Citation Nr: 21066774 Decision Date: 11/02/21 Archive Date: 11/02/21 DOCKET NO. 17-47 889 DATE: November 2, 2021 ORDER The petition to reopen a claim for service connection for a left arm condition is granted. Entitlement to a rating in excess of 70 percent from June 30, 2011, for posttraumatic stress disorder (PTSD) is denied. Entitlement to a total disability rating based on individual unemployability (TDIU) is granted. REMANDED Entitlement to a rating in excess of 10 percent prior to March 16, 2015, and in excess of 20 percent thereafter for degenerative disc disease and herniated nucleus pulposus with left L5 nerve root compression is remanded. Entitlement to an initial rating in excess of 10 percent prior to March 16, 2015, and in excess of 20 percent thereafter for left lower extremity radiculopathy is remanded. Service connection for a left arm disability is remanded. Service connection for a stomach condition is remanded. Service connection for breathing problems is remanded. Service connection for a skin condition is remanded. FINDINGS OF FACT 1. A June 2010 rating decision denied service connection for a left arm condition due to a lack of a current diagnosis; the Veteran did not appeal the decision, and new and material evidence was not received within one year of notice of its issuance. 2. The evidence received since the June 2010 rating decision is new and relates to an unestablished fact necessary to substantiate the claim. 3. The severity, frequency, and duration of the Veteran's PTSD symptoms did not more closely approximate total occupational and social impairment. 4. Resolving reasonable doubt in the Veteran's favor, the Veteran's service-connected disabilities preclude him from obtaining or maintaining substantially gainful employment. CONCLUSIONS OF LAW 1. The criteria to reopen the claim for service connection for left arm condition have not been met. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 2. The criteria for entitlement to a rating in excess of 70 percent for service-connected PTSD have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9411. 3. The criteria for entitlement to TDIU have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.3, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1982 to March 1987 with additional Reserve and National Guard service. This matter comes before the Board of Veterans' Appeals (Board) from October 2011 and March 2015 rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO). In May 2019, the Veteran testified before the undersigned Veterans Law Judge at a videoconference hearing. A transcript is of record. Additional VA-generated evidence was also associated with the claims file after the appeal was certified and transferred to the Board. In May 2019, the Veteran's representative waived RO consideration. Therefore, the Board may review the evidence in the first instance. See 38 C.F.R. § 20.1304 (c). The Board has recharacterized the claimed skin issue as entitlement to service connection on the merits, without requiring new and material evidence to reopen a previously denied claim. This is because additional service department records were received in October 2005 following the original denial of service connection for a skin disability in a May 2000 rating decision. 38 C.F.R. § 3.156 (c). New and Material 1. The petition to reopen a claim for service connection for a left arm condition is granted. The Secretary must reopen a finally disallowed claim when new and material evidence is presented or secured with respect to that claim. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. New evidence means existing evidence not previously submitted to agency decision makers. 38 C.F.R. § 3.156 (a). Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. Id. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened and must raise a reasonable possibility of substantiating the claim. Id. Service connection for a left arm condition was previously denied in a June 2010 rating decision because medical evidence failed to show that a left arm disability had been clinically diagnosed. The Veteran was notified of the decision and his appellate rights in a June 2010 correspondence. He did not file a notice of disagreement, and no relevant evidence was received within one year of notification. Therefore, that rating decision is final. See 38 U.S.C. § 7105; 38 C.F.R. §§ 3.156 (b), 20.1103; Buie v. Shinseki, 24 Vet. App. 242, 252 (2010). The Veteran sought to reopen his claim in June 2011. The current appeal stems from the October 2011 rating decision that declined to reopen the claim on the basis that new and material evidence had not been received. Evidence associated with the record since the June 2010 rating decision includes VA treatment records, lay statements, Social Security Administration records, a photograph showing the Veteran with a cast, and his May 2019 Board hearing testimony. In pertinent part, Veteran testified at the hearing about how his arm was injured; he noted that a platform collapsed onto his arm, hitting his elbow. He testified that his arm hurts all the time and when carrying anything heavy it feels like his arm is going to just fall off. He indicated that his arm pain has been recurrent since leaving military service. The Board also notes that the VA treatment records include a December 2015 treatment note showing a subjective complaint of chronic left shoulder pain and the Veteran's report of having injured it while in the military. A clinical finding of 'probable left arm bursitis' was rendered. New and material evidence has been received to reopen the claim for service connection for a left arm condition. Some of the evidence, including the hearing testimony and the identified VA treatment record, is new and has not been previously considered by the RO. This new evidence is also material because it relates to both a current disability and whether there is causal relationship between a current left arm disability and service, as the Veteran reports recurrent symptoms since the service injury. For the purposes of evaluating a request to reopen a previously denied claim, the credibility of his testimony is be presumed. Justus v. Principi, 3 Vet. App. 510, 513 (1992). This evidence at the very least triggers the need for a VA examination or medical opinion pursuant to Shade. Therefore, as the low threshold for new and material evidence is met, the petition to reopen the final disallowed claim of service connection for a left arm condition is granted. Increased Rating 2. Entitlement to a rating in excess of 70 percent from June 30, 2011, for PTSD is denied. The Veteran seeks a rating in excess of 70 percent from June 30, 2011, for his service-connected PTSD. A May 2010 rating decision granted service connection for PTSD with a 50 percent rating effective February 4, 2009. In June 2011, the Veteran sought an increased rating for his service-connected PTSD. An October 2011 rating decision continued the Veteran's 50 percent rating; however, the Veteran timely appealed the rating decision. A March 2015 rating decision granted a 70 percent rating effective June 30, 2011, the date of the Veteran's increased rating claim. Therefore, the period on appeal begins June 30, 2010, one year prior to receipt of the Veteran's increased rating claim. For the reasons that follow, the Board finds entitlement to an increased rating is not warranted. The Veteran's PTSD is rated under the General Formula for Mental Disorders (General Formula). Under the General Formula, the Board must conduct a "holistic analysis" that considers all associated symptoms, regardless of whether they are listed as criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); 38 C.F.R. § 4.130. The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages. Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 2013). The issue in this appeal is whether the Veteran's associated symptoms caused the level of impairment required for a disability rating of 100 percent. The Board concludes that the Veteran's symptoms did not cause the level of impairment required for a disability rating of 100 percent. The Veteran's symptoms more closely approximated the symptoms associated with a 70 percent rating and resulted in a level of impairment that most closely approximated the level of impairment associated with a 70 percent rating. Under the General Formula, a 50 percent rating is assigned when symptoms such as flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; or difficulty in establishing and maintaining effective work and social relationships cause occupational and social impairment with reduced reliability and productivity. A 70 percent rating is assigned when symptoms such as suicidal ideation; obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); or inability to establish and maintain effective relationships cause occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. A 100 percent rating is assigned for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; or memory loss for names of close relatives, own occupation or own name. Generally, VA treatment records indicate the Veteran displayed good hygiene; unremarkable psychomotor activity, no psychosis, hallucinations, or delusions; alertness and orientation; cognition; mildly constricted and frustrated affect; intact judgment and insight; and no suicidal or homicidal ideation. See, e.g., February 2011 VA treatment record. A July 2011 VA treatment record indicates the Veteran is a stay at home parent to his girlfriend's children. During an October 2011 VA examination, the Veteran reported being single but living with his girlfriend and providing care for her children. The examiner described the Veteran as somewhat disheveled and unkempt with a bland affect and somewhat reserved mood. The examiner noted no evidence of a thought disorder other than severe memory problems. The Veteran denied delusions or hallucinations. He denied suicidal ideation and homicidal ideation but acknowledged a long history of assault and fighting. He reported panic attacks that occur roughly once a week but do not last very long. He indicated he is generally not depressed but reported substantial sleep disturbance. The examiner indicated the Veteran's symptoms remain essentially unchanged but noted the Veteran feels that he meets the criteria for a 70 percent rating in terms of his history of irritability and violence and memory problems. The Veteran underwent an additional VA examination in April 2014. The examiner characterized the Veteran's level of impairment as occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood. During the examination, the Veteran reported living with his girlfriend, having some contact with his parents, and limited contact with siblings. The examiner described the Veteran as orientated; neatly groomed; mildly agitated; and displaying appropriate affect, spontaneous speech, linear thought process, somewhat scattered abstract thinking, fair insight, and 'ok' judgment. The Veteran reported 'hot and cold' temperament, making conscious efforts to keep in better control of impulse, awful memory, and sleep disturbance. He denied suicidal and homicidal ideation, excessive worry, panic attacks, obsessive thoughts, and compulsive or ritualistic behaviors. The examiner noted associated symptoms of depressed mood, anxiety, chronic sleep impairment, mild memory loss, disturbance of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, and difficulty in adapting to stressful circumstances. In a June 2017 VA examination, the examiner characterized the Veteran's level of impairment as occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood. The Veteran reported marrying his long-time girlfriend the year prior. He reported having one close friend and staying in touch with his mother. The examiner noted associated symptoms of depressed mood; anxiety; suspiciousness; near-continuous panic or depression affecting the ability to function independently, appropriately, and effectively; chronic sleep impairment; mild memory loss, such as forgetting names, directions or recent events; impaired judgment; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; difficulty in adapting to stressful circumstances, including work or a worklike setting; inability to establish and maintain effective relationships; and impaired impulse control, such as unprovoked irritability with periods of violence. The examiner described the Veteran as alert and oriented to person, place, and time. He displayed logical and goal-oriented thinking, loud and somewhat pressured speech, anxious mood and constricted affect. However, he exhibited no signs of hallucinations or delusions or homicidal or suicidal ideation. After a review of the evidentiary record, the Board finds entitlement to a rating in excess of 70 percent is not warranted. VA and private treatment records; the October 2011, April 2014, and June 2017 VA examinations; and the Veteran's lay statements show that the Veteran's PTSD was primarily manifested by symptoms associated with a 70 percent rating, including impaired impulse control (such as unprovoked irritability with periods of violence), difficulty in adapting to stressful circumstances (including work or a worklike setting), and inability to establish and maintain effective relationships. He also displayed memory loss symptoms. The Board finds the severity, frequency, and duration of the Veteran's symptoms more closely approximate the symptoms contemplated by a 70 percent rating, which are less severe, less frequent, and shorter in duration than those contemplated by a 100 percent rating. See 38 C.F.R. § 4.126. The Veteran experienced occupational and social impairment with deficiencies in most areas. The April 2014 and June 2017 VA examiners determined that the Veteran's overall level of social and occupational impairment was best described as 'occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood,' which is consistent with the 70 percent rating currently assigned. These assessments are probative as the examiners reviewed the file and performed clinical interviews and examinations in conjunction with these assessments regarding the severity of the Veteran's disability. While the record shows the Veteran's PTSD was manifested by memory loss, the record show the clinicians described his memory loss as mild, such as forgetting names, directions, or recent events. Therefore, the severity, frequency, and duration of the Veteran's memory loss is most consistent with the level contemplated by a 30 percent rating. Indeed, a 30 percent rating is assigned when symptoms, including but not limited to, mild memory loss (such as forgetting names, direction, and recent events), cause occupational and social impairment with reduced reliability and productivity. See 38 C.F.R. § 4.130, Diagnostic Code 9411. Additionally, the Veteran has not experienced any unlisted symptoms of such a severity, frequency, or duration similar to the listed criteria for a total 100 percent rating under the General Formula during this time period. Critically, the evidence does not show total occupational and social impairment due to PTSD under the rating criteria set forth in 38 C.F.R. § 4.130. While the record reflects the Veteran is unemployed and has difficulty in establishing and maintaining effective work and social relationships, the record reflects he at minimum maintains a relationship with his girlfriend and her children, which is inconsistent with a finding of total social impairment. Thus, neither the symptoms nor the overall level of impairment meets the criteria for a 100 percent rating under the General Formula. In short, the preponderance of the evidence weighs against finding that the severity, frequency, and duration of the Veteran's symptoms resulted in the level of impairment required for a 100 percent rating. The criteria for a 100 percent or higher rating are not met and the appeal must be denied. 3. Entitlement to a total disability rating based on individual unemployability is granted. The Veteran seeks entitlement to a total disability rating based on individual unemployability. His claim for a TDIU is part and parcel of his appeal for a higher rating for his service-connected PTSD. See Rice v. Shinseki, 22 Vet. App. 447 (2009). For the reasons that follow, the Board finds entitlement to a TDIU is warranted. If the schedular rating is less than total, a total disability evaluation can be assigned based on individual unemployability if the Veteran is unable to secure or follow a substantially gainful occupation as a result of service-connected disability, provided that the Veteran has one service-connected disability rated at 60 percent or higher; or two or more service-connected disabilities, with one disability rated at 40 percent or higher and the combined rating is 70 percent or higher. 38 C.F.R. § 4.16 (a). The Court recently defined the term "unable to secure and follow a substantially gainful occupation" to have two components: one economic and one noneconomic. The economic component means an occupation earning more than marginal income (outside of a protected environment) as determined by the U.S. Department of Commerce as the poverty threshold for one person. The non-economic component includes consideration of the veteran's history, education, skill, and training; whether the veteran has the physical ability to perform the type of activities required by the occupation at issue; and whether the veteran has the mental ability to perform the activities required by the occupation at issue. Ray v. Wilkie, 31 Vet. App. 58, 72-73 (2019). The central inquiry is whether service-connected disabilities alone are of sufficient severity to produce unemployability. Hatlestad v. Brown, 5 Vet. App. 524 (1993). Neither nonservice-connected disabilities nor advancing age may be considered in the determination. 38 C.F.R. § 3.341, 4.16, 4.19; Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). Consideration shall be given to the Veteran's level of education, special training, and previous work experience. Therefore, the Board must evaluate whether there are circumstances in the Veteran's case, apart from any non-service-connected conditions and advancing age, which would justify a TDIU rating. 38 C.F.R. § 3.341 (a), 4.16 (a), 4.19. The Veteran is service-connected for PTSD (50 percent prior to June 30, 2011, and 70 percent thereafter); degenerative disc disease and herniated nucleus pulposus with L5 nerve root compression (10 percent from prior to March 16, 2015, and 20 percent thereafter); left lower extremity radiculopathy (10 percent prior to March 16, 2015, and 20 percent thereafter); and tinnitus (10 percent from September 30, 1999). He meets the schedular requirements for a TDIU from June 30, 2011. As a preliminary matter, the Board notes the Veteran did not submit a VA Form 21-8940, Application for Increased Compensation Based on Unemployability. The Board notes the Veteran was notified of and provided with a VA Form 21-8940 in June 2017. While failure to complete the form is not fatal to a TDIU claim in and of itself, the failure to do so deprives the Board of information as to the Veteran's employment history, educational history and training, and income information necessary to properly address a claim for TDIU. See generally, Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). The Veteran's DD Form 214 reflects a military occupational specialty of aviation support technician. The Veteran's Social Security Administration (SSA) record indicate he reported working as a truck driver with a plow and providing transportation to and from the airport. He also reported working as a tire change worker in 2001, an exterior painter in 2007, and a general cleaner (shoveling) from 2007 to 2008. He indicated he received his general educational development (GED) and completed training for a commercial driver's license. He reported he stopped working in April 2008. In February 2013, the SSA found he had not engaged in substantially gainful activity and has been disabled since December 2007. The Board notes that SSA determinations are not binding on the Board though they may be "pertinent" to VA claims. See Murincsak v. Derwinski, 2 Vet. App. 363 (1992); Collier v. Derwinski, 1 Vet. App. 412 (1991). Resolving reasonable doubt in the Veteran's favor, the Board finds he meets the economic component in Ray. Although the Veteran did not complete the VA Form 21-8940, the evidence of record indicates he has not maintained substantially gainful employment during the period on appeal. Thus, the remaining question is whether his service-connected disabilities have precluded such employment. Regarding the Veteran's back and radiculopathy, an October 2011 VA examination indicates the Veteran's disabilities do not impact his ability to work but notes decreased range of motion; pain; pain on movement; interference with sitting, standing, and/or weight-bearing; and mild intermittent pain of the left lower extremity. In contrast, a March 2015 VA examination indicates the Veteran's peripheral nerve condition does impact his ability to work due to pain with loss of sensation in the left lower extremity and increased risk of falls. Similarly, his back condition was found to impact his ability to work due to pain with reduced range of motion; weakness and loss of sensation in left lower extremity; and increased pain with flexion, right lateral rotation, prolonged sitting, standing, walking, driving, weight bearing, stair climbing, and getting in and out of chairs and care. A June 2017 VA examination further indicates his back condition impacts his ability to work as activities involving trunk range of motion and weight bearing cause low back pain. His decreased range of motion of the back also affects ambulation and activities requiring use of the back. A June 2017 VA opinion indicates the Veteran's degenerative disc disease and herniated nucleus pulposus with left L5 nerve root compression and radiculopathy of the left lower extremity cause constant pain, which is exacerbated by trunk range of motion (bending, twisting), weight bearing (standing, walking) and prolonged sitting. The examiner found these symptoms would impair the performance of physical occupational/employment but would not impair occupational activities primarily non-physical in nature, such as desk work. Regarding his service-connected PTSD, an October 2011 VA examination reflects moderately severe PTSD with substantial sleep disturbance, impaired memory, and irritability. An April 2014 VA examination found occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood. A June 2017 VA examiner also characterized his PTSD as manifesting as occupational and social impairment with deficiencies in most areas, such as work, judgment, thinking and/or mood. The examiner indicated the Veteran's irritability or outbursts of anger, exaggerated startle response, acting or feeling traumatic events are recurring, apathy and anhedonia, detachment or estrangement, restricted range of affect, panic attacks, and worthlessness severely impair his ability to work cooperatively and effectively with coworkers, supervisors, and the public. His difficulty concentrating, recurrent and distressing recollection of traumatic events, intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event, physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event, acting or feeling like traumatic events are recurring, hypervigilance, and avoidance of thoughts or feeling associated with traumatic events severely impair his ability to understand and follow instructions, to retain instructions, to communicate effectively in writing, and to solve technical or mechanical problems. The examiner further found severe impairment of the Veteran's ability to maintain task persistence and pace, to arrive at work on time, and to work a regular schedule without excessive absences. After a review of the evidentiary record, the Board finds sufficient evidence to award entitlement to a TDIU. Generally, the treatment records and VA examination reports reflect the Veteran's service-connected disabilities result in both physical and mental limitations, including difficulty sitting for prolonged periods and difficulty communicating. None of the Veteran's service-connected disabilities alone appear to preclude substantially gainful employment; however, the combined effect of the Veteran's service-connected disabilities on his physical and mental condition have had a significant impact such that it is reasonable to conclude that the Veteran would not be able to follow substantially gainful employment consistent with his education, skills, and work experience. Resolving reasonable doubt in the Veteran's favor, the combined symptoms of his service-connected disabilities reasonably preclude him from securing or following substantially gainful employment. Accordingly, entitlement to a TDIU is granted. REASONS FOR REMAND 4. Entitlement to a rating in excess of 10 percent prior to March 16, 2015, and in excess of 20 percent thereafter for degenerative disc disease and herniated nucleus pulposus with left L5 nerve root compression is remanded. 5. Entitlement to an initial rating in excess of 10 percent prior to March 16, 2015, and in excess of 20 percent thereafter for left lower extremity radiculopathy is remanded. While the record contains a contemporaneous VA examination regarding the Veteran's degenerative disc disease and herniated nucleus pulposus with left L5 nerve root compression, the examination does not comply with the requirements in Sharp v. Shulkin, 29 Vet. App. 26, 34-36 (2017). The June 2017 examiner did not attempt to elicit relevant information regarding the description of the Veteran's flare-ups and any additional functional loss suffered during flare-ups. While the examiner stated that an opinion could not be provided without resort to speculation, the examiner did not indicate that the speculation was due to lack of knowledge within the medical community. Accordingly, on remand, an addendum examination must be obtained. Additionally, during his May 2019 Board hearing, the Veteran indicated that his service-connected left lower extremity radiculopathy associated with his service-connected back disability may have increased in severity since he was last examined by VA in June 2017. Accordingly, on remand, the Veteran should be provided an opportunity to report for a VA examination to ascertain the current severity and manifestations of his radiculopathy. 6. Service connection for a left arm condition is remanded. The Veteran seeks service connection for a left arm disorder. Service treatment records show the Veteran sustained injury to his left arm in August 1985when a platform collapsed onto it. A December 2015 VA treatment note reflects a subjective complaint of chronic left shoulder pain and the Veteran's report of having injured it while in the military. A clinical finding of 'probable left arm bursitis' was made. The Veteran has recently testified that he has experienced recurrent left arm pain since discharge from service. He also reports that when carrying anything heavy it feels like his arm is going to just fall off. An examination is needed to determine whether the Veteran has a left arm disability related to his in-service injury. 7. Service connection for a stomach condition is remanded. 8. Service connection for breathing problems is remanded. 9. Service connection for a skin condition is remanded. In a VA Form 21-4138, Statement in Support of Claim, dated December 12, 1999, the Veteran provided specific details about the nature and extent of his exposures to paint and other corrosion-control materials that he believes caused his current skin, stomach, and/or respiratory disorders. A VA skin examination was obtained in December 1999, and VA stomach and respiratory examinations were obtained in October 2011. However, VA nexus opinions were not obtained. The Board cannot make a fully informed decision on the issues of service connection for a stomach condition, breathing problems, or a skin condition because no VA examiner has opined whether he currently has stomach, breathing, or skin disorders that were incurred in or caused by service. The Veteran's service records include a record of personal occupational exposures- the list includes exposures to lead, chromium, 'Cr VI,' and arsenic during activities such as grit blasting, spray painting, and sanding. During his 2019 hearing, the Veteran reported that his military occupational specialty of painter included him being exposed to various chemicals and other caustic materials. He noted use of caustic paint strippers, exposure to paint fumes, and sandblasting without adequate breathing protection in closed rooms. He also asserted that he noticed breathing problems in service that have been recurrent since. The Veteran also testified that he first noticed skin problems in service while he was sandblasting. He recalls that he was told it was shingles. He noted that his current symptoms include tags and other 'stuff' growing all over him and a sensation that bees are stinging him in his back. Finally, the Veteran testified that his stomach troubles began during service. His representative asserted that his stomach disorder may be related to his service-connected PTSD. On remand, VA examinations and nexus opinions should be obtained. The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected back disability and associated radiculopathy. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria. In so doing, the examiner must test the Veteran's active motion, passive motion, and pain with weight-bearing and without weight-bearing and provide the corresponding ranges of motion. The examiner must also attempt to elicit information regarding the severity, frequency, and duration of any flare-ups or with repeated use, and the degree of functional loss during flare-ups or with repeated use. If it is not possible to provide a specific measurement based on direct observation, the examiner should provide an estimate, if at all possible, of the additional impairment based on the other evidence of record and the Veteran's statements. If it is not possible to provide a specific measurement without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). 2. Schedule the Veteran for examination by an appropriate clinician(s) to determine the nature and etiology of his claimed left arm, skin, breathing, and stomach disabilities. If a diagnosis cannot be provided but the Veteran's condition manifests in symptoms that cause functional impairment, then the examiner should consider them a "disability" for the purpose of providing the requested opinion(s) below. The examiner is asked to provide a response to the following: a) Provide current diagnoses for the claimed left arm, skin, stomach, and/or respiratory disorders. b) Is the Veteran's currently diagnosed left arm disorder at least as likely as not related to service, to include the August 1985 injury sustained after a platform fell on his arm? c) Are any of the Veteran's currently diagnosed skin, stomach, and/or respiratory disorders at least as likely as not related to service, including as a result of paint and other corrosion control materials exposures as part of his military occupational specialty? The Veteran's service records include a record of personal occupational exposures- the list includes exposures to lead, chromium, 'Cr VI,' and arsenic during activities such as grit blasting, spray painting, and sanding. The examiner's attention is directed to Remand summary above as well as the hearing transcript wherein the Veteran reported exposures to paint, paint strippers, and sandblasting without adequate breathing protection and in closed rooms. See May 2019 Hearing Transcript, pages 19-26. He also reportedly first noticed skin problems in service while he was sandblasting. He recalls that he was told it was shingles. He noted that his current symptoms include tags and other 'stuff' growing all over him and a sensation that bees are stinging him in his back. See Hearing Transcript, pages 36-38. Finally, the Veteran testified that his stomach troubles began during service and in the alternative, may be related to his service-connected PTSD. See Hearing Transcript, pages 1, 33-35. The examiner's attention is also directed to a VA Form 21-4138, Statement in Support of Claim, dated December 12, 1999, wherein the Veteran provided specific details about the nature and extent of his exposures to paint and other corrosion control materials that he believes caused his current skin, stomach, and/or respiratory disorders. The examiner must provide a rationale to support the opinions. In providing the requested opinions and supporting rationale, the examiner must consider the Veteran's description of his in-service injury and symptoms as well as his post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran's reported injuries and symptoms in service and thereafter represented the onset of his current respective disabilities, this should be noted. Stated another way, do the Veteran's reports about his symptoms align with how the currently diagnosed disabilities are known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible? d) Finally, the examiner should indicate whether the Veteran's claimed stomach disorders is at least as likely as not either proximately due to his service-connected PTSD; or, aggravated beyond its natural progression by the service-connected PTSD. D. JOHNSON Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M.Aoughsten, Associate 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.