Citation Nr: 21069036 Decision Date: 11/17/21 Archive Date: 11/17/21 DOCKET NO. 18-09 303 DATE: November 17, 2021 ORDER New and material evidence having been submitted, the previously denied claim of entitlement to service connection for depression, bipolar disorder, and posttraumatic stress disorder (PTSD) is reopened, and to this extent only, the appeal is granted. New and material evidence having been submitted, the previously denied claim of entitlement to service connection for a skin rash, to include folliculitis on the scalp, is reopened, and to this extent only, the appeal is granted. New and material evidence having been submitted, the previously denied claim of entitlement to service connection for a respiratory disorder, claimed as "shortness of breath," is reopened, and to this extent only, the appeal is granted. Service connection for major depressive disorder with anxiety is granted. Service connection for folliculitis of the scalp is granted. Service connection for type II diabetes mellitus as due to herbicide (Agent Orange) exposure is granted. Service connection for erectile dysfunction as due to herbicide (Agent Orange) exposure is dismissed. REMANDED Service connection for a respiratory disorder, to include as due to exposure to asbestos, is remanded. Service connection for a cervical spine disorder is remanded. Service connection for a right shoulder disorder is remanded. An initial rating greater than 10 percent for a lumbosacral strain is remanded. FINDINGS OF FACT 1. An earlier August 2009 rating decision denied service connection for depression, bipolar disorder, and PTSD. The Veteran was notified of his rights but did not appeal or submit new and material evidence during the applicable one-year appellate period. 2. The evidence associated with the claims file after the final August 2009 rating decision is not cumulative and redundant of evidence previously of record and raises a reasonable possibility of substantiating the Veteran's claim of service connection for an acquired psychiatric disorder (to include PTSD). 3. An earlier August 2009 rating decision denied service connection for a skin rash, to include folliculitis of the scalp, claimed as "bumps in the hair." The Veteran was notified of his rights but did not appeal or submit new and material evidence during the applicable one-year appellate period. 4. The evidence associated with the claims file after the final August 2009 rating decision is not cumulative and redundant of evidence previously of record and raises a reasonable possibility of substantiating the Veteran's claim of service connection for a skin rash, to include folliculitis of the scalp. 5. An earlier August 2009 rating decision denied service connection for a respiratory disorder, claimed as "shortness of breath." The Veteran was notified of his rights but did not appeal or submit new and material evidence during the applicable one-year appellate period. 6. The evidence associated with the claims file after the final August 2009 rating decision is not cumulative and redundant of evidence previously of record and raises a reasonable possibility of substantiating the Veteran's claim of service connection for a respiratory disorder, claimed as "shortness of breath." 7. The onset of the Veteran's current major depressive disorder with anxiety was during active service in the U.S. Navy from 1969 to 1972, after experiencing various traumatic incidents including scary, close-call helicopter landings at Da Nang Air Base in Vietnam in 1970. 8. The most probative evidence of record establishes that the Veteran has no current diagnosis of PTSD in accordance with the DSM-5 and applicable VA regulation. 9. The Veteran has folliculitis of the scalp that first manifested during his period of active service in the Navy from 1969 to 1972. Post-service, his folliculitis of the scalp has continued to flare-up intermittently. 10. The Veteran served aboard the USS Sacramento in 1969 and 1970 "offshore of the Republic of Vietnam," encompassing service in the territorial sea extending 12 nautical miles from the shores of both the Republic of Vietnam and Cambodia. Moreover, the Veteran served on the landmass of the Republic of Vietnam during the Vietnam era in 1970. Either way, he is presumed to have been exposed to Agent Orange or other herbicide agents during such service. 11. The Veteran has type II diabetes mellitus, manifest to a degree of 10 percent post-service, which is the result of his presumed in-service exposure to Agent Orange or other herbicide agents during his service offshore of the Republic of Vietnam and during his confirmed trips by helicopter to pick up mail at the Da Nang Air Base on the Vietnam landmass. 12. In a March 2021 rating decision, the Agency of Original Jurisdiction (AOJ) granted the Veteran's claim for service connection for erectile dysfunction as due to herbicide (Agent Orange) exposure. The AOJ also awarded the ancillary benefit of SMC under 38 U.S.C. § 1114(k) and 38 C.F.R. § 3.350(a) for loss of use of a creative organ due to erectile dysfunction. As such, this rating decision was a full grant of the benefits sought. There is no indication in the claims file the Veteran disagrees with this favorable determination. 13. With regard to the issue of entitlement to service connection for erectile dysfunction as due to herbicide (Agent Orange) exposure, there is no longer a controversy regarding the benefit sought on appeal, as the AOJ has already granted this particular claim. CONCLUSIONS OF LAW 1. New and material evidence sufficient to reopen the claim of service connection for depression, bipolar disorder, and PTSD has been received after the final August 2009 rating decision. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). 2. New and material evidence sufficient to reopen the claim of service connection for a skin rash, to include folliculitis of the scalp, has been received after the final August 2009 rating decision. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). 3. New and material evidence sufficient to reopen the claim of service connection for a respiratory disorder, claimed as "shortness of breath," has been received after the final August 2009 rating decision. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). 4. The criteria have been met for service connection for major depressive disorder with anxiety on a direct basis, but not PTSD. 38 U.S.C. §§ 1110, 1154(a), 5107; 38 C.F.R. §§ 3.102, 3.303(a), (d), 3.304, 4.125. 5. The criteria have been met for service connection for folliculitis of the scalp. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 6. The criteria have been met for presumptive service connection for type II diabetes mellitus due to herbicide (Agent Orange) exposure. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1116, 1116A, 1154(a), 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.313. 7. There is no longer an issue of fact or law before the Board pertaining to whether service connection for erectile dysfunction as due to herbicide (Agent Orange) exposure is warranted. 38 U.S.C. §§ 511, 7104, 7105 (2012); 38 C.F.R. § 20.104 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty service from March 1969 to December 1972 in the U.S. Navy. This included service in the Republic of Vietnam (in-country) during multiple postal duty flights to Da Nang Air Base to pick up mail for delivery throughout the year 1970. This matter comes to the Board of Veterans' Appeals (Board) on appeal from April 2017 and July 2017 rating decisions issued by an Agency of Original Jurisdiction (AOJ) of the Department of Veterans Affairs (VA). In March 2020, the Veteran and his spouse presented testimony at a Board videoconference hearing before the undersigned Veterans Law Judge (VLJ). A transcript of that hearing is associated with the Veteran's claims file. I. New and Material Evidence New and material evidence is required in order to reopen a claim that has been previously adjudicated in a final decision. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). For legacy claims to reopen decided prior to February 19, 2019, a claimant may reopen a finally adjudicated claim by submitting new and material evidence. New evidence means existing evidence not previously submitted to agency decision makers. 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. 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. 38 C.F.R. § 3.156(a). In any case involving a finally denied claim, the Board must address whether new and material evidence has been received to reopen before addressing the merits of the claim, regardless of whether or not the AOJ has already addressed the question. Jackson v. Principi, 265 F.3d 1366, 1369 (Fed. Cir. 2001); Wakeford v. Brown, 8 Vet. App. 237, 23940 (1995). The Court has viewed the phrase "raises a reasonable possibility of substantiating the claim" as "enabling rather than precluding reopening." The Court has emphasized that the threshold is low for purposes of reopening a claim. That is, reopening a claim does not require new and material evidence regarding each element of the claim that was not proved in the prior decision. Shade v. Shinseki, 24 Vet. App. 110, 117-120 (2010). It is unnecessary for the newly presented evidence to be probative of all the elements required to award the claim; rather, the newly presented evidence only needs to be probative with regard to each element that was a specified basis for the last disallowance. Evans v. Brown, 9 Vet. App. 273, 284 (1996). Stated another way, new and material evidence need only be submitted with respect to one previously unestablished fact, in order to reopen the claim. Shade, 24 Vet. App. at 12022. In short, there is a low threshold for determining whether evidence is new and material. For the purpose of reopening a claim, the credibility, but not the weight, of newly submitted evidence is presumed, unless the evidence is inherently incredible or consists of statements that are beyond the competence of the person or persons making them. See Justus v. Principi, 3 Vet. App. 510, 513 (1992). Mere offering of an alternative theory of entitlement for service connection (such as secondary service connection) does not constitute new and material evidence sufficient to reopen the claim. Roebuck v. Nicholson, 20 Vet. App. 307 (2006); Bingham v. Principi, 18 Vet. App. 470 (2004), aff'd 421 F.3d 1346 (Fed. Cir. 2005). However, evidence offered in support of an alternative theory of entitlement (e.g., clinical evidence of secondary service connection) can be sufficient to warrant reopening of the claim, if it meets the definition of new and material. Boggs v. Peake, 520 F.3d 1330, 133637 (Fed. Cir 2008). A. Depression, Bipolar Disorder, and PTSD In an earlier August 2009 rating decision, the AOJ denied service connection for depression, bipolar disorder, and PTSD. The Veteran was notified of the August 2009 rating decision and of his appellate rights, but he did not submit a notice of disagreement (NOD), or new and material evidence, within one year of the notice of this rating decision. Therefore, the August 2009 rating decision became final for the psychiatric disorder issue. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.156(b), 3.160(d), 20.200, 20.201, 20.302, 20.1103 (2009). In the final August 2009 rating decision, the AOJ denied service connection for depression, bipolar disorder, and PTSD. The AOJ determined that the Veteran's service treatment records (STRs) were negative for any evidence of a psychiatric disorder during service. Also, there was no current diagnosis for depression, bipolar disorder, or PTSD in the clinical evidence of record. In addition, there was no evidence demonstrating a nexus or link between any psychiatric disorder and his service in the Navy from 1969 to 1972. Finally, pertaining to the PTSD issue, the Veteran did not provide any evidence or description of an in-service traumatic stressor during the Veteran's service in the Navy in order to confirm its occurrence with the Joint Services Records Research Center (JSRRC). That is, there was no credible evidence or verification of any in-service stressor. The Board emphasizes that service connection for PTSD has unique evidentiary and regulatory requirements, with the necessity for a showing of credible evidence to support the occurrence of in-service non-combat stressor. See 38 C.F.R. § 3.304(f). Initially, the Board has determined that that the Veteran's currently alleged PTSD and depressive disorder has the "same factual basis" as the previously denied psychiatric issues from the August 2009 rating decision. See Velez v. Shinseki, 23 Vet. App. 199, 204 (2009) (when determining whether a new and material evidence analysis is required, the focus of VA's analysis must be on whether the evidence presented truly amounts to a new claim "based upon distinctly diagnosed diseases or injuries," or whether it is evidence tending to substantiate an element of the previously adjudicated matter). It follows that a new and material evidence analysis is required for all his currently alleged psychiatric disorders. Here, the Board finds that new and material evidence has been received with respect to the service connection for depression and bipolar disorder issues, subsequent to the final August 2009 rating decision. See 38 C.F.R. § 3.156(a). Specifically, the record now contains current psychiatric diagnoses major depressive disorder or a depressive disorder with anxiety. See e.g., January 2017 VA PTSD examination; January 2017 VA psychiatry individual note; and February 2016 VA mental health assessment. The record also contains a favorable medical opinion demonstrating a nexus to service for his depressive disorder. See February 2017 VA psychological opinion from VA examiner. Assuming the credibility of this evidence, this medical evidence relates to a previously unestablished fact (the lack of current diagnosis and nexus to service) and raises a reasonable possibility of substantiating the acquired psychiatric disorder claim (for depression with anxiety). 38 U.S.C. § 5108; 38 C.F.R. § 3.156. Therefore, this evidence is new and material evidence. The claim for service connection for an acquired psychiatric disorder, to include depression and a bipolar disorder, is reopened. In addition, new and material evidence has been received with respect to the service connection for PTSD issue, subsequent to the final August 2009 rating decision. See 38 C.F.R. § 3.156(a). In this regard, service connection for PTSD has unique evidentiary requirements. It generally requires: (1) medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a) (i.e., DSM-5); (2) credible supporting evidence that the claimed in service stressor actually occurred; and (3) medical evidence of a link between current symptomatology and the claimed in service stressor. 38 C.F.R. § 3.304(f). See also Cohen v. Brown, 10 Vet. App. 128 (1997). Here, the Veteran has submitted various PTSD stressor statements and photographs describing his alleged traumatic in-service incidents, including scary, close-call helicopter landings at Da Nang Air Base in Vietnam, during his period of active duty in the Navy from 1969 to 1972. See e.g., July 2016 PTSD stressor statement (VA Form 21-0781a); July 2016 buddy statements from other service members in the Veteran's mail delivery unit; photographs submitted in July 2016 of Veteran flying on a helicopter into Da Nang Air Base in 1970; and March 2020 videoconference hearing testimony. In summary, these new lay assertions and photographs from the Veteran provide the first details of his alleged in-service traumatic stressors, and credible supporting evidence that the alleged helicopter stressors actually occurred. The Court has held that a lay statement, when competent, can be material for purposes of reopening a claim. Shade, 24 Vet. App. at 122. Assuming the credibility of this lay evidence for purposes of reopening only, the Board finds that the PTSD stressor statements and photographs of the Veteran's helicopter landing at Da Nang Air Base relates to a previously unestablished fact and raises a reasonable possibility of substantiating the claim of service connection for PTSD. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. Therefore, this evidence is new and material. The claim for service connection for PTSD is reopened. B. Skin Rash / Folliculitis of the Scalp In an earlier August 2009 rating decision, the AOJ denied service connection for a skin rash, to include folliculitis of the scalp, claimed as "bumps in the hair." The Veteran was notified of the August 2009 rating decision and of his appellate rights, but he did not submit a NOD, or new and material evidence, within one year of the notice of this rating decision. Therefore, the August 2009 rating decision became final for the skin rash / folliculitis issue. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.156(b), 3.160(d), 20.200, 20.201, 20.302, 20.1103 (2009). In the final August 2009 rating decision, the AOJ denied service connection for a skin rash, to include folliculitis of the scalp, claimed as "bumps in the hair." The AOJ determined there was no clinical evidence of a current skin disability in the Veteran's STRs or in his post-service medical records. Here, the Board finds that new and material evidence has been received to reopen the skin rash / folliculitis of the scalp issue, subsequent to the final August 2009 rating decision. See 38 C.F.R. § 3.156(a). Specifically, VA treatment records diagnosed the Veteran with a current skin rash disability (the Veteran describes the condition as folliculitis of his scalp). In particular, a December 2011 VA primary care note recorded that the Veteran was prescribed Triamcinolone 0.1% Cream by a private provider. Subsequently, VA treatment records dated from 2011 to 2017 confirm that VA medical providers continued to renew the Veteran's prescription for Triamcinolone 0.1% Cream to treat his skin for "inflammation" as needed. This prescription medication confirming the existence of a current skin condition was previously not of record at the time of the final August 2009 rating decision. The Board adds that the Veteran's current skin condition (folliculitis of the scalp) has the "same factual basis" as the previously denied skin rash (described as "bumps in the hair" in the earlier August 2009 rating decision). See Velez v. Shinseki, 23 Vet. App. 199, 204 (2009) (when determining whether a new and material evidence analysis is required, the focus of VA's analysis must be on whether the evidence presented truly amounts to a new claim "based upon distinctly diagnosed diseases or injuries," or whether it is evidence tending to substantiate an element of the previously adjudicated matter). Assuming the credibility of this VA clinical evidence diagnosing a current skin disorder for the scalp, this evidence relates to a previously unestablished fact and raises a reasonable possibility of substantiating the skin rash / folliculitis of the scalp claim. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. This evidence is therefore new and material. The claim for service connection for a skin rash / folliculitis of the scalp is reopened. C. Respiratory Disorder In an earlier August 2009 rating decision, the AOJ denied service connection for "shortness of breath." The Veteran was notified of the August 2009 rating decision and of his appellate rights, but he did not submit a NOD, or new and material evidence, within one year of the notice of this rating decision. Therefore, the August 2009 rating decision became final for the "shortness of breath" issue. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.156(b), 3.160(d), 20.200, 20.201, 20.302, 20.1103 (2009). In the final August 2009 rating decision, the AOJ denied service connection for "shortness of breath." The AOJ determined that the Veteran's STRs dated from 1969 to 1972 were negative for any evidence of a respiratory disorder during service. Also, there was no current diagnosis for "shortness of breath" in the clinical evidence of record. In addition, there was no evidence demonstrating a nexus or link between any respiratory disorder and his service in the Navy from 1969 to 1972. Here, the Board finds that new and material evidence has been received to reopen the "shortness of breath" issue, subsequent to the final August 2009 rating decision. See 38 C.F.R. § 3.156(a). Specifically, a September 2013 chest X-ray revealed a current diagnosis of chronic obstructive pulmonary disease (COPD). Thereafter, VA treatment records dated from 2013 to 2018 recorded that the Veteran was prescribed various inhalers (budesonide, albuterol) to control symptoms of shortness of breath, coughing, and wheezing from his COPD. This COPD diagnosis for his respiratory system was previously not of record prior to the final August 2009 rating decision. The Board adds that the Veteran's current COPD has the "same factual basis" as the previously denied "shortness of breath" in the earlier August 2009 rating decision. See Velez v. Shinseki, 23 Vet. App. 199, 204 (2009) (when determining whether a new and material evidence analysis is required, the focus of VA's analysis must be on whether the evidence presented truly amounts to a new claim "based upon distinctly diagnosed diseases or injuries," or whether it is evidence tending to substantiate an element of the previously adjudicated matter). That is, one of the primary symptoms of his COPD diagnosis is shortness of breath. Assuming the credibility of this VA clinical evidence diagnosing a current respiratory disorder, this evidence relates to a previously unestablished fact and raises a reasonable possibility of substantiating the respiratory disorder claim. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. This evidence is therefore new and material. The claim for service connection for a respiratory disorder, claimed as "shortness of breath," is reopened. II. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the disease or injury incurred or aggravated during service the "nexus" requirement. Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Under 38 C.F.R. § 3.303(d), disorders diagnosed after discharge may also still be service connected if all the evidence, including pertinent service records, establishes the disorder was incurred in service. See Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). VA is to give "due consideration" to "all pertinent medical and lay evidence" in evaluating a claim for disability benefits. 38 U.S.C. § 1154(a). Thus, there is no categorical rule that medical evidence is required when the determinative issue is either medical etiology or a medical nexus. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). The Board should make explicit findings regarding the competency and, if necessary, the credibility of the lay evidence of record. Miller v Wilkie, 32 Vet. App. 249, 257-262 (2020). Lay testimony is competent to describe the presence of readily observable features or symptoms of injury or illness that are not medical in nature, such as varicose veins, tinnitus, and flat feet. See 38 C.F.R. § 3.159(a)(2); Barr v. Nicholson, 21 Vet. App. 303, 307-310 (2007). The Federal Circuit has also clarified that lay evidence can be competent for the medical diagnosis or etiology of a condition if: (1) the layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). And if the disability is of the type for which lay evidence is competent, the Board must weigh the probative value of that lay evidence against other evidence of record in making its determination regarding the award of service connection. Buchanan v. Nicholson, 451 F.3d 1331, 1334-37 (Fed. Cir. 2006). In determining whether service connection is warranted, the Board shall consider the benefit-of-the-doubt doctrine. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1991). The claimant is entitled to the benefit of the doubt when the evidence is in "approximate" balancei.e., "nearly equal"but does not require that the evidence be in exact equipoise. Lynch v. McDonough, 999 F.3d 1391, 1394 (Fed. Cir. 2021). A. Major Depressive Disorder with Anxiety Upon review of the evidence, service connection for major depressive disorder with anxiety is granted. Initially, none of the psychiatric disorders at issue on appeal are one of the enumerated "chronic disease[s]" listed under 38 C.F.R. § 3.309(a); therefore, the presumptive provisions based on "chronic" symptoms in service and "continuous" symptoms since service at 38 C.F.R. § 3.303(b) do not apply here. Walker v. Shinseki, 708 F.3d 1331, 1338-39 (Fed. Cir. 2013). Instead, 38 C.F.R. § 3.303(a) and (d) apply in the present case for the psychiatric disorder(s) on appeal. That is, none of the Veteran's current psychiatric disorders are listed as a "psychosis" under 38 C.F.R. § 3.384. Service treatment records (STRs) dated from 1969 to 1972 are negative for any complaint, treatment, or diagnosis of a psychiatric disorder for the Veteran. However, the Veteran has submitted credible evidence of in-service exposure to traumatic incidents during service, in particular scary, close-call helicopter landings at Da Nang Air Base in Vietnam in 1970. See e.g., July 2016 PTSD stressor statement (VA Form 21-0781a); July 2016 buddy statements from other service members in the Veteran's mail delivery unit; photographs submitted in July 2016 of the Veteran himself flying on a helicopter into Da Nang Air Base in 1970; and March 2020 videoconference hearing testimony. These traumatic landings when riding as a passenger in helicopters flying from the USS Sacramento to Da Nang Air Base to retrieve mail and other supplies as part of his MOS duties as a mail clerk, are consistent with the places, types, and circumstances of his service in the Navy. See 38 U.S.C. § 1154(a); 38 C.F.R. § 3.303(a). As such, the second element of service connection is met here in terms of the occurrence of a traumatic in-service event or incident. See 38 C.F.R. § 3.303(a). In addition, as to in-service incurrence, a July 2016 buddy statement from a service member in the Veteran's unit witnessed the Veteran becoming increasingly violent and angry during active duty in 1970 after exposure to multiple rough landings in helicopters at Da Nang Air Base in Vietnam, as well as from other stressors. This buddy statement provides credible lay evidence in support of in-service incurrence for his mental health symptoms. See 38 C.F.R. § 3.303(a); Petitti v. McDonald, 27 Vet. App. 415, 427 (2015) (holding that where a regulation does not speak to the type of evidence required, it cannot be said to restrict the types of evidence which satisfy its requirements (such as lay evidence)). Moreover, these lay reports and buddy statements presenting mental health symptomatology and exposure to traumatic incidents during service are supported by a latter medical opinion by a medical professional, as will be explained further below. See Jandreau, 492 F.3d at 1376-77. Thus, the third Jandreau category for a competent lay assertion supported by latter medical evidence is applicable in this case. Post-service, the Veteran's spouse and a co-worker have submitted competent and credible lay statements asserting ongoing and persistent psychiatric symptoms of the Veteran's anger and social withdrawal in the 1970s, a short time after separation from service in December 1972. See 38 C.F.R. § 3.159(a)(2); Jandreau, 492 F.3d at 1377 (discussing that a lay person is competent to report a contemporaneous medical diagnosis); Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006) (discussing general competency of a veteran or others to report observable psychiatric symptoms). Specifically, the Veteran's spouse in a July 2016 statement advised that she met the Veteran in 1973 immediately after his separation from the Navy. They married in 1975. She noticed the Veteran was angry, argumentative, demanding, and controlling. He experienced nightmares and insomnia in 1975, which he blamed on an in-service traumatic stressor when his helicopter almost crashed in bad weather at Da Nang Air Base in Vietnam. He became terrified of flying thereafter as well. In addition, in a July 2016 statement from a co-worker who worked with the Veteran at the U.S. Forest Service from 1978 to 1980 asserted that the Veteran exhibited anxiety and stress and isolation at his work due to his prior Vietnam service. Post-service, as to the third requirement of a nexus, most importantly, there is probative medical evidence of a nexus or link between the Veteran's current depressive disorder with anxiety and his in-service traumatic incidents involving scary, close-call helicopter landings at Da Nang Air Base in Vietnam in 1970. Holton, 557 F.3d at 1366. See also 38 C.F.R. § 3.303(a), (d). Specifically, a January VA psychological examination with a February 2017 VA medical opinion concluded that the Veteran had a persistent depressive disorder with anxiety, which is "at least as likely as not" a result of in-service stressor events, including multiple helicopter incidents. The VA examiner provided a rationale that the Veteran's traumatic in-service experiences appear to have affected him over the years, as he and his wife report low level depressive and anxiety symptoms for years that have improved recently with treatment and medication. A January 2017 VA psychiatry individual note diagnosed this condition as "major depression." Notably, there is no contrary, unfavorable medical opinion of record for his depressive disorder. The Board should not remand for additional development when the present record is sufficient to grant service connection. Andrews (David) v. McDonough, __ Vet. App. __, No. 19-0352 (June 22, 2021). Stated another way, VA may not order additional development for the sole purpose of obtaining evidence unfavorable to a claimant. Mariano v. Principi, 17 Vet. App. 305, 312 (2003). See also 38 C.F.R. § 3.304(c) (the development of evidence in connection with claims for service connection will be accomplished when deemed necessary but it should not be undertaken when evidence present is sufficient for this determination). Accordingly, resolving doubt in the Veteran's favor, the evidence supports service connection for major depressive disorder with anxiety. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. The claim is granted. Despite awarding service connection for major depressive disorder with anxiety in the present decision, the Board has also considered whether service connection is warranted for any other acquired psychiatric disorder, to include PTSD. See Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009) (holding that the scope of a mental health disability claim includes any mental disability that may reasonably be encompassed by the claimant's description of the claim, reported symptoms, and the other information of record). Service connection for PTSD has unique evidentiary requirements. It generally requires: (1) medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a) (i.e., DSM-5); (2) credible supporting evidence that the claimed in service stressor actually occurred; and (3) medical evidence of a link between current symptomatology and the claimed in service stressor. 38 C.F.R. § 3.304(f). See also Cohen v. Brown, 10 Vet. App. 128 (1997). With respect to the criteria of a current diagnosis of PTSD, the threshold consideration for any service connection claim is the existence of a current disability. 38 U.S.C. § 1110; 38 C.F.R. § 3.303; Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000). In particular, aside from corroboration of an in-service stressor, current medical evidence diagnosing PTSD in accordance with 38 C.F.R. § 4.125(a) (i.e., DSM-5) is required, as well as competent evidence of a nexus between current PTSD symptomatology and a verified in service stressor. 38 C.F.R. § 3.304(f). See also Cohen v. Brown, 10 Vet. App. 128 (1997). However, here, the most probative medical evidence weighs against a finding that the Veteran has a current PTSD diagnosis in accordance with 38 C.F.R. § 4.125(a) (i.e., DSM-5). In fact, no medical professional in the record has diagnosed the Veteran with PTSD. A VA psychological examiner in a February 2017 medical opinion explained that the Veteran did not meet the current DSM-5 criteria for PTSD. A February 2016 VA mental health assessment note found that there is "little to suggest" that the Veteran has a diagnosis of PTSD. This evidence outweighs the Veteran's one positive PTSD screen in December 2011. The Board points out that potential PTSD symptomatology such as nightmares and avoidance and anxiety and anger from the Veteran's confirmed in-service stressful incidents have been attributed to his diagnosis of major depressive disorder with anxiety, which is now a service-connected disability. Moreover, although the Veteran is competent to describe his psychiatric symptoms, by regulation, PTSD is a condition that can only be diagnosed by a medical professional, according to 38 C.F.R. § 3.304(f). In this regard, the Federal Circuit has held that "PTSD is not the type of medical condition that lay evidence... is competent and sufficient to identify." Young v. McDonald, 766 F.3d 1348, 1352-53 (Fed. Cir. 2014). Accordingly, the preponderance of the evidence is against the Veteran's service connection claim for PTSD. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The PTSD claim is denied. (In any event, the award of service connection for major depressive disorder with anxiety in the present Board decision encompasses all of the Veteran's current psychiatric symptomatology). B. Folliculitis of the Scalp Upon review of the evidence, service connection for folliculitis of the scalp is granted. At the outset, the Veteran's alleged skin condition (folliculitis of the scalp) is not listed as an enumerated "chronic disease" under 38 C.F.R. § 3.309(a); therefore, the presumptive provisions based on "chronic" symptoms in service and "continuous" symptoms since service at 38°C.F.R. § 3.303(b) do not apply for his alleged skin condition. Walker, 708 F.3d at 1338-39. Instead, 38 C.F.R. § 3.303(a) and (d) apply for his alleged skin condition. The Veteran's STRs dated from 1969 to 1972 are for the most part negative for any complaint, treatment, or diagnosis of any skin condition, with one exception. That is, a November 1972 STR dermatology clinic note at the Naval Hospital in Yokosuka, Japan diagnosed folliculitis of the scalp for the Veteran. There were scattered areas of crusted oozing seen on his scalp. He was prescribed PHisoHex, LCD shampoo, and Synalar Solution. Thus, the Veteran's STRs reveal a clear diagnosis of folliculitis of the scalp or a similar skin condition during active service. See 38 C.F.R. § 3.303(a). Post-service, in VA treatment records dated from 2015 to 2017, there were notations of a rash to the Veteran's neck and scalp. On most occasions, no rash was observed to be present. However, a December 2011 VA primary care note recorded that the Veteran was prescribed Triamcinolone 0.1% Cream by a private provider. Subsequently, VA treatment records dated from 2011 to 2017 confirm that VA medical providers continued to renew the Veteran's prescription for Triamcinolone 0.1% Cream to treat his skin for "inflammation" as needed. The Veteran has competently and credibly indicated this skin medication was prescribed to treat his occasional flare-ups of folliculitis of the scalp. When his folliculitis flare-ups, the Veteran testified it is present on his scalp, around his ears, and on his neck. See March 2020 videoconference hearing testimony. Post-service, as to the third requirement of a nexus, the Veteran has been competent and credible in describing ongoing "intermittent" flare-ups of folliculitis of the scalp, usually on a seasonal basis, ever since his separation from active duty in 1972. See 38 C.F.R. § 3.159(a)(2); Barr, 21 Vet. App. at 307-09. He reported to the April 2017 VA skin examiner that in the mid-1970s, a few years after separation from service, he saw his private doctor for folliculitis of his scalp "but they didn't know what to do for it." He made a similar assertion at the March 2020 videoconference hearing, adding that this skin condition "comes and goes." In this respect, the Board is aware of the Court's decision in Ardison v. Brown, 6 Vet. App. 405, 408 (1994), a case which, similar to the present case, concerned a skin disorder that fluctuated in its degree of disability, that is, a skin disorder which had "active and inactive stages" or was subject to remission and recurrence. The requirement for service connection that there be a current disability is satisfied when the disability is shown at the time of the claim or during the pendency of the claim, even though the disability subsequently resolves. McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). With regard to his lay testimony, in McCartt v. West, 12 Vet. App. 164, 167 (1999), in support of a claim for service connection for a skin disorder, the veteran in that case indicated that his skin condition had manifested in boils, blotches, a rash, soreness, and itchiness after 1968 during service in Vietnam. The Court in McCartt determined that a skin condition may be the type of condition lending itself to lay observation and satisfy the nexus requirement. Id. And based on other VA case law, it would appear that a veteran in certain instances can be competent to testify to the fact that his skin condition he experienced in service or immediately thereafter is reflective of the same condition he is currently diagnosed with. Davidson, 581 F.3d at 1316. In the present case, both the lay and clinical evidence of record confirms that the Veteran has been treated for folliculitis of the scalp both in-service and post-service on an intermittent basis. With regard to medical evidence of a nexus, an April 2016 VA attending note documented that the Veteran experiences ingrown hairs at the base of his scalp and dry spots on his scalp with thinning of his hair noted. The Veteran accurately reported to the VA clinician that he was treated in the Navy for this same condition in 1972. See Kowalski v. Nicholson, 19 Vet. App. 171, 179 (2005) (the Court has held that VA cannot reject a medical opinion or medical evidence simply because it is based on a history supplied by the veteran and that the critical question is whether that history was accurate); Coburn v. Nicholson, 19 Vet. App. 427, 432 (2006) (reliance on a veteran's statement renders a medical report incredible only if the Board rejects the statements of the veteran). Therefore, the April 2016 VA attending note provides some limited clinical evidence in support of a nexus to service for the Veteran's folliculitis of his scalp. Holton, 557 F.3d at 1366. See also 38 C.F.R. § 3.303(a), (d). Accordingly, resolving doubt in the Veteran's favor, the evidence supports service connection for folliculitis of the scalp. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. This claim is granted. C. Type II Diabetes Mellitus With regard to presumptive service connection, the law provides that certain diseases will be considered to have been incurred in service, even if there is no record of the disease during service, if that disease is associated with exposure to "herbicide agents" used in support of military operations in the Republic of Vietnam during the Vietnam era. 38 U.S.C. § 1116(a)(1); 38 C.F.R. § 3.307(a)(6). The term "herbicide agent" means a chemical in an herbicide used in support of the United States and allied military operations in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975, specifically: 2,4-D; 2,4,5-T and its contaminant TCDD; cacodylic acid; and picloram. 38 U.S.C. § 1116(a)(3); 38 C.F.R. § 3.307(a)(6)(i). A veteran is presumed to have been exposed to a herbicide agent if he or she served in the Republic of Vietnam between January 9, 1962, and May 7, 1975, unless there is affirmative evidence to establish that the veteran was not exposed to any such agent during that period of service. 38 U.S.C. § 1116(f); 38 C.F.R. § 3.307(a)(6)(iii)-(iv). Under VA regulation, service in the Republic of Vietnam is defined as "service in the waters offshore and service in other locations if the conditions of service involved duty or visitation in the Republic of Vietnam." 38 C.F.R. § 3.307(a)(6)(iii). In addition, the Federal Circuit has held that for the purposes of determining whether a veteran may be presumed to have been exposed to herbicide agents, the term "Service in the Republic of Vietnam" includes service on the landmass, inland waterways, and in the territorial sea extending 12 nautical miles from the shores of that nation. See Procopio v. Wilkie, 913 F.3d 1371, 1380-81 (Fed. Cir. 2019) (en banc). Therefore, a veteran is considered to have "served in the Republic of Vietnam," regardless of whether the veteran had duty or visitation on the ground or in the inland waters of Vietnam." Id. at 1380-81. Thereafter, on June 25, 2019, the President signed into law the Blue Water Navy Vietnam Veterans Act of 2019 (Blue Water Act). See Pub. L. No. 116-23, § 2, 133 Stat. 966, 966-67 (2019). The Blue Water Act codified the Procopio holding and extended the presumption of herbicide exposure to those veterans who served "offshore of the Republic of Vietnam," encompassing service in the territorial sea extending 12 nautical miles from the shores of both the Republic of Vietnam and Cambodia. See 38 U.S.C. § 1116A(d). In short, the Blue Water Act provides that the presumption of exposure to herbicide agents extends to all veterans who served between January 9, 1962 and May 7, 1975 "offshore of the Republic of Vietnam" meaning locations within the 12-nautical-mile territorial sea of the Republic of Vietnam. 38 U.S.C. § 1116A(a)-(d). Type II diabetes mellitus is one of the diseases associated with herbicide exposure for purposes of the presumption. 38 U.S.C. § 1116(a)(2)(H); 38 C.F.R. § 3.309(e). The presumption of service connection requires exposure to a herbicide agent and manifestation of type II diabetes mellitus to a degree of 10 percent or more any time after service. 38 C.F.R. § 3.307(a)(6)(ii). Upon review of the evidence of record, service connection for type II diabetes mellitus as due to herbicide (Agent Orange) exposure is granted. First, the Veteran served for 90 days or more continuously during a period of war after December 31, 1946, thus meeting the minimum service requirements for presumptive service connection. 38 U.S.C. § 1112(a); 38 C.F.R. § 3.307(a)(1). That is, he served from 1969 to 1972 with the U.S. Navy during the Vietnam era. Second, with regard to presumptive service connection, service personnel records (SPRs) and lay and other credible evidence of record confirm the Veteran had "service in the Republic of Vietnam" on various occasions in 1970, such that exposure to Agent Orange or other herbicide agent may be presumed. See 38 U.S.C. § 1116; 38 C.F.R. § 3.307(a)(6), 3.313(a). That is, the Veteran set foot on the Vietnam landmass at Da Nang Air Base approximately 20 to 25 times throughout the year 1970 as part of his MOS duties as a mail clerk. His lay statements and hearing testimony regarding his frequent helicopter trips to Da Nang Air Base in Vietnam in 1970 are consistent with the "places, types, and circumstances" of his service in the Navy aboard the USS Sacramento in 1970. See 38 U.S.C. § 1154(a); 38 C.F.R. § 3.303(a). The Veteran's lay statements and hearing testimony concerning presumed exposure to herbicide agents by way of service on the Vietnam landmass are corroborated in the present case, as explained below. See Bardwell v. Shinseki, 24 Vet. App. 36, 40 (2010). Specifically, with regard to evidence in support of the Veteran's service on the Vietnam landmass in 1970, a SPR enlisted performance record verified the Veteran served on the USS Sacramento from May 1969 to October 1970. SPRs also confirm that the Veteran had an MOS as a mail clerk during this time period on the USS Sacramento. Also, information on the ship list concerning the USS Sacramento advised that the "USS Sacramento (AOE-1) regularly sent helicopters ashore to Da Nang for mail pick-up during March through August of 1970." Buddy statements dated in July 2016 from other servicemembers reported that they worked with the Veteran and flew with him to Da Nang Air Base on multiple mail runs in 1970. A July 2016 internet ship history record for the USS Sacramento included an article and photos of the current Veteran working as a postal clerk in 1970, with a report that part of his duties was "frequent hops into Da Nang to pick up Yankee Station mail...." In July 2016, the Veteran even submitted contemporary photographs of him flying on a helicopter into Da Nang Air Base in Vietnam to pick up mail as part of his MOS duties as a postal clerk. An undated USS Sacramento newsletter thanked the service members "for all those special mail runs into Da Nang and other places." A December 2016 Defense Personnel Records Information Retrieval System (DPRIS) response from the Joint Services Records Research Center (JSRRC) documented that the deck logs for the USS Sacramento reveal that on April 9, 1970, at 08:16 hours, the ship launched a helicopter to Da Nang, Vietnam. A December 2016 email supported the addition of the USS Sacramento to the VA ship list of vessels that served in the inland waterways, since as a Fast Combat Support Ship it regularly sent helicopters ashore to Da Nang for mail pick-up from March 1970 to August 1970, when the Veteran was onboard serving as a mail clerk. What's more, an August 2017 rating decision already awarded the Veteran service connection for prostate cancer based on presumed in-service exposure to herbicide agents in Vietnam based on the Veteran regularly flying in helicopters to Da Nang Air Base in Vietnam to pick up mail in 1970. Finally, a May 2009 3101 response from the National Personnel Records Center (NPRC) confirmed that the USS Sacramento was in the official waters of the Republic of Vietnam at various times in 1969 to 1970. SPRs also confirm that the Veteran was on board the USS Sacramento on all those occasions. He has credibly stated that he could see the Vietnam landmass on several occasions from the vessel. This and the Veteran's lay statements serve as sufficient evidence that the USS Sacramento sailed in the blue waters of Vietnam within the 12-nautical-mile territorial sea of the Republic of Vietnam, while the Veteran was serving on board. That is, the Veteran served "offshore of the Republic of Vietnam," encompassing service in the territorial sea extending 12 nautical miles from the shores of both the Republic of Vietnam and Cambodia. See 38 U.S.C. § 1116A(b), (d). In light of the above evidence demonstrating both service on the landmass of the Republic of Vietnam and service within the 12-nautical-mile territorial sea of the Republic of Vietnam, it follows the Veteran is presumed to have been exposed to herbicide agents, including Agent Orange, during his active duty service in 1969 and 1970. In fact, there is no affirmative evidence to establish that the Veteran was not exposed to any such herbicide agent during his service in the Navy. See 38 U.S.C. §§ 1116, 1116(A); 38 C.F.R. § 3.307(a)(6)(iii), 3.313(a). The Veteran's lay statements and hearing testimony on this matter are uncontroverted and consistent with the general information contained in his SPRs and in other documentary evidence, which was discussed in detail above. See also Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006) (noting that the Board, as fact finder, is responsible for assessing the credibility, competence, and probative value of evidence). Third, the Veteran meets the threshold criterion for service connection of a current type II diabetes mellitus disability. See 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Specifically, a March 2014 VA treatment record confirmed a recent diagnosis of Type II diabetes mellitus for which the Veteran was to begin Metformin. More recently, a January 2018 VA primary care note and a January 2018 VA pharmacy note documented that the Veteran takes Metformin 500mg tablet by mouth daily with meals to treat his type II diabetes mellitus, in light of laboratory testing confirming the diagnosis of type II diabetes mellitus. In addition, these VA treatment records record the Veteran was ordered diabetic socks, recommended to lose weight, improve his diet, and exercise in order to treat his type II diabetes mellitus. Fourth, the Veteran's type II diabetes mellitus was manifest to a degree of at least 10 percent or more after service. 38 C.F.R. § 3.307(a)(6)(ii). In this regard, VA treatment records discussed above confirm that his type II diabetes mellitus is managed by a restricted diet and an oral hypoglycemic agent, which supports at least a 10 percent rating under the relevant VA rating criteria. See 38 C.F.R. § 4.119, Diagnostic Code 7913. Accordingly, the evidence supports presumptive service connection for the Veteran's type II diabetes mellitus due to presumed herbicide (Agent Orange) exposure, based on service on the Vietnam landmass in 1970 and Blue Water service offshore of the Republic of Vietnam in 1969 and 1970. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. This claim is therefore granted. III. Dismissal The Secretary shall decide all questions of law and fact necessary to a decision by the Secretary under a law that affects the provision of benefits by the Secretary to the Veterans or the dependents or survivors of veterans. 38 U.S.C. §§ 511(a), 7104 (2012). All questions in a matter which under section 511(a) of title 38, United States Code, are subject to decision by the Secretary shall be subject to one review on appeal to the Secretary. Final decisions on such appeals shall be made by the Board. Decisions of the Board shall be based on the entire record in proceedings and upon consideration of all evidence and material of record and applicable provisions of law and regulation. 38 U.S.C. § 7104(a) (2012). The Board may dismiss any appeal which fails to allege error of fact or law in the determination being appealed. 38 U.S.C. § 7105(d)(5) (2012). In the present case, in a recent March 2021 rating decision, the AOJ granted the Veteran's claim for service connection for erectile dysfunction as due to herbicide (Agent Orange) exposure in Vietnam. The AOJ also determined the Veteran was entitled to the ancillary benefit of SMC under 38 U.S.C. § 1114(k) and 38 C.F.R. § 3.350(a) for loss of use of a creative organ due to his erectile dysfunction, effective from March 2, 2021. There is no indication in the claims file the Veteran disagrees with this favorable determination. That is, in a March 9, 2021 accompanying notification letter, the AOJ advised the Veteran that if he did not agree with the March 2021 rating decision awarding service connection for erectile dysfunction, he could select a "review option" such as a Supplemental Claim, a Higher-Level Review, or an Appeal to the Board of Veterans' Appeals, within one year of the March 9, 2021 letter. As of this date, the Veteran has not appealed either the initial rating or effective date assigned for his service-connected erectile dysfunction. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997) (the veteran must separately appeal these downstream issues). In this regard, it appears this is a full grant of the benefits that had been sought on appeal for erectile dysfunction. Thus, the erectile dysfunction claim on appeal to the Board is rendered moot. In other words, there is no longer a question or controversy remaining for this issue. Nor are any exceptions to the mootness doctrine present because the ultimate relief sought on appeal, entitlement service connection for erectile dysfunction, has been accomplished without the need for action by the Board. 38 U.S.C. §§ 511, 7104, 7105; 38 C.F.R. § 20.104 (2020). See also Thomas v. Brown, 9 Vet. App. 269, 270 (1996); Hudgins v. Brown, 8 Vet. App. 365, 367-68 (1995); Bond v. Derwinski, 2 Vet. App. 376, 377 (1992). Accordingly, the Veteran's appeal for the issue of entitlement to service connection for erectile dysfunction as due to herbicide (Agent Orange) exposure is dismissed. REASONS FOR REMAND 1. Service connection for a respiratory disorder, to include as due to exposure to asbestos, is REMANDED. The Veteran should be scheduled for a VA DBQ examination with an appropriate clinician to determine if his current respiratory condition is causally or etiologically related to his service in the Navy from 1969 to 1972, to include his asbestos exposure and his documented in-service treatment for respiratory symptoms. See 38 U.S.C. § 5103A(d)(2); 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). As to asbestos exposure, the Board has reviewed a VA table describing the probability of asbestos exposure using a veteran's MOS. Given this Veteran's occupational duties as a postal clerk aboard the USS Sacramento, it is "probable" he had exposure to asbestos in-service. Therefore, the VA examiner must address whether any current respiratory condition is associated with his confirmed in-service asbestos exposure aboard the USS Sacramento in 1969 and 1970. See McGinty v. Brown, 4 Vet. App. 428 (1993). The Board acknowledges the AOJ previously secured a September 2016 VA respiratory examination and opinion, which included a May 2017 VA addendum opinion from a VA nurse practitioner addressing the etiology of the Veteran's current COPD. She initially provided a favorable medical opinion for the Veteran's COPD. Then she changed her opinion to conclude there was no relationship to the Veteran's confirmed in-service asbestos exposure. Neither the VA examination nor the VA medical opinions were fully adequate. On this point, when VA provides a VA examination or obtains a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The VA examiner failed to review or discuss the Veteran's STRs confirming treatment for multiple upper respiratory infections and respiratory symptoms from 1969 to 1972, in the context of determining whether the Veteran's current COPD was incurred during his period of active service in the Navy from 1969 to 1972. On this issue, the Court has held that an adequate medical opinion with regard to etiology should consist of a discussion of all relevant evidence. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). The Court has also held that a VA medical examiner's conclusions were of "questionable probative value" when the VA examiner failed to consider certain relevant information. Mariano v. Principi, 17, Vet. App. 305, 312 (2003). 2. Service connection for a cervical spine disorder is REMANDED. 3. Service connection for a right shoulder disorder is REMANDED. The Veteran should be scheduled for separate VA DBQ examinations with an appropriate clinician to determine if the Veteran's current cervical spine and right shoulder conditions are causally or etiologically related to the Veteran's credible description of a January 1972 in-service fall five feet down from a semitrailer and landing dock while unloading mail at a Navy Post Office in Yokosuka, Japan. See 38 U.S.C. § 5103A(d)(2); 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). This fall is consistent with his MOS duties as a postal clerk. He is also already service-connected by the AOJ for a lumbosacral strain likely stemming from the same January 1972 in-service incident. Additionally, the Veteran has reported being treated by private medical providers from 1978 to 2020 for his cervical spine (and possibly his right shoulder) disabilities on appeal. See e.g., July 2016 Veteran statement and March 2020 videoconference hearing testimony. However, these particular private treatment records are not currently present in the claims file. In this respect, VA is required to make reasonable efforts to obtain all "relevant" records, including private and non-Federal records like these, which the Veteran adequately identifies and authorizes VA to obtain. 38 U.S.C. § 5103A(b); 38 C.F.R. § 3.159(c)(1). The Federal Circuit Court has held that the duty to assist for VA to obtain private records applies to relevant or potentially relevant records, such as the private records discussed above. See Golz v. Shinseki, 590 F.3d 1317, 1320 (Fed. Cir. 2010) (emphasis added). "Reasonable efforts" will generally consist of an initial request for the records and, if the records are not received, at least one follow-up request, unless it is clear after the first request that a second request would be futile. 38 C.F.R. § 3.159(c)(1). Therefore, the AOJ should contact the Veteran and ask him to submit himself the private treatment records he has mentioned at various times during the appeal, if he has them in his personal possession, or to complete and return the necessary authorizations (VA Form 21-4142) and (VA Form 21-4142a) for VA to obtain them for him. 4. An initial rating greater than 10 percent for a lumbosacral strain is REMANDED. For the increased rating issue for the lumbar spine, at the March 2020 videoconference hearing, the Veteran testified that his lumbar spine disability has increased in severity since the Veteran was last examined by VA in September 2016. The Board sees the last VA examination for the lumbar spine was five years ago. When a claimant asserts that the severity of a disability has increased since the most recent VA rating examination, and the evidence of record is otherwise insufficient to evaluate the appeal, an additional VA examination is appropriate. See 38 C.F.R. § 3.327(a); VAOPGCPREC 11-95 (April 7, 1995). See also Snuffer v. Gober, 10 Vet. App. 400 (1997); Caffrey v. Brown, 6 Vet. App. 377 (1994). Therefore, the Veteran should be provided an opportunity to report for a new VA examination to ascertain the current severity and manifestations of his service-connected lumbosacral strain. (On a side note, the Board is cognizant of the recent changes to the Rating Schedule that addresses the musculoskeletal system and muscle injuries, which are effective February 7, 2021. One such change impacts Diagnostic Code 5242 for degenerative arthritis of the spine. See Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76453, 76462 (Nov. 30, 2020) (to be codified at 38 C.F.R. § 4.71a). Specifically, Diagnostic Code 5242 now indicates that degenerative arthritis of the spine includes degenerative disc disease (DDD) other than intervertebral disc syndrome (IVDS). VA has also added an instruction to Diagnostic Code 5243 for IVDS to assign this diagnostic code only when there is disc herniation with compression and / or irritation of the adjacent nerve root; otherwise, assign Diagnostic Code 5242 for degenerative arthritis for all other diagnoses. Id. It follows that the new VA thoracolumbar spine examination should be in accordance with the new rating criteria for degenerative arthritis (DC 5242) and IVDS (DC 5243), which are effective February 7, 2021, to the extent either DC applies to the facts of the Veteran's case.) In addition, for the increased rating issue for the lumbar spine, at the March 2020 videoconference hearing, the Veteran testified that he was treated for his lumbar spine disability as recently as February 2020 at the VA Medical Center (VAMC) in Albuquerque, New Mexico. In this regard, the Board sees the Veteran's VA treatment records on file from the VAMC in Albuquerque, New Mexico only date to January 2018. Any additional VA treatment records are within VA's constructive possession and are considered potentially relevant to the increased rating issue on appeal for the lumbar spine, as well as for the other respiratory, right shoulder, and cervical spine service connection issues being remanded. Therefore, a remand is required to allow VA to obtain all the Veteran's VA treatment records from the VAMC in Albuquerque, New Mexico dated from January 2018 to the present. Therefore, these issues are REMANDED for the following action: 1. Obtain the Veteran's VA treatment records from the VAMC in Albuquerque, New Mexico dated from January 2018 to the present and associate them with the claims file. 2. Ask the Veteran to complete and return the necessary authorizations (VA Form 21-4142) and (VA Form 21-4142a) to secure multiple private treatment records (listed below). If the Veteran provides the required authorization with sufficient information to identify and locate these private records, the AOJ should make two requests for the authorized records from these private facilities, unless it is clear after the first request that a second request would be futile. Finally, the Veteran is also asked to provide any of the private treatment records (listed below) himself, if he has them in his possession. The missing private records (mentioned in a July 2016 Veteran statement and at his March 2020 videoconference hearing testimony) consist of the following: Private treatment with the following physicians: "Mesilbov, Lahiri, Andrettia, Sussman, Simmons, and Wengs." Private treatment at a family practice with Dr. Larry Schreiber, M.D. (an internal medicine physician) from 1978 to 2010, located in Taos, New Mexico. Private treatment (for the Veteran's neck / cervical spine / and possibly right shoulder) with Dr. Urvij M. Modhia, M.D. (an orthopedic surgeon) at the University of New Mexico Hospital in Albuquerque, New Mexico. Private treatment (for the Veteran's neck / cervical spine / and possibly right shoulder) with a private neurologist in 2020. Private treatment for the Veteran's neck / cervical spine with a "local doctor" in the mid to late 1970s. 3. After completion of steps 1 and 2, schedule the Veteran for the appropriate VA DBQ examination to determine the etiology of the Veteran's current respiratory condition(s). The VA examiner must review the claims file. The Veteran must be interviewed. The VA examination should include any diagnostic testing, studies, or evaluations deemed necessary. The VA examiner must address the Veteran's relevant lay assertions, and if necessary, address whether the Veteran's lay assertions are consistent or inconsistent with his medical history and clinical data. The VA examiner must provide a rationale to support the opinions. Alternatively, in light of the Covid-19 pandemic, the VA examiner can schedule a telehealth interview, review of the record, etc., if an in-person examination is not feasible for the Veteran's respiratory condition(s). The VA examiner is asked to provide a response to the following inquiries: (a.) Is it at least as likely as not (i.e., an approximate balance) that the Veteran's current respiratory condition(s) developed as the result of his confirmed in-service asbestos exposure in the Navy from 1969 to 1972? In answering this particular question, pre-service, in-service, and any post-service exposure to asbestos should all be discussed. The VA examiner is advised that VA is conceding the Veteran was exposed to some degree of asbestos in-service on account of his military occupational specialty (MOS) as a postal clerk and his service below decks aboard the USS Sacramento from May 1969 to October 1970. That is, aboard the USS Sacramento, the Veteran was exposed to asbestos, especially in storerooms where exposed pipes, ceilings, and walls were coated / insulated with asbestos which went into the ventilation systems. In short, for purpose of rendering the above medical opinion, in-service exposure to asbestos is assumed for this Veteran. Post-service, the Veteran only worked in office settings and outdoors, with no post-service asbestos exposure mentioned thus far. Post-service, the Veteran has no history of tobacco use. The Veteran did not report any respiratory symptoms at a January 2000 private Taos Orthopedic Clinic progress note. In December 2011 VA primary care notes, the Veteran denied shortness of breath, wheezing, chest pain, or difficulty breathing. His exam of his lungs was normal at that time. September 2013 X-rays from Holy Cross assessed COPD for the first time in the record. He was prescribed inhalers in VA treatment records dated from 2014 to 2018. (b.) Is it at least as likely as not (i.e., an approximate balance) that the Veteran's current respiratory condition(s) is causally or etiologically related to his multiple incidents of in-service treatment for upper respiratory infections and respiratory symptoms documented in his STRs from 1969 to 1972? In answering this particular question, the VA examiner should review and address the following relevant evidence contained in the Veteran's STRs: An August 1969 STR observed the Veteran had a cold and sore throat x 3 days. An October 1969 STR documented treatment for a cold, throat pain, and nasal drainage. A December 1969 STR observed coughing. A February 1972 STR recorded treatment for flu syndrome x 2 days. The assessment was an upper respiratory infection for which the Veteran was prescribed medications. An April 1972 STR revealed another upper respiratory infection x 4 days with cold symptoms, coughing, and nausea. The Veteran was prescribed medications. An August 1972 STR indicated the Veteran had another upper respiratory infection x 2 days. His symptoms included fever, sore throat, chest congestion, coughing. The assessment was pharyngitis / cold for which the Veteran was prescribed medications. A November 1972 STR chest X-ray was normal. 4. After completion of steps 1 and 2, schedule the Veteran for the appropriate VA DBQ examination to determine the etiology of the Veteran's current cervical spine and right shoulder condition(s). The VA examiner must review the claims file. The Veteran must be interviewed. The VA examination should include any diagnostic testing, studies, or evaluations deemed necessary. The VA examiner must provide a rationale to support the opinions. Alternatively, in light of the Covid-19 pandemic, the VA examiner can schedule a telehealth interview, review of the record, etc., if an in-person examination is not feasible for the Veteran's cervical spine and right shoulder condition(s). The VA examiner is asked to provide a response to the following inquiries: (a.) Is it at least as likely as not (i.e., an approximate balance) that the Veteran's current cervical spine and right shoulder condition(s) are causally or etiologically related to the Veteran's credible description of a January 1972 in-service fall five feet down from a semitrailer and landing dock while unloading mail at a Navy Post Office in Yokosuka, Japan? In answering this particular question, assume the Veteran is at least credible in his description of a January 1972 in-service fall five feet down from a semitrailer and landing dock while unloading mail at a Navy Post Office in Yokosuka, Japan. This fall is consistent with his MOS duties as a postal clerk. And VA has already service-connected the Veteran for a lumbosacral strain stemming from the same in-service incident, based on a January 1972 STR showing treatment for a low back strain. What is unclear is whether the Veteran sustained any residual disability to his cervical spine and right shoulder from the same in-service incident. (b.) Is the Veteran's lay description of his in-service injury and cervical spine / right shoulder symptoms as well as his lay description of his post-service symptoms consistent or inconsistent with general medical knowledge, the Veteran's medical history, and the clinical data of record? In other words, does the Veteran's lay description of his in-service injury and post-service symptoms align with how his currently diagnosed cervical spine and right shoulder disabilities are clinically known to develop over time? In answering this particular question, the VA examiner is directed to the following in-service and post-service evidence of record for the neck: STRs dated from 1969 to 1972 are negative for any complaint, treatment, or diagnosis of a cervical spine disorder. At a January 2000 private Taos Orthopedic Clinic progress note, the Veteran denied neck pain at that time. A December 2011 VA primary care note showed a normal examination of the neck. VA primary care treatment notes dated in June 2012, December 2013, March 2014, May 2014, September 2014, January 2015, and April 2015 specifically documented NO neck pain or stiffness. A June 2015 VA primary care nursing note described his neck pain as "acute" in nature. The Veteran underwent a June 2015 C4-C5 anterior cervical discectomy and fusion for his neck. A September 2016 VA neck examination and opinion rendered a favorable nexus for the Veteran's current neck / cervical spine disability to his in-service injury. However, the VA examiner did not discuss the Veteran's STRs or relevant post-service medical evidence of record. In answering this particular question, the VA examiner is directed to the following post-service evidence of record for the right shoulder: STRs dated from 1969 to 1972 are negative for any complaint, treatment, or diagnosis of a right shoulder disorder. A January 2000 private Taos Orthopedic Clinic progress note documented that his right shoulder pain began one year earlier in 1999. In a September 2000 private right shoulder surgical report, the Veteran underwent arthroscopic rotator cuff repair, arthroscopic subacromial decompression and arthroscopic biceps tenotomy and labral debridement, for right shoulder rotator cuff tear and impingement. An October 2001 private Taos Orthopedic Clinic progress note found that the Veteran was now able to return to work full time in terms of "heavy labor" required on his ranch. A December 2017 VA primary care note reflected complaints of right shoulder pain. Finally, in answering this particular question, the VA examiner is advised of the Veteran's post-service occupational history, as listed in an August 2016 statement from the Veteran and in various VA treatment records: From 1973 to 1978 he worked at a sporting goods store. From 1978 to 1980 he worked at the US Forest Service as a timber technician. From 1980 to 2005 he worked as a computer specialist. From 2001 to 2012 he also had a hobby as a rancher bailing hay (per various VA treatment records). 5. Schedule the Veteran for a VA thoracolumbar spine examination by an appropriate clinician to determine the current severity and manifestations of his service-connected lumbosacral strain. The VA examiner must review the claims file. Any and all studies, tests, and evaluations deemed necessary by the VA examiner should be performed. The VA examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's lumbosacral strain under the rating criteria. The VA examiner must provide a rationale to support any opinion provided. (Alternatively, in light of the Covid-19 pandemic, the VA examiner can schedule a telehealth interview, review of the record, etc., if an in-person examination is not feasible for the Veteran's lumbar spine disability). ***Please also note the AOJ should provide a copy to the VA examiner of the new, revised rating criteria for degenerative arthritis (Diagnostic Code 5242) and intervertebral disc syndrome (IVDS) (Diagnostic Code 5243), which are effective February 7, 2021.*** DAVID L. WIGHT Veterans Law Judge Board of Veterans' Appeals Attorney for the Board P.S. Rubin, 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.