Citation Nr: 21064133 Decision Date: 10/19/21 Archive Date: 10/19/21 DOCKET NO. 18-31 816 DATE: October 19, 2021 ORDER The issue of entitlement to service connection for urticaria been withdrawn. The issue of entitlement to service connection for angioedema has been withdrawn. The petition to reopen the claim of service connection for a lumbar spine disorder is granted. The petition to reopen the claim of service connection for a cervical spine disorder is granted. The petition to reopen the claim of service connection for a psychiatric disorder, to include depressive disorder/anxiety, is granted. The petition to reopen the claim of service connection for a traumatic brain injury (TBI), claimed as head injury, is granted. The petition to reopen the claim of service connection for a right ankle disorder is granted. REMANDED Entitlement to service connection for a lumbar spine disorder is remanded. Entitlement to service connection for a cervical spine disorder is remanded. Entitlement to service connection for a psychiatric disorder, to include depressive disorder/anxiety/PTSD, is remanded. Entitlement to service connection for a TBI, claimed as head injury, is remanded. Entitlement to service connection for a right ankle disorder is remanded. Entitlement to service connection for erectile dysfunction (ED) is remanded. Entitlement to service connection for chronic pain syndrome is remanded. Entitlement to service connection for hypertension is remanded. Entitlement to service connection for a digestive disorder is remanded. Entitlement to service connection for a sleep disorder is remanded. Entitlement to a disability evaluation in excess of 10 percent for a left ankle sprain is remanded. Entitlement to a total disability evaluation based upon individual unemployability (TDIU) is remanded. FINDINGS OF FACT 1. At his April 2021 virtual hearing, the Veteran testified that he was withdrawing the claim of service connection for urticaria and that he no longer wished to pursue this issue. 2. At his April 2021 virtual hearing, the Veteran testified that he was withdrawing the claim of service connection for angioedema and that he no longer wished to pursue this issue. 3. The RO denied entitlement to service connection for a lumbar spine disorder in October 2012. The Veteran was notified of the denial and did not file a notice of disagreement nor was evidence received which would have allowed the claim to remain open. 4. Evidence received since the October 2012 denial of entitlement to service connection for a lumbar spine disorder raises a reasonable possibility of substantiating the claim. 5. The RO denied entitlement to service connection for a cervical spine disorder in October 2012. The Veteran was notified of the denial and did not file a notice of disagreement nor was evidence received which would have allowed the claim to remain open. 6. Evidence received since the October 2012 denial of entitlement to service connection for a cervical spine disorder raises a reasonable possibility of substantiating the claim. 7. The RO denied entitlement to service connection for a TBI, claimed as a head injury, in October 2012. The Veteran was notified of the denial and did not file a notice of disagreement nor was evidence received which would have allowed the claim to remain open. 8. Evidence received since the October 2012 denial of entitlement to service connection for a TBI, claimed as a head injury, raises a reasonable possibility of substantiating the claim. 9. The RO denied entitlement to service connection for a psychiatric disorder, to include a depressive disorder and an anxiety disorder, in October 2012. The Veteran was notified of the denial and did not file a notice of disagreement nor was evidence received which would have allowed the claim to remain open. 10. Evidence received since the October 2012 denial of entitlement to service connection for a psychiatric disorder, to include a depressive disorder and an anxiety disorder, raises a reasonable possibility of substantiating the claim. 11. The RO denied entitlement to service connection for a right ankle disorder in October 2012. The Veteran was notified of the denial and did not file a notice of disagreement nor was evidence received which would have allowed the claim to remain open. 12. Evidence received since the October 2012 denial of entitlement to service connection for a right ankle disorder raises a reasonable possibility of substantiating the claim. CONCLUSIONS OF LAW 1. The criteria for withdrawal of an appeal by the Veteran on the issue of entitlement to service connection for urticaria have been met. 38 U.S.C. § 7105(b)(2), (d)(5) (2012); 38 C.F.R. § 20.204 (2020). 2. The criteria for withdrawal of an appeal by the Veteran on the issue of entitlement to service connection for angioedema have been met. 38 U.S.C. § 7105(b)(2), (d)(5) (2012); 38 C.F.R. § 20.204 (2020). 3. The October 2012 rating determination denying service connection for a lumbar spine disorder became final. 38 U.S.C. § 7105(c) (2012); 38 C.F.R. §§ 20.302, 20.1103 (2020). 4. New and material evidence sufficient to reopen the claim of service connection for a lumbar spine disorder has been received. 38 U.S.C. §§ 5108, 7105 (2012); 38 C.F.R. § 3.156 (2020). 5. The October 2012 rating determination denying service connection for a cervical spine disorder became final. 38 U.S.C. § 7105(c) (2012); 38 C.F.R. §§ 20.302, 20.1103 (2020). 6. New and material evidence sufficient to reopen the claim of service connection for a cervical spine disorder has been received. 38 U.S.C. §§ 5108, 7105 (2012); 38 C.F.R. § 3.156 (2020). 7. The October 2012 rating determination denying service connection for a TBI, claimed as a head injury, became final. 38 U.S.C. § 7105(c) (2012); 38 C.F.R. §§ 20.302, 20.1103 (2020). 8. New and material evidence sufficient to reopen the claim of service connection for a TBI, claimed as a head injury, has been received. 38 U.S.C. §§ 5108, 7105 (2012); 38 C.F.R. § 3.156 (2020). 9. The October 2012 rating determination denying service connection for a psychiatric disorder, to include a depressive disorder and an anxiety disorder, became final. 38 U.S.C. § 7105(c) (2012); 38 C.F.R. §§ 20.302, 20.1103 (2020). 10. New and material evidence sufficient to reopen the claim of service connection for a psychiatric disorder, to include a depressive disorder and an anxiety disorder, has been received. 38 U.S.C. §§ 5108, 7105 (2012); 38 C.F.R. § 3.156 (2020). 11. The October 2012 rating determination denying service connection for a right ankle disorder became final. 38 U.S.C. § 7105(c) (2012); 38 C.F.R. §§ 20.302, 20.1103 (2020). 12. New and material evidence sufficient to reopen the claim of service connection for a right ankle disorder has been received. 38 U.S.C. §§ 5108, 7105 (2012); 38 C.F.R. § 3.156 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran, who is the appellant, had active service from February 1993 to June 1995. The Veteran appeared at a virtual hearing before the undersigned Veterans Law Judge. A transcript of the hearing is of record. Urticaria and Angioedema The Board may dismiss any appeal which fails to allege specific error of fact or law in the determination being appealed. 38 U.S.C. § 7105. An appeal may be withdrawn as to any or all issues involved in the appeal at any time before the Board promulgates a decision. 38 C.F.R. § 20.204. Withdrawal may be made by the appellant or by his or her authorized representative. 38 C.F.R. § 20.204. In the present case, the Veteran, at his April 2021 virtual hearing, testified that he was withdrawing the claims of service connection for urticaria and angioedema and that he no longer wished to pursue these issues. The consequences for withdrawing his appeals was explained. Hence, there remain no allegations of errors of fact or law for appellate consideration as it relates to these issues. Accordingly, the Board does not have jurisdiction to review the appeal as it relates to these issues and they are dismissed. New and Material Prior unappealed rating decisions may not be reopened absent the submission of new and material evidence warranting revision of the previous decision. 38 U.S.C.§ 5108; 38 C.F.R. § 3.156. "New" evidence means evidence "not previously submitted to agency decisionmakers." 38 C.F.R. § 3.156(a). "Material" evidence means "evidence that, by itself or when considered with previous evidence of record, related to an unestablished fact necessary to substantiate the claim." Id. The Court has elaborated that material evidence is: (1) evidence on an element where the claimant initially failed to submit any competent evidence; (2) evidence on an element where the previously submitted evidence was found to be insufficient; (3) evidence on an element where the appellant did not have to submit evidence until a decision of the Secretary determined that an evidentiary presumption had been rebutted; or (4) some combination or variation of the above three situations. Kent v. Nicholson, 20 Vet. App. 1 (2006). In order to be "new and material" evidence, the evidence must not be cumulative or redundant, and "must raise a reasonable possibility of substantiating the claim," which has been found to be enabling, not preclusive. See Shade v. Shinseki, 24 Vet. App. 110 (2010). When determining whether the claim should be reopened, the credibility of the newly submitted evidence is to be presumed. Justus v. Principi, 3 Vet. App. 510, 513 (1991). Further, RO decisions become final "only after the period for appeal has run," and "[a]ny interim submissions before finality must be considered by the VA as part of the original claim." Jennings v. Mansfield, 509 F.3d 1362, 1368 (Fed. Cir. 2007). If new and material evidence is received within one year after the date of mailing of an RO decision, it may be "considered as having been filed in connection with the claim which was pending at the beginning of the appeal period that prevents an initial determination from becoming final." King v. Shinseki, 23 Vet. App. 464, 466-67 (2010). When VA fails to consider new and material evidence submitted within the one-year appeal period pursuant to § 3.156(b), and that evidence establishes entitlement to the benefit sought, the underlying RO decision does not become final. Young v. Shinseki, 22 Vet. App. 461, 466 (2009); see also Buie v. Shinseki, 24 Vet. App. 242, 252 (2011) (remanding for the Board to consider the application of 38 C.F.R. § 3.156(b) and whether the regional office correctly viewed the statements in question "as new claims"). In Buie, the Court explained that, when statements are received within one year of the rating decision, the Board's inquiry is not limited to whether those statements constitute notices of disagreement but whether those statements include the submission of new and material evidence under 38 C.F.R. § 3.156(b). Lumbar Spine In October 2012, the RO denied service connection for a lumbar spine disorder. The Veteran was notified of that decision and did not appeal nor was evidence received which would have allowed the claim to remain open. In denying service connection, the RO noted that a VA medical opinion found no link between the diagnosed medical condition and military service. The RO indicated that it had received medical evidence which discussed the symptoms of the Veteran's medical condition. The RO stated that although the Veteran was seen in service for an injured low back, the VA examiner opined it was less likely than not that the current back condition was incurred in or caused by military service. The Board notes that one of the bases for the denial was that there was a lack of continuity of care and chronicity of care from 1996. Evidence available to the RO at that time included the Veteran's service treatment records, service personnel records, post-service treatment records, and the results of several VA examinations, including a lumbar spine examination. Evidence added to the record since the denial includes additional treatment records, statements and testimony of the Veteran, and buddy statements in support of the Veteran's claim to reopen. Treatment records added to the record noted the Veteran reporting having had chronic back pain since 1993. The statements and testimony of the Veteran have also indicated continuous back pain since service. In addition, the buddy statements added to the record note the Veteran's inservice and continuous complaints of back pain along with continuous worsening since service. Given the inservice findings of back problems, the current findings of back problems, the testimony and statements from the Veteran as to continuous problems since service, and the buddy statements noting the Veteran's back injury in service along with continued complaints and progressive worsening since service, the newly received evidence relates to previously unestablished elements of the claim of a current disability and a possible link between the current disability and his period of service and provides a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). For these reasons, the Board finds that the evidence received since the October 2012 determination is new and material to reopen the claim of service connection for a lumbar spine disorder. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. The reopened issue will be addressed in the remand section below. Cervical Spine Disorder In October 2012, the RO denied service connection for a cervical spine disorder. The Veteran was notified of that decision and did not appeal nor was evidence received which would have allowed the claims to remain open. In denying service connection, the RO noted that the VA medical opinion found no link between the diagnosed medical condition and military service. The RO indicated that it had received medical evidence which discussed the symptoms of the Veteran's medical condition. The RO stated that although the Veteran was seen in service for injury to the neck, the VA examiner opined it was less likely than not that the current degenerative disc disease was incurred in or caused by military service. Evidence available to the RO at that time included the Veteran's service treatment records, service personnel records, post-service treatment records, and the results of several VA examinations, including the cervical spine examination. Evidence added to the record since the denial includes additional treatment records, statements and testimony of the Veteran, and buddy statements in support of the Veteran's claim to reopen. Treatment records added note the Veteran reporting having had chronic neck pain since 1993. The statements and testimony of the Veteran have also indicated continuous neck pain since service. In addition, the buddy statements added to the record note the Veteran's inservice and continuous complaints of neck pain along with continuous worsening since service. Given the inservice findings of neck problems, the current findings of neck problems, the testimony and statements from the Veteran as to continuous problems since service, and the buddy statements noting the Veteran's neck injury in service along with continued complaints and progressive worsening since service, the newly received evidence relates to previously unestablished elements of the claim of a current disability and a possible link between the current disability and his period of service and provides a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). For these reasons, the Board finds that the evidence received since the October 2012 determination is new and material to reopen service connection for a cervical spine disorder. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. The reopened issue will be addressed in the remand section below. Right Ankle In October 2012, the RO denied service connection for a right ankle disorder. The Veteran was notified of that decision and did not appeal nor was evidence received which would have allowed the claim to remain open. In denying service connection, the RO noted that the VA medical opinion found no link between a diagnosed medical condition and military service. It observed that while service treatment records reflected complaints, treatment, or a diagnosis similar to that claimed, the medical evidence supported the conclusion that a persistent disability was not present in service. There was no continuity of symptoms from service to the present. It was noted that although it was shown that the Veteran was treated for a right ankle condition in service, the VA examiner opined that the subjective complaints of right ankle condition were not related to military service as there was no support to show the Veteran had current ongoing problems with a chronic right ankle condition. The Board notes that one of the bases for the denial was that there was no current right ankle disability. Evidence available to the RO at that time included the Veteran's service treatment records, service personnel records, post-service treatment records, and the results of several VA examinations, including an ankle examination. Evidence added to the record since the denial includes additional treatment records, statements and testimony of the Veteran, and buddy statements in support of the Veteran's claim to reopen. VA examination and treatment records added to the record note the Veteran to have chronic ankle pain with a finding of suspected right ankle instability or dislocation being reported at the time of the April 2017 VA ankle examination. The Veteran has also reported having had bilateral ankle problems since his period of service. Given the inservice findings of right ankle problems, the current findings of right ankle problems and the statements from the Veteran as to continuous problems since service, the newly received evidence relates to previously unestablished elements of the claim of a current disability and a possible link between the current disability and his period of service and provides a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). For these reasons, the Board finds that the evidence received since the October 2012 determination is new and material to reopen service connection for a right ankle disorder. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. The reopened issue will be addressed in the remand section below. Psychiatric Disorder In October 2012, the RO denied service connection for a psychiatric disorder, to include depression and anxiety. The Veteran was notified of that decision and did not appeal nor was evidence received which would have allowed the claim to remain open. In denying service connection, the RO noted that the VA medical opinion found no link between the diagnosed medical condition and military service. The RO stated that it had received the medical evidence which discussed the symptoms of the Veteran's medical condition. The RO indicated that although it was shown that the Veteran had a current diagnosis of depressive disorder, not otherwise specified, in remission, the VA examiner opined it was less likely than not that the condition was incurred in or caused by military service. Evidence available to the RO at that time included the Veteran's service treatment records, service personnel records, post-service treatment records, and the results of several VA examinations, including the VA psychiatric examination. Evidence added to the record since the denial includes additional treatment records, statements and testimony of the Veteran, and buddy statements in support of the Veteran's claim to reopen. VA examination and treatment records added to the record note the that the Veteran currently has depression related to his low back problems. The Veteran has also reported having been sexually assaulted while in service leading to his current psychiatric difficulties. Given the current psychiatric findings, the Veteran's claim for a low back disorder being reopened, and the statements and testimony of the Veteran as to an inservice assault contributing to his current psychiatric difficulties, the newly received evidence relates to previously unestablished elements of the claim of a current disability and a possible link between the current disability and his period of service and/or a possible service-connected disability and provides a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). For these reasons, the Board finds that the evidence received since the October 2012 determination is new and material to reopen service connection for a psychiatric disorder. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. The reopened issue will be addressed in the remand section below. TBI Claimed as Head Injury In October 2012, the RO denied service connection for a TBI, claimed as a head injury. The Veteran was notified of that decision and did not appeal nor was evidence received which would have allowed the claim to remain open. In denying service connection, the RO noted that the VA medical opinion found no link between the diagnosed medical condition and military service. The RO indicated that it had received the medical evidence which discussed the symptoms of the Veteran's medical condition. The RO noted that while service treatment records reflected complaints, treatment, or a diagnosis similar to that claimed, the medical evidence supported the conclusion that a persistent disability was not present in service. The RO noted that although the Veteran was seen in service for a mild TBI; despite current subjective complaints, symptom pattern did not support a current diagnosis of a TBI with residuals. The claimed condition was less likely incurred in or caused by military service. Evidence available to the RO at that time included the Veteran's service treatment records, service personnel records, post-service treatment records, and the results of several VA examinations, including the VA TBI examination. Evidence added to the record since the denial includes additional treatment records, statements and testimony of the Veteran, and buddy statements in support of the Veteran's claim to reopen. The evidence added includes VA treatment records citing a TBI causing a personality change. Given the current findings in VA treatment records and the head injuries sustained in service, the newly received evidence relates to previously unestablished elements of the claim of a current disability and a possible link between the current disability and his period of service and provides a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). For these reasons, the Board finds that the evidence received since the October 2012 determination is new and material to reopen service connection for a TBI, claimed as a head injury. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. The reopened issue will be addressed in the remand section below. REASONS FOR REMAND As it relates to the claims of service connection for a cervical spine disorder, a lumbar spine disorder, a right ankle disorder, a psychiatric disorder, and a TBI, claimed as a head injury, as the Board has found that new and material evidence has been received to reopen the previously denied claims and the matters have been reopened, additional development, to include VA examinations, is warranted. As it relates to the claim of service connection for chronic pain syndrome, the Board notes that in the June 2016 VA examination opinion relating to GI and sleep disorder, the Veteran was noted to have chronic pain syndrome involving the neck, back and hands. The examiner did not address the origin of the pain syndrome nor did he discuss what relationship, if any, it had to the Veteran's period of service. The Veteran has reported having continuous problems with pain since service. Given the foregoing, additional development is warranted to determine the etiology of any current chronic pain syndrome and its relationship, if any, to the Veteran's service. As it relates to the claim of service connection for a sleep disorder, the Board notes that in conjunction with his claim, the Veteran was afforded a VA examination in June 2016, at which time the examiner indicated that the Veteran's depression and chronic pain syndrome caused difficulty sleeping. Given that the Veteran's claims of service connection for a psychiatric disorder and chronic pain syndrome are being remanded for further development, the Veteran's claim for service connection for a sleep disorder is inextricably intertwined with these issues. As it relates to the claim for service connection for a gastrointestinal disorder, the Veteran was afforded a VA examination in June 2016. At that time, the examiner opined that the Veteran's GI complaints were related to morphine used to treat his generalized chronic pain syndrome. As the issue of service connection for chronic pain syndrome is being remanded for further development, the issue of service connection for a digestive disorder is inextricably intertwined with this issue. As it relates to the claim of service connection for hypertension, the Board notes that the Veteran was afforded a VA examination in September 2016. Following examination, the examiner opined that the Veteran's hypertension was not related to his period of service or service-connected left ankle sprain. The examiner did not address the impact of any medications taken for the left ankle sprain and their impact, if any, on his hypertension. Moreover, the issues of service connection for a psychiatric disorder and chronic pain syndrome are being remanded for further development. The Veteran and his attorney have indicated that it is their belief that his chronic pain syndrome and/or psychiatric disorder, to include medications taken for these disorders, cause or aggravate his hypertension. As these issues are being remanded for further development, they are inextricably intertwined with the claim of service connection for hypertension. As it relates to the claim of service connection for ED, the Board notes that the Veteran was afforded a VA examination in September 2016. The examiner found no relationship between the Veteran's ED and his service-connected left ankle sprain, to include medication taken for the sprain. The examiner indicated that the Veteran reported that he had ED as a result of back pain. As noted above, the issue of service connection for a back disorder is being remanded for further development. The Veteran and his representative have also raised the issue of service connection for ED as a result of medications taken for his various physical ailments, many of which are also being remanded for further development. Given the foregoing, this matter is inextricably intertwined with several issues currently on appeal which require further development. As it relates to the claim for an increased evaluation for a left ankle sprain, the Board notes that the Veteran, at the time of his April 2021 hearing, testified that his left ankle condition had worsened. VA is obligated to afford a veteran a contemporaneous examination where there is evidence of an increase in the severity of the disability. VAOPGCPREC 11-95 (1995). Moreover, the Veteran is competent to provide an opinion that his disability has worsened. Proscelle v. Derwinski, 2 Vet. App. 629 (1992). Accordingly, the Board finds that a remand for an additional VA examination is required. 38 U.S.C. § 5103A(d) (2012). As it relates to the claim of a TDIU, in addition to this matter being inextricably intertwined with the remanded issues, the Board observes that Court has held that, in the case of a claim for TDIU, the duty to assist requires that VA obtain an examination which includes an opinion on what effect the service-connected disabilities have on a Veteran's ability to work. Friscia v. Brown, 7 Vet. App. 294, 297 (1994). As such, a medical opinion is needed. The matters are REMANDED for the following action: 1. Undertake appropriate development to obtain all outstanding VA and/or private treatment records related to the Veteran's outstanding claims. If any requested records are not available, the record should be annotated to reflect such and the Veteran notified. 2. After all available records have been associated with the claims file, the Veteran should be scheduled for an appropriate VA examination so as to determine the current nature and etiology of any current low back, cervical spine, and right ankle sprain and the current severity of his service-connected left ankle disability. The entire record must be made available to and reviewed by the examiner in conjunction with the examination. The examiner should note in the examination report that the entire record has been reviewed. All indicated tests should be performed and all findings should be reported in detail. As it relates to the thoracolumbar spine, the cervical spine, and the right ankle, the examiner is requested to provide the following opinions: Does the Veteran have a cervical spine, thoracolumbar spine, and/or right ankle disorder? If so, please identify each disorder that is present. For each disorder found to be present, is it at least as likely as not (50 percent probability or greater) that the identified disorder had its onset in or is otherwise related to the Veteran's period of service. When rendering the above opinions, the examiner must address and discuss the Veteran's reports of and/or buddy statements noting continuous problems since service. As it relates to the left ankle disorder, in order to comply with the Court's precedential decision in Correia v. McDonald, 28 Vet. App. 158 (2016), the examiner must test and record the range of motion for both ankles in active motion, passive motion, weight-bearing, and nonweight-bearing and comment on the extent of functional impairment during flareups. If the examiner is unable to conduct the required testing or concludes that the required testing is not necessary in this case, he or she should clearly explain why that is so. In reporting the results of range of motion testing, the examiner should identify any objective evidence of pain, and the degree at which pain begins. The extent of any weakened movement, excess fatigability, and incoordination on use should also be described by the examiner. The examiner should assess the additional functional impairment due to weakened movement, excess fatigability, or incoordination in terms of the degree of additional range of motion loss. The examiner is reminded that he/she should specify the degree of additional functional loss/motion due to pain, to include during flare-ups, or state why it was not feasible to provide such information, as required for an adequate examination. The examiner should also determine whether the Veteran has ankylosis of the left ankle. To the extent possible, the examiner is asked to provide retrospective commentary on the Veteran's level of the ankle disability during the appeal period, to include the prior VA examinations performed in conjunction with this claim, and to comment on the range of motion movements that would be painful on passive use, in weight-bearing and non-weight-bearing. The examiner must provide a comprehensive report including complete rationales for all opinions and conclusions reached, citing the objective medical findings leading to the conclusions. 4. After all available records have been associated with the claims file, the Veteran should be scheduled for an appropriate VA examination so as to determine the nature and etiology of any current sleep disability. The entire record must be made available to and reviewed by the examiner in conjunction with the examination. The examiner should note in the examination report that the entire record has been reviewed. All indicated tests should be performed and all findings should be reported in detail. Does the Veteran have a sleep disability? If so, please identify each disorder that is present. For each disorder found to be present, is it at least as likely as not (50 percent probability or greater) that the identified disorder had its onset in or is otherwise related to the Veteran's period of service? When rendering the above opinion, the examiner must address and discuss the Veteran's reports of and/or buddy statements noting continuous problems since service. If not, is it as likely as not (50 percent probability or greater) that any current sleep disability is caused by another disorder? The examiner is requested to identify the disorder. If not, is it at least as likely as not (50 percent probability or greater) that any current sleep disability is aggravated by another disorder? If so, please identify this disorder. If aggravation is found, to the extent that is possible, the examiner is requested to provide an opinion as to approximate baseline level of severity of the sleep disability before the onset of aggravation. Complete detailed rationale is requested for each opinion that is rendered. 5. After all available records have been associated with the claims file, the Veteran should be scheduled for an appropriate VA examination to determine the nature and etiology of any current TBI/residuals of a head injury. The entire record must be made available to and reviewed by the examiner in conjunction with the examination. The examiner should note in the examination report that the entire record has been reviewed. All indicated tests should be performed and all findings should be reported in detail. The examiner is requested to provide the following opinions: Does the Veteran have a TBI/residual of a head injury? If so, please identify each disorder that is present. For each disorder found to be present, is it at least as likely as not (50 percent probability or greater) that the identified disorder had its onset in or is otherwise related to the Veteran's period of service. When rendering the above opinions, the examiner must address and discuss the Veteran's reports of continuous problems since service. Complete detailed rationale is requested for each opinion that is rendered. 6. Schedule the Veteran for a VA examination to determine the nature and etiology of any psychiatric disorder(s), including PTSD, which may be present. The entire record should be made be available for review by the examiner in conjunction with the examination. The examiner is requested to render an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the Veteran currently has PTSD related to his period of service. If a diagnosis of PTSD is rendered, the examiner should identify the claimed stressor that serves as the basis for the diagnosis of PTSD. Alternatively, if PTSD is not found on examination, the examiner must delineate all diagnoses reached to account for the Veteran's psychiatric symptomatology. The examiner must also express an opinion as to whether any psychiatric disorder(s) found on examination, is/are related to the Veteran's period of service. If not, is it as likely as not (50 percent probability or greater) that any current psychiatric disorder is caused by another disorder? The examiner is requested to identify the disorder. If not, is it at least as likely as not (50 percent probability or greater) that any current psychiatric disorder is aggravated by another disorder? If so, please identify this disorder. If aggravation is found, to the extent that is possible, the examiner is requested to provide an opinion as to approximate baseline level of severity of the sleep disability before the onset of aggravation. Complete detailed rationale must be provided for any opinion that is rendered. 7. After all available records have been associated with the claims file, the Veteran should be scheduled for an appropriate VA examination so as to determine the etiology of any current chronic pain syndrome. The entire record must be made available to and reviewed by the examiner in conjunction with the examination. The examiner should note in the examination report that the entire record has been reviewed. All indicated tests should be performed and all findings should be reported in detail. The examiner is requested to provide the following opinions: Does the Veteran have chronic pain syndrome? If so, is it at least as likely as not (50 percent probability or greater) that chronic pain syndrome had its onset in or is otherwise related to the Veteran's period of service. When rendering the above opinions, the examiner must address and discuss the Veteran's reports of continuous problems since service. Complete detailed rationale is requested for each opinion that is rendered. 8. After all available records have been associated with the claims file, the Veteran should be scheduled for an appropriate VA examination so as to determine the nature and etiology of any current hypertension. The entire record must be made available to and reviewed by the examiner in conjunction with the examination. The examiner should note in the examination report that the entire record has been reviewed. All indicated tests should be performed and all findings should be reported in detail. If hypertension is found to be present, is it at least as likely as not (50 percent probability or greater) that it had its onset in or is otherwise related to the Veteran's period of service. If not, is it as likely as not (50 percent probability or greater) that any current hypertension is caused by another disorder, to include medication taken for that disorder? The examiner is requested to identify the disorder. If not, is it at least as likely as not (50 percent probability or greater) that any current hypertension is aggravated by another disorder, to include medication taken for that disorder? If so, please identify this disorder. If aggravation is found, to the extent that is possible, the examiner is requested to provide an opinion as to approximate baseline level of severity of the hypertension before the onset of aggravation. Complete detailed rationale is requested for each opinion that is rendered. 9. After all available records have been associated with the claims file, the Veteran should be scheduled for an appropriate VA examination so as to determine the nature and etiology of any current ED. The entire record must be made available to and reviewed by the examiner in conjunction with the examination. The examiner should note in the examination report that the entire record has been reviewed. All indicated tests should be performed and all findings should be reported in detail. If ED is found to be present, is it at least as likely as not (50 percent probability or greater) that it had its onset in or is otherwise related to the Veteran's period of service. If not, is it as likely as not (50 percent probability or greater) that any current ED is caused by another disorder, to include medication taken for that disorder? The examiner is requested to identify the disorder. If not, is it at least as likely as not (50 percent probability or greater) that any current ED is aggravated by another disorder, to include medication taken for that disorder? If so, please identify this disorder. If aggravation is found, to the extent that is possible, the examiner is requested to provide an opinion as to approximate baseline level of severity of the ED before the onset of aggravation. Complete detailed rationale is requested for each opinion that is rendered. 10. After all available records have been associated with the claims file, the Veteran should be scheduled for an appropriate VA examination so as to determine the nature and etiology of any current gastrointestinal disorder. The entire record must be made available to and reviewed by the examiner in conjunction with the examination. The examiner should note in the examination report that the entire record has been reviewed. All indicated tests should be performed and all findings should be reported in detail. If a gastrointestinal disorder is found to be present, is it at least as likely as not (50 percent probability or greater) that it had its onset in or is otherwise related to the Veteran's period of service. If not, is it as likely as not (50 percent probability or greater) that any current gastrointestinal disorder is caused by another disorder, to include medication taken for that disorder? The examiner is requested to identify the disorder. If not, is it at least as likely as not (50 percent probability or greater) that any current gastrointestinal disorder is aggravated by another disorder, to include medication taken for that disorder? If so, please identify this disorder. If aggravation is found, to the extent that is possible, the examiner is requested to provide an opinion as to approximate baseline level of severity of the hypertension before the onset of aggravation. Complete detailed rationale is requested for each opinion that is rendered. 11. Schedule the Veteran for a VA examination to obtain evidence as to the functional effects of service-connected disabilities on his ability to obtain or maintain substantially gainful employment in light of his work history and level of education. 12. Readjudicate all the claims on appeal, reviewing all evidence to include evidence added after the issuance of the last statement of the case. K. Parakkal Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. S. Kelly, 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.