Citation Nr: 21015833 Decision Date: 03/18/21 Archive Date: 03/18/21 DOCKET NO. 10-17 924 DATE: March 18, 2021 ORDER Service connection for an acquired psychiatric disability is granted. A rating in excess of 20 percent prior to October 4, 2017 for right shoulder degenerative joint disease, acromioclavicular joint spur (hereinafter “right shoulder disability”) is denied. A rating in excess of 40 percent since October 4, 2017 for right shoulder disability is denied. REMANDED Entitlement to service connection for a digestive system disorder (previously claimed as stomach reflux), to include as secondary to service-connected disabilities and/or medications, is remanded. Entitlement to a compensable rating for bilateral hearing loss with chronic recurrent otitis media in the right ear is remanded. Entitlement to a rating in excess of 20 percent for hypertension is remanded. Entitlement to a compensable rating for residuals of status post right orchiectomy is remanded. Entitlement to a rating in excess of 30 percent for bilateral plantar fasciitis is remanded. Entitlement to a rating in excess of 10 percent for mild left Achilles tendinitis is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. FINDINGS OF FACT 1. The Veteran’s current acquired psychiatric disability as likely as not was incurred while in service. 2. From May 4, 2006 to October 3, 2017, the Veteran’s service-connected right shoulder disability was not manifested by at least motion limited to midway between side and shoulder level (under the old or new rating criteria), ankylosis, or impairment of the humerus. 3. Since October 4, 2017, the Veteran’s service-connected right shoulder disability assigned at 40 percent, the maximum rating authorized, under Diagnostic Code 5201. CONCLUSIONS OF LAW 1. With resolution of reasonable doubt in the Veteran’s favor, the criteria for entitlement to service connection for an acquired psychiatric disability have been satisfied. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2019). 2. The criteria for entitlement to a rating in excess of 20 percent prior to October 4, 2017 for right shoulder disability have not been met. 38 U.S.C. §§ 1155, 5103, 5103A; 38 C.F.R. §§ 3.102, 3.103, 3.159, 3.327, 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.59, 4.21, 4.71a, Diagnostic Codes 5010-5201. 3. There is no legal basis for the assignment of a schedular rating in excess of 40 percent since October 4, 2017 for right shoulder disability. 38 C.F.R. § 4.71a, Diagnostic Code 5010-5201. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from October 1981 to October 2001. A private attorney revoked her representation and withdrew as the Veteran’s representative for the issues on appeal February 2020 after the certification of this appeal. The record reflects that written notice was provided to the Board and the Veteran. In June 2020, a notice letter was sent to the Veteran affording him the opportunity to select another representative. As of this date, there has been no response from the Veteran and the Veteran proceeded with the Board hearing in December 2020 unrepresented; therefore, the Board will proceed under the assumption that he wishes to represent himself. See 38 C.F.R. § 20.6 (2019). In June 2015, in April 2016, and August 2017, the Board remanded the case. The issue of entitlement to service connection for migraines was granted in an August 2018 VA rating decision, which represents a full grant of the benefits sought so it is no longer on appeal before the Board. The remaining issues on appeal have been returned to the Board for appellate review. In April 2016, the Board also denied the issue of service connection for hyperlipidemia and remanded the issue of entitlement to service connection for an acquired psychiatric disability for issuance of a statement of the case (SOC). The agency of original jurisdiction (AOJ) adjudicated this issue in a September 2017 SOC, the Veteran submitted a timely substantive appeal in response, and the AOJ certified this issue to the Board for appellate review. Given the decision below for this issue, a detailed explanation of how VA complied with its duties to notify and assist is unnecessary. There was substantial compliance with the prior Board remand directives for the issues on appeal discussed below on the merits. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Specifically, the AOJ issued a SOC for the issue of entitlement to service connection for an acquired psychiatric disability. VA treatment records from Kerrville, Texas were obtained and associated with the claims file in August 2017. In May 2016 and October 2017 notice letters, the Veteran was requested to identify VA providers and/or facility who have treated him. As of this date, the Veteran has yet to respond to this request, to include any identified VA facility in Georgia since November 2012. The Veteran was provided a VA Disability examination for shoulder and arm conditions in October 2017. The AOJ also readjudicated the issues in October 2016 and August 2018 supplemental statements of the case (SSOCs). With regard to the increased rating claim on appeal discussed below on the merits, the requirements of 38 U.S.C. §§ 5103 and 5103A have been met. VA’s duty to notify was satisfied by July 2007 and July 2009 letters. 38 U.S.C. §§ 5102, 5103, 5103A; 38 C.F.R. § 3.159. VA fulfilled its duty to assist the Veteran in obtaining identified and available evidence needed to substantiate a claim to include where warranted by law, and affording the Veteran VA examinations, VA medical opinions, and a hearing before the Board. 38 U.S.C. §§ 5103, 5103A. There is no evidence that additional records have yet to be requested. In sum, there is no evidence of any VA error in notifying or assisting him with the claim on appeal for service-connected right shoulder disability that reasonably affects the fairness of this adjudication. 38 C.F.R. § 3.159(c). 1. Entitlement to service connection for an acquired psychiatric disability Service connection may be established for disability resulting from personal injury suffered or disease contracted in line of duty in the active military, naval, or air service. 38 U.S.C. §§ 1110, 1131. Service connection may be granted for any injury or disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d). In a June 2013 VA Form 21-526, the Veteran requested service connection for PTSD. In an October 2017 VA Form 21-526b, the Veteran requested to amend the claim on appeal for PTSD to include an acquired psychiatric disorder to include depressive disorder. In light of the Veteran’s contentions, the Board has recharacterized the Veteran’s claim for PTSD more broadly to an acquired psychiatric disability in order to clarify the nature of the benefit sought and ensure complete consideration of the claim. Clemons v. Shinseki, 23 Vet. App. 1, 5-6, 8 (2009). The Veteran has a current diagnosis of an acquired psychiatric disability, diagnosed as unspecified depressive disorder, during the appeal period. The element of a current disability has been met in this case. Next, review of the May 2017 VA examination report for PTSD shows that after the in-person examination and review of the electronic VA claims file, the examiner explained why the Veteran’s current diagnosis of unspecified depressive disorder was as likely as not was incurred in military service. The Board finds this opinion was based on an accurate factual history and there is no probative contrary medical opinion of record. As a result, the Board finds that the criteria to establish service connection for an acquired psychiatric disability on a direct basis has been met in this case. For the reasons and bases discussed above and after resolving all reasonable doubt in favor of the Veteran, the Board finds that service connection is warranted for an acquired psychiatric disability on a direct basis. See 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. Entitlement to a rating in excess of 20 percent prior to October 4, 2017 and in excess of 40 percent thereafter for a right shoulder disability Disability ratings are determined by applying the criteria set forth in VA’s Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. If two evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When reasonable doubt arises as to the degree of disability, such doubt will be resolved in the veteran’s favor. 38 C.F.R. § 4.3. Where entitlement to compensation has already been established and an increase in the disability rating is at issue, such as for the service-connected right shoulder disability in this case, the present level of disability is of primary concern. Although a rating specialist is directed to review the recorded history of a disability to make a more accurate evaluation, the regulations do not give past medical reports precedence over current findings. 38 C.F.R. § 4.2; Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Pertinent regulations do not require that all cases show all findings specified by the Rating Schedule, but that findings sufficiently characteristic to identify the disease and the resulting disability and above all, coordination of rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21. On May 4, 2007, the Veteran’s request for a higher rating for the issue on appeal was obtained and associated with the record. In the February 2010 VA rating decision, the AOJ assigned the service-connected right shoulder disability a 20 percent disability rating effective from May 4, 2007. See 38 C.F.R. § 4.71A, Diagnostic Code 5010-5201. In the August 2018 VA rating decision, the AOJ also assigned the service-connected right shoulder disability a 40 percent disability rating effective from October 4, 2017. Id. Since the 20 and 40 percent disability ratings are not the maximum ratings available prior to October 4, 2017 or thereafter, the issue has been returned to the Board and characterized accordingly. See AB v. Brown, 6 Vet. App. 35 (1993). The Board considers whether a rating in excess of 20 percent prior to October 4, 2017 and in excess of 40 percent thereafter for right shoulder disability is warranted in this case. See 38 C.F.R. § 4.71a, Diagnostic Code 5010-5201. During the pendency of the appeal, the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a were amended effective February 7, 2021. 85 Fed. Reg. 230 (Nov 30, 2020). These amendments revised select Diagnostic Codes “to ensure that this portion of the rating schedule uses current medical terminology and provides detailed and updated criteria for the evaluation of musculoskeletal disabilities.” Id. If a law or regulation changes during the course of a claim or an appeal, the version more favorable to the Veteran will apply, to the extent permitted by any stated effective date in the amendment in question. 38 U.S.C. § 5110(g); see also Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). If the revised version of the regulation is more favorable, the implementation of that regulation under 38 U.S.C. § 5110(g) can be no earlier than the effective date of that change. If the former version is more favorable, VA can apply the earlier version of the regulation for the period prior to, and from, the effective date of the change. Id. Review of the portion of the rating schedule that addresses the musculoskeletal system revised effective February 7, 2021 shows that Diagnostic Codes 5010 and 5201 were changed. As a result, the Board will consider the Veteran’s claim under Diagnostic Codes 5010 and 5201 pursuant to the old criteria prior to February 7, 2021 and both the old and new rating criteria from February 7, 2021. Again, the criteria that is more favorable to the Veteran will be applied. Diagnostic Code 5010 Prior to the regulatory change, Diagnostic Code 5010 provides that arthritis, due to trauma and substantiated by x-ray findings, is rated as degenerative arthritis. See 38 C.F.R. § 4.71a. Degenerative arthritis is rated under DC 5003, which provides that degenerative arthritis, established by x-ray findings, is rated according to limitation of motion for the joint or joints involved. Id. As of February 7, 2021, under the amended criteria, Diagnostic Code 5010 provides that post-traumatic arthritis is rated as limitation of motion, dislocation, or other specified instability under the affected joint. See 38 C.F.R. § 4.71a. In this case, the service-connected right shoulder disability is manifested by arthritis; however, since ratings in excess of 20 percent and 40 percent are not available under Diagnostic Code 5010, analysis under this rating criteria is not relevant and will not be discussed further. Diagnostic Code 5201 Prior to the regulatory change, Diagnostic Code 5201 provides criteria for limitation of motion of the arm. A minimum 20 percent evaluation is warranted for the major arm when its motion is limited to the shoulder level. 38 C.F.R. § 4.71a. A 30 percent evaluation is warranted for the major arm when its motion is limited to midway between side and shoulder level. Id. A 40 percent evaluation, the maximum available, is warranted for the major arm when its motion is limited to 25 degrees from the side. Id. As of February 7, 2021, under the amended criteria, Diagnostic Code 5201 provides criteria for limitation of motion of the arm. A minimum 20 percent evaluation is warranted for the major arm when its motion is limited to the shoulder level. 38 C.F.R. § 4.71a. A 30 percent evaluation is warranted for the major arm when its motion is limited to midway between side and shoulder level (flexion and/or abduction limited to 45 degrees). Id. A 40 percent evaluation, the maximum available, is warranted for the major arm when flexion and/or abduction is limited to 25 degrees from the side. Id. For VA compensation purposes, normal forward elevation (flexion) and abduction of the shoulder is from 0 degrees to 180 degrees, with 90 degrees being shoulder level. 38 C.F.R. § 4.71, Plate I. In this case, the August 2007 and October 2017 VA examination reports and December 2020 Board hearing transcript document the Veteran is right hand dominant, thus the service-connected right shoulder disability is the major extremity. Evidence and Analysis under Diagnostic Code 5201 from May 4, 2006 to October 3, 2017 After review of the evidence for symptomatology of the Veteran’s right shoulder disability during the appeal period from May 4, 2006 (one year prior to the date of claim) to October 3, 2017, the Board finds that the Veteran’s service-connected right shoulder disability was not manifested by at least motion limited to midway between side and shoulder level. In the May 2007 VA Form 21-4138, the Veteran reported his right shoulder is stiff when he moves and becomes sore and painful, he cannot use handguns or hand tools, and takes medication for pain. At the VA examination in August 2007, the Veteran reported current symptoms of morning stiffness, constant localized pain elicited by activity, limited physical activity, as well as weakness, swelling, heat, and giving way with activity. He denied any redness, lack of endurance, locking, fatigability, dislocation, or incapacitation of the right shoulder. Upon clinical evaluation of the right shoulder, he demonstrated tenderness, guarding of movement, and active painful flexion to 90 degrees and abduction to 90. He also demonstrated additional functional loss after repetitive use due to pain but by 0 degrees. There were no findings of edema, effusion, weakness, redness, heat, subluxation, or additional functional loss due following repetitive use due to fatigue, weakness, lack of endurance, or incoordination. The VA examiner confirmed the current diagnosis of degenerative joint disease (DJD) acromioclavicular joint spur and explained there was no change in the diagnosis due to subjective history of DJD and objective evidence of tenderness, guarding, and reduced range of motion on exam. Additionally, review of private and VA treatment records dated during the appeal period are silent for any clinical findings or worsening symptoms of the Veteran’s right shoulder disability. The Board finds that such symptomatology, as discussed above, is contemplated in the currently assigned 20 percent disability rating during the appeal period prior to October 4, 2017. In fact, while the Veteran reported his inability to use handguns or hand tools and his limited physical activity of the right shoulder, his range of motion findings of the right shoulder were during the appeal period, at worst, to 90 degrees flexion and to 90 degrees abduction following active motion and repetitive use testing, which is contemplated in the currently assigned 20 percent disability rating. To meet the next-higher 30 percent criteria as the major arm, motion limited to midway between side and shoulder level would need to have been shown. See 38 C.F.R. § 4.71a, Diagnostic Code 5201. When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) (“[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran’s disability, after which a rating is determined based on the § 4.71a criteria.”). After a review of the evidence discussed above, the Board finds that the functional equivalent of motion limited to midway between side and shoulder level is not shown at any time during the appeal period prior to October 4, 2017. Such findings were not shown, even when considering the Veteran’s reported symptomatology for the service-connected right shoulder disability, including limited motion, at worst, to 90 degrees flexion after active and repetitive use testing and active painful motion. The Veteran’s reported symptomatology did not, when viewed in conjunction with the medical evidence, tend to establish additional limitations of motion to the degree that would warrant a rating in excess of 20 for the service-connected right shoulder disability at any time during the appeal prior to October 4, 2017 under 38 C.F.R. §§ 4.40, 4.45, and 4.59 and the holdings in DeLuca and Mitchell. As such, the Board finds that a rating in excess of 20 percent prior to October 4, 2017 for the service-connected right shoulder disability is not warranted in this case. See 38 C.F.R. § 4.71a, Diagnostic Code 5201. Analysis under Diagnostic Code 5201 since October 4, 2017 Since the Veteran’s service-connected right shoulder disability has been assigned the maximum schedular rating available for the limitation of motion of the major extremity during the appeal period since October 4, 2017, the Board finds there is no legal basis upon which to award a higher schedular evaluation for the right shoulder disability under the old or new rating criteria for limitation of motion. As such, entitlement to a rating in excess of 40 percent since October 4, 2017 for right shoulder disability is not warranted on a schedular basis under Diagnostic Code 5201. See Sabonis v. Brown, 6 Vet. App. 426 (1994). Given that the Veteran is already in receipt of the schedular maximum for limitation of motion of the major arm since October 4, 2017 under both the old and new criteria, inquiry into the DeLuca factors is moot. See DeLuca, 8 Vet. App. at 206; Johnston v. Brown, 10 Vet. App. 80, 87 (1997). Additional Considerations Diagnostic Code 5200 provides ratings higher than 20 and 40 percent for ankylosis of the major arm. See 38 C.F.R. § 4.71a. Ankylosis is the complete immobility of a joint in a fixed position, either favorable or unfavorable. Lewis v. Derwinski, 3 Vet. App. 259 (1992); Dinsay v. Brown, 9 Vet. App. 79, 81 (1996) (ankylosis is “stiffening or fixation of a joint as the result of a disease process, with fibrous or bony union across the joint”). Review of the evidentiary record in this case does not indicate the service-connected right shoulder disability has been manifested by or demonstrated the functional equivalent of ankylosis to warrant a rating in excess of 20 or 40 percent at any time during the appeal period. In fact, the August 2007 and October 2017 VA examination reports document active range of motion findings of the Veteran’s right shoulder. The October 2017 examiner specifically found that the Veteran did not have ankylosis of the right shoulder. Diagnostic Code 5202 also provides ratings higher than 20 and 40 percent for impairment of the humerus for the major arm under both the old and new criteria. See 38 C.F.R. § 4.71a. Review of the evidentiary record in this case does not indicate the service-connected right shoulder disability has been manifested by or demonstrated the functional equivalent of impairment of the humerus to warrant a rating in excess of 20 or 40 percent at any time during the appeal period. In fact, and while the August 2007 VA examination report noted objective evidence of right shoulder guarding the VA examiner did not document any impairment of the Veteran’s right humerus. Additionally, the most recent VA examination report in October 2017 documents no impairment of the right humerus following the clinical evaluation. The Board has considered other potentially applicable Diagnostic Codes to warrant a rating higher than the currently assigned 20 and 40 percent evaluations, as discussed above. See Schafrath v. Derwinski, 1 Vet. App. 589 (1995). In this case, the evidence does not reflect that there are any other musculoskeletal disorders of the shoulder that the Veteran’s right shoulder disability is more properly rated under another Diagnostic Code. See 38 C.F.R. § 4.71a, Diagnostic Code 5201. Accordingly, higher ratings under alternate Diagnostic Codes is not warranted. The Board also considered the Veteran’s reported history of symptomatology related to the service-connected right shoulder disability, including stiffness, soreness, painful motion, tenderness, guarding, weakness, swelling, limited range of motion, and inability to use handguns or hand tools. At the December 2020 Board hearing, he also reported the right shoulder hurts all the time, he cannot use tools or lift stuff above shoulder, his arm gets tired easily, and he cannot lift heavy things with the right arm. He is competent to report such symptoms and observations because this requires only personal knowledge as it comes through one’s senses. Layno v. Brown, 6 Vet. App. 465, 470 (1994). In this case, although the descriptions of his symptoms are competent and credible, they do not show that the criteria for ratings higher than the currently assigned 20 and 40 percent for the respective appeal periods for his right shoulder disability have been met. Kahana v. Shinseki, 24 Vet. App. 428 (2011). In this case, competent evidence concerning the nature and extent of the Veteran’s disability has been provided in the medical evidence of record. As such, the Board finds these records to be more probative than the Veteran’s subjective reported worsened symptomatology. See Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991). Lastly, the Board considered the possibility of further staged ratings and finds that the proper ratings for right shoulder disability have been in effect for the appropriate appeal periods. Accordingly, further staged ratings are inapplicable. See Hart v. Mansfield, 21 Vet. App. 505 (2007). REASONS FOR REMAND 1. Entitlement to service connection for a digestive system disorder, to include as secondary to service-connected disabilities and/or medications The Veteran reported having stomach reflux from 2000 until present and taking daily pain medication in a May 2007 VA Form 21-4138, and the Veteran’s representative (at that time) specified the Veteran’s request for entitlement to service connection for stomach reflex in a July 2007 correspondence. In light of the Veteran’s diagnoses of gastroesophageal reflux disease (GERD) and H. pylori during the appeal period, the Board has recharacterized the Veteran’s claim for stomach reflux more broadly to a digestive system disorder in order to clarify the nature of the benefit sought and ensure complete consideration of the claim. Clemons, 23 Vet. App. at 5-6, 8. While the Veteran asserts that his symptoms began while on active duty and have continued to the present, the April 2016 Board remand notes that review of the Veteran’s service treatment records document reports of stomach symptoms and there also appears to be some indication in the clinical records that this stomach disorder may be related to his service-connected disabilities and medications taken for such disabilities. In October 2017, the Veteran was afforded VA examinations for esophageal conditions (including GERD and hiatal hernia) and for stomach duodenal conditions in October 2017 by the same VA examiner. Following the clinical evaluations, the VA examiner rendered diagnoses of GERD and H. pylori and explained why they are less likely than not related to the Veteran’s military service. Nevertheless, review of the record does not show that a VA medical opinion has been provided addressing the etiology of the Veteran’s current diagnoses of digestive system disorders on a secondary basis. See 38 C.F.R. § 3.310 (2019); Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). As a result, additional development is needed to properly adjudicate this claim on a secondary basis. 2. Entitlement to a compensable rating for bilateral hearing loss with chronic recurrent otitis media in the right ear During the course of the appeal, the Veteran was afforded VA examinations for hearing loss in February 2013, October 2017 and VA examinations for ear conditions in February 2013, October 2017. Most recently, at the December 2020 Board hearing, the Veteran reported that since the VA examinations in October 2017 he has had tubes put in his right and left ears and that his service-connected bilateral hearing loss with chronic recurrent otitis media in the right ear has worsened. As a result, the Board finds that additional development is needed to properly adjudicate the appeal. See 38 U.S.C. § 5103A(a) (2012); 38 C.F.R. § 3.159 (2019); Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). 3. Entitlement to a rating in excess of 20 percent for hypertension On May 4, 2007, the Veteran’s request for a higher rating for the issue on appeal was obtained and associated with the record. In the February 2010 VA rating decision, the AOJ assigned the service-connected hypertension a 20 percent disability rating effective from May 4, 2007. Id. The Board considers whether a rating in excess of 20 percent for hypertension is warranted at any time since or within one year prior to the date of claim on May 4, 2007. During the appeal, the Veteran was afforded two VA examinations in connection with service-connected hypertension. The August 2007 VA examination report documents the Veteran demonstrated the following systolic over diastolic blood pressure readings: 192 over 127, 175 over 124, and 196 over 121. Most recently, the October 2017 VA examination report documents he demonstrated the following systolic over diastolic blood pressure readings: 134 over 84, 128 over 80, and 124 over 71. While the October 2017 VA examiner marked “yes” for the Veteran having a history of a diastolic blood pressure elevation to predominantly 100 or more and specifically noted that the “frequency and severity of [the Veteran’s] diastolic [blood pressure] evaluation is [or] was treated with blood pressure medications, the VA examiner further noted that “the [Veteran’s] diastolic pressure is predominantly 120 or more.” In light of the inconsistent conclusions made by the October 2017 VA examiner and review of the blood pressure readings during the appeal period since May 4, 2006, the Board finds that additional evidentiary development is needed is needed to properly adjudicate the appeal, to include an addendum VA medical opinion for clarification on the severity of the Veteran’s service-connected hypertension. See 38 U.S.C. § 5103A(a) (2012); 38 C.F.R. § 3.159 (2019). 4. Entitlement to a compensable rating for residuals of status post right orchiectomy On May 4, 2007, the Veteran’s request for a compensable rating for the issue on appeal was obtained and associated with the record. The Board considers whether a compensable rating for status post right orchiectomy is warranted at any time since or within one year prior to the date of claim on May 4, 2007. During the appeal, the Veteran was afforded VA examinations in connection with the service-connected residuals of status post right orchiectomy in August 2007 and October 2017. The most recent VA examination report in October 2017 documents the Veteran’s reported residual pain at time and the VA examiner’s notation of no functional impact from the Veteran’s male reproductive system condition. Nevertheless, at the December 2020 Board hearing, the Veteran reported he now has trouble walking due to the absence of the right testicle as well as phantom pain from the right testicle area and pain in the existing left testicle. In light of the Veteran’s most recent contentions, a new examination is warranted. See 38 U.S.C. § 5103A(a) (2012); 38 C.F.R. §§ 3.159 (2019). 5. Entitlement to a rating in excess of 30 percent for bilateral plantar fasciitis On May 4, 2007, the Veteran’s request for a compensable rating for service-connected capsulitis, first and second metatarsophalangeal joint of the left foot, and for residuals stress reaction in the right first and second metatarsal bones was obtained and associated with the record. In the August 2018 VA rating decision, the AOJ combined the service-connected disabilities of capsulitis, first and second metatarsophalangeal joint of the left foot, and residuals stress reaction in the right first and second metatarsal bones and recharacterized the service-connected disability as bilateral plantar fasciitis assigned at 30 percent disabling effective from May 4, 2007. See 38 C.F.R. § 4.71a, Diagnostic Code 5276. The Board considers whether a rating in excess of 30 percent for bilateral plantar fasciitis is warranted at any time since or within one year prior to the date of claim on May 4, 2007. In this case, the Veteran was provided VA examinations in connection with the service-connected bilateral plantar fasciitis in August 2007 and October 2017. The October 2017 VA examiner documented clinical findings of bilateral pain on use, bilateral pain on manipulation, and extreme tenderness of plantar surfaces, marked “no” for marked probation, and noted the Veteran has not used any arch supports, built up shoes, or orthotics. Nevertheless, review of private treatment records during the appeal period shows the Veteran was issued orthotics in 2015 and pronation of both feet were observed in 2014. Additionally, the Veteran reported at the December 2020 Board hearing to wearing pool shoes, he cannot wear boots or hard soled shoes, and reiterated that he cannot walk for long periods or run at all. In light of the Veteran’s most recent lay statements regarding the severity of the service-connected bilateral plantar fasciitis and clinical findings in private treatment records during the appeal period, additional development is needed to properly adjudicate the appeal. See 38 U.S.C. § 5103A(a); 38 C.F.R. § 3.159; Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). 6. Entitlement to a rating in excess of 10 percent for mild left Achilles tendinitis On May 4, 2007, the Veteran’s request for a compensable rating for the issue on appeal was obtained and associated with the record. In the August 2018 VA rating decision, the AOJ assigned the service-connected mild left Achilles tendinitis a 10 percent disability rating effective from May 4, 2007. See 38 C.F.R. § 4.71A, Diagnostic Code 5024-5271. The Board considers whether a rating in excess of 10 percent for mild left Achilles tendinitis is warranted at any time since or within one year prior to the date of claim on May 4, 2007. In this case, the Veteran was provided VA examinations in connection with the service-connected mild left Achilles tendinitis in August 2007 and October 2017. While the Veteran informed the October 2017 VA examiner of left ankle pain with standing, clinical findings revealed no pain on examination of the left ankle. Nevertheless, at the most recent Board hearing in December 2020 the Veteran reported his left Achilles is really tight, he experiences pain upon flexion of the foot, and gets a “knot” and has to stretch it a lot. In light of the Veteran’s most recent lay statements regarding the severity of the service-connected mild left Achilles tendinitis, additional development is needed to properly adjudicate the appeal. See 38 U.S.C. § 5103A(a); 38 C.F.R. § 3.159; Barr, 21 Vet. App. at 312. 7. Entitlement to a TDIU While the Board granted the issue of entitlement to service connection for an acquired psychiatric disability, the assigned disability rating and effective date by the AOJ will impact this claim for TDIU. Additionally, while the Board remands the issue of entitlement to a compensable rating for bilateral hearing loss with chronic recurrent otitis media in the right ear for additional evidentiary development, that decision may impact this claim for TDIU. As such, these issues are inextricably intertwined. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). The matters are REMANDED for the following actions: 1. Return the Veteran’s claims file to the examiner who conducted the October 2017 VA examinations for esophageal conditions (including GERD and hiatal hernia) and for stomach duodenal conditions so a supplemental opinion may be provided. If that examiner is no longer available, provide the Veteran’s claims file to a similarly qualified clinician. The entire claims file and a copy of this remand must be made available to the examiner for review. A new examination (physical or telehealth) is only required if deemed necessary by the examiner. The examiner must opine as to the following: (a.) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s GERD (even if since resolved) was proximately due to or the result of any of his service-connected disabilities and/or medications. (b.) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s H. pylori (even if since resolved) was proximately due to or the result of any of his service-connected disabilities and/or medications. (c.) Whether it is at least as likely as not that the Veteran’s GERD was aggravated beyond its natural progression by any of his service-connected disabilities and/or medications. (d.) Whether it is at least as likely as not that the Veteran’s H. pylori was aggravated beyond its natural progression by any of his service-connected disabilities and/or medications. (e.) Note – the Veteran’s service-connected disabilities include the following: right shoulder disability, hypertension, bilateral plantar fasciitis, mild left Achilles tendinitis, status post right orchiectomy, bilateral hearing loss with chronic recurrent otitis media in the right ear, hypertensive heart disease, lumbar spine disability, tinnitus, appendiceal scar, migraines, and bronchitis. The examiner must provide all findings, along with a complete rationale for his or her opinions in the examination report. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion. 2. Schedule the Veteran for examination(s) with an appropriate clinician to determine the current severity of his service-connected bilateral hearing loss with chronic recurrent otitis media in the right ear. The entire claims file and a copy of this remand must be made available to the examiner for review. Although an independent review of the claims file is required, the Board calls the examiner’s attention to the following: At the December 2020 Board hearing, the Veteran reported having tubes put in his right and left ears since the VA examinations in October 2017 The examiner must provide all findings, along with a complete rationale for any opinions provided. 3. Return the Veteran’s claims file to the examiner who conducted the October 2017 VA examination for hypertension so a supplemental opinion may be provided. If that examiner is no longer available, provide the Veteran’s claims file to a similarly qualified clinician. The entire claims file and a copy of this remand must be made available to the examiner for review. A new examination (physical or telehealth) is only required if deemed necessary by the examiner. Although an independent review of the claims file is required, the Board calls the examiner’s attention to the following: Review of private treatment records shows the Veteran demonstrated the following systolic over diastolic pressure readings: 163 over 114 (March 2014), 119 over 85 (May 2014), 132 over 72 (June 2014), 143 over 94 (July 2014), 152 over 78 (October 2014), 140 over 82 (January 2015), 142 over 84 (February 2015), 129 over 91 (May 2015), 148 over 98 (November 2015), 120 over 84 (December 2015), 130 over 86 (February 2016), 154 over 108 (May 2016), 132 over 80 and 145 over 100 (July 2016), and 132 over 95 (May 2017). Review of VA treatment records shows the Veteran demonstrated the following systolic over diastolic pressure readings: 161 over 101 and 155 over 103 (May 2009) and 121 over 77 (April 2014) At the August 2007 VA examination, the Veteran demonstrated the following systolic over diastolic blood pressure readings: 192 over 127, 175 over 124, and 196 over 121 At the October 2017 VA examination for hypertension, the Veteran demonstrated the following systolic over diastolic blood pressure readings: 134 over 84, 128 over 80, and 124 over 71 The examiner must provide an opinion regarding the severity of the Veteran’s service-connected hypertension since May 4, 2006, including clarification of the following conclusions provided in the October 2017 VA examination report for hypertension: the Veteran having a history of a diastolic blood pressure elevation to predominantly 100 or more and “the [Veteran’s] diastolic pressure is predominantly 120 or more.” The examiner must provide all findings, along with a complete rationale for any opinions provided. 4. Schedule the Veteran for an examination with an appropriate clinician to determine the current severity of residuals of a right orchiectomy. The entire claims file and a copy of this remand must be made available to the examiner for review. Although an independent review of the claims file is required, the examiner’s attention is called to the Veteran’s December 2020 hearing testimony, where he states that he has phantom pain, pain while walking, and sometimes left testicle pain as well as right. All pertinent symptomatology and findings must be reported in detail. 5. Return the Veteran’s claims file to the examiner who conducted the October 2017 VA examination for foot conditions so a supplemental opinion may be provided. If that examiner is no longer available, provide the Veteran’s claims file to a similarly qualified clinician. The entire claims file and a copy of this remand must be made available to the examiner for review. A new examination (physical or telehealth) is only required if deemed necessary by the examiner. Although an independent review of the claims file is required, the Board calls the examiner’s attention to the following: Review of private treatment records shows the Veteran was issued orthotics in 2015 and pronation of both feet were observed in 2014. At the December 2020 Board hearing, the Veteran reported he wears pool shoes, cannot wear boots or hard soled shoes, and that he cannot walk for long periods or run at all. The examiner must provide an opinion regarding the severity of the Veteran’s service-connected bilateral plantar fasciitis since May 4, 2006, including clarification of whether this disability has been manifested by marked pronation and whether there was any improvement by use of orthopedic shoes or appliances. The examiner must provide all findings, along with a complete rationale for any opinions provided. 6. Schedule the Veteran for an examination with an appropriate clinician to determine the current severity of his service-connected mild left Achilles tendinitis. The entire claims file and a copy of this remand must be made available to the examiner for review. Although an independent review of the claims file is required, the Board calls the examiner’s attention to the following: At the December 2020 Board hearing the Veteran reported his left Achilles is really tight, he experiences pain upon flexion of the foot, and gets a “knot” and has to stretch it a lot. The examiner must provide all findings, along with a complete rationale for any opinions provided. If any findings include severe spasm of the left tendo Achilles on manipulation, the examiner should clarify whether such symptomatology is manifested by the service-connected bilateral plantar fasciitis or service-connected left Achilles tendinitis. If the examiner is unable to make a distinction, provide a complete rationale. 7. Then, review all examination reports and medical opinions provided to ensure that the requested information was provided. If any report or opinion is deficient in any manner, the AOJ must implement corrective procedures. 8. Then, readjudicate the claims. If any decision is adverse to the Veteran, issue a Supplemental Statement of the Case and allow the applicable time for response. Then, return the case to the Board. D. Martz Ames Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Carter, 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.