Citation Nr: 21028012 Decision Date: 05/10/21 Archive Date: 05/10/21 DOCKET NO. 16-24 021A DATE: May 10, 2021 ORDER Reconsideration of the claim of entitlement to service connection for bilateral hearing loss, previously denied in an August 2008 rating decision, is granted. Reconsideration of the claim of entitlement to service connection for chronic fatigue syndrome (CFS), previously denied in an August 2008 rating decision, is granted. Reconsideration of the claim of entitlement to service connection for "general joint pain," previously denied in an August 2008 rating decision, is granted. Reconsideration of the claim of entitlement to service connection for a "muscular condition (unspecified muscle)," previously denied in an August 2008 rating decision, is granted. Reconsideration of the claim of entitlement to service connection for a "nerve condition (unspecified nerve)," previously denied in an August 2008 rating decision, is granted. REMANDED Entitlement to service connection for CFS is remanded. Entitlement to service connection for bilateral hearing loss is remanded. Entitlement to service connection for fibromyalgia is remanded. Entitlement to service connection for "general joint pain" is remanded. Entitlement to service connection for a "muscular condition (unspecified muscle)" is remanded. Entitlement to service connection for a "nerve condition (unspecified nerve)" is remanded. Entitlement to service connection for disequilibrium is remanded. Entitlement to service connection for a traumatic brain injury (TBI) is remanded. Entitlement to service connection for tinnitus is remanded. From May 23, 2013, entitlement to a rating greater than 10 percent for restless leg syndrome is remanded. FINDINGS OF FACT 1. In an August 2008 rating decision, the agency of original jurisdiction (AOJ) denied service connection for, inter alia, bilateral hearing loss, CFS, "general joint pain," a "muscular condition (unspecified muscle)," and a "nerve condition (unspecified nerve)." The Veteran did not appeal these denials. 2. New evidence associated with the claims file since the August 2008 denials of service connection for bilateral hearing loss, CFS, "general joint pain," a "muscular condition (unspecified muscle)," and a "nerve condition (unspecified nerve)" includes relevant official service department records not previously considered. CONCLUSION OF LAW As pertinent evidence received since the August 2008 denials of service connection for bilateral hearing loss, CFS, "general joint pain," a "muscular condition (unspecified muscle)," and a "nerve condition (unspecified nerve)" includes official service department records that had not been associated with the claims file when VA first decided the claim, the criteria for reconsideration of the claims for service connection for bilateral hearing loss, CFS, "general joint pain," a "muscular condition (unspecified muscle), and a "nerve condition (unspecified nerve)" have been met. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. § 3.156(c). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran had active service from October 1990 to June 1991. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2013 rating decision of an Agency of Original Jurisdiction (AOJ) of the Department of Veterans Affairs (VA). The issues on appeal were previously remanded by the Board in April 2020, as well as the issues of the issues of entitlement to service connection for a lumbar spine disorder and a urinary disorder, to include benign prostatic hypertrophy. Service connection for degenerative arthritis of the spine and benign prostate hyperplasia, overactive bladder, and urinary incontinence, was awarded in an August 2020 rating decision. As this is considered a full grant of benefits, those two issues are no longer on appeal and will not be addressed in this Board decision. As explained below, the Board finds that the claims adjudicated as a request to reopen are more appropriately characterized as a request for reconsideration, consistent with the provisions of 38 C.F.R. § 3.156(c). Moreover, given the decision granting reconsideration (set forth below), the underlying service connection claims are also before the Board and are being remanded for further development; thus, the Veteran is not prejudiced by the Board's recharacterization. Issue 1: Reconsideration of the claim of entitlement to service connection for bilateral hearing loss Issue 2: Reconsideration of the claim of entitlement to service connection for chronic fatigue syndrome (CFS Issue 3: Reconsideration of the claim of entitlement to service connection for "general joint pain" Issue 4: Reconsideration of the claim of entitlement to service connection for a "muscular condition (unspecified muscle)" Issue 5: Reconsideration of the claim of entitlement to service connection for a "nerve condition (unspecified nerve)" Background Law Under 38 C.F.R. § 3.156(a), VA requires new and material evidence to reopen a claim it previously denied, and which has gone final. Subsection (c) provides an exception to this rule. It states: (c) Service department records. (1) Notwithstanding any other section in this part, at any time after VA issues a decision on a claim, if VA receives or associates with the claims file relevant official service department records that existed and had not been associated with the claims file when VA first decided the claim, VA will reconsider the claim, notwithstanding paragraph (a) of this section. Such records include, but are not limited to: (i) Service records that are related to a claimed in-service event, injury, or disease, regardless of whether such records mention the veteran by name, as long as the other requirements of paragraph (c) of this section are met; (ii) Additional service records forwarded by the Department of Defense or the service department to VA any time after VA's original request for service records; and (iii) Declassified records that could not have been obtained because the records were classified when VA decided the claim. (2) Paragraph (c)(1) of this section does not apply to records that VA could not have obtained when it decided the claim because the records did not exist when VA decided the claim, or because the claimant failed to provide sufficient information for VA to identify and obtain the records from the respective service department or from any other official source. (3) An award made based all or in part on the records identified by paragraph (c)(1) of this section is effective on the date entitlement arose or the date VA received the previously decided claim, whichever is later, or such other date as may be authorized by the provisions of this part applicable to the previously decided claim. (4) A retroactive evaluation of disability resulting from disease or injury subsequently service connected on the basis of the new evidence from the service department must be supported adequately by medical evidence. Where such records clearly support the assignment of a specific rating over a part or the entire period of time involved, a retroactive evaluation will be assigned accordingly, except as it may be affected by the filing date of the original claim. In August 2020, the U.S. Court of Appeals for the Federal Circuit held in Kisor v. Wilkie, No. 2016-1929, that, in the context of 38 C.F.R. § 3.156(c)(1), a record is "relevant" if it addresses a matter in dispute. Indeed, to be relevant, a record must address a dispositive issue and therefore affect the outcome of the case. Merits The procedural history of Issues 1-5 is complex, so the Board will explain it below. On October 23, 2007, the Veteran claimed service connection for nine issues: 1) Hearing loss 2) PTSD 3) Chronic Fatigue 4) Sleeping Disorder 5) Urinary Condition 6) Memory 7) Dental Condition 8) General Joint Pain 9) Muscle Condition (Nerve Condition) The AOJ, in response, issued a rating decision on August 26, 2008. It adjudicated three issues: 1) Service connection for PTSD 2) Service connection for hearing loss 3) Service connection for "mental condition (claimed as memory), sleep condition (claimed as sleeping disorder), chronic fatigue syndrome, urinary condition, general joint pain, muscular condition (unspecified muscle), and nerve condition (unspecified nerve)." For Issue 3, the AOJ stated: Service connection for mental condition (claimed as memory), sleep condition (claimed as sleeping disorder), chronic fatigue syndrome, urinary condition, general joint pain, muscular condition (unspecified muscle), and nerve condition (unspecified nerve) is denied since there is no evidence the claimed conditions exist. Service treatment notes were reviewed and there is no mention of diagnosis or treatment of these conditions. On March 25, 2008, we sent you a letter asking you to submit to us current medical evidence of your claimed conditions and evidence showing these conditions existed from military service to the present time. As of this date, no information has been received. The Veteran did not appeal this decision, nor did he submit new and material evidence within one year of it. However, this does not end the inquiry. In October 2012, the Board explained: In November 2009, the Veteran resubmitted evidence pertinent to the matter of service connection for PTSD, which was accepted by the RO as a request to reopen the claim. In an April 2011 rating decision, the RO denied service connection for PTSD and for adjustment disorder with depressed and anxious mood. In July 2011 the Veteran filed a NOD concerning PTSD and adjustment disorder. The RO issued a SOC reflecting the denial of service connection for a mental disorder in March 2012, and the Veteran filed a substantive appeal (via VA Form 9) in April 2012. The Board subsequently found that, as it related to a PTSD appeal that is not part of this appeal stream, "the nature of additional evidence received since the August 2008 rating decision provides basis for reconsidering the claim." As relevant here, it further stated: In the present case, in July 2010, the RO submitted request to JSRRC for information concerning, among others, the Veteran's claimed stressor of experiencing ongoing Scud missile attacks while stationed at the Port of Dammam in Dhahran, Saudi Arabia between November 1990 and May 1991. The request reflects that the Veteran was a member of the 180th Transportation Company between November 1990 and June 1991 and that he reported a Scud missile attack in which twenty-eight people were killed from a Pennsylvania Quarter Master unit and the fear he experienced from Scud missile warnings 'going off all the time.' The July 2010 response from JSRRC indicates that an After Action Report (AAR) for the 180th Transportation Company documents that, during Operation Desert Storm, the mission of the company was to conduct port clearance at the Port of Dammam in Dhahran, and that during the time period of January and February 1991, the morale of the company was down due to enemy Scud missile attacks. Also found by JSRRC was an Information Paper submitted by the Office of the Special Assistant for Gulf War Illnesses in which it was documented that Dhahran was subjected to Iraqi Scud missile attacks on seven occasions between January 20, 1991 and February 22, 1991. The Board finds that the service department records described in JSRRC's July 2010 summary report fall within the exception created by 38 C.F.R. § 3.156(c), as such records were in existence at the time of the original denial of service connection and are relevant to the issue of entitlement to service connection for an acquired psychiatric disability, including PTSD. In February 2013, the Veteran claimed service connection for 10 issues: 1) TBI 2) Hearing loss 3) Tinnitus 4) Disequilibrium (lack of balance or dizziness) 5) Low back 6) Restless Leg Syndrome 7) Widespread muscle twitching 8) Fibromyalgia 9) Chronic Fatigue Syndrome 10) Urinary Dysfunction In June 2013, the AOJ created an internal, deferred rating decision. It says, as relevant here: Chronic fatigue syndrome, urinary dysfunction, widespread muscle twitching (previously claimed as muscular condition) restless leg syndrome (previously claimed as nerve condition and muscular condition) and fibromyalgia (previously claimed as nerve condition and general joint pain) denied 8/26/08 there was no evidence of an actual disability. That same month, the AOJ issued a Veterans Claims Assistance Act (38 U.S.C. § 5103) letter. It says: You were previously denied service connection for Bilateral Hearing Loss, Chronic Fatigue Syndrome, Urinary Dysfunction, Widespread Muscle Twitching, Restless Leg Syndrome, and Fibromyalgia. You were notified of the decision on August 26, 2008. The appeal period for that decision has expired and the decision is now final. In order for us to reopen your claim, we need new and material evidence. Your claim was previously denied because the disabilities were not incurred nor caused by service. Therefore, the evidence you submit must be new and relate to this fact. In August 2013, the AOJ issued a rating decision. It: 1) Granted "service connection for restless leg syndrome (also claimed as widespread muscle twitching), as secondary to the service-connected disability of post-traumatic stress disorder (PTSD)." 2) Denied "service connection for fibromyalgia (also claimed as widespread muscle twitching, muscular condition, and nerve condition)" 3) Denied service connection for TBI 4) Denied service connection for urinary disorder 5) Denied service connection for low back 6) "Confirmed and continued" the previous denial of service connection for chronic fatigue syndrome. 7) Denied reopening of "the claim for service connection for hearing loss, urinary dysfunction, disequilibrium, nerve condition, muscular condition, and joint condition" because "no new and material evidence has been submitted." For Issue 7, it says: We have determined that your claim for hearing loss, urinary dysfunction, disequilibrium, nerve condition, muscular condition, and joint condition may not be reopened because you did not submit new and material evidence to support your claim. On the rating decision dated August 25, 2008, you were denied service connection for hearing loss, urinary dysfunction, disequilibrium, nerve condition, muscular condition, and joint condition and were subsequently notified of this by letter. You did not appeal this decision within the one-year appellate period established by law, therefore this decision is considered final. You were previously denied service connection for these conditions because there was no evidence these claimed conditions existed. For the convenience of future adjudicators and for the Veteran's understanding, the Board notes that the July 2010 Joint Services Records Research Center (JSRRC) report cited above is listed as "Military Personnel Record" with a November 3, 2010 upload date in the Veteran's claims file. For Issue 1 (hearing loss), the Board notes a DD Form 214 uploaded in January 13, 2017, documents the Veteran's mobilization with the Army from October 11, 1990, to June 11, 1991. The Board finds this service department record, along with the service department records noted in the July 2010 JSRRC report, are relevant to the question of an in-service acoustic injury. Specifically, exposure to Scud missiles, to include warning systems of impending attacks, and the dates of the Veteran's service, relate to reasons the AOJ denied the hearing loss claim (lack of an in-service event or nexus) in August 2008. Because these records are relevant, the Board finds the August 2008 rating decision did not go final for this issue, and it will grant reconsideration. For Issue 2 (CFS), the Board finds the service department records noted in the July 2010 JSRRC report relevant to the question of an in-service injury. Specifically, exposure to Scud missiles, to include the airborne content of exploded missiles, relates to a reason the AOJ denied the CFS claim (lack of an in-service injury and nexus) in August 2008. Because these records are relevant, the Board finds the August 2008 rating decision did not go final for this issue, and it will grant reconsideration. For Issues 3-5 (general joint pain, muscle condition, and nerve condition), the Board finds the service department records noted in the July 2010 JSRRC report relevant to the question of an in-service injury and nexus. Specifically, exposure to Scud missiles, to include the airborne content of exploded missiles, relates to a reason the AOJ denied the claim for "general joint pain," a "muscular condition (unspecified muscle)," and a "nerve condition (unspecified nerve)." Because these records are relevant, the Board finds the August 2008 rating decision did not go final for these issues, and it will grant reconsideration. This, however, is not the end of the inquiry for Issues 3-5. The Board recognizes the historical overlapping, inconsistent treatment of Issues 3-5 cited above. That is, it is unclear whether the "general joint pain," the "muscular condition (unspecified muscle)," and the "nerve condition (unspecified nerve)" represents a single disability or multiple disabilities. Starting with the August 2008 rating decision, the AOJ listed multiple disabilities in a single issue (Issue 3 of that decision). However, the language in the rating decision says "conditions," which the Board interprets as discrete disabilities. Moreover, the codesheet accompanying the rating decision lists "general joint pain" under Diagnostic Code 5003, the "muscle condition" under Diagnostic Code 5237, and the "nerve condition" under Diagnostic Code 8515, which further suggests three separate disabilities. While the June 2013 DTA letter cuts against separating the disabilities, the AOJ did not follow what it said in its letter when it adjudicated the August 2013 rating decision. That is, the AOJ reversed itself by separately adjudicating service connection for fibromyalgia from Issue 7 in that rating decision service connection for "hearing loss, urinary dysfunction, disequilibrium, nerve condition, muscular condition, and joint condition." In essence, the AOJ did the same thing for Issue 7 in the August 2013 rating decision that it did in Issue 3 in the August 2008 rating decision: it combined disabilities into a single issue that it should not have. This muddied appellate review. Moreover, the codesheet accompanying the August 2013 rating decision continued to list "general joint pain" under Diagnostic Code 5003, the "muscle condition" under Diagnostic Code 5237, and the "nerve condition" under Diagnostic Code 8515, while it added Diagnostic Code 5025 for fibromyalgia, which suggests four separate disabilities. Accordingly, the Board will, pending remand, construe the claims as four separate disabilities. REASONS FOR REMAND Remand is warranted for the remaining 10 issues. CFS The Board finds the AOJ should readjudicate the CFS issue, in the first instance, now that Board has found that it is proper to reconsider it under 38 C.F.R. § 3.156(c). See Sprinkle v. Shinseki, 733 F.3d 1180, 118384 (Fed. Cir. 2013) (noting that veterans' claims are initially developed and adjudicated by the RO and reviewed on appeal by the Board, and that, "[t]o ensure that claimants receive the benefit of this two-tiered review within the agency, all evidence relevant to a claim generally must be considered by the AOJ in the first instance"). Bilateral hearing loss In August 2008, the AOJ denied the hearing loss claim. It stated: Service connection for hearing loss is denied since this condition neither occurred in nor was caused by service. VA audiological examination on July 21, 2008 found you to be suffering from bilateral hearing loss. VA examiner gave diagnosis of bilateral hearing loss and gave opinion: '(Your) bilateral hearing loss is not 'as least as likely as not' caused by or due to your military service'. VA examiner went on to say and gave rationale for his opinion by stating that after reviewing all audiometric records, it is apparent that you suffered significant hearing loss between 1987 and your redeployment examination of 1991. The cause of your hearing loss is unknown but would have been during non-combat reserve military time or due to your vocational and avocational noise exposure. The Army mobilized the Veteran from October 11, 1990 June 11, 1991, as seen in a DD Form 214 uploaded on January 13, 2017. Six months into this mobilization, the Army examined him on April 16, 1991, according to a medical report created the same day. This examination, which included an audiogram, was for "redeployment" purposes even though he was already in Southwest Asia. The Board has not found a pre-deployment physical before the mobilization started. The July 2008 examiner's analysis therefore compares a 1987 audiogram with the April 16, 1991 audiogram after which the Vet had already been deployed for six months. Thus, the AOJ erred in relying on the July 2008 examination, and a new examination is warranted. Fibromyalgia, "general joint pain," a "muscular condition (unspecified muscle)," and a "nerve condition (unspecified nerve)" For the reasons articulated above, the Board has construed the Veteran's appeal, at this stage, to include four discrete disabilities. However, that does not end the inquiry. Despite this action, the Board wants to be clear. Pursuant to Wood v. Derwinski, 1 Vet. App. 190, 193 (1991), VA's duty to assist the Veteran in prosecuting his claim is a two-way street. If he desires for VA to help him, he cannot passively wait for that help in those circumstances where he may or should have information that is essential in obtaining relevant evidence. He is obligated, as relevant here, to explain the precise nature of what he is claiming given the similarities of the claims. Without this information, VA cannot properly evaluate what he is claiming. The Board will order the AOJ to notify the Veteran of this requirement. If he fails to respond, it will adversely affect his appeal. Disequilibrium, TBI, and tinnitus In February 2013, the Veteran claimed service connection for these disabilities. He wrote: While serving in the Gulf War, I served as a truck driver hauling ammunition. During my service with the 502nd Armored Division, I was driving a truck that was being escorted by MP's. The MP's struck a landmine or IED. I believe this incident occurred in January 1991. My truck was approximately 80 feet from them at the time. I felt the "shock wave" from the explosion. The cab of the truck did not have interior padding which made the noise from the explosion even more intense. I had temporary decreased hearing, tinnitus, and dizziness or disequilibrium immediately after the IED blast. I continue to have problems with these conditions. Also have difficulties with memory, focus, concentration, and feel this might be related to IED explosion. I would also like to point out that I drove a 'turbo' truck in Desert Storm. It made a high-pitched sound. I drove about 25,000 miles while serving in the Gulf. While I did wear ear plugs whenever feasible, there were times when I had to hear and so consequently did not have complete ear protection. The ear plugs themselves were not adequate in shielding all of the noise. To understand this statement, we must examine earlier statements for unrelated claims. First, the Veteran, as part of a prior appeal for service connection for PTSD, stated that he was in the "425th Battalion, 7th Group 180th on (MTC) ... (forward logistics support, front line attached to the 502'd Armor division Tiger Brigade." This is documented as "correspondence" in the claims file with an upload date of November 24, 2009. Second, the July 2010 JSRRC report cited above said: We researched the After-Action Report (AAR) for Operation Desert Shield/Storm submitted by the 180TH TRANSPORTATION COMPANY. The AAR documents that during Operation Desert Storm the mission of the company was to conduct port clearance at the Port of Dammam in Dhahran Saudi Arabia. Also, the AAR stated that during the time period January and February 1991 the morale of the company was down due to the enemy Scud attacks. In addition, we researched the Information Paper submitted by the Office of the Special Assistant for Gulf War Illnesses regarding Iraq Scud Ballistic Missiles fired during the 1990 to 1991 Gulf War. The paper provides listing of the documented Iraqi Scud missile attacks against Saudi Arabia, Qatar, and Bahrain from January 20 - February 26, 1991. The specific documented locations in Saudi Arabia that were subjected to Iraqi SCUD missile attacks are the following: Dhahran, Riyadh, Al Jubayl, King Khalid Military City (Log Base Bravo), and Hafir Al Batin. This paper states that on January 20, 21, 22, 23, 26 and February 16, 22, 1991 Dhahran was subjected to Iraqi SCUD missile attacks. In June 2013, as part of research into the disequilibrium claim, the AOJ contacted JSRRC again. The JSRRC said: We were unable to locate 1990-1991 unit records for the 180th Transportation Company. However, we researched the After-Action Report (AAR) for Operation Desert Storm and Unit History submitted by the 419th Transportation Battalion, the higher headquarters for the 180th Transportation Company. The AAR and History documents elements from the 180th Transportation Company were in support of the 82nd Airborne Division and elements of the 1st Cavalry Division. These documents did not document the 180th Transportation Company was in support of the 502nd Armor Division. Also, these documents did not document an element from the 180th Transportation Company was subjected to an explosion. In addition, we researched the 1990-1991 unit records for the 82nd Airborne Division and the 1st Cavalry Division. The records also did not document an element from the 180th Transportation Company was subjected to an explosion. The Board also notes, for context, a 2002 Board decision, 2002 BVA LEXIS 23467. In relevant part, it says: A July 2001 letter from USACRUR states that they were unable to locate documentation concerning the 180th Transportation Company during the Persian Gulf War, except for an April 1991 report. The letter also states that an element of the 180th Transportation Company was in the Ad Dammam area (Khobar Tower) during the February 25, 1991 Scud attack, but that verification of the individuals stationed there could not be obtained. The attached April 1991 report indicates that the mission of port clearance at the Port of Damman was successfully completed, and that the company was oriented by the 419th Battalion and supported by the 791st Battalion and 425th Brigade. In short, the Board is unclear as to whether the JSRRC thoroughly researched the Veteran' claims. First, an AAR for the 180th Transportation Company existed as of July 2010, but supposedly a "unit history" does not. It is not clear what the distinction is, so an addendum is warranted. Second, the Veteran cites the "425th Battalion" in his November 24, 2009 statement, which the JSRRC did not address. Given the language in the 2002 Board case, the Veteran may have meant the "425th Brigade." Therefore, remand is necessary to more fully investigate this. Restless Leg Syndrome (RLS) VA service connected the Veteran "restless leg syndrome, secondary to posttraumatic stress disorder" in August 2013. It assigned a single, 10 percent rating under Diagnostic Code 8720 "based on mild neuralgia in both legs," effective May 25, 2013. He appealed the rating. As background, RLS is a neurological disorder characterized by throbbing, pulling, creeping, or other unpleasant sensations in the legs and an uncontrollable, and sometimes overwhelming, urge to move them. Symptoms occur primarily at night when a person is relaxing or at rest and can increase in severity during the night. VA rates RLS under the appropriate peripheral neuropathy code(s) that most closely approximates the area of the extremity or extremities affected by the distribution of the symptoms. As the appeal was pending, VA service connected the Veteran's left lower extremity radiculopathy and right lower extremity radiculopathy in August 2020. It assigned 10 percent ratings to each disability under Diagnostic Code 8520, effective February 25, 2013. The Board, in attempting to adjudicate the RLS appeal, is confronted with two questions. First, the Board is unclear why the AOJ assigned a single RLS rating when it expressly found the disability in both legs. Remand is necessary to clarify. Second, Diagnostic Code 8720 and Diagnostic Code 8520, those assigned to rate the RLS and radiculopathy, respectively, involve impairment of the same nerve, i.e., the sciatic nerve. As such, the Board is unclear as to how to differentiate the impairment each disability causes. Remand is necessary to clarify. The matters are REMANDED for the following action: 1. Contact the Veteran to request he that he more fully explain his 1) fibromyalgia, 2) "general joint pain," 3) "muscular condition (unspecified muscle), and 4) "nerve condition (unspecified nerve)" claims. Explain to the Veteran that he should clarify to what body system each claim applies. Given the potential for overlapping symptoms, he should also explain how many discrete, separate disabilities he is claiming (1, 2, 3, or 4) and why he believes they are separate from one another. The Veteran should be informed that the Veteran's failure to provide this clarifying information may adversely affect VA's ability to fully evaluate his claims. 2. Contact the JSRRC or any other appropriate entity to attempt to verify the Veteran's February 2013 contention that he witnessed and was involved in an IED explosion during his service in Southwest Asia. The Army mobilized the Veteran from October 11, 1990 June 11, 1991, as seen in a DD Form 214 uploaded on January 13, 2017. The Veteran estimates the incident occurred in January 1991, but please ensure the research covers the entire window of the Veteran's mobilization, i.e., October 11, 1990 June 11, 1991. As part of this inquiry, the AOJ should answer the following: a) How does an After-Action Report (AAR) differ from a "unit history?" The record reveals that the JSRRC stated that, as of July 2010, an AAR was available for the 180th Transportation Company, but that, as of July 2013, a "unit history" for the 180th Transportation Company was not. The Board needs to understand the differences between the documents. b) As of an October 2002 Board decision, the U.S. Armed Services Center for Research of Unit Records, the predecessor of the JSRRC, identified a "1991 report" for the 180th Transportation Company. Please determine, to the extent possible, if this "1991 report" is likely the AAR the JSRRC identified in July 2010. c) What relationship, if any, existed between the 180th Transportation Company and the 425th Brigade while the Veteran served in Southwest Asia from October 11, 1990 June 11, 1991? Please explain as fully as possible. 3. Based on the answers received from Directive #1, undertake any additional development deemed warranted for the CFS, disequilibrium, TBI, and tinnitus claims. 4. Schedule the Veteran for a VA audiological examination to determine the nature and etiology of his bilateral hearing loss. The examiner, after conducting the customary examination, should opine: a) Is it at least as likely as not (50 percent probability) that the Veteran's bilateral hearing loss began during, or was otherwise caused by, military service? Why or why not? The Army mobilized the Veteran from October 11, 1990 June 11, 1991, as seen in a DD Form 214 uploaded on January 13, 2017. Six months into this mobilization, the Army examined him on April 16, 1991, according to a medical report created the same day. This examination, which included an audiogram, was for "redeployment" purposes even though he was already in Southwest Asia. The Board has not found a pre-deployment physical before the mobilization started. The July 2008 examiner's analysis, therefore, erroneously compares a 1987 audiogram with the April 16, 1991 audiogram after which the Vet had already been deployed for six months. Failure to correct this error will result in an inadequate examination and/or opinion. 5. Determine why the Veteran received only a single rating for RLS when the August 2013 rating decision awarding service connection stated that the disability exists in both legs. Document any explanation so the Board can understand the AOJ's decision. 6. Obtain an addendum opinion from the examiner who examined the Veteran in August 2020 for his back disability. If the examiner is not available, obtain an addendum opinion from a qualified medical professional. The opinion needed is: a) Is it possible to differentiate the impairment the Veteran's RLS causes from the impairment the Veteran's radiculopathy causes? If yes, explain how. If no, explain why not? b) If it is NOT possible to differentiate the impairment the RLS causes from the impairment the radiculopathy causes, would you agree that separate disability ratings for these two disabilities are duplicative? Why or why not? 7. After completing the requested actions above, and any additional notification and/or development deemed warranted, adjudicate the claims on appeal, considering all the pertinent evidence (to include all evidence added to the electronic claims file since the last adjudication) and legal authority. Tiffany Dawson Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Sopko, 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.