Citation Nr: 21061456 Decision Date: 10/04/21 Archive Date: 10/04/21 DOCKET NO. 17-32 005 DATE: October 4, 2021 ORDER An effective date earlier than March 31, 1992 for service connection for right lower extremity scars is dismissed. An effective date earlier than September 26, 2012 for service connection for left lower extremity scars is denied. An effective date earlier than September 26, 2012 for service connection for an acquired psychiatric disorder, to include unspecified depressive disorder is denied. An effective date earlier than September 26, 2012 for service connection for muscle injury residuals from a gunshot wound to the right leg is denied. An effective date earlier than September 26, 2012 for service connection for muscle injury residuals from a gunshot wound to the left leg is denied. An effective date earlier than September 26, 2012 for service connection for right foot metatarsalgia is denied. A higher initial disability rating in excess of 30 percent for muscle injury residuals from a gunshot wound to the right leg is denied. A higher initial disability rating in excess of 30 percent for muscle injury residuals from a gunshot wound to the left leg is denied. A higher initial disability rating in excess of 20 percent for metatarsalgia in the right foot (right foot disability) is denied. A higher initial disability rating in excess of 10 percent for bilateral tinnitus, as a matter of law, is denied. REMANDED A higher (compensable) initial rating for right lower extremity scars is remanded. A higher (compensable) initial rating for left lower extremity scars is remanded. A higher initial disability rating in excess of 30 percent for unspecified depressive disorder is remanded. An increased disability rating in excess of 10 percent for left foot reflex sympathetic dystrophy (left foot disability) is remanded. Service connection for irritable bowel syndrome, including as secondary to the service-connected unspecified depressive disorder, is remanded. Service connection for a skin disorder, including as secondary to the service-connected right and left lower extremity scars, is remanded. Service connection for a neurological disorder is remanded. FINDINGS OF FACT 1. After the unappealed December 1992 rating decision, the first communication expressing an intent to seek an earlier effective date for the grant of service connection for right lower extremity scars was received in June 2017, more than a year after the December 1992 rating decision; clear and unmistakable error (CUE) is not alleged. 2. There were no communications received prior to September 26, 2012 that could be construed as a formal or informal claim for service connection for left lower extremity scars. 3. There were no communications received prior to September 26, 2012 that could be construed as a formal or informal claim for service connection for an acquired psychiatric disorder, to include unspecified depressive disorder. 4. On September 26, 2012, the Veteran filed a claim for an increased rating for bilateral foot pain secondary to leg wounds, which was construed as a claim for service connection for muscle injury residuals from a gunshot wound to the right leg; there were no communications received prior to September 26, 2012 that could be construed as a formal or informal claim for service connection for muscle injury residuals from a gunshot wound to the right leg. 5. On September 26, 2012, the Veteran filed a claim for an increased rating for bilateral foot pain secondary to leg wounds, which was construed as a claim for service connection for muscle injury residuals from a gunshot wound to the right leg; there were no communications received prior to September 26, 2012 that could be construed as a formal or informal claim for service connection for muscle injury residuals from a gunshot wound to the right leg. 6. On September 26, 2012, the Veteran filed a claim for an increased rating for bilateral foot pain secondary to leg wounds, which was construed as a claim for service connection for right foot metatarsalgia; there were no communications received prior to September 26, 2012 that could be construed as a formal or informal claim for service connection for right foot metatarsalgia. 7. For the entire initial rating period on appeal from September 26, 2012, the Veteran is in receipt of the maximum schedular rating of 30 percent for the service-connect muscle injury residuals from a gunshot wound to the right leg. 8. For the entire initial rating period on appeal from September 26, 2012, the Veteran is in receipt of the maximum schedular rating of 30 percent for the service-connect muscle injury residuals from a gunshot wound to the left leg. 9. For the entire initial rating period on appeal from September 26, 2012, the service-connected right foot disability has not been manifested by a severe right foot injury. 10. For the entire initial rating period on appeal from September 26, 2012, the service connected tinnitus has been assigned the maximum 10 percent schedular rating available under Diagnostic Code 6260. CONCLUSIONS OF LAW 1. The Veteran's attempted freestanding claim seeking an effective date prior to March 31, 1992 for the grant of service connection for right lower extremity scars lacks legal merit. 38 U.S.C. § 5109A, 7105; 38 C.F.R. § 20.101; Rudd v. Nicholson, 20 Vet. App. 296 (2006). 2. The criteria for an effective date prior to September 26, 2012 for the award of service connection for left lower extremity scars have not been met. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.155, 3.400. 3. The criteria for an effective date prior to September 26, 2012 for the award of service connection for an acquired psychiatric disorder, to include unspecified depressive disorder, have not been met. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.155, 3.400. 4. The criteria for an effective date prior to September 26, 2012 for the award of service connection for muscle injury residuals from a gunshot wound to the right leg have not been met. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.155, 3.400. 5. The criteria for an effective date prior to September 26, 2012 for the award of service connection for muscle injury residuals from a gunshot wound to the left leg have not been met. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.155, 3.400. 6. The criteria for an effective date prior to September 26, 2012 for the award of service connection for metatarsalgia in the right foot have not been met. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.155, 3.400. 7. For the entire initial rating period on appeal from September 26, 2012, the criteria for a higher initial disability rating in excess of 30 percent for muscle injury residuals from a gunshot wound to the right leg have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.56, 4.73, Diagnostic Code 5311. 8. For the entire initial rating period on appeal from September 26, 2012, the criteria for a higher initial disability rating in excess of 30 percent for muscle injury residuals from a gunshot wound to the left leg have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.56, 4.73, Diagnostic Code 5311. 9. For the entire initial rating period on appeal from September 26, 2012, the criteria for a higher initial disability rating in excess of 20 percent for the right foot disability have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107, 7104; 38 C.F.R. §§ 3.102, 3.159, 3.321, 3.326(a), 4.1, 4.3, 4.7, 4.10, 4.20, 4.21, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5284. 10. There is no legal basis for the assignment of a disability rating in excess of 10 percent for tinnitus for any period. 38 U.S.C. §§ 1155, 5103, 5103A; 38 C.F.R. §§ 3.159, 3.326, 4.1, 4.2, 4.10, 4.87, Diagnostic Code 6260. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran, who is the appellant, served on active duty from February 1988 to March 1992. Effective Date Legal Criteria Except as otherwise provided, the effective date of an evaluation and award of compensation based on an original claim, a claim reopened after final disallowance, or a claim for increase will be the date of receipt of the claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. After a final disallowance of a claim, the effective is the date of receipt of the new claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400(q)(2). For an increase in disability compensation, the effective date will be the earliest date as of which it is factually ascertainable that an increase in disability had occurred if a claim is received within one year from such date, otherwise the date the claim was received. 38 U.S.C. § 5110; 38 C.F.R. § 3.400(o)(2). For claims received prior to March 24, 2015, as pertinent to this case, a "claim" is defined as a formal or informal communication, in writing, requesting a determination of entitlement, or evidencing a belief in entitlement to a benefit and VA is required to identify and act on informal claims for benefits. 38 C.F.R. §§ 3.1(p), 3.155(a); see also Servello v. Derwinski, 3 Vet. App. 196, 198 200 (1992). Pursuant to 38 C.F.R. § 3.155, any communication or action indicating intent to apply for one or more VA benefits, including statements from a veteran's duly authorized representative, may be considered an informal claim. Such an informal claim must identify the benefit sought. 38 C.F.R. § 3.1(p) defines application as a formal or informal communication in writing requesting a determination of entitlement or evidencing a belief in entitlement to a benefit. See also Rodriguez v. West, 189 F.3d. 1351 (Fed. Cir. 1999). The date of receipt of a claim is the date on which a claim, information, or evidence is received by VA. 38 C.F.R. § 3.1(r). 1. Earlier effective date for service connection for right lower extremity scars The Veteran seeks an effective date earlier than March 31, 1992, for service connection for right lower extremity scars. He has not put forth any specific contentions as to why he is entitled to an earlier effective date. The request for earlier effective date is a legal nullity, not a claim, and not an appealable issue. In the December 1992 rating decision, the RO granted service connection for right lower extremity scars, with a noncompensable rating effective from March 31, 1992. In January 1993, the Veteran was notified of that rating decision and provided notice of procedural and appellate rights. Because he did not appeal the December 1992 rating decision within one year of that notice, and no additional evidence was received within one year of that notice, the December 1992 rating decision assigning the effective date became final. In June 2017, the Veteran attempted to raise the issue of an effective date earlier than March 31, 1992 for service connection for right lower extremity scars; however, such a request is untimely, as it is submitted more than one year after the December 1992 rating decision was issued assigning the effective date for service connection for right lower extremity scars. Such request for an earlier effective date is not a claim, is not a recognizable legal issue, but is a legal nullity that can only be dismissed as such. See Rudd v. Nicholson, 20 Vet. App. 296 (2006) (holding that an attempted freestanding claim for an earlier effective date is a nullity, and the only basis for challenging the effective of a now final decision date is CUE). Because the Veteran has not alleged CUE in the December 1992 rating decision that assigned the effective date for service connection for right lower extremity scars, the Board finds that the present assertion for entitlement to an effective date earlier than March 31, 1992 for the grant of service connection for right lower extremity scars, is an invalid attempt to establish a freestanding claim for an earlier effective date, which is not permitted under Rudd. Accordingly, this matter lacks legal merit, and must be dismissed. 2. Earlier effective date for service connection for left lower extremity scars 3. Earlier effective date for service connection for unspecified depressive disorder 4. Earlier effective date for service connection for muscle injury residuals from a gunshot wound to the right leg 5. Earlier effective date for service connection for muscle injury residuals from a gunshot wound to the left leg 6. Earlier effective date for service connection for the right foot disability The Veteran generally asserts that earlier effective dates for the awards of service connection for left lower extremity scars, unspecified depressive disorder, muscle injuries from a gunshot wound to the right and left legs, and the right foot disability are warranted. See June 2017 Notice of Disagreement. In this case, the Board finds that an effective date earlier than September 26, 2012 for the awards of service connection for left lower extremity scars, unspecified depressive disorder, muscle injuries from a gunshot wound to the right and left legs, and the right foot disability are not warranted. The Veteran submitted a formal claim for service connection for an acquired psychiatric disorder and a claim for increased ratings related to leg wounds sustained during service (which was broadly construed as claims for service connection for left lower extremity scars, muscle injuries from a gunshot wound to the right and left legs, and a right foot disability) on September 26, 2012. The Board finds that there was no correspondence received by VA prior to September 26, 2012 that can be construed as a claim, either formal or informal, for service connection for left lower extremity scars, unspecified depressive disorder, muscle injuries from a gunshot wound to the right and left legs, and the right foot disability. Furthermore, the Veteran has not asserted that a formal or informal claim for left lower extremity scars, unspecified depressive disorder, muscle injuries from a gunshot wound to the right and left legs, and the right foot disability was received by VA earlier than September 26, 2012. On these facts, because the earliest effective date legally possible (September 26, 2012) has been assigned under 38 C.F.R. §§ 3.400(q)(2) and (r), and no effective dates for service connection earlier than September 26, 2012 (date of receipt of claim for service connection an acquired psychiatric disorder and for increased ratings related to leg wounds sustained during service) are assignable, the appeals for earlier effective dates for the awards of service connection for left lower extremity scars, unspecified depressive disorder, muscle injuries from a gunshot wound to the right and left legs, and the right foot disability are without legal merit, and must be denied. See Sabonis v. Brown, 6 Vet. App. 426, 430 (1994) (where the law is dispositive, the claim must be denied due to a lack of legal merit). For these reasons, the Board concludes that effective dates prior to September 26, 2012, for the awards of service connection for left lower extremity scars, unspecified depressive disorder, muscle injuries from a gunshot wound to the right and left legs, and the right foot disability are not warranted as a matter of law. Disability Rating Legal Criteria Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule) found in 38 C.F.R. Part 4. 38 U.S.C. § 1155. It is not expected that all cases will show all the findings specified; however, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances. 38 C.F.R. § 4.21. Where there is a question as to which of two disability ratings shall be applied, the higher rating 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. It is the defined and consistently applied policy of VA to administer the law under a broad interpretation, consistent, however, with the facts shown in every case. 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 C.F.R. § 4.3. When evaluating disabilities of the musculoskeletal system, 38 C.F.R. § 4.40 allows for consideration of functional loss due to pain and weakness causing additional disability beyond that reflected on range of motion measurements. DeLuca v. Brown, 8 Vet. App. 202 (1995); Mitchell v. Shinseki, 25 Vet. App. 32 (2011). Further, 38 C.F.R. § 4.45 provides that consideration also be given to decreased movement, weakened movement, excess fatigability, incoordination, and pain on movement, swelling, and deformity or atrophy of disuse. Painful motion is considered limited motion at the point that pain actually sets in. See VAOPGCPREC 9-98. 7. Rating muscle injury residuals from a gunshot wound to the right leg 8. Rating muscle injury residuals from a gunshot wound to the left leg For the entire initial rating period on appeal from September 26, 2012, the Veteran is in receipt of initial 30 percent ratings for muscle injury residuals from a gunshot wound to the right and left legs under Diagnostic Code 5311, which encompasses muscle injuries to the foot, ankle, and calf. 38 C.F.R. § 4.73. Initially, the Board notes the Veteran is also in receipt of separate 10 percent disability ratings for nerve injury residuals from a gunshot wound in the right and left legs under 38 C.F.R. § 4.124A, Diagnostic Code 8520, which addresses complete/incomplete paralysis of the sciatic nerve involving the foot, knee, and muscles below the knee, in contravention to 38 C.F.R. § 4.55. The Veteran is also in receipt of initial 20 percent and 10 percent ratings for right and left foot disabilities under 38 C.F.R. § 4.71a, Diagnostic Code 5284 (addressing foot injuries) and 38 C.F.R. § 4.124A, Diagnostic Code 8525 (addressing neuritis of the posterior tibial nerve, affecting the foot), respectively. Receipt of separately compensable ratings under the Diagnostic Codes specified above violates the rule against pyramiding as the Veteran is in receipt of compensable ratings for the same overlapping symptoms. 38 C.F.R. § 4.14. Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994) (the critical element in permitting the assignment of several ratings under various diagnostic codes is that none of the symptomatology for any one of the conditions is duplicative or overlapping with the symptomatology of the other condition); Lyles v. Shulkin, 29 Vet. App. 107 (2017) (holding that 38 C.F.R. § 4.14 prohibits paying compensation twice for the same symptoms or functional impairment). Disabilities resulting from muscle injuries are classified as slight, moderate, moderately severe, and severe. 38 C.F.R. § 4.56 (d). Pertinent in this case, a "severe" muscle disability contemplates a through and through or deep penetrating wound due to a high velocity missile, or large or multiple low velocity missiles, or with shattering bone fracture or open comminuted fracture with extensive debridement, prolonged infection, or sloughing of soft parts, intermuscular binding, and scarring; a service department record or other evidence showing hospitalization for a prolonged period for treatment of the wound; a record of consistent complaint of cardinal signs and symptoms of muscle disability, worse than those shown for moderately severe muscle injuries; and, if present, evidence of inability to keep up with work requirements. Objectively, there are ragged, depressed, and adherent scars indicating wide damage to muscle groups in the missile track; palpation shows loss of deep fascia or muscle substance, or soft flabby muscles in the wound area; muscles swell and harden abnormally in contraction; and tests of strength, endurance, or coordinated movements indicate severe impairment of function when compared with the uninjured side. Diagnostic Code 5311 addresses injuries to Muscle Group XI, which encompasses plantar flexion of the foot and include muscles of the foot, ankle, and calf. Disabilities resulting from muscle injuries to Muscle Group XI are classified as slight, moderate, moderately severe, or severe, and are rated as noncompensable (0 percent), 10 percent, 20 percent, and 30 percent, respectively. 38 C.F.R. §§ 4.56 (d), 4.73, Diagnostic Code 5311. In this case, the Veteran is in receipt of initial 30 percent disability ratings for muscle injury residuals from a gunshot wound to the right and left legs under Diagnostic Code 5311, which is the maximum schedular rating available. As the Veteran's muscle injury residuals from a gunshot wound to the right and left legs have already been rated as 30 percent disabling, the maximum allowable rating under Diagnostic Code 5311, a higher initial rating in excess of 30 percent is not possible. 38 C.F.R. § 4.73. 9. Rating the right foot disability For the entire initial rating period on appeal from September 26, 2012, the Veteran is in receipt of a 20 percent disability rating for the service-connected right foot disability under Diagnostic Code 5284. 38 C.F.R. § 4.71a. Diagnostic Code 5284, which addresses other foot injuries, provides a 10 percent rating for impairment of moderate degree, a 20 percent rating for moderately severe impairment, a 30 percent rating for severe impairment, and a 40 percent rating for actual loss of the use of the foot. 38 C.F.R. § 4.71a. Having reviewed all the evidence of record, the Board finds that the service-connected right foot disability has not been manifested by a severe right foot injury, and that a higher initial disability rating in excess of 20 percent for the right foot disability is not warranted for any period from September 26, 2012. The Veteran underwent a VA examination in July 2013, the examination report for which reflects the Veteran endorsed symptoms of pain and hypersensitivity, but also lack of sensation in the right foot. The July 2013 VA examiner noted findings of metatarsalgia in the right foot, with symptoms of numbness, hypersensitivity, and pain. The record also includes an October 2015 private medical examination report wherein the private provider assessed the Veteran's right foot disability manifested in moderately severe symptoms given the Veteran's impeded ability to stand due to weakness and pain in the right foot. The October 2015 private provider did not assess that the right foot disability has manifested in symptoms of a severe foot injury. Furthermore, as discussed above, the Veteran is already in receipt of pyramided ratings related to his right foot symptoms under Diagnostic Code 5311 (muscle injuries involving the foot, calf, and knee) and Diagnostic Code 8520 (complete/incomplete paralysis of the sciatic nerve involving the foot, knee, and muscles below the knee). Based on the foregoing, the Board finds that, for the entire initial rating period from September 26, 2012, the weight of the evidence shows the right foot disability did not manifest in a severe right foot injury, and that a higher initial disability rating in excess of 20 percent under Diagnostic Code 5284 is not warranted. 10. Rating bilateral tinnitus For the entire initial rating period on appeal from September 26, 2012, the Veteran is in receipt of an initial 10 percent disability rating for bilateral tinnitus under Diagnostic Code 6260. 38 C.F.R. § 4.87. The Veteran generally appeals for a higher initial rating in excess of 10 percent for tinnitus. See June 2017 Notice of Disagreement. Tinnitus is rated under Diagnostic 6260, which provides a 10 percent maximum disability rating for recurrent tinnitus. 38 C.F.R. § 4.87. Note (2) further explains that the Board must assign only a single rating for recurrent tinnitus, whether the sound is perceived in one ear, both ears, or in the head. The Federal Circuit affirmed VA's long-standing interpretation of Diagnostic Code 6260 as authorizing only a single 10 percent rating for tinnitus, whether perceived as unilateral or bilateral. Smith v. Nicholson, 451 F.3d 1344 (Fed. Cir. 2006). Citing United States Supreme Court precedent, the Federal Circuit explained in Smith that an agency's interpretation of its own regulations was entitled to substantial deference by the courts as long as that interpretation was not plainly erroneous or inconsistent with the regulations. Finding that there was a lack of evidence in the record suggesting that VA's interpretation of Diagnostic Code 6260 was plainly erroneous or inconsistent with regulations, the Federal Circuit concluded that the Court had erred in not deferring to VA's interpretation. In view of the foregoing, the Board concludes that the regulations preclude a schedular rating in excess of a single 10 percent rating for tinnitus; therefore, the appeal for a higher initial disability rating in excess of 10 percent for tinnitus must be denied under Diagnostic Code 6260, Note 2, as a matter of law. 38 C.F.R. § 4.87. As disposition of this issue is based on the law and not the facts of the case, the issue must be denied based on a lack of entitlement under the law. See Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). REASONS FOR REMAND 11. Rating the right lower extremity scars is remanded. 12. Rating the left lower extremity scars is remanded. The Veteran is in receipt of noncompensable (0 percent) ratings for right and left lower extremity scars under 38 C.F.R. § 4.118, Diagnostic Code 7802. The Veteran was provided with a VA examination in May 2017, the examination report for which reflects the VA examiner's findings that the multiple scars located on the right and left lower extremities are all superficial, non-linear, not painful or unstable, and are not productive of any limitation of function. However, a May 2017 VA examination for muscle injuries conducted by the same VA examiner noted findings of ragged, depressed and adherent scars that indicated wide damage to the muscle groups. July 2013 VA examinations for skin and foot conditions also reflect findings of deep scars with deformities located in the right and left calves. Based on the evidence of record, it does not appear that the May 2017 VA examination for scars contains accurate findings of the current severity of the right and left lower extremity scars. Accordingly, remand for a new VA examination is needed. 13. Rating unspecified depressive disorder is remanded. The Veteran is currently in receipt of an initial 30 percent disability rating for unspecified depressive disorder under Diagnostic Code 9435. 38 C.F.R. § 4.130. A review of the medical evidence of record indicates a worsening of psychiatric symptoms since undergoing a VA examination in May 2017. Specifically, the Veteran has endorsed symptoms of near continuous depression, impaired impulse control, neglect of personal appearance, difficulty adapting to stressful circumstances, and inability to establish effective relationships. As such, the Board find that a more current examination is warranted. 14. Rating the left foot disability is remanded. The Veteran is in receipt of a 10 percent disability rating for the left foot disability under 38 C.F.R. § 4.118, Diagnostic Code 8525, which addresses neuritis of the posterior tibial nerve, affecting the foot. However, the file does not include a VA examination for peripheral nerve conditions. As such, the Board finds that remand for a new VA examination is needed. 15. Service connection for IBS is remanded. The Veteran generally asserts that IBS is the result of service in the Southwest Asian Theatre of Operations during the Gulf War Era, or that it is result of active service. The Veteran also claims that the currently diagnosed IBS is exacerbated by his psychiatric symptoms related to the service-connected unspecified depressive disorder. See July 2013 VA examination report. However, the record does not include a VA medical opinion as to whether the Veteran's current IBS was either caused or worsened beyond its normal progression by the service-connected unspecified depressive disorder. Accordingly, remand is needed to obtain a VA medical opinion. 16. Service connection for a skin disorder is remanded. The Veteran asserts that a current skin disorder is etiologically related to the gunshot wounds to the right and left legs sustained during service. The Veteran was provided with a VA examination for skin conditions in July 2013, the examination report for which shows the Veteran was diagnosed with erythema in 2011. Despite the July 2013 VA examination report reflecting a current diagnosis for a skin disorder, the VA examiner provided a negative opinion that the claimed skin disorder is related to the gunshot sounds to the right and left lower extremities sustained during service. The July 2013 VA examiner simply stated that the Veteran is not currently diagnosed with a skin disorder. However, as the July 2013 VA examination report clearly reflects a current diagnosis for erythema, the Board finds that remand for a VA addendum opinion is needed. 17. Service connection for a neurological disorder is remanded. The Veteran generally seeks service connection for a neurological disorder. The Veteran was provided with a VA examination in July 2013, the examination report for which shows the Veteran was diagnosed with dizziness. Additionally, the July 2013 VA examination report notes several positive findings for symptoms specifically related to a cranial nerve disorder (CNS) such as depression, cognitive impairment or dementia. However, despite these findings, the July 2013 VA examiner did not provide a medical nexus opinion. Thus, it is unclear to the Board whether the Veteran is in fact currently diagnosed with a neurological disorder. As such, remand for a new VA examination and VA opinion is needed. The matters are REMANDED for the following actions: 1. Schedule the appropriate VA examination in order to assist in determining the current level of severity of the service-connected right and left extremity scars. 2. Schedule the appropriate VA examination in order to assist in determining the current level of severity of the service-connected unspecified depressive disorder. 3. Schedule the appropriate VA examination in order to assist in determining the current level of severity of the service-connected left foot reflex sympathetic dystrophy (left foot disability). 4. Request that a VA medical professional review the electronic file and provide the VA addendum opinions requested below for the claimed IBS. If the VA examiner determines that additional examination(s) of the Veteran is necessary to provide reliable opinions as to causation, such examination(s) should be scheduled; however, the Veteran should not be required to report for another examination as a matter of course, if it is not found to be necessary. The VA examiner should provide the following opinions: a) Is it at least as likely as not (i.e., 50 percent probability or greater) that the current IBS was caused by the service-connected unspecified depressive disorder? b) Is it at least as likely as not (i.e., 50 percent probability or greater) that the current IBS was worsened beyond its natural progression by the service-connected unspecified depressive disorder? 5. Request that a VA medical professional review the electronic file and provide the VA addendum opinions requested below for the claimed skin disorder. If the VA examiner determines that additional examination(s) of the Veteran is necessary to provide reliable opinions as to causation, such examination(s) should be scheduled; however, the Veteran should not be required to report for another examination as a matter of course, if it is not found to be necessary. The VA examiner should provide the following opinions: a) Is it at least as likely as not (i.e., 50 percent probability or greater) that the current skin disorder, including erythema, was caused by the gunshot wounds to the right and left legs sustained during service? b) Is it at least as likely as not (i.e., 50 percent probability or greater) that the current skin disorder, including erythema, was worsened beyond its natural progression by the gunshot wounds to the right and left legs sustained during service? 6. Schedule the appropriate VA examination in order to assess the claimed neurological disorder. The VA examiner should provide the following opinions: a) Does the Veteran have a currently diagnosed neurological disorder? b) If and only if the Veteran has a currently diagnosed neurological disorder, is it at least as likely as not (i.e., 50 percent probability or greater) that the current neurological disorder was caused by the gunshot wounds to the right and left legs sustained during service and/or the service-connected unspecified depressive disorder? (Continued on the next page) c) If and only if the Veteran has a currently diagnosed neurological disorder, is it at least as likely as not (i.e., 50 percent probability or greater) that the current neurological disorder was worsened beyond its natural progression by the gunshot wounds to the right and left legs sustained during service and/or the service-connected unspecified depressive disorder? J. PARKER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Choi, 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.