Citation Nr: 21025024 Decision Date: 04/27/21 Archive Date: 04/27/21 DOCKET NO. 17-13 742 DATE: April 27, 2021 ORDER New and material evidence has been submitted, and the claim to reopen service connection for an acquired psychiatric disability, to include PTSD (acquired psychiatric disability) is granted. New and material evidence has been submitted and the claim to reopen service connection for a neck disability (cervical spine disability) is granted. Service connection for alcoholic polyneuropathy is denied. Entitlement to a temporary, total 100 percent rating for convalescence due to surgical treatment for deviated septum with septoplasty is denied. REMANDED The service connection claim for an acquired psychiatric disability is remanded. The claim to reopen service connection for a lumbar spine disability is remanded. The claim to reopen service connection for bilateral hearing loss is remanded. The claim to reopen service connection for tinnitus is remanded. The claim to reopen service connection for an eye disability is granted. The service connection claim for a cervical spine disability is remanded. The claim of service connection for obstructive sleep apnea is remanded. The claim of service connection for a heart condition, to include as secondary to obstructive sleep apnea is remanded. The claim of an increased, compensable rating for sinusitis, to include residuals of deviated septum with septoplasty (deviated septum residuals) is remanded. The claim of an increased, compensable rating for bilateral shin splints is remanded. The claim of an entitlement to a 10 percent combined evaluation for multiple non-compensable service-connected disabilities is remanded. The claim of an entitlement to compensation for ARDS, under 38 U.S.C. S 1151, is remanded. The claim of an entitlement to a total disability rating for an individual unemployability (TDIU) is remanded. FINDINGS OF FACT 1. New and material evidence submitted since the last, final December 2007 rating decision that denied service connection for an acquired psychiatric disability, includes medical evidence of a diagnosis of a psychiatric disability, other than PTSD, as well as lay evidence of treatment for a psychiatric disability immediately after the Veteran separation from service. 2. New and material evidence submitted since the last, final December 2007 rating decision that denied service connection for a cervical spine disability, includes medical evidence of a cervical spine disability, and lay evidence of an in-service injury that may be related to the Veteran’s cervical spine disability. 3. The Veteran’s alcoholic neuropathy is not eligible for VA compensation, for purposes of direct service connection; and the probative evidence does not show that his alcoholic neuropathy is secondary to his psychiatric disability, and/or any of his service-connected disabilities. 4. After the Veteran’s January 2018 septoplasty for his service-connected deviated septum, his residuals did not require at least month of convalescence; and/or it was not manifested by severe postoperative septoplasty residuals. CONCLUSIONS OF LAW 1. The criteria for reopening service connection for an acquired psychiatric disability have been met. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.104, 3.156. 2. The criteria for reopening service connection for a cervical spine disability have been met. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.104, 3.156. 3. The criteria for service connection for alcoholic polyneuropathy, to include as secondary to a service-connected disability, have not been met. 38 U.S.C. §§ 105, 1110, 5107; 38 C.F.R. §§ 3.1, 3.102, 3.301, 3.303, 3.310. 4. The criteria for a temporary, total 100 percent disability rating for convalescence following a septoplasty procedure for a service-connected deviated septum have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.30. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from May 1984 to September 1987, and from August 2006 to October 2006, with additional periods of unverified service in the Army Reserve and Army National Guard. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from April 2015, November 2015, May 2016, and March 2018 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in New Orleans, Louisiana. In February 2020, the Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge. A transcript of this hearing is of record. New and Material Evidence VA may reopen and review a claim that has been previously denied if new and material evidence is submitted by or on behalf of a Veteran. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a); Hodge v. West, 155 F. 3d 1356 (Fed. Cir. 1998). New evidence is evidence not previously submitted to agency decision makers. Material evidence is 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 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). In determining whether new and material evidence has been received, VA must initially decide whether evidence associated with the claims file since the prior final denial is new. New evidence is that which was not of record at the time of the last final disallowance on any basis of the claim, and is not merely cumulative of other evidence that was then of record. 38 C.F.R. § 3.156(a). The claims for an acquired psychiatric disability and a cervical spine disability were previously denied in a December 2007 rating decision. Following this December 2007 rating decision for both disabilities, the Veteran did not perfect an appeal, and thus, the rating decision for each of these disabilities became final. 38 U.S.C. § 7105(c); 38 C.F.R. §§ 3.104. 1. Acquired Psychiatric Disability In the December 2007 rating decision, the RO denied the service connection claim for an acquired psychiatric disability because it found that there is no evidence that the Veteran suffered from, or was diagnosed with any other acquired psychiatric disability, to include PTSD, and that there was no evidence to support the Veteran’s claim that he suffered from a traumatic personal trauma event during service. Probative to this claim, evidence received since this last, final December 2007 rating decision, includes and is not limited to, a May 2020 medical opinion from a private psychologist, Dr. B.V., which reflects an additional diagnosis of a psychiatric disability, and specifically, major depressive disorder, as well as lay testimony from the Veteran’s February 2020 videoconference hearing, in which he stated that he sought mental health treatment in August 2007 (less than a year after his separation from service), and that he started his mental health treatment in Helena, Montana. These pieces of evidence are new because they were not previously considered by VA; and they are material because they provide a clearer picture of the history of the Veteran’s acquired psychiatric disability, and collectively, serve as proof of an unestablished fact from the prior December 2007 rating decision, namely, evidence of an acquired psychiatric disability, other than PTSD. The Board recognizes that this additional piece of evidence is presumed to be credible for the purpose of reopening the claim. Justus, 3 Vet. App. at 512 – 13. Therefore, these additional pieces of evidence, when considered in conjunction with the record as a whole, raises a reasonable possibility of substantiating the Veteran’s claim. Thus, as new and material evidence has been submitted, the service connection claim for an acquired psychiatric disability is reopened. 2. Cervical Spine Disability In the December 2007 rating decision, the RO denied the service connection claim for a cervical spine disability because it found that a VA examination failed to show that the Veteran suffered from any chronic neck condition that began during or was caused by military service. Probative to this claim, evidence received since this last, final December 2007 rating decision, includes and is not limited to, medical treatment records which reflect a cervical spine disability, and testimony at a February 2021 videoconference hearing, in which the Veteran asserted that his neck pain resulted from wearing his helmet during active service. These pieces of evidence are new because they were not previously considered by VA; and they are material because they provide clarification about the relationship between the Veteran’s neck pain and an in-service complaint, and collectively, serve as proof of an unestablished fact from the prior December 2007 rating decision. The Board recognizes that this additional piece of evidence is presumed to be credible for the purpose of reopening the claim. Justus, 3 Vet. App. at 512 – 13. Therefore, these additional pieces of evidence, when considered in conjunction with the record as a whole, raises a reasonable possibility of substantiating the Veteran’s claim. Thus, as new and material evidence has been submitted, the service connection claim for a cervical spine disability is reopened. Service Connection for Alcoholic Neuropathy Service connection may be granted for a disability resulting from a disease or injury incurred in, or aggravated during service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. That determination requires a finding of a current disability that is related to an injury or disease in service. Service connection may be granted for a disability diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability is due to disease or injury that was incurred or aggravated in service. 38 C.F.R. § 3.303(d). Generally, to establish service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313(Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). Alternatively, a disability which is proximately due to or the result of a service-connected disease or injury shall be service connected. When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. 38 C.F.R. § 3.310(a). Thus, secondary service connection may also be established for a nonservice-connected disability which is aggravated by a service-connected disability. In such an instance, the Veteran may be compensated for the degree of disability over and above the degree of disability existing prior to the aggravation. 38 C.F.R. § 3.310(b); see Allen v. Brown, 7 Vet. App. 439, 448 (1995). The Veteran suggests that his alcoholic polyneuropathy, which was induced from drinking alcohol, is related to his active service. See February 2020 Videoconference Hearing Transcript. In support of his claim, the Veteran has submitted a medical opinion from a private physician, Dr. E.W. In this opinion, Dr. E.W. confirmed that the onset of the Veteran’s alcoholic polyneuropathy began in 2014. Pertinently, in this June 2020 private opinion, June 2020, Dr. E.W. explained that the Veteran’s two condition, which commonly contribute to neuropathy are diabetes and alcohol abuse. He clarified that although diabetes is the more well-known cause of neuropathy, alcohol abuse commonly leads to this condition. Further, he explained that studies have shown that between 25 – 66 percent of chronic alcoholics exhibit neuropathy, and that the severity of this neuropathy is correlated with the severity of alcohol abuse. Therefore, based on this rationale, he opined that the Veteran’s long-standing alcohol abuse has significantly contributed to his current neuropathy. Where the Veteran’s own willful misconduct or abuse of drugs or alcohol results in a disability, the resulting disability cannot be eligible for VA compensation. 38 U.S.C. § 1110. However, as an exception to this rule, where a service-connected disability results in alcohol abuse, an alcohol-related disability may be eligible for service connection. See 38 U.S.C. § 105; 38 C.F.R. §§ 3.1(m), 3.301(d); see also Allen v. Principi, 237 F.3d 1368 (holding that when read in light of its legislature history, 38 U.S.C. § 1110 did not preclude a veteran from receiving compensation for alcohol or drug-related disabilities that are secondary to a service-connected disability). However, in light of the June 2020 private opinion from Dr. E.W., as discussed above, the Veteran is not service-connected, nor has he filed a service connection claim for diabetes. Nonetheless, the Veteran asserts that his alcoholic polyneuropathy is related to his anxiety. See February 2020 Hearing Transcript. Although the Veteran is not service-connected for a psychiatric disability at this time, the Board finds that even if VA were to award service connection for a psychiatric disability, the probative evidence does not show that his alcoholic polyneuropathy is secondary to anxiety and/or a psychiatric disability. Thus, it follows that even though the issue of service connection for an acquired psychiatric disability is remanded, there must be medical evidence that suggests that the Veteran’s alcoholic polyneuropathy is caused by and/or aggravated by his psychiatric disability, to constitute as an intertwined claim, for purposes of remanding this claim with the claim for a psychiatric disability. However, the Veteran’s statements alone, that his alcoholic polyneuropathy is related to his anxiety, as noted above, are insufficient to warrant a medical examination, based on secondary service connection. Doing so would, contrary to Congress’ intent, result in VA “routinely and virtually automatically” providing VA examinations to all veterans claiming service connection. See, e.g., Waters v. Shinseki, 601 F.3d 1274 (Fed. Cir. 2010). Therefore, under these circumstances, VA is under no duty to remand this claim, as an intertwined issue, and to obtain a medical opinion. While the Veteran is permitted to report the circumstances of his service and any symptoms and/or manifestations he may experience, as they are capable of lay observation, he does not have, nor has he shown or indicated that he has the training or expertise to provide an opinion on the etiology of his alcoholic polyneuropathy. Such an opinion requires specialized knowledge and/or medical expertise on an internal physical process extending beyond an immediately observable cause-and-effect relationship, as it requires knowledge of the neurological system. Woehlaert v. Nicholson, 21 Vet. App. 456 (2007) (finding that although the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions). Thus, as there is no indication that the Veteran has the medical training and/or expertise to provide an opinion that his alcoholic polyneuropathy is caused by his anxiety, this opinion has no probative value. Nonetheless, the Board has also considered all additional evidence which the Veteran has submitted, including additional lay statements, a second private medical opinion from a psychiatrist, Dr. B.V., and supporting medical literature that Dr. B.V. submitted, in support of his private medical opinion. In a June 2020 memorandum, the Veteran quoted the June 2020 medical opinion from Dr. E.W. and reiterated excerpts from Dr. E.W.’s June 2020 medical opinion, and stated that since the Veteran’s alcohol abuse is related to service, then service connection for alcoholic polyneuropathy is warranted. In support of this claim, the Veteran submitted another private opinion from a second psychologist, Dr. B.V. In this May 2020 medical opinion, Dr. B.V. opined that the Veteran’s alcohol use disorder is more likely than not incurred in, or caused by the verified trauma stressors and his major depressive disorder that occurred in service, thus making his alcohol use disorder service connected. As the rationale for this opinion, Dr. B.V. reasoned, on the one hand, that with respect to relevant substance abuse history, the Veteran reported that he drank some alcohol occasionally, prior to Panama, but when the harassment from his superior started in Panama, he drank nearly daily; when he left Panama, he drank less; his drinking picked up again, in about 2000, as he was in a poor place, he was having problems with his sons, and his job was getting difficult; and that currently, he drinks approximately one coffee mug of vodka every night. On the other hand, however, Dr. B.V. also stated that the Veteran’s alcohol use disorder was secondary to and co-morbid with his major depressive disorder, which was a factor that caused him to drink heavily for decades and “not be able to quit using alcohol.” However, Dr. B.V.’s statements contradict one another, and they do not suggest or support a pattern that is consistent with “drinking heavily for decades”, since the Veteran reported that he drank alcohol prior to his service in Panama, and that he drank less, after he served in Panama, until 2000, and that the reason for his drinking in approximately 2000, was not due to any military service, but rather, personal problems. Moreover, these statements contradict the Veteran’s testimony from his February 2020 videoconference hearing, where the Veteran reported that he separated from service in October 2006 and that he started drinking a lot of alcohol “[back] in 2006.” Thus, the Board finds that the Veteran’s statements about the onset and excessiveness of his drinking, during and post-service, as related to his psychiatric disability, are not credible. Pertinently, Dr. B.V. misstated Dr. E.W.’s June 2020 medical opinion. Specifically, Dr. B.V. noted that Dr. E.W. opined that the Veteran’s alcohol use disorder was secondary to and co-morbid with his major depressive disorder, which was a factor that caused him to continue to drink heavily for decades and not be able to quit abusing alcohol. Dr. B.V. further noted, “[alcohol] abuse especially heavily over the course of years, is a known significant risk factor in developing alcoholic polyneuropathy. Please refer to Dr. [E.W.’s] Independent Medical Opinion.” Notably, Dr. B.V. rendered his medical opinion in May 2020, prior to the time Dr. E.W. rendered his medical opinion, in June 2020. See Dr. B.V.’s May 10, 2020 Private Medical Opinion; see also Dr, E.W’s June 1, 2020 Private Medical Opinion. Furthermore, while Dr. E.W.’s June 2020 medical opinion does state that the Veteran’s alcohol abuse is a known significant risk factor in developing alcoholic polyneuropathy, as noted above, he did not mention anything about major depressive disorder or a psychiatric disability; and/or he did not address or discuss anything about a correlation between alcoholic polyneuropathy and a psychiatric disability. In evaluating this May 2020 opinion, the Board has also considered and evaluated all supporting medical literature that Dr. B.V. has provided, in support of his opinion. Notwithstanding, the Board finds that Dr. B.V.’s May 2020 medical opinion is based on an inaccurate factual premise, as he inaccurately stated that Dr. E.W. found that the “Veteran’s Alcohol Use Disorder was secondary to and co-morbid with his Major Depressive Disorder, which was a factor that caused him to continue to drink heavily for decades and not be able to quit abusing alcohol.” See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (holding that a medical opinion based on an inaccurate factual premise has no probative value.); see also Monzingo v. Shinseki, 26 Vet. App. 97, 107 (2012) (finding that “[if] the opinion is based on an inaccurate factual premise, then it is correct to discount it entirely”) (citing Reonal). Thus, the Board shall not afford any probative value to this opinion. In this regard, the Board finds that the preponderance of the evidence is against this claim, as the probative evidence does not show that the Veteran’s alcoholic polyneuropathy is secondary to a psychiatric disability, and/or any service-connected disability. Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990); 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Therefore, service connection for alcoholic polyneuropathy, to include as secondary to a psychiatric disability, must be denied. Temporary, Total Rating for Convalescence Care A temporary total disability rating shall be assigned under 38 C.F.R. § 4.30 when it is established by report at hospital discharge or outpatient release that treatment of a service-connected disability resulted in surgery necessitating at least one month of convalescence, surgery with severe post-operative residuals, such as incompletely healed surgical wounds, stumps of recent amputations, therapeutic immobilization of one major joint or more, application of a body case, or the necessity for house confinement, or the necessity for continued use of a wheelchair or crutches, or immobilization by cast, without surgery, of one major joint or more. 38 C.F.R. § 4.30. A temporary total disability rating will be assigned, effective from the date of a hospital admission and continuing for a period of 1, 2, or 3 months from the first day of the month following such hospital discharge, if the hospital treatment of a service-connected disability resulted in: (1) surgery necessitating at least one month of convalescence, (2) surgery with respect to postoperative residuals such as incompletely healed surgical wounds, stumps and recent amputations, therapeutic immobilization of one major joint or more, application of a body cast, or the necessity for house confinement, or the necessity for continued use of a wheelchair or crutches (regular weight-bearing prohibited), or (3) immobilization by cast, without surgery, of one major joint or more. 38 C.F.R. § 4.30(a). A total rating under section (1), (2) or (3) above may be extended for intervals of 30, 60 or 90 days. 38 C.F.R. § 4.30(b)(1). A total rating under section (2) or (3) above may be extended for up to 6 months beyond the initial 6-month period. 38 C.F.R. § 4.30(b)(2). The Veteran asserts that he underwent 7 weeks of recovery for his July 2018 surgical procedure for septoplasty, and that thus, he is entitled to a 100 percent, temporary, total disability rating for convalescence. See February 2018 Fully-Developed Claim; see also November 2018 Statement in Support of Claim. Medical treatment records reflect that the Veteran underwent septoplasty for his service-connected deviated septum on January 18, 2018. See January 2018 Surgery Operative Note; see also January 2018 Nursing Outpatient Operative Note. However, after a review of all probative evidence, the Board finds that a temporary, total, 100 percent compensation for convalescent care, following the Veteran’s septoplasty is not warranted. Specifically, the medical evidence does not reflect any instructions, directives, or disclaimers that show that the Veteran’s recovery and/or post-surgery septoplasty residuals necessitated at least one month of convalescence. As a matter of fact, and to the contrary, hospital discharge instructions noted that the sole purpose for the Veteran’s overnight stay at the hospital was because he did not have transportation to take him home after surgery; and specifically, tolerated physical activities, on discharge from the hospital, included, no limitations on weight bearing, lifting, mobility, driving, bathing, sexual activity, and the Veteran was allowed to return to work. See January 2018 Education Discharge Note. Additionally, the medical evidence does not show that the Veteran’s surgery was manifested by severe postoperative residuals, such as, for example, incompletely healed surgical wounds, stumps and recent amputations, therapeutic immobilization of one major joint or more, application of a body cast, or the necessity for house confinement, or the necessity for continued use of a wheelchair or crutches, with regular weight-bearing prohibited. As noted above, the January 2018 education discharge note, specifically stated that tolerated physical activities, included and were not limited to, weightbearing with no limitations. The Board acknowledges that although the Veteran also did not have post-service residuals, such as incompletely healed surgical wounds, stumps and recent amputations, therapeutic immobilization of a major joint or more, an application of a body cast, necessitated house confinement, or the necessity for continued use of a wheelchair or crutches, the Veteran, however, reported having respiratory issues, with an increase in shortness of breath, with drops in his oxygen level, approximately six days after his septoplasty. However, the medical evidence does not show that the Veteran’s surgery resulted in severe postoperative residuals. While the Veteran complained of low oxygen levels, and that he was reportedly hospitalized with an acute infection requiring him to be sent home on oxygen, the evidence also reflects that the Veteran was still smoking shortly after his septoplasty. For example, in a January 30, 2018 primary care note, which was documented approximately 12 days after his procedure, the attending nursing observed that the Veteran had a tremendous tobacco (cigarette) odor. Additionally, she noted that the Veteran was on oxygen; he reported that he had been coughing up green phlegm for the two weeks prior to this consultation; and that when she asked the Veteran whether he was still smoking, he confirmed that he was still smoking. A February 2018 otolaryngology note indicates that after his septoplasty, the Veteran was hospitalized, on or around January 30, 2018 (the same day as the January 30, 2018 primary care note), with an acute infection which required him to be sent home on oxygen; the Veteran reported that he was unsure of what happened to him, but knows that he was very sick; he was unable to keep up with his nasal saline treatment (from his septoplasty) during his hospital stay because the hospital apparently did not have anyone that knew how to administer the nasal saline; and that the Veteran continued to smoke. However, the medical evidence does not suggest that the Veteran’s hospitalization for an acute infection, which required him to utilize an oxygen tank, is a postoperative residual of his septoplasty, nor has the Veteran asserted that this is the case. As a matter of fact, a January 2018 education note suggests that severe residuals of the Veteran’s post-operative septoplasty may include, fevers, chills, night sweats, facial pressure/pain that is out of proportion, or double vision that does not improve, thereby instructing the Veteran that he should seek medical attention if he experienced any of these symptoms or physical changes. Rather, at a February 2020 follow up visit, which was approximately one month after his procedure, the Veteran reported, in pertinent part, that he was doing well, status-post January 2018 septoplasty, he had not been using his saline irrigations; he continued to use his allergy spray, prescribed by his primary care physician; he continued to smoke, though he had cut back to smoking ½ a pack per day; and pertinently, he denied having epistaxis, facial pain, rhinorrhea, fevers, and chills. Thus, despite the January 2018 education note’s disclaimer about severe post-operative septoplasty residuals, as identified above, this February 2020 otolaryngology note confirms that the Veteran did not experience any of these severe post-operative septoplasty residuals. Pertinently, the January 2018 education note specifically cautioned the Veteran that, “NO amount of smoking, smokeless tobacco, or second-hand smoke is safe”, and that exposure to smoke could cause heart disease, cancer, breathing problems, and other serious illnesses.” This disclaimer, by explaining that smoking could lead to symptoms, including and not limited to, breathing problems, suggests that the Veteran’s reported shortness of breath, with drops in his oxygen level, approximately six days after his septoplasty, were likely the result of his continued smoking habit, rather than a manifestation of a severe post-operative septoplasty residual. The smoking disclaimer from the January 2018 education note served as cautionary post-operative instructions, rather than post-operative septoplasty residuals. The medical evidence reflects that regardless of this disclaimer, the Veteran continued smoking shortly after his procedure, and subsequently, he complained of shortness of breath with decreased oxygen levels. Thus, clearly, the Veteran’s failure to comply with post-operative procedures, by engaging in willful conduct that likely impacted and/or interfered with his recovery, was not a post-operative septoplasty residual. At his February 2020 hearing, the Veteran did not raise any issues, complaints or assertions that he had postoperative septoplasty residuals; and additionally, he did not submit medical evidence, such as, for example, a private medical opinion, to support any conclusion that he had severe post-operative residuals from his January 2018 septoplasty. Further, he did not mention, nor did he provide any supporting evidence, that his post-surgical septoplasty necessitated convalescence for at least one month. Rather, the Veteran merely testified that “for 30 years, [his deviated septum residuals] never got fixed until in Houston in 2018, [when] they did surgery and corrected the problem.” He further stated that by correcting the problem, he could now breath out of both nostrils. Thus, as evidence of surgery necessitating at least one month of convalescence and/or surgery with severe post-operative septoplasty residuals is not shown, the preponderance of the evidence is against this claim, and thus, entitlement to a temporary, total, 100 percent rating for the service-connected deviated septum, status-post septoplasty must be denied. REASONS FOR REMAND The Board regrets further delay, but finds that additional development is necessary before a decision may be rendered on the remaining issues on appeal. 1. Unverified Periods of Additional Service The evidence of records indicates that the Veteran served in the United States Army Reserve and National Guard. However, some of his forms, DD-214: Certificate of Release or Discharge from Active Duty are illegible, and pertinently, there is no evidence or documentation of verified characterizations of service, such as, for example, active duty, active duty for training (ACTDUTRA), or inactive duty for training (INACTDUTRA) for these additional periods of service. Thus, as the Veteran’s period of service in the Reserve and National Guard are unverified, as well as characterization of service, a remand is required for the Veteran’s to confirm the Veteran’s periods and characterization of service in the Army Reserve and National Guard, and if applicable, obtaining all outstanding service personnel and treatment records, for purposes of associating them with the claims file. 2. Claim for Acquired Psychiatric Disability The Veteran asserts that his acquired psychiatric disability, to include major depressive disorder, is a result of his active service. At his February 2020 videoconference hearing, the Veteran testified that he begun mental health treatment in August 2007, which is less than a year after his separation from service, and that additionally, he started mental health treatment at the VA Medical Center in Helena, Montana. However, even though the Veteran appears to have submitted some records from VAMC Montana, it appears that additional treatment records form this facility are outstanding, and despite obtaining medical treatment records from other facilities, the AOJ has not obtained any treatment records from VAMC Montana. Therefore, a remand is required for the AOJ to obtain all outstanding treatment records from VAMC Montana, and to provide the Veteran with a VA examination, for an assessment of the etiology of the Veteran’s major depressive disorder, given the Veteran’s lay evidence of a reported stressor/in-service event, as well as evidence of a current mental disability. See e.g. November 2018 Rehabilitation Psychological Note. 3. Claims to Reopen Lumbar Spine, Bilateral Hearing Loss, Tinnitus & Vision Disabilities; Service Connection Claims for Cervical Spine, Obstructive Sleep Apnea, and Eye Disabilities; the Service Connection Claim for a Heart Condition, as Secondary to Obstructive Sleep Apnea; and the Claim for ARDS, under 38 U.S.C. S 1151 In addition to unverified periods of service in the Reserve and National Guard, as well as outstanding treatment records from VAMC, treatment records from VA Montana, treatment records from VAMC Arlington have not been updated since January 2017. Thus, as the record is incomplete, the Board cannot adjudicate the above-mentioned claims. In this regard, a remand is required for the AOJ to verify all periods of service, obtain any outstanding STRs, and to obtain all outstanding post-service treatment records to associate them with the claims file. With respect to the Veteran’s claim for ARDS, under 38 U.S.C. § 1151, the Veteran asserts that he developed ARDS due to VA’s failure to timely treat his respiratory symptoms when it did not schedule the Veteran for an appointment immediately. In support of his claim, the Veteran submitted buddy statements from M.H., his spouse, B.B., and stepdaughter, M.P., explaining the events leading up to the Veteran’s visit to the emergency room and eventual hospitalization, and resulting impairment that almost cost him his life. Thus, a remand is also required for the AOJ to obtain a VA medical opinion on the Veteran’s ARDS claim. 4. Increased Rating Claims for Bilateral Shin Splints and Deviated Septum Residuals The Veteran asserts entitlement to an increased rating for his service-connected bilateral shin splints, as well as deviated septum residuals. However, the current severity of these appealed service-connected disabilities is not discernable. Specifically, as noted above with respect to his other claims, his claims file has not been updated with treatment records in four years. Additionally, he underwent a septoplasty procedure for his deviated septum residuals in January 2018, and at his February 2020 videoconference hearing, he indicated that there were outstanding treatment records pertaining to his chronic sinusitis/deviated septum residuals, which were not in the claims file. Additionally, the last time the Veteran was afforded a comprehensive VA examination for his bilateral shin splints, as well as for his deviated septum residuals, was in February 2016. Therefore, a remand is required for the AOJ to update the Veteran’s claims file with outstanding treatment records, as well as affording the Veteran with a contemporaneous VA examination for his bilateral shin splints and deviated septum residual disabilities. 5. Claim for a 10 Percent Combined Evaluation for Multiple Non-Compensable Service-Connected Disabilities The Veteran also asserts entitlement to a 10 percent combined rating for multiple non-compensable service-connected disabilities. “Whenever a veteran is suffering from two or more separate permanent service-connected disabilities of such character as clearly to interfere with normal employability, even though none of the disabilities may be of compensable degree”, a 10 percent disability rating is warranted, although the assigned, 10 percent compensable rating cannot be combined with any other rating. 38 C.F.R. § 3.324. Pertinent to this claim, the Veteran is currently assigned noncompensable ratings for his bilateral shin splints and his deviated septum residuals. However, as indicated above, the Veteran has also filed increased, compensable rating claims for these same service-connected disabilities. Thus, given that the issue of entitlement to a 10 percent combined evaluation for multiple non-service-connected disabilities may become moot if either increased rating claim is assigned an increased, compensable rating, the claim for a 10 percent combined evaluation for multiple non-compensable service-connected disabilities is intertwined with the increased, compensable rating claims for the bilateral shin splints and deviated septum residuals. See Harris v. Derwinski, 1 Vet. App. 180 (1991). Therefore, a remand is also required for this claim, pending the outcome of the increased rating claims for the service-connected bilateral shin splints and deviated septum residuals. 6. TDIU A claim for a TDIU is generally part of an increased rating claim when that claim is raised by the record. See Rice v. Shinseki, 22 Vet. App. 447, 453 – 54 (2009). In this case, TDIU is explicitly raised by the record. Specifically, for example, the Veteran filed an August 2015 application for increased compensation based on unemployability (TDIU application). He asserts that he is unemployable as result of multiple disabilities, including his heart condition and psychiatric disability, which are currently on appeal. See August 2015 TDIU application; see also June 2020 Memorandum. Thus, this TDIU claim is intertwined with some of the service connection claims that are remanded. Thus, as these service connection claims may result in a potential grant for service connection, they impact the outcome of the Veteran’s TDIU claim. See Harris v. Derwinski, 1 Vet. App. 180 (1991). Accordingly, the TDIU claim is also remanded. The matters are REMANDED for the following action: 1. Prior to scheduling any VA examinations and obtaining an opinion, verify the Veteran’s period of service in the Army Reserve and National Guard. Thereafter, undertake the following developments: a. Provide a clearly enumerated list of the Veteran’s periods of service in the Army Reserve and in the National Guard, which should indicate for each period, whether the service was active duty, ACTDUTRA, INACTDUTRA or unverified. If necessary, a request should be submitted to the Defense Finance and Accounting Service (DFAS). b. If any information is unavailable, provide the Veteran with a Memorandum of Unavailability, and associate a copy with the claims file. 2. After verifying the Veteran’s periods of active duty, ACTDUTRA, and INACTDUTRA in the Army Reserve and National Guard, obtain the following outstanding records, if applicable, and associate them with the claims file: a. All outstanding service personnel records and STRs, if any, from the Veteran’s service in the Army Reserve and National Guard. b. All outstanding VA treatment records from VAMC, Alexandria, from January 20, 2017 to current. c. All treatment records from VAMC Helena, Montana, from August 16, 2007 to current. d. All outstanding private treatment, after obtaining the requisite, executed authorization and release from the Veteran. e. Thereafter, undertake any additional developments that are requisite and/or collateral to the claims on appeal, to include scheduling the Veteran for a VA examination and/or obtaining an opinion. If any medical record is unavailable, provide the Veteran with a Memorandum of Unavailability, and associate a copy with the claims file. 3. After undertaking all of the above-mentioned developments, schedule the Veteran for a new VA examination with a physician (VA examiner) to determine the etiology of his acquired psychiatric disability, to include, major depressive disorder. The VA examiner must review the claims file and must note that review in the report. A copy of this REMAND must be made available to the VA examiner. The VA examiner must undertake the following: a. Opine whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s acquired psychiatric disability was incurred in service, the result of an in-service injury, illness, disease, or event; and/or is otherwise related the Veteran’s active service. b. In rendering an opinion, the VA examiner should consider the Veteran’s lay statements about onset and symptoms, as well as any other statements from other witnesses. c. Also, if documented in the record, the VA examiner must consider the Veteran’s treatment for a mental disability, which occurred less than one year after his separation from service. A detailed explanation is requested for all opinions provided. If an opinion cannot be provided without resort to speculation, provide an explanation as to why this is so and note what, if any, additional evidence would permit such an opinion to be rendered. 4. Also, schedule the Veteran for new VA examinations to determine the current severity of the Veteran’s deviated septum residuals and bilateral shin splints. The VA examiner must undertake the following developments: a. For each disability being examined, utilize the appropriate disability benefits questionnaire form, to the extent possible. b. For each disability, describe the functional effects or otherwise state how the disability interferes with normal employability. 5. Obtain a VA opinion on the Veteran’s ARDS claim, under 38 U.S.C. § 1151. The VA examiner must review the claims file and must note that review in the report. A copy of this REMAND must be made available to the VA examiner. The VA examiner must undertake the following: a. Opine whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s ARDS disability was the result of VA’s failure to timely schedule the Veteran for an appointment to address his complaints of respiratory symptoms. b. If the Veteran has additional disability as a result of VA’s failure to timely schedule the Veteran for an appointment, opine whether it is at least as likely as not the proximate cause of the Veteran’s ARDS was carelessness, negligence, lack of proper skill, error in judgement, or similar instance on the part of VA, by failing to timely provide the hospital care or medical treatment. A detailed explanation is requested for all opinions provided. If an opinion cannot be provided without resort to speculation, provide an explanation as to why this is so and note what, if any, additional evidence would permit such an opinion to be rendered. M. Tenner Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board V-N. Pratt 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.