Citation Nr: 21067940 Decision Date: 11/08/21 Archive Date: 11/08/21 DOCKET NO. 17-13 792 DATE: November 8, 2021 REMANDED Entitlement to an increased initial rating for post-traumatic stress disorder (PTSD) and other specified depressive disorder (hereinafter PTSD) in excess of 10 percent prior to February 13, 2017 is remanded. Entitlement to an initial rating in excess of 30 percent for PTSD from February 13, 2017 until December 17, 2020 is remanded. Entitlement to an initial rating in excess of 70 percent for PTSD since December 17, 2020 is remanded. Entitlement to a compensable initial rating for allergic rhinitis is remanded. Entitlement to a compensable initial rating for dermatitis is remanded. Entitlement to a compensable initial rating for right leg shin splints prior to July 16, 2020 is remanded. Entitlement to a compensable initial rating for left leg shin splints prior to July 16, 2020 is remanded. Entitlement to an initial rating in excess of 10 percent for right leg shin splints since July 16, 2020 is remanded. Entitlement to an initial rating in excess of 10 percent for left leg shin splints since July 16, 2020 is remanded. Entitlement to service connection for a bilateral hearing loss disability is remanded. Entitlement to service connection for residuals of a right wrist cyst is remanded. Entitlement to service connection for a genitourinary disability is remanded. Entitlement to service connection for right wrist carpal tunnel syndrome (CTS) is remanded. Entitlement to service connection for left wrist CTS is remanded. Entitlement to service connection for a respiratory disability, other than lung nodules and scarring from old granulomatous disease, is remanded. Entitlement to a 10 percent rating based on multiple noncompensable service-connected disabilities for the period prior to April 19, 2015 is remanded. REASONS FOR REMAND The Veteran had active service from June 1992 to November 1994. He also had subsequent Reserve service. These matters are before the Board of Veterans' Appeals(Board) on appeal from rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO). In March 2020, the Veteran testified before the undersigned Veterans Law Judge (VLJ) at a video conference hearing. A transcript of his testimony is of record. These matters were last before the Board in June 2020, when they were remanded for additional development. While the June 2020 remand included the issue of entitlement to service connection for a bilateral eye disability other than allergic conjunctivitis, that claim was granted in a March 2021 rating decision. Accordingly, that issue has been resolved and is not presently on appeal before the Board. Additionally, during the pendency of the appeal, a July 2020 decision awarded a 10 percent rating for bilateral allergic conjunctivitis effective April 19, 2015. Nevertheless, as the Veteran had a noncompensable combined disability rating prior to April 19, 2015, his claim of entitlement to a 10 percent rating based on multiple noncompensable service-connected disabilities remains pending for the period prior to April 19, 2015. 1. Entitlement to an increased initial rating for PTSD in excess of 10 percent prior to February 13, 2017 is remanded. 2. Entitlement to an initial rating in excess of 30 percent for PTSD from February 13, 2017 until December 17, 2020 is remanded. 3. Entitlement to an initial rating in excess of 70 percent for PTSD since December 17, 2020 is remanded. 4. Entitlement to a compensable initial rating for allergic rhinitis is remanded. 5. Entitlement to a compensable initial rating for dermatitis is remanded. 6. Entitlement to a compensable initial rating for right leg shin splints prior to July 16, 2020 is remanded. 7. Entitlement to a compensable initial rating for left leg shin splints prior to July 16, 2020 is remanded. 8. Entitlement to an initial rating in excess of 10 percent for right leg shin splints since July 16, 2020 is remanded. 9. Entitlement to an initial rating in excess of 10 percent for left leg shin splints since July 16, 2020 is remanded. 10. Entitlement to service connection for a bilateral hearing loss disability is remanded. 11. Entitlement to service connection for residuals of a right wrist cyst is remanded. 12. Entitlement to service connection for a genitourinary disability is remanded. 13. Entitlement to service connection for right wrist CTS is remanded. 14. Entitlement to service connection for left wrist CTS is remanded. 15. Entitlement to service connection for a respiratory disability, other than lung nodules and scarring from old granulomatous disease, is remanded. 16. Entitlement to a 10 percent rating based on multiple noncompensable service-connected disabilities for the period prior to April 19, 2015 is remanded. The evidence indicates there may be outstanding relevant VA treatment records. A May 13, 2021 VA treatment record indicates that the Veteran was to return for a follow up appointment in August or September 2021. The records associated with the claims file do not document that appointment and records after August 26, 2021 have not been associated with the claims file. A remand to obtain the outstanding records is required. Unfortunately, there has not been substantial compliance with the Board's previous remand directives. The June 2020 remand requested an addendum opinion addressing whether the Veteran's sinusitis, which was noted at the April 2015 VA examination, was a manifestation of or progression of his service-connected allergic rhinitis or a separate and distinct disability. While he was provided VA examinations in December 2020 and July 2021, neither examination report addressed whether the Veteran's sinusitis was a manifestation of or progression of his service-connected allergic rhinitis. Accordingly, an addendum opinion is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). The June 2020 remand requested a VA examination to address the Veteran's genitourinary claim. The Veteran was provided a VA examination in December 2020. While the examiner acknowledged that the Veteran had current symptoms, including blood in urine and urine drip, the examiner stated there was no diagnosis because there were no findings, signs, or symptoms to support a diagnosis. Considering the conflicting findings, further clarification is required. Id. The June 2020 remand directed that the Veteran be provided a VA examination to address his respiratory claim. While he was provided a VA examination in December 2020, the examiner only noted a diagnosis of asthma and did not address or acknowledge the other diagnoses of record and did not, as requested, address the October 2015 VA examiner's statement that the Veteran's cough maybe related to his post-nasal drip and soot exposure during service. Accordingly, another opinion is required. Id. The June 2020 remand directed that the Veteran be provided a VA examination to address his CTS claims. He was provided a VA examination in December 2020. The examiner stated that the Veteran's current symptoms included loss of grip strength, ongoing pain, soreness, and tingling in his fingers, wrist and forearms. Nevertheless, the examiner later stated that there was no diagnosis because there were no findings, signs and or symptoms to support a diagnosis. Moreover, the examiner did not acknowledge or address the May 2011 record from Dr. Kent noting that a nerve conduction study was consistent with left carpal tunnel syndrome. Accordingly, another examination is required. Id. The June 2020 remand requested a VA opinion regarding the Veteran's status post right ganglion cyst removal. While an opinion was obtained in December 2020, the examiner's opinion was conclusory and did not explain why the Veteran's ganglion cyst development was not related to his reported pain and numbness in his wrists and forearms during service after extensive computer use and performing push-ups during physical fitness training. Accordingly, another opinion is required. Id. The June 2020 remand requested VistA Imaging records referenced in April 11, 2019, April 15, 2019, and April 22, 2019 VA record entries be associated with the claims file. It does not appear that the records have been associated with the claims file. The Board acknowledges that an October 2020 records request response indicated that the records were already scanned into CAPRI in VistA Imaging. Nevertheless, the Board does not have access to VistA Imaging and scans of the records do not appear to have been uploaded into the claims file. Accordingly, another remand is required. Id. While an October 2020 VA letter requested that the Veteran complete a VA Form 21-4142 authorizing VA to obtain his Vet Center and Workman's Compensation records, to date no response has been received. As the claims must be remanded for other development, on remand the Veteran should be provided another opportunity to submit the record or authorize VA to obtain the records on his behalf. The Veteran is advised that the failure to provide the above requested information could negatively affect his claim. Wood v. Derwinski, 1 Vet. App. 190, 193 (1991) ("The duty to assist is not always a one-way street. If a veteran wishes help, he cannot passively wait for it in those circumstances where he may or should have information that is essential in obtaining the putative evidence."). Finally, additional VA treatment records, including a May 26, 2021 dermatology record, were associated with the claims file subsequent to the June 2021 Supplemental Statement of the Case and prior to the appeal being transferred to the Board on July 18, 2021. Such records must be reviewed on remand. 38 C.F.R. §§ 19.31(b)(2), 19.37, (2020). The matters are REMANDED for the following actions: 1. Ask the Veteran to provide the names and addresses of all medical care providers who have recently treated him for his claimed disabilities, to specifically include the unidentified Vet Center and Workman's Compensation records, including a complete copy of the July 2011 Workman's Compensation evaluation authored by Dr. Castro. Request any relevant records identified. In addition, obtain updated VA treatment records dated since August 26, 2021 as well as the VistA Imaging records referenced in the April 11, 2019, April 15, 2019, and April 22, 2019 VA record entries. If any requested records are unavailable, the Veteran should be notified of such. 2. After records development is completed, forward the claims file to a VA clinician to obtain an addendum opinion. The clinician should address whether the sinusitis, diagnosed at the April 2015 VA examination, is a manifestation of or progression of his service-connected allergic rhinitis or a separate and distinct disability. If the Veteran's sinusitis is a separate and distinct disability that is unrelated to his service-connected allergic rhinitis, the examiner should, to the extent possible, differentiate between the symptoms and functional impairment attributable to each disability. A complete rationale should be provided for all opinions and conclusions expressed. 3. After records development is completed, the Veteran should be afforded a VA examination to determine the nature of any genitourinary disability and to obtain an opinion as to whether such is possibly related to service. The claims file should be reviewed by the examiner in conjunction with the examination. All necessary tests should be conducted, and the results reported. Following review of the claims file and examination of the Veteran, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that any current disability of the genitourinary system arose during service or is otherwise related to service, including the Veteran's reported in-service fall. The examiner should address the December 2020 VA examination report noting that the Veteran has current symptoms of blood in urine and urine dripping. A complete rationale should be provided for all opinions and conclusions expressed. 4. After records development is completed, the Veteran should be afforded a VA examination to determine the nature of any wrist and/or forearm disability and to obtain an opinion as to whether such is possibly related to service. The claims file should be reviewed by the examiner in conjunction with the examination. All necessary tests, including nerve conduction study and/or electromyography should be conducted, and the results reported. If the examiner determines that such testing is not warranted, the examiner should explain why it is not needed. Following review of the claims file and examination of the Veteran, the examiner should opine whether it is at least as likely as not (50 percent probability or greater) that any current neurological disability of the right or left wrist and/or forearm arose during service or is otherwise related to service, including the Veteran's in-service duties as a software analyst and his physical training involving push-ups. If the examiner finds that the Veteran does not have a wrist and/or forearm disability, the examiner should address the May 2011 nerve conduction study from Dr. Kent. A complete rationale should be provided for all opinions and conclusions expressed. 5. After records development is completed, forward the claims file to a VA clinician to obtain an addendum opinion regarding the Veteran's claim for a respiratory disability, other than lung nodules and scarring from old granulomatous disease. If an examination is deemed necessary to respond to the questions presented, one should be scheduled. Following review of the claims file, the clinician should opine: (a.) Whether it is at least as likely as not (50 percent probability or greater) that any respiratory disability other than lung nodules and scarring from old granulomatous disease had its onset during service or is otherwise related to service. In so opining, the clinician should address the Veteran's assertions that his respiratory symptoms are related to his environmental exposures while stationed in Korea. (b.) Whether it is at least as likely as not (50 percent probability or greater) that respiratory disability, other than lung nodules and scarring from old granulomatous disease, was caused by the Veteran's service-connected allergic rhinitis? (c.) If not caused by the service-connected allergic rhinitis, is it at least as likely as not that any respiratory disability, other than lung nodules and scarring from old granulomatous disease, is worsened beyond natural progression (aggravated) by his service-connected allergic rhinitis? If the clinician finds that any respiratory disability was aggravated by his service-connected allergic rhinitis, the clinician should attempt to quantify the level of aggravation beyond the baseline level of the respiratory disability. In rendering the above requested opinions, the clinician must address the documented diagnoses of asthma, recurrent bronchitis, reactive airway disease, and a chronic cough. The clinician must also address the statement from the October 2015 VA examiner indicating that the Veteran's cough may be related to, inter alia, his post-nasal drip and soot exposures during service. 6. After records development is completed, forward the claims file to a VA clinician to obtain an addendum opinion regarding the Veteran's claim for a right wrist cyst. If an examination is deemed necessary to respond to the questions presented, one should be scheduled. Following review of the claims file, the clinician should opine whether it is at least as likely as not (50 percent probability or greater) that the Veteran's status post ganglion cyst excision arose during service or is otherwise related to service. In so opining, the clinician must address the Veteran's reported pain and numbness in his wrists and forearms during service after extensive computer use and performing push-ups during physical fitness training. A complete rationale should be provided for all opinions and conclusions expressed. K. A. BANFIELD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Anderson 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.