Citation Nr: 21013241 Decision Date: 03/09/21 Archive Date: 03/09/21 DOCKET NO. 16-22 291 DATE: March 9, 2021 ORDER New and material evidence having been received, the petition to reopen the claim for service connection for an acquired psychiatric disorder, to include generalized anxiety disorder and depression, is granted. Entitlement to service connection for an acquired psychiatric disorder, to include generalized anxiety disorder and depression, is granted. REMANDED Entitlement to service connection for bilateral hearing loss is remanded. Entitlement to service connection for tinnitus is remanded. Entitlement to an initial rating in excess of 10 percent for a pilonidal cyst, status-post excision with residual tenderness, is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. FINDINGS OF FACT 1. A September 2014 rating decision, in pertinent part, denied entitlement to service connection for anxiety and depression. The Veteran was notified of that decision, but did not initiate an appeal, and new and material evidence was not received within one year of the notice of that rating decision. 2. Some of the evidence received since September 2014, when considered by itself or in connection with evidence previously assembled, relates to unestablished facts necessary to substantiate the claim, and raises a reasonable possibility of substantiating the claim of service connection for an acquired psychiatric disorder, to include generalized anxiety disorder and depression. 3. The evidence is at least in equipoise as to whether the currently diagnosed acquired psychiatric disorder was incurred in or is otherwise attributable to the Veteran’s active duty service. CONCLUSIONS OF LAW 1. The September 2014 rating decision, which, in pertinent part, denied the Veteran’s claims of entitlement to service connection for anxiety and depression, is final. 38 U.S.C. § 7105(c); 38 C.F.R. §§ 3.104, 3.156, 20.201, 20.302, 20.1103. 2. The evidence received since the September 2014 rating decision is new and material, and the claim of entitlement to service connection for an acquired psychiatric disorder is reopened. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 3. The criteria for entitlement to service connection for an acquired psychiatric disorder, to include generalized anxiety disorder and depression, have been met. 38 U.S.C. §§ 1131, 5103, 5103A, 5107(b); 38 C.F.R. §§ 3.102, 3.159, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from December 1967 to January 1970. These matters come before the Board of Veterans’ Appeals (Board) on appeal from July 2011, August 2015, March 2016, and August 2016 rating decisions by a Department of Veterans Affairs (VA) Regional Office (RO). In February 2020, the Veteran testified at a Board videoconference hearing before the undersigned. An incomplete copy of the transcript of that hearing has been associated with the claims file. In an October 2020 letter, the Board informed the Veteran that recording malfunctions made portions of his hearing inaudible, causing the hearing transcript to be incomplete. As a result, the Board offered the Veteran the opportunity to testify at another hearing, pursuant to 38 C.F.R. § 20.717. However, in an October 2020 response, the Veteran stated that he did not want to appear at another Board hearing and asked that his case be considered based on the evidence of record. See October 2020 Hearing Request. During the February 2020 Board hearing, the undersigned agreed to keep the record open for 90 days to allow the Veteran additional time to submit evidence to support his claim. See February 2020 Hearing Transcript, page 20. Additional argument and evidence, to include private treatment records, were received in March 2020. See March 2020 Medical Treatment Record –Government Facility. The Board further notes that the February 2018 statement of the case reopened the Veteran’s claim of entitlement to service connection for generalized anxiety disorder, but denied the claim based on de novo review of the evidence. As a threshold matter, however, the Board must determine whether new and material evidence has been submitted to reopen a previously denied claim. See Jackson v. Principi, 265 F.3d 1366 (Fed. Cir. 2001); Barnett v. Brown, 83 F.3d 1380 (Fed. Cir. 1996). The Board has re-characterized the claim of entitlement to service connection for an acquired psychiatric disorder, to include generalized anxiety disorder and depression. Clemons v. Shinseki, 23 Vet. App. 1 (2009) (The scope of a mental health disability claim includes any mental disability that may reasonably be encompassed by the claimant’s description of the claim, reported symptoms, and the other information of record.). New and Material Evidence In order to reopen a claim which has been denied by a final decision, the claimant must present new and material evidence. 38 U.S.C. § 5108. New evidence means existing evidence not previously submitted to VA. Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). For purposes of reopening a claim, the credibility of newly submitted evidence is generally presumed. See Justus v. Principi, 3 Vet. App. 510, 513 (1993) (in determining whether evidence is new and material, the “credibility” of newly presented evidence is to be presumed unless the evidence is inherently incredible or beyond the competence of the witness). The language of 38 C.F.R. § 3.156(a) creates a low threshold for finding new and material evidence, and views the phrase “raises a reasonable possibility of substantiating the claim” as “enabling rather than precluding reopening.” Evidence “raises a reasonable possibility of substantiating the claim,” if it would trigger VA’s duty to provide an examination in adjudicating a non-final claim. Shade v. Shinseki, 24 Vet. App. 110 (2010). 1. New and material evidence having been received, the petition to reopen the claim for service connection for an acquired psychiatric disorder, to include generalized anxiety disorder and depression, is granted. In May 2010, the Board denied the Veteran’s claim for entitlement to service connection for an acquired psychiatric disorder, to include anxiety and/or depression. Specifically, the Board found that the weight of the competent and credible medical and lay evidence of record established that the Veteran’s psychiatric disorder, to include anxiety and/or depression, if any, had its onset many years following his discharge from service and was not otherwise related to any disease, injury or other incident of service. See May 2010 BVA Decision. The Veteran did not appeal the May 2010 Board decision. Accordingly, it is final. The Veteran filed a request to reopen his claim for entitlement to service connection for an acquired psychiatric disorder in October 2013. See October 2013 Correspondence. In a September 2014 rating decision, the RO noted that additional lay statements and VA and private medical records, showing that the Veteran had carried a diagnosis of anxiety since at least February 1993, had been added to the claims file since the May 2010 Board decision. However, the RO found that although new, the additional evidence was not material because it did not show that the Veteran’s diagnosed anxiety disorder began in or was aggravated or caused by his active military service, and as a result, the RO declined to reopen the Veteran’s claim. See September 2014 Rating Decision – Narrative. The Board notes that, in January 2015, the Veteran submitted a letter to his Congressman, in which he reported that his diagnosed anxiety was aggravated beyond its natural progression by his service-connected pilonidal cyst and by his father’s death. See January 2015 Congressionals. However, the Board notes that the Court has consistently held that a new etiological theory does not constitute a new claim. See Velez v. Shinseki, 23 Vet. App. 199 (2009); Ashford v. Brown, 10 Vet. App. 120, 123 (1997); Roebuck v. Nicholson, 20 Vet. App. 307 (2006). In this regard, a new theory of entitlement cannot be the basis to reopen a claim under 38 U.S.C. § 7104(b) when there is no evidence supporting the new theory of entitlement. Boggs v. Peake, 520 F.3d 1330, 1336-37 (Fed. Cir. 2008). In the present case, no new and material evidence to support this new theory of entitlement was received within a year of the September 2014 rating decision, and the Veteran did not submit a valid notice of disagreement (NOD) within one year of the notice thereof. As such, the September 2014 rating decision became final. Evidence considered at the time of the September 2014 rating decision included service treatment records (STRs), VA and private medical treatment records, multiple lay statements from the Veteran and from his friends and family members, and a March 2010 VA hearing transcript. See September 2014 Rating Decision – Narrative. The Board notes that the Veteran submitted a letter, dated in May 2015, stating that he wanted to refile his claims of entitlement to service connection for depression and anxiety. See May 2015 VA Form 21-4138 Statement in Support of Claim. Thereafter, the RO issued a letter to the Veteran, dated in June 2015, stating that VA regulations required that all claims to be submitted on a standardized form. See June 2015 Report of Contact. However, the Veteran did not take any additional action to reopen his claims for entitlement to service connection for anxiety or depression until May 2016. As noted above, the Veteran filed his claim to reopen in May 2016. See May 2016 VA Form 21-526EZ, Fully Developed Claim (Compensation). Since the final September 2014 RO decision, VA treatment records, private treatment records, a June 2016 VA examination report and medical opinion, addendum medical opinions dated in July and August 2016, statements from the Veteran dated in January 2015, December 2018, and March 2020, service personnel records (SPRs), Social Security Administration (SSA) records, and a partial February 2020 hearing transcript were added to the claims file. In the June 2016 VA medical opinion, the examiner opined that it was at least as likely as not that the Veteran’s diagnosed generalized anxiety disorder was incurred in service. In support of his opinion, the examiner noted that the Veteran reported that his symptoms manifested during service after his request to marry his pregnant girlfriend was denied, and she, in turn, left him. See July 2016 CAPRI. This evidence is new and material because it was not of record at the time of the final RO decision in September 2014 and indicates that the Veteran has a current acquired psychiatric disorder which may have manifested during his active duty service. The Board finds this evidence would trigger VA’s duty to provide an examination in adjudicating a non-final claim. Accordingly, the Board finds this new evidence raises a reasonable possibility of substantiating the Veteran’s claim of entitlement to service connection for an acquired psychiatric disorder, to include generalized anxiety disorder and depression, and as such, the claim is now reopened. See Shade, 24 Vet. App. at 110. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated during service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. In order to establish entitlement to service connection, there must be (1) evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) a causal connection between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Lay evidence presented by a Veteran concerning continuity of symptoms after service may not be deemed to lack credibility solely because of a lack of contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331 (2006). The Board has the authority to discount the weight and probity of evidence in light of its own inherent characteristics and its relationship to other evidence. Madden v. Gober, 125 F.3d 1477 (Fed. Cir. 1997). The Board must assess the credibility and weight of all the evidence, including the medical evidence, to determine its probative value, accounting for evidence which it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. Masors v. Derwinski, 2 Vet. App. 181 (1992); Wilson v. Derwinski, 2 Vet. App. 614 (1992); Hatlestad v. Derwinski, 1 Vet. App. 164 (1991); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Equal weight is not accorded to each piece of evidence contained in the record; every item of evidence does not have the same probative value. The Board must determine whether the evidence supports the claim or is in relative equipoise, with the appellant prevailing in either case, or whether the preponderance of the evidence is against the claim, in which case, service connection must be denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 2. Entitlement to service connection for an acquired psychiatric disorder, to include generalized anxiety disorder and depression, is granted. The Veteran states that his acquired psychiatric disorder manifested while he was serving on active duty. Specifically, the Veteran reported that his generalized anxiety disorder and depression manifested after his commander denied his request to marry his girlfriend, a local woman who was pregnant with his child, while he was stationed in Zaragoza, Spain. The Veteran further stated that his girlfriend left him shortly thereafter because she believed that he did not want to marry her. In addition, the Veteran stated that he slipped on an oily catwalk and injured his back, at or around the same time, and reported that the loss of his girlfriend, in conjunction with pain from his in-service injury, caused significant anxiety and depression. In this regard, the Veteran reported that he went away without leave (AWOL) for two days, started drinking heavily, and stopped writing home, which led his mother to contact the Red Cross. See March 2010 Hearing Testimony, pages 7-8; February 2020 Hearing Transcript, pages 21-22; January 2021 Medical Treatment Record – Government Facility. Alternatively, the Veteran reported that his diagnosed acquired psychiatric disorder may have been caused by stress associated with his in-service occupation as an electrical power production specialist. To this end, the Veteran reported that he worked at a powerplant that supplied electricity to his entire base and stated that the base had two power outages while he was stationed there. In addition, the Veteran reported that his acquired psychiatric disorder may have been caused or aggravated by his service-connected pilonidal cyst. See April 2014 Correspondence; January 2015 Congressionals. In support of his claim, the Veteran submitted multiple lay statements from family members and friends, which corroborate his statements that he was depressed and consumed excessive amounts of alcohol following his discharge from active duty service. See March 2014 Correspondence; December 2017 Buddy/Lay Statement. The Veteran’s STRs are silent for any findings or diagnoses of acquired psychiatric disorders, to include generalized anxiety disorder and depression. See April 2015 STR – Medical. A review of the Veteran’s SPRs confirms that he was stationed in Zaragoza, Spain from August 1968 to January 1970. In addition, an airman performance report for the period from December 1968 to May 1969 shows that the Veteran’s performance had been far below the accepted Air Force minimums. In this regard, the performance report indicates that letters requesting disciplinary action be taken against the Veteran had to be forwarded to the First Sergeant twice during the aforementioned period. The report further describes the Veteran’s approach to technical jobs as “lackadaisical[,]” and states that his deficiencies appeared to stem from a lack of basic knowledge which was required in the mechanical electrical career field. In addition, statements from the Veteran’s superior officers dated in December 1969 confirm that the Veteran was found sleeping on a couch in the lobby of the Base Chapel where he was on duty and that he had to be removed from shift duty, a position of vital importance to the plant, Base Electrical system and mission. In this regard, the statements show that the Veteran’s chronic lateness, poor initiative, and lack of self-progress and discipline rendered him untrustworthy to perform tasks dealing directly with the section’s assigned mission and that the possibility for motivation was extinct. Thereafter, a December 1969 Commander’s Report notes that the Veteran was sectioned for apathy, defective attitude, and inability to expend effort constructively. See May 2017 Military Personnel Record; June 2017 Military Personnel Record. A review of the post-service treatment records shows that the Veteran began receiving ongoing treatment for psychiatric symptoms in June 1991. See June 2007 Medical Treatment Record – Non-Government Facility. In addition, an April 2010 private treatment record from Cherokee Health Systems notes that the Veteran had been diagnosed with generalized anxiety disorder and bereavement, rule out major depression in December 2009. See July 2010 Third Party Correspondence. The Veteran was afforded a VA examination for mental disorders in June 2016. The examiner diagnosed the Veteran with generalized anxiety disorder. During the examination, the Veteran reported that he dated and cohabitated with a woman during service. He stated that they were expecting a child and decided to get married, but that his Commander refused to authorize the union. In this regard, the Veteran reported that he tried to get support for his intentions to marry from a priest but that, before he was able to do so, his girlfriend accused him of not really wanting to marry her and left. The examiner noted that a performance review for the period from December 1967 to December 1968 indicated that the Veteran had been performing well, while subsequent evaluations showed a marked decline in the Veteran’s performance. To this end, the Veteran reported that his low performance evaluation marks corresponded with his Commander’s refusal to allow him to marry his pregnant girlfriend. He further stated that he began drinking heavily during this period, which contributed to his disciplinary and performance problems. After performing an examination and reviewing the evidence of record, the examiner opined that it was at least as likely as not that the Veteran’s diagnosed generalized anxiety disorder was incurred in service. In support of her opinion, the examiner acknowledged the Veteran’s statements that his symptoms manifested after he was denied permission to marry his pregnant girlfriend, and she broke up with him. The examiner further opined that the Veteran’s back problems and pilonidal cyst had not contributed significantly to his anxiety beyond the expected course of the conditions. To this end, the examiner noted that the Veteran reported increased anxiety with increased stress in his life, as well as his condition gradually increasing over time. See July 2016 CAPRI. In July 2016, VA obtained an addendum medical opinion from the June 2016 VA examiner. The examiner opined that the Veteran’s diagnosed generalized anxiety disorder was incurred in military service because it manifested while the Veteran was serving on active duty and was related to life stressors in his relationship at that time. In this regard, the examiner clarified that life stressors that occurred at the time of his military service, to include relationship problems with his girlfriend and fears that he could not get permission to marry her or that she would refuse him, resulted in the onset of symptoms of generalized anxiety disorder. The examiner noted that these occurred during the Veteran’s active military service, though they were not specifically related to his military service. However, the examiner also determined that the Veteran’s generalized anxiety disorder was not related to his military service, in that there were no events during service that caused or otherwise resulted in the condition. In addition, the examiner found that the Veteran’s back problems and pilonidal cyst did not cause, result in, or contribute to the development of his generalized anxiety disorder. See March 2020 Medical Treatment Record – Government Facility. VA obtained another addendum medical opinion from the June 2016 VA examiner in August 2016. The examiner noted that the choice of either “caused by” or “related to” created confusion in findings where a claimed condition was incurred in service. In this regard, the examiner noted that there were no markers in the Veteran’s STRs for an acquired psychiatric disorder, though the Veteran’s self-report indicated that his symptoms manifested during service. The examiner further noted that it is not unheard of for a service member to neglect to report symptoms of mental health concerns to primary care providers on their entrance and exit examinations and stated that it was possible that that is the case for the Veteran. In addition, the examiner reiterated that her opinion was based only on the Veteran’s self-reports on the date of the examination. See August 2016 VA Form 21-2507a Request for Physical Examination. After a review of the evidence of record, the Board finds that entitlement to service connection for an acquired psychiatric disorder, to include generalized anxiety disorder and depression, is warranted. In the present case, there is sufficient evidence that the Veteran meets the threshold criterion for service connection of a current disability. Specifically, the June 2016 VA examiner diagnosed the Veteran with generalized anxiety disorder. See July 2016 CAPRI. As such, the remaining question is whether the Veteran’s current acquired psychiatric disorder is related to his service. In this regard, the Board notes that the Veteran's STRs contain no complaints, findings, or diagnosis of a mental health disorders and psychiatric complaints or findings, to include generalized anxiety disorder and depression. However, the Board finds that the June 2016 VA examiner's opinion, when considered in connection with the July and August 2016 addendum medical opinions and the Veteran’s SPRs, are probative and adequate to corroborate the Veteran’s reports that his diagnosed acquired psychiatric disorder manifested while he was serving on active duty. In this regard, the Board finds that the examiner’s opinions were based on a thorough review of the record, are supported by a reasoned analysis of medical facts, and are consistent with the evidence of record. Barr v. Nicholson, 21 Vet. App. 303 (2007); Stefl v. Nicholson, 21 Vet. App. 120 (2007); Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Thus, after resolving reasonable doubt in the Veteran’s favor, the Board finds that entitlement to service connection for an acquired psychiatric disorder, to include generalized anxiety disorder and depression, is warranted. The claim is granted. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). REASONS FOR REMAND 1. Entitlement to service connection for bilateral hearing loss is remanded. 2. Entitlement to service connection for tinnitus is remanded. In a March 2015 statement, the Veteran reported that he began receiving treatment at the James H. Quillen VA Medical Center (VAMC) in 1971. See March 2015 VA 21-4138 Statement in Support of Claim. The Board observes that there are no records dated from January 1971 through June 1991 or from September 1995 through September 2010 currently associated with the claims file. Therefore, the Board finds that on remand, all outstanding records from the James H. Quillen VAMC should be obtained and associated with the claims folder. In addition, a review of the record shows that the Veteran receives regular treatment at his local VA Medical Center. However, the most recent VA medical records in the claims file are dated in September 2017. Thus, in order to adequately adjudicate the claim on appeal the Board finds that a remand is also necessary to obtain updated VA medical records. 38 U.S.C. § 5103A. 3. Entitlement to an initial rating in excess of 10 percent for a pilonidal cyst, status-post excision with residual tenderness, is remanded. The Veteran last underwent a VA examination for skin diseases in January 2015. The examiner noted that the Veteran had been diagnosed with a cyst. During the examination, the Veteran reported residual pain and tenderness at the site of his excision. The examiner found that the Veteran did not have any benign or malignant skin neoplasms, systemic manifestations due to any skin diseases, and that he had not been treated in the preceding 12 months for any skin condition. In addition, the examiner noted that the Veteran’s skin condition did not cause scarring of disfigurement of the head, face, or neck. See May 2015 CAPRI. A March 2015 primary care nursing note shows that the Veteran endorsed lower back pain in the area of his pilonidal cyst excision. To this end, the Veteran reported that his pain had increased, and he believed that something more was going on with his back. In April 2015, the Veteran reported that he had been experiencing increased pain at the site of his pilonidal cyst excision for approximately one month. In this regard, the Veteran endorsed chronic pain and a deeper ache. On examination, the examiner noted posterior thoracic tenderness to palpation and a marked right medial buttock fold and scar tenderness. The assessment included pilonidal cyst status-post two surgeries with chronic residual parasthesia. See May 2015 CAPRI. In April 2015, the Veteran also underwent a pelvis CT for a pilonidal cyst with worsening pain. The impression included poorly distended/contracted urinary bladder with some diffuse wall thickening and multilevel lumbar degenerative spondylosis and other chronic/nonacute findings. In addition, the examiner reported that no formed fluid collection to suggest a recurrent cyst/abcess or obvious acute inflammation at the site of the Veteran’s pilonidal cyst surgical scar and no infection or recurrence of the pilonidal cysts. However, the examiner did find abnormal thickening of the skin and subcutaneous soft tissue (scar tissue) at the pilonidal cyst surgical site. See July 2016 CAPRI. In June 2016, the Veteran underwent a VA examination for back conditions. During the examination, the Veteran reported that he received medical care from VA, Pain Specialist of East Tennessee and from the Tennessee Brain and Spine Clinic. In addition, the examiner reported that he took oxycodone, gabapentin, and oxymorphone to deal with the pain from his re-current skin cyst and chronic back pain. To this end, the Veteran reported that the medications kept him mobile and moving without increased pain and stiffness in his back. See June 2016 C&P examination. During the February 2020 Board hearing, the Veteran testified that the severity and intensity of symptoms that he ascribed to his service-connected pilonidal cyst had progressively worsened over time. In this regard, the Veteran reported that his back pain had increased to the point that he was no longer able to get out of bed or move without Oxycodone. He also reported that he had a large scar on his back from the pilonidal cyst excision that extended into his spine and damaged his L5 and L6 vertebrae. See February 2020 Hearing Transcript, pages 9-12. Evidence of a change in the condition or allegation of worsening of the condition renders an examination inadequate for rating purposes. See Palczewski v. Nicholson, 21 Vet. App. 174, 181 (2007); see also Snuffer v. Gober, 10 Vet. App. 400, 403 (1997). Thus, because there are reports of worsening, a remand is necessary to obtain a VA examination to determine the current severity of the Veteran’s service-connected pilonidal cyst. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159. Moreover, as noted above, a review of the record shows that the Veteran receives regular treatment at his local VA Medical Center. However, the most recent VA medical records in the claims file are dated in September 2017. Thus, in order to adequately adjudicate the claim on appeal the Board finds that a remand is also necessary to obtain updated VA medical records. 38 U.S.C. § 5103A. Lastly, during his June 2016 VA examination for back conditions, the Veteran reported that he received treatment for his service-connected pilonidal cyst at the Pain Specialist of East Tennessee and from the Tennessee Brain and Spine Clinic. See June 2016 C&P examination. However, private medical records from the aforementioned providers have not been associated with the claims file. As such, the Board finds that a remand is also required to obtain these records. 4. Entitlement to a TDIU is remanded. The Veteran reports that he is unable to obtain or maintain employment due to his service-connected pilonidal cyst. See September 2011 VA Form 21-8940 Veterans Application for Increased Compensation Based on Unemployability. The Board finds that the issue of entitlement to a TDIU is part and parcel of the Veteran’s claim for an increased disability rating. See Rice v Shinseki, 22 Vet. App. 447 (2009). However, as the issue on appeal is being remanded, consideration of the Veteran’s claim of entitlement to a TDIU, at this juncture, would be premature as the issue is inextricably intertwined with the remanded claim on appeal. Accordingly, the Board will defer TDIU adjudication. See Parker v. Brown, 7 Vet. App. 116 (1994); Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (holding that two issues are “inextricably intertwined” when they are so closely tied together that a final Board decision cannot be rendered unless both are adjudicated). The matters are REMANDED for the following action: 1. With any necessary identification of sources by the Veteran, request all VA treatment records not already associated with the claims file from the Veteran’s VA treatment facilities, and all private treatment records from the Veteran not already associated with the file. Specifically, attempts should be made to obtain VA treatment records dated from January 1971 through June 1991, from September 1995 through September 2010, and from September 2017 to the present, to include any archived records. In addition, attempts should be made to obtain all outstanding treatment records from Pain Specialist of East Tennessee and from the Tennessee Brain and Spine Clinic. If any treatment records are unavailable, issue a formal finding of unavailability and notify the Veteran so that he can submit any medical records in his possession. be necessary before an opinion could be rendered should be identified. 2. After completion of the development in #1, schedule the Veteran for a VA examination to determine the current nature and severity of his service-connected pilonidal cyst, status-post excision with residual tenderness. The examiner should review the pertinent documents in the Veteran’s claims file in connection with the examination. Any indicated evaluations, studies, and tests should be conducted. The examiner should identify the nature and severity of all current manifestations of the Veteran’s service-connected pilonidal cyst, as well as the impact that such has on his occupational functioning. (Continued on the next page)   3. After completion of the above development, readjudicate any claims remaining on appeal. S. HENEKS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Justis, Attorney-Advisor 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.