Citation Nr: 21063622 Decision Date: 10/14/21 Archive Date: 10/14/21 DOCKET NO. 18-00 627 DATE: October 14, 2021 ORDER New and material evidence has been received to reopen a claim of entitlement to service connection for an acquired psychiatric disability, to include posttraumatic stress disorder, and the petition to reopen the claim is granted. New and material evidence has been received to reopen a claim of entitlement to service connection for a respiratory disability, to include chronic obstructive pulmonary disease (COPD), and the petition to reopen the claim is granted. An effective date earlier than May 23, 2014 for the grant of a 10 percent rating for bilateral hearing loss is denied. REMANDED Entitlement to service connection for peripheral neuropathy, right lower extremity, is remanded. Entitlement to service connection for peripheral neuropathy, left lower extremity, is remanded. Entitlement to service connection for peripheral neuropathy, right upper extremity, is remanded. Entitlement to service connection for peripheral neuropathy, left upper extremity, is remanded. Entitlement to service connection for diabetes mellitus, type II, is remanded. Entitlement to service connection for cerebrovascular accident is remanded. Entitlement to service connection for coronary artery disease is remanded. Entitlement to service connection for erectile dysfunction is remanded. Entitlement to special monthly compensation (SMC) due to loss of use of a creative organ is remanded. Entitlement to service connection for an acquired psychiatric disability, to include PTSD, is remanded. Entitlement to service connection for a respiratory disability, to include COPD, is remanded. Entitlement to a disability rating in excess of 10 percent for bilateral hearing loss is remanded. Entitlement to a compensable disability rating for left shin laceration is remanded. Entitlement to a compensable disability rating for crush injury, right fifth digit, is remanded. FINDINGS OF FACT 1. In a July 1999 rating decision, the Agency of Original Jurisdiction (AOJ) denied entitlement to service connection for bilateral lung disorder; the Veteran did not file a notice of disagreement and no new evidence was received within a year of issuance of the rating decision. 2. Additional evidence received since the July 1999 rating decision is new and relates to an unestablished fact necessary to substantiate the claim of service connection for a respiratory disability, to include COPD. 3. In an August 2013 rating decision, the AOJ denied confirmed an earlier denial of service connection for PTSD; the Veteran did not file a notice of disagreement and no new evidence was received within a year of issuance of the rating decision. 4. Additional evidence received since the August 2013 rating decision is new and relates to an unestablished fact necessary to substantiate the claim of service connection for PTSD. 5. On May 23, 2014, the Veteran filed a VA 21-526EZ, Fully Developed Claim for an increased rating for bilateral hearing loss. 6. Prior to May 23, 2014, it was not factually ascertainable that the rating criteria for a 10 percent disability rating for bilateral hearing had been met. CONCLUSIONS OF LAW 1. New and material evidence has been received since the July 1999 rating decision which denied service connection for bilateral lung disorder and the claim of service connection for a respiratory disability, to include COPD, is reopened. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). 2. New and material evidence has been received since the August 2013 rating decision which confirmed an earlier denial of service connection for PTSD and the claim is reopened. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). 3. The criteria for an effective date of May 23, 2014 for a 10 percent rating for bilateral hearing loss have not been met. 38 U.S.C. §§ 1155, 5103(a), 5103A, 5107; 38 C.F.R. §§ 3.400, 4.85, 4.86, Diagnostic Code 6100. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS These matters come to the Board of Veterans' Appeals (Board) from a July 2015 rating decision of a Department of Veterans Affairs (VA) Regional Office which, in pertinent part, determined that new and material evidence had been received to reopen the claim of service connection for PTSD; denied service connection for the above disabilities; granted a 10 percent disability rating for bilateral hearing loss, effective May 23, 2014; and, denied increased ratings for residuals of crush injury, right fifth digit and left shin laceration scar. A notice of disagreement was received in July 2015, a statement of the case was issued in November 2017, and a substantive appeal was received in December 2017. The Veteran testified at a Board hearing in July 2021. New & Material Evidence Even where the RO determines that new and material evidence has been received to reopen a claim, or that an entirely new claim has been received, the Board is not bound by that determination and must nevertheless consider whether new and material evidence has been received. Jackson v. Principi, 265 F.3d 1366 (Fed. Cir. 2001). If new and material evidence is presented or secured with respect to a claim that has been disallowed, VA must reopen the claim and review its former disposition. 38 U.S.C. § 5108. See Hodge v. West, 155 F.3d 1356, 1362 (Fed. Cir. 1998). New and material evidence is existing evidence that by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim and raises a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). For the purpose of establishing whether new and material evidence has been submitted, the credibility of the evidence, although not its weight, is presumed. Justus v. Principi, 3 Vet. App. 510, 513 (1992). There is a low threshold for finding new evidence that raises a reasonable possibility of substantiating a claim. Shade v. Shinseki, 24 Vet. App. 110, 117 (2010). VA should consider whether the newly received evidence could reasonably substantiate the claim were the claim to be reopened, including whether VA's duty to provide a VA examination is triggered. There must be new and material evidence as to at least one of the bases of the prior disallowance to warrant reopening. Shade, 24 Vet. App. at 117-20. In September 1998, the Veteran filed a claim of service connection for "left and right lungs." In a July 1999 rating decision, service connection was denied for a bilateral lung condition on the basis of no relationship of his diagnoses (chronic recurrent bronchitis, tobacco abuse, obstructive sleep apnea) to service, to include claimed asbestos exposure. The Veteran did not file a notice of disagreement and no evidence was received within a year of issuance of the rating decision. 38 U.S.C. § 7105; Bond v. Shinseki, 659 F.3d 1362, 1367-68 (Fed. Cir. 2011); 38 C.F.R. § 3.156(b). In May 2001, the Veteran filed an informal claim of service connection for PTSD. In a February 2002 rating decision, service connection was denied on the basis that no diagnosis had been established. The Veteran did not file a notice of disagreement and no evidence was received within a year of issuance of the rating decision. 38 U.S.C. § 7105; Bond v. Shinseki, 659 F.3d 1362, 1367-68 (Fed. Cir. 2011); 38 C.F.R. § 3.156(b). In April 2004, the Veteran filed a claim of service connection for PTSD. In a December 2004 rating decision, service connection for PTSD was denied on the basis of a lack of corroborated stressors. The Veteran did not file a notice of disagreement and no evidence was received within a year of issuance of the rating decision. 38 U.S.C. § 7105; Bond v. Shinseki, 659 F.3d 1362, 1367-68 (Fed. Cir. 2011); 38 C.F.R. § 3.156(b). In June 2012, the Veteran submitted a claim of service connection for PTSD. In an August 2013 rating decision, service connection for PTSD was denied in consideration of the new PTSD criteria per 38 C.F.R. § 3.304(f)(3). In May 2014, the Veteran submitted a claim of service connection for PTSD and COPD. In support of his COPD claim, VA treatment records reflect a diagnosis of COPD, and the Veteran asserts that he has COPD due to exposure to herbicides. In support of his PTSD claim, the Veteran has submitted VA 21-0871 Statement in Support of Claim for PTSD. He also underwent a March 2015 C&P examination wherein schizoaffective disorder was diagnosed. VA treatment records have been associated with the claims folder which reflect psychiatric treatment. At the Board hearing, the Veteran testified that a fellow soldier, a helicopter crewman, died in friendly fire while he was stationed on the USS Ranger in 1973. 07/06/2021 Hearing Transcript at 13-14. As detailed above, there is a low threshold for finding new evidence that raises a reasonable possibility of substantiating the claims. Based on the diagnoses of record and the Veteran's assertions, the Board finds that such provides the basis for reopening the claims of service connection for a respiratory disorder and PTSD. For the above reasons, the claims of service connection for a respiratory disorder, to include COPD, and service connection for an acquired psychiatric disability, to include PTSD, is reopened. 38 U.S.C. § 5108. Earlier Effective Date The assignment of effective dates of awards is generally governed by 38 U.S.C. § 5110 and 38 C.F.R. § 3.400. Except as otherwise provided, the effective date of an evaluation and an award of compensation based on an original claim or a claim for increase will be the date of receipt of the claim or the date entitlement arose, whichever is the later. 38 C.F.R. § 3.400. If the increase became ascertainable more than one year prior to the date of receipt of the claim, then the proper effective date would be the date of claim. In a case where the increase became ascertainable after the filing of the claim, then the effective date would be the date of increase. See Harper v. Brown, 10 Vet. App. 125 (1997). The "date of the claim" means the date of the application based upon which benefits are awarded, not the original claim for service connection. See Sears v. Principi, 16 Vet. App. 244, 246-47 (2002), aff'd, 349 F.3d 1326 (Fed. Cir. 2003). In this context, it should be noted that the provisions of 38 U.S.C. § 5110 also refer to the date an application is received. A claim means a written or electronic communication requesting a determination of entitlement or evidencing a belief in entitlement, to a specific benefit under the laws administered by VA submitted on an application form prescribed by the Secretary. 38 C.F.R. §§ 3.1(p), 3.155. In fixing an effective date for an award of increased compensation, VA must make two essential determinations. It must determine when a claim for increased compensation was received, and when a factually ascertainable increase in disability occurred. The Rating Schedule provides a table for ratings purposes (Table VI) to determine a Roman numeral designation (I through XI) for hearing impairment, established by a state-licensed audiologist including a controlled speech discrimination test (Maryland CNC), and based upon a combination of the percent of speech discrimination and the puretone threshold average which is the sum of the puretone thresholds at 1000, 2000, 3000 and 4000 Hertz, divided by four. 38 C.F.R. § 4.85. Table VII is used to determine the percentage evaluation by combining the Roman numeral designations for hearing impairment of each ear. The horizontal row represents the ear having the poorer hearing and the vertical column represents the ear having the better hearing. Id. When the puretone threshold at each of the four specified frequencies (1000, 2000, 3000, and 4000 Hertz) is 55 decibels or more, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIa, whichever results in the higher numeral. Each ear will be evaluated separately. 38 C.F.R. § 4.86(a). When the puretone threshold is 30 decibels or less at 1000 Hertz, and 70 decibels or more at 2000 Hertz, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIa, whichever results in the higher numeral. That numeral will then be elevated to the next higher. 38 C.F.R. § 4.86(b). To evaluate the degree of disability from defective hearing, the rating schedule establishes eleven auditory acuity levels designated from "I" for essentially normal acuity, through "XI" for profound deafness. 38 C.F.R. § 4.85, Tables VI, VII. A noncompensable evaluation is provided where hearing in the better ear is I and hearing in the poorer ear is I through IX; where hearing in the better ear is II, and hearing in the poorer ear is II to IV; or where there is level III hearing in both ears. A 10 percent disability rating is warranted where hearing in the better ear is I, and hearing in the poorer ear is X to XI; or where hearing in the better ear is II, and hearing in the poorer ear is V to XI; or where hearing in the better ear is III, and hearing in the poorer ear is IV to VI. 38 C.F.R. § 4.85, Table VII, Diagnostic Code 6100. Pertinent case law provides that the assignment of disability ratings for hearing impairment are to be derived by the mechanical application of the Ratings Schedule to the numeric designations assigned after audiometry evaluations are rendered. Lendenmann v. Principi, 3 Vet. App. 345 (1992). In a July 1999 rating decision, service connection was established for bilateral hearing loss, rated 0% disabling, effective September 24, 1998. The Veteran did not file a notice of disagreement; the rating decision is final. 38 U.S.C. § 7105. In April 2009, the Veteran filed an informal claim for an increased rating for bilateral hearing loss. In a July 2009 rating decision, an increased rating was denied. The Veteran did not file a notice of disagreement; the rating decision is final. 38 U.S.C. § 7105. The assigned effective date of May 23, 2014 for the 10 percent rating for bilateral hearing loss corresponds to the date of receipt of the Veteran's claim for an increased rating. Specifically, on May 23, 2014, the Veteran submitted VA 21-526EZ, Application for Disability Compensation and Related Compensation Benefits, in which he claimed an increased rating for hearing loss. In fixing an effective date for an award of increased compensation, VA must make two essential determinations. It must determine when a claim for increased compensation was received, and when a factually ascertainable increase in disability occurred. As in effect prior to March 2015, under 38 C.F.R. § 3.155(a), a veteran or a representative of a veteran can file an informal claim by communicating an intent to apply for one or more VA benefits. See also 38 C.F.R. § 3.1(p). With respect to the first determination, a specific claim in the form prescribed by the Secretary must be filed in order for benefits to be paid to any individual under the laws administered by VA. 38 U.S.C. § 5101(a); 38 C.F.R. § 3.151. Any communication or action indicating intent to apply for one or more benefits under the laws administered by VA from a claimant may be considered an informal claim. 38 C.F.R. § 3.155(a). When a claim has been filed which meets the requirements of 38 C.F.R. § 3.151, an informal request for increase or reopening will be accepted as a claim. 38 C.F.R. § 3.155(c). Once a formal claim for compensation has been allowed, receipt of one of the following will be accepted as an informal claim for increased benefits: 1) report of examination or hospitalization by VA or uniformed services; 2) evidence from a private physician or layman; and 3) examination reports, clinical records, and transcripts of records received from State and other institutions. 38 C.F.R. § 3.157. VA must look to all communications from a claimant that may be interpreted as applications or claims - formal and informal - for increased benefits and is requested to identify and act on informal claims for benefits. Servello v. Derwinski, 3 Vet. App. 196 (1992). The assigned effective date of May 23, 2014, for the 10 percent rating for bilateral hearing loss is the date of receipt of the Veteran's increased rating claim. There is no indication in the file, or any allegation from the Veteran, that any unadjudicated increased rating claim was filed prior to May 23, 2014. As detailed, the Veteran did file an increased rating claim in April 2009 and a July 2009 rating decision denied an increased rating based on the evidence of record at that time which included a June 2009 C&P audiological examination. Such rating decision is final as the Veteran did not submit a notice of disagreement and did not submit any other evidence within a year of issuance of the rating decision. There is no other communication pertaining to his bilateral hearing loss filed by the Veteran subsequent to the July 2009 rating decision and prior to submission of the May 23, 2014 increased rating for bilateral hearing loss. There is no other submission from the Veteran that could be interpreted as an informal claim for an increased rating for bilateral hearing loss. Moreover, there are no records of pertinent treatment within the timeframe specified under 38 C.F.R. § 3.157(b) such as to enable a finding of an informal claim based on a report of treatment. The Board has reviewed the claims folder to determine whether there is any medical evidence that is of record for the one-year period prior to May 23, 2014, to support a 10 percent disability rating for bilateral hearing loss. VA outpatient treatment records have been associated with the claims folder for the one-year period prior to May 23, 2014, but none of the records pertain to treatment for bilateral hearing loss. As there are no findings reflected in VA outpatient treatment records or any other records pertaining to hearing loss treatment for the period from May 28, 2013, there is no basis for a finding that it was factually ascertainable that his service-connected disability had increased in severity in the year prior to May 28, 2014. There is no demonstrated symptomatology in the year prior to May 28, 2014, which could support a 10 percent rating. While the AOJ reviewed the VA outpatient treatment records on file, the 10 percent rating was assigned based on findings reflected in the March 2015 C&P examination. The effective date corresponds to the date of receipt of his increased rating claim. 38 C.F.R. §§ 3.400, 4.85, 4.86, Diagnostic Code 6100. Accordingly, an effective date prior to May 23, 2014, for a 10 percent disability rating for bilateral hearing loss is clearly not warranted. REASONS FOR REMAND Peripheral neuropathy, bilateral lower and upper extremities; diabetes mellitus, type II; cerebrovascular accident; coronary artery disease; erectile dysfunction The Veteran asserts that his peripheral neuropathy, diabetes mellitus, cerebrovascular accident, coronary artery disease, and erectile dysfunction are due to in-service exposure to herbicides during active service. A "veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975, shall be presumed to have been exposed during such service to an herbicide agent, unless there is affirmative evidence to establish that the veteran was not exposed to any such agent during that service." 38 U.S.C. § 1116 (f); 38 C.F.R. § 3.307 (a)(6)(iii). A Veteran who served in the Republic of Vietnam or other locations, if the conditions of service involved duty or visitation in Vietnam or its territorial waters, between January 9, 1962, and May 7, 1975, is presumed to have been exposed to Agent Orange. 38 U.S.C. § 1116 (f); 38 C.F.R. § 3.307 (a)(6)(iii). On January 29, 2019, the Federal Circuit Court issued an en banc decision in Procopio v. Wilkie, which held that the phrase "service in the Republic of Vietnam" in 38 U.S.C. § 1116 includes the territorial sea of the Republic ... and is not limited to the landmass or inland waterways of that nation," essentially reversing Haas v. Peake, 544 F.3d 1306 (Fed. Cir. 2008). Procopio v. Wilkie, 913 F.3d 1370 (Fed. Cir. 2019). Congress implemented the Procopio holding in the Blue Water Navy Vietnam Veterans Act of 2019 (Blue Water Act). 38 U.S.C. § 1116, the statute pertaining to the presumption of in-service herbicide exposure was revised pursuant to P.L. 116-23, § 3(a), 133 Stat. 969 (added June 25, 2019). Effective January 1, 2020, 38 U.S.C. § 1116A was added to extend the presumption of in-service herbicide exposure to Blue Water navy veterans who served within 12 nautical miles off-shore of the Republic of Vietnam between January 9, 1962 and May 7, 1975. 38 U.S.C. § 1116A, states that VA must treat a location as being "offshore" of Vietnam (and therefore falling within the presumption of herbicide agent exposure) "if the location is not more than 12 nautical miles seaward of a line commencing on the southwestern demarcation line of the waters of Vietnam and Cambodia." Thus, the presumption of herbicide exposure now extends to "Blue Water" Navy veterans who served aboard a ship that navigated within a 12 nautical mile radius off the coast of Vietnam. If a veteran was exposed to a herbicide agent during active military, naval, or air service, certain diseases shall be service connected if the requirements of 38 U.S.C. § 1116 and 38 C.F.R. § 3.307 (a)(6)(iii) are met, even though there is no record of such disease during service, provided further that the rebuttable presumption provisions of 38 U.S.C. § 1113; 38 C.F.R. § 3.307 (d) are also satisfied. 38 C.F.R. § 3.309 (e). Such diseases include, among others, ischemic heart disease, diabetes mellitus, type II, and early-onset peripheral neuropathy. 38 C.F.R. § 3.309 (e). The Veteran's DD Form 214 reflects that he served in the United States Navy as a Machinist's Mate. The Veteran testified that he served as a Gunner and machinist or engineerman machinist. During his period of service from August 1972 to June 1976 he had 3 years, 4 months, and 28 days of foreign and/or sea service. During his period of service from June 1976 to June 1982 he had 3 years, 9 months, and 11 days of sea service and no foreign service. He is in receipt of the Vietnam Service Medal and National Defense Service Medal. He served aboard the USS Ranger (CV-61) from January 1973 to July 1975 and aboard the USS Hepburn from August 1975 to January 1978. 07/09/2013 Military Personnel Record at 4-6. The Veteran did not have active service on the ground in the Republic of Vietnam but asserts that he was exposed to herbicides while aboard the USS Ranger and USS Hepburn. Specifically, he asserts that he drank water off the USS Ranger and USS Hepburn that had tested positive for traces of Agent Orange. Also, while he was aboard the USS Hepburn they "would go in close to shore, provide fire support." He asserted they were off the coast north of Da Nang." They would pull "troops that got overran or runoff" and "[e]verything [he] did was beach." He asserted that he was "right on shore." While aboard the USS Ranger "we pulled in enough [sic] close enough that all the guys that wanted to shoot and that was qualified to shoot, would lay on the flight deck and provide fire support for people that we was [sic] bringing out. Also, we'd go in close enough for fire support to get combat pay for the whole ship, which you could just about throw a rock to that beach. And did the same thing on the Hepburn, so." 07/06/2021 Hearing Transcript at 3-4. The VA Compensation Intranet used to keep data regarding 'Vietnam Era Navy Ship Agent Orange Exposure.' The website now indicates the following: Exposure to herbicides based on any type of nautical service in or near the Republic of Vietnam, to include what was previously considered "close coastal waters" and inland waterways is now determined quickly and with precision using VBA's internal claims processing system used to determine ship location(s). As such, the ship list which was previously used in making these determinations is no longer being updated, and its use is being discontinued. A link to the US Navy Deck Logs from the Vietnam Era on the National Archives website contains deck logs from the USS Ranger from January to April 1973. The November 2017 statement of the case states the following with regard to a finding that the Veteran was not presumed to be exposed to herbicides during service: VA maintains a list of ships that served on the inland waterways of Vietnam (brown water) as well as ships that had personnel disembark and go to shore in Vietnam. The USS Ranger and USS Hepburn are ships not found to be either. There is no documentary evidence contained in the claims folder pertaining to a list of ships and any such list is no longer contained on VA websites. Remand is necessary to obtain further information as to whether the USS Ranger from January to April 1973 had any port call or docking in the Republic of Vietnam or within 12 nautical miles off the coast of the Republic of Vietnam. PTSD In March 2015, the Veteran underwent a C&P examination wherein the examiner diagnosed schizoaffective disorder. The examiner determined that the Veteran did not meet the DSM-V criteria for PTSD based on his claimed stressors. At the Board hearing, however, the Veteran testified as to a stressor that is not contained in the examination report. He testified that a fellow solider, a helicopter crewman, died in friendly fire while he was stationed on the USS Ranger in 1973. 07/06/2021 Hearing Transcript at 13-14. Also, the March 2015 C&P examiner did not proffer an opinion regarding the etiology of his schizoaffective disorder. Thus, Remand is necessary for further opinions. COPD The Veteran has asserted that he has a respiratory disability due to asbestos exposure and due to exposure to herbicides. As detailed above, the Veteran served in the Navy aboard the USS Ranger and USS Hepburn. The claimed asbestos exposure is deemed consistent with the circumstances of the Veteran's service in the Navy. 38 U.S.C. § 1154(a). Thus, asbestos exposure has been established as consistent with the circumstances service. However, it is important to note that mere exposure to asbestos is insufficient to achieve service connection. Rather, the evidence must show that any exposure caused a Veteran to develop a chronic disease. VBA Manual guidelines provide, in part, that the clinical diagnosis of asbestosis requires a history of exposure and radiographic evidence of parenchymal disease; that rating specialists are to develop any evidence of asbestos exposure before, during and after service; and that a determination must be made as to whether there is a relationship between asbestos exposure and the claimed disease, keeping in mind the latency period and exposure information. See VBA Manual M21-1I, V.ii.2.C.2.g and h; see also Ennis v. Brown, 4 Vet. App, 523, 527 (1993); McGinty v. Brown, 4 Vet. App. 428, 432 (1993). A December 1973 service treatment record reflects treatment for an upper respiratory infection with productive cough. 07/09/2013 STR-Medical at 104. A November 1978 service treatment record reflects productive cough for the past 24 hours. Id. at 91. A July 1981 service treatment record reflects that he was treated for rule out possible bronchitis secondary to upper respiratory infection. Id. at 82. A May 1999 C&P examination reflects the Veteran's report of being exposed to asbestos. He reported that while on a carrier ship and all other ships, he was continually breathing asbestos. He reported that during that time, respirators or protective devices were not required and it was part of his job to remove the asbestos layering from the pipes and fittings and put new back on. Since that time, he complained of chronic congestion and chronic cough with white sputum production. He reported that he smokes one pack every three to four days. He complained of recurring bronchitis. He denied recurrent incidents of pneumonia and denied shortness of breath at rest. He complained of shortness of breath with heavy activity. He uses a CPAP respirator at night for a diagnosis of obstructive sleep apnea. The diagnoses were: history of reported asbestos exposure; chronic recurrent bronchitis, per history; and, obstructive sleep apnea, requiring CPAP machine. A May 1999 VA treatment record reflects moderate obstructive airway disease. Subsequent VA treatment records reflect a diagnosis of COPD. The Veteran should be afforded an examination to assess the nature and etiology of his respiratory disability. Bilateral hearing loss At the Board hearing, the Veteran asserted that his bilateral hearing loss had worsened. The Veteran's most recent examination was conducted in March 2015, thus over 6 years ago. The Veteran should be afforded an examination to assess the severity of his bilateral hearing loss. Right little finger In April 2015, the Veteran underwent an examination to assess the severity of his right little finger disability. As such examination was conducted over 6 years ago, and contemporaneous treatment records do not contain relevant findings, the should be afforded an examination to assess the severity of his disability. Left shin laceration In April 2015, the Veteran underwent an examination to assess the severity of his left shin laceration. As such examination was conducted over 6 years ago, and contemporaneous treatment records do not contain relevant findings, the Veteran should be afforded an examination to assess the severity of his disability. VA outpatient treatment records are on file through November 13, 2017. On Remand, updated treatment records must be associated with the claims folder. The matters are REMANDED for the following actions: 1. Associate with the claims folder updated VA treatment records for the period from November 14, 2017. 2. Contact an appropriate repository to determine whether for the period from January to April 1973 the USS Ranger had any port call or docking in the Republic of Vietnam or within 12 nautical miles off the coast of the Republic of Vietnam. The results of this search should be clearly notated in the claims file. 3. Schedule the Veteran for an examination with a psychologist or psychiatrist to assess the nature and etiology of his claiming acquired psychiatric disability, to include PTSD. The entire claims file, including a copy of the Remand, should be made available to, and be reviewed by, the VA examiner. After review of the record, the examiner should respond to the following: a) Identify all acquired psychiatric disorders. Consideration should be given to the diagnoses of record. The examiner should specifically indicate whether the Veteran has a diagnosis of PTSD pursuant to DSM-5. The examiner should provide an opinion as to the following: b) Whether the Veteran currently suffers from PTSD related to his fear of hostile military or terrorist activity while on active duty and whether it is adequate to support a diagnosis of PTSD. For purposes of this paragraph, "fear of hostile military or terrorist activity" means that a Veteran experienced, witnessed, or was confronted with an event or circumstance that involved actual or threatened death or serious injury, or a threat to the physical integrity of the Veteran or others, such as from an actual or potential improvised explosive device; vehicle-imbedded explosive device; incoming artillery, rocket, or mortar fire; grenade; small arms fire, including suspected sniper fire; or attack upon friendly military aircraft, and the Veteran's response to the event or circumstance involved a psychological or psycho-physiological state of fear, helplessness, or horror; OR c) Whether the Veteran has PTSD due to the stressor of a fellow serviceman being killed in friendly fire on the USS Ranger or any of the other asserted stressors contained in the claims folder. d) For any psychiatric diagnosis rendered other than PTSD the examiner is requested to render an opinion as to whether it is at least as likely as not (a likelihood of 50 percent or more) that any currently diagnosed psychiatric disorder is a result of service or any incident therein. The clinician is advised that the Veteran is competent to report his symptoms and history, and such reports must be specifically acknowledged and considered in formulating any opinions. A detailed rationale should be provided for the opinions rendered. If the examiner cannot provide the requested information without resort to speculation, he or she must state the reasons why, and if an additional clinical evaluation is necessary to render the requested information, then that opportunity should be made available. 4. Schedule the Veteran for an examination with a clinician with appropriate expertise to assess the nature and etiology of his claimed respiratory disability, to include COPD. The entire claims file, including a copy of the Remand, should be made available to, and be reviewed by, the examiner. The examiner should review the claims folder and provide an opinion regarding the following: a) Please identify all respiratory disabilities. Consideration should be given to the diagnoses of record. b) Is a respiratory disability at least as likely as not (a 50 percent or more probability) related to service, to include in-service treatment for upper respiratory infections and/or exposure to asbestos? Exposure to asbestos is conceded due to the Veteran's service in the United States Navy aboard the USS Ranger and USS Hepburn. In formulating the opinion, the examiner must provide an appropriate rationale, and give consideration to the medical evidence of record and the Veteran's lay assertions of in-service exposures. 5. Schedule the Veteran for a VA audiological examination for the purpose of determining the severity of his bilateral hearing loss. The Veteran's Virtual folder should be reviewed in conjunction with the examination. The examiner shall perform an evaluation for hearing impairment as required by 38 C.F.R. § 4.85, which shall include a controlled speech discrimination test (Maryland CNC) and a puretone audiometry test. The examiner should elicit information from the Veteran regarding the functional effects or limitations associated with his bilateral hearing loss, to include any impacts on activities of daily living, to include occupational effects. Please provide a comprehensive rationale for any discussion given. 6. Schedule the Veteran for an orthopedic examination with an examiner with appropriate expertise to assess the severity of his disability of the right little finger and associated right hand symptomatology. The virtual folder should be made available to the examiner for review in conjunction with the examination. Any medically indicated special tests should be accomplished, and all special test and clinical findings should be clearly reported. The examiner should comment on whether the Veteran has favorable or unfavorable ankylosis of the little finger of the right hand; and, comment on any functional limitations as a result of the little finger disability. The examiner should identify any neurological symptomatology associated with the little finger. The examiner is to provide a statement concerning how the little finger of the right hand affects his functioning and activities, to include in an occupational setting. The examiner is asked to describe the types of limitations he would experience as a result of his disability of the little finger. The examiner must provide a comprehensive rationale for the opinions. 7. Schedule the Veteran for a VA examination with appropriate expertise to determine the severity of his service-connected scar, left shin. All pertinent symptomatology and findings should be reported in detail. The examiner should determine the level of disfigurement of the scar. The examiner should specifically comment on each of the eight disfiguring factors under Diagnostic Code 7800 for the scars: (1) scar five or more inches in length; (2) scar at least one-quarter inch wide at widest part; (3) surface contour of scar elevated or depressed on palpation; (4) scar adherent to underlying tissue; (5) skin hypo-or hyper- pigmented in an area exceeding six square inches (39 sq. cm.); (6) skin texture abnormal (irregular, atrophic, shiny, scaly, etc.) in an area exceeding six square inches (39 sq. cm.); (7) underlying soft tissue missing in an area exceeding six square inches (39 sq. cm.); or (8) skin indurated and inflexible in an area exceeding six square inches (39 sq. cm.). (Continued on the next page) The examiner should also comment on whether the scar is painful or unstable. The examiner should also comment on any residual left leg symptomatology due to the scar. Eric S. Leboff Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M.W. Kreindler, 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.