Citation Nr: 21077563 Decision Date: 12/30/21 Archive Date: 12/30/21 DOCKET NO. 20-20 518 DATE: December 30, 2021 ORDER The appeal for service connection for tinnitus is dismissed. The appeal for service connection for sleep apnea is dismissed. New and material evidence having been received, the application to reopen the previously denied claim for service connection for gastroesophageal reflux disease (GERD) is granted. New and material evidence having been received, the application to reopen the previously denied claim for service connection for dermatitis is granted. New and material evidence having been received, the application to reopen the previously denied claim for service connection for a bilateral eye disability is granted. New and material evidence having been received, the application to reopen the previously denied claim for service connection for a right Achilles disability is granted. New and material evidence having been received, the application to reopen the previously denied claim for service connection for a right calf disability is granted. New and material evidence having been received, the application to reopen the previously denied claim for service connection for a right bundle branch block is granted. Service connection for a right upper extremity nerve disorder is granted. Service connection for a left upper extremity nerve disorder is granted. Service connection for dermatitis is granted. Service connection for an acquired psychiatric disability is granted. Service connection for a right ankle disability, to include as secondary to the service-connected right and/or left leg residuals of tibial stress fractures, is denied. Service connection for a left ankle disability, to include as secondary to the service-connected right and/or left leg residuals of tibial stress fractures, is denied. Service connection for a right calf disability, to include as secondary to the service-connected right and/or left leg residuals of tibial stress fractures, is denied. Service connection for a right Achilles disability, to include as secondary to the service-connected right and/or left leg residuals of tibial stress fractures, is denied. A compensable rating for the service-connected hypertension is denied. REMANDED Service connection for bilateral hearing loss is remanded. Service connection for GERD is remanded. Service connection for a bilateral eye disability is remanded. Service connection for a skin disability, other than dermatitis, manifested by an intermittent rash of the bilateral lower extremities, claimed as MRSA, is remanded. Service connection for a heart disability, to include a right bundle branch block, and to include as secondary to the service-connected hypertension, is remanded. Entitlement to a compensable rating for the service-connected right leg residuals of tibial stress fracture is remanded. Entitlement to a compensable rating for the service-connected left leg residuals of tibial stress fracture is remanded. Entitlement to a rating in excess of 30 percent for the service-connected bilateral plantar fasciitis is remanded. Entitlement to an initial rating in excess of 10 percent for the service-connected thoracolumbar strain is remanded. Entitlement to a total disability rating based on individual unemployability due to service-connected disability (TDIU), to include on an extraschedular basis, is remanded. FINDINGS OF FACT 1. At the October 2021 hearing (before the promulgation of a decision), the Veteran explicitly, unambiguously, and with a full understanding of the consequences, notified the Board of Veterans' Appeals (Board) that he wished to withdraw his appeals for service connection for tinnitus and sleep apnea. The withdrawals were affirmed in writing submitted to VA by his representative later that same day. 2. A January 2012 rating decision denied service connection for GERD. The Veteran did not perfect an appeal on this issue, and new and material evidence was not received within the time period needed to prevent finality of that decision. 3. Evidence associated with the file since the January 2012 rating decision includes evidence that relates to an unestablished fact necessary to substantiate the claim, is neither cumulative nor redundant of evidence already of record, and raises a reasonable possibility of substantiating the claim for service connection for GERD. 4. An August 2011 rating decision denied the claims for service connection for dermatitis; a bilateral eye twitch; a right Achilles disability; a right calf disability; and a right bundle branch block. The Veteran did not perfect an appeal on these issues, and new and material evidence was not received within the time period needed to prevent the decision from becoming final. 5. The evidence associated with the file since the August 2011 rating decision includes evidence that relates to unestablished facts necessary to substantiate the claims, is neither cumulative nor redundant of evidence already of record, and raises a reasonable possibility of substantiating the claims for service connection for dermatitis; a bilateral eye twitch; a right Achilles disability; a right calf disability; and a right bundle branch block. 6. Affording the Veteran any benefit of the doubt, he has a current right upper extremity nerve disorder which is etiologically related to service. 7. Affording the Veteran any benefit of the doubt, he has a current left upper extremity nerve disorder which is etiologically related to service 8. Affording the Veteran any benefit of the doubt, he has a current diagnosis of dermatitis which is etiologically related to service. 9. Affording the Veteran any benefit of the doubt, his acquired psychiatric disability is etiologically related to active service. 10. The most competent evidence of record fails to show that the Veteran has been diagnosed with a right ankle disability at any time during the period on appeal. 11. The most competent evidence of record fails to show that the Veteran has been diagnosed with a left ankle disability at any time during the period on appeal. 12. The most competent evidence of record fails to show that the Veteran has been diagnosed with a right calf disability other than that for which he is already service-connected at any time during the period on appeal. 13. The most competent evidence of record fails to show that the Veteran has been diagnosed with a right Achilles disability at any time during the period on appeal. 14. The Veteran's hypertension has not been shown to manifest with blood pressure readings with the diastolic pressure predominantly at 100 or greater or with the systolic pressure predominantly at 160 or greater at any time during the period on appeal. CONCLUSIONS OF LAW 1. The criteria for withdrawal of the appeals for service connection for tinnitus and sleep apnea are met. 38 U.S.C. § 7105; 38 C.F.R. § 19.55. 2. The January 2012 rating decision that denied service connection for GERD is final. 38 U.S.C. § 7105 (2012); 38 C.F.R. §§ 3.104, 20.302, 20.1103 (2011). 3. The evidence received since the January 2012 rating decision is new and material evidence and serves to reopen the Veteran's claim for service connection for GERD. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. § 3.156(a). 4. The August 2011 rating decision that denied service connection for dermatitis; a bilateral eye twitch; a right Achilles disability; a right calf disability; and a right bundle branch block is final. 38 U.S.C. § 7105 (2006); 38 C.F.R. §§ 3.104, 20.302, 20.1103 (2011). 5. The evidence received since the August 2011 rating decision is new and material evidence and serves to reopen the Veteran's claims for service connection for dermatitis; a bilateral eye twitch; a right Achilles disability; a right calf disability; and a right bundle branch block. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. § 3.156(a). 6. The criteria for service connection for a right upper extremity nerve disorder have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 7. The criteria for service connection for a left upper extremity nerve disorder have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 8. The criteria for service connection for dermatitis have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 9. The criteria for service connection for an acquired psychiatric disability have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 10. The criteria for service connection for a right ankle disability, on direct and secondary bases, are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 11. The criteria for service connection for a left ankle disability, on direct and secondary bases, are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 12. The criteria for service connection for a right calf disability, on direct and secondary bases, are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 13. The criteria for service connection for a right Achilles disability, on direct and secondary bases, are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 14. The criteria for a compensable rating for the service-connected hypertension have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.104, Diagnostic Code (DC) 7101. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from June 2006 to July 2010. In October 2021, the Veteran testified at a hearing before the undersigned Veterans Law Judge (VLJ). A number of the service connection issues on appeal have been recharacterized as above to reflect better the medical evidence of record and the Veteran's contentions. Dismissal Service Connection for Tinnitus and Sleep Apnea The Board may dismiss any appeal which fails to allege specific error of fact or law in the determination being appealed. 38 U.S.C. § 7105. An appeal may be withdrawn as to any or all issues involved in the appeal at any time before the Board promulgates a decision. 38 C.F.R. § 20.204. A veteran or his/her authorized representative may make the withdrawal. 38 C.F.R. § 20.204. At the October 2021 hearing, the Veteran explicitly and unambiguously, and with a full understanding of the consequences, withdrew his appeals for service connection for tinnitus and sleep apnea. The undersigned clearly identified the withdrawn issues, and the Veteran affirmed that he was requesting a withdrawal as to these appeals. His representative further confirmed his desire to withdraw these appeals in a written statement submitted to VA later that same day. As the Veteran has withdrawn these appeals, there remain no allegations of errors of fact or law for appellate consideration of these issues. The Board does not have jurisdiction to review them, and they are dismissed. New and Material Evidence A claimant may reopen a finally adjudicated claim by submitting new and material evidence. New evidence means existing evidence not previously submitted to agency decisionmakers. 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 U.S.C. § 5108; 38 C.F.R. § 3.156(a). Regardless of how the Regional Office (RO) decided a reopening question, the Board must consider the matter on appeal. Reopening is a threshold jurisdictional question for the Board. Jackson v. Principi, 265 F.3d 1366 (Fed. Cir. 2001). The United States Court of Appeals for Veterans Claims (Court) has held that the credibility of evidence must be presumed for the purpose of deciding whether it is new and material. Justus v. Principi, 3 Vet. App. 510, 513 (1992). The United States Court of Appeals for the Federal Circuit has held, however, that evidence that is merely cumulative of other evidence in the record cannot be new and material, even if that evidence had not been previously presented to the Board. Anglin v. West, 203 F.3d 1343 (Fed. Cir. 2000). When deciding whether received evidence meets the definition of new and material evidence, the Board is cognizant of whether that evidence could, if the claim were reopened, reasonably result in substantiation of the claim. Shade v. Shinseki, 24 Vet. App. 110 (2010). GERD In a January 2012 rating decision, the RO denied service connection for the Veteran's GERD because there was not sufficient evidence that the Veteran had a chronic GERD condition since originally being diagnosed with such in service in 2008. The Veteran did not perfect an appeal on this denial, nor did he submit any additional evidence within the time frame needed to prevent it from becoming final. 38 C.F.R. § 3.156(b); Bond v. Shinseki, 659 F.3d 1362 (Fed. Cir. 2011). Thus, the January 2012 rating decision became final as to this issue, based on the evidence then of record. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.104(a), 20.302, 20.1103. The evidence added to the record since the January 2012 rating decision includes the Veteran's October 2021 testimony before the Board, when he described his current symptoms of acid reflux that had continued since service when he was first diagnosed with GERD. This evidence, presumed as credible for new and material purposes, relates to an element of the Veteran's appeal that was not met when the claim was denied in January 2012. Thus, this evidence is neither cumulative nor redundant of the evidence of record and raises a reasonable possibility of substantiating the claim for service connection for GERD. The claim is reopened. Dermatitis; a Bilateral Eye Disability; a Right Achilles Disability; a Right Calf Disability; and a Right Bundle Branch Block In an August 2011 rating decision, the RO denied service connection for dermatitis; a bilateral eye twitch; a right Achilles disability; a right calf disability; and a right bundle branch block because there was not sufficient evidence that the Veteran currently suffered from these chronic conditions. The Veteran did not perfect an appeal on these denials, nor did he submit any additional evidence within the time frame needed to prevent them from becoming final. 38 C.F.R. § 3.156(b); Bond v. Shinseki, 659 F.3d 1362 (Fed. Cir. 2011). Thus, the August 2011 rating decision became final as to these issues, based on the evidence then of record. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.104(a), 20.302, 20.1103. The evidence added to the record since the August 2011 rating decision includes the Veteran's October 2021 testimony before the Board, when he described the eye symptoms which he continued to experience since service and alluded to currently having all other claimed conditions due to incidents of service. This evidence, presumed as credible for new and material purposes, relates to an element of the Veteran's appeals that was not met when the claims were denied in August 2011. Thus, this evidence is neither cumulative nor redundant of the evidence of record and raises a reasonable possibility of substantiating the claims for service connection for dermatitis; a bilateral eye twitch; a right Achilles disability; a right calf disability; and a right bundle branch block. As such, the claims are reopened. Service Connection Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C. §§ 1110; 38 C.F.R. § 3.303. Service connection requires competent evidence showing: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Furthermore, a layperson is competent to report on the onset and continuity of his or her current symptomatology. Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a veteran is competent to report on that of which he or she has personal knowledge). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall resolve reasonable doubt in favor of the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518 (1996). Bilateral Upper Extremity Nerve Disorders The Veteran seeks service connection for bilateral upper extremity nerve disorders, originally claimed as carpal tunnel syndrome of the right and left upper extremities. In this regard, the Veteran underwent a VA peripheral nerves conditions examination in April 2018 to determine the etiology of his claimed bilateral upper extremity carpal tunnel syndrome. The examiner found that the Veteran did not have carpal tunnel syndrome of either upper extremity, but diagnosed the Veteran with bilateral ulnar nerve entrapment. The Board acknowledges that the Veteran reported to this examiner that he had been diagnosed with bilateral carpal tunnel syndrome, but there is no medical evidence confirming such a diagnosis. Significantly, and in any event, the Veteran has uncontested diagnoses of bilateral upper extremity nerve disorders other than carpal tunnel syndrome. As such, the current disability prong of these claims for service connection have been met. Further, the Veteran reported to the April 2018 VA peripheral nerves conditions examiner that he began to notice his bilateral upper extremity nerve symptoms in 2007 while he was stationed in Norfolk, Virginia, in service. At that time, he began to experience bilateral hand numbness and tingling after working at a computer for long periods of time. Further, he reported that the symptoms had continued at the same severity since they began during service. The Board recognizes that the 2018 VA examiner opined against service connection for bilateral upper extremity carpal tunnel syndrome because the Veteran did not meet the diagnostic criteria for carpal tunnel syndrome in either upper extremity. However, while the Board cannot ignore or disregard the VA examiner's medical conclusion [Willis v. Derwinski, 1 Vet. App. 66 (1991)], the Board is free to assess medical evidence and is not compelled to accept a medical opinion. Wilson v. Derwinski, 2 Vet. App. 614 (1992). Here, the 2018 VA examiner did not render a nexus opinion on the conditions with which the Veteran was actually diagnosed. As such, this examiner's opinion against service connection for carpal tunnel syndrome holds no probative value to the issue of a medical nexus for bilateral upper extremity ulnar nerve entrapment. In this case, the Veteran has sufficiently asserted experiencing symptoms of his diagnosed bilateral upper extremity nerve disorders since active service, and this lay evidence is not contradicted by any competent, probative medical opinion of record. As such, the evidence supporting service connection is at least in equipoise. Affording the Veteran any benefit of the doubt, service connection is warranted for his right and left upper extremity nerve disorders. Dermatitis The Veteran also seeks service connection for dermatitis. He testified before the Board in October 2021 that this condition began during active service. It manifests as a rash on his face, particularly after shaving. His VA treatment records confirm that he has a current diagnosis of dermatitis and treated with VA in 2018 for the condition. As such, the current disability prong of this claim is met, and the remaining issue is whether the disability is medically related to any incident of active service or whether it onset therein. The Veteran's service treatment records confirm that he sought medical treatment numerous times in service for dermatitis. Further, they reveal that he was prescribed a topical cream with instructions to apply to the affected area after shaving. Moreover, he was clinically evaluated as normal as to his skin on his 2006 entrance examination and reported no history of skin conditions on the concurrent report of medical history. The medical evidence supports his competent testimony as to the nature and history of his dermatitis symptoms onsetting in service. The Veteran has not been afforded a VA skin conditions examination to address the etiology of his current dermatitis. As such, there are no negative nexus opinions of record which refute his account of the onset of this condition. In light of the above, the Board finds that the Veteran has sufficiently asserted experiencing symptoms of his dermatitis since active service, and this lay evidence is not contradicted by any competent, probative medical opinion of record. To the contrary, it is actually supported by his medical records. As such, the evidence supporting service connection is at least in equipoise. Affording the Veteran any benefit of the doubt, service connection is warranted for his dermatitis. Acquired Psychiatric Disability The Veteran also seeks service connection for an acquired psychiatric disability, claimed as posttraumatic stress disorder (PTSD). In this regard, his in-service stressors have not yet been verified to support a claim for service connection for PTSD. However, his VA treatment records reveal that he has other acquired psychiatric diagnoses, including a mood disorder. As such, the current disability prong of this claim for service connection has been met. Further, the Veteran testified before the Board in October 2021 that he began to notice his psychiatric symptoms during service following a particularly traumatic personal assault situation involving a confrontation with a fellow servicemember who had pulled loaded gun on another servicemember. He also testified that none of his psychiatric symptoms existed prior to his entry into active service and that the symptoms have continued since they onset therein. The Board finds the Veteran's competent lay reports as to the onset of his symptoms to be credible, as there is no reason to doubt his consistent, competent statements regarding their onset. Further, his testimony alone is sufficient to establish the in-service onset for his acquired psychiatric disability. The Board acknowledges that the Veteran has not been afforded a VA examination to determine the etiology of any acquired psychiatric disability. Thus, there are no VA etiological opinions which contradict a finding that the condition onset in service. Also, his medical treatment records do not contain any other persuasive medical opinions which challenge his reported onset of acquired psychiatric symptoms. Thus, his statements are not contradicted by any competent medical evidence of record. In light of the above, and in affording any benefit of the doubt to the Veteran, the weight of the evidence supports a finding that symptoms of Veteran's acquired psychiatric disability onset in service and have continued since then. Accordingly, service connection for an acquired psychiatric disability is warranted, as it is a current disability that onset in active service. Bilateral Ankle Disabilities; Right Calf Disability; and Right Achilles DisabilityAll to Include as Secondary to the Service-Connected Right and/or Left Leg Residuals of Tibial Stress Fractures The Veteran also seeks service connection for right and left ankle disabilities, a right calf disability, and a right achilles disability, all claimed as to include as secondary to the service-connected right and/or left leg residuals of tibial stress fractures. Although the Veteran testified before the Board in October 2021 that he has all of these disabilities due to incidents of service, the totality of the evidence is against a finding that he has current left or right ankle disabilities, a current right calf disability for which he is not already service-connected; or a right Achilles disability. VA treatment records spanning the period on appeal are silent for his having mentioned ankle issues, right calf issues not already service-connected by the service-connected residuals of right leg residuals of tibial stress fracture, or a right Achilles disability. To the contrary, the Veteran was afforded multiple VA examinations throughout the appeal period which failed to show diagnoses of such. Specifically, the Veteran underwent an April 2018 VA foot conditions examination where the examiner did not diagnose the Veteran with having, or having had, any right Achilles disability. The Veteran underwent VA knee and lower leg conditions examinations in April 2018 and in December 2021. Neither examination diagnosed a right calf disability which was not already considered part of the Veteran's service-connected right leg residuals of tibial stress fracture. Further, neither examination noted the Veteran had any ankle conditions or symptoms. There is simply no evidence that the Veteran has been diagnosed with a bilateral ankle disability, right calf disability not already service-connected by his service-connected right leg residuals of tibial stress fracture, or a right achilles disability at any time during the appeal period. He has not identified any medical evidence which would support a current diagnosis for any of these claimed conditions. While the Board does not doubt that the Veteran is sincere in his belief that he has these disabilities, he is not competent to provide diagnoses of such conditions. The issues are medically complex, as they require expert medical knowledge of the systems involved. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence, or lack thereof. Symptoms alone, even without an underlying diagnosis, can still constitute a current disability for VA compensation purposes if they reach the level of a functional impairment of earning capacity. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). However, the Veteran has not alleged, and the weight of the evidence does not reflect, that his claimed bilateral ankle disabilities, right calf disability, or right achilles condition has had this effect. Even giving him the benefit of the doubt as to whether he experiences current symptoms of these claimed conditions, given the lack of such complaints ever having been made to medical providers, it would not rise to the level sufficient to satisfy the current disability prongs of service connection claims. To warrant service connection, the threshold requirement is competent evidence of the existence of the claimed disability at some point during a veteran's appeal. McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). While the Board recognizes the Veteran's sincere belief in his bilateral ankle disability; right calf disability; and right Achilles disability claims and descriptions of his symptoms, the most competent evidence of record does not show that he has a right or left ankle disability; a right calf disability; or a right Achilles disability at any time during this appeal. Accordingly, the record does not support the claims for service connection for a right or left ankle disability, a right calf disability, or a right Achilles disability. In reaching this determination, the Board is mindful that all reasonable doubt is to be resolved in the Veteran's favor. Gilbert, 1 Vet. App. at 53-56. However, because the preponderance of the evidence is against the claims, the claims must be denied. Increased Rating -- Hypertension Disability ratings are determined by applying the criteria set forth in the VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity resulting from disability. Separate DCs identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. If two ratings are potentially applicable, the higher rating will be assigned if the disability picture more nearly approximates the criteria for the higher rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. 38 C.F.R. § 4.3. A veteran's entire history is to be considered when assigning disability ratings. 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). The Board will consider entitlement to staged ratings to compensate for times since filing the claim when the disability may have been more severe than at other times during the course of the claim on appeal. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). The Veteran seeks a higher rating than that currently assigned for his service-connected hypertension. His hypertension has been rated noncompensable throughout the period on appeal under DC 7101. This Diagnostic Code provides that a 10 percent rating is assigned for diastolic pressure predominately 100 or more or systolic pressure predominantly 160 or more, or an individual with a history of diastolic blood pressure predominately 100 or more requiring continuous medication for control. A 20 percent rating is assigned for diastolic pressure predominately 110 or more or systolic pressure predominantly 200 or more. A 40 percent rating is assigned for diastolic pressure predominantly 120 or more. A 60 percent rating is assigned for diastolic pressure predominantly 130 or more. 38 C.F.R. § 4.104, DC 7101. Further, Note (1) to this diagnostic code states that hypertension must be confirmed by readings taken two or more times on at least three different days. Id. at Note (1). For purposes of this section, hypertension means that the diastolic blood pressure is predominantly 90mm. or greater. Id. The VA regulations do not define the term "predominantly." The Merriam Webster dictionary defines the term "predominantly" as "for the most part" or "mainly." See Predominantly Definition, Merriam-Webster.com, available at https://www.merriam-webster.com/dictionary/predominantly (last visited December 15, 2021) (defining the term "predominantly" as "for the most part" or "mainly.") Thus, in order for the Veteran to meet the criteria for a compensable rating, the evidence must show, at the very least, that his diastolic pressure is predominantly at 100 or that his systolic pressure is predominantly at 160. Such has not been shown. In 2018, the Veteran was afforded a VA hypertension examination. The examination consisted of his blood pressure readings being taken over three days. The examination report noted that he was not taking blood pressure medication. On examination, his blood pressure (or "BP") readings on day one were: 130/90; 130/88; and 128/88. 127/82, 118/73, and 117/71. The BP readings on day two were: 130/88; 130/86 and 130/90. The BP readings on day three were: 128/90; 126/86; and 128/90. Thus, the Veteran's diastolic pressures were never even near 100, much less mainly 100; nor were his systolic pressure reading ever near 160, much less mainly 60. The VA examiner even noted that the Veteran had a chronic condition of hypertension which was then in remission. Further, the Veteran testified before the Board in October 2021 regarding the severity of his hypertension. At that time, he stated that his hypertension had improved immensely from where it had been in service. A thorough review of the Veteran's treatment records did not reveal that his blood pressure readings therein were any more severe than shown on the 2018 VA examination. Accordingly, based on a review of the above evidence, the Board concludes that entitlement to a compensable rating for the service-connected hypertension is not warranted. He has not met the schedular criteria for a compensable rating under DC 7101 for his hypertension, and the claim must be denied. REASONS FOR REMAND Service connection for bilateral hearing loss The Veteran also seeks service connection for bilateral hearing loss. His VA treatment records show that he underwent audiological testing with VA in December 2017 and was found to have bilateral sensorineural hearing loss. However, the audiometric data from this hearing test has not been associated with the claims file. The Veteran also went a VA audiological examination in April 2018, at which time the examiner found that the Veteran did not have hearing loss in either ear. However, the examiner also noted that the Veteran had to undergo audiometric and speech recognition testing multiple times before she came to this conclusion, as his responses were not consistent in both ears. As such, the Board finds that a new VA examination is needed before it can decide this claim, given the inconsistent nature of findings in the record regarding whether the Veteran has hearing loss in either ear for VA purposes. Further, the audiometric data from the Veteran's December 2017 audiological testing must also be obtained for review as it could help substantiate his claim for service connection for bilateral hearing loss. Service connection for GERD The Veteran also seeks service connection for GERD. He was initially denied service connection for GERD because he failed to appear without good cause at a September 2011 VA examination to determine the nature of his claimed GERD disability. As his Service Treatment Records (STRs) reflect that he was diagnosed with GERD in service and he testified before the Board that his symptoms have continued since they onset in service, but his VA treatment records are silent for any complaints related to or any diagnosis of GERD, a VA examination is imperative to determine whether he has a current diagnosis of GERD. The record is not clear as to why the Veteran failed to appear at the examination in September 2011 without good cause. Regardless, such an examination was to have occurred prior to the current appeal period, and the Board finds that the Veteran should be given another opportunity to report for a VA examination with regard to the current appeal. By this Remand, however, the Veteran is hereby notified that, while VA has a statutory duty to assist a veteran in developing evidence pertinent to a claim, he/she also has a duty to assist and cooperate with the VA in developing evidence. In other words, VA's duty to assist is not a one-way street. If a veteran wishes help, he or she cannot passively wait for it in those circumstances where he or she may or should have information that is essential in obtaining the relevant evidence. Wood v. Derwinski, 1 Vet. App. 190 (1991); Hayes v. Brown, 5 Vet. App. 60, 68 (1993). VA's duty must be understood as a duty to assist a veteran in developing his or her claim, rather than a duty on the part of VA to develop the entire claim with the veteran performing only a passive role. Turk v. Peake, 21 Vet. App. 565, 568 (2008). Service connection for a bilateral eye disability The Veteran seeks service connection for a bilateral eye disability. He was initially denied service connection for this condition because, although he had indicated on his claim application prior to separating from service that he suffered from symptoms of a bilateral eye condition (i.e., eye twitches), he failed to appear for a VA eye conditions examination in November 2010 without showing good cause. Thus, the RO determined that there was insufficient evidence of a current disability. Here, the record reflects that the Veteran's eye symptoms began during service, and he testified before the Board in October 2021 that they continued since that time and have even worsened to the point where one eye lid now droops and is not as easy to control as the other. However, because his VA treatment records are silent for any complaints or treatment related to any diagnosed bilateral eye disability, a VA examination is imperative to determine whether the Veteran has a current diagnosable bilateral eye disability. The record is not clear as to why the Veteran failed to appear at the examination in November 2010 without good cause. Regardless, such an examination was to have occurred prior to the current appeal period, and the Board finds that the Veteran should be given another opportunity to report for a VA examination with regard to the current appeal. By this Remand, however, the Veteran is again hereby notified that, while VA has a statutory duty to assist a veteran in developing evidence pertinent to a claim, he/she also has a duty to assist and cooperate with the VA in developing evidence. In other words, VA's duty to assist is not a one-way street. If a veteran wishes help, he or she cannot passively wait for it in those circumstances where he or she may or should have information that is essential in obtaining the relevant evidence. Wood, 1 Vet. App. at 193; Hayes, 5 Vet. App. at 68. VA's duty must be understood as a duty to assist a veteran in developing his or her claim, rather than a duty on the part of VA to develop the entire claim with the veteran performing only a passive role. Turk, 21 Vet. App. at 568. Service connection for a skin condition, other than dermatitis, manifested by an intermittent rash of the bilateral lower extremities, claimed as MRSA The Veteran also seeks service connection for a skin condition he asserts was caused by exposure to MRSA in service. The Veteran's VA treatment indicate that he has suffered from MRSA-related skin conditions during the period on appeal. However, the nature and etiology of his skin disorders are not clear from the treatment records. The Veteran testified that his MRSA-related skin condition manifests on his lower extremities and that it began to appear during service. In this regard, his service treatment records show that he sought treatment in service in August 2009 for a rash on his legs. Although the Veteran did not know how he acquired the rash, he was assessed with poison ivy at the time. Given the likelihood that such an assessment may have been speculative in nature, and given that the Veteran has testified that his current MRSA-related skin condition manifests as a rash on his legs that comes and goes and onset in service, a VA examination is needed to address the nature and etiology of this disability as the Veteran has not yet been afforded one. Service connection for a heart disability, to include a right bundle branch block, and to include as secondary to the service-connected hypertension The Veteran also seeks service connection for a heart disability, claimed as a right bundle branch block, which he asserts is either directly related to service or secondary to his service-connected hypertension. His STRS reveal that he underwent an EKG in December 2009 which revealed that he had a borderline 1st degree VA block and an incomplete right bundle branch block. He underwent a VA general medical conditions examination in September 2010. The examination report, however, is unclear as to whether the Veteran has a chronic heart condition. For example, the examination report states that the Veteran's heart had right atrial enlargement and ST elevation, possibly pericarditis, and that his ECG was abnormal. Further down on the same page of the report, however, the examiner stated that no heart abnormality had been diagnosed. In light of the above, the Board finds that a new VA examination is needed to determine the nature and etiology of any current heart condition the Veteran has or has had at any time during the pendency of the appeal. Entitlement to compensable ratings for the service-connected right and left leg residuals of tibial stress fractures The Veteran also seeks higher ratings for his service-connected right and left leg residuals of tibial stress fractures. He testified before the Board in October 2021 that these conditions had worsened since he was last examined by VA for the severity of these disabilities in April 2018. However, in conjunction with development initiated by the RO subsequent to the Veteran filing a claim for a TDIU in August 2021, he was afforded a new VA knee and lower leg conditions examination in December 2021. That examination was inadequate as the examination report contains contradictory information regarding additional functional loss for the Veteran's disabilities after repeated use over time and as the examiner failed to complete sections needed for rating bilateral shin splints, which are part of these service-connected disabilities. A new VA examination with a different examiner is needed before the Board can decide these claims. Entitlement to a rating in excess of 30 percent for the service-connected bilateral plantar fasciitis The Veteran also seeks a higher rating for his service-connected bilateral plantar fasciitis. He testified before the Board in October 2021 that his bilateral plantar fasciitis had worsened since he was last examined by VA for the severity of this disability in April 2018. He should be afforded a new VA examination to ascertain the current severity of his bilateral plantar fasciitis before final appellate review. Entitlement to an initial rating in excess of 10 percent for the service-connected thoracolumbar strain. The Veteran also seeks a higher rating for his service-connected thoracolumbar strain. He testified before the Board in October 2021 that his back had worsened since he was last examined by VA for the severity of this disability in May 2018. He should be afforded a new VA examination to ascertain the current severity of his thoracolumbar strain before the Board can decide this claim. Entitlement to a TDIU, to include on an extraschedular basis A claim for a TDIU rating is part of an increased rating claim when such claim is raised by the record. Rice v. Shinseki, 22 Vet. App. 447, 453 (2009). Here, in light of the Veteran's assertions that his service-connected disabilities, particularly his bilateral lower extremity residuals of tibial fractures, have precluded him from obtaining and/or maintaining substantially gainful employment, the issue of entitlement to a TDIU is raised by the record, is part and parcel of the higher rating claims on appeal, and is thus properly before the Board. A remand of this issue is necessary in light of the grants decided herein. Indeed, when a veteran is unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities but fails to meet the schedular requirements for TDIU set forth in 38 C.F.R. § 4.16(a), the case may be referred to VA's Director of Compensation Service for consideration of TDIU on an extraschedular basis. Prior to being assigned disability ratings for disabilities for which service connection has been granted herein, the Veteran has not met the schedular criteria for TDIU at any time during the appeal period. Further, the record reflects that the RO is currently in the process of developing the Veteran's TDIU claim, having recently requested employment information from the Veteran's prior employers and from the Veteran. Should the requested development result in evidence supporting a TDIU, and should the ratings assigned to disabilities for which service connection is granted herein not allow him to meet the schedular criteria for TDIU, the case must be referred to VA's Director of Compensation Service for consideration. Accordingly, these matters are REMANDED for the following action: 1. Locate and associate with the Veteran's file his complete December 2017 VA audiology treatment records, to include audiometric results (pure tone testing, audiograms, speech reception thresholds, word recognition and discrimination scores, and all other audiometric data). 2. Schedule the Veteran for an appropriate VA examination to determine the nature and etiology of any right and/or left ear hearing loss he may have. The examiner should review the entire claims file, conduct all necessary tests and studies, and provide the requested opinions for the disability of right and/or left ear hearing loss, if such is diagnosed: Is it at least as likely as not (i.e., 50 percent probability or greater) that any right and/or left ear hearing loss onset in, or is otherwise related to, the Veteran's service or any incident therein, to include the in-service noise exposure to which he testified at the October 2021 Board hearing? The examiner is advised that the absence of in-service evidence of a hearing disability during service is not always fatal to a service connection claim. Evidence of a current hearing loss disability and a medically sound basis for attributing that disability to service may serve as a basis for a grant of service connection for hearing loss where there is credible evidence of acoustic trauma due to significant noise exposure in service, post-service audiometric findings meeting the regulatory requirements for hearing loss disability for VA purposes, and a medically sound basis upon which to attribute the post-service findings to the injury in service. The examiner is advised that the Veteran is competent to report his symptoms/history and that such reports must be acknowledged and considered in formulating any opinion. If the Veteran's reports are discounted, the examiner should provide a reason for doing so. A rationale for all requested opinions shall be provided. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation stating why this is so. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. 3. Schedule the Veteran for an appropriate examination to determine the nature of his claimed GERD disability. The examiner should review the entire claims file, to include specifically the Veteran's October 2021 Board testimony regarding his gastroesophageal symptoms and a copy of this Remand, conduct all necessary tests and studies, and provide the requested opinion for this claim: Does the Veteran now have, or has he had at any time during the pendency of the appeal (from November 2017 to present) a diagnosis of GERD or any other gastroesophageal condition manifested by reflux? The examiner is advised that the Veteran is competent to report his symptoms/history and that such reports must be acknowledged and considered in formulating any opinion. If the Veteran's reports are discounted, the examiner should provide a reason for doing so. A rationale for all requested opinions shall be provided. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation stating why this is so. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. 4. Schedule the Veteran for an appropriate examination to determine the nature of his claimed bilateral eye disability. The examiner should review the entire claims file, to include specifically the Veteran's October 2021 Board testimony regarding his bilateral eye condition symptoms and a copy of this Remand, conduct all necessary tests and studies, and provide the requested opinions for this claim: (a.) Does the Veteran now have, or has he had at any time during the pendency of the appeal (from November 2017 to present) a diagnosis of a bilateral eye disability manifested by the symptoms he has reported either on examination or in his October 2021 Board testimony? (b.) If the Veteran does not have, nor has he had at any time during the pendency of the appeal (from November 2017 to present) a diagnosable eye disability, do his reported bilateral eye symptoms amount to a functional impairment in his earning capacity? The examiner is advised that the Veteran is competent to report his symptoms/history and that such reports must be acknowledged and considered in formulating any opinion. If the Veteran's reports are discounted, the examiner should provide a reason for doing so. A rationale for all requested opinions shall be provided. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation stating why this is so. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. 5. Schedule the Veteran for an appropriate examination to determine the nature of his lower extremity skin disability claimed as MRSA. The examiner should review the entire claims file, to include specifically the Veteran's October 2021 Board testimony regarding his claimed "MRSA" symptoms, a copy of this Remand, and all pertinent medical records, conduct all necessary tests and studies, and provide the requested opinions for this claim: (a.) Does the Veteran now have, or has he had at any time during the pendency of the appeal (from November 2017 to present) a diagnosed dermatologic condition manifested by an intermittent rash on his bilateral lower extremities, to include as a result of MRSA exposure? (b.) If so, for each such diagnosed condition, the examiner should opine as to whether it is at least as likely as not (i.e., 50 percent probability or greater) that any such skin disability onset in, or is otherwise related to, the Veteran's service or any incident therein, to include the bilateral lower extremity rash for which he sought treatment in service on August 4, 2009 or his alleged exposure to MRSA in service? The examiner is advised that the Veteran is competent to report his symptoms/history and that such reports must be acknowledged and considered in formulating any opinion. If the Veteran's reports are discounted, the examiner should provide a reason for doing so. A rationale for all requested opinions shall be provided. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation stating why this is so. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. 6. Schedule the Veteran for an appropriate examination to determine the nature of his claimed heart disability. The examiner should review the entire claims file, to include specifically the Veteran's October 2021 Board testimony regarding his cardiac symptoms, a copy of this Remand, and all pertinent medical records, conduct all necessary tests and studies, and provide the requested opinion for this claim: (a.) Does the Veteran now have, or has he had at any time during the pendency of the appeal (from November 2017 to present) a diagnosed heart condition? (b.) If so, for each heart condition diagnosed on examination or at any time during the pendency of the appeal (from November 2017 to present), the examiner should opine: a. Is it at least as likely as not (i.e., 50 percent probability or greater) that any such heart disability onset in, or is otherwise related to, the Veteran's service or any incident therein, to include his borderline 1st degree VA block and/or incomplete right bundle branch block revealed in the Veteran's December 2009 EKG in service? b. Is it at least as likely as not (i.e., 50 percent probability or greater) that any diagnosed heart disability was caused by the Veteran's service-connected hypertension? c. Is it at least as likely as not (i.e., 50 percent probability or greater) that any diagnosed heart disability was aggravated (i.e., made worse) by the Veteran's service-connected hypertension? If so, the examiner should identify the degree of impairment that is due to such aggravation. The examiner is advised that the Veteran is competent to report his symptoms/history and that such reports must be acknowledged and considered in formulating any opinion. If the Veteran's reports are discounted, the examiner should provide a reason for doing so. A rationale for all requested opinions shall be provided. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation stating why this is so. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. 7. Schedule the Veteran for an appropriate examination with an examiner other than the one who performed the December 2021 VA knee and lower legs conditions examination to determine the current severity of the Veteran's service-connected residuals of left and right tibial fractures. The examiner should review the claims file, to include specifically the Veteran's October 2021 Board testimony regarding his service-connected bilateral lower leg disabilities' symptoms and a copy of this Remand, in conjunction with the examination. All necessary tests should be completed, and all pertinent pathology associated with these service-connected disabilities should be clearly annotated in the examination report. Further, all follow up questions in the examination report regarding the associated pathology(ies) must be completed in full. The examiner must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups and the degree of functional loss during flare upsas well as the degree of functional loss after repetitive use over time. To the extent possible, the examiner should identify any symptoms and functional impairments due to these service-connected disabilities alone and discuss the effect of the disabilities on any occupational functioning and activities of daily living. If it is not possible to provide a specific measurement or an opinion regarding additional functional loss due to repetitive use over time or flare-ups without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). A rationale for all requested opinions shall be provided. 8. Schedule the Veteran for an appropriate examination to determine the current severity of his service-connected bilateral plantar fasciitis. The examiner should review the claims file, to include specifically the Veteran's October 2021 Board testimony regarding his bilateral plantar fasciitis symptoms and a copy of this Remand, in conjunction with the examination. All necessary tests should be completed, and all pertinent pathology associated with this service-connected disability should be annotated in the examination report. The examiner must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups and the degree of functional loss during flare upsas well as the degree of functional loss after repetitive use over time. To the extent possible, the examiner should identify any symptoms and functional impairments due to the service-connected disability alone and discuss the effect of the disability on any occupational functioning and activities of daily living. If it is not possible to provide a specific measurement or an opinion regarding additional functional loss due to repetitive use over time or flare-ups without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). A rationale for all requested opinions shall be provided. 9. Schedule the Veteran for an appropriate examination to determine the current severity of his service-connected thoracolumbar strain. The examiner should review the claims file, to include specifically the Veteran's October 2021 Board testimony regarding his thoracolumbar spine symptoms and a copy of this Remand, in conjunction with the examination. All necessary tests should be completed, and all pertinent pathology associated with this service-connected disability should be annotated in the examination report. The examiner must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups and the degree of functional loss during flare upsas well as the degree of functional loss after repetitive use over time. To the extent possible, the examiner should identify any symptoms and functional impairments due to the service-connected disability alone and discuss the effect of the disability on any occupational functioning and activities of daily living. If it is not possible to provide a specific measurement or an opinion regarding additional functional loss due to repetitive use over time or flare-ups without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). A rationale for all requested opinions shall be provided. 10. After all above and other relevant development has been completed, and, if the Veteran still does not meet the schedular criteria for TDIU, if necessary, refer the issue of entitlement to a TDIU to VA's Director of Compensation Service for consideration in accordance with 38 C.F.R. § 4.16(b) as to whether the Veteran has been unable to obtain or maintain substantially gainful employment due to his service-connected disabilities. No action is required of the Veteran until he is notified by VA. However, he is advised of his obligation to cooperate in ensuring the duty to assist is satisfied. Kowalski v. Nicholson, 19 Vet. App. 171 (2005). His failure to report for a VA medical examination may impact the determination made. 38 C.F.R. § 3.655. The Veteran also is advised that he has the right to submit additional evidence and argument with respect to this matter. Kutscherousky v. West, 12 Vet. App. 369 (1999). This appeal must be afforded prompt treatment. THERESA M. CATINO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Davidoski, 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.