Citation Nr: 21005103 Decision Date: 01/29/21 Archive Date: 01/29/21 DOCKET NO. 15-37 697 DATE: January 29, 2021 ORDER Entitlement to service connection for a right eye disability, to include legal blindness of the right eye is denied. Entitlement to service connection for bilateral sensorineural hearing loss is granted. Entitlement to service connection for tinnitus is granted. Entitlement to service connection for hypertension is denied. Entitlement to service connection for type II diabetes mellitus (diabetes) is denied. Entitlement to service connection for prostate adenocarcinoma, status post radical prostatectomy (prostate cancer) is denied. Entitlement to service connection for erectile dysfunction is denied. Entitlement to service connection for peripheral neuropathy of the left upper extremity is denied. Entitlement to service connection for peripheral neuropathy of the left lower extremity is denied. Entitlement to service connection for peripheral neuropathy of the right upper extremity is denied. Entitlement to service connection for peripheral neuropathy of the right lower extremity is denied. REMANDED Entitlement to service connection for an acquired psychiatric disorder to include posttraumatic stress disorder (PTSD), generalized anxiety disorder, and depression is remanded. Entitlement to a total disability rating based upon individual unemployability due to service-connected disabilities (TDIU) is remanded. FINDINGS OF FACT 1. The preponderance of the evidence of record does not reflect that the Veteran’s current right eye disability, to include legal blindness, anatomical loss of the right eye, and right eye vitreous hemorrhage was incurred in or otherwise related to his active duty service. 2. Resolving all reasonable doubt in favor of the Veteran, he has experienced bilateral hearing loss and tinnitus since his separation from service. 3. The preponderance of the evidence of record does not reflect that the Veteran’s current diagnosis of hypertension was incurred in or is otherwise related to his active duty service. 4. The preponderance of the evidence reflects that the Veteran did not have service in the Republic of Vietnam or along the Korean demilitarized zone (DMZ) during the Vietnam era, and he is not shown by competent and probative evidence to have been exposed to herbicide agents. 5. The preponderance of the evidence of record does not reflect that the Veteran’s current diagnosis of diabetes was incurred in or is otherwise related to his active duty service. 6. The preponderance of the evidence of record does not reflect that the Veteran’s prostate cancer was incurred in or is otherwise related to his active duty service. 7. The preponderance of the evidence of record does not reflect that the Veteran’s current diagnosis of erectile dysfunction was incurred in or is otherwise related to his active duty service. 8. The preponderance of the evidence of record does not reflect that the Veteran’s current diagnosis of peripheral neuropathy of the left upper extremity was incurred in or is otherwise related to his active duty service. 9. The preponderance of the evidence of record does not reflect that the Veteran’s current diagnosis of peripheral neuropathy of the left lower extremity was incurred in or is otherwise related to his active duty service. 10. The preponderance of the evidence of record does not reflect that the Veteran’s current diagnosis of peripheral neuropathy of the right upper extremity was incurred in or is otherwise related to his active duty service. 11. The preponderance of the evidence of record does not reflect that the Veteran’s current diagnosis of peripheral neuropathy of the right lower extremity was incurred in or is otherwise related to his active duty service. CONCLUSIONS OF LAW 1. The criteria for service connection for a right eye disability, to include legal blindness of the right eye are not met. 38 U.S.C. §§ 1110, 1111, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303(a), (c). 2. The criteria for entitlement to service connection for bilateral sensorineural hearing loss are met. 38 U.S.C. §§ 1110, 1112, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303(a)-(b), 3.307, 3.309(a). 3. The criteria for entitlement to service connection for tinnitus are met. 38 U.S.C. §§ 1110, 1112, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303(a)-(b), 3.307, 3.309(a). 4. The criteria for entitlement to service connection for hypertension are not met. 38 U.S.C. §§ 1110, 1112, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303(a)-(b), 3.307, 3.309(a). 5. The criteria for entitlement to service connection for diabetes are not met. 38 U.S.C. §§ 1110, 1112, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303(a)-(c), 3.307, 3.309. 6. The criteria for entitlement to service connection for prostate cancer are not met. 38 U.S.C. §§ 1110, 1112, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303(a)-(c), 3.307, 3.309. 7. The criteria for service connection for erectile dysfunction are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303(a), (c), 3.310. 8. The criteria for service connection for peripheral neuropathy of the left upper extremity are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303(a), (c), 3.310. 9. The criteria for service connection for peripheral neuropathy of the left lower extremity are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303(a), (c), 3.310. 10. The criteria for service connection for peripheral neuropathy of the right upper extremity are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303(a), (c), 3.310. 11. The criteria for service connection for peripheral neuropathy of the right lower extremity are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303(a), (c), 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served in the United States Army from May 1973 to May 1975. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ) rating decision dated in May 2015. The Board remanded the case to the AOJ in June 2017 and September 2018. Service Connection Service connection will be granted if the evidence demonstrates that current disability resulted from an injury or disease incurred in active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) current disability; (2) in-service disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). Consistent with this framework, service connection is warranted for a disease first diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). At the outset the Board notes that VA has been unable to obtain the Veteran’s service treatment records. See October 2013 VA Memorandum; August 2019 Response to Request for Information. In cases such as this, where the Veteran’s service records are unavailable through no fault of the claimant, there is a heightened obligation to carefully consider the benefit-of-the-doubt rule. See O’Hare v. Derwinski, 1 Vet. App. 365 (1991). In addition, the Board notes that the absence of contemporaneous records does not preclude granting service connection for a claimed disability. See Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006); Barr v. Nicholson, 21 Vet. App. 303 (2007). 1. Entitlement to service connection for a right eye disability 2. Entitlement to service connection for legal blindness of the right eye The Veteran seeks service connection for a right eye disability and legal blindness of the right eye, which he asserts are related to service. The Board has carefully reviewed the evidence of record and finds that, based upon a preponderance of the evidence, the criteria for service connection for a right eye disability on any basis have not been met. At the outset, the Board notes that a current diagnosis of a right eye disability including legal blindness has been established. A November 2007 VA examination reflects a diagnosis of right eye blindness and band keratopathy of the right eye; and a September 2017 VA examination reflects a diagnosis of atrophy of the right eye globe. The preponderance of the evidence, including objective medical evidence and lay evidence, reflects that the Veteran’s right eye disability, including legal blindness of the right eye, did not have its onset during service. Post-service treatment records reflect that the Veteran was initially treated for an injury to his right eye in June 1985. The treatment provider noted that the Veteran sustained a laceration in approximately May 1985. Later in April 1986, during a VA examination, the Veteran reported that part of a nail flew into his right eye in May 1985. The Veteran has repeatedly asserted that his right eye blindness was due to a nail injuring his right eye. See August 2007 private treatment record and November 2007 VA examination; see Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331, 1336-1337 (2006); Layno v. Brown, 6 Vet. App. 465, 469 (1994). In September 2017, a VA examiner opined that the Veteran’s right eye disability was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in service injury or event. The Veteran once again reported that he injured his right eye after service in approximately the late 1980s, early 1990s. The Board notes in December 2014, a private examiner opined that the Veteran had ophthalmologic disease, which was more probable than not secondary to his military service. The examiner noted that the Veteran reported right eye pain, blurred vision with marked visual loss; and noted that ophthalmologic evaluation was diagnostic of vitreous hemorrhage for which several surgical procedures had been performed. The examiner did not provide any rationale to support his opinion that the Veteran’s right eye condition was related to service; and the examiner did not discuss the June 1985 private treatment record, which reflects that the Veteran had sustained an eye injury in May 1985. In contrast, the September 2017 opinion was supported by a thorough analysis of the Veteran’s medical treatment records and lay evidence. See Guerrieri v. Brown, 4 Vet. App. 467, 470-471 (1993); Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The Board therefore attaches significant probative value to this opinion and the most probative value in this case, as the opinion was well reasoned, detailed, and consistent with other evidence of record. See Prejean v. West, 13 Vet. App. 444, 448-449 (2000). In reaching the above conclusions, the Board has considered the applicability of the benefit of the doubt doctrine. The Board notes that under the provisions of 38 U.S.C. § 5107(b), the benefit of the doubt is to be resolved in the claimant’s favor in cases where there is an approximate balance of positive and negative evidence in regard to a material issue. However, as the preponderance of the evidence is against the Veteran’s claim, that doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Gilbert v. Derwinski, 1 Vet. App. 49 (1990); O’Hare, supra. 3. Entitlement to service connection for bilateral sensorineural hearing loss 4. Entitlement to service connection for tinnitus The Veteran seeks service connection for bilateral sensorineural hearing loss and tinnitus, which he asserts is related to service. The Board has carefully reviewed the evidence of record and finds that the Veteran’s symptoms of bilateral sensorineural hearing loss and tinnitus have been chronic and continuous since service. Thus, resolving all reasonable doubt in favor of the Veteran, the criteria for service connection for bilateral sensorineural hearing loss and tinnitus have been met. See 38 C.F.R. § 3.303(b) (Service connection may be granted based on chronicity or continuity of symptomatology for a disability which is due to a disease enumerated on the list of chronic diseases in 38 U.S.C. § 1101(3) or 38 C.F.R. § 3.309(a), including sensorineural hearing loss and tinnitus). At the outset, the Board notes that a current diagnosis of bilateral sensorineural hearing loss has been established. See December 2014 private examination. In addition, a current diagnosis of tinnitus has also been established. Id. But see September 2017 VA examination; Wise, supra. Resolving all reasonable doubt in favor of the Veteran, and with consideration of the objective medical evidence as well as the subjective lay evidence, the Board finds that there is a nexus between the Veteran’s current bilateral sensorineural hearing loss and tinnitus and service. In December 2014, a private examiner provider opined that the Veteran’s hearing loss and tinnitus were more likely than not secondary to exposure to military operations in service. As noted, the Veteran reported that he had hazardous noise exposure during service and had experienced hearing loss and tinnitus since military service. The Board also concedes that the Veteran was exposed to hazardous noise during service. Due consideration shall be given to the places, types, and circumstances of such Veteran’s service as shown by such Veteran’s service record, the official history of each organization in which such Veteran served, such Veteran’s medical records, and all pertinent medical and lay evidence. 38 U.S.C. § 1154(a). The Veteran’s DD-214 notes that the Veteran’s military occupational specialty (MOS) was field wireman; which has been shown to have a “moderate” probability of exposure to hazardous noise. The Veteran has competently and credibly stated that he was exposed to hazardous noises during military operations in service and that he has had hearing loss and tinnitus since service. See Jandreau, supra, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan, supra; Layno, supra. But see September 2017 VA examination; Wise, supra. Therefore, resolving all reasonable doubt in favor of the Veteran, the Board concedes that the Veteran was exposed to hazardous noise; and it is at least as likely as not that the Veteran’s current bilateral hearing loss and tinnitus are attributable to the Veteran’s noise exposure in service. See Hensley v. Brown, 5 Vet. App. 155 (1993); Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992). Further, the Board notes that the September 2017 VA examiner’s opinion that the Veteran’s bilateral sensorineural hearing loss was not at least as likely as not caused by or a result of an event in military service, also essentially provides some support for a finding that entitlement to service connection for bilateral hearing loss and tinnitus is warranted. Specifically, the VA examiner noted that it was well known that prolonged exposure to noise of high intensity and short duration, such as a military type, could cause permanent damage in the structures of the inner ear, resulting in irreversible hearing loss; and noted that hearing deficits appear, either immediately after a noise trauma, or gradually, during the noise exposure period. As previously noted, VA has been unable to obtain the Veteran’s service treatment records; however, the Veteran has stated that he had experienced hearing loss since service. Therefore, the Board notes that while there is no objective evidence available to determine whether the Veteran had experienced any hearing deficits during service; there is competent and credible lay evidence that the Veteran has experienced hearing loss and tinnitus in service. Thus, the Board finds that the evidence is in equipoise as to whether the Veteran’s bilateral sensorineural hearing loss and tinnitus are related to service. Wise, supra. The December 2014 opinion, with regard to the Veteran’s claim of entitlement to service connection for bilateral hearing loss and tinnitus is competent, credible and probative, and coupled with the other medical evidence of record including the lay evidence, supports a conclusion that service connection for bilateral sensorineural hearing loss and tinnitus is warranted. Therefore, the September 2017 VA opinion cannot be afforded greater probative value. Reonal v. Brown, 5 Vet. App. 458, 460-61 (1993). Resolving all reasonable doubt in favor of the Veteran and based on the medical and lay evidence of record, the Board finds that the evidence of record supports a finding that service connection for bilateral sensorineural hearing loss and tinnitus is warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Gilbert, supra. 5. Entitlement to service connection for hypertension The Veteran seeks service connection for hypertension, which he asserts is related to service. The Board has carefully reviewed the evidence of record and finds that, based upon a preponderance of the evidence, the criteria for service connection for hypertension, on any basis, have not been met. At the outset, the Board notes that a current diagnosis of hypertension has been established. See November 2007 VA examination. The Veteran does not assert, and the evidence does not demonstrate, that the Veteran’s hypertension occurred during a period of qualifying service. The Veteran has stated that he underwent a surgical procedure for hernia in Alaska and was hospitalized for 18 days; and asserted that his conditions were consequences of service. However, the Veteran did not assert that his hypertension had its onset during service. See May 2020 Correspondence and October 2020 Notice of Disagreement. In addition, post-service treatment records reflect that the Veteran’s hypertension had its onset from at least 1990 by a private treatment provider. See September 2017 VA examination; see also November 2007 VA examination; October 1999 private treatment record. The November 2007 VA examiner noted that the Veteran’s hypertension occurred after service; and did not occur during service. Thus, based on a preponderance of the evidence, the Board finds that there is no nexus between the Veteran’s current hypertension and service. In September 2017, the VA examiner opined that it was less likely than not that the Veteran’s hypertension was incurred in or caused by an in-service injury, event or illness; and noted that the Veteran’s hypertension had been diagnosed in the 1990s. The Board notes that the December 2014 private examiner who opined that the Veteran’s hypertension was more probable than not secondary to his military performance did not discuss whether the Veteran’s hypertension began during service or within the applicable one-year presumptive period. See 38 C.F.R. § 3.307, 3.309. Although the examiner noted that the Veteran reported symptoms of dizziness, sudden onset headaches, palpitations, diaphoresis and chest tightness episodes, the examiner did not discuss when the Veteran’s symptoms began, nor did the examiner provide any rationale or analysis in support of his finding that the Veteran’s current diagnosis of hypertension was related to service. See Guerrieri, supra; Nieves-Rodriguez, supra. In contrast, the September 2017 VA examiner’s opinion was supported by a thorough analysis of the Veteran’s medical treatment records and the Veteran’s statements. The Board therefore attaches significant probative value to this opinion and the most probative value in this case, as the opinion was well reasoned, detailed, and consistent with other evidence of record. See Prejean, supra. In reaching the above conclusions, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claim, that doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Gilbert, supra; O’Hare, supra. 6. Entitlement to service connection for diabetes 7. Entitlement to service connection for prostate cancer The Veteran seeks service connection for diabetes and prostate cancer which he asserts are related to service. The Board has carefully reviewed the evidence of record and finds that based upon a preponderance of the evidence, the criteria for service connection for diabetes and the criteria for service connection for prostate cancer, on any basis, have not been met, including as due to exposure to herbicides. See 38 U.S.C. § 1113 and 38 C.F.R. § 3.307(d) (Service connection may be granted based on exposure to a herbicide agent during active service during the Vietnam Era in the Republic of Vietnam or along the Korean DMV for specific diseases listed in 38 C.F.R. § 3.309(e), including type II diabetes mellitus and prostate cancer.) As noted, the Veteran served in the United States Army from September 1973 to May 1975 during the Vietnam era. In September 2017, the Veteran reported that he had served in Saigon, Vietnam from 1974 to 1975. However, the preponderance of the evidence does not reflect that the Veteran had any service in the Republic of Vietnam or along the Korean DMV. Notably, the Veteran’s DD-214 indicates that the Veteran had foreign and/or sea service in Alaska for 1 year and 6 months during service; and there is no indication that the Veteran had any service in the Republic of Vietnam or along the Korean DMV. See August 2012 Response to Request for Information; see Buchanan, supra. Thus, the Board finds that the presumption of exposure to herbicides has not been established. The Board notes that a current diagnosis of type II diabetes mellitus has been established. See September 2017 VA examination. A current diagnosis of prostate adenocarcinoma has also been established. See September 2017 VA examination. The Veteran does not assert, and the evidence does not demonstrate, that the Veteran’s diabetes or prostate cancer occurred during a period of qualifying service. The Veteran has stated that he underwent a surgical procedure for hernia in Alaska and was hospitalized for 18 days; and asserted that his conditions were consequences of service. However, the Veteran did not assert that his diabetes or prostate cancer had their onset during service. See May 2020 Correspondence and October 2020 Notice of Disagreement. In addition, post-service treatment records reflect that the Veteran was diagnosed with type II diabetes mellitus from at least 1990 by a private treatment provider; and the Veteran was diagnosed with prostate cancer in July 1993 and underwent a radical prostatectomy in August 1993. See November 2007 VA examination. In September 2017, the VA examiner opined that it was less likely than not that the Veteran’s prostate cancer was incurred in or caused by an in-service injury, event or illness; and noted that the Veteran’s prostate cancer was diagnosed in 1993, which was more than 15 years after the Veteran’s discharge from service. The September 2017 VA examiner also opined that it was less likely than not that the Veteran’s diabetes was incurred in or caused by an in-service injury, event or illness; and noted that the Veteran’s diabetes had been diagnosed in the 1990s. Thus, based on a preponderance of the evidence, the Board finds that there is no nexus between the Veteran’s current diabetes and service; and there is no nexus between the Veteran’s prostate cancer and service. The Board notes that the December 2014 private examiner who opined that the Veteran’s diabetes was more probable than not secondary to his military performance did not discuss whether the Veteran’s diabetes began during service or within the presumptive period. Although the examiner noted that the Veteran reported symptoms of polyuria, polydipsia, polyphagia with numbness, tingling, sensorial loss, cramps, weakness and pain of the upper and lower limps; and libido loss and sexual dysfunction; the examiner did not discuss when the Veteran’s symptoms began, nor did the examiner provide any rationale or analysis in support of his finding that the Veteran’s diabetes was related to service. Similarly, the December 2014 private examiner who opined that the Veteran’s prostate cancer was more probable than not secondary to his military performance did not discuss whether the Veteran’s prostate cancer began during service or within the presumptive period. Notably, the examiner acknowledged that the Veteran underwent a urology evaluation in August 1993 and was diagnosed with prostate adenocarcinoma. In addition, the examiner did not provide any rationale or analysis in support of his finding that the Veteran’s prostate cancer was related to service. See Guerrieri, supra; Nieves-Rodriguez, supra. In contrast, the September 2017 VA examiner’s opinions, were supported by a thorough analysis of the Veteran’s medical treatment records and the Veteran’s statements. The Board therefore attaches significant probative value to these opinions and the most probative value in this case, as the opinions were well reasoned, detailed, and consistent with other evidence of record. See Prejean, supra. As such, the Veteran has not met the criteria for either presumptive or direct service connection for diabetes or prostate cancer. See 38 U.S.C. §§ 1110, 1117, 1118, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.317; Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994); Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). In reaching the above conclusions, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claim, that doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Gilbert, supra; O’Hare, supra. 8. Entitlement to service connection for erectile dysfunction 9. Entitlement to service connection for peripheral neuropathy of the left upper extremity 10. Entitlement to service connection for peripheral neuropathy of the left lower extremity 11. Entitlement to service connection for peripheral neuropathy of the right upper extremity 12. Entitlement to service connection for peripheral neuropathy of the right lower extremity The Veteran seeks service connection for erectile dysfunction and peripheral neuropathy of the bilateral upper and lower extremities. The Board has carefully reviewed the evidence of record and finds that, based upon a preponderance of the evidence, the criteria for service connection for erectile dysfunction on any basis have not been met. See 38 C.F.R. § 3.310 (Service connection may be granted for a disability that is proximately due to, or aggravated by, a service-connected disease or injury). At the outset the Board notes that service connection for type II diabetes mellitus and prostate cancer have not been established. The Board notes that a current diagnosis of erectile dysfunction has been established. See September 2017 VA examination. A current diagnosis of diabetic neuropathy of the bilateral upper and lower extremities has also been established. See September 2017 VA examination. The Veteran does not assert, and the evidence does not demonstrate, that the Veteran’s erectile dysfunction or diabetic neuropathy occurred during a period of qualifying service. See also May 2020 Correspondence and October 2020 Notice of Disagreement. Post-service treatment records reflect that the Veteran was diagnosed with erectile dysfunction secondary to his radical prostatectomy, which occurred in 1993. See November 2007 VA examination. Post-service treatment records reflect that the Veteran was diagnosed with diabetic neuropathy of the bilateral upper and lower extremities in December 2014. Based on a preponderance of the evidence, the Board finds that there is no nexus between the Veteran’s current erectile dysfunction and service; and there is no nexus between the Veteran’s diabetic neuropathy of the bilateral upper and lower extremities and service. In September 2017, the VA examiner opined that it was less likely than not that the Veteran’s erectile dysfunction was incurred in or caused by an in-service injury, event or illness. The examiner noted that the Veteran had erectile dysfunction since he had undergone a radical prostatectomy, which the examiner opined was most likely etiologic factor; and noted that the Veteran’s erectile dysfunction was more than 15 years after service. The September 2017 VA examiner also opined that it was less likely than not that the Veteran’s diabetic neuropathy of the bilateral upper and lower extremities was incurred in or caused by an in-service injury, event or illness; and noted that the Veteran’s diabetic neuropathy was produced by his long standing metabolic disorder. The Board notes that the December 2014 private examiner who opined that the Veteran’s erectile dysfunction was more probable than not secondary to his military performance, did not discuss whether the Veteran’s erectile dysfunction began during service. The examiner also did not discuss when the Veteran’s symptoms of libido loss and sexual dysfunction began, and the examiner did not provide any rationale or analysis in support of his finding that the Veteran’s erectile dysfunction was related to service. Similarly, the December 2014 private examiner who opined that the Veteran’s symptoms of numbness, tingling, sensorial loss, weakness and pain of the upper and lower limbs were more probable than not secondary to his military performance, did not discuss whether the Veteran’s symptoms began during service. The examiner also did not discuss when his symptoms began, and the examiner did not provide any rationale or analysis in support of his finding that the Veteran’s symptoms were related to service. See Guerrieri, supra; Nieves-Rodriguez, supra. In contrast, the September 2017 VA examiner’s opinions, were supported by a thorough analysis of the Veteran’s medical treatment records and the Veteran’s statements. The Board therefore attaches significant probative value to these opinions and the most probative value in this case, as the opinions were well reasoned, detailed, and consistent with other evidence of record. See Prejean, supra. In reaching the above conclusions, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claims, that doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Gilbert, supra. REASONS FOR REMAND 1. Entitlement to service connection for an acquired psychiatric disorder The Veteran seeks service connection for a psychiatric disorder, which he asserts is related to service. The Board notes that the September 2017 VA examiner who opined that the Veteran did not have a diagnosis of PTSD which conformed to the DSM-V criteria; did not discuss whether the Veteran had a diagnosis of PTSD based upon his reported stressor of being subjected to racism and mistreatment in the military. See August 2007 private examination. Thus, the Board finds that a new examination is warranted to determine the nature and etiology of the Veteran’s psychiatric disorder. 2. Entitlement to a TDIU is remanded. The Veteran has established service connection for bilateral sensorineural hearing loss and tinnitus, which have not been evaluated. A remand is necessary to determine whether the Veteran’s service-connected disabilities meet the schedular requirements for a TDIU under 38 C.F.R. § 4.16(a). The matters are REMANDED for the following action: 1. Request that the Veteran complete a current formal TDIU application form (VA Form 21-8940). Conduct all indicated development to adjudicate the Veteran’s TDIU claim. 2. Schedule the Veteran for a VA examination to ascertain the nature and etiology of the Veteran’s psychiatric disorder. The AOJ should ensure that the examiner has access to the Veteran’s claims file, including a copy of this remand. Following a review of the Veteran’s record, the examiner should address whether Veteran’s reported stressor of being subjected to racism and mistreatment during service is sufficient to support a diagnosis of PTSD based upon the DSM-V diagnostic criteria. The examiner should provide a complete rationale for all opinions expressed and conclusions reached. S. L. Kennedy Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Gerline R. Fleury Johnson 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.