Citation Nr: 21021594 Decision Date: 04/13/21 Archive Date: 04/13/21 DOCKET NO. 15-22 530 DATE: April 13, 2021 ORDER As new and material evidence has not been received, the petition to reopen a claim for entitlement to service connection for right ear hearing loss is denied. As new and material evidence has not been received, the petition to reopen a claim for entitlement to service connection for scar, removal of cyst on buttocks, is denied. As new and material evidence has not been received, the petition to reopen a claim for entitlement to service connection for squamous cell carcinoma, to include as due to in-service exposure to chemicals, is denied. As new and material evidence has been received, the claim for entitlement to service connection for a back disability is reopened; to that extent only, the appeal is granted. As new and material evidence has been received, the claim for service connection for epididymitis is reopened; to that extent only, the appeal is granted. Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) is denied. Entitlement to an initial compensable evaluation for left ear hearing loss is denied. REMANDED Entitlement to service connection for a right shoulder disability is remanded. Entitlement to service connection for epididymitis is remanded. Entitlement to service connection for a back disability is remanded. FINDINGS OF FACT 1. In a June 2012 rating decision, the RO denied the Veteran’s claim for entitlement to service connection for right ear hearing loss; the Veteran did not submit a Notice of Disagreement (NOD), no new and material evidence was received within one year of the decision, and the decision became final. 2. The evidence received since the June 2012 rating decision is cumulative or redundant of the evidence of record, does not relate to an unestablished fact, and does not raise a reasonable possibility of substantiating the Veteran’s claim of entitlement to service connection for right ear hearing loss. 3. In a June 2012 rating decision, the RO denied the Veteran’s claim for entitlement to service connection for scar, removal of cyst on buttocks; the Veteran did not submit a NOD, no new and material evidence was received within one year of the decision, and the decision became final. 4. The evidence received since the June 2012 rating decision is cumulative or redundant of the evidence of record, does not relate to an unestablished fact, and does not raise a reasonable possibility of substantiating the Veteran’s claim of entitlement to service connection for scar, removal of cyst on buttocks. 5. In a June 2012 rating decision, the RO denied the Veteran’s claim for entitlement to service connection for squamous cell carcinoma, to include as due to in-service exposure to chemicals; the Veteran did not submit a NOD, no new and material evidence was received within one year of the decision, and the decision became final. 6. The evidence received since the June 2012 rating decision is cumulative or redundant of the evidence of record, does not relate to an unestablished fact, and does not raise a reasonable possibility of substantiating the Veteran’s claim of entitlement to service connection for squamous cell carcinoma, to include as due to in-service exposure to chemicals. 7. In a June 2012 rating decision, the RO denied the Veteran’s claim for entitlement to service connection for a back disability; the Veteran did not submit a NOD, no new and material evidence was received within one year of the decision, and the decision became final. 8. The evidence received since the June 2012 rating decision is not cumulative or redundant of the evidence of record, does relate to an unestablished fact, and does raise a reasonably possibility of substantiating the Veteran’s claim of entitlement to service connection for a back disability. 9. In a June 2012 rating decision, the RO denied the Veteran’s claim for entitlement to service connection for epididymitis; the Veteran did not submit a NOD, no new and material evidence was received within one year of the decision, and the decision became final. 10. The evidence received since the June 2012 rating decision is not cumulative or redundant of the evidence of record, does relate to an unestablished fact, and does raise a reasonably possibility of substantiating the Veteran’s claim of entitlement to service connection for epididymitis. 11. The competent and credible evidence does not demonstrate that the Veteran’s currently diagnosed MDD had its onset during active duty service or was otherwise etiologically related to service. 12. Throughout the appeal period, the Veteran has at worst Level II in the left ear. CONCLUSIONS OF LAW 1. The June 2012 rating decision that denied the claim for entitlement to service connection for right ear hearing loss is final. 38 U.S.C. § 7105; 38 C.F.R. §§ 19.52, 20.1103. 2. New and material evidence has not been received to reopen the claim of entitlement to service connection for right ear hearing loss. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 3. The June 2012 rating decision that denied the claim for entitlement to service connection for scar, removal of cyst on buttocks, is final. 38 U.S.C. § 7105; 38 C.F.R. §§ 19.52, 20.1103. 4. New and material evidence has not been received to reopen the claim of entitlement to service connection for scar, removal of cyst on buttocks. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 5. The June 2012 rating decision that denied the claim for entitlement to service connection for squamous cell carcinoma, to include as due to in-service exposure to chemicals, is final. 38 U.S.C. § 7105; 38 C.F.R. §§ 19.52, 20.1103. 6. New and material evidence has not been received to reopen the claim of entitlement to service connection for squamous cell carcinoma, to include as due to in-service exposure to chemicals. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 7. The June 2012 rating decision that denied the claim for entitlement to service connection for a back disability is final. 38 U.S.C. § 7105; 38 C.F.R. §§ 19.52, 20.1103. 8. New and material evidence has been received to reopen the claim for entitlement to service connection for a back disability. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 9. The June 2012 rating decision that denied the claim for entitlement to service connection for epididymitis is final. 38 U.S.C. § 7105; 38 C.F.R. §§ 19.52, 20.1103. 10. New and material evidence has been received to reopen the claim for entitlement to service connection for epididymitis. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 11. The criteria for entitlement to service connection for an acquired psychiatric disorder, to include PTSD and MDD, have not been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. § 3.102, 3.159, 3.303. 3.304. 12. The criteria for entitlement to an initial compensable evaluation for left ear hearing loss have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.7, 4.10, 4.85, Diagnostic Code 6100. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S. Navy from June 1976 to June 1979. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a May 2014 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In the May 2014 rating decision, the RO, in pertinent part, granted service connection for left ear hearing loss and assigned a noncompensable evaluation, effective September 26, 2013; denied service connection for right ear hearing loss, MDD, PTSD, and a right shoulder disability; and denied reopening the claims for a back disability, epididymitis, squamous cell carcinoma, and scar, removal of cyst on buttocks. The Veteran appealed for a compensable evaluation and service connection. Duties to Notify and Assist Pursuant to the Veterans Claims Assistance Act (VCAA), VA has duties to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C. §§ 5102, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.156(a), 3.159. Neither the Veteran nor his representative has raised any issues with the duty to notify or duty to assist. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board . . . to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). New and Material Evidence 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 (NOD) 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), 19.20, 19.21, 19.22, 19.52. 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 decisionmakers. 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 U.S. Court of Appeals for Veterans Claims (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). 1. Whether new and material evidence has been received to reopen a claim for entitlement to service connection for right ear hearing loss In a June 2012 rating decision, the RO denied the Veteran’s original claim for service connection, because there was no evidence of a current right ear hearing loss diagnosis for VA purposes. That decision is final. Since the Veteran’s last prior final denial in June 2012, the record includes VA treatment records, lay statements, and a February 2014 VA examination. None of these records establish that the Veteran has a diagnosis for right ear hearing loss that met the requirements under 38 C.F.R. § 3.385. The Board finds that these records, while new, are cumulative or redundant of the evidence at the time of the last prior final denial. They do not relate to an unestablished fact and do not raise a reasonable possibility of substantiating the claim. Consequently, the claim may not be reopened, because no new and material evidence has been received suggesting that the Veteran has a right ear hearing loss diagnosis for VA purposes. 2. Whether new and material evidence has been received to reopen a claim for entitlement to service connection for scar, removal of cyst on buttocks In a June 2012 rating decision, the RO denied the Veteran’s original claim for scar, removal of cyst on buttocks, because there was no evidence that his preexisting scar, removal of cyst on buttocks, was aggravated by service. That decision is final. Since the Veteran’s last prior final denial in June 2012, the record includes VA treatment records and lay statements. None of these records establish that the Veteran’s preexisting scar, removal of cyst on buttocks, was aggravated by service. The Board finds that these records, while new, are cumulative or redundant of the evidence at the time of the last prior final denial. They do not relate to an unestablished fact and do not raise a reasonable possibility of substantiating the claim. Consequently, the claim may not be reopened, because no new and material evidence has been received suggesting that the Veteran’s scar, removal of cyst on buttocks, was aggravated by service. 3. Whether new and material evidence has not been received to reopen a claim for entitlement to service connection for squamous cell carcinoma, to include as due to in-service exposure to chemicals In a June 2012 rating decision, the RO denied the Veteran’s original claim for service connection for squamous cell carcinoma, to include as due to in-service exposure to chemicals, because there was no evidence linking the Veteran’s squamous cell carcinoma to his military service. That decision is final. Since the Veteran’s last prior final denial in June 2012, the record includes VA treatment records and lay statements. None of these records establish that the Veteran’s squamous cell carcinoma was caused by his active duty service, to include in-service exposure to chemicals. The Board finds that these records, while new, are cumulative or redundant of the evidence at the time of the last prior final denial. They do not relate to an unestablished fact and do not raise a possibility of substantiating the claim. Consequently, the claim may not be reopened, because no new and material evidence has been received suggesting that the Veteran’s squamous cell carcinoma was related to his active duty service, to include in-service exposure to chemicals. 4. Whether new and material evidence has been received to reopen a claim for entitlement to service connection for a back disability In a June 2012 rating decision, the RO denied the Veteran’s original claim for service connection for a back disability, because there was no evidence that the Veteran had a back condition. That decision is final. Since the Veteran’s last prior final denial in June 2012, the record includes an October 2013 VA treatment record diagnosing back pain with probable cervical nerve impingement and a December 2013 VA treatment record diagnosing cervical spine degenerative joint disease (DJD). The Board finds that this evidence is new as it was not previously of record and tends to relate to a previously unestablished fact necessary to substantiate the underlying claim of service connection. The October 2013 and December 2013 VA treatment records will be presumed credible for the purpose of reopening the claim. Consequently, the claim of entitlement to service connection for a back disability is reopened. 5. Whether new and material evidence has been received to reopen a claim for service connection for epididymitis In a June 2012 rating decision, the RO denied the Veteran’s original claim for epididymitis, because there was no evidence that linked his current epididymitis to his in-service diagnosis for left epididymitis. That decision is final. Since the Veteran’s last prior final denial in June 2012, the record includes an October 2013 VA treatment record discussing the results of an October 2013 echogram, which revealed that his current symptoms were likely related to his prior epididymitis. The Board finds that this evidence is new as it was not previously of record and tends to relate to a previously unestablished fact necessary to substantiate the underlying claim of service connection. The October 2013 VA treatment record will be presumed credible for the purpose of reopening the claim. Consequently, the claim of entitlement to service connection for epididymitis is reopened. Service Connection 6. Entitlement to service connection for an acquired psychiatric disorder, to include PTSD and MDD The Veteran generally asserts that he warrants service connection for an acquired psychiatric disorder. The question before the Board is whether the Veteran’s acquired psychiatric disorder is etiologically related to his active duty service. Based on a careful review of all the subjective and clinical evidence, the Board finds that the preponderance of the evidence weighs against finding service connection for an acquired psychiatric disorder, to include PTSD and MDD, is warranted. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Generally, service connection requires: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. See Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); see also Caluza v. Brown, 7 Vet. App. 498 (1995). Service connection may also be granted for any disease diagnosed after discharge when the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection for PTSD requires medical evidence diagnosing the condition; a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred. 38 C.F.R. § 3.304(f). A diagnosis of PTSD must be established in accordance with 38 C.F.R. § 4.125(a), which provides that all psychiatric diagnoses must conform to the fifth edition of the American Psychiatric Association's Diagnostic and Statistical Manual for Mental Disorders (DSM-5). See 38 C.F.R. § 3.304(f). Effective August 4, 2014, VA amended the portion of its Rating Schedule dealing with mental disorders and its adjudication regulations that define the term "psychosis" to remove outdated references to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, of the American Psychiatric Association (DSM-IV) and replace them with references to the recently updated Fifth Edition (DSM-5). See 79 Fed. Reg. 149, 45094 (August 4, 2014). The provisions of the interim final rule apply to all applications for benefits that are received by VA or that were pending before the AOJ on or after August 4, 2014. VA adopted as final, without change, the interim final rule and clarified that the provisions of this interim final rule do not apply to claims that have been certified for appeal to the Board or are pending before the Board on or before August 4, 2014, even if such claims are subsequently remanded to the AOJ. See 80 Fed. Reg. 53, 14308 (March 19, 2015). The Veteran’s military personnel records reflect that his military occupational specialty was Airman Recruit. Throughout his service, the records show that the Veteran had multiple disciplinary issues, including a May 1977 offense for having canisters of hashish, January 1978 and March 1978 offenses for being absent without leave, and June 1979 offenses for dereliction of duty and falsifying fuel watch log books. In May 1978, the Veteran was court-martialed for failure to go to appointed placed of duty, failure to obey lawful order, signing an official record with intent to deceive, and sleeping on post. For those offenses, the Veteran’s rank was reduced. For the June 1979 offenses, the Veteran’s punishment included being placed on bread and water for three days. The Veteran’s service treatment records do not document any findings related to any complaints, treatment, or diagnosis for any mental health problems. At the Veteran’s May 1979 separation examination, no abnormal psychiatric clinical evaluation results were identified. Post-service VA treatment records beginning in 2013 document the Veteran’s complaints for mental health problems. At a November 2013 VA clinic visit, the Veteran reported experiencing depressive symptoms after his divorce, which began in 1996 when his wife accused him of abuse and placed a restraining order against him. He said that the divorce process was long and difficult, and he lost custody of his two children. He also explained that since his divorce, he had been homeless and extensively transient. He never stayed in one place for an extended period of time. His living conditions were unsafe, and he witnessed and was threatened with violence, including with knives and guns, on multiple occasions. Because of those circumstances, he described feeling hypervigilant, becoming isolated and having a depressed mood, anhedonia, poor concentration, irritability, and hopelessness. He also experienced nightmares, especially about his divorce and losing his children. The Veteran was diagnosed with major depression. At subsequent VA clinic visits in December 2013 and January 2014, the Veteran continued to report that his symptoms began following his three-year long divorce process, that he was distressed about his children, and that he had anxiety over his past history of traumatic, violent incidents. At a February 2014 VA examination, the VA examiner summarized the Veteran’s multiple disciplinary issues in the military and his reports of being placed on bread on water for the last three days of his service. Following an objective evaluation, the VA examiner diagnosed the Veteran with severe major depressive disorder. The VA examiner found that based on the Veteran’s own report, his depression had its onset with the breakup of his marriage and losing custody of his children beginning in 1996. Certainly, the Veteran is competent to report his history of psychiatric problems. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). Notably, the Veteran’s own lay assertions provide that his mental health symptoms began in 1996, more than 15 years after his discharge, and were precipitated by his divorce and child custody issues, which were then followed by his homelessness. The Veteran has not presented any competent and credible evidence that his currently diagnosed major depressive disorder is related to his active duty service. Moreover, the Veteran has not demonstrated that he has any specialized knowledge or training to provide such a medically complex etiological opinion. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F. 3d 1372, 1376-77 (Fed. Cir. 2007). Accordingly, the Board finds that the preponderance of the evidence weighs against finding in favor of the Veteran’s service connection claim for an acquired psychiatric disorder, to include PTSD and MDD. Therefore, the benefit-of-the-doubt rule does not apply, and the service connection claim must be denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Higher Evaluation 7. Entitlement to a compensable evaluation for left ear hearing loss The Veteran generally asserts that his left ear hearing loss is worse than his current evaluation reflects. Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4. The rating schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of, or incident to, military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise the lower rating will be assigned. 38 C.F.R. § 4.7. Because the level of disability may have varied over the course of the claim, the rating may be "staged" higher or lower for segments of time during the period under review in accordance with such variations. Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007); Fenderson v. West, 12 Vet. App. 119, 126 (1999). In initial-rating cases, where the appeal stems from a granted claim of service connection with respect to the initial evaluation assigned, VA assesses the level of disability from the effective date of service connection. See Fenderson, 12 Vet. App. at 125; 38 U.S.C. § 5110; 38 C.F.R. § 3.400. The Veteran’s left ear hearing loss has been currently evaluated as noncompensable, effective September 26, 2013, under 38 C.F.R. § 4.85, Diagnostic Code 6100. Evaluations of defective hearing are based on organic impairment of hearing acuity as measured by the results of controlled speech discrimination testing together with the average hearing threshold level as measured by puretone audiometric tests in the frequencies 1000, 2000, 3000, and 4000 Hertz (Hz). To evaluate the degree of disability from defective hearing, the rating schedule requires assignment of a Roman numeral designation, ranging from I to XI. Other than exceptional cases, VA arrives at the proper designation by mechanical application of Table VI, which determines the designation based on results of standard test parameters. Table VII is then applied to arrive at a rating based upon the respective Roman numeral designations for each ear. Where impaired hearing is service connected in only one ear, the nonservice-connected ear will be assigned a Roman numeral I for rating purposes. 38 C.F.R. § 4.85, Diagnostic Code 6100. Under 38 C.F.R. § 4.86, when the puretone threshold at each of the four specified frequencies (1000, 2000, 3000, and 4000 Hz) is 55 decibels (dB) or more, the rating specialist will determine the Level designation for hearing impairment from either Table VI or Table VIa, whichever results in the higher numeral. Each ear will be evaluated separately. Further, when the average puretone threshold is 30 dB or less at 1000 Hz, and 70 dB or more at 2000 Hz, the rating specialist will determine the Level designation for hearing impairment from either Table VI or Table VIa, whichever results in the higher numeral. That numeral will then be elevated to the next higher level. Each ear will be evaluated separately. 38 C.F.R. § 4.86(b). In February 2014, the Veteran underwent a VA audiological examination. The results of puretone threshold testing were in the right ear at 1000, 2000, 3000, and 4000 Hz of 20, 25, 35, and 35 dB, respectively, for an average over the four frequencies of interest of 29 dB. Test results of puretone threshold testing were in the left ear at 1000, 2000, 3000, and 4000 Hz of 55, 50, 65, and 90 dB, respectively, for an average over the four frequencies of interest of 65 dB. Speech audiometry revealed speech recognition scores of 100 percent in the right ear and 96 percent in the left ear. The results show that the Veteran does not have exceptional hearing loss in his right or left ears as contemplated in 38 C.F.R. § 4.86. The February 2014 measurement results show that the application of 38 C.F.R. § 4.85 Table VI results in the assignment of Roman numeral I in the right ear, as a nonservice-connected ear, and Roman numeral II in the left ear. A noncompensable evaluation is derived from the application of Table VII of 38 C.F.R. § 4.85. In Martinak v. Nicholson, 21 Vet. App. 447 (2007), the Court held that in addition to dictating objective test results, a VA audiologist must fully describe the functional effects caused by a hearing disability in his or her final report. Martinak v. Nicholson, 21 Vet. App. at 455. Here, the February 2014 VA examiner found that the Veteran had difficulty hearing the television and conversations. The Board has considered the Veteran's assertion that his left ear hearing loss is worse than is contemplated by his current evaluation. However, in determining the actual degree of disability, an objective examination is most probative of the degree of the Veteran's impairment. Furthermore, the opinions and observations of the Veteran alone cannot necessarily meet the burden imposed by the rating criteria under 38 C.F.R. § 4.85, Diagnostic Code 6100 with respect to determining the severity of his service-connected left ear hearing loss disability. Cf. Ingram v. Nicholson, 21 Vet. App. 232, 256-57 (2007) ("It is the pro se claimant who knows what symptoms he is experiencing and that are causing him disability,.... [and] it is the Secretary who knows the provisions of title 38 and can evaluate whether there is a potential under the law to compensate an averred disability based on a sympathetic reading of the material in a pro se submission."). In summary, the preponderance of the evidence weighs against finding in favor of the Veteran's compensable evaluation claim for left ear hearing loss. Therefore, the benefit-of-the-doubt rule does not apply, and the compensable evaluation claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). REASONS FOR REMAND 1. Entitlement to service connection for a right shoulder disability is remanded. The Veteran asserts that his right shoulder disability was caused by an in-service incident, where he was blown into a catwalk while serving aboard the U.S.S. Independence. VA treatment records in October 2010 and April 2012 document that the Veteran has been diagnosed with right shoulder arthritis. In May 2012, the Veteran was afforded a VA examination for his right shoulder. Although the VA examiner noted the radiological evidence for the Veteran’s right shoulder arthritis, no etiological opinion was provided addressing this diagnosis. Rather, the VA examiner limited the opinion to his now service-connected long thoracic nerve injury chronic right with neuropathy. The record does not include any other etiological opinions addressing the Veteran’s right shoulder disability. Because the available competent evidence is insufficient to decide the claim, the Board finds that a remand is required to obtain a supplemental VA opinion specifically addressing the Veteran’s diagnosis for right shoulder arthritis. 2. Entitlement to service connection for epididymitis is remanded. At a May 2012 VA examination, the VA examiner noted that the Veteran had been diagnosed during service with left epididymitis in 1978, which resolved following treatment with antibiotics and bedrest. Following the current evaluation, the VA examiner found that no epididymitis was noted. Moreover, the VA examiner explained that the findings of a November 2010 ultrasound showed no evidence of epididymitis. According to the VA examiner, the bilateral epididymal cysts, left small varicocele and bilateral very small hydrocele found on the same 2010 ultrasound were not caused by or a result of the Veteran’s in-service left epididymitis. Since the May 2012 VA examination, the record includes VA treatment records in 2013 that show the results of an October 2013 echogram. The VA urologist interpreted those results and found that the findings of an enlarged left epididymal head, without increased vascular flow, were nonspecific, but likely represented sequelae from prior epididymitis. The VA urologist also noted that the Veteran’s history of epididymitis with the ultrasound result were suggestive of a chronic process. At a December 2013 VA clinic visit, the VA treating physician documented the Veteran’s current treatment for chronic left epididymitis with antibiotics. Given these clinical findings, the Board finds that the available evidence is insufficient to decide the claim. Therefore, a remand is required to obtain a supplemental VA opinion for his epididymitis. 3. Entitlement to service connection for a back disability is remanded. The Veteran contends that during service, he injured his back after he was blown from the flight deck and landed feet first onto the catwalk. He explained that he currently experienced pain in both his back and right shoulder; however, he also said that he was not sure of the exact diagnosis or if the symptoms were one or two different conditions. At a May 2012 VA thoracolumbar spine examination, the VA examiner found that the Veteran did not now or ever have been diagnosed with a thoracolumbar spine condition. The VA examiner did not document any objective findings, so it is not clear whether any objective evaluation was actually performed. The VA examiner determined that the Veteran’s complaints and symptoms were not related to his back, but were only related to his right scapula. The VA examiner concluded that the Veteran’s only problem was related to his now service-connected long thoracic nerve injury chronic right with neuropathy. The record includes an October 2013 VA treatment record, which documents that the Veteran presented with complaints of his “back locking up” for the past few days and that he reported having a history of disk problems. The VA treating physician diagnosed the Veteran with chronic back pain with probable cervical nerve impingement. At a December 2013 VA clinic visit, the Veteran reported having upper back pain radiating to his upper extremities. An MRI of the Veteran’s cervical spine revealed C4-C7 DJD. Given that both the Veteran’s subjective reports and the clinical findings suggest that the Veteran’s “back” claim may encompass more than just his low or middle back, the Board will broadly construe the issue of his back disability to include his upper back and cervical spine. See Clemons v. Shinseki, 23 Vet. App. 1, 6 (2009). Further, the Board finds that the Veteran was not afforded an adequate VA examination to address his service connection claim, as the May 2012 VA examiner made no objective findings. Because the record clearly shows that the Veteran has made complaints related to his back and he has received diagnoses related to his back, the Board finds that a new, adequate VA examination is warranted. On remand, the Veteran should be afforded a examination that includes his cervical spine and thoracolumbar spine to ensure that all of his complaints and symptoms are evaluated. The matters are REMANDED for the following actions: 1. Obtain all the outstanding treatment records for the Veteran’s right shoulder disability, epididymitis, and back disability that are not currently of record. 2. Obtain an addendum opinion by an appropriately qualified clinician as to whether the Veteran’s right shoulder disability, diagnosed as right shoulder arthritis, is at least as likely as not related to his active duty service. In providing the above opinion, the examiner should consider the Veteran’s assertion that during service, he sustained a right shoulder injury after being blown into a catwalk while aboard the U.S.S. Independence. A complete rationale with discussion of medical literature for any opinion expressed must be provided. If an opinion cannot be expressed without resort to speculation, discuss why this is the case. 3. Obtain an addendum opinion by an appropriately qualified clinician as to whether the Veteran’s current epididymitis is at least as likely as not related to his active duty service, to include his in-service left epididymitis. In providing the above opinions, the examiner must address the October 2013 VA treatment record documenting that the Veteran’s ultrasound findings were suggestive of a chronic process related to his history of epididymitis and likely represented sequelae from prior epididymitis. The examiner must also address the December 2013 VA treatment record documenting the Veteran’s treatment for chronic left epididymitis and his reports of relating the onset of symptoms to his in-service left epididymitis. A complete rationale with discussion of medical literature for any opinion expressed must be provided. If an opinion cannot be expressed without resort to speculation, discuss why this is the case. 4. Schedule the Veteran for an examination of his thoracolumbar spine and cervical spine by an appropriately qualified examiner to determine the nature and etiology of any back disability. The examiner should provide an opinion, which addresses the following: (a.) Identify all of the Veteran’s current diagnoses related to his back, to include any cervical spine and thoracolumbar spine disabilities. (b.) For each diagnosis, the examiner should opine as to whether any back disability is at least as likely as not related to his active duty service, to include his reported in-service back injury. In providing the above opinions, the examiner must address his documented diagnoses for chronic back with probable cervical nerve impingement and C4-C7 DJD. The examiner must also address the Veteran’s lay reports concerning the onset and continuity of his back problems. The examiner should evaluate the Veteran’s entire spine when considering his “back” problems. A complete rationale with discussion of medical literature for any opinion expressed must be provided. If an opinion cannot be expressed without resort to speculation, discuss why this is the case. 5. Readjudicate the issues on appeal. If the benefits sought on appeal are not granted to the Veteran’s satisfaction, then provide the Veteran and his representative a supplemental statement of the case and an opportunity to respond. If necessary, return the case to the Board for further appellate review. LESLEY A. REIN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Journet Shaw, 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.