The Veteran claimed that he had chest pain and sinus ventricular tachycardia (SVT) during service. The service medical records show complaints of chest pain. July 1988 and November 1993 chest X-rays were normal. In an April 1999 VA examination, the Veteran reported chest pain since childhood, and that he experienced SVT with occasional dizziness one to two times per year during in service. The condition had not been associated with any chest pain. On examination, there was a normal sinus rhythm without any evidence of murmurs, gallops, or thrills. The AOJ concluded that the chest disability preexisted service. The evidence did not indicate any in-service treatment although there were complaints of chest pain and congestion. Further, the AOJ found that there was no aggravation or worsening of the chest disability, and there was no medical evidence of record which indicated that any current chest disability occurred in or was caused by service. Evidence associated with the claims file since the May 1999 AOJ decision includes additional lay statements, VA and private treatment records, and SSA records. The VA and private treatment records, and SSA records added to the claims file are new, but they are not material, as none of the treatment providers give any indication that the Veteran has a chest disability that was caused, aggravated, or worsened by active duty service. All of the statements from the Veteran reiterate the previously considered assertion that he has a chest disability related to or aggravated by his service. Therefore, those statements merely reiterate contentions that were previously considered by the AOJ in the May 1999 decision. Thus, those statements are cumulative and are not material evidence. The Board finds the evidence added to the claims file since the May 1999 RO decision is cumulative or redundant of the evidence of record and does not raise a reasonable possibility of substantiating the claim. The evidence added to the record does not include any new competent and credible evidence which suggests that the Veteran has a current diagnosis of a chest disability that aggravate, or worsened by active duty service, which was the basis for the prior determination. The Veteran’s lay statements are redundant of the evidence previously considered, and the medical reports do not show a connection between any disability manifested by chest pain and his service. As the information provided in support of the application to reopen the claim for service connection for a chest disability does not include new and material evidence, the appeal as to that issue remains denied and the claim is not reopened. 3. Whether new and material evidence has been received to reopen a claim of entitlement to service connection for residuals of asbestos exposure Service connection for residuals of asbestos exposure was denied in a February 2005 rating decision. The Veteran did not perfect an appeal, and the decision became final. The Veteran claimed that he was exposed to asbestosis during service and had residuals due to that exposure. However, he did not identify a specific disability or give any indication of what the residuals were from the exposure. In August 2004, the Veteran was advised that exposure was not a disability, and that he needed to specify a disability due to the asbestos exposure. The AOJ concluded that there was no evidence of any current disability that manifested as residuals due to asbestosis exposure. Evidence associated with the claims file since the February 2005 AOJ decision includes additional lay statements, VA and private treatment records, and SSA records. The VA and private treatment records, and SSA records added to the claims file are new, but they are not material, as none of the treatment providers give any indication that the Veteran has a disability that was caused by active duty service, to include any residuals of asbestos exposure. All of the statements from the Veteran reiterate the previously considered assertion that he has residuals of asbestos exposure that occurred during his service. Therefore, those statements merely reiterate contentions that were previously considered by the AOJ in the February 2005 decision. Thus, those statements are cumulative and are not material evidence. The Board finds the evidence added to the claims file since the February 2005 RO decision is cumulative or redundant of the evidence of record and does not raise a reasonable possibility of substantiating the claim. The evidence added to the record does not include any new competent and credible evidence which suggests that the Veteran has a current diagnosis of a disability due to residuals of asbestos exposure that occurred in service, which was the basis for the prior determination. The Veteran’s lay statements are redundant of the evidence previously considered, and the medical reports do not show a connection between any disability manifested by residuals of asbestos exposure and his service. As the information provided in support of the application to reopen the claim for service connection for residuals of asbestos exposure does not include new and material evidence, the appeal as to that issue remains denied and the claim is not reopened. 4. Whether new and material evidence has been received to reopen a claim of entitlement to service connection for a psychiatric disability, to include schizophrenia Service connection for a psychiatric disability was originally denied in a February 2005 rating decision. The Agency of Original Jurisdiction (AOJ) found there was no evidence of a psychiatric disability in service. Further, the AOJ determined that the evidence did not link the current disability to service or the service-connected head injury with headaches (later recharacterized as separate ratings for TBI and headaches). The AOJ observed that the service medical records did not show signs, symptoms, or a diagnosis of a psychiatric disability. A January 2005 VA examination diagnosed anxiety, a panic disorder, and psychosis. Post-service treatment records indicated severe psychiatric problems. The AOJ concluded that service connection for psychiatric disability was not warranted because the evidence did not show a disability that occurred in or was caused by service, and the evidence did not show that the current psychiatric disability was caused or aggravated by the service-connected head injury with headaches. The denial was confirmed in a June 2009 rating decision that found the additional private treatment records were new but not material. An April 2008 VA examination diagnosed paranoid schizophrenia. The new evidence showed a psychiatric disability but did not indicate a link to service or a service-connected disability. Evidence associated with the claims file since the June 2009 AOJ decision includes additional lay statements from the Veteran; lay statements from others; VA and private treatment records; SSA records; VA examinations in November 2009, June 2015, and August 2015; and a June 2018 private evaluation. In a June 2018 private evaluation, a doctor opined that the Veteran’s psychiatric disability more likely than not began in service, and that the psychiatric disability was also permanently aggravated by TBI, headaches, eye, and toe disabilities. The examiner was unable to differentiate the TBI from the schizophrenia due to similar impairments in cognition, memory, mood, daily living, and work and social functioning. The credibility of the newly submitted evidence is presumed in determining whether or not to reopen a claim. Justus v. Principi, 3 Vet. App. 510 (1992). As the evidence is presumed to be credible for the limited purpose of attempting to reopen a previously denied claim, this evidence raises a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). Accordingly, the additional evidence is also material. As new and material evidence has been received, the claim for service connection for a psychiatric disability is reopened. Although the new and material evidence discussed is adequate for the limited purpose of reopening the claim, that does not make it sufficient to allow the grant of the benefits sought. The claim is remanded for development. Service Connection Service connection may be established for disability caused by disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. In order to establish service connection for a claimed disability, there must be (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in service incurrence or aggravation of a disease or injury; and (3) evidence, generally medical, of a causal relationship between the claimed in service disease or injury and the current disability. Hickson v. West, 12 Vet. App. 247 (1999). Service connection may also be established for any disease initially diagnosed after service, when the evidence establishes that the disease was incurred in service. 38 U.S.C. § 1113(b); 38 C.F.R. § 3.303(d); Cosman v. Principi, 3 Vet. App. 503 (1992). The disease entity for which service connection is sought must be chronic rather than acute and transitory in nature. For the showing of chronic disease in service, a combination of manifestations must exist sufficient to identify the disease entity and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word chronic. Furthermore, service incurrence will be presumed for certain chronic diseases if manifest to a compensable degree within one year after active service. 38 U.S.C. § 1112; 38 C.F.R. §§ 3.307, 3.309. A Veteran need only demonstrate that there is an approximate balance of positive and negative evidence in order to prevail. To deny a claim on its merits, the preponderance of the evidence must be against the claim. Alemany v. Brown, 9 Vet. App. 518 (1996); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 5. Entitlement to service connection for sleep apnea The service medical records do not show any signs, symptoms, or treatment for any respiratory disability, to include sleep apnea. The Veteran has a current diagnosis of sleep apnea. The Board finds that the preponderance of evidence is against a finding that current obstructive sleep apnea was incurred, caused, or aggravated by active service. VA treatment records show that the Veteran was diagnosed with sleep apnea several years after service. The Veteran has sought ongoing medical treatment through the VA. However, the Veteran has not offered any reason or support for the contention that the sleep apnea is related to service. Further, the Veteran has not submitted any competent medical evidence that supports a finding that the sleep apnea is due to service or was caused or aggravated by any event, injury, or disease during service. The Board finds that the competent evidence of record does not support a finding that relates any current obstructive sleep apnea to service. The Board acknowledges that the Veteran has not been provided a VA examination with respect to his claim for service connection for sleep apnea, but finds no examination was required because the evidence does not indicate that the claimed disability, or symptoms thereof, may be associated with the Veteran’s active service. 38 U.S.C. § 5103A(d); McLendon v. Nicholson, 20 Vet. App. 79 (2006). The Board finds there is no competent evidence that sleep apnea may be related to service. The Board finds a VA medical opinion is not necessary to decide the claim. 38 C.F.R. § 3.159. Therefore, as there is no competent evidence linking a currently diagnosed sleep apnea disability to service, the claim must be denied on a direct basis. Accordingly, the Board finds that the preponderance of the evidence is against the claim for service connection for sleep apnea, and the claim must be denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Earlier Effective Date In order for benefits to be paid to any individual under the laws administered by VA, a specific claim in the form prescribed by VA must be filed. 38 C.F.R. § 3.151(a). A claim or application is defined by VA regulation as a formal or informal communication in writing requesting a determination of entitlement or evidencing a belief in entitlement to a benefit. 38 C.F.R. § 3.1(p). An informal claim is any communication or action, indicating intent to apply for one or more benefits. 38 C.F.R. § 3.155(a). Upon receipt of an informal claim, if a formal claim has not been filed, an application form will be forwarded to the claimant for execution. 38 C.F.R. § 3.155(a). The general rule regarding the assignment of effective date for an award based on an original claim for VA benefits is that the effective date shall be fixed in accordance with the facts found, but shall not be earlier than the date of receipt of application therefor. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400. An exception to the general rule applies if an application for benefits is received within one year from the date of a Veteran’s separation from active service, and an award is made on the basis of that application. In that limited situation, the effective date of the award is made retroactive to the day following the date of separation from service. 38 U.S.C. § 5110(b)(1); 38 C.F.R. § 3.400(b)(2). Otherwise, the effective date will be the later of the date of receipt of claim or the date entitlement arose. 38 U.S.C. § 5110; 38 C.F.R. § 3.400(b)(2). With regard to the award of an increased rating, the effective date shall be the earliest date that it is factually ascertainable that an increase in disability occurred, if a claim is received within one year from that date. Otherwise, the effective date shall be the later of the date of claim or date of factually ascertainable increase in disability, whichever is later. 38 U.S.C. § 5110(b)(2); 38 C.F.R. § 3.400(o)(2). The increase in disability must have occurred during the one year period prior to the date of the Veteran’s claim in order to receive the benefit of an earlier effective date. Gaston v. Shinseki, 605 F.3d 979 (Fed. Cir. 2010). VA has a duty to maximize a claimant’s benefits. Buie v. Shinseki, 24 Vet. App. 242 (2011); AB v. Brown, 6 Vet. App. 35 (1993); Bradley v. Peake, 22 Vet. App. 280 (2008). Therefore, a case encompasses all potential claims raised by the evidence, applying all relevant laws and regulations, regardless of whether the claim is specifically labeled. Szemraj v. Principi, 357 F.3d 1370 (Fed. Cir. 2004); Roberson v. Principi, 251 F.3d 1378 (Fed. Cir. 2001). 6. Entitlement to an effective date prior to April 7, 2015, for an increased rating of 10 percent for left eye macular lesion with scotoma The Veteran contends that a 10 percent rating for a left eye disability should have an effective date prior to April 7, 2015. On a VA Form 21-526EZ, stamped as received by VA on April 7, 2015, the Veteran requested that the VA increase the rating for a left eye disability. In a July 2015 VA examination, the examiner found a decreased visual field that showed the average concentric contraction in the left eye to be 59 degrees. The Board notes that the criteria for the 10 percent rating were first shown to be met at the July 2015 VA examination. That was the first time it was factually ascertainable that the 10 percent criteria were met. There is no earlier evidence of record which supports a finding that a 10 percent rating was warranted for left eye disability. There is no evidence within one year prior to the receipt of the April 7, 2015, claim for increase that show any increase in the left eye disability such that the criteria for a 10 percent rating were met. Therefore, the selection of April 7, 2015, as the effective date for the rating is most favorable to the Veteran, as that is the date VA received the claim for an increased rating. The Veteran does not assert, nor does the evidence show, that there was any pending formal or informal claim for an increased rating for left ear hearing loss prior to April 7, 2015. The evidence does not show that the Veteran’s left eye disability increased in severity such that a 10 percent rating was warranted in the year prior to the July 2015 VA examination. Accordingly, the Board finds that the preponderance of the evidence is against the claim for an earlier effective date for the assignment of a 10 percent disability rating for left eye disability. Therefore, the appeal is denied. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). REASONS FOR REMAND 1. Entitlement to service connection for a psychiatric disability, to include schizophrenia is remanded. The Veteran asserts that a psychiatric disability is due to service. In the alternative, the Veteran contends that a psychiatric disability is due to service-connected TBI and headaches. In a June 2018 private evaluation, the examiner was unable to differentiate the TBI from the schizophrenia due to similar impairments in cognition, memory, mood, daily living, work and social functioning. As the claim is reopened, the Board finds that a VA examination is necessary to make a determination on this issue. On remand, the Veteran should be provided a VA examination to assess the nature and etiology of any psychiatric disability, to include as secondary to service-connected disabilities. 2. Entitlement to service connection for a forehead scar, to include as secondary to TBI and post-traumatic headaches is remanded. 3. Entitlement to higher ratings for TBI and post-traumatic headaches is remanded. The Veteran last underwent VA examination of TBI in July 2015 and August 2015, and of migraines associated with residuals of TBI in November 2017. In a September 2020 statement, the Veteran reported that the headaches had increased in frequency and severity. Specifically, he stated that he experienced headaches up to six times per week with sensitivity to light and sound. The Veteran reported missing work and leaving work early due to the headaches. Where the evidence of record does not show the current state of the Veteran’s disability, a more current VA examination must be conducted. Schafrath v. Derwinski, 1 Vet. App. 589 (1991); 38 C.F.R. § 3.327(a). In light of the increased symptomatology reported, remand is required to obtain updated treatment records and provide the Veteran a more current VA examination that indicates the current symptomatology of the TBI and migraine disabilities. In addition, the August 2015 and November 2017 VA examiners noted a forehead scar that was related to the TBI and headaches. However, earlier examinations did not report the presence of a forehead scar. The Board cannot make a fully-informed decision on the issue of the forehead scar because no VA examiner has opined whether the scar was incurred in or caused by the head injury during service. 4. Entitlement to a rating higher than 0 percent for a fractured great right toe is remanded. The Veteran last underwent VA examination of the right toe disability in August 2015. The examiner noted that there were no residuals of a right toe fracture. However, the examiner did not provide a response for the section addressing whether there was a malunion or nonunion of tarsal or metatarsal bones. The Board finds the examination incomplete. A remand is required to obtain updated treatment records and provide the Veteran a more current VA examination that indicates the current symptomatology of the right toe disability. 5. Entitlement to a rating higher than 10 percent for a left eye macular lesion with scotoma is remanded. In a July 2015 VA examination, the examiner reported that the visual field testing documented the average concentric contraction in the left eye to be 59 degrees. However, in reviewing the attached Goldmann chart, the examiner did not record at least 16 meridians. The Board finds the examination report incomplete. On remand, the Veteran should be provided with an updated examination after outstanding treatment records are obtained. The matters are REMANDED for the following action: 1. After obtaining appropriate authorization, obtain any VA and private treatment records identified by the Veteran that are not already of record. 2. Schedule the Veteran for a VA examination to determine the etiology of any psychiatric disability, to include schizophrenia. The examiner must review the record and should note that review in the report. All appropriate tests or studies should be accomplished, and all clinical findings should be reported in detail. The examiner should identify all appropriate psychiatric diagnoses. The examiner should opine whether it is at least as likely as not (50 percent or greater probability) that any identified psychiatric disability had its onset in or is otherwise related to service, to include due to a head injury during service. The examiner should also opine whether it is at least as likely as not (50 percent probability or greater) that a psychiatric disability was caused by the service-connected disabilities, to specifically include TBI and headache disabilities. The examiner should further opine as to whether it is at least as likely as not (50 percent probability or greater) that any psychiatric disability has been aggravated (increased in severity beyond the natural progress of the disorder) by service-connected disabilities, to specifically include TBI and headache disabilities. If it is determined that there is another likely etiology for the Veteran’s psychiatric disability, that should be stated. A complete rationale for all opinions expressed should be clearly provided. The examiner must consider the Veteran’s statements and all lay statements regarding onset in-service and statements regarding the continuity of symptomatology. 3. Schedule the Veteran for a VA scar examination to determine the current nature and etiology of any scar associated with a head injury during service and whether that scar is a residual of the in-service head injury. The examiner must review the record and should note that review in the report. The VA examiner should identify all scars on the head, and determine the nature and etiology of any scars. The examiner should opine whether it is at least as likely as not (50 percent or greater probability) that any head scar had its onset during active service or is related to any incident of service. A rationale for all opinions should be provided. 4. Schedule the Veteran for a TBI examination to be conducted by one of the four designated specialists, physiatrist, psychiatrist, neurologist, or neurosurgeon. The examiner should specifically state which of those credentials applies. The examiner must review the claims file and should note that review in the report. The examiner should provide information regarding symptomatology in all facets used for rating TBI. The examiner should describe all symptoms related to the TBI and should discuss the effects on those symptoms on occupational function. To the extent possible, the examiner should identify which manifestations of the diagnosed residuals of a TBI are clearly separable from the diagnosed psychiatric disability. 5. Schedule the Veteran for a VA examination to assess the current severity of headaches. The examiner must review the claims file and should note that review in the report. All indicated studies deemed necessary by the examiner should be performed, and all findings should be reported in detail. All opinions must be accompanied by a rationale. The examiner is asked to describe in detail the frequency, duration, and severity of the Veteran’s headaches. In discussing the severity of the headaches, the examiner should opine as to whether the Veteran’s migraine headaches are characterized by: (a) Very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability; (b) Characteristic prostrating attacks occurring on an average once a month over the last several months; or (c) Characteristic prostrating attacks averaging one in two months over the last several months. 6. Schedule the Veteran for a VA foot examination to assist in determining the current nature and severity of a service-connected right great toe disability. The examiner must review the record and should note that review in the report. The examiner should provide ranges of right great toe motion and should state whether there is any loss of motion due to pain or any arthritis of the right great toe. The examiner should specifically state whether there is malunion or nonunion of any tarsal or metatarsal bones. The examiner should also opine whether there is loss of function of the great toe such that the Veteran would be equally well served with amputation and a prosthesis. 7. Schedule the Veteran for a VA eye examination to determine the severity of service-connected left eye macular lesion with scotoma. The examiner must review the claims file and should note that review in the report. The examiner should specifically identify all disabilities found, and describe in detail all pertinent symptomatology and findings of any visual impairment found, including any visual field loss. The examiner is asked to provide an opinion on whether any diagnosed eye disability is etiologically related to service. The examiner should also provide an opinion on whether any other diagnosed eye disability is proximately due to or aggravated by the service-connected left eye disability. A rationale for any opinion expressed should be provided. The examiner should consider all applicable rating criteria during the appeal period, including the versions of the eye rating criteria effective prior to and effective as of May 13, 2018. A complete rationale should be provided for any opinions expressed. Harvey P. Roberts Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Kass, 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.