Citation Nr: 21070508 Decision Date: 11/24/21 Archive Date: 11/24/21 DOCKET NO. 17-25 914 DATE: November 24, 2021 ORDER Service connection for a back disability, to include acute lumbar strain and lumbar degenerative arthritis, is denied. Service connection for right lower extremity radiculopathy, to include as secondary to a back disability, is denied. Service connection for left lower extremity radiculopathy, to include as secondary to a back disability, is denied. Service connection for Parkinson's disease, to include restless leg syndrome/leg tremors, right facial hypesthesia/paresthesias, with spatial loss, vertigo/dizziness, abnormal gait, and favored posturing, is denied. Service connection for a sleep disorder, to include insomnia, is denied. Service connection for a sinus disability, to include sinus congestion, sinusitis, and post-nasal drip, is denied. Service connection for nocturia is denied. Service connection for a disability manifested by an altered gait other than the claimed back disability, bilateral lower extremity radiculopathy, Parkinson's disease, and residuals of a left knee strain is denied. Service connection for residuals of a right ear growth is denied. Service connection for residuals of a left knee strain is denied. Service connection for gynecomastia is denied. Service connection for an inguinal hernia is denied. Service connection for priapism is denied. Service connection for bilateral pulmonary embolism is denied. Service connection for parotid neoplasms is denied. Service connection for thrombocytopenia is denied. Service connection for Hepatitis C is denied. REMANDED Entitlement to service connection for residuals of a head trauma is remanded. Entitlement to service connection for hypertension is remanded. Entitlement to service connection for anemia is remanded. Entitlement to service connection for monoclonal gammopathy is remanded. Entitlement to service connection for posttraumatic stress disorder (PTSD) is remanded. Entitlement to service connection for depression is remanded. Entitlement to an initial compensable rating for bilateral hearing loss is remanded. FINDINGS OF FACT 1. The preponderance of the evidence is against the finding that the Veteran was exposed to an herbicide agent during service, to include during service in Korea from January 8, 1972, to February 9, 1973. 2. The preponderance of the evidence is against finding that the current lumbar spine degenerative arthritis began during active service or within one year of separation from service, or is otherwise related to an in-service injury or disease. 3. The preponderance of the evidence is against finding that any current right lower extremity radiculopathy is secondary to any service-connected condition, or that it began during active service, or is otherwise related to an in-service injury or disease. 4. The preponderance of the evidence is against finding that any current left lower extremity radiculopathy is secondary to any service-connected condition, or that it began during active service, or is otherwise related to an in-service injury or disease. 5. The preponderance of the evidence of record is against finding that the Veteran has had a diagnosis of Parkinson's disease at any time during the pendency of the claim. 6. The preponderance of the evidence of record is against finding that the Veteran has had a sleep disorder at any time during the pendency of the claim. 7. The preponderance of the evidence of record is against finding that the Veteran has had a sinus disability at any time during the pendency of the claim. 8. The preponderance of the evidence of record is against finding that the Veteran has had a diagnosis of nocturia at any time during the pendency of the claim. 9. The preponderance of the evidence of record is against finding that the Veteran has had a diagnosis of a disability manifested by an altered gait other than the claimed back disability, bilateral lower extremity radiculopathy, Parkinson's disease, and residuals of a left knee strain at any time during the pendency of the claim. 10. The preponderance of the evidence is against finding that the right ear growth began during active service, or is otherwise related to an in-service injury or disease. 11. The preponderance of the evidence is against finding that the left knee strain began during active service, or is otherwise related to an in-service injury or disease. 12. The preponderance of the evidence is against finding that the gynecomastia began during active service, or is otherwise related to an in-service injury or disease. 13. The preponderance of the evidence is against finding that the inguinal hernia began during active service, or is otherwise related to an in-service injury or disease. 14. The preponderance of the evidence is against finding that the priapism began during active service, or is otherwise related to an in-service injury or disease. 15. The preponderance of the evidence is against finding that the bilateral pulmonary embolism began during active service, or is otherwise related to an in-service injury or disease. 16. The preponderance of the evidence is against finding that the parotid neoplasms began during active service, or are otherwise related to an in-service injury or disease. 17. The preponderance of the evidence is against finding that the thrombocytopenia began during active service, or is otherwise related to an in-service injury or disease. 18. The preponderance of the evidence is against finding that the Hepatitis C began during active service, or is otherwise related to an in-service injury or disease. CONCLUSIONS OF LAW 1. The criteria for service connection for a back disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for right lower extremity radiculopathy are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 3. The criteria for service connection for left lower extremity radiculopathy are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 4. The criteria for service connection for Parkinson's disease are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 5. The criteria for service connection for a sleep disorder are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 6. The criteria for service connection for a sinus disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 7. The criteria for service connection for nocturia are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 8. The criteria for service connection for a disability manifested by an altered gait other than the claimed back disability, bilateral lower extremity radiculopathy, Parkinson's disease, and residuals of a left knee strain are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 9. The criteria for service connection for residuals of a right ear growth are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 10. The criteria for service connection for residuals of a left knee strain are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 11. The criteria for service connection for gynecomastia are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 12. The criteria for service connection for an inguinal hernia are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 13. The criteria for service connection for priapism are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 14. The criteria for service connection for bilateral pulmonary embolism are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 15. The criteria for service connection for parotid neoplasms are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 16. The criteria for service connection for thrombocytopenia are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 17. The criteria for service connection for Hepatitis C are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the Army from July 1971 to January 1988. Service Connection To prevail on a direct service connection claim, there must be competent evidence of (1) a current disability, (2) in-service incurrence or aggravation of a disease or injury, and (3) a nexus between the in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). A disability may be service connected on a secondary basis if it is proximately due to or the result of a service-connected disease or injury; or, if it is aggravated beyond its natural progress by a service-connected disease or injury. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.310(a), (b). Certain diseases, including arthritis, are listed among the "chronic diseases" under 38 C.F.R. § 3.309(a); therefore, 38 C.F.R. § 3.303(b) applies. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013); Fountain v. McDonald, 27 Vet. App. 258, 271 (2015). Where the evidence shows a "chronic disease" in service or "continuity of symptoms" after service, the disease shall be presumed to have been incurred in service. For the showing of "chronic" disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. With chronic disease as such in service, subsequent manifestations of the same chronic disease at any later date, however remote, are service-connected, unless clearly attributable to intercurrent causes. If a condition noted during service is not shown to be chronic, then generally, a showing of "continuity of symptoms" after service is required for service connection. Herbicide exposure The Veteran asserts that his claimed disabilities are due to his service as an infantryman and/or exposure to Agent Orange while stationed at the Korean DMZ. See the November 2012 and December 2014 claims for service connection. Certain diseases associated with exposure to herbicide agents may be presumed to have been incurred in service even if there is no evidence of the disease in service, provided the requirements of 38 C.F.R. § 3.307(a)(6) are met. See 38 C.F.R. § 3.309(e). The term "herbicide agent" means a chemical in an herbicide, including Agent Orange, used in support of the United States and allied military operations in the Republic of Vietnam during the Vietnam era. The types of diseases for which service connection may be presumed to be due to an association with herbicide agents include Parkinsonism. See 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307(a)(6)(ii), 3.309(e). A veteran who has active service in or near the Korean DMZ, during the period beginning on September 1, 1967, and ending on August 31, 1971, is entitled to a presumption of herbicide exposure. 38 U.S.C. § 1116B. Unfortunately, the Board finds that the evidence of record weighs against a finding that the Veteran was exposed to herbicide agents during his period of service, including his service in the Korean DMZ. The Veteran's service personnel records indicate that he served in Korea from January 8, 1972, to February 9, 1973, and from February 3, 1976, to February 28, 1977. As such, exposure to herbicides cannot be conceded on a presumptive basis. In a March 2014 memorandum, VA determined that the evidence did not establish exposure ot tactical herbicides for the Veteran. In addition to being stationed in Korea outside of the presumptive time period, a review of the Veteran's service treatment records (STRs) and personnel records yielded no conclusive proof that he was exposed to tactical herbicides during military service. The Board acknowledges the Veteran's statement that "there was common knowledge" that Agent Orange was still in the soil and vegetation along the DMZ in 1972. In this regard, the Board points to the established fact that herbicide use near the Korean DMZ ended in 1969, over two years before Veteran's period of Korean service began in 1972. See McKinney v. McDonald, 796 F.3d, 1377, 1379 (Fed Cir. 2015). Under § 3.307(a)(6)(iv), the initial period during which service in or near the Korean DMZ would justify a presumption of herbicide exposure was initially set from April 1968 to July 1969. See McKinney, 796 F.3d at 1380. In the final rule, however, VA extended the period end date from July 31, 1969, to August 31, 1971. Herbicide Exposure and Veterans with Covered Service in Korea, 76 Fed. Reg. 4245, 4245-46 (Jan. 25, 2011). "In adopting this change, the VA explained that 'it is reasonable and consistent with the intent of Congress to concede exposure for veterans who served in or near the Korean DMZ after herbicide application ceased, because of the potential for exposure to residuals of herbicides applied in that area.'" McKinney, 796 F.3d at 1380 (quoting 76 Fed. Reg. at 4245). Thus, August 31, 1971, was established "as a reasonable outside date for residual exposure." Id. In sum, the Board finds that the preponderance of the evidence is against the Veteran's claim that he was exposed to herbicides while in service. See 38 C.F.R. § 3.307(a)(6). 1. Service connection for a back disability. 2. Service connection for right lower extremity radiculopathy. 3. Service connection for left lower extremity radiculopathy. The Veteran contends that the claimed back disability is due to service, and that the bilateral radiculopathy is due to the back condition. See the November 2012 claim for disability benefits. STRs indicate that in August 1973, the Veteran reported having injured his back while playing basketball one week ago. He was having right lower back pain radiating to his right hip, which was assessed as a lower back strain. In December 1976, the Veteran reported being injured when he fell off a cliff. He was found to have an acute lumbosacral strain. In April 1977, the Veteran reported low back pain, with a sudden onset that morning. He was noted to have mild lumbar paraspinal spasm, which was assessed as musculoskeletal back pain. In a February 1980 examination, the Veteran's spine and lower extremities were found to be clinically normal, and he denied having a history of recurrent back pain. In a June 1987 examination, the Veteran's spine and lower extremities were again both found to be clinically normal. Post-service private treatment records indicate that the Veteran was seen in an emergency room in March 1995 complaining of low back pain on the left side and left lower extremity pain. He reported that the pain started when he bent over the toilet, and denied any trauma or fall. X-rays showed degenerative changes of the lower lumbosacral spine with no evidence of acute abnormality. He was diagnosed with an acute left lumbar spasm. In August 2013, the Veteran was afforded a VA back conditions examination. He reported that he had fallen down a cliff in service in South Korea and had injured his back. In 1995, the Veteran developed an acute lumbar strain while bending over. His last back attack was approximately 18 months ago, and was aggravated by bending, prolonged sitting and standing, and lifting. His back condition was under control because he knew what he could and could not do. He stated that his legs "start jumping" at times, which he described as painful jolts lasting seconds, and which began in 2007. On examination, range of motion included at least 90 degrees of flexion, 25 degrees of extension, 20 degrees of right and left lateral flexion, and 25 degrees of right and left lateral rotation, without objective evidence of painful motion. There was no localized tenderness or pain to palpation, and muscle strength testing and deep tendon reflexes were normal. Results of a sensory examination and straight leg raising test were also normal. The Veteran did not have radicular pain or other signs or symptoms of radiculopathy. The examiner opined that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The acute back strains noted in STRs in 1973, 1976, and 1977 improved and resolved, and there was no evidence to suggest that the degenerative changes were present in service, nor was there evidence to support a radicular process during service. The earliest evidence of degenerative changes was in 1995, which was eight years after discharge from service. Moreover, the VA examination was conducted 26 years after service, and there was no evidence of continuity of treatment. Finally, there was no basis for secondary service connection for radiculopathy because there was no back condition that was the result of service. The Board finds that the VA examiner's opinion is competent and credible, and as such, entitled to significant probative weight. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994). The opinion was rendered after reviewing the Veteran's STRs and other medical records, soliciting a medical history from the Veteran, and conducting a physical examination and clinical testing of the Veteran. See Prejean v. West, 13 Vet. App. 444 (2000) (factors for assessing the probative value of a medical opinion include the examiner's access to the claims folder and the Veteran's history, and the thoroughness and detail of the opinion). The VA examiner provided facts and rationale on which she based her opinions, including expressly considering and discussing relevant in-service and post-service records. Furthermore, neither the Veteran nor his representative has produced a medical opinion to contradict the conclusions of the VA examiner. As such, there is no competent medical evidence that relates the current lumbar spine degenerative arthritis or any lower extremity radiculopathy to military service. The Board also finds that although the Veteran can describe observable symptoms including pain, his statements cannot be used to determine whether a lumbar spine diagnosis is related service or to an in-service injury. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007) (explaining in footnote 4 that a Veteran may be competent to provide a diagnosis of a simple condition such as a broken leg, but not competent to provide evidence as to more complex medical questions). There is no evidence that the Veteran has the medical education and training required to make competent clinical diagnosis, or to attribute such a diagnosis to specific events or injuries. As such, the Board finds the Veteran's statements probative with regard to establishing his current symptoms, but finds little probative value with regard to establishing service connection. In any case, their probative value is outweighed by the probative value assigned to an evaluation conducted by a person who has expertise and training pertinent to lumbar spine diagnoses. In sum, the weight of the competent and credible evidence of record weighs against the claims for service connection for a back disability and bilateral lower extremity radiculopathy. As the preponderance of the evidence is against the claims, the benefit-of-the-doubt doctrine does not apply. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 4. Service connection for Parkinson's disease. 5. Service connection for a sleep disorder. 6. Service connection for a sinus disability. 7. Service connection for nocturia. 8. Service connection for a disability manifested by an altered gait. The Board finds that the Veteran does not have a diagnosis of Parkinson's disease, a sleep disorder, sinus condition, nocturia, or a disability manifested by an altered gait. VA and private treatment records associated with the claims file do not reveal a relevant diagnosis. Specifically, VA treatment records dated in 1990 and from July 2002 to October 2021 are silent for complaints, diagnosis, or treatment relevant to Parkinson's disease, a sinus disability, nocturia, or a disability manifested by an altered gait other than the claimed back disability, bilateral lower extremity radiculopathy, and left knee disability. With regard to the claimed sleep disorder, the Veteran reported having poor sleep due to mental health symptoms, but has never been noted to have a sleep disorder in nearly 20 years' worth of treatment records. Private treatment records dated in 1995 and 2003 are also silent for mention of Parkinson's disease, a sleep disorder, sinus disability, nocturia, or a disability manifested by an altered gait other than the claimed back disability, bilateral lower extremity radiculopathy, and left knee disability. The Board notes that the Veteran has not been afforded VA examinations for these claimed disabilities. Under applicable law, a medical examination and/or opinion is deemed "necessary" if the information and evidence of record does not contain sufficient competent medical evidence to decide the claim, but (1) contains competent lay or medical evidence of a current diagnosed disability or persistent or recurrent symptoms of disability; (2) establishes that the veteran suffered an event, injury, or disease in service, or has a disease or symptoms of a disease listed in 38 C.F.R. §§ 3.309, 3.313, 3.316, and 3.317 manifesting during an applicable presumptive period, provided the claimant has the required service or triggering event to qualify for that presumption; and (3) indicates that the claimed disability or symptoms may be associated with the established event, injury, or disease in service or with another service-connected disability. 38 C.F.R. § 3.159(c)(4). Here, there is no competent and credible evidence that the Veteran has diagnoses of Parkinson's disease, a sleep disorder, sinus disability, nocturia, or a disability manifested by an altered gait other than the claimed back disability, bilateral lower extremity radiculopathy, and left knee disability. As such, examinations are not required. In sum, the Board finds that the Veteran does not have current diagnosis of Parkinson's disease, a sleep disorder, sinus disability, nocturia, or a disability manifested by an altered gait other than the claimed back disability, bilateral lower extremity radiculopathy, and left knee disability, and has not had a relevant diagnosis at any time during the pendency of the claims. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); 38 C.F.R. § 3.303(a), (d). The Veteran contends that service connection is warranted for these disabilities, but the Board cannot rely on his assertions regarding medical diagnoses. The issues are medically complex, as they require specialized medical education and knowledge. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence, which is silent for diagnoses of Parkinson's disease, a sleep disorder, sinus disability, nocturia, or a disability manifested by an altered gait other than the claimed back disability, bilateral lower extremity radiculopathy, and left knee disability. Without competent evidence of relevant diagnosed disorders, service connection for the claimed disabilities cannot be awarded. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) ("In the absence of proof of a present disability, there can be no valid claim."); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004) (holding that service connection requires a showing of current disability). 9. Service connection for residuals of a right ear growth. 10. Service connection for residuals of a left knee strain. 11. Service connection for gynecomastia. 12. Service connection for an inguinal hernia. 13. Service connection for priapism. 14. Service connection for bilateral pulmonary embolism. 15. Service connection for parotid neoplasms. 16. Service connection for thrombocytopenia. 17. Service connection for Hepatitis C. The Board finds that although the Veteran has clearly been diagnosed with a right ear nodule, likely cystic; fall on left knee; gynecomastia; left inguinal hernia, status post repair procedure; priapism; bilateral pulmonary emboli; parotid gland mass, status post two parotidectomies; thrombocytopenia; and Hepatitis C; the weight of the evidence does not establish that the diagnoses are related to his active military service. STRs are silent for complaints, diagnosis, or treatment of any related conditions, including examinations conducted in February 1980 and June 1987, and the Veteran has not identified or submitted any medical evidence or supporting statements that would suggest that any of the current diagnoses are related to his military service. To the extent to which the Veteran argues continuity of symptoms since service, the record contradicts these assertions. In weighing credibility, VA may consider interest, bias, inconsistent statements, bad character, internal inconsistency, facial plausibility, self-interest, consistency with other evidence of record, malingering, desire for monetary gain, and demeanor of the witness. See generally Caluza v. Brown, 7 Vet. App. 498 (1995). As discussed above, STRs are silent for mention of relevant symptoms or diagnosis. Post-service VA treatment records indicate that the right ear nodule was diagnosed in January 2004, and the Veteran reported that he had noticed it 3-4 months prior; the left knee fall was reported in September 2021 and it had occurred several weeks ago; gynecomastia was diagnosed in July 2014, which the Veteran first noticed about four weeks prior; the left inguinal hernia was diagnosed in December 2009 and he had a repair procedure on it in April 2010; priapism was first reported in November 2005; bilateral pulmonary emboli were found in February 2013; the parotid gland mass was diagnosed in September 2004, and the Veteran reported a six-month history; thrombocytopenia was diagnosed in June 2005; Hepatitis C was diagnosed in October 2003. In sum, the earliest evidence of symptoms or diagnoses of a relevant condition was in 2003, which was 15 years after the Veteran's separation from active military service. As such, the Board finds that the Veteran's lay assertions alone are not sufficient to establish continuity since service. The Board notes that the Veteran has not been afforded VA examinations for these claimed disabilities. Under applicable law, a medical examination and/or opinion is deemed "necessary" if the information and evidence of record does not contain sufficient competent medical evidence to decide the claim, but (1) contains competent lay or medical evidence of a current diagnosed disability or persistent or recurrent symptoms of disability; (2) establishes that the veteran suffered an event, injury, or disease in service, or has a disease or symptoms of a disease listed in 38 C.F.R. §§ 3.309, 3.313, 3.316, and 3.317 manifesting during an applicable presumptive period, provided the claimant has the required service or triggering event to qualify for that presumption; and (3) indicates that the claimed disability or symptoms may be associated with the established event, injury, or disease in service or with another service-connected disability. 38 C.F.R. § 3.159(c)(4). Here, there is no competent and credible evidence event suggesting that the right ear nodule, fall on left knee, gynecomastia, left inguinal hernia, priapism, bilateral pulmonary emboli, parotid gland mass, thrombocytopenia, or Hepatitis C may be associated to the Veteran's military service. As such, examinations are not required. In sum, the probative evidence of record weighs against the claims for service connection for residuals of a right ear growth, residuals of left knee strain, gynecomastia, inguinal hernia, priapism, bilateral pulmonary emboli, parotid neoplasms, thrombocytopenia, and Hepatitis C. As the preponderance of the evidence is against the claims, the benefit-of-the-doubt doctrine does not apply. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). REASONS FOR REMAND 1. Entitlement to service connection for residuals of a head trauma is remanded. 2. Entitlement to service connection for hypertension is remanded. 3. Entitlement to service connection for anemia is remanded. 4. Entitlement to service connection for monoclonal gammopathy is remanded. The Veteran asserts that his head trauma occurred when he fell off a cliff in service. He also claims, without further elaboration, that the claimed hypertension, anemia, and monoclonal gammopathy occurred in or are due to service. See the December 2014 claim for disability benefits. STRs indicate that in March 1972, the Veteran was found to have labile hypertension of unknown etiology. In December 1976, the Veteran reported being injured when he fell off a cliff, and was treated for an acute lumbosacral strain. In a February 1980 report of medical history, the Veteran was noted to have had a broken jaw in August 1979. In December 1982, the Veteran was involved in a traffic accident and was seen for a laceration on his mid-forehead. No neurological deficits were found, but he was told to follow instructions on a "head trauma sheet." In April 1986, the Veteran was assessed as having microcytic anemia; and in June 1987, he was found to have anemia after reporting symptoms of fatigue, oversleeping, and having problems getting up. Post-service VA treatment records indicate that the Veteran was diagnosed with anemia in January 2004, which was noted to be "likely due to nutritional deficiencies" due to chronic alcohol and tobacco abuse. In June 2004, he was noted to microcytic anemia. In May 2005, bloodwork showed that the Veteran did not anemia, but he did have monoclonal gammopathy. In January 2014, the Veteran was noted to have "significant asymptomatic hypertension," for which he declined starting treatment. As such, the Board finds that the evidence of record supports the need for VA medical opinions on the issues. See McLendon v. Nicholson, 20 Vet. App. 79 (2006), 38 U.S.C. § 5103A(d). 5. Entitlement to service connection for PTSD is remanded. 6. Entitlement to service connection for depression. In an April 2015 formal finding, it was determined that there was insufficient evidence to forward to the U.S. Army and Joint Services Records Research Center (JSRRC) for corroboration of the claimed PTSD stressors. The memorandum noted that the Veteran had not responded to requests for details of the claimed stressors. In August 2018, however, the Veteran submitted a stressor statement, noting four stressors. Accordingly, remand is warranted to verify the claimed stressors. In addition, VA treatment records indicate that in February 2017, the Veteran was diagnosed with PTSD and treatment records also reflect a diagnosis of depression; however, the diagnosis appears to be based significantly on a non-service related incident. Specifically, the Veteran asserted that his father was abusive and one day he gave his mother a gun. His mother pulled the trigger and killed his father. Accordingly, the Board finds that the Veteran should be afforded a VA examination to determine the nature and etiology of the claimed PTSD and depression. 7. Entitlement to an increased rating for bilateral hearing loss is remanded. The Veteran was most recently examined for this disability in June 2015. It is unclear to the Board whether his hearing has worsened since then; however, in a September 2021 Informal Hearing Presentation, the Veteran's representative requested that a new VA audiological examination be scheduled to determine the current severity of the Veteran's hearing loss disability. As such, a new audiological examination is needed to determine the severity of the service-connected hearing loss. See 38 U.S.C. § 5103A(d); Chotta v. Peake, 22 Vet. App. 80, 84 (2008). In addition, VA treatment records indicate that the Veteran had an audiological evaluation in June 2018. The audiogram results, however, are noted to be located in the Computerized Patient Record System (CPRS) and/or VistA Imaging, neither of which the Board has access to view. As such, remand is required to obtain this audiogram. The matters are REMANDED for the following action: 1. Send the claims file to an appropriate VA examiner and ask the examiner to review the record and prepare a medical opinion on the etiology of the claimed residuals of a head trauma, hypertension, anemia, and monoclonal gammopathy. After reviewing the entire record, the examiner should note any current diagnosis relevant to the claimed head trauma, hypertension, anemia, and/or monoclonal gammopathy. For each diagnosis, the examiner should provide a medical opinion on whether it is at least as likely as not (50 percent probability or greater) that the diagnosis is related to incident, injury, or event in active service, to include discussion of relevant STRs and post-service diagnoses. A thorough rationale should be provided for all opinions expressed. If any requested medical opinion cannot be given, the examiner should state the reason(s) why. If the VA examiner determines that further examination is necessary in order to render the requested medical opinions, the AOJ should schedule the Veteran for such an examination. 2. Attempt to verify the Veteran's reported PTSD stressors, to include contacting the appropriate sources, and document these attempts in the claims file. 3. Schedule the Veteran for a VA psychiatric examination to determine the nature and etiology of any mental health disorder to include PTSD and depression. The entire claims file, including a copy of this REMAND, must be reviewed by the examiner in conjunction with the examinations. All indicated studies, tests, and evaluations deemed necessary should be performed. If the Veteran is diagnosed with PTSD, the examiner must explain how the diagnostic criteria are met and whether PTSD is at least as likely as not related to an in-service injury, event, or disease. The examiner should additionally state whether the Veteran's claimed stressors are adequate to support a diagnosis of PTSD and whether PTSD is at least as likely as not related to the claimed fear of hostile military or terrorist activity. For any diagnosis other than PTSD, the examiner should provide a medical opinion on whether it is at least as likely as not (50 percent probability or greater) that the diagnosis is related to incident, injury, or event in active service, to include discussion of relevant STRs and post-service diagnoses. 4. Associate with the claims file all relevant VA audiological treatment records dated from November 2012 to present, to include associating all audiogram results located in CPRS and/or scanned into VistA Imaging. 5. Schedule the Veteran for a VA audiology examination to determine the nature and severity of the service-connected hearing loss. The entire claims file, including a copy of this REMAND, must be reviewed by the examiner in conjunction with the examinations. All indicated studies, tests, and evaluations deemed necessary should be performed. The examiner should report the severity of the Veteran's hearing loss in terms conforming to the applicable rating criteria. The examiner should also describe the functional effects caused by the Veteran's hearing loss, to include any effects on employment and daily life. (Continued on the next page) The examiner should clearly outline the rationale for any opinion expressed. If any requested medical opinion cannot be given, the examiner should state the reason(s) why. H. SEESEL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board N. Nelson 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.