Citation Nr: 21008744 Decision Date: 02/17/21 Archive Date: 02/17/21 DOCKET NO. 18-48 538 DATE: February 17, 2021 ORDER Entitlement to service connection for obstructive sleep apnea is dismissed. Entitlement to service connection for a psychiatric disability other than PTSD (to include a bipolar disability) is dismissed. Entitlement to service connection for a low sperm count is dismissed. Entitlement to service connection for a vision impairment is denied. Entitlement to a 100 percent rating from April 15, 2013 for the Veteran’s PTSD is granted. Entitlement to a total disability rating due to individual unemployability is dismissed. New and material evidence has been received in the Veteran’s claim for service connection for a low back disability is reopened. REMANDED Entitlement to service connection for a low back disability is remanded. Entitlement to service connection for a neck disability is remanded Entitlement to service connection for a left upper extremity dysesthesia to include as secondary to a neck disability is remanded. Entitlement to service connection for a bilateral foot disability is remanded. Entitlement to a compensable rating for bilateral hearing loss is remanded. Entitlement to service connection for vertigo to include as secondary to bilateral hearing loss and tinnitus is remanded. Entitlement to service connection for sinus disability to include rhinitis and recurrent epistaxis is remanded. Entitlement to service connection for chronic fatigue syndrome is remanded. Entitlement to service connection for fibromyalgia is remanded. Entitlement to service connection for headaches to include as secondary to service-connected PTSD is remanded. Entitlement to service connection for erectile dysfunction to include as secondary to service-connected PTSD is remanded. FINDINGS OF FACT 1. On November 19, 2020, at the Board hearing, prior to the promulgation of a decision in the appeal, the Board received testimony from the Veteran that a withdrawal of his appeals for entitlement to service connection for obstructive sleep apnea, a psychiatric disability other than PTSD to include a bipolar disability, and a low sperm count were requested and full comprehension of the consequences of these withdrawals was explained and acknowledged at the hearing. 2. The Veteran does not have a current vision disability which can be service connected. 3. The Veteran’s PTSD symptoms result in total occupational and social impairment throughout the pendency of the appeal. 4. As the Veteran had been granted a 100 percent rating for his PTSD for the entire appeal period and the Veteran does not meet the criteria for special monthly compensation under 38 U.S.C. § 1114(s), the issue of entitlement to TDIU is moot. 5. In an unappealed March 2011 rating decision, the RO denied service connection for lumbar strain based on a finding that there was no evidence of inservice incurrence. 6. The evidence added to the record since the March 2011 rating decision, when viewed by itself or in the context of the entire record, relates to an unestablished fact that is necessary to substantiate the claim of service connection for a low back disability. CONCLUSIONS OF LAW 1. The criteria for withdrawal of the appeals with respect to the issues of entitlement to service connection for obstructive sleep apnea, a psychiatric disability other than PTSD to include a bipolar disability, and a low sperm count have been met. 38 U.S.C. § 7105(b)(2), (d)(5); 38 C.F.R. § 20.204. 2. The criteria for entitlement to service connection for vision disability have not been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304. 3. The criteria for a 100 percent rating for PTSD for the entirety of the appeal period have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 4.1-4.14, 4.125, 4.130, Diagnostic Code (DC) 9411. 4. The claim of entitlement to TDIU is moot. 38 U.S.C. §§ 7104, 7105; 38 C.F.R. § 20.101. 6. The March 2011 rating decision that denied service connection for a lumbar strain is final. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.104(a), 3.160(d), 20.200, 20.302, 20.1103. 7. With respect to the Veteran’s claim for service connection for a low back disability, new and material evidence has been received since the March 2011 denial. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Air Force from March 1995 to September 2002. Service Connection 1. Entitlement to service connection for obstructive sleep apnea, a psychiatric disability other than PTSD to include a bipolar disability, and a low sperm count. 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. Withdrawal may be made by the Veteran or by his authorized representative. 38 C.F.R. § 20.204. In the present case, the Veteran, in his testimony in his November 2020 hearing, has withdrawn his appeal for service connection for obstructive sleep apnea, a psychiatric disability other than PTSD to include a bipolar disability, and a low sperm. The consequences of this withdrawal were explained and acknowledged by the Veteran at the hearing. Hence, there remain no allegations of errors of fact or law for appellate consideration. Accordingly, the Board does not have jurisdiction to review the appeal of service connection for these issues and the appeals as to these issues are therefore dismissed. 2. Entitlement to service connection for a vision impairment. The Veteran contends that his eye degradation is related to his active service. However, upon review of the claims file, the evidence does not support a current disability which can be service connected. The Veteran in his November 2020 hearing testified that he had no damage to his eye and did not know of any specific diagnosis other than degradation. Likewise, the Veteran’s August 2019 VA treatment record includes a notation from an optometrist in which he noted that the eyes and vision included no abnormal findings. Moreover, the Board notes to the extent the Veteran contends that any difficulty with vision defects, such as refractive error of the eyes, this is not a disease or injury within the meaning of applicable legislation and, thus, are not disabilities for which service connection may be granted. 38 C.F.R. § 3.303 (c); see also 38 C.F.R. § 4.9 ; Beno v. Principi, 3 Vet. App. 439 (1992). As such, service connection is not available for vision problems attributable to refractive errors such as myopia. Absent superimposed disease or injury, service connection may not be allowed for a congenital or developmental defect of the eyes, even if visual acuity decreased in service, as this is not a disease or injury within the meaning of applicable legislation relating to service connection. Parker v. Derwinski, 1 Vet. App. 522 (1991); McNeely v. Principi, 3 Vet. App. 357, 364 (1992). However, neither the Veteran nor the other evidence of record has suggested that the Veteran experienced a vision change during service as a result of a disease or injury. In sum, the evidence does not support a finding that the Veteran has a current diagnosed vision disability or one that could be service connected. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) (there can be no valid claim for service connection in the absence of a present disability). In the absence of a current disability, service connection cannot be awarded. Accordingly, the preponderance of the evidence is against the Veteran’s claim, and entitlement to service connection for a vision disability is denied. Increased Rating Disability ratings are determined by applying the criteria set forth in VA’s Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155 ; 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Reasonable doubt as to the degree of disability will be resolved in the Veteran’s favor. 38 C.F.R. § 4.3. The Veteran’s PTSD is rated under the General Rating Formula for Mental Disorders (General Formula). According to the applicable rating criteria, when evaluating a mental disorder, the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the individual’s capacity for adjustment during periods of remission must be considered. 38 C.F.R. § 4.126 (a) (2016). In addition, the evaluation must be 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. Id. Further, when evaluating the level of disability from a mental disorder, the extent of social impairment is considered, but the rating cannot be assigned solely on the basis of social impairment. 38 C.F.R. § 4.126 (b). The symptoms listed in DC 9411 are not intended to constitute an exhaustive list, but rather serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. See Mauerhan v. Principi, 16 Vet. App. 436 (2002). A Veteran, however, may only qualify for a given disability rating “by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration.” Vazquez-Claudio v. Shinseki, 713 F.3d 112, 117 (Fed. Cir. 2013) (“Reading [38 C.F.R. §§ 4.126 and 4.130] together, it is evident that the ‘frequency, severity, and duration’ of a Veteran’s symptoms must play an important role in determining his disability level.”). A 70 percent rating is warranted when there is 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); inability to establish and maintain effective relationships. A 100 percent rating is warranted when there is 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; memory loss for names of close relatives, own occupation, or own name. 38 C.F.R. § 4.130, DC 9411. 3. Entitlement to an increased rating in excess of 30 percent for posttraumatic stress disorder. The Veteran contends that he is entitled to a higher disability rating for his PTSD. Upon review of the claims file, the evidence supports a 100 percent rating for the entirety of the appeal period. A 100 percent evaluation requires the Veteran’s PTSD to cause total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; danger of hurting self or others; intermittent inability to perform activities of living (including maintenance of minimal hygiene); disorientation to time or place; or, memory loss for names of close relatives, occupation, or own name. See 38 C.F.R. § 4.130, Diagnostic Code 9411. In reviewing the Veteran’s VA medical evidence, the Board found that the Veteran symptoms are severe and characterized by continual auditory and visual hallucination throughout the appeal period. While the Veteran psychiatric treatment record demonstrates the Veteran’s repeated and continual suicidal ideation, the Board finds the Veteran’s continual auditory and later visual hallucinations throughout the appeal period to be dispositive in determining the appropriate rating. These hallucination are documented beginning in an August 2013 VA treatment note where he reported having visions; in March 2014, he believed he was being stalked at work; in July 2014, he reported he was struggling with auditory hallucinations and called a VA emergency number the same month to complain of the auditory hallucination and told the phone operator “I don’t know where to get help, help me.” At this time, the Veteran’s wife was unsure if the Veteran could remain in the household because of his disruptive behavior and the strain it was placing on the family as reported in a July 2014 treatment note. The Veteran was then incarcerated and admitted for psychiatric treatment in July 2014. He reported in an August 2015 VA treatment note that he had continual suicidal ideation, and while he claimed he had no plan, he admitted that the fact that he did not have a car “stopped him.” The Veteran continued to suffer from hallucination following intensive psychiatric treatment which was ordered by the Veteran Treatment Court of Texas, following several driving under the influence convictions which are documented in an October 2014 VA treatment note. In particular, the character of these hallucination are reported in an April 2016 VA treatment note where the Veteran explained he saw “shadows on the peripheral, no definite figures just shadows,” and he reported hearing voices which do not say anything specific but are just there. He continued to report hearing voices and other hallucinations in VA treatment notes in September 2017, June 2018, October 2018, December 2019, January 2020 February 2020, and April 2020. Similarly, the Veteran was provided with a VA examination in April 2019 wherein the examiner noted “the Veteran attempted suicide in 2014 via hanging with a rope and has endorsed continued auditory hallucination a few times per month. These hallucinations typically include someone saying, ‘help me.’” The examiner continued to state that the Veteran also endorses visual hallucinations of ghosts. The Board thus concludes from this evidence that these hallucinations have been continual source of impairment for the Veteran throughout the course of the appeal period. In terms of social and occupational functioning, the Board finds that the evidence demonstrates that the Veteran’s symptoms more closely resemble a total lack of social and occupational ability as described in the 100 percent rating criteria as his PTSD symptoms include continual auditory and visual hallucination. Moreover, this evidence supports the fact that the Veteran’s hallucinations will continue to totally impair his social and occupational ability. In considering this evidence the Board acknowledges that the Court has held in Vazquez-Claudio v. Shinseki, 2012-7114 (Fed. Cir. Apr. 8, 2013), that entitlement to a particular disability rating requires sufficient symptoms of the kind listed for that rating, or others of similar severity, frequency, or duration, that cause the level of occupational and social impairment associated with that rating. Based on the foregoing evidence, the Board finds that the Veteran’s overall disability picture equates to total occupational and social impairment, he has demonstrated, continual hallucinations which have led to the loss of his career and his relationships to include his marriage. The evidence demonstrates that the character of mental impairment has remained consistent throughout the appeal period. Therefore, in sum, the evidence demarcated above supports an award of a 100 percent disability rating for PTSD for entirety of the appeal period. 4. Entitlement to a total disability rating due to individual unemployability The Court has recognized that a 100 percent rating under the Schedule for Rating Disabilities means that a Veteran is totally disabled. Holland v. Brown, 6 Vet. App. 443, 446 (1994), citing Swan v. Derwinski, 1 Vet. App. 20, 22 (1990). Thus, if VA has found a veteran to be totally disabled as a result of a particular service-connected disability or combination of disabilities pursuant to the rating schedule, there is no need, and no authority, to otherwise rate that veteran totally disabled on any other basis. The Board notes that the Veteran has claimed that he became too disabled to work in October 2013 in his January 2016, and December 2020 VA application for increased rating due to unemployability. Thus, the Veteran’s August 2013 entitlement of a 100 percent rating for PTSD would predate any potential award for TDIU. However, the Board notes that the presence of a 100 percent disability rating does not necessarily render the issue of TDIU moot. In Bradley v. Peake, 22 Vet. App. 280, 293 (2008), the Court held that a TDIU satisfies the total (100 percent) rating requirement if the TDIU evaluation was, or can be, predicated upon a single disability and there exists additional disability or disabilities independently ratable at 60 percent or more, for purposes of entitlement to SMC for a housebound rating. In other words, 38 U.S.C. § 1114(s) for housebound benefits does not limit “a service-connected disability rated as total” to only a schedular rating of 100 percent. Id. A TDIU rating based on a single disability is permitted to satisfy the statutory requirement of a total rating. Id. Consequently, the Board will consider whether a TDIU is warranted for a single disability at any point during the appeal period. In light of the above decision, the Veteran may be entitled to SMC pursuant to 38 U.S.C. § 1114(s) at any point during the appeal period of his TDIU claim. See Bradley, 22 Vet. App. at 294; Akles v. Derwinski, 1 Vet. App. 118, 121 (1991). Under 38 U.S.C. § 1114(s), SMC is payable at the housebound rate if a veteran has a single service-connected disability rated as 100 percent and either of the following are met: (1) there is additional service-connected disability or disabilities independently ratable at 60 percent, separate and distinct from the 100 percent service-connected disability and involving different anatomical segments or bodily systems; or (2) he is permanently housebound by reason of service-connected disability or disabilities. 38 U.S.C. § 1114(s); 38 C.F.R. § 3.350(i). In the present case, the Veteran does not have any additional service-connected disability rated at 60 percent. His tinnitus and irritable bowel syndrome are rated at 10 percent disabling, and his service-connected bilateral hearing loss is rated as noncompensable. Further, these is no indication that his current service-connected disabilities render him permanently housebound. Accordingly, the provisions of Bradley are inapplicable to this case. Thus, as the Court has held in Herlehy v. Principi, 15 Vet. App. 33, 35 (2001), a request for TDIU is moot where a 100 percent schedular rating was awarded for the same period. Thus, the Veteran’s claim for a TDIU is moot as he has been awarded a 100 percent schedular rating for his PTSD for the entirety of the period where TDIU would be under consideration and does not meet the criteria for special monthly compensation under 38 U.S.C. § 1114(s). New and Material Evidence Initially, the Board notes that whenever a claim to reopen is filed, regardless of how it was characterized by the agency of original jurisdiction, the Board must make a de novo determination as to whether new and material evidence has been received. Barnett v. Brown, 83 F.3d 1380, 1383 (Fed. Cir. 1996) (whether new and material evidence has been submitted must be asked and answered by the Board de novo whenever a claim to reopen is filed). New evidence is defined as existing evidence not previously submitted to agency decision makers. Material evidence means 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 previously of record, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). For the purpose of establishing whether new and material evidence has been submitted, the credibility of evidence is presumed unless the evidence is inherently incredible or consists of statements that are beyond the competence of the person or persons making them. Justus v. Principi, 3 Vet. App. 510, 513 (1992); Meyer v. Brown, 9 Vet. App. 425, 429 (1996); King v. Brown, 5 Vet. App. 19, 21 (1993). 5. Whether new and material evidence has been submitted to reopen a claim for service connection for a low back disability. The Veteran was denied service connection for a lumbar strain in a March 2011 rating decision, in part, because there was no evidence that the Veteran’s disability was incurred in service. The threshold for determining whether new and material evidence raises a reasonable possibility of substantiating a claim is “low.” Shade v. Shinseki, 24 Vet. App. 110, 117 (2010). In determining whether this low threshold is met, consideration need not be limited to consideration of whether the newly submitted evidence relates specifically to the reason why the claim was last denied, but instead should ask whether the evidence could reasonably substantiate the claim were the claim to be reopened, either by triggering the VA’s duty to assist or through consideration of an alternative theory of entitlement. 38 C.F.R. § 3.156(a); Shade v. Shinseki, supra. The Veteran’s testimony in November 2020 that he had symptoms of low back pain while on active duty and that his Air Force Specialty Code as a Security Forces Journeyman included duties which led to the injury of his back in his November 2020 hearing is new in that it was not previously of record. It is also material because it relates to unestablished facts necessary to substantiate the Veteran’s claim for service connection for a low back disability. Specifically, due to the prior lack of evidence showing of an incurrence during the Veteran’s service, this new evidence is material because it relates to an element that was previously not shown, an in-service incurrence. See Shade, supra. Accordingly, the Board finds that new and material evidence has been submitted, and the claim for service connection for a low back disability is reopened. 38 U.S.C. § 5108. REASONS FOR REMAND 1. Entitlement to service connection for a low back disability and neck disability. The Board finds that the September 2015 VA examinations provided to the Veteran for his low back disability and neck disability are, in part, inadequate. The Veteran in his November 2020 testimony to the Board indicated that his back pain and neck pain began in service due to the physical requirement of heavy lifting in his security forces position. The VA examiners in September 2015 did not address these contentions, and the Board is not competent to address whether the Veteran’s current low back and/or neck disability are related to his described duties of heavy lifting in service. The United States Court of Appeal for Veterans Claims has held that that once VA undertakes the effort to provide an examination when developing a claim, even if not statutorily obligated to do so, VA must ensure that the examination provided is adequate. See Barr v. Nicholson, 21 Vet. App. 303, 311-12 (2007). As the examinations did not address this portion of the Veteran’s contention, the Board finds that it was, in part, inadequate and that new VA examinations should be provided. 2. Entitlement to service connection for a left upper extremity dysesthesia to include as secondary to a neck disability is remanded The Veteran has submitted evidence in the form of a January 2020 private examination which found that the Veteran’s left upper extremity dysesthesia is related to his diagnosis of cervical spondylosis and foraminal stenosis/central stenosis. However, adjudication cannot proceed on this issue until the underlying claim of service connection for a neck disability is adjudicated. Hence, this final issue is not yet ripe for appellate review and must be deferred pending readjudication of those other remanded claims. See Tyrues v. Shinseki, 23 Vet. App. 166, 177 (2009) (en banc) Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (noting that two or more issues are inextricably intertwined if the disposition of one claim could have a significant impact on the outcome of another). 3. Entitlement to service connection for a bilateral foot disability. The Veteran has submitted evidence in the form a January 2018 private note wherein a clinician diagnosed the Veteran with bilateral plantar fasciitis. The Veteran in his November 2020 hearing testified this this foot disability began in active duty service due to the physical requirement of heavy lifting in his security forces position. The Veteran has not been provided with a VA examination to investigate these contentions, and the Board finds that such an examination is warranted. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). 5. Entitlement to service connection for vertigo The Veteran January 2018 private treatment record contains a diagnosis for vertigo. The Veteran in his November 2020 hearing testified that he contends that his hearing loss and tinnitus have caused this vertigo. Additionally, a January 2018 private treatment record includes a notation that the Veteran’s vertigo may be related to a “history of head trauma from serving in the Army.” Similarly, the Veteran in his June 2016 VA application for benefits noted that he fell off a Humvee and hit his head. The Board recognizes that the Veteran’s type of service in the security forces would have placed him in or around this type of vehicle. Considering the foregoing, the Board finds that Veteran should be provided a VA examination to address whether he suffered a head injury in service that may have caused his current vertigo or whether it is otherwise etiologically related to his active duty service or is secondary to his hearing loss or service connected tinnitus. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). 6. Entitlement to service connection for a sinus disability to include rhinitis and recurrent epistaxis. The Veteran has been diagnosed with rhinitis in a March 2018 private treatment note and was also diagnosed with recurrent epistaxis in a January 2018 treatment note. The Veteran in his November 2020 testimony contends that these disabilities are related to his exposure to “burn pits” while he was stationed in the Persian Gulf. In support of his contention, the Veteran, in March 2020, submitted an article titled “Scientist Who Exposed Health Impacts of Burn Pits in Iraq Awarded Carson Prize.” The article, in sum, is recognition of a scientist who discovered very high levels of mercury, lead, titanium, and various toxic metal in the hair of children and parents in and around Iraqi cities and matched these toxins to results found in U.S. Military Veterans. The Board finds that the Veteran has provided sufficient evidence to warrant further investigation by a competent medical professional between his current rhinitis and recurrent epistaxis and his exposure to “burn pits” while on active duty in the Persian Gulf. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). 7. Entitlement to service connection for chronic fatigue syndrome and fibromyalgia now to include inflammatory musculoskeletal disease as due to Persian Gulf War syndrome. The Veteran provided evidence in March 2020 that documented that he has been diagnosed with both chronic fatigue syndrome per an October 2018 private examination and fibromyalgia per a May 2019 private examination. These examinations diagnoses contradict the findings of the November 2019 VA examination which found that the Veteran did not have a diagnosis of chronic fatigue syndrome and the October 2019 VA examination which found that the Veteran did not have diagnosis of fibromyalgia. More concerning, the October 2019 VA examiner did not address the Veteran’s diagnosis of fibromyalgia in a January and February 2014 private treatment notes which were contained in the claims file at the time of that examination. Moreover, while the October 2019 VA examiner suggested in his fibromyalgia examination that the Veteran has inflammatory musculoskeletal disease, he did not address whether this disability could be interpreted as a medically unexplained chronic multi-symptom illness or address its potential etiology to his Persian Gulf service. Considering these contradictions and omissions, the Board finds the November 2019 and October 2019 VA examinations are, in part, inadequate, and due to these inadequacies VA should provide the Veteran with another Persian Gulf War examination. See Barr v. Nicholson, 21 Vet. App. 303, 311-12 (2007). 8. Entitlement to service connection for headaches to include as secondary to service-connected PTSD. The Veteran contends that his headaches are related to his service-connected PTSD. Upon review of the evidence, the Board notes that the November 2019 VA examiner noted that the Veteran’s headaches are “characteristically provoked by stress and poor sleep.” With this statement in mind, the Board notes that the Veteran is service connected for posttraumatic stress disorder with the symptom of sleep disturbance attributed to this diagnosis per an April 2019 VA examination of his PTSD. The Board finds that it was an error for the examiner not to address the potential etiology of the Veteran’s headaches being related to his PTSD. As such, a new VA examination is warranted to address whether the Veteran’s headaches are related to his PTSD. 9. Entitlement to service connection for erectile dysfunction to include as secondary to PTSD. The Veteran contends in his November 2020 hearing that his erectile dysfunction is related to his service-connected PTSD. The Board observers that while the Veteran was provided a VA examination for his erectile dysfunction in October 2015, which included a diagnosis for erectile dysfunction, no opinion on etiology was rendered. This was an error, and as such, the Board finds that the Veteran’s October 2015 erectile dysfunction examination is, in part, insufficient. See Barr v. Nicholson, 21 Vet. App. 303, 311-12 (2007). Therefore, the Veteran should be provided with a new VA examination. Additionally, the Board notes that the Veteran’s claims file includes references that the Veteran has sought and has acquired benefits from the Social Security Administration (SSA). Namely, in an April 2016 VA treatment note, there is a notation that the Veteran brough in social security disability forms that required his physician approval. Additionally, in a January 2018 VA treatment note the Veteran wrote that he is “approved and receiving social security as of Jan 2017.” The claims file does not contain any evidence from SSA. VA’s duty to assist the Veteran particularly applies to relevant evidence known to be in the possession of the Federal Government, such as VA or Social Security Administration records. See 38 C.F.R. § 3.159(c)(2). Therefore, because the records from the SSA may contain pertinent information to all the Veteran’s claims, VA is obligated to obtain them. The matters are REMANDED for the following action: 1. Contact the Veteran and request that he identify the names, addresses, and approximate dates of treatment for all VA and non-VA health care providers who have treated him for his disabilities. The Veteran should be requested to sign any necessary authorization for release of medical records to VA, and appropriate steps should be made to obtain any identified records. If any requested records are not available, or the search for any such records otherwise yields negative results, that fact must clearly be documented in the claims file. If the records are unavailable, notify the Veteran in accordance with 38 C.F.R. § 3.159. 2. Request from SSA all of the records related to the Veteran’s claim for Social Security disability benefits, including medical records and copies of any decisions or adjudication, and associate them with the claims folder. All negative responses should be properly documented in the claims file, to include preparing a memorandum of unavailability and following the procedures outlined in 38 C.F.R. § 3.159(e), if appropriate. 3. After the above development is accomplished, schedule the Veteran for appropriate VA examinations. The claims folder (including a copy of this remand) must be provided to and reviewed by the examiners as part of the examination. A notation to the effect that this review has taken place should be made in the evaluation report. All tests, studies, and evaluations should be performed as deemed necessary by the examiners, and the results of any testing must be included in the examination report. (A) LOW BACK DISABILITY: After considering the pertinent information in the record in its entirety, the VA examiner should identify any low back disability present. The examiner is asked to opine as to whether it is at least as likely as not i.e. 50 percent probability or greater, that any low back disability identified was incurred or aggravated by his active duty or otherwise etiologically related to his active service. Take a detailed history from the Veteran regarding the onset of this disability and any continuity of symptoms since that time. In providing an opinion, the examiner should address the Veteran’s testimony in his November 2020 hearing that the physical nature of his job in the Air Force security forces along with his 5’6” height and weight of 118 pounds made in particular vulnerable to a low back injury. (B) NECK DISABILITY: After considering the pertinent information in the record in its entirety, the VA examiner should identify any neck disability present. The examiner is asked to opine as to whether it is at least as likely as not i.e. 50 percent probability or greater, that any neck disability identified was incurred or aggravated by his active duty or otherwise etiologically related to his active service. Take a detailed history from the Veteran regarding the onset of this disability and any continuity of symptoms since that time. In providing an opinion, the examiner should address the Veteran’s testimony in his November 2020 hearing that the physical nature of his job in the Air Force security forces along with his 5’6” height and weight of 118 pounds made in particular vulnerable to a neck injury. (C) LEFT UPPER EXTREMITY: After considering the pertinent information in the record in its entirety, the VA examiner should identify any left upper extremity disability to include dysesthesia, present. The examiner is asked to opine as to whether it is at least as likely as not i.e. 50 percent probability or greater, that any left upper extremity disability identified was incurred or aggravated by his active duty or whether it is at least as likely as not caused by or aggravated by his neck disability. (D) BILATERAL FOOT DISABILITY: After considering the pertinent information in the record in its entirety, the VA examiner should identify any bilateral foot disability, to include bilateral plantar fasciitis. The examiner is asked to opine as to whether it is at least as likely as not i.e. 50 percent probability or greater, that any bilateral foot disability identified was incurred or aggravated by his active duty. Take a detailed history from the Veteran regarding the onset of this disability and any continuity of symptoms since that time. In providing an opinion, the examiner should address the Veteran’s testimony in his November 2020 hearing that the physical nature of his job in the Air Force security forces along with his 5’6” height and weight of 118 pounds made in particular vulnerable to a low back injury. (E) VERTIGO: After considering the pertinent information in the record in its entirety, the VA examiner should identify any vertigo disability, present, including addressing the diagnosis of vertigo in the 2018 private treatment record. The examiner is asked to opine as to whether it is at least as likely as not i.e. 50 percent probability or greater, that vertigo identified was incurred or aggravated by his active duty or whether it is at least as likely as not caused by or aggravated by his bilateral hearing loss and tinnitus disabilities. Take a detailed history from the Veteran regarding the onset of this disability and any continuity of symptoms since that time. In providing an opinion the examiner should address: (i) the Veteran’s November 2020 hearing testimony wherein he contends that his hearing loss and tinnitus has caused this vertigo; (ii) a January 2018 private treatment record which includes a notation that the Veteran’s vertigo may be related to a “history of head trauma from serving in the Army;” and (iii) the Veteran June 2016 VA application for benefits wherein he noted that he fell of a Humvee and hit his head. (F) SINUS DISABILITY: After considering the pertinent information in the record in its entirety, the VA examiner should identify any sinus disability to include rhinitis and/or recurrent epistaxis present. The examiner is asked to opine as to whether it is at least as likely as not i.e. 50 percent probability or greater, that any sinus disability identified was incurred or aggravated by his active duty. Take a detailed history from the Veteran regarding the onset of this disability and any continuity of symptoms since that time. In providing an opinion, the examiner should address the article submitted in March 2020 titled “Scientist Who Exposed Health Impacts of Burn Pits in Iraq Awarded Carson Prize.” The article, in sum, is recognition of a scientist who discovered very high levels of mercury, lead, titanium, and various toxic metal in the hair of children and parents in and around Iraqi cities and matched these toxins to results found in U.S. Military Veterans. (G) CHRONIC FATIGUE, FIBROMYALGIA, AND INFLAMMATORY MUSCULOSKELETAL DISEASE: Provide the Veteran with a Persian Gulf War examination. After examining the Veteran, the examiner should provide an opinion regarding whether the Veteran has chronic fatigue syndrome, fibromyalgia and/or inflammatory musculoskeletal disease, an undiagnosed illness, or a medically unexplained chronic multi-symptom illness. The examiner is advised that the Veteran is competent to attest to observable symptoms, such as pain. If there is a medical basis to support or doubt the reports of symptomatology, the examiner should provide a fully reasoned explanation. In providing an opinion the examiner should address a (i) January and February 2014 private treatment note wherein the Veteran was diagnosed with fibromyalgia (ii) Private medical examination submitted in March 2020 that documented that he has been diagnosed with both chronic fatigue syndrome per an October 2018 private examination and fibromyalgia per a May 2019 private examination, and (iii) a October 2019 VA examination wherein the VA examiner suggested in his fibromyalgia examination that the Veteran has inflammatory musculoskeletal disease. (H) HEADACHES: After considering the pertinent information in the record in its entirety, the VA examiner should identify any headache disability present. The examiner is asked to opine as to whether it is at least as likely as not i.e. 50 percent probability or greater, that any headaches disability identified was incurred or aggravated by his active duty or whether it is at least as likely as not caused by or aggravated by his PTSD to include medication used to treat his PTSD. In providing an opinion, the examiner should address a (i) a November 2019 VA examination wherein the examiner noted that the Veteran’s headaches are “characteristically provoked by stress and poor sleep and (ii) an April 2019 PTSD examination wherein sleep disturbance was attributed to the Veteran’s PTSD. (I) ERECTILE DYSFUNCTION: After considering the pertinent information in the record in its entirety, the VA examiner should identify any erectile dysfunction disability. The examiner is asked to opine as to whether it is at least as likely as not i.e. 50 percent probability or greater, that any erectile dysfunction disability identified was incurred or aggravated by his active duty or whether it is at least as likely as not caused by or aggravated by his PTSD to include medication used to treat his PTSD. 4. Ensure that the examination report complies with this remand and the questions presented in this request. If the report is insufficient, it must be returned to the examiner for necessary corrective action, as appropriate. 5. After completing the requested actions and any additional notification and/or development deemed warranted, readjudicate the issues on appeal. If the benefit sought on appeal is not granted, the Veteran and his representative must be furnished a supplemental statement of the case and afforded the appropriate time period for response. GAYLE E. STROMMEN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Acosta, 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.