Citation Nr: 21021150 Decision Date: 04/09/21 Archive Date: 04/09/21 DOCKET NO. 18-22 206 DATE: April 9, 2021 ORDER Entitlement to service connection for peripheral neuropathy of the left upper extremity, to include as secondary to service-connected diabetic mellitus, type II (DM II), is denied. Entitlement to service connection for peripheral neuropathy of the right upper extremity, to include as secondary to service-connected DM II, is denied. Entitlement to service connection for hypertension, to include as secondary to service-connected DM II, is denied. Entitlement to service connection for a kidney disability, to include as secondary to service-connected DM II, is denied. Entitlement to service connection for an acquired psychiatric disorder, diagnosed as other specified trauma and stressor related disorder, is granted. REMANDED Entitlement to a disability rating higher than 10 percent for peripheral neuropathy of the right lower extremity is remanded. Entitlement to a disability rating higher than 10 percent for peripheral neuropathy of the left lower extremity is remanded. FINDINGS OF FACT 1. The preponderance of the probative evidence of record is against finding that the Veteran has had peripheral neuropathy in the left or right upper extremity at any time during or approximate to the pendency of the claim. 2. The preponderance of the evidence is against finding that hypertension or a kidney disability began during active duty, is otherwise related to an in-service injury or disease, or is caused or aggravated by a service-connected disability. 3. Reading the evidence in a favorable light most favorable to the Veteran, the Veteran has an acquired psychiatric disorder, diagnosed as other specified trauma and stressor related disorder, that is due to his service in Vietnam. CONCLUSIONS OF LAW 1. The criteria for service connection for peripheral neuropathy of the left upper lower extremity, to include as secondary to service-connected diabetes mellitus, type II, are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 2. The criteria for service connection for peripheral neuropathy of the right upper lower extremity, to include as secondary to service-connected diabetes mellitus, type II, are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 3. The criteria for service connection for hypertension, to include as secondary to service-connected diabetes mellitus, type II, are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 4. The criteria for service connection for a kidney disability, to include as secondary to service-connected diabetes mellitus, type II, are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 5. The criteria for service connection for an acquired psychiatric disability, to include other specified trauma and stressor related disorder, are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1965 to September 1967, including service in the Republic of Vietnam. This appeal to the Board of Veterans Appeals (Board) arose from a June 2017 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In June 2019, the Veteran and his wife testified during a Board videoconference hearing before a Veterans Law Judge. A hearing transcript is of record. In January 2021, the Board informed the Veteran that the Veterans Law Judge who conducted the June 2019 hearing was no longer employed at the Board. As such, he was offered an opportunity to participate in another such hearing. The Veteran did not respond to this letter, and as conveyed in such, it may be assumed that the Veteran does not wish to participate in another Board hearing. Service Connection 1. Entitlement to service connection for peripheral neuropathy of the right and left upper extremities, to include as secondary to service-connected DM II, is denied. Service connection is not warranted for this claim as the preponderance of the probative evidence demonstrates the Veteran does not have a current disability of peripheral neuropathy of the left or right upper extremity at any time during the appeal period. Even assuming that a probative diagnosis of upper extremity neuropathy exists, the claims would fail as the late onset does not indicate it is related to service, and both VA and private medical records indicate the Veteran’s reported conditions are not secondary to his diabetes mellitus, type II, condition. The Veteran’s claim for service connection for the bilateral upper extremities secondary to the Veteran’s diabetes mellitus, type II, was filed in March 2017 and received by VA in April 2017. In June 2019, the Veteran testified that he has been diagnosed by a Dr. Paruchuri with bilateral upper extremity neuropathy and is receiving treatment for upper extremity neuropathy. He reported that his doctors told him that his condition was “just as bad” as his neuropathy in his legs. He stated that he was previously using Aleve to treat the condition, but that he no longer used the Aleve. He also reported that his private physician reported that the condition was due to Agent Orange. Then, he reported that his physician said that the condition had the same etiology as his lower extremities. Service records do not indicate neurological issues with the upper extremities during active duty. At his August 1967 exit examination, the Veteran checked “normal” as to upper extremities. He also checked “no” as to cramps in his legs, foot trouble, neuritis, and paralysis. Post service medical records weigh against the claim. Prior to filing for service connection in 2017, relevant medical records did not report the present of any neuropathy specifically in the bilateral upper extremities. Private medical records from September 2013 report the bilateral upper extremities were normal strength and tone. The Veteran submitted a June 2014 Diabetes examination completed by his private physician. The diagnosis section reports the Veteran had a diagnosis of diabetic neuropathy; and it was also reported that diabetic neuropathy was a complication of the Veteran’s diabetes. Yet additional explanation was not provided. Notably, this was submitted in conjunction with the Veteran’s claim for service connection for peripheral neuropathy of the lower extremities. An August 2016 VA examination reported the Veteran had a diagnosis of bilateral lower extremity neuropathy, but neuropathy for the upper extremities was not reported. A September 2016 private correspondence from Dr. Paruchuri reports the Veteran has been diagnosed with diabetic peripheral neuropathy as far back as 2012. Yet the physician does not specifically report the Veteran is diagnosed with peripheral neuropathy of the bilateral upper extremities. In association with his March 2017 claim for peripheral neuropathy of the upper extremities, the Veteran underwent an April 2017 VA examination for diabetes and diabetic sensory-motor peripheral neuropathy. While peripheral neuropathy was reported as a condition associated with the Veteran’s diabetes, symptoms were not reported in either upper extremity. As noted in the Board’s prior remand, the Veteran’s treating private physician, Dr. Paruchuri, provided a December 2017 letter noting that he does suffer from peripheral neuropathy of his upper and lower extremities. This was alluded to earlier, in the Veteran’s June 2019 testimony. The physician mistakenly indicated that service connection is in effect for the upper extremities, while providing the opinion that lower extremity neuropathy and upper extremity neuropathy have similar etiologies. Thus, the examiner provided the opinion that the lower extremity neuropathy is at least as likely as not related to service-related activities during his Vietnam service. While the Board interprets the physician’s opinion to refer to his upper extremity neuropathy, rather than that of the lower extremities, the Board notes that while service connection for the lower extremity neuropathy was established as secondary to service-connected DM II, as diabetic neuropathy, the examiner did not specifically address the presence of diabetic neuropathy in the upper extremities. Moreover, in opining that the neuropathy is at least as likely as not related to service-related activities, the Board notes that the examiner did not provide reasons for this opinion, other than to state that the upper and lower extremity neuropathies haver similar etiologies. See Nieves-Rodriguez, 22 Vet. App. at 303. Accordingly, the opinion was found to be inadequate. More recently, in a December 2019 Diabetes examination completed by the Veteran’s private physician, it was checked “no” as to whether the Veteran had the complication of diabetic neuropathy as a complication of the diabetes. In March 2020, while the Veteran reported that he had begun to experience numbness and tingling in his bilateral upper extremities, again, a VA examination reported that the Veteran did not experience any symptoms in his bilateral upper extremities that were attributable to diabetic neuropathy. Accordingly, the preponderance of the probative evidence, both private and VA medical records, indicates the Veteran does not have a current disability of peripheral neuropathy in the upper extremities. To the extent the Veteran reported he experienced numbness and tingling in his upper extremities, the Board the Board finds these assertions competent and credible; however, the Veteran has not demonstrated that he has the medical training and expertise to attribute symptoms to a specific diagnosis or comment on the etiology of any disability with credibility. Medical records indicate the Veteran did not begin to experience this tingling sensation until around 2017, and his lay statements, including his claim, was not until 2017. Moreover, as noted, the Veteran reported normal extremities while in service. Accordingly, direct service connection cannot be warranted as the Veteran lacks a current disability of peripheral neuropathy; and to the extent the Veteran experienced numbness and tingling the record indicates this is not due to service at there is no inservice incurrence and the onset is almost 50 years after service. While the Veteran has reported in the alternative that he has peripheral neuropathy as secondary to his diabetes, service connection on a secondary basis is not warranted either. As discussed, these feelings of numbness and tingling are not related to his diabetes as both the Veteran’s own private December 2019 Diabetes examination and the recent March 2020 VA examination reports the Veteran does not experience symptoms or neuropathy as a condition of his diabetes. Accordingly, the claim is denied on a direct and secondary basis. The Board acknowledges, as discussed below, the RO did not comply with the Board’s prior remand instruction regarding development for private medical records. More specifically, the Veteran signed a release for medical records from September 2019 to January 2020 from Tami Harris at Barnett Family Practice. Yet, as discussed, even if a current disability was present, the claim would be denied as the probative evidence, both VA and private, indicates the condition was not incurred in service, is not related to service, and is not a complication of his diabetes mellitus, type II. Thus, to the extent there was any deficiency in the prior remand instructions, it did not constitute prejudicial error as it relates to these claims. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (holding that the rule of prejudicial error applies to whether there was compliance with the Board’s remand directives). Stegall does not require compliance with Board remand directives when non-compliance does not result in prejudicial error. Id. at 271. 2. Entitlement to service connection for hypertension, to include as secondary to service-connected DM II, is denied. Service connection is not warranted for this claim as the preponderance of the evidence indicates the Veteran’s hypertension is not related to service, and is not secondary to his diabetes mellitus, type II. The Veteran’s claim for service connection for hypertension as secondary to his diabetes was filed in March 2017 and received by the VA in April 2017. He testified in June 2019 that his medical doctor reported that his hypertension is due to his diabetes and that this etiology opinion can be found amongst his medical records from Bethany Medical. Service medical records do not contain complaints of, diagnosis of, or treatment of, any hypertension or high blood pressure. At his September 1967 separation examination, the Veteran checked “no” as to whether he had or ever had high or lower blood pressure or palpitation or pounding in his heart. His blood pressure was recorded as 110/70 at that time. Yet based on the March 2020 VA opinion, the Veteran reported that when he served in Vietnam, he would go a day or more without urinating, and this contributed to his hypertension condition. Review of the Veteran’s private and VA treatment records reveals that he has been treated with hypertension since at least December 2005, and that he has been assessed with stage 2 chronic kidney disease, and as having a kidney cyst. A June 2014 private diabetes examination reports the Veteran had hypertension in the presence of diabetic renal disease. However, an accompanying hypertension examination was not attached; nor was there any further explanation discussing how the examiner came to this conclusion. Thus, standing alone, this opinion is inadequate as there was no rationale supporting the conclusion that the Veteran’s hypertension was at least as likely as not due to his diabetes mellitus, type II. See Nieves-Rodriguez, 22 Vet. App. at 303. More recently, an additional December 2019 private diabetes examination reported the Veteran does not have hypertension that is at least as likely as not related to his diabetes mellitus type II. Also, at a March 2020 VA examination for hypertension the Veteran reported that he had elevated hypertension since he was in service. He attributed the high blood pressure to work he was doing at the time. He reported that he was not started on anti-hypertensives until the 1990’s. However, the VA examiner opined that the Veteran’s hypertension was not due to service. It was explained that to the extent the Veteran had hypertension in service, the condition was acute only. The examiner reported even considering the Veteran’s accounts of going a day or more without urinating, there was no link between this event and the Veteran’s current hypertension diagnosis. Moreover, the Veteran’s separation examination did not indicate high blood pressure either. As such, a nexus had not been established. A preponderance of the evidence is against hypertension being linked to service. With the exception of the Veteran’s statements, his medical records and a VA examiner weigh against this condition being linked to service. Unlike the June 2014 opinion, the March 2020 VA examiner reviewed the Veteran’s medical records and took into account his lay statements. Thus, the Board places more probative value on the VA examiner’s opinion. Moreover, as noted, on his separation examination his specific gravity discharge was normal, his blood pressure was 110/70, and he reported that he had not experienced high blood pressure. While he also reports that he did not start taking hypertensive until the 1990’s, over two decades after his discharge from service in 1967, the Board finds that it is reasonable to expect that he would have reported his symptoms to a health care provider or been treated for the condition within a 20 plus year span. Although the Board has taken into consideration the Veteran’s wife’s report that a previous stroke has affected his memory, and there are a lot of things he does not remember; the preponderance of the evidence is against a nexus between the hypertension and the Veteran’s service. Accordingly, service connection is not warranted on a direct basis. In the alternative, the Veteran contends that his hypertension is secondary to his service-connected DM. Service connection may be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury. 38 C.F.R. § 3.310. Private medical records from Bethany Medical report the Veteran was seen numerous times between 2012 and October 2017 for his hypertension. Repeatedly, it was reported that a risk factor for his hypertension was obesity. In November 2014 a VA diabetic examination reported the Veteran did not have any conditions due to diabetes. Additionally, the examiner reported that the Veteran lacked evidence to make an equivocal diagnosis of diabetes. Also, the Veteran’s private December 2019 examination reported the Veteran did not have hypertension as a result of his diabetes. Moreover, his private December 2019 examination reported hyperglycemia and not diabetes mellitus, type II. Thus, to the extent the Veteran has a current diagnosis of diabetes, both the November 2014 VA examination and his private December 2019 examination did not report that he had hypertension as a condition that was at least as likely as not due to his diabetes. An August 2016 physical report from Dr. Paruchuri reported the Veteran’s diabetes was controlled without complications. Moreover, a March 2020 examination reports the Veteran’s hypertension is not aggravated by his diagnosis of diabetes. It was reasoned that the Veteran’s hypertension is currently well controlled by his medication as indicated by his blood pressure readings on the examination. Thus, there has been no aggravation beyond its natural progression. To the extent the Veteran reported that his private physician reported that his hypertension is due to his diabetes and it could be found in his medical records, as discussed, his objective medical records report the contrary. The Board’s review specifically included medical records from Bethany Medical as discussed at his hearing, but a secondary nexus statement was not included in these medical records. Moreover, these medical records repeatedly report obesity as a risk factor to the Veteran’s hypertension, not diabetes. The Board concludes that, while the Veteran has a current disability of hypertension, the preponderance of the evidence is against finding that it is proximately due to or the result of or aggravated beyond its natural progression by his service-connected diabetes. 38 U.S.C. §§ 1110, 1131; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc); 38 C.F.R. § 3.310(a). While the Veteran believes his hypertension is proximately due to or has been aggravated beyond its natural progression by his service-connected diabetes, he is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge and the interpretation of complicated diagnostic medical testing. Therefore, it is outside the competence of in this case because the record does not show that he has the skills or medical training to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Accordingly, the Board gives more probative weight to the November 2014 VA examination, the August 2016 report of no complications from diabetes, the private December 2019 examination, and the opinion of the March 2020 VA examiner. Absent competent credible evidence of a nexus to a service-connected disability, the Veteran does not meet the criteria for secondary service connection. Accordingly, the claim of entitlement to service connection for hypertension on a direct basis and secondary basis is denied. There is no doubt to resolve. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. The Board acknowledges, as discussed below, the RO did not comply with the Board’s prior remand instruction regarding development for private medical records. As noted, these records concern treatment from his family physician between 2019 and 2020. The issue is not whether the Veteran’s hypertension exists, it is whether there is a nexus to being unable to urinate for long periods during service or due to his service-connected disability. While the Veteran reported that an etiology opinion could be found in his private medical records, these medical records were from Bethany Medical, which have been discussed above. Thus, to the extent there was any deficiency in the prior remand instructions, it did not constitute prejudicial error as it relates to this claim. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (holding that the rule of prejudicial error applies to whether there was compliance with the Board’s remand directives). 3. Entitlement to service connection for a kidney disability, to include as secondary to service-connected type II diabetes mellitus (DM II), is denied. The Veteran’s claim for service connection for a kidney disability secondary to diabetes was received by the VA in April 2017. The Veteran testified in June 2019 that he has issues with his kidney as secondary to his diabetes. Similar to his hypertension claim, he reported that physicians at Bethany Medical report that his kidney conditions are due to his diabetes. He also reported that his kidney problems are related to service when he was unable to use the bathroom for long periods of time. Service medical records do not contain complaints of, diagnosis of, or treatment of, any kidney condition. At his September 1967 separation examination, the Veteran checked “no” as to whether he had or ever had: “frequent or painful urination” or “kidney stone or blood in urine.” A February 2011 abdominal ultrausound reported a history of right upper quadrant pain. A 1.0 cm right renal cortical cyst was found. In April 2012, and forward, private medical records from Bethany Medical report the presence of chronic kidney disease. Medical records between March 2014 and June 2016, and in February 2017 from Bethany Medical report the Veteran had chronic kidney disease stage 2 as a past medical problem. A May 2014 kidney x-ray reports a stable right renal cortical cyst with small postvoid residual. In March 2020, a VA examiner opined that the Veteran’s condition is not related to service, including the Veteran’s reports of dehydration. The examiner reported that to the extent the Veteran had the condition during service, it was only acute. He reported that ultrasound findings from February 2011 demonstrated a 1.0 cm right renal cortical cyst, and that the Veteran’s chronic kidney disease from April 2012 remained stable. The rationale also noted the Veteran’s specific gravity at discharge was normal at 1.018 which does not indicate dehydration. He had taken into account the Veteran’s lay statements of service in Vietnam and going a day or more without urinating, but the evidence of no kidney function issue at separation along with the first evidence of kidney disease documented being over 40 years after separation, indicated it is less likely than not an event in service caused the Veteran’s chronic kidney disease. As to his right renal cyst, there were no complaints or findings that link his right renal cyst to his time in service, also. The finding of this cyst was an incidental finding and there were no sequela secondary to this condition. Moreover, the finding was also made over 40 years after discharge from service. Accordingly, a nexus was not established. A preponderance of the evidence is against the Veteran’s kidney conditions being linked to service. With the exception of the Veteran’s statements, his medical records, particularly those from Bethany Medical, his inservice medical records, the late onset of the conditions, and the March 2020 nexus opinion weigh against this condition being linked to service. While the Veteran believes his kidney conditions are linked to service when he went for long periods without urinating, he lacks the requisite medical expertise to make an etiology opinion. The issue is medically complex, as it requires medical expertise and the interpretation of complicated diagnostic medical testing. Therefore, it is outside the competence of in this case because the record does not show that he has the skills or medical training to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Accordingly, absent competent and probative evidence of a nexus to service, direct service connection is not warranted for this condition. In the alternative, the Veteran also reports that his kidney conditions are due to his diabetes. Private medical records from Bethany Medical, including those from January 2015, December 2015, February 2016, and July 2017 denied urinary frequency as a symptom of the Veteran’s diabetes mellitus, type II. Moreover, from May 2016 to August 2016, private medical records reported his diabetes was controlled without complications. The Veteran’s December 2019 private diabetes examination reports the Veteran did not have renal dysfunction caused by diabetes mellitus moreover it was not at least as likely as not that the Veteran’s diabetes permanently worsened any renal disease. Moreover, a March 2020 VA examiner reported that it was less likely than not that the Veteran’s kidney condition was due to his diabetes. It was explained that the Veteran’s eGFR associated with his kidney disease began to decline in 2012. However, the Veteran maintained a normal A1C which, which determines whether a person is diabetic. His A1C was normal in 2014 (5.9), and more recently, it was still normal at 6.4 Therefore, the Veteran’s diagnosis of chronic kidney disease preceded the diagnosis of diabetes type II, and no nexus had been established. The Board notes it lacks the requisite medical knowledge to interpret A1C and eGFRs, but as noted in the hypertension discussion, a November 2014 VA examination reported a diabetes diagnosis could not be made; and more recently, the Veteran’s private December 2019 diabetes examination reported the Veteran had high fasted glucose, and not diabetes. Accordingly, the record indicates the Veteran was being treated for hypertension when his blood glucose was too low to be considered diabetes mellitus type, II; and the March 2020 opinion is corroborated by the record. The Board concludes that, while the Veteran has a current disability of a kidney condition, the preponderance of the evidence is against finding that it is proximately due to or the result of or aggravated beyond its natural progression by his service-connected diabetes. 38 U.S.C. §§ 1110, 1131; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc); 38 C.F.R. § 3.310(a). While the Veteran believes his kidney condition is proximately due to or has been aggravated beyond its natural progression by his service-connected diabetes he is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires medical expertise and the interpretation of complicated diagnostic medical testing. Therefore, it is outside the competence of in this case because the record does not show that he has the skills or medical training to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Accordingly, the Board gives more probative weight to the private medical records, the private December 2019 examination, and the opinion of the Mach 2020 VA examiner. Absent competent credible evidence of a nexus to a service-connected disability, the Veteran does not meet the criteria for secondary service connection. Accordingly, the claim of entitlement to service connection for a kidney disability on a direct basis and secondary basis is denied. There is no doubt to resolve. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. The Board acknowledges, as discussed below, the RO did not comply with the Board’s prior remand instruction regarding development for private medical records. The issue is not whether a kidney disability has been diagnosed, it is whether there is a nexus to service or due to his service-connected disability. While the Veteran reported that an etiology opinion existed in his private medical records from Bethany Medical, the outstanding medical records are from another medical institution, and his Bethany Medical records have been discussed. Thus, to the extent there was any deficiency in the prior remand instructions, it did not constitute prejudicial error. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (holding that the rule of prejudicial error applies to whether there was compliance with the Board’s remand directives). Stegall does not require compliance with Board remand directives when non-compliance does not result in prejudicial error. Id. at 271. 4. Entitlement to service connection for an acquired psychiatric disorder is granted. Entitlement to service connection for PTSD is not warranted, as the Veteran lacks a current diagnosis of PTSD. However, reading the evidence in a light most favorable to the Veteran, service connection for his acquired psychiatric disorder of other specified trauma and stressor related disorder. At his Board hearing, the Veteran testified that he suffered PTSD symptoms as a result of fear of hostile military activity due to stressors that he experienced during his Vietnam service, including engaging in artillery fire multiple times with the enemy when put on guard duty near a town out in the jungle, and as a result of an incident where a truck that was part of his convoy was blown up during an attack. As noted in the Board’s prior remand, while the Veteran’s records do not confirm that he engaged in combat, his reported stressors appear to be consistent with the era and circumstances of his service, including his military occupational specialty (MOS) as a heavy vehicle driver during his Vietnam service. Additionally, his STRs report treatment in Vietnam. The Veteran was previously afforded a VA PTSD examination in April 2017. With respect to the reported stressor, the examiner noted “fear in Vietnam.” With respect to the diagnostic criteria, the examiner appeared to indicate that the Veteran met multiple diagnostic criteria for PTSD, by checking boxes indicating the presence of multiple manifestations of the criteria. However, the examiner then noted that the Veteran did not meet criterion G. The examiner did not provide any discussion as to why the criterion was not met. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 303 (2008) (“most of the probative value of a medical opinion comes from its reasoning”). In conclusion, the examiner determined that the Veteran did not have significant symptoms meeting the criteria for PTSD or a mental disorder that conformed with DSM-V criteria. This was in apparent contrast to the multiple symptoms noted in analyzing the specific diagnostic criteria. The Veteran’s wife submitted a January 2018 statement describing his psychiatric symptoms, including nightmares, flashbacks, hypervigilance, exaggerated startle response, and paranoia. She noted that she had been married to the Veteran for 35 years and that he has always had nightmares and flashbacks. Further, during his Board hearing, the Veteran testified that he had been dealing with his symptoms for 57 years. The Board remanded this claim for development as to whether the Veteran had an actual diagnosis of PTSD and to corroborate his reported stressors. While the Veteran does not have a diagnosis of PTSD, a March 2020 VA examiner confirmed a diagnosis of other specified trauma and stressor related disorder, adjustment-like disorder with prolonged duration of more than 6 months without prolonged duration of stressor. The examiner reported while the Veteran worked in a stressful and potentially traumatic occupations as a security guard, after service, his psychosocial symptoms were endorsed prior to employment as a security guard and related to his service in Vietnam. Moreover, his self-report is indicative of mild impairment in social and occupational functioning as a result of the mental health condition stated. While the March 2020 examiner’s opinion relies heavily on the Veteran’s self-reported symptoms, the VA examiner reviewed the Veteran’s associated private and VA medical records. This opinion, along with his MOS and his time in Vietnam weigh in favor of the claim. Accordingly, the Board finds, reading the evidence in a light most favorable to the Veteran, service connection is warranted for a diagnosis of other specified trauma and stressor related disorder, adjustment-like disorder with prolonged duration of more than 6 months without prolonged duration of stressor. REASONS FOR REMAND 1. Entitlement to a disability rating higher than 10 percent for peripheral neuropathy of the right and left lower extremities are remanded. The previous remand requested development for the Veteran’s private medical records. Specifically, the RO was instructed to let the Veteran know that if any outstanding medical records were not obtained, explain the efforts taken to obtain them, and describe further action to be taken. Subsequently, the Veteran completed a VA 21-4142 Authorization for Release of Information for medical records from Barnett Family Practice, dating from September 2019 to January 2020. A January 2020 letter was sent to the private facility. In response, the private facility reported that a signed HIPPAA compliant authorization was still needed. The RO then sent a letter to the Veteran in February 2020 generally notifying him of the request, but it did not report that a HIPAA compliant authorization was still needed; they also sent a follow-up to the Barnett Family Practice facility. Yet the February 2020 letter to the private facility was returned to the RO. After the returned mail, no further notification was given to the Veteran. As these medical records may refer to the current severity of the Veteran’s service-connected conditions, the Board finds that a remand is needed to allow the Veteran to submit these private medical records to the VA, and to ensure compliance with the Board’s prior remand. In remanding this case, the Board makes no credibility determination, expressed or implied, at this juncture. The matters are REMANDED for the following action: 1. Assist the Veteran in obtaining his reported medical records from Barnett Family Practice, following the current procedures set forth in 38 C.F.R. § 3.159. All records/responses received should be associated with the claims file. If any records sought are not obtained, notify the Veteran of the records that were not obtained, explain the efforts taken to obtain them, and describe further action to be taken. SCOTT W. DALE Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Wade 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.