Citation Nr: 21030780 Decision Date: 05/19/21 Archive Date: 05/19/21 DOCKET NO. 17-62 801 DATE: May 19, 2021 ORDER The claim of service connection for cold injuries, residual of the right hand is dismissed. The claim of service connection for reversible cold injury, without residuals of the left hand is dismissed. Service connection for hypertension is denied. Service connection for unspecified depressive disorder is granted. Service connection for loss of memory or traumatic brain injury (TBI) is denied. REMANDED Entitlement to service connection for a bilateral hip disability secondary to the service-connected orthopedic disabilities is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. FINDINGS OF FACT 1. During the September 14, 2020 Board hearing, prior to the promulgation of a decision in the appeal, the Board received notification from the appellant and, through his attorney, that a withdrawal of his appeal for service connection for cold injuries, residual of the right hand and service connection for reversible cold injury, without residuals of the left hand is requested. 2. The Veteran's hypertension did not have its onset in service, did not manifest to a compensable degree within one year of discharge, and is not otherwise causally related to any in-service injury or disease. 3. The evidence is at least evenly balanced as to whether the Veteran's current diagnosis of unspecified depressive disorder is related to his active military service. 4. The Veteran does not have a diagnosis of TBI or any residuals; memory loss has been attributed to a vascular disability. CONCLUSIONS OF LAW 1. The criteria for withdrawal of a substantive appeal as to the issue of entitlement to service connection for cold injuries, residual of the right hand by the appellant are met. 38 U.S.C. § 7105; 38 C.F.R. § 19.55. 2. The criteria for withdrawal of a substantive appeal as to the issue of entitlement to service connection for reversible cold injury, without residuals of the left hand by the appellant have been met. 38 U.S.C. § 7105; 38 C.F.R. § 19.55. 3. The criteria for entitlement to service connection for hypertension have not been met. 38 U.S.C. §§ 1110, 1111, 1131, 5107; 38 C.F.R. § § 3.102, 3.303, 3.304, 3.306, 3.307, 3.309. 4. Resolving all doubt in the Veteran's favor, the criteria for service connection for unspecified depressive disorder have been met. 38 U.S.C. §§ 1110, 1154, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. 5. The criteria for service connection for loss of memory or TBI have not been met. 38 U.S.C. §§ 1110, 1154, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty with the United States Army from December 1976 to July 1980. These matters come before the Board of Veterans Appeals (Board) on appeal from a January 2014, December 2014, and December 2017 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran timely appealed the denials. In July 2015, the Veteran testified before a Decision Review Office (DRO); a transcript of the hearing is of record. In September 2020, the Veteran testified before the undersigned Veterans Law Judge (VLJ); a transcript of the hearing is of record. Withdrawals The Board may dismiss any appeal which fails to allege specific error of fact or law in the determination being appealed. 38 U.S.C. § 7105. An appeal may be withdrawn as to any or all issues involved in the appeal at any time before the Board promulgates a decision. 38 C.F.R. § 20.205, 38 C.F.R. § 19.55. Withdrawal may be made by the appellant or by his or her authorized representative. Id. An oral withdrawal of an appeal, such as one made at a hearing, must be (1) explicit, (2) unambiguous, and (3) done with a full understanding of the consequences of such action on the part of the claimant. DeLisio v. Shinseki, 25 Vet. App. 45, 57 (2011); see Acree v. O'Rourke, 891 F.3d 1009, 1014 (Fed. Cir. 2018) (the Board must address all three prongs of the DeLisio standard when it applies). During the September 14, 2020 Board hearing, the Veteran withdrew the appeal as to the claims of service connection for cold injuries, residual of the right hand and service connection for reversible cold injury, without residuals of the left hand. The withdrawal was explicit, unambiguous, and done with a full understanding of the consequences of such action. Hence, there remain no allegations of errors of fact or law for appellate consideration. Accordingly, the Board does not have jurisdiction to review the appeals and they are dismissed. Service Connection Service connection will be granted if the evidence demonstrates that current disability resulted from an injury suffered or disease contracted in active military, naval, or air service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) current disability; (2) in-service injury or disease; and (3) a relationship between the two. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). Consistent with this framework, service connection is warranted for a disease first diagnosed after service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Pursuant to 38 C.F.R. § 3.303(b), where a chronic disease is shown as such in service, subsequent manifestations of the same chronic disease are generally service connected; if a chronic disease is noted in service but chronicity in service is not adequately supported, a showing of continuity of symptomatology after separation is required. Entitlement to service connection based on chronicity or continuity of symptomatology pursuant to 38 C.F.R. § 3.303(b) applies only when the disability for which the Veteran is claiming compensation is due to a disease enumerated on the list of chronic diseases in 38 U.S.C. § 1101(3) or 38 C.F.R. § 3.309(a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). In addition, such chronic diseases are presumed to have been incurred in service if they manifested to a compensable degree within one year of separation from service. 38 U.S.C. §§ 1101(3), 1112(a)(1), 1113; 38 C.F.R. §§ 3.307(a), 3.309(a). A Veteran is presumed to have been sound upon entry into active service, except as to defects, infirmities, or disorders noted at the time of the acceptance, examination, or enrollment, or where clear and unmistakable evidence demonstrates that the condition existed before acceptance and enrollment and was not aggravated by such service. 38 U.S.C. § 1111; 38 C.F.R. § 3.304(b). In other words, "[w]hen no preexisting condition is noted upon entry into service, the veteran is presumed to have been sound upon entry." Wagner v. Principi, 370 F.3d 1089, 1096 (Fed. Cir. 2004). 1. Entitlement to service connection for hypertension The Veteran contends that his diagnosed hypertension is due to his active military service. Service treatment records (STRs) do not reflect a diagnosis, treatment, or symptoms of hypertension. His blood pressure was taken regularly throughout his active duty service. His enlistment report of medical examination reflects a blood pressure reading of 124/78. In September 1978, his blood pressure was 114/84. In November 1979, his blood pressure was noted as 118/60 and 120/80, taken 15 minutes apart. In December 1979, his blood pressure was noted as 130/70. In January 1980, his blood pressure reading was 126/64. In February 1980, his blood pressure 120/70 and he was seen in the emergency room for low blood pressure and pain from lower and middle right leg. In the same month, his blood pressure reading was noted as 118/80. In March 1980, his blood pressure was 110/74 and 108/66 the next day. In that same week, his blood pressure was 120/80. The term "hypertension" means that the diastolic blood pressure is predominantly 90 mm. or greater, or systolic blood pressure is predominantly 160 or more. 38C.F.R. §4.104, Diagnostic Code 7101 n.1. A diagnosis of hypertension "must be confirmed by readings two or more times on at least three different days." Id. The requirement of multiple blood pressure readings to be taken over multiple days as specified in Note (1) of DC 7101 applies to confirming the existence of hypertension. Gill v. Shinseki, 26 Vet. App. 386, 391 (2013). Thus, as seen in the above blood pressure readings, hypertension was not seen in service. Post-service, VA treatment records reflect that in May 2013, the Veteran was seen in the emergency department for past medical history significant for hypertension and he ran out of medication. His discharge diagnosis was hypertension. This is the earliest diagnosis of hypertension seen in the medical records. Further review of the VA treatment records reflect that hypertension ran in the family (his father) and the Veteran continued to be seen intermittently for uncontrolled hypertension. During the September 2020 Board hearing, the Veteran's attorney argued that in service, on December 10, 1979, he had two separate high blood pressure readings that were borderline pre-hypertensive. The Veteran testified that he has been treated for the past six years for his hypertension. Upon review of the evidence of record, service connection for hypertension is not warranted. In this case, no examination is necessary in order to adjudicate the Veteran's claim. As indicated in the discussion above, the evidence does not show that hypertension may be associated with service. To the extent that the Veteran has asserted that hypertension had its onset during service, or is otherwise related to service, such a conclusory generalized lay statement alleging nexus between a current disability and service does not meet the standard to warrant a VA examination. Waters v. Shinseki, 601 F.3d 1274, 1278-79 (Fed. Cir. 2010). As noted above, STRs do not reflect any indication of hypertension when evaluating the blood pressure readings or any hypertension symptomatology; none was noted until 2013. Moreover, the December 10, 1979 STR to which the Veteran's attorney refers at the Board hearing does not show that the Veteran was "borderline pre-hypertensive." According to regulation, 110/80 and 130/70 does not, on its face, represent "pre-hypertension." Moreover, these readings were taken during treatment for pain and vomiting, and it is a well-established medical principle that blood pressure can vary depending on the circumstances, and in this case, the Veteran had one normal blood pressure reading and one blood pressure reading of 130/70 during a time when he was in pain and discomfort. Thus, the Veteran's attorney's argument that the Veteran had pre-hypertension during service is not supported by the STRs or other evidence of record. The Veteran's hypertension did not have its onset in service and did not manifest to a compensable degree within one year of discharge. VA treatment records do not indicate that the Veteran's hypertension is related to his active service. While the Veteran, through his attorney, argues that his STRs reflect blood pressure readings that are pre-hypertensive, all of his blood pressure readings were within normal limits during service and the attorney has not indicated that he possesses the requisite medical knowledge to provide a competent opinion linking his post-service hypertension to any injury or disease in service. Although the Veteran believes that his hypertension is related to service, he is not competent to provide a nexus opinion in this case. The issue is medically complex, as it requires specialized medical education/knowledge of the interaction between multiple organ systems in the body/the ability to interpret complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Consequently, the Veteran's lay assertions are afforded no probative value. Thus, a nexus has not been established. For the foregoing reasons, the preponderance of the evidence is against the claim for service connection for hypertension. The benefit of the doubt doctrine is not for application, and entitlement to service connection for hypertension is not warranted. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. 2. Entitlement to service connection for unspecified depressive disorder The Veteran contends that he has a diagnosis of posttraumatic stress disorder (PTSD) that is due to his active military service. STRs do not reflect a diagnosis, treatment, or symptoms of a psychiatric disability. Military personnel records reflect that in August 1979 a career development report reflects that the Veteran should be considered for promotion before his peers as he was an asset to the battalion and his knowledge of his duties and eagerness to learn made him stand above his peers. It was noted that the Veteran was a very dependable and reliable soldier. However, November 1979 disciplinary data reflect that the Veteran had a disregard for authority for which he has been constantly counseled on. He displayed belligerence to authority, bad attitude, and failure to follow given orders from his superiors that puts him below the required military standards. In June 1980, elimination proceedings for unsuitability begun based on the Veteran's inability to improve his conduct/duty performance. Post-treatment, VA treatment records from an August 2013 mental health initial visit reflect that the Veteran was referred for psychological evaluation and treatment. The examiner found that potential PTSD was not assessed in their interview. The diagnostic impression was depression, chronic pain, social isolation, and financial stress. May 2014 VA AtlantiCare behavioral health treatment records reflect that the clinician noted a diagnosis of PTSD. He was also diagnosed with major depressive disorder, recurrent, severe with psychotic features. He was discharged from outpatient behavioral health in June 2014. VA treatment records from July 2015 reflect that on psychiatric examination, he was negative for anxiety, depress, and sleep disturbances. However, the Veteran was reportedly on Zoloft for his depression. In January 2016, the Veteran reported that he was anxious and depressed. During a July 2015 DRO hearing, the Veteran testified that in the fall, while in Germany, he was working on a truck when it exploded. He reported that it took him maybe 25 feet from his jeep. He reported that the jeep was mangled after the explosion. In a September 2015 statement, the Veteran reported that he witnessed his roommate overdose in the room they shared together. He reported that this traumatized him. He reported that he was put on light duty for this incident. In a July 2016 defense personnel records information retrieval system (DPRIS) response, it was reported that they were not able to locate any unit records pertaining to the 9th Engineer Battalion, for the calendar year of 1978. They were unable to document the death of a Mr. [REDACTED] (roommate). In September 2016, the VA issued a formal finding of a lack of information required to corroborate stressors associated with a claim for service connection for PTSD. A December 2016 Disability Benefits Questionnaire (DBQ) report reflects that the Veteran had a diagnosis of unspecified depressive disorder, cannabis use disorder, and stimulant (cocaine) use disorder. The examiner noted that it is not possible to differentiate what symptoms are attributable to each diagnosis. The Veteran reported that the stimulant use disorder has been in sustained remission for 10 years. His depression and use of marijuana are both mild and therefore the examiner could not differentiate symptoms associated with either diagnosis. He reported that there are multi-symptom overlap between depression and mild cannabis use. The examiner noted that the Veteran has been diagnosed on several occasions with PTSD but found that this diagnosis is in error due to lack of sufficient traumatic injury to cause PTSD and lack of sufficient clinically significant symptoms at this time. VA behavioral health treatment records from December 2016 reflect that the Veteran reported symptoms that may be consistent with major depression, moderate to severe anxiety, and PTSD. A February 2017 psychiatry intake evaluation reflects the diagnostic impression was major depressive disorder, recurrent, PTSD, cannabis use disorder, moderate, and cocaine use disorder in remission. In an August 2017 clarifying statement, the December 2016 clinician reported that the rationale should state that the Veteran's statement of traumatic experiences is insufficient to warrant a diagnosis of PTSD. The Veteran did not appear to have mental health symptoms congruent with PTSD or an anxiety disorder that reached threshold for clinical significance. He has never engaged in formal treatment for PTSD. He concluded that mild symptoms of depression were evident and non-compliance with prescription for sertraline. A May 2018 VA examination report reflects that the Veteran has a diagnosis of unspecified depressive disorder. The examiner noted that the Veteran did not mention his back or knee conditions until asked directly about them. His focus was on circumstances of his discharge from service, specific events in service he identified as traumatic, and limitations of functioning due to his three strokes in 2013 or 2014. He also spontaneously mentioned that not seeing his granddaughter caused depression. When asked directly about his back and knee conditions, he said little about them and did not attribute emotional significance to them. The clinician concluded that his unspecified depressive disorder is less likely as not proximately due to or the result of thoracolumbar strain with spondylolisthesis, right knee strain with DJD, left knee chondromalacia. The clinician also reported that the Veteran reported onset of his depression during service when informed that he would be discharged from service and that it has been continuous since onset. He noted that the narrative reason for separation given on the DD 214 states "unsuitability-apathy, defective attitude or inability to expend effort constructively." This description of behavioral problems in service is quite consistent with depression and supports that Veteran had symptoms of depression during service. He concluded that his current Unspecified Depressive Disorder is at least as likely as not a continuation and/or progression of the symptoms he had during service. During the September 2020 Board hearing, the Veteran testified that in August 1977, he observed his roommate post overdose. He testified that this was very traumatic and scared him. He was unsure if his roommate died. He testified that he was given orders to do certain things and would argue with the officer or the sergeant that is in command. He testified that sometimes he wouldn't perform them, sometimes he would half-heartedly. He stated that he then got Article 15s and his rank taken down. He reported that after the incident with his roommate, he started to become combative. A November 2020 opinion from a private psychologist, Dr. L.L., reflects that he found that it is more likely than not that the Veteran suffered from depression and PTSD as a result of his in-service activities. However, his rationale was based on his conclusion that the Veteran suffered multiple head traumas and the behaviors upon discharge were suggestive of impulse control problems as well as impaired reasoning and judgment which he considered was consistent with multiple brain injuries. Upon review of the evidence of record, the Board finds that service connection for unspecified depressive disorder is warranted. While the Veteran claims he has had a diagnosis of PTSD throughout the entire period on appeal, the evidence of record does not support this contention. In addition to the general service connection requirements stated above, establishing service connection for PTSD, as opposed to other mental health disorders, requires the following: (1) medical evidence establishing a diagnosis of the condition in accordance with 38 C.F.R. § 4.125; (2) credible supporting evidence that the claimed in-service stressor occurred; and (3) a link, established by medical evidence, between current symptomatology and the claimed in-service stressor. 38 C.F.R. § 3.304 (f); Cohen v. Brown, 10 Vet. App. 128, 138 (1997). As noted above, the STRs do not reflect a diagnosis of PTSD. VA treatment records intermittently reflect a diagnosis of PTSD. However, the August 2017 and May 2018 clinicians explained why the Veteran's diagnosis is unspecified depressive disorder and not PTSD. Notably, the VA examination reports just note "PTSD" with no formal diagnosis. Furthermore, there is no evidence of a PTSD diagnosis based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) criteria. Even if the record showed a PTSD diagnosis based on the DSM criteria, the Veteran's alleged stressors have not been independently corroborated. When a reported stressor is not related to either combat or the fear of hostile military or terrorist activity, then a Veteran's statements and testimony alone are not enough to establish the occurrence of a claimed in-service stressor. Hall v. Shinseki, 717 F.3d 1369 (2013). There must be credible supporting evidence that the in-service stressor happened. Cohen v. Brown, 10 Vet. App. 128, 138 (1997). In this case, the evidence does not show that the Veteran engaged in combat, or that he was exposed to hostile military or terrorist activity; therefore, the presumptions afforded to veterans who allege fear of hostile military or terrorist activity are inapplicable in this case. As noted above, the Veteran's two stressors, the explosion and his roommate's overdose) has not been corroborated. The VA issued a formal finding that there is a lack of information required to corroborate stressors. Therefore, service connection for PTSD is not warranted. However, the Veteran does have a mental health diagnosis of unspecified depressive disorder that has been attributed to his active military service. The only medical opinion of record establishes a nexus between the Veteran's unspecified depressive disorder and his active military service. Moreover, the psychologist who provided this opinion explained the reasons for the opinion based on an accurate characterization of the evidence. The opinion is therefore entitled to substantial probative weight. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (most of the probative value of a medical opinion comes from its reasoning). There are no contrary medical opinions of record as to the etiology of the Veteran's unspecified depressive disorder. For the foregoing reasons, the evidence reflects that the Veteran's unspecified depressive disorder is due to his active military service. Entitlement to service connection for unspecified depressive disorder is therefore warranted. 3. Entitlement to service connection for loss of memory or TBI The Veteran contends that he has loss of memory and a TBI due to multiple head injuries noted in service. STRs reflect that in his October 1976 enlistment report of medical history, the Veteran checked that he has had a head injury and the examiner noted "head injury in past...injury findings-1974." The coinciding report of medical examination notes a normal clinical evaluation for the head. In May 1978, the Veteran reported that he had a head injury around the right eye five years prior to that date. He reported that now, he has period headaches and peripheral deficiency. He was referred to ophthalmology. Following a motor vehicle accident in September 1978, he reported headaches. In November 1979, the Veteran reported that he bumped his head and experienced headache and dizziness since then. He reported that eye movement was painful. The examiner noted that there was no history of concussions. The impression was contusion on the head, tender sinus. In May 1980, the Veteran had traumat to the right mandible and a brief loss of consciousness. There was no evidence of mandible fracture. Post-service, an April 2017 DBQ report notes that the examiner found that the Veteran did not have a diagnosis of TBI or any residuals. He reported that the Veteran had mild impairments in short term memory. The examiner noted that the Veteran had a history of strokes in the past. He reported that he was involved in a blast explosion while riding in a motor pool in 1980 where he lost consciousness at the scene for 15 minutes. He reported that he struck his head in the vehicle he was riding in. He stated that he was hospitalized for four days and told he had a concussion. He reported headaches for approximately six days following the blast injury with no tinnitus. The examiner noted that the Veteran's history of head trauma sustained during service was insufficient to result in a traumatic brain surgery. He reported that this is supported by lack of medical treatment, objective medical findings, and subjective complaints immediately following the injury and on a consistent basis to date. He concluded that there is no objective evidence to support a diagnosis of TBI in claims file, no diagnosis is warranted. He stated that symptoms noted on examination are due to another etiology. The claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. He concluded that the Veteran does not have residual symptoms that would be attributed to post concussive syndrome at this time. In April 2017, the Veteran was seen for an initial memory clinic evaluation. He was assessed with mild cognitive impairment, multi-domain, probably vascular. There was no further evaluation or treatment for cognitive impairment indicated at this time. During the September 2020 Board hearing, the Veteran testified that in September 1978, there was an explosion near him where he was lifted off the ground and landed about 50 feet away. He testified that he landed on his shoulder and his head. He reported that he was sent to medical on base and was told that nothing was wrong with him. He reported that he still had headaches. His attorney testified that he fell down the stairs, complained of periodic headaches and visual dysfunction, painful eye movement, and a diagnosis of head contusion in service. In a November 2020 opinion from Dr. L.L., he found that the Veteran had multiple head traumas in service with behaviors suggesting impulse control problems, as well as impaired reasoning and judgment, which he reported was consistent with brain injury. He concluded that the Veteran suffered from multiple traumatic brain injuries during his time in service as well as suffering from depression and PTSD as a result of his in-service activities. Upon review of the evidence of record, service connection for memory loss or TBI is not warranted. Initially, while the Veteran's October 1976 entrance report of medical examination notes that the Veteran had "head injury in past...injury findings-1974," the narrative report did not find that there were any residuals associated with the head injury. Notably, the examiner reported that the injury was in the past with findings in 1974two years before the Veteran started service. Furthermore, the examiner indicated a normal clinical evaluation at the time of entry for his head. Accordingly, the Veteran is presumed sound at entry with regard to any head injury. The weight of the above evidence reflects that the Veteran has not had a diagnosis of TBI during the pendency of the claim. While a "disability" for the purposes of awarding VA disability benefits is not only a disease or an injury, but also any "other physical or mental defect." 38 U.S.C. § § 1701 (1); Allen v. Brown, 7 Vet. App. 439, 444-45 (1995) (applying definition of disability in section 1701(1) to statutes describing "eligibility for disability compensation for service-connected disabilities"), here the evidence does not reflect any diagnosis or treatment for diabetes mellitus. As the Veteran has not had TBI, entitlement to service connection is not warranted. Palczewski v. Nicholson, 21 Vet. App. 174, 181 (2007) ("Without a current disability, of course, there can be no service connection and, thus, no disability compensation"). While the November 2020 private medical opinion from Dr. L.L. found that the Veteran had TBI, the Veteran was not physically examined by him. Notably, in his rationale, he noted the in-service reports of head injury with no finding that the Veteran had current symptoms resulting from any in-service injury. Thus, the opinion is inadequate. See Buchanan v. Nicholson, 451 F.3d 1331, 1336, n. 1 (Fed. Cir. 2006) (noting that a VA's examiner's opinion, which relied on the absence of contemporaneous medical evidence, "failed to consider whether the lay statements presented sufficient evidence of the etiology of [the veteran's] disability such that his claim for service connection could be proven without contemporaneous medical evidence"). In contrast to the above inadequate opinion, the April 2017 medical opinion was based on the Veteran's statements, examination, and a review of the medical history. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (most of the probative value of a medical opinion comes from its reasoning; threshold considerations are whether the person opining is suitably qualified and sufficiently informed). To be adequate, an examination must take into account an accurate history. Nieves-Rodriguez v. Nicholson, 22 Vet. App. 295 (2008). Finally, while the April 2017 DBQ report and memory clinic evaluation found memory impairment, memory loss has been attributed to a vascular injury, unrelated to service or TBI. While the Veteran, through his attorney, argues that he has a TBI or memory loss due to his in-service complaints of head injury, the overwhelming evidence does not support this contention. The Veteran is not competent to provide a nexus opinion in this case. The issue is medically complex, as it requires specialized medical education/knowledge of the interaction between multiple organ systems in the body/the ability to interpret complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Consequently, the Veteran's lay assertions are afforded no probative value. Thus, a nexus has not been established. For the foregoing reasons, the preponderance of the evidence is against the claim for service connection for memory loss or TBI. The benefit of the doubt doctrine is not for application, and entitlement to service connection for memory loss or TBI is not warranted. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. REASONS FOR REMAND 1. Entitlement to service connection for a bilateral hip disability secondary to the service-connected orthopedic disabilities is remanded. The Veteran contends that he has a bilateral hip disability that is due to his service-connected lumbar spine and bilateral knee disability. In December 2016, the Veteran underwent a VA examination; however, the opinion provided was only as to a direct claim and not secondary. During the September 2020 Board hearing, the Veteran, through his attorney, requested a VA examination and opinion addressing his contentions that his bilateral hip disability developed due to his other orthopedic conditions. A VA examination is warranted to determine whether the Veteran's lumbar spine and bilateral knee disability caused or aggravates a bilateral hip disability. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate). 2. Entitlement to a TDIU is remanded. The Veteran's service-connected disabilities are a lumbar spine disability, right and left knee disability, right and left foot disability, and now unspecified depressive disorder. The Veteran has not established service connection for his bilateral hip disability. As the record currently reflects that the Veteran has not worked since 2013, and that his unspecified depressive disorder and possibly his bilateral hip disability appear to play a major role in his inability to engage in employment, the outcome of those outstanding claims may impact the Veteran's current claim of entitlement to a TDIU, they must be addressed prior to further adjudication of this matter. As such, the claims are inextricably intertwined. See Harris v. Derwinski, 1 Vet. App. 180 (1991). The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination to determine the nature and likely etiology of a bilateral hip disability. The claims folder, to include a copy of this Remand, must be made available to and reviewed by the examiner prior to completion of the opinion, and the opinion must reflect that the claims folder was reviewed. The examiner should identify all hip disabilities that have existed since the date of the claim. The examiner should opine as to whether it is at least as likely as not (at least a 50 percent probability) that the Veteran's bilateral hip disability was either (a) caused or (b) aggravated by the service-connected lumbar spine and bilateral hip disability. The clinician should also consider and discuss all lay assertions, to include the Veteran's assertions as to the nature, onset, and continuity of symptoms. 2. Following adjudication of the inextricably intertwined claims, readjudicate the TDIU claim. If the benefit remains denied, issued a SSOC to the Veteran and his attorney L. B. CRYAN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Laroche, N. 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.