Citation Nr: 21006336 Decision Date: 02/03/21 Archive Date: 02/03/21 DOCKET NO. 15-25 291 DATE: February 3, 2021 ORDER Entitlement to service connection for diabetes mellitus is denied. Entitlement to service connection left upper extremity neuropathy is denied. Entitlement to service connection for left lower extremity neuropathy is denied. New and material evidence having been received for a claim of entitlement to service connection for a heart disorder, the claim is reopened. The claim of entitlement to service connection for a heart disorder, including coronary artery disease and ischemic heart disease, is denied. Eligibility for financial assistance for an automobile and adaptive equipment or for adaptive equipment only is denied. REMANDED Entitlement to service connection for a lung disorder, to include as secondary to asbestos exposure, is remanded. Entitlement to service connection for a skin disorder is remanded. Entitlement to service connection for a kidney disorder, including chronic kidney disease and kidney stones, is remanded. Entitlement to service connection for hypertension is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. Entitlement to special monthly compensation based on a need for aid and attendance or due to being housebound is remanded. REFERRED The Veteran submitted a VA Form 21-526EZ in February 2019 requesting entitlement to service connection for Hodgkin’s disease. This issue is referred to the Agency of Original Jurisdiction (AOJ) for adjudication. FINDINGS OF FACT 1. The Veteran’s assertions of having served on the U.S.S. Oklahoma City, on the landmass of Vietnam, or in the blue waters surrounding Vietnam, are not credible. 2. Diabetes mellitus is not shown to have been present in service, or for many years thereafter, nor is it the result of any incident of his period of active military service. 3. The Veteran’s left upper extremity neuropathy is not shown to have been present in service, or for many years thereafter, nor is it the result of any incident of his period of active military service. 4. A left lower extremity neuropathy disorder is not shown to have been present in service, or for many years thereafter, nor is it the result of any incident of his period of active military service. 5. A January 2014 decision by the Board of Veterans’ Appeals (Board) which denied entitlement to service connection for ischemic heart disease is final. Evidence has been received since the January 2014 decision which relates to an unestablished fact necessary to substantiate the claim. 6. A heart disorder, including ischemic heart disease and coronary artery disease, is not shown to have been present in service, or for many years thereafter, nor is it the result of any incident of his period of active military service. 7. The Veteran is service connected for posttraumatic stress disorder (PTSD), tinnitus, hearing loss, and a scar. 8. The Veteran’s service-connected disabilities do not result in loss or loss of use of a hand or foot, permanent vision impairment of both eyes, severe burn injury, amyotrophic lateral sclerosis, or ankylosis of a knee or hip. CONCLUSIONS OF LAW 1. Diabetes mellitus was not incurred in or aggravated by service and may not be presumed to have been incurred in service. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309. 2. Left upper extremity neuropathy was not incurred in or aggravated by service and may not be presumed to have been incurred in service. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309. 3. Left lower extremity neuropathy was not incurred in or aggravated by service and may not be presumed to have been incurred in service. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309. 4. The January 2014 Board decision is final; new and material evidence has been received to reopen the claim of entitlement to service connection for ischemic heart disease. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.104, 3.156, 20.1100, 20.1103. 5. A heart disorder was not incurred in or aggravated by service and may not be presumed to have been incurred in service. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309. 6. The criteria for establishing eligibility for financial assistance for an automobile or adaptive equipment are not met. 38 U.S.C. §§ 3901, 3902, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.808. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1973 to July 1975, with additional service in the Army National Guard. This case comes to the Board from January 2015, November 2015, and February 2016 rating decisions of the Department of Veterans Affairs (VA) Regional Office. In August 2016, the Board remanded the issues for further development and for the issuance of a Statement of the Case for the issues of entitlement to service connection for kidney stones, hypertension, diabetes mellitus, and left upper and lower extremity neuropathy. The Veteran appealed these additional issues, and they have now been merged with the other issues on appeal. In a January 2018 rating decision, the Veteran was granted entitlement to service connection for PTSD. This is a full grant of the benefit sought, and the issue is no longer on appeal. See Grantham v. Brown, 114 F. 3d 1156, 1158 (Fed. Cir. 1997). Diabetes Mellitus and Left Upper and Lower Extremity Neuropathy The Veteran has claimed entitlement to service connection for diabetes mellitus and for left upper and lower extremity neuropathy which were caused by exposure to herbicide agents in Vietnam. At the May 2019 Board hearing, the Veteran testified that he had severe neuropathy preventing use of his left arm and causing problems with his left leg which was caused by a burst cerebral blood vessel. He stated that he had not had any problems with neuropathy until he had a stroke in 2004. The Veteran’s representative also suggested the Veteran’s neuropathy could be aggravated by his diabetes. The Veteran testified that he was stationed on the U.S.S. Oklahoma City, which sailed into the Delta north of Saigon, as well as near Cambodia and Laos. He stated that they did dock in Saigon and that he got off the ship while there. He said that he had worked as a demolitions specialist and that they went up the river in a river patrol boat as part of the blockade of ports in North Vietnam. Generally, service connection may be granted for a disability resulting from disease or injury incurred coincident with or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection requires evidence satisfying three criteria: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship (“nexus”) between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). A veteran who served in the Republic of Vietnam during the period from January 9, 1962 to May 7, 1975 shall be presumed to have been exposed during such service to an herbicide agent, unless there is affirmative evidence to establish that the veteran was not exposed to any such agent during that service. 38 C.F.R. § 3.307(a). The law establishes a presumption of entitlement to service connection for diseases associated with exposure to certain herbicide agents even though there is no record of such disease in service. See 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307, 3.309(e). Diseases associated with such exposure include diabetes mellitus, early-onset peripheral neuropathy, and ischemic heart disease. 38 C.F.R. § 3.309(e). The recent Blue Water Navy Vietnam Veterans Act of 2019 (Public Law 116-23) added 38 U.S.C. § 1116A which, in pertinent part, includes in the presumption of exposure to herbicide agents those veterans who served offshore of the Republic of Vietnam during the period from January 9, 1962 to May 7, 1975. “Offshore” is defined as a location not more than 12 nautical miles seaward of a line commencing on the southwestern demarcation line of the waters of Vietnam and Cambodia and intersecting at certain points. While it is not clear from the Veteran’s treatment records that he actually has diagnoses of diabetes mellitus or peripheral neuropathy, his VA treatment records show diabetes mellitus and idiopathic peripheral neuropathy in his problem list, and the Board will therefore accept that he does as likely as not have current diagnoses of these disorders. The evidence does not, however, show that these disorders are related to the Veteran’s service. The Board has considered the Veteran’s assertions that he had service in the Republic of Vietnam, but unfortunately finds these assertions are not credible, and service connection for left upper or lower extremity peripheral neuropathy and for diabetes mellitus on a presumptive basis is not warranted. The Board, as the factfinder, is required to evaluate the credibility of evidence. See Buchanan v. Nicholson, 451 F3.d 1331, 1336-37 (Fed. Cir. 2006); Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997) (recognizing the Board’s “authority to discount the weight and probity of evidence in light of its own inherent characteristics and its relationship to other items of evidence”). The credibility of a witness can be impeached by a showing of interest, bias, and inconsistent statements. See Caluza v. Brown, 7 Vet. App. 498, 511 (1995), aff'd per curiam, 78 F.3d 604 (Fed. Cir. 1996). The Veteran’s statements regarding his service in Vietnam are inconsistent and implausible when compared to the other evidence of record, including his service personnel records and treatment records indicating the circumstances of his service. See Bardwell v. Shinseki, 24 Vet. App. 36, 40 (a non-combat veteran’s lay statements must be weighed against other evidence, including the absence of military records supporting the lay assertions) (citing Caluza, 7 Vet. App. at 506). The Veteran claims to have had extensive service in Vietnam from 1972 to 1973. In February 2011, the Veteran submitted a letter, through an attorney, that he had served as part of a Navy Seal Team on board the U.S.S. Oklahoma City, and that from August 1972 to May 1973, the ship had been deployed to the Mekong River Delta in Vietnam. In February 2012, he wrote that he had served in Vietnam from October 1972 to May 1973 and was part of Special Operations in Vietnam, Cambodia, and Laos, including setting up ambushes and destroying cashes of arms. At a September 2013 Board hearing for an earlier claim for service connection, the Veteran stated that he had been a Navy Seal with missions in Vietnam and Cambodia, operating out of the U.S.S. Oklahoma City, which was stationed at the mouth of the Mekong River. He stated that he served in a small boat in the “Brown Water” of Vietnam. While the Veteran has written and testified that he served on the U.S.S. Oklahoma City, this is not reflected in his service personnel or treatment records. The Veteran’s personnel records include an Enlisted Performance Record which shows that he was stationed on the U.S.S. Nashville from September 1, 1973 until June 30, 1975. This is supported by the Veteran’s service treatment records, which also show that he received treatment specifically noted to be on the U.S.S. Nashville in October 1973, June 1974, November 1974, and May 1975. There is no indication in these records that the Veteran was ever posted to or onboard the U.S.S. Oklahoma City. In some of the Veteran’s submissions, he has argued that his service on the U.S.S. Oklahoma City occurred prior to his U.S.S. Nashville service, in 1972 and 1973. There are absolutely no records indicating that the Veteran had any service prior to July 1973, and in fact the records clearly establish that he first joined the service at that time. The Veteran’s DD Form 214 states that he served from July 1, 1973 to July 2, 1975. It notes that there were 0 days of prior service. This is consistent with the Veteran’s Immunization Record, which shows all of his immunizations occurring in 1973. Documentation from the U.S. Navy Recruiting District shows that the Veteran enlisted on May 11, 1973. The Veteran underwent a Pre-Induction examination in May 1973, further demonstrating that the Veteran was not yet in the military at that time. His Recruit Training was completed on July 13, 1973. Additionally, the Veteran’s Enlisted Classification Record shows that he attended high school from September 1969 to January 1973, which would indicate that he was still in high school at the time that he claims to have been in Vietnam. The Board also notes that the Veteran has separately argued for some of his other claims, that he did serve on the U.S.S. Nashville, and that it was his experience on this ship, when it collided with the U.S.S. Iwo Jima in March 1975 which was his stressor which led to the development of PTSD. A history of the U.S.S. Nashville shows that in 1974, it was stationed primarily in Virginia, with one trip to Cuba and Haiti. The Veteran’s representative submitted deck logs from the U.S.S. Nashville which also show that it was primarily stationed in Norfolk, Virginia, but also that in 1975 it travelled to the Mediterranean, where the collision with the U.S.S. Iwo Jima took place. The Veteran has also been inconsistent regarding where his exposure to Agent Orange took place. In a February 2012 Form 9 submitted for an earlier claim for heart disease due to herbicide agent exposure, the Veteran, through an attorney, wrote that he was claiming Agent Orange exposure from his service on the U.S.S. Nashville while it was in dry dock at the Norfolk Naval Shipyard. He wrote that Agent Orange had spilled on the deck, which exposed the Veteran. In a letter hand-written by the Veteran and submitted in March 2015, the Veteran wrote that Agent Orange did not spill on the dock when he was in dry dock in Portsmouth, but actually spilled on the deck in the cargo hold on the U.S.S. Nashville, and that he had to clean it up. He wrote that he had removed pallets of barrels of Agent Orange from the ship. He also wrote that he had been on patrol in Vietnam. The Board finds that the overwhelming majority of the evidence indicates that the Veteran was stationed on the U.S.S. Nashville for the majority of his active duty service, and he did not serve on the U.S.S. Oklahoma City or any other ship which had service in the blue water surrounding of Vietnam. The majority of the evidence is also clearly against finding that the Veteran had any service on the landmass of Vietnam. In light of the extensive documentation in the personnel and service treatment records indicating where and when the Veteran served, the Board finds that the evidence weighs against the assertion that the Veteran was, at any time, stationed in the Republic of Vietnam or in the waters near Vietnam. The Board acknowledges that while the Veteran may not intentionally have provided statements which are incredible in light of the evidence of record, human memory is fallible, and the Veteran may not have correctly remembered the events that occurred over 45 years ago. The Board therefore finds that the Veteran’s statements regarding service in Vietnam are not credible and are not afforded any probative weight. As the Veteran had no in-country Vietnam service or service in the blue waters around Vietnam, he is not entitled to service connection for any disorder on a presumptive basis. The Board also finds no evidence to support the Veteran’s earlier claims of being exposed to herbicide agents on the deck of his ship while in Norfolk, and since the Veteran no longer asserts that this was how he was exposed to Agent Orange, or that his assertions regarding exposure to herbicide agents are credible in light of their highly inconsistent nature, the Board does not find that any further development for this possible type of exposure is warranted. The Veteran has based his claims entirely upon presumptive herbicide exposure in Vietnam; i.e., the Veteran has not indicated that diabetes mellitus or peripheral neuropathy was otherwise caused or aggravated by an in-service disease or injury, nor is such indicated by the other evidence of record to include the service treatment records. Further, no other presumptive provision appears applicable to the facts of this case. While diabetes mellitus and organic diseases of the nervous system are considered chronic conditions, there is no evidence that the Veteran’s diabetes mellitus or peripheral neuropathy was incurred in service or manifested any symptoms in service or within one year of separation from service. See 38 U.S.C. § 1101; 38 C.F.R. §§ 3.303(b), 3.309(a); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). In addition, there is absolutely no competent medical evidence of record that establishes a causal connection between the Veteran’s diabetes mellitus or peripheral neuropathy and his military service. See Maggitt v. West, 202 F.3d 1370, 1375 (Fed. Cir. 2000). This evidentiary deficiency concerning the nexus element is fatal to the claim. See Watson v. Brown, 4 Vet. App. 309, 314 (1993). None of the medical evidence of record includes any indication that the Veteran’s diabetes mellitus or peripheral neuropathy could have been caused by exposure to herbicides through any other means beyond presumption due to service in Vietnam, or that it can be connected to service in any way. The lay assertions of the Veteran that herbicide exposure may have caused his disorders do not constitute competent and credible evidence to satisfy this nexus requirement. The Veteran, as a layperson, is not shown to possess appropriate medical training and expertise in order to render a persuasive or competent medical opinion on the etiology of a condition such as diabetes mellitus or peripheral neuropathy. Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Thus, the weight of the competent and credible evidence fails to relate the Veteran’s diabetes mellitus and peripheral neuropathy to any event or injury in his military service. Regarding the Veteran’s assertion at the May 2019 Board hearing that his left arm and leg neuropathy are secondary to his cerebrovascular accident/stroke, this does not provide a basis for service connection, as the Veteran is not service connected for a stroke, nor is any such disorder currently on appeal. Service connection may be granted on a secondary basis for a disability which is proximately due to or the result of an established service-connected disorder. 38 C.F.R. § 3.310(a); Allen v. Brown, 7 Vet. App. 439 (1995). Because a cerebrovascular accident/stroke is not service connected, no service connection of a secondary basis is warranted, and service connection on a secondary basis must be denied as a matter of law. See 38 C.F.R. § 3.310; Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). The Board also notes that the Veteran was not afforded a VA examination to evaluate his claimed diabetes or peripheral neuropathy, but the duty to afford the Veteran such examinations was not triggered. VA is obliged to provide a VA medical examination when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) evidence establishing that an event, injury, or disease occurred in service, or establishing that certain diseases manifested during an applicable presumptive period for which the claimant qualifies; and (3) an indication that the disability or persistent/recurrent symptoms of a disability may be associated with the Veteran's service or with another service-connected disability; but (4) insufficient competent medical evidence on file for the Secretary to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). In this case, while the Veteran’s medical history includes these disabilities, there is absolutely no evidence indicating that any event, injury, or disease occurred in service which could be related to his diabetes mellitus or peripheral neuropathy. There is also no evidence that these disorders or any associated symptoms have been caused or aggravated by any service-connected disability. In the absence of any such evidence, a VA examination is not warranted. In sum, the Board finds that the Veteran’s assertions that he served in the Republic of Vietnam or on its grey water or blue water waterways are not credible, and no presumption of exposure to herbicide agents can be applied. There is also no competent and probative medical evidence indicating that the Veteran’s diabetes mellitus, left arm neuropathy, or left leg neuropathy are related to any event in service. The Veteran has not provided any other medical evidence indicating that he had chronic disorders during or in the years following service, and there is no probative medical evidence indicating a relationship between the Veteran’s diabetes or neuropathy and his military service. The preponderance of the probative and competent evidence therefore weighs against finding that diabetes mellitus, left arm neuropathy, or left leg neuropathy had their onset during service or are otherwise related to any event or injury in service. The claims are denied. In reaching this determination, the Board has considered the doctrine of reasonable doubt, however, as the preponderance of the evidence is against the claims, the doctrine is not for application. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Ischemic Heart Disease The Veteran also contends that he had exposure to herbicide agents in Vietnam which led to the development of ischemic heart disease. The Veteran’s claim for service connection for ischemic heart disease was initially denied in a July 2009 rating decision. The Veteran appealed this decision to the Board, and the Board denied the claim in a January 2014 decision on the basis that although the Veteran reported having chest pains, he did not have a current diagnosis of ischemic heart disease. The Veteran did not appeal this decision, and it is final. See 38 U.S.C. § 7105; 38C.F.R. §20.1100. A previously denied claim may be reopened by the submission of new and material evidence.  38 U.S.C. § 5108; 38 C.F.R. § 3.156.  Evidence is new if it has not been previously submitted to agency decision makers.  Id.  Evidence is material if it, either by itself or considered in conjunction with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim.  Id.  New and material evidence cannot be cumulative or 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.  Id.  The phrase “raises a reasonable possibility of substantiating the claim” is meant to create a low threshold that enables, rather than precludes, reopening.  Shade v. Shinseki, 24 Vet. App. 110, 117 (2010).  When determining if new and material evidence has been received to reopen a finally adjudicated claim, the evidence will be presumed credible.  See Kutscherousky v. West, 12 Vet. App. 369, 371 (1999). Since the January 2014 Board decision, the Veteran has submitted a March 2016 private record which shows that he had a CT angiography of the chest. The scan found that there was atherosclerotic vascular disease of the thoracic aorta and ascending aorta and coronary artery disease. The Board accepts that the issue of entitlement to ischemic heart disease can reasonably be expanded to include any heart disorder. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). As the Veteran has now provided evidence that he does have a current diagnosis of a heart disorder, the claim can be reopened. The Board does not find, however, that the Veteran’s current heart disorder is related to any incident in service, and the claim for service connection for a heart disorder is denied. The Veteran has essentially asserted that he has a diagnosis of heart disease and should be awarded service connection on a presumptive basis due to exposure to herbicide agents in Vietnam. See 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307, 3.309(e). Coronary artery disease is one of the disorders which is associated with exposure to herbicide agents and which can be granted presumptive service connection for certain veterans. See 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307, 3.309(e). As was discussed above at length, the Veteran’s claims of service in Vietnam or in the waters around Vietnam are not credible, and the evidence clearly demonstrates that he did not have any service which would allow for a presumption of exposure to herbicide agents. Entitlement to service connection for coronary artery disease due to exposure to herbicide agents such as Agent Orange is therefore not warranted. While the Veteran has not asserted any other basis for service connection for this disorder, the Board also finds that service connection on a direct basis is not warranted. Heart disease is considered a chronic condition, but there is no evidence that the Veteran’s coronary artery disease was incurred in service or manifested any symptoms in service or within one year of separation from service. See 38 U.S.C. § 1101; 38 C.F.R. §§ 3.303(b), 3.309(a). The earliest evidence of a diagnosis of coronary artery disease is from 2016, which is over 40 years after his separation from service. There is absolutely no competent medical evidence of record that establishes a causal connection between the Veteran’s coronary artery disease and his military service, and this evidentiary deficiency is fatal to the claim. See Watson, 4 Vet. App. at 314. None of the medical evidence of record indicates that the Veteran’s coronary artery disease could have been caused by any other event or injury in service. The Veteran has asserted that his heart disease was caused by exposure to herbicide agents in service, but his lay assertions are not competent medical evidence and provide no probative evidence which can weight in favor of the claim regarding this etiology question. Jandreau, 492 F.3d at 1376-77. While the Veteran was not afforded a VA heart examination, the Board finds that VA had no duty to provide the Veteran with such an examination. There is no evidence of record indicating that the Veteran has any heart disorder which had its onset during service, or which is related to service or a service-connected disability. Further, the Veteran has not presented any argument regarding why he believes service connection a heart disorder is warranted other than his assertion that it should be presumptively secondary to exposure to Agent Orange. Given all of the foregoing the threshold criteria to trigger VA’s duty to provide a VA examination has not been met, and no examination is warranted. McLendon, 20 Vet. App. at 81. In sum, the Board finds that the Veteran’s assertions that he served in the Republic of Vietnam or on its grey water or blue water waterways are not credible, and no presumption of exposure to herbicide agents can be applied. There is also no competent and probative medical evidence indicating that the Veteran’s coronary artery disease is related to any event in service. There is no probative medical evidence indicating a relationship between the Veteran’s coronary artery disease and his military service. The preponderance of the probative and competent evidence therefore weighs against finding that coronary artery disease had its onset during service or is related to any event or injury in service, and the claim is denied. The Board has again considered the doctrine of reasonable doubt, but the preponderance of the evidence is against the claim. Gilbert, 1 Vet. App. 49. Automobile and Adaptive Equipment The Veteran testified at the May 2019 Board hearing that he was paralyzed on the left side due to his stroke. He said that he had not been able to use his arm for years. Financial assistance may be provided to an “eligible person” in acquiring an automobile or other conveyance and adaptive equipment, or adaptive equipment only. 38 U.S.C. § 3902(a)(b). Eligibility for assistance to purchase a vehicle and adaptive equipment is warranted where one of the following exists as the result of injury or disease incurred or aggravated during active service: (1) loss or permanent loss of use of one or both feet; (2) loss or permanent loss of use of one or both hands; (3) permanent impairment of vision of both eyes, meaning central visual acuity of 20/200 or less in the better eye, with corrective glasses, or central visual acuity of more than 20/200 if there is a field defect in which the peripheral field has contracted to such an extent that the widest diameter of visual field subtends an angular distance no greater than 20 degrees in the better eye; (4) severe burn injury precluding effective operation of an automobile; (5) amyotrophic lateral sclerosis; or, (6) for adaptive equipment only, ankylosis of one or both knees or one or both hips. 38 U.S.C. § 3901; 38 C.F.R. § 3.808. The medical evidence does establish that the Veteran has severe difficulty with his left arm and leg. The Veteran’s VA treatment records show that he has undergone extensive treatment to address his left-sided weakness following a stroke. A November 2005 examination found that he had only gross, uncoordinated movements in the left arm and no use of the hand or fingers. His left foot and leg had foot drop and jerky movements. The Veteran’s physician D.R. wrote that the Veteran had weakness in his left leg and left arm following a stroke, with the left arm being basically unusable. He was able to walk but was very unsteady and slow and required the assistance of a walker. Unfortunately, the Veteran is not service connected for his left arm or leg disabilities, and therefore they cannot be the basis for an award of financial assistance for an automobile or adaptive equipment. To be eligible for one of the grants described above, a Veteran must have a service-connected disability which meets one of the criteria under 38 C.F.R. § 3.808. The Veteran is service connected for PTSD with major depressive disorder, bilateral tinnitus, hearing loss, and a scar. None of these disabilities relate to the criteria required for a grant of financial assistance for an automobile and adaptive equipment or for adaptive equipment only. None of these disabilities cause loss of use of a hand or foot, nor do they affect the Veteran’s vision. The issues of entitlement to service connection for a kidney disorder and for hypertension are still on appeal and are remanded below, but these disorders also do not relate to the criteria required for this benefit, and even if granted, would not allow for an award of financial assistance for an automobile or adaptive equipment. The preponderance of the probative medical evidence demonstrates that the Veteran does not any service-connected disabilities which result in loss or loss of use of a hand or foot, permanent vision impairment of both eyes, severe burn injury, amyotrophic lateral sclerosis, or ankylosis of a knee or hip. The Board has considered the lay statements of the Veteran regarding his problems with mobility and using his left arm. The Board does not doubt those assertions, as the Veteran is competent to report that he has weakness in his left side and difficulty moving his left arm and leg. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Those statements are credible and consistent with the medical evidence of record. These statements, however, are insufficient to establish entitlement to this benefit, as the Veteran is not actually service connected for his left arm and leg disabilities. See 38 C.F.R. §§ 3.808. In sum, the weight of the competent and probative medical evidence preponderates against finding that the Veteran’s service-connected disabilities meet any of the criteria under 38 C.F.R. § 3.808, the claim for an automobile and adaptive equipment or adaptive equipment only is denied. REASONS FOR REMAND Lung Disorder In August 2016, the Board remanded this issue in order to obtain an addendum medical opinion regarding whether the Veteran’s currently diagnosed chronic obstructive pulmonary disease (COPD) was as likely as not related to service, including due to in-service asbestos exposure. A VA medical opinion was obtained in December 2016. The examiner checked the box indicating that the condition was at least as likely as not incurred in or caused by service. She then wrote that review of the medical records indicated that the Veteran did have a diagnosis of COPD “for which he is service connected,” but there was no indication of a diagnosis of asbestosis. She was then asked to provide an addendum to that opinion, and the examiner was informed that she was incorrect regarding her assumption that the Veteran was already service connected for COPD. She then wrote that it was less likely than not that the COPD was related to the Veteran’s active duty. Most of the probative value of an opinion comes from its underlying reasoning or rationale. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008). Here, the examiner did not actually provide any rationale at all, and the Board finds this opinion to be completely inadequate for deciding the current claim. This issue is remanded so that a new and adequate VA medical opinion can be obtained. Skin Disorder The August 2016 Board remand also found that because the January 2015 VA examiner had noted that a dermatologist might be more capable of providing an accurate diagnosis and service connection opinion, the issue should be remanded in order to afford the Veteran an examination with a dermatologist. It appears that a VA examination was scheduled for April 2017, but the Veteran did not appear for the examination. While it is a Veteran’s responsibility to cooperate in the development of a claim, the Board accepts that because he did attend a VA examination in January 2015 which found a diagnosis of bilateral lower extremity dermatitis, an addendum medical opinion from a dermatologist could have been obtained, even without the attendance of the Veteran. Unfortunately, such an opinion was not obtained. The Board remands this issue to afford the Veteran another opportunity to attend a VA skin examination, and if he fails to attend that examination, a medical opinion based on review of the record should be obtained in its place. Kidney Stones The Veteran contends that he has a kidney disorder which had its onset during or is related to his active duty service. At the May 2019 Board hearing, the Veteran stated that he started having kidney stones within a couple months after leaving service. The Veteran initially filed a claim just for kidney stones, but the Board notes that in March 2017, the Veteran submitted a claim for “kidney disease.” The Veteran’s VA treatment records show that he has since been diagnosed with kidney disease in addition to reporting kidney stones. An April 2017 kidney scan showed significantly delayed flow and very poor renal function in the left kidney. He was found to have severe left hydronephrosis and hydroureter in the left side. The Veteran’s physician found that the Veteran had acute kidney injury with underlying chronic kidney disease likely related to hypertensive nephrosclerosis and ischemic nephropathy with baseline creatinine. He wrote that the Veteran’s left kidney was essentially nonfunctioning. The Veteran’s claim has so far been developed only as a claim for kidney stones, but the Board finds that it should be expanded to encompass any kidney disorder. See Clemons, 23 Vet. App. 1. The Veteran has not yet been afforded a VA examination to evaluate his kidney disorders. Because the Veteran has asserted that he began experiencing kidney stones immediately after separation from service, and passing a kidney stone is the type of symptom that he is likely competent to self-identify, the Board will, for the time being, accept this evidence as credible and finds that the duty to assist has been triggered to afford the Veteran with a VA examination. See McLendon, 20 Vet. App. at 81. The Board also requests that the Veteran provide VA with the private records, or authorization to obtain records, relating to treatment which occurred after service, and with his more recent kidney treatment. In May and August 2017, the Veteran reported to his VA providers that he was being treated for left-sided hydronephrosis and kidney stones at St. Francis Urology Department in Tulsa, Oklahoma. Hypertension The Veteran also contends that his current hypertension was caused by exposure to Agent Orange in service. At the May 2019 Board hearing, the Veteran stated that he has had problems with hypertension within a year after he left service. The Veteran’s VA treatment records show that the Veteran has been diagnosed with hypertension since 2003, but the Veteran asserts that he has had hypertension much longer than that. While the Veteran’s assertions of exposure to herbicide agents in service have not been found to be credible, the Board will afford the Veteran an opportunity to provide evidence of hypertension manifesting within one year of service, as hypertension is included in the list of chronic diseases under 3.309(a). Additionally, because the Veteran has a current diagnosis of hypertension and he has asserted that this chronic disorder began within one year of separation from service, but no VA examination has yet been afforded to the Veteran, the Board will afford him an opportunity to attend an examination to address the etiology of this disorder. See id. TDIU and Special Monthly Compensation The Board also remands these issues, as they are inextricably intertwined with the issues now being remanded. See Harris v. Derwinski, 1 Vet. App. 180 (1991). The Board notes that while the Veteran has been assigned a 100 percent rating for PTSD since May 20, 2008, the Court of Appeals for Veterans Claims held in Bradley v. Peake, 22 Vet. App. 280 (2008) that there could be situations where a veteran has a total rating for a particular disability and could establish entitlement to a TDIU for another service-connected disability to qualify for special monthly compensation under 38 U.S.C. § 1114(s). The Board therefore finds that the issue of entitlement to a TDIU remains on appeal. The matters are REMANDED for the following action: 1. Obtain all VA treatment records since April 2018. 2. Send to the Veteran and his representative a letter requesting that the appellant provide sufficient information and a signed and dated authorization, via a VA Form 21-4142 (Authorization and Consent to Release Information) to enable VA to obtain the Veteran’s relevant private treatment records, including any treatment for kidney stones or hypertension in the 1970s and from St. Francis Urology Department in Tulsa, Oklahoma in 2017.  They should be informed that they may also submit these records themselves.  If the Veteran provides completed release forms authorizing VA to obtain these treatment records, then attempt to obtain them with at least one follow-up request if no reply is received.  3. Obtain a VA medical opinion regarding the nature and etiology of the Veteran’s lung disorders, including COPD. If it is found that a VA examination must be held prior to providing such an opinion, schedule the Veteran for an examination. It may be conducted via telehealth or similar service during social distancing restrictions, if possible.  The record and a copy of this remand must be made available to, and reviewed by, the examiner.   The examiner should then address: a) What are the Veteran’s current lung disorders? b) For all disorders found, is it at least as likely as not that any current lung disorder is related to his military service, including due to exposure to asbestos serving on the U.S.S. Nashville? A complete, well-reasoned rationale must be provided for all conclusions and opinions. If the requested opinions cannot be rendered without resorting to speculation, the examiner must explain why. 4. Schedule the Veteran for a skin examination to address the nature and etiology of any current skin disorder, including dermatitis, from a dermatologist. It may be conducted via telehealth or similar service during social distancing restrictions, if possible.  If the Veteran is not able to attend the examination, obtain an addendum opinion from a dermatologist based on a review of the record. The record and a copy of this remand must be made available to, and reviewed by, the examiner.   The examiner should then address: a) What are the Veteran’s current skin diagnoses? b) For all diagnoses found, is it at least as likely as not that any current skin disorder is related to his military service? The examiner is asked to specifically address the Veteran’s assertions, which were previously noted by the Board to be competent and credible, that he developed blisters on his skin two to three years after his separation from service. Please also discuss the Veteran’s reported exposure to asbestos while on board the U.S.S. Nashville. A complete, well-reasoned rationale must be provided for all conclusions and opinions. If the requested opinions cannot be rendered without resorting to speculation, the examiner must explain why. 5. Schedule the Veteran for an examination to address the nature and etiology of any kidney disorder. The examination may be conducted via telehealth or similar service during social distancing restrictions, if possible.  The record and a copy of this remand must be made available to, and reviewed by, the examiner.   The examiner should then address: a) What are the Veteran’s current kidney disorders? Please discuss his April 2017 CT scan which found severe impairment in the left kidney and the Veteran’s reports of having had multiple, recent kidney stones. b) For all disorders found, is it at least as likely as not that any current kidney disorder lung disorder was incurred in or otherwise related to his military service, including due to exposure to asbestos serving on the U.S.S. Nashville? Please also consider the Veteran’s lay assertions, which have not been disproved, that he first had a kidney stone within a few months after separation from service. A complete, well-reasoned rationale must be provided for all conclusions and opinions. If the requested opinions cannot be rendered without resorting to speculation, the examiner must explain why. 6. Schedule the Veteran for an examination to address the nature and etiology of his hypertension. The examination may be conducted via telehealth or similar service during social distancing restrictions, if possible.  The record and a copy of this remand must be made available to, and reviewed by, the examiner.   The examiner should then address: Is it at least as likely as not that the Veteran’s hypertension was incurred in or otherwise related to his military service, including due to exposure to asbestos serving on the U.S.S. Nashville? Please also consider the Veteran’s lay assertions that he first was found to have hypertension within a year after separation from service A complete, well-reasoned rationale must be provided for all conclusions and opinions. If the requested opinions cannot be rendered without resorting to speculation, the examiner must explain why. DAVID L. WIGHT Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Mary E. Rude, 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.