Citation Nr: 21005384 Decision Date: 02/01/21 Archive Date: 02/01/21 DOCKET NO. 14-29 498 DATE: February 1, 2021 ORDER Entitlement to an initial 70 percent rating for posttraumatic stress disorder (PTSD) beginning August 12, 2009 is granted, subject to the laws and regulations governing monetary benefits. Entitlement to a rating in excess of 70 percent for PTSD, from December 11, 2015 to September 10, 2019 is denied. Entitlement to service connection for recurrent tinnitus is granted. Entitlement to service connection for a back burn is denied. Entitlement to service connection for a back condition, to include as secondary to a back burn is denied. Entitlement to service connection for a neck condition, to include as secondary to a back burn is denied. REMANDED Entitlement to service connection for a lung condition, to include as due asbestos exposure and/or herbicide exposure is remanded. Entitlement to service connection for loss of vision is remanded. Entitlement to service connection for bilateral hearing loss is remanded. Entitlement to service connection for a skin condition is remanded. Entitlement to service connection for a stomach condition (claimed as gastroesophageal reflux disease (GERD)), to include as due to herbicide exposure and/or secondary to PTSD and/or secondary to diabetes mellitus, type II (DMII) is remanded. Entitlement to an effective date prior to prior to December 11, 2015 for a total disability rating due to individual unemployability (TDIU) is remanded. Entitlement to special monthly pension, due to aid and attendance (A&A) is remanded. FINDINGS OF FACT 1. Throughout the entire period on appeal, the Veteran’s PTSD has manifested in occupational and social impairment, with deficiencies in most areas. 2. The Veteran’s recurrent tinnitus was caused by active service. 3. The preponderance of the probative evidence is against finding that the Veteran has a current diagnosis for any residuals of an in-service burn to the back region during the period on appeal. 4. The Veteran’s low back condition did not incur during active service, was not caused by active service, and did not manifest to a compensable degree within one year of separation from active duty. 5. The Veteran’s neck condition did not incur during active service, was not caused by active service, and did not manifest to a compensable degree within one year of separation from active duty. CONCLUSIONS OF LAW 1. The criteria for entitlement to an initial 70 percent rating for PTSD beginning August 12, 2009 have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.7, 4.130, Diagnostic Code 9411. 2. The criteria for entitlement to a rating in excess of 70 percent for PTSD, from December 11, 2015 to September 10, 2019, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.7, 4.130, Diagnostic Code 9411. 3. The criteria for entitlement to service connection for tinnitus have been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304. 4. The criteria for entitlement to service connection for a back burn have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.304. 5. The criteria for entitlement to service connection for a back condition, to include as secondary to a back burn have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309, 3.310. 6. The criteria for entitlement to service connection for a neck condition, to include as secondary to a back burn have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1966 to February 1970. The Veteran testified before the undersigned Veterans Law Judge (VLJ) during a September 2017 videoconference hearing. The Board of Veterans’ Appeals (Board) notes the Veteran has been diagnosed with multiple nodules of the lung and chronic obstructive pulmonary disease (COPD). Therefore, the Board has recharacterized the claim for service connection for nodules of the lung to a claim for service connection for a lung condition. The July 2020 rating decision granted a 100 percent rating for PTSD, effective September 11, 2019. The 100 percent rating represents a full grant of the benefits sought; and therefore, the appeal was granted in full as of September 11, 2019. The July 2020 rating decision also granted entitlement to TDIU with an effective date of December 11, 2015. However, pursuant to Harper, the issue of TDIU prior to December 11, 2015 is still pending in conjunction with the claims for increased ratings. See Harper v. Wilkie, 30 Vet. App. 356 (2018). Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366 (2017). 1. Entitlement to an initial 70 percent rating for PTSD Disability ratings are determined by applying the criteria set forth in VA’s Schedule for Rating Disabilities. Ratings are based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where entitlement to compensation has already been established, and an increase in disability rating is at issue, the present level of disability is of primary concern. Although a rating specialist is directed to review the recorded history of a disability in order to make a more accurate evaluation, the regulations do not give medical reports precedence over current findings. See Francisco v. Brown, 7 Vet. App. 55 (1994); 38 C.F.R. § 4.2. Staged ratings are, however, appropriate for an increased rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. The relevant focus for adjudicating an increased rating claim is on the evidence concerning the state of the disability from the time period one year before the claim was filed until VA makes a final decision on the claim. See Hart v. Mansfield, 21 Vet. App. 505 (2007). Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating; otherwise the lower rating will be assigned. See 38 C.F.R. § 4.7. The General Rating Formula for Mental Disorders provides a 50 percent rating for occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. 38 C.F.R. § 4.130, Diagnostic Code 9411. The criteria for a 70 percent rating are occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work like setting); and inability to establish and maintain effective relationships. Id. The criteria for a 100 percent rating are total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; and memory loss for names of close relatives, own occupation or own name. Id. Furthermore, as the United States Court of Appeals for the Federal Circuit (Federal Circuit) has explained, evaluation under 38 C.F.R. § 4.130 is “symptom-driven,” meaning that “symptomatology should be the fact-finder’s primary focus when deciding entitlement to a given disability rating” under that regulation. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 116-17 (Fed. Cir. 2013). The symptoms listed are not exhaustive, but rather “serve as examples of the type and degree of symptoms, or their effects, that would justify a particular rating.” See Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). Additionally, consideration is given to the frequency, severity, and duration of psychiatric symptoms, the length of remission, and the Veteran’s capacity for adjustment during periods of remission. The rating agency shall assign an evaluation based on all the evidence of record that bears on occupational and social impairment, rather than solely on the examiner’s assessment of the level of disability at the moment of the examination. See 38 C.F.R. § 4.126(a). Furthermore, when evaluating the level of disability arising from a mental disorder, the rating agency will consider the extent of social impairment but shall not assign an evaluation solely on the basis of social impairment. 38 C.F.R. § 4.126(b). It is necessary to evaluate a disability from the point of view of the Veteran working or seeking work. 38 C.F.R. § 4.2. In August 2008 VA treatment records, the Veteran reported auditory hallucinations and suicidal ideations. In September 2008 VA treatment records, the Veteran reported being easily irritated, avoiding crowds, panic attacks, and suicidal ideations. In October 2008 VA treatment notes, the Veteran reported hearing voices telling him to suck on a gun, panic attacks, and the inability to control him emotions to include angry outburst. The Veteran also reported suicidal ideations in December 2008, March 2009, June 2009, July 2009, September 2009, March 2010 and April 2010 VA treatment notes. The Board notes the Veteran had a suicidal plan in the June 2009 and April 2010 VA treatment notes. The Veteran was provided with a VA examination in June 2010. The Veteran reported that he once grabbed his wife by the throat during a nightmare. The Veteran reported suicidal thoughts 3 to 4 times a week, but denied suicidal attempts. The Veteran reported sleep impairment. He had not had assaultive behavior since 1994. The examiner noted anxiousness; avoidance of activities, places and people; blunted affect; diminished interest or participation; feeling detached or estranged; irritability with outburst of anger; and difficulty concentrating. The Board notes there was no evidence of thought disorder, hallucinations, delusions, or memory problems; and the Veteran was oriented in all spheres. The Veteran was diagnosed with mild PTSD. The Veteran was provided with a VA examination in January 2016. The examiner found that the Veteran’s PTSD manifested in occupational and social impairment with reduced reliability and productivity. The Veteran had recurrent suicidal ideation with a sketchy formulated plan. The examiner noted symptoms of depressed mood; anxiety; suspiciousness; chronic sleep impairment; circumstantial, circumlocutory or stereotyped speech; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; suicidal ideation; and neglect of personal appearance and hygiene. The examiner found the short- and long-term memory were deficient. The Board has examined the Veteran’s psychological profile and symptoms as evidenced by the claims file, to include VA medical records and examinations. By viewing the evidence in a light most favorable to the Veteran, and examining the rating criteria for a 50 percent, 70 percent and 100 percent rating under 38 C.F.R. § 4.130, the Board finds the Veteran is entitled to an initial 70 percent rating for PTSD. Beginning, within a year of the Veteran’s claim, there was evidence of persistent suicidal ideations and occasional auditory hallucinations. The aforementioned symptoms, in concert with evidence of auditory hallucinations and the persistent suicidal ideations most closely approximate an initial 70 percent rating. From December 11, 2015 to September 10, 2019, the Board finds that the evidence does not warrant a rating in excess of the currently assigned 70 percent. In the January 2016 VA examination, the Veteran’s symptoms did not manifest in total social and occupational impairment. The examiner based their findings upon a comprehensive review of the Veteran’s psychological history and an interview. The Board has also considered the criteria found under a 100 percent rating and notes the record does not support finding that any of the Veteran’s symptoms are contemplated by the 100 percent rating prior to September 11, 2019. Although there is evidence of suicidal ideation, the Board finds the Veteran’s suicidal ideation is contemplated by the 70 percent rating and does not rise to the level of peristent danger of hurting himself as contemplated by the 100 percent rating. There is no persuasive evidence of total social and occupational impairment. In summary, the Veteran’s PTSD symptoms most closely approximate those listed for a 70 percent rating, from August 12, 2009 to September 10, 2019. 38 C.F.R. § 4.7. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Secondary service connection may be granted for a disability that is proximately due to, or aggravated by, a service-connected disease or injury. 38 C.F.R. § 3.310. Alternately, service connection may be established under 38 C.F.R. § 3.303(b) by (a) evidence of (i) the existence of a chronic disease in service or during an applicable presumption period under 38 C.F.R. § 3.307 and (ii) present manifestations of the same chronic disease, or (b) when a chronic disease is not present during service, evidence of continuity of symptomatology. Certain chronic diseases, including degenerative arthritis, may be service connected if manifested to a degree of 10 percent disabling or more within one year after separation from service. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. In the absence of proof of a present disorder (and, if so, of a nexus between that disorder and the active military service), there can be no valid claim for service connection. Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998); Brammer v. Derwinski, 3 Vet. App. 223 (1992); see also Boyer v. West, 210 F.3d 1351 (Fed. Cir. 2000). 2. Entitlement to service connection for recurrent tinnitus The Veteran was provided a VA examination in September 2009. The Veteran reported he mainly noticed tinnitus since active service. The examiner diagnosed him with recurrent tinnitus, but the examiner rendered a negative nexus opinion. The Veteran did not provide a positive medical nexus opinion regarding tinnitus; however, the Board finds the Veteran’s lay testimony regarding the onset of tinnitus highly probative. The Veteran reported service as the onset of tinnitus to the VA examiner. The Board has every reason to believe he was offering a truthful account of his experiences to his clinicians in an attempt to receive appropriate medical care, and the Board affords each statement a great deal of probative weight. The Veteran is competent to provide testimony as to the symptomology and etiology of his tinnitus. See Charles v. Principi, 16 Vet. App. 370, 374 (2002) (holding that a veteran is competent to identify tinnitus). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the claimant. The VA medical opinion provided negative nexus opinions for tinnitus, and the Veteran provided credible and competent testimony of a positive nexus between active service and tinnitus. Accordingly, service connection for tinnitus is warranted, and the claim is granted. 38 C.F.R. § 5107(b). 3. Entitlement to service connection for a back burn The Veteran submitted his claim for service connection in August 2009. The Veteran’s entrance examination is silent for any burn to the Veteran’s back. July 1969 service treatment records show the Veteran’ suffered 1st and 2nd degree burns over approximately 14 percent of his back. At his February 1970 exit examination, there was no notation of any lingering symptoms of the burn suffered earlier during active service. The Veteran was provided a VA examination in December 2009. The examiner noted the in-service burn to the back, but found no current scarring, disfigurement, or residuals of the prior injury. In the February 2017 hearing, the Veteran reported his back, in relation to the scar, was no longer painful. While there is evidence the Veteran experienced a serious back burn in-service, there is no evidence of any current residuals of the injury. Although a nexus opinion has not been provided, the Board finds that a VA opinion is not necessary. Under VA’s duty to assist, a medical examination or medical opinion is considered necessary if the information and evidence of record does not contain sufficient competent medical evidence to decide the claim, but (1) contains competent medical evidence of a currently diagnosed disability or persistent or recurrent symptoms of a disability; (2) establishes that the Veteran suffered an event, injury, or disease in service; and (3) indicates that the claimed disability or symptoms may be associated with an established event, injury or disease in service or with another service-connected disability. See McClendon v. Nicholson, 20 Vet. App. 79 (2006); 38 C.F.R. § 3.159(c)(4). The requirements to secure a VA examination are a low bar. Although McClendon sets a low bar, that bar has not been met here. There is no objective evidence of a current back burn or residuals of a back burn within proximity of the Veteran’s August 2009 claim, as contemplated under McClain v. Nicholson, 21 Vet. App. 319, 321 (2007), and the preponderance of the evidence is against finding the Veteran has current diagnoses. Id. Available post-service VA and private medical records are negative for evidence of an active back burn disability. There is no competent evidence to suggest that the Veteran has or had a diagnosable back burn throughout the pendency of the appeal. In light of the above evidence, the Board finds that the preponderance of the evidence is against a determination that the Veteran has the condition at issue or that it is attributable to service. Accordingly, service connection for a back burn must be denied. Brammer, supra. As the preponderance of the evidence is against the Veteran’s claim, the benefit-of-the-doubt standard of proof does not apply. 38 U.S.C. § 5107(b). 4. Entitlement to service connection for a back condition, to include as secondary to a back burn The Veteran’s entrance examination in May 1966 was negative for a conditions or complaints of the back. Private treatment records show the Veteran suffered a back injury in September 1983, when he fell 10 to 12 feet at work. At the time of the 1983 back injury, he denied prior significant back difficulty. September 1983 private records show lumbar arthritic changes. The Veteran was provided with a VA examination in December 2009. The Veteran reported his lower back pain began in the early 1970s after the military when he began working as a carpenter. He thought the back pain may have been caused by his duties as a carpenter. The Veteran was diagnosed with moderate degenerative disc disease (DDD). The examiner determined the DDD was not caused by the in-service burn and was less likely than not caused by or a result of military service. The present pain and stiffness experienced by the Veteran was musculoskeletal and not residual scar tissue. The Veteran had one complaint of back pain in-service, and the Veteran was able to perform heavy lifting as a tree trimmer post active service. The Veteran reported his pain began after the military when he started working as a carpenter. The DDD was caused by or exacerbated by the Veteran’s present age, poor posture, obesity, and heavy physical or repeated lifting. There was no evidence of DDD while the Veteran was in the military. Based on the foregoing reasons, the examiner provided the negative nexus opinion. The VA examiner’s opinion was based upon a complete review of the Veteran’s claims file, and the examiner provided a negative opinion and adequate rationale to support the findings. The Board notes that there is no probative evidence in the record relating the Veteran’s current back condition to active duty. Certain chronic diseases will be presumed related to service if they were noted as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if continuity of the same symptomatology has existed since service, with no intervening cause. 38 U.S.C. §§ 1101, 1112, 1113, 1137; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2012). The Board concludes that, while the Veteran has DDD of the lumbar spine, it was not chronic in service or had continued since service. The Veteran provided evidence to medical providers that his back pain began post active service in the early 1970s when he started as a carpenter. The Board has every reason to believe he was offering a truthful account of his experiences to his clinicians in an attempt to receive appropriate medical care. However, arthritis did not manifest to a compensable degree within a presumptive period. There is no evidence in the record which shows diagnosed degenerative changes by February 1971, within a year of separation from active service. The earliest evidence of degenerative changes is located in a September 1983 private treatment records. This is approximately 13 years after separation from active service. The evidence supports finding that the Veteran’s back condition was diagnosed over one year after his separation from active service, outside of the applicable presumptive period. While the Veteran is competent to report having experienced symptoms of back pain since service, he does not possess the training or credentials necessary to provide a competent diagnosis in this case or to determine that these symptoms were manifestations of arthritis, which is diagnosed with radiographic evidence. The issue is medically complex, as it requires interpretation of complicated medical diagnostic imaging. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). The Board gives more probative weight to competent medical evidence, which establishes that these symptoms are not related to the pain in active duty service. Accordingly, the preponderance of the evidence is against the claim, and the claim for service connection for a back condition must be denied. 38 U.S.C. § 5107(b). In regard to the Veteran’s contention that his back condition was caused or aggravated by the back burn, service connection for the back burn is denied in the decision herein. As service connection for a back burn has been denied, further discussion of the secondary relationship between the Veteran’s back condition and the in-service back burn is not necessary. 5. Entitlement to service connection for a neck condition, to include as secondary to a back burn The Veteran’s entrance examination in May 1966 was negative for a conditions or complaints of the neck. In May 1969 STRs, the Veteran complained of pain in the back of the neck when lifting heavy objects. June 1996 VA treatment records show the Veteran was diagnosed with stenosis of the cervical spine. The Veteran was provided with a VA examination in December 2009. The Veteran reported his neck pain began in the early 1970s after the military, when he began working as a carpenter. He thought the neck pain may have been caused by his duties as a carpenter. The Veteran was diagnosed with moderate to severe DDD of the cervical spine. The examiner determined the DDD was not caused by the in-service burn and was less likely than not caused by or a result of military service. The present pain and stiffness experienced by the Veteran was musculoskeletal and not residual scar tissue. The Veteran had one complaint of neck pain in-service, and he was able to perform heavy lifting as a tree trimmer post active service. The Veteran reported his pain began after the military when he started working as a carpenter. The DDD was caused by or exacerbated by the Veteran’s present age, poor posture, obesity, and heavy physical or repeated lifting. There was no evidence of DDD while the Veteran was in the military. Based on the foregoing reasons, the examiner provided the negative nexus opinion. The VA examiner’s opinion was based upon a complete review of the Veteran’s claims file, and the examiner provided a negative opinion and adequate rationale to support the findings. The Board notes that there is no probative evidence in the record relating the Veteran’s current neck condition to active duty. The Board also concludes that, while the Veteran has DDD of the cervical spine, which is a chronic disease under 38 C.F.R. § 3.309(a), it was not chronic in service or had continued since service. The Veteran provided evidence to medical providers that his neck pain began post active service in the early 1970s, when he started as a carpenter. The Board has every reason to believe he was offering a truthful account of his experiences to his clinicians in an attempt to receive appropriate medical care. However, arthritis did not manifest to a compensable degree within a presumptive period. There is no evidence in the record which shows diagnosed degenerative changes by February 1971, within a year of separation from active service. The earliest evidence of degenerative changes is located in December 2009 VA examination. This is approximately 40 years after separation from active service. The evidence supports finding that the Veteran’s neck condition was diagnosed over one year after his separation from active service, outside of the applicable presumptive period. While the Veteran was competent to report having experienced symptoms of neck pain since service, he does not possess the training or credentials necessary to provide a competent diagnosis in this case or to determine that these symptoms were manifestations of arthritis, which is diagnosed with radiographic evidence. The issue is medically complex, as it requires interpretation of complicated medical diagnostic imaging. Jandreau, supra. The Board gives more probative weight to competent medical evidence, which establishes that these symptoms are not related to the pain in active duty service. Accordingly, the preponderance of the evidence is against the claim, and the claim for service connection for a neck condition must be denied. 38 U.S.C. § 5107(b). In regard to the Veteran’s contention that his neck condition was caused or aggravated by the back burn, service connection for the back burn is denied in the decision herein. As service connection for a back burn has been denied, further discussion of the secondary relationship between the Veteran’s neck condition and the in-service back burn is not necessary. REASONS FOR REMAND 1. Entitlement to service connection for a lung condition is remanded. The Veteran was provided a VA examination and nexus opinion in September 2019. The examiner provided a negative opinion because they found no current evidence of nodules in the lung. However, the Board notes the VA treatment records provide evidence of diagnosed lung nodules and COPD during the period on appeal. See November 2019 VA treatment notes. The Board also notes March 2010 VA treatment notes show a current prescription for an albuterol inhaler. The evidence of diagnoses made during the period on appeal, even if not present at the time of the examinations, meet the requirement of a “current” disability under McClain. Therefore, an addendum opinion is needed to provide a nexus opinion for any diagnosed lung condition diagnosed during the period on appeal. The Board notes VA already conceded likely asbestos exposure in the July 2010 rating decision. 2. Entitlement to service connection for loss of vision is remanded. The Veteran was provided a VA examination in October 2009. The Board notes the Veteran’s claims file was not available to the VA examiner. Therefore, a new VA examination and opinion is necessary, based upon a complete review of the Veteran’s file. 3. Entitlement to service connection for bilateral hearing loss is remanded. The Veteran contends his hearing loss was related to his duties as a loader on anti-aircraft battery on the USS Union, and his close proximity to rocket attacks while in Vietnam. See December 2009 Correspondence. The Veteran was provided a VA examination in November 2009. The examiner provided a negative nexus opinion, finding the Veteran’s hearing loss was more likely than not due to occupational and/or recreational noise exposure, aging, and medical and/or environmental factors. The examiner listed the history of the Veteran’s occupational and recreational noise exposure, but did not explain why such noise exposure would cause hearing loss rather than the in-service noise exposure. The Veteran listed medical conditions such as hypertension, depression, cholesterol, arthritis, and breathing problems, but the examiner did not explain how these medical factors would cause hearing loss. In November 2020, the Veteran, through his representative, requested a new VA examination for hearing loss due to the timeframe since the 2009 examination. For the aforementioned reasons, the Board finds the rationale inadequate, and a new examination and opinion are needed prior to adjudication of the Veteran’s claim. 4. Entitlement to service connection for a skin condition is remanded. The Veteran contends his skin condition was caused by herbicide exposure. The Veteran was provided a VA examination and opinion in September 2019. The examiner diagnosed the Veteran with skin tags; and provided a negative nexus opinion, finding the skin tags may be related to friction and heredity. Obesity and pregnancy were also noted as being related to the incidence of skin tags. The examiner failed to explain how heredity applies to the Veteran’s specific medical history, and mentioning pregnancy is irrelevant because the Veteran is a male. Additionally, the examiner failed to address the Veteran’s contention of herbicide exposure causing the skin condition. Therefore, the Board finds the rationale inadequate, and an addendum opinion with a complete rationale is needed prior to adjudication of the Veteran’s claim. 5. Entitlement to service connection for a stomach condition is remanded. The Board remanded the service connection claim for a stomach condition to obtain a new VA examination and opinion in March 2018. The Veteran was afforded a VA examination in September 2019. The Veteran was diagnosed with hiatal hernia and GERD. The examiner determined the Veteran’s GERD was caused by his hiatal hernia. The examiner also noted that there is a 21 percent association between PTSD and GERD, but found that GERD was not aggravated by PTSD. The examiner found the hiatal hernia and obesity to be the primary causes, but aggravation was not specifically addressed by the examiner. The examiner also did not address secondary service connection caused by type II diabetes mellitus, as directed by the prior remand directives. A remand by the Board confers upon the Veteran, as a matter of law, the right to compliance with the Board’s remand order. Stegall v. West, 11 Vet. App. at 270-71 (1998). As prior remand orders were not complied with, and in accordance with Stegall, remand for full compliance with the Board’s prior remand is warranted. In this case, the Board finds that this claim must be sent back again in order to obtain an addendum opinion which addresses all theories of entitlement. 6. Entitlement to SMP, due to A&A; and entitlement to an effective date prior to prior to December 11, 2015 for a TDIU are remanded. Finally, since the Veteran’s disability picture is unresolved, the claims for a TDIU and SMP are inextricably intertwined with the service connection claims. Harris v. Derwinski, 1 Vet. App. 180. Thus, adjudication of these claims must be deferred until after completion of the actions requested below. The matters are REMANDED for the following action: 1. Forward the claims file to a qualified medical professional to obtain an addendum opinion to determine the nature and likely etiology of the Veteran’s lung condition, even if currently resolved. The record and a copy of this remand must be made available to and reviewed by the examiner. The examiner should be asked to address the following: (a.) Identify all lung conditions, demonstrated during the appeal period (since August 2009) or in proximity to the claim, even if currently resolved; (b.) Provide an opinion as to whether any diagnosed lung condition at least as likely as not (50 percent probability or greater) was incurred during or was caused by active service, to include conceded exposure to asbestos and exposure to herbicides in-service. Please articulate the reasoning underpinning the conclusions. That is, (1) identify what facts and information--whether found in the record or outside the record--support the opinion, and (2) explain how that evidence justifies the opinion. 2. Forward the claims file to a qualified medical professional, to obtain an addendum opinion to determine the nature and likely etiology of the Veteran’s loss of vision, even if currently resolved. The record and a copy of this remand must be made available to and reviewed by the examiner. The examiner should be asked to address the following: (a.) Identify all vision disabilities demonstrated during the appeal period (since August 2009) or in proximity to the claim, even if currently resolved; (b.) Provide an opinion as to whether any diagnosed vision disability at least as likely as not (50 percent probability or greater) was incurred during or was caused by active service, to include the Veteran’s lay contentions provided in the Board hearing, in which he recounts hitting his head on the ship. Please articulate the reasoning underpinning the conclusions. That is, (1) identify what facts and information--whether found in the record or outside the record--support the opinion, and (2) explain how that evidence justifies the opinion. 3. Forward the claims file to a qualified medical professional, to obtain a VA examination to determine the nature and likely etiology of the Veteran’s hearing loss. The record and a copy of this remand must be made available to and reviewed by the examiner. Based on a review of the results of the Veteran’s physical examination, his statements regarding the development and treatment for his disability, and a thorough review of the claims file, the examiner should provide an opinion as to whether any hearing loss at least as likely as not (50 percent probability or greater) was incurred during or was caused by active service, to include the Veteran’s lay contentions provided in the Board hearing. Please articulate the reasoning underpinning the conclusions. That is, (1) identify what facts and information--whether found in the record or outside the record--support the opinion, and (2) explain how that evidence justifies the opinion. 4. Forward the claims file to a qualified medical professional, to obtain an addendum opinion to determine the nature and likely etiology of the Veteran’s skin condition, even if currently resolved. The record and a copy of this remand must be made available to and reviewed by the examiner. The examiner should be asked to address the following: (a.) Identify all skin disabilities demonstrated during the appeal period (since August 2009) or in proximity to the claim, even if currently resolved; (b.) Provide an opinion as to whether any diagnosed skin disability at least as likely as not (50 percent probability or greater) was incurred during or was caused by active service, to include herbicide exposure. Please articulate the reasoning underpinning the conclusions. That is, (1) identify what facts and information--whether found in the record or outside the record--support the opinion, and (2) explain how that evidence justifies the opinion. 5. Forward the claims file to a qualified medical professional, to obtain an addendum opinion to determine the nature and likely etiology of the Veteran’s stomach condition, even if currently resolved. The record and a copy of this remand must be made available to and reviewed by the examiner. The examiner should be asked to address the following: (a.) Identify all gastrointestinal conditions, demonstrated during the appeal period (since August 2009) or in proximity to the claim, even if currently resolved; (b.) Provide an opinion as to whether any diagnosed gastrointestinal condition at least as likely as not (50 percent probability or greater) was incurred during or was caused by active service, to include herbicide exposure; (c.) Provide an opinion as to whether any diagnosed gastrointestinal condition at least as likely as not was caused by or aggravated beyond its natural progression by service-connected PTSD; and (d.) Provide an opinion as to whether any diagnosed gastrointestinal condition at least as likely as not was caused by or aggravated beyond its natural progression by service-connected type II diabetes mellitus. Please articulate the reasoning underpinning the conclusions. That is, (1) identify what facts and information--whether found in the record or outside the record--support the opinion, and (2) explain how that evidence justifies the opinion. A. C. MACKENZIE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. N. Quarles, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.