Citation Nr: 21015208 Decision Date: 03/16/21 Archive Date: 03/16/21 DOCKET NO. 20-13 421 DATE: March 16, 2021 ORDER Entitlement to compensation under 38 U.S.C. § 1151 for right frontal meningioma, status post resection with bowel dysfunction, urinary dysfunction and vestibular disorder (claimed as brain tumor with balance issues, headaches, craniotomy and dizziness) resulting from delayed diagnosis by VA is denied. New and material evidence having not been received the Veteran’s claim for entitlement to service connection for Barrett’s Esophagus (a precancerous condition of the throat) is not reopened. New and material evidence having been received the Veteran’s claim for entitlement to service connection for posttraumatic stress disorder (PTSD) and adjustment disorder with anxiety disorder (to include symptoms of memory issues, confusion, anger, depression, anxiety, and cognitive issues) is reopened. Entitlement to service connection for an acquired psychiatric disorder, to include PTSD, adjustment disorder with anxiety disorder, depression, and alcohol use disorder (to include symptoms of memory issues, confusion, anger, depression, anxiety, and cognitive issues) is denied. Entitlement to service connection for seizures due to craniotomy is denied. REMANDED Entitlement to service connection for gastrointestinal reflux disease (GERD), to include as due to contaminated water exposure at Camp Lejeune is remanded. Entitlement to service connection for allergic rhinitis, to include as due to contaminated water exposure at Camp Lejeune is remanded. Entitlement to service connection for adenomatous polyps of the colon (also claimed as sclerotic lesion in the left iliac), to include as due to contaminated water exposure at Camp Lejeune is remanded. Entitlement to service connection for anemia (also claimed as hereditary blood disorder, thalassemia), to include as due to contaminated water exposure at Camp Lejeune is remanded. Entitlement to a compensable rating for service-connected bilateral hearing loss is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities is remanded. FINDINGS OF FACT 1. An additional disability to include right frontal meningioma, status post resection with bowel dysfunction, urinary dysfunction and vestibular disorder (claimed as brain tumor with balance issues, headaches, craniotomy and dizziness), did not result from carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on the part of VA, or an event not reasonably foreseeable. 2. In a final decision issued in October 2013, the RO denied the claim for service connection for Barrett’s Esophagus (a precancerous condition of the throat). 3. Evidence added to the record since the final October 2013 denial is cumulative or redundant of the evidence of record at the time of the prior decision and does not raise a reasonable possibility of substantiating the Veteran’s claim of entitlement to service connection for Barrett’s Esophagus (a precancerous condition of the throat). 4. In a final decision issued in February 2015, the RO confirmed and continued the prior denial of the Veteran’s claim of entitlement to service connection for PTSD and adjustment disorder with anxiety disorder (to include symptoms of memory issues, confusion, anger, depression, anxiety, and cognitive issues). 5. Evidence added to the record since the last final denial in February 2015 is not cumulative or redundant of the evidence of record at the time of the decision and raises a reasonable possibility of substantiating the Veteran’s claim of entitlement to service connection for PTSD and adjustment disorder with anxiety disorder (to include symptoms of memory issues, confusion, anger, depression, anxiety, and cognitive issues). 6. At no time during the pendency of the claim does the Veteran have current diagnoses of PTSD or alcohol use disorder. 7. An acquired psychiatric disorder, other than PTSD and alcohol use disorder, to include adjustment disorder with anxiety disorder, and depression (to include symptoms of memory issues, confusion, anger, depression, anxiety, and cognitive issues) is not shown to be causally or etiologically related to any disease, injury, or incident during service, and a psychosis did not manifest within one year of the Veteran’s discharge from active service. 8. At no time during, or prior to, the pendency of the claim does the Veteran have a current diagnosis of seizures or a seizure disability. CONCLUSIONS OF LAW 1. The criteria for compensation under 38 U.S.C. § 1151 for right frontal meningioma, status post resection with bowel dysfunction, urinary dysfunction and vestibular disorder (claimed as brain tumor with balance issues, headaches, craniotomy and dizziness) resulting from a delayed diagnosis by VA have not been met. 38 U.S.C. §§ 1151, 5107; 38 C.F.R. §§ 3.102, 3.361. 2. The October 2013 rating decision that denied the Veteran’s claim of entitlement to service connection for Barrett’s Esophagus (a precancerous condition of the throat) is final. 38 U.S.C. § 7105 (c); 38 C.F.R. §§ 3.104, 20.302, 20.1103. 3. New and material evidence has not been received to reopen the claim of entitlement to service connection for Barrett’s Esophagus (a precancerous condition of the throat). 38 U.S.C. § 5108; 38 C.F.R. § 3.156 (a). 4. The February 2015 rating decision that confirmed and continued the prior denial of the Veteran’s claim of entitlement to service connection for PTSD and adjustment disorder with anxiety disorder (to include symptoms of memory issues, confusion, anger, depression, anxiety, and cognitive issues) is final. 38 U.S.C. § 7105 (c); 38 C.F.R. §§ 3.104, 20.302, 20.1103. 5. New and material evidence has been received to reopen the claim of entitlement to service connection for PTSD and adjustment disorder with anxiety disorder (to include symptoms of memory issues, confusion, anger, depression, anxiety, and cognitive issues). 38 U.S.C. § 5108; 38 C.F.R. § 3.156 (a). 6. The criteria for service connection for an acquired psychiatric disorder, to include PTSD, adjustment disorder with anxiety disorder, depression, and alcohol use disorder (to include symptoms of memory issues, confusion, anger, depression, anxiety, and cognitive issues), have not been met. 38 U.S.C. §§ 101 (24), 1101, 1110, 1112, 1131, 5107; 38 C.F.R. §§ 3.1 (d), 3.6(a), 3.102, 3.303, 3.307, 3.309. 7. The criteria for service connection for seizures or a seizure disorder have not been met. 38 U.S.C. §§ 1110, 1116, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Marine Corps from August 1981 to June 1985 and from July 1986 to June 1990. The Board must discuss all theories of entitlement raised by the Veteran or by the evidence of record. Robinson v. Mansfield, 21 Vet. App. 545 (2008). Accordingly, the Board has recharacterized the claims as indicated above to afford the Veteran the broadest possible scope of review. See Clemons v. Shinseki, 23 Vet. App. 1, 5-6 (2009). 1151 Claim Entitlement to compensation under 38 U.S.C. § 1151 for right frontal meningioma, status post resection with bowel dysfunction, urinary dysfunction and vestibular disorder (claimed as brain tumor with balance issues, headaches, craniotomy and dizziness) resulting from delayed diagnosis by VA is denied. The Veteran contends that he is entitled to compensation under the provisions of 38 U.S.C. § 1151 for right frontal meningioma, status post resection with bowel dysfunction, urinary dysfunction and vestibular disorder (claimed as brain tumor with balance issues, headaches, craniotomy and dizziness). In this regard, he alleges that he underwent a brain MRI in 2011 and a subsequent scan in 2018 at VA. However, a growth was identified in 2018 that had also been present in 2011, but not identified. He alleges that but for the delayed diagnosis, he would not have developed his disability. Compensation under 38 U.S.C. § 1151 is awarded for a qualifying additional disability caused by improper VA treatment. A disability is a qualifying additional disability if the disability was not the result of the veteran’s willful misconduct and the disability was caused by hospital care, medical or surgical treatment, or examination furnished the veteran under any law administered by the Secretary of the VA, either by a Department employee or in a Department facility and the proximate cause of the disability was carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on the part of the Department in furnishing the hospital care, medical or surgical treatment, or examination; or an event not reasonably foreseeable. 38 U.S.C. § 1151; 38 C.F.R. § 3.361. In Viegas v. Shinseki, the United States Court of Appeals for the Federal Circuit noted that section 1151 delineates three prerequisites for obtaining disability compensation. First, a putative claimant must incur a “qualifying additional disability” that was not the result of his own “willful misconduct.” 38 U.S.C. § 1151 (a). Second, that disability must have been “caused by hospital care, medical or surgical treatment, or examination furnished the Veteran” by VA or in a VA facility. Finally, the “proximate cause” of the Veteran’s disability must be “carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on the part” of VA, or “an event not reasonably foreseeable.” See Viegas v. Shinseki, 705 F.3d 1374 (Fed. Cir. 2013); § 1151(a)(1)(A), (a)(1)(B). Thus, section 1151 contains two causation elements-a Veteran’s disability must not only be caused by the hospital care or medical treatment he received from VA, but also must be proximately caused by the VA’s fault or an unforeseen event. In determining whether a veteran has an additional disability, VA compares the Veteran’s condition immediately before the beginning of the hospital care or medical or surgical treatment upon which the claim is based to the Veteran’s condition after care or treatment is rendered. 38 C.F.R. § 3.361 (b). To establish causation, the evidence must show that the hospital care or medical or surgical treatment resulted in the Veteran’s additional disability. Merely showing that a Veteran received care or treatment and that the Veteran has an additional disability does not establish causation. 38 C.F.R. § 3.361 (c)(1). Hospital care or medical or surgical treatment cannot cause the continuance or natural progress of a disease of injury for which the care or treatment was furnished unless VA’s failure to timely diagnose and properly treat the disease or injury proximately caused the continuance or natural progress. 38 C.F.R. § 3.361 (c)(2). To establish that carelessness, negligence, lack of proper skill, error in judgment, or similar instance on VA’s part in furnishing hospital care, medical or surgical treatment, or examination proximately caused a Veteran’s additional disability, it must be shown that the hospital care or medical or surgical treatment caused the Veteran’s additional disability; and (i) VA failed to exercise the degree of care that would be expected of a reasonable health care provider, or (ii) VA furnished the hospital care or medical or surgical treatment without the Veteran’s informed consent. Determinations of whether there was informed consent involve consideration of whether the health care providers substantially complied with the requirements of 38 C.F.R. § 17.32. Minor deviations from the requirements of 38 C.F.R. § 17.32 that are immaterial under the circumstances of a case will not defeat a finding of informed consent. 38 C.F.R. § 3.361 (d)(1). Whether the proximate cause of a Veteran’s additional disability was an event not reasonably foreseeable is in each claim to be determined based on what a reasonable health care provider would have foreseen. The event need not be completely unforeseeable or unimaginable but must be one that a reasonable health care provider would not have considered to be an ordinary risk of the treatment provided. In determining whether an event was reasonably foreseeable, VA will consider whether the risk of that event was the type of risk that a reasonable health care provider would have disclosed in connection with the informed consent procedures of 38 C.F.R. §§ 17.32. 38 C.F.R. § 3.361(d)(2). Finally, when there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). Treatment records show that in March 2018 the Veteran was diagnosed with and underwent treatment for a right frontal meningioma resection. The Veteran underwent a VA Central Nervous System and Neuromuscular Diseases examination in August 2018 with an accompanying disability benefit questionnaire. The Veteran reported dizziness, syncope, weakness, poor memory, headaches, hearing loss and vision changes since 2011. The Veteran reported that he underwent an MRI brain scan in September 2011, but went undiagnosed until his brain tumor was discovered in March 2018. The Veteran underwent a frontal meningioma resection, but stated that his symptoms had not resolved. The examiner provided an opinion stating that the Veteran’s condition did become worse as a result of VA treatment. That the initial failure to identify the meningioma in 2011 lead to worsening of the condition. Therefore, the condition could have been reasonably foreseen and diagnosed in a more timely fashion and could have prevented additional disability. However, as the examiner failed to specifically address whether additional disability resulted from carelessness, negligence, lack of skill, or similar incidence of fault on the part of the attending VA personnel, such was determined by the RO to be insufficient for rating purposes. Furthermore, the Board notes that the August 2018 examiner failed to provide a complete rationale for his opinion, therefore the Board also affords the opinion little, if any, probative weight. An additional Medical Opinion was obtained in November 2018. The examiner reviewed the Veteran’s records and opined that it was less likely than not that the claimed condition was caused by carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on the part of the VA. The examiner provided the rationale that the medical records did not show in the September 2011 brain study any right frontal mass. Later in 2018, when comparing the radiology reports, it was noted that the Veteran had the same right frontal mass although smaller in 2011. It was noted that since the mass was not mentioned in the 2011 report, the Veteran was not informed of it. However, the 2011 area of consideration did not include the right frontal lobe. At the time of the September 2011 scan, the Veteran was being evaluated for left sided hearing difficulties and the purpose of the scan was to evaluated hearing related structures on the left side for causative pathology. The right frontal lobe area would not have been a consideration for close inspection. Moreover, the growth in the September 2011 scan as small and escaped the scrutiny of the reviewing radiologist. The structure was of the size that it may have been considered an artifact. Furthermore, it was noted that the growth was only seen on a few images. Therefore, the area was not initially detected after reviewing multiple films and its presence would likely only have been detected after a comparison with the later film in 2018. After a thorough review of the record, the Board finds that compensation under 38 U.S.C. § 1151 is not warranted because an additional disability to include right frontal meningioma, status post resection with bowel dysfunction, urinary dysfunction and vestibular disorder (claimed as brain tumor with balance issues, headaches, craniotomy and dizziness, did not result from carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on the part of VA, or an event not reasonably foreseeable. In this regard, the Board accords great probative weight to the November 2018 opinion as it is predicated on an interview with and examination of the Veteran and a thorough review of the record, which includes medical records concerning the treatment in question and the Veteran’s statements, in which his contentions are fully articulated. Indeed, such opinion considered all the pertinent evidence of record and provided a complete rationale, relying on and citing to the records received and medical literature. Moreover, the clinician offered a clear conclusion with supporting data. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (“[A]medical opinion...must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions”). Furthermore, while the August 2018 opinion did indicate that the Veteran’s disability was the result of a possible lack of skill and could have been reasonably foreseeable, as previously noted, the examiner provided no explanation for such a determination rather he simply reiterated the timeline. Therefore, the Board affords little, if any, probative weight to the August 2018 opinion. The Board understands the Veteran’s sincerely held belief that his right frontal meningioma, status post resection with bowel dysfunction, urinary dysfunction and vestibular disorder (claimed as brain tumor with balance issues, headaches, craniotomy and dizziness was the result of a delay in diagnosis by the VA and that such was reasonably foreseeable. While the Veteran, as a lay person, may report on observable symptoms and discomfort and the nature of the treatment he received, an assessment of the proper treatment for his symptoms is a complex, medical matter requiring training and clinical experience that lay persons do not possess. Therefore, his lay assessment of what should be gleamed from a brain scan and what a radiologist should note or be able to determine is not competent as such are complex medical questions and the statements in this regard are non-probative. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007)(noting general competence to testify as to symptoms but not to provide medical diagnosis). As the most probative evidence of record shows that an additional disability to include right frontal meningioma, status post resection with bowel dysfunction, urinary dysfunction and vestibular disorder (claimed as brain tumor with balance issues, headaches, craniotomy and dizziness, did not result from carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on the part of VA, or an event not reasonably foreseeable, the “benefit of the doubt” rule is not for application, and the Board must deny the claim. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, supra. Petitions to Reopen and Service Connection Claims Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury. Id.; also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff’d, 78 F.3d 604 (Fed. Cir. 1996) [(table)]. Where a Veteran served for at least 90 days during a period of war or after December 31, 1946, and manifests certain chronic diseases, such as arthritis, to a degree of 10 percent within one year, from the date of termination of such service, such disease shall be presumed to have been incurred or aggravated in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112, 1137; 38 C.F.R. §§ 3.307, 3.309. Alternatively, when a disease at 38 C.F.R. § 3.309 (a) is not shown to be chronic during service or the one-year presumptive period, service connection may also be established by showing continuity of symptomatology after service. See 38 C.F.R. § 3.303 (b). However, the use of continuity of symptoms to establish service connection is limited only to those diseases listed at 38 C.F.R. § 3.309 (a) and does not apply to other disabilities which might be considered chronic from a medical standpoint. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Pertinent to a claim for service connection, such a determination requires a finding of current disability that is related to an injury or disease in service. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The requirement of a current disability is satisfied when the Veteran has a disability at the time, he files his service connection claim or during the pendency of that claim, even if the disability resolves prior to adjudication of the claim. McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). However, when the record contains a recent diagnosis of disability prior to the Veteran’s filing of a claim for benefits based on that disability, the report of the diagnosis is relevant evidence that the Board must address in determining whether a current disability existed at the time the claim was filed or during its pendency. Romanowsky v. Shinseki, 26 Vet. App. 289 (2013). Under applicable regulation, the term “disability” means impairment in earning capacity resulting from diseases and injuries and their residual conditions. 38 C.F.R. § 4.1; see also Hunt v. Derwinski, 1 Vet. App. 292 (1991). Service connection for PTSD requires medical evidence establishing a diagnosis of the condition in accordance with 38 C.F.R. § 4.125 (a) (i.e., the diagnosis must comply with the Fourth Edition of the Diagnostic and Statistical Manual of Mental Disorders, 1994 (DSM-IV)); in certain circumstances, credible supporting evidence that the claimed in-service stressor occurred; and a link, established by medical evidence, between current symptomatology and the claimed in-service stressor. See 38 C.F.R. §§ 3.304 (f), 4.125; see also Cohen v. Brown, 10 Vet. App. 128, 140 (1997). [Parenthetically, the Board notes that the DSM-IV has been recently updated with a Fifth Edition (DSM-5). Effective August 4, 2014, VA issued an interim rule amending the portion of its Schedule for Rating Disabilities dealing with mental disorders and its adjudication regulations to refer to certain mental disorders in accordance with the DSM-5. The provisions of the interim final rule only apply, however, to all applications for benefits that are received by VA or that are pending before the AOJ on or after August 4, 2014. Since the Veteran’s claim was received after that date, the DSM-5 is applicable.] The evidence needed to establish the occurrence of a claimed in-service stressor is typically dependent upon whether the Veteran engaged in combat with the enemy, as well as whether the claimed in-service stressor is related to such combat; or, if not, whether there is objective evidence to verify the occurrence of the claimed stressor. See 38 C.F.R. § 3.304 (f); Cohen, 10 Vet. App. at 147; Moreau v. Brown, 9 Vet. App. 389, 395 (1996); see also 38 U.S.C. § 1154 (b). On July 13, 2010, VA published a final rule that amended its adjudication regulations governing service connection for PTSD by liberalizing, in certain circumstances, the evidentiary standard for establishing the occurrence of in-service stressors involving “fear of hostile military or terrorist activity.” See 75 Fed. Reg. 39843 (July 13, 2010), and 75 Fed. Reg. 41092 (July 15, 2010) (correcting the effective and applicability dates from July 12, 2010 to July 13, 2010). Initially, the Board notes that the Veteran’s in-service stressor of participation in “mine sweeping operations in the Persian Gulf during Operation Earnest Will” have already been confirmed. Therefore, there is no need to further discuss whether such meet the criteria for service connection for PTSD. Rating actions are final and binding based on evidence on file at the time the claimant is notified of the decision and may not be revised on the same factual basis except by a duly constituted appellate authority. 38 C.F.R. § 3.104 (a). The claimant has one year from notification of a RO decision to initiate an appeal by filing a notice of disagreement with the decision, and the decision becomes final if an appeal is not perfected within the allowed time period. 38 U.S.C. § 7105 (b) and (c); 38 C.F.R. §§ 3.160 (d), 20.200, 20.201, 20.202, and 20.302(a). Generally, a claim which has been denied in an unappealed Board decision or an unappealed RO decision may not thereafter be reopened and allowed. 38 U.S.C. §§ 7104 (b), 7105(c). The exception to this rule is 38 U.S.C. § 5108, which provides that if new and material evidence is presented or secured with respect to a claim which has been disallowed, the Secretary shall reopen the claim and review the former disposition of the claim. New evidence means existing evidence not previously submitted to agency decision makers. Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156 (a). The Court has held that the determination of whether newly submitted evidence raises a reasonable possibility of substantiating the claim should be considered a component of the question of what is new and material evidence, rather than a separate determination to be made after the Board has found that evidence is new and material. See Shade v. Shinseki, 24 Vet. App. 110 (2010). The Court further held that new evidence would raise a reasonable possibility of substantiating the claim if, when considered with the old evidence, it would at least trigger the Secretary’s duty to assist by providing a medical opinion. Id. For the purpose of establishing whether new and material evidence has been submitted, the credibility of the evidence is to be presumed. Justus v. Principi, 3 Vet. App. 510, 513 (1992). When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § § 5107 (b); 38 C.F.R. § § 3.102. When all of the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a fair preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert, 1 Vet. App. at 55. New and material evidence having not been received the Veteran’s claim for entitlement to service connection for Barrett’s Esophagus (a precancerous condition of the throat) is not reopened. The Veteran initially claimed entitlement to service connection for Barrett’s Esophagus in October 2012, which was denied in a decision issued in October 2013. At the time of the October 2013 decision, the RO considered the Veteran’s service treatment records as well as post-service treatment records and a February 2013 VA examination. The RO found that the record did not show that this condition had been incurred in service. In this regard, the Veteran’s service treatment records are negative for complaints, treatment, or diagnoses referable to any esophageal disability. Furthermore, while the Veteran claimed exposure to contaminated water at Camp Lejeune, which was confirmed, Barrett’s Esophagus is not a condition presumptively related to such exposure. Therefore, the RO found no etiological connection between the Veteran’s Barrett’s Esophagus and his service, and denied service connection. The Veteran was advised of the decision and his appellate rights. However, no further communication regarding his claim of entitlement to service connection for Barrett’s Esophagus was received until April 2018, when VA received his application to reopen such claim. Therefore, the October 2013 rating decision is final. 38 U.S.C. § 7105 (c); 38 C.F.R. §§ 3.104, 20.302, 20.1103. In this regard, the Board has considered the applicability of 38 C.F.R. § 3.156 (b), which provides that, when new and material evidence is received prior to the expiration of the appeal period, it will be considered as having been filed in connection with the claim which was pending at the beginning of the appeal period. However, in the instant case, such regulation is inapplicable as no evidence pertaining to the Veteran’s claim for service connection for Barrett’s Esophagus was received prior to the expiration of the appeal period stemming from the October 2013 rating decision. See also Bond v. Shinseki, 659 F.3d 1362, 1367 (Fed. Cir. 2011); Roebuck v. Nicholson, 20 Vet. App. 307, 316 (2006); Muehl v. West, 13 Vet. App. 159, 161-62 (1999). The evidence received since the October 2013 rating decision includes additional treatment records and lay statements. However, while such records document treatment for a variety of conditions, they do not reflect any findings which relate the Veteran’s condition to his active duty service, to include any contaminated water exposure. Additionally, while the Veteran has submitted statements regarding the onset and continuity of his esophageal condition during the course of the appeal, such are duplicative of his contentions that were previously of record at the time of the October 2013 rating decision. Specifically, he simply continues to contend that his condition is the result of or began during service, specifically as a result of his contaminated water exposure at Camp Lejeune. Therefore, the Board finds that the evidence received since the October 2013 rating decision is cumulative or redundant of the evidence of record at the time of the prior decision and does not raise a reasonable possibility of substantiating the Veteran’s claim of service connection for Barrett’s Esophagus. Consequently, new and material evidence has not been received to reopen such claim and the Veteran’s appeal must be denied. New and material evidence having been received the Veteran’s claim for entitlement to service connection for PTSD and adjustment disorder with anxiety disorder (to include symptoms of memory issues, confusion, anger, depression, anxiety, and cognitive issues) is reopened. The Veteran initially claimed entitlement to service connection for PTSD in October 2012, which was denied in a decision issued in October 2013. The Veteran then filed to reopen his claim for service connection for PTSD in February 2014, which was denied in a February 2015 rating decision. Of record at the time of the February 2015 rating decision were the Veteran’s service treatment records, post-service treatment records, VA examinations in September 2013 and February 2015 as well as lay statements. The RO noted that the Veteran’s in-service stressor had been confirmed, but that his service treatment records were silent for any complaints, treatment or diagnosis of PTSD. Furthermore, the VA examiner found that the Veteran did not meet the DSM-5 criteria for a PTSD diagnosis. However, the examiner did find that the Veteran met the diagnostic criteria for adjustment disorder with anxiety. In addition, the RO noted that the Veteran’s service treatment records reflected complaints, treatment, or a diagnosis similar to that claimed, however there was no evidence of a persistent disability in service. In addition, the VA examiner found that the Veteran’s disabilities were not incurred in or related to service or any noted symptoms therein. Consequently, the RO determined that while the Veteran’s prior claim was reopened, but as there was no evidence of a relationship between the claimed disability and service, their prior denial was confirmed and they continued to deny service connection. The Veteran was advised of the decision and his appellate rights. However, no further communication regarding his claim of entitlement to service connection for PTSD and adjustment disorder with anxiety was not received until January 2018, when VA received his application to reopen such claim. Therefore, the February 2015 rating decision is final. 38 U.S.C. § 7105 (c); 38 C.F.R. §§ 3.104, 20.302, 20.1103. In this regard, the Board has considered the applicability of 38 C.F.R. § 3.156 (b), which provides that, when new and material evidence is received prior to the expiration of the appeal period, it will be considered as having been filed in connection with the claim which was pending at the beginning of the appeal period. However, in the instant case, such regulation is inapplicable as no evidence pertaining to the Veteran’s claim for service connection for PTSD and adjustment disorder with anxiety was received prior to the expiration of the appeal period stemming from the February 2015 rating decision. See also Bond, 659 F.3d at 1367; Roebuck, 20 Vet. App. at 316; Muehl, 13 Vet. App. at 161-62. The evidence received since the February 2015 decision includes additional treatment records, VA examinations in February and August 2018, and lay statements. The Veteran further contended that he suffered from an acquired psychiatric disability which was caused by his in-service stressor or began during his active duty service. The Board notes that the Veteran is capable of reporting observable symptoms of an injury or illness, as well as the length of time those symptoms have persisted. See Layno v. Brown, 6 Vet. App. 465, 469-70 (1994). Presuming the credibility of the Veteran’s statements pursuant to Justus, 3 Vet. App. at 513 and, in light of the additional VA examinations, the Board finds that the evidence received since the February 2015 rating decision is neither cumulative nor redundant, and raises the possibility of substantiating the claim of service connection. See 38 C.F.R. § 3.156 (a). In this regard, the Veteran’s claim for PTSD and adjustment disorder with anxiety is now claimed as an acquired psychiatric disorder, to include PTSD, adjustment disorder with anxiety disorder, depression, and alcohol abuse disorder (to include symptoms of memory issues, confusion, anger, depression, anxiety, and cognitive issues). Furthermore, it was previously denied in February 2015 as the record did not indicate a definitive diagnosis of PTSD and the evidence did not support an etiological relationship between the Veteran’s adjustment disorder with anxiety. Since such time, the Veteran’s records indicate that the Veteran underwent additional VA examinations which show additional acquired psychiatric disabilities and the Veteran contends that such were caused by his confirmed in-service stressor or in the alternative began in service. Therefore, based on the foregoing reasons, the Board finds that new and material evidence has been received and, accordingly, the claim of entitlement to service connection for PTSD and adjustment disorder with anxiety disorder (now claimed as an acquired psychiatric disorder, to include PTSD, adjustment disorder with anxiety disorder, depression, and alcohol abuse disorder (to include symptoms of memory issues, confusion, anger, depression, anxiety, and cognitive issues)) is reopened, and the appeal is granted to this extent only. Entitlement to service connection for an acquired psychiatric disorder, to include PTSD, adjustment disorder with anxiety disorder, depression, and alcohol abuse disorder (to include symptoms of memory issues, confusion, anger, depression, anxiety, and cognitive issues) is denied. The Veteran alleges that he suffers from an acquired psychiatric disability to include PTSD, adjustment disorder with anxiety disorder, depression, and alcohol use disorder (to include symptoms of memory issues, confusion, anger, depression, anxiety, and cognitive issues). Specifically, the Veteran alleges that he participated in mine sweeping operations in the Persian Gulf during Operation Earnest Will. In the alternative, he has alleged that his current acquired psychiatric disability began during service. The Board notes that the Veteran’s service treatment records reflect treatment for “bad nerves,” as well as anger and depression. However, the Veteran’s service treatment records are silent for any further findings of a chronic acquired psychiatric disorder to include for any complaints, treatment or diagnosis of PTSD. The Veteran’s contention that he participated in mine sweeping operations in the Persian Gulf however was confirmed in January 2015. Post-service treatment records are silent for any complaints, treatment or diagnosis of an acquired psychiatric disability until 2013. In 2013, the Veteran reported that he began experiencing psychiatric symptoms within the past year. In September 2013 the Veteran was diagnosed with adjustment disorder with depression and anxiety. Furthermore, while it was noted that the Veteran exhibited some symptoms of PTSD, such did not meet the diagnostic criteria. Furthermore, the Veteran repeatedly underwent PTSD screenings which were negative. In 2014, while the Veteran was given a provisional diagnosis of PTSD, such was in the clinical context and no definitive PTSD diagnosis was given. In 2015 the Veteran was diagnosed with adjustment disorder with anxiety, and in 2018 the Veteran was diagnosed with unspecified anxiety disorder. However, none of the examiners opined that the Veteran’s acquired psychiatric disabilities were the result of the Veteran’s service, to include his in-service stressor, or began during his active duty service. The Veteran has undergone several VA mental health examinations throughout the course of his appeal. The first examination was conducted in September 2013. After reviewing the Veteran’s file and interviewing the Veteran, the examiner diagnosed the Veteran with adjustment disorder mixed with anxiety and depression. The examiner found that the Veteran did not meet the DSM-IV diagnostic criteria for PTSD. The Veteran reported depressed mood, anxiety, chronic sleep impairment and disturbances of mood and motivation. He also noted that while he drank alcohol in service and was required to attend alcohol counseling, post-service he denied alcohol abuse and only minor social use. The examiner assigned a GAF score of 70 and found that the Veteran’s acquired psychiatric disability caused occupational and social impairment due to mild or transient symptoms which decreased work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by medication. The examiner opined that the Veteran’s claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event or illness. The examiner found that the Veteran did not meet the diagnostic criteria for PTSD, and while he did have some symptoms of PTSD, the Veteran denied they caused any impairment. In addition, his adjustment disorder with depression and anxiety was not found to be related to the claimed PTSD or in-service stressor but rather was secondary to current life stressors to include the recent death of his father-in-law and stressful work environment. Finally, the examiner noted that the onset of the Veteran’s adjustment disorder was within the prior year, many years after his military service. In February 2015 the Veteran underwent an additional VA PTSD examination with an accompanying DBQ. The examiner found that the Veteran did not meet the DSM-5 diagnostic criteria for PTSD. However, the examiner found that the Veteran did meet the diagnostic criteria for adjustment disorder with anxiety. The Veteran reported anxiety and chronic sleep impairment. Furthermore, he denied alcohol use, stating that he drank less than once a month and he did all his drinking in service. The examiner found that the Veteran’s acquired psychiatric disability symptoms were not severe enough to interfere with occupational and social functioning or require continuous medication. The examiner opined that the Veteran’s adjustment disorder with anxiety, claimed as PTSD, was less likely as not incurred in or caused by the confirmed combat stressor of service during Operation Earnest Will in 1987. Furthermore, the examiner found that the Veteran’s adjustment disorder with anxiety was less likely as not incurred in or caused by the treatment in service for “bad nerves,” anger and depression. The examiner noted that the Veteran did not meet the diagnostic criteria for PTSD. In addition, the examiner noted the 2014 treatment notes that indicated a PTSD diagnosis but found that such was based on subjective reports rather than an objective assessment and therefore was not adequately assessed. Furthermore, the examiner found no identifiable connection between the Veteran’s current condition and his service, to include in-service “bad nerves,” anger and depression. In February 2018 the Veteran underwent an additional VA PTSD examination with an accompanying DBQ. The examiner found that the Veteran did not meet the diagnostic criteria for PTSD but did make the criteria for adjustment disorder with depression and anxiety. The examiner found that the Veteran’s acquired psychiatric disability caused occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by medication. The Veteran reported anxiety and that he occasionally drank, but only drank heavily in service. The examiner stated that the Veteran’s depression and anxiety were the result of his fear of being unable to perform his job. However, the examiner also stated that based on the Veteran’s reports and when giving him the benefit of the doubt, there was a clear nexus between the Veteran’s symptomatology and his service. However, as the examination is internally inconsistent and unclear as to nexus and etiology, the Board affords it little, if any, probative weight. In August 2018 the Veteran underwent an additional VA Mental Disorders examination with an accompanying DBQ. The examiner diagnosed the Veteran with unspecified anxiety disorder and found that the Veteran did not have more than one mental health disability. The examiner found that the Veteran’s disability caused occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation. The Veteran reported depressed mood, anxiety, chronic sleep impairment, mild memory loss, disturbances of mood and motivation, and impaired impulse control. The Veteran reported alcohol use in service and a DUI in the 1990s, but otherwise denied alcohol problems since discharge. The examiner provided no etiological opinion. Throughout the appeal, the Veteran has submitted statements indicating his belief that he not only suffers from an acquired psychiatric disability but that such was the result of or began during his active duty service. PTSD and alcohol use disorder The Veteran contends that he suffers from PTSD as a result of his mine sweeping operations in the Persian Gulf. Furthermore, the Veteran has alleged that he suffers from alcohol use disorder but has provided no additional argument in support of such. While the Veteran’s service treatment records show that the Veteran reported extensive alcohol use in service, there is no diagnosis of alcohol use disorder, and there are no complaints, treatment or diagnosis of PTSD. In addition, while the Veteran’s alleged in-service stressor has been confirmed, and while there was one post-service treatment record which reflected a possible diagnosis of PTSD, such was definitely addressed and negated by the February 2015 VA examiner. Furthermore, none of the VA examiners of record found that the Veteran’s symptoms or in-service stressor met the criteria for a PTSD diagnosis. Furthermore, post-service treatment as well as all of the VA examinations reflected that the Veteran denied alcohol use and there is no objective evidence or definitive diagnosis of alcohol use disorder. The Board finds that service connection for PTSD and/or alcohol use disorder cannot be established, as the Veteran does not have current disabilities or diagnoses for PTSD or alcohol use disorder during the pendency of his claim. Furthermore, the record does not contain a recent diagnosis of disabilities prior to the Veteran’s filing of a claim. See McClain, supra; Romanowsky, supra. In this regard, the evidence of record contains no diagnosis of PTSD or alcohol use disorder. The Board has considered the Veteran’s allegations that he has experienced PTSD and alcohol use disorder symptoms since service. In this regard, while he is competent to report symptoms, he is not competent to provide diagnoses. The Board finds that any determination as to the presence of the claimed disabilities is medical in nature. See Jandreau, 492 F.3d at 1977. Thus, the Veteran, as a layperson, is not competent to offer a diagnosis with respect to his alleged PTSD and/or alcohol use disorder as he does not possess the requisite specialized knowledge. In this regard, such diagnoses require medical expertise and testing. Therefore, as such are complex medical questions, the Veteran is not competent to offer diagnoses in this regard. See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). Therefore, the Veteran’s claims must be denied, as the evidence of record shows no current diagnosis for which service connection can be granted with respect to the Veteran’s claimed PTSD and/or alcohol use disorder. See Brammer, supra (in the absence of proof of the claimed disability, there can be no valid claim). In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, the preponderance of the evidence is against the Veteran’s claims of entitlement to service connection for PTSD and/or alcohol use disorder. As such, that doctrine is not applicable in the instant appeal, and his claims must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, supra. An acquired psychiatric disability, other than PTSD and alcohol use disorder The Veteran alleges that he has an acquired psychiatric disability, to include adjustment disorder with anxiety disorder, depression (to include symptoms of memory issues, confusion, anger, depression, anxiety, and cognitive issues) that either began in service or are related to his in-service participation in mine sweeping operations. Here, as previously noted, the Veteran’s service treatment records reflect treatment for “bad nerves,” as well as anger and depression. However, the Veteran’s service treatment records are silent for any complaints, treatment, or diagnoses related to a chronic psychiatric disability or any other psychiatric disorder. In addition, there was no evidence post-service of psychiatric complaints, treatment or diagnosis until 2013. Furthermore, the September 2013 VA examiner found that the Veteran’s acquired psychiatric disabilities onset within one year of the examination, specifically noting that such was many years post service. In addition, the examiner found that the Veteran’s reported symptoms and diagnoses were in response to current stressors to include the recent death of the Veteran’s father-in-law and a stressful work environment. Therefore, it appears that the Veteran’s in-service symptoms resolved and/or were in response to stress in service and not indicative of a chronic acquired psychiatric disorder. Therefore, service connection for adjustment disorder with anxiety disorder, depression (to include symptoms of memory issues, confusion, anger, depression, anxiety, and cognitive issues), on the basis that they began in service and have persisted, is not warranted. Similarly, the only psychiatric diagnoses qualifying for presumptive service connection under 38 C.F.R. § 3.309 (a) are psychoses, and the Veteran’s adjustment disorder with anxiety disorder and depression are not shown to be, or otherwise involve, psychotic pathology. Moreover, there is no evidence that any psychoses were manifested to a compensable degree within the first post-service year. Therefore, presumptive service connection (as a chronic disease under 38 U.S.C. § 1112) is not warranted. Consequently, the only remaining question for the Board to consider is whether the Veteran’s adjustment disorder with anxiety disorder, depression (to include symptoms of memory issues, confusion, anger, depression, anxiety, and cognitive issues) are otherwise related to service, to include an event, injury or stressor therein. As to direct service connection, the Board acknowledges that the Veteran has alleged that he participated in mine sweeping operations in the Persian Gulf, which he alleges caused his acquired psychiatric disabilities, and the Board does not question the veracity of those allegations. However, whether such a relationship exists is a medical question beyond the scope of lay observation. Jandreau, 492 F.3d at 1372. Upon careful review of all of the competent and credible evidence of record, the Board finds that direct service connection is not warranted as the most competent, credible medical evidence of record does not relate the Veteran’s current adjustment disorder with anxiety disorder, depression (to include symptoms of memory issues, confusion, anger, depression, anxiety, and cognitive issues) to his military service. As previously noted, the Veteran’s service treatment records reflect that he was treated for “bad nerves,” anger and depression during service. Furthermore, the fact that he participated in mine sweeping operations during service has been confirmed. Therefore, the Board finds that the in-service element has been satisfied. As to a current disability, the Board notes that the pertinent evidence of record confirms a current diagnosis of adjustment disorder with anxiety disorder, depression (to include symptoms of memory issues, confusion, anger, depression, anxiety, and cognitive issues). The VA examiners in September 2013, February 2015, February 2018, and August 2018 confirmed the Veteran’s diagnoses. Therefore, the Board finds that the current disability element for direct service connection is met. However, as to the nexus element, the Board must find against the Veteran’s claim, as the most competent, credible medical evidence of record does not relate the Veteran’s adjustment disorder with anxiety disorder, depression (to include symptoms of memory issues, confusion, anger, depression, anxiety, and cognitive issues) to his military service. Here, the only pertinent probative medical etiological opinions are from September 2013 and February 2015. The examiners both stated that the Veteran’s acquired psychiatric disabilities did not have their onset in service. Specifically, as previously noted the September 2013 examiner found that the Veteran’s disabilities onset within one year of the examination and the February 2015 examiner specifically found that the Veteran’s disabilities were not incurred in or caused by the treatment in service for “bad nerves,” anger and depression. Furthermore, the February 2015 examiner noted that the Veteran’s conditions were not only not related to service, but also not related to his reported stressor therein. The Board notes that these opinions are supported by robust rationales citing to supporting factual evidence. See Nieves- Rodriguez, supra; Stefl, supra. Therefore, they are highly probative. Absent any other probative evidence to the contrary, those opinions are also persuasive. Furthermore, the Board notes that there are no probative contrary opinions of record. Consequently, the preponderance of the evidence is against finding that the Veteran’s adjustment disorder with anxiety disorder, depression (to include symptoms of memory issues, confusion, anger, depression, anxiety, and cognitive issues) are related to events, injuries, or stressors in service, and service connection for such disabilities, on the basis that they are otherwise related to service, is also not warranted. The Board acknowledges the Veteran’s assertion that his current acquired psychiatric disabilities are related to his service. Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), as to the specific issue in this case, determining the etiology of acquired psychiatric disabilities, falls outside the realm of common knowledge of a lay person. In this regard, while the Veteran can competently report the onset of symptoms, any opinion regarding the nature and etiology of his disabilities requires medical expertise that the Veteran has not demonstrated because the cause of his conditions is a complex medical question thereby requiring medical expertise to discern the cause. See Jandreau, 492 F.3d at 1376-77. As such, the Board assigns no probative value to the Veteran’s assertions that his acquired psychiatric disabilities are in any way related to his service. For the reasons stated above, the Board finds that the most probative evidence of record does not relate the Veteran’s acquired psychiatric disabilities, to include adjustment disorder with anxiety disorder, depression (to include symptoms of memory issues, confusion, anger, depression, anxiety, and cognitive issues) to his military service. Therefore, the Board finds that the preponderance of the evidence is against the Veteran’s claim for service connection for an acquired psychiatric disability, to include adjustment disorder with anxiety disorder, depression (to include symptoms of memory issues, confusion, anger, depression, anxiety, and cognitive issues). As such, the benefit-of-the-doubt doctrine is not applicable, and his claim is denied. 38 U.S.C. § 5107; Gilbert, supra.   Entitlement to service connection for seizures due to craniotomy is denied. The Veteran generally contends that he suffers from seizures due to a craniotomy that is the result of his service but has presented no specific argument in support of this appeal. The Veteran’s service treatment records are silent for any complaints, treatment or diagnosis of seizures. The Veteran’s post-service treatment records are also silent for any complaints, treatment or diagnosis of seizures. Furthermore, while the Veteran has generally reported that his claimed seizures began in or were caused by his active duty service, the evidence of record does not support the Veteran’s claim. There is simply no indication of any seizures or seizure disorder. Rather, post-service the Veteran specifically denied seizures on multiple occasions. Consequently, the Board finds that VA is under no obligation to provide the Veteran with an examination in connection with his claim. See McLendon v. Nicholson, 20 Vet. App. 79 (2006) (recognizing that 38 C.F.R. § 3.159 (c) (4) presents a low threshold for the requirement of a VA examination). The Board finds that service connection is not warranted for the Veteran’s claimed seizure or seizure disorder to include as due to craniotomy as the probative evidence of record fails to demonstrate a current disability related to the Veteran’s military service. In the instant case, the probative evidence of record fails to demonstrate a current diagnosis of seizures or a seizure disorder. While the Board has also considered the Court’s holding in Romanowsky, supra, there is also no probative evidence of a recent diagnosis of this disability prior to the Veteran’s claim. The Veteran’s service treatment records and post-service treatment records are silent for any complaints, treatment or diagnosis of seizures or a seizure disorder. In this regard, the Board notes that the Veteran is competent to report his own symptoms or matters within his personal knowledge. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). In addition, laypersons may, in some circumstances, opine on questions of diagnosis and etiology. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009) (the Board’s categorical statement that ‘a valid medical opinion’ was required to establish nexus, and that a layperson was ‘not competent’ to provide testimony as to nexus because she was a layperson, conflicts with Jandreau). However, the matter of a medical diagnosis for a disability not capable of lay observation, such as that of issue here, is a matter within the province of trained medical professionals. See Jones v. Brown, 7 Vet. App. 134, 137-38 (1994). Specifically, the diagnosis of seizures or a seizure disorder involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship and requires the administration and interpretation of specialized testing. In the instant case, there is no suggestion that the Veteran has had any medical training. Therefore, as the Veteran does not have the appropriate medical training and expertise to competently self-diagnose seizures or a seizure disorder, the lay assertions in this regard have no probative value. Jandreau, supra at 1377 n.4 (“[s]ometimes the layperson will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer”); see also Woehlaert, 21 Vet. App. at 456 (although the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions). The Board emphasizes that Congress has specifically limited entitlement to service connection for disease or injury to cases where such incidents have resulted in disability. See 38 U.S.C. §§ 1110; 38 C.F.R. §§ 3.30, 3.310. Thus, where, as here, the probative evidence indicates that the Veteran does not have a current diagnosis of seizures or a seizure disorder for the entire appeal period, there can be no valid claim for service connection. See Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998); Brammer, supra. In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, the preponderance of the evidence is against the Veteran’s claim of entitlement to service connection for seizures or a seizure disorder due to craniotomy. As such, that doctrine is not applicable in the instant appeal, and his claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, supra. REASONS FOR REMAND Although the Board regrets the delay, a remand is necessary to ensure that due process is followed and that there is a complete record upon which to decide the Veteran’s claims so that he is afforded every possible consideration. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159. Entitlement to service connection for GERD, allergic rhinitis, adenomatous polyps of the colon, and anemia (also claimed as hereditary blood disorder, thalassemia), to include as due to contaminated water exposure at Camp Lejeune are remanded. The Veteran alleges that his conditions to include GERD, allergic rhinitis, adenomatous polyps of the colon, and anemia are due to his active service, specifically due to exposure to contaminated water at Camp Lejeune. The Veteran’s personnel records confirm that he served at Camp Lejeune, therefore potential exposure has been conceded. However, GERD, allergic rhinitis, adenomatous polyps of the colon, and anemia are not among the enumerated diseases listed in 38 C.F.R. § 3.309 (f) as presumptively due to such exposure. Therefore, the presumptive provisions do not apply. However, such finding is not fatal to the Veteran’s claims; he may still establish service connection with affirmative evidence of a nexus between his GERD, allergic rhinitis, adenomatous polyps of the colon, and anemia and his exposure to contaminated water or his service otherwise. Furthermore, while the Veteran underwent a VA Sinusitis and Rhinitis examination in February 2013, the examiner did not discuss the Veteran’s contaminated water exposure. Finally, the Veteran has never been examined in conjunction with his claims of service connection for GERD, adenomatous polyps of the colon, and anemia. Therefore, on remand, examinations which determine the etiology of the Veteran’s GERD, allergic rhinitis, adenomatous polyps of the colon, and anemia and consider the Veteran’s allegation of exposure to contaminated water, should be obtained. In providing the requested opinions, the examiners should note that the mere fact that a condition is not noted by VA to be related to service at Camp Lejeune under 38 C.F.R. § 17.400, is not, in and of itself, a sufficient basis to deny service connection for that condition. See generally Polovick v. Shinseki, 23 Vet. App. 48, 55 (2009) (holding that it is inappropriate to “permit the denial of direct service connection simply because there is no presumptive service connection.”). Rather, if the condition is linked to service or to exposure to contaminated water by probative medical opinion, service connection can be granted. Therefore, on remand examinations which determine the likely etiology of the Veteran’s GERD, allergic rhinitis, adenomatous polyps of the colon, and anemia should be obtained. Entitlement to a compensable rating for service-connected bilateral hearing loss is remanded. The Veteran contends that his service-connected bilateral hearing loss is worse than is reflected by his noncompensable rating. Relevant to the Veteran’s claim for a compensable rating for his bilateral hearing loss, the Court has held that, where the record does not adequately reveal the current state of a claimant’s disability, fulfillment of the statutory duty to assist requires a contemporaneous medical examination, particularly if there is no additional medical evidence that adequately addresses the level of impairment of the disability since the last examination. Allday v. Brown, 7 Vet. App. 517, 526 (1995). The Board finds that the Veteran’s claim for a compensable rating for his service-connected bilateral hearing loss must be remanded in order to afford him a contemporaneous VA examination in order to assess the current nature and severity of his service-connected disability. In this regard, the record reflects that the Veteran was most recently afforded a VA Hearing Loss and Tinnitus examination in September 2018. In light of the degenerative nature of the Veteran’s condition and the amount of time which has passed since the Veteran’s prior examination, the Board finds that a remand is required in order to afford the Veteran a contemporaneous VA examination so as to determine his current level of impairment with regard to his service-connected bilateral hearing loss. See Snuffer v. Gober, 10 Vet. App. 400 (1997); Caffrey v. Brown, 6 Vet. App. 377 (1994); VAOPGCPREC 11-95 (1995).   Entitlement to a TDIU due to service-connected disabilities is remanded. In regard to the Veteran’s TDIU claim, such must be remanded because it is inextricably intertwined with the other claims herein remanded, as the outcome of the other claims may impact the TDIU claim. A hypothetical grant of the other claims could significantly change the adjudication of the TDIU issue as grants of such would increase the Veteran’s overall combined disability percentage. See Parker v. Brown, 7 Vet. App. 116 (1994); Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (issues are “inextricably intertwined” when a decision on one issue would have a “significant impact” on a Veteran’s claim for the second issue). Consideration of entitlement to a TDIU must therefore be deferred until the intertwined issues are resolved. See Harris, 1 Vet. App. at 183 (where a claim is inextricably intertwined with another claim, the claims must be adjudicated together). The Board also notes that while the Veteran does not currently meet the schedular requirements for a TDIU, he asserts that his conditions prevented him from securing substantially gainful employment; that his disabilities present an unusual disability picture that would entitle him to a TDIU on an extraschedular basis. See 38 C.F.R. § 4.16 (a). While the Board cannot make a determination about entitlement to a TDIU on an extraschedular basis in the first instance, the Board finds that if after an additional adjudication of the other remanded claims, the Veteran continues to not meet the schedular criteria, the AOJ should consider entitlement to an extraschedular TDIU. The matters are REMANDED for the following action: 1. Obtain updated treatment records. 2. Schedule the Veteran for examinations with appropriate VA examiners to determine the likely etiology of his GERD, allergic rhinitis, adenomatous polyps of the colon, and anemia. The claims file must be reviewed by the examiners in conjunction with the examinations. After review of the claims file and examining the Veteran, the examiners should provide opinions as to whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s GERD, allergic rhinitis, adenomatous polyps of the colon, and anemia arose during or are etiologically related to his military service, to include his exposure to contaminated drinking water at Camp Lejeune. 3. The Veteran should be afforded a VA examination to determine the current nature and severity of his service-connected bilateral hearing loss. The claims file, to include a copy of this remand, must be made available and be reviewed by the examiner, and the examination report should note that review. Any indicated evaluations, studies, and tests should be conducted. 4. If after adjudication of the other remanded claims, the Veteran continues to not meet the schedular criteria for a TDIU, refer the Veteran’s claim for a TDIU to VA’s Director of Compensation Service for extraschedular consideration. L. M. BARNARD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Unger, 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.