Citation Nr: 21031428 Decision Date: 05/21/21 Archive Date: 05/21/21 DOCKET NO. 17-50 198A DATE: May 21, 2021 ORDER New and material evidence having been received, the petition to reopen the claim of entitlement to service connection for a left knee condition is granted. New and material evidence having been received, the petition to reopen the claim of entitlement to service connection for a right knee condition is granted. New and material evidence having been received, the petition to reopen the claim of entitlement to service connection for a left ankle condition is granted. New and material evidence having been received, the petition to reopen the claim of entitlement to service connection for a right ankle condition is granted. New and material evidence having been received, the petition to reopen the claim of entitlement to service connection for a cervical spine condition is granted. New and material evidence having been received, the petition to reopen the claim of entitlement to service connection for sleep apnea is granted. REMANDED Entitlement to service connection for a left knee condition is remanded. Entitlement to service connection for a right knee condition is remanded. Entitlement to service connection for a left ankle condition is remanded. Entitlement to service connection for a right ankle condition is remanded. Entitlement to service connection for a bilateral foot condition is remanded. Entitlement to service connection for a cervical spine condition is remanded. Entitlement to service connection for a left shoulder condition is remanded. Entitlement to service connection for a sinus condition is remanded. Entitlement to service connection for Meniere's syndrome is remanded. Entitlement to service connection for an acquired psychiatric disorder is remanded. Entitlement to service connection for a sleep disorder, to include sleep apnea, is remanded. Entitlement to service connection for angina is remanded. Entitlement to service connection for a heart murmur is remanded. Entitlement to service connection for tension headaches is remanded. Entitlement to service connection for alcoholism, to include as secondary to service-connected disabilities, is remanded. Entitlement to a compensable disability evaluation for bilateral hearing loss is remanded. Entitlement to a disability evaluation in excess of 40 percent for thoracolumbar degenerative disc disease (DDD) is remanded. Entitlement to a disability evaluation in excess of 10 percent for radiculopathy of the right lower extremity is remanded. Entitlement to a disability evaluation in excess of 10 percent for radiculopathy of the left lower extremity is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. FINDINGS OF FACT 1. In rating decisions issued in August 1994, May 1995, June 2006, and October 2013, the Veteran's claims of entitlement to service connection for bilateral ankle conditions, bilateral knee conditions, a cervical spine condition, and sleep apnea were denied. The Veteran did not perfect appeals of the decisions, and they became final. 2. New and material evidence was received after the final rating decisions. CONCLUSIONS OF LAW 1. The rating decisions issued in August 1994, May 1995, June 2006, and October 2013 denying the Veteran's claims of entitlement to service connection for bilateral ankle conditions, bilateral knee conditions, a cervical spine condition, and sleep apnea are final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. 2. As new and material evidence has been submitted, the criteria for reopening the claims of service connection for bilateral ankle conditions, bilateral knee conditions, a cervical spine condition, and sleep apnea are met. 38 U.S.C. § 5108, 7105; 38 C.F.R. § 3.156. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from February 1974 to February 1994. These matters come before the Board of Veterans' Appeals (Board) on appeal from February 2017 and June 2017 rating decisions issued by a Department of Veterans Affairs (VA) Regional Office (RO). In November 2020, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A copy of the hearing transcript is associated with the claims file. Reopened Claims A finally adjudicated claim may be reopened if the claimant submits new and material evidence. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. New evidence means existing evidence not previously submitted to agency decision makers. Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). The provisions of 38 C.F.R. § 3.156(a) create a low threshold, with the phrase "raise a reasonable possibility of substantiating the claim" enabling rather than precluding reopening and not constituting a third requirement that must be met before the claim is reopened. Shade v. Shinseki, 24 Vet. App. 110 (2010). 1. Petition to reopen the claim of entitlement to service connection for a left knee condition 2. Petition to reopen the claim of entitlement to service connection for a right knee condition 3. Petition to reopen the claim of entitlement to service connection for a left ankle condition 4. Petition to reopen the claim of entitlement to service connection for a right ankle condition 5. Petition to reopen the claim of entitlement to service connection for a cervical spine condition 6. Petition to reopen the claim of entitlement to service connection for sleep apnea The claim of service connection for a right ankle condition was denied in an August 1994 rating decision, and the claim of service connection for a cervical spine condition was denied in a May 1995 rating decision. In a June 2006 rating decision, service connection claims for a left ankle and bilateral knee conditions were denied, and in an October 2013 rating decision, service connection for sleep apnea was denied. The Veteran did not initiate appeals or submit new and material evidence within one year of the decisions, and they became final. 38 C.F.R. § 3.156 (b). In October 2016, the Veteran petitioned to reopen the previously denied claims. In a February 2017 rating decision, the RO denied reopening the Veteran's claims. The RO found that the evidence submitted with his claims did not constitute new and material evidence. Evidence submitted since the final rating decisions from August 1994, May 1995, June 2006, and October 2013 includes VA and private medical treatment notes, VA examination reports, private medical assessments, lay statements, and testimony from the November 2020 Board hearing. Given that the threshold for substantiating a claim to reopen is low, the evidence associated with the claims file since the prior denials, when considered by itself or in connection with evidence previously assembled, relates to an unestablished fact necessary to substantiate the claims for service connection and raises a reasonable possibility of substantiating the claims. Thus, the claims of entitlement to service connection for bilateral ankle conditions, bilateral knee conditions, a cervical spine condition, and sleep apnea are reopened. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. REASONS FOR REMAND 1. Entitlement to service connection for a right ankle condition is remanded. 2. Entitlement to service connection for a left ankle condition is remanded. 3. Entitlement to service connection for a left knee condition is remanded. 4. Entitlement to service connection for a right knee condition is remanded. 5. Entitlement to service connection for a bilateral foot condition is remanded. The Veteran contends he is entitled to service connection for bilateral knee, bilateral ankle, and bilateral foot conditions, to include as secondary to his service-connected lumbar spine disability. Service treatment records show the Veteran complained of knee, ankle, and foot pain. He was afforded a VA joints examination shortly after service separation in June 1994 to assess his ankles and knees, during which he reported experiencing ankle and knee pain. However, the examiner determined that the Veteran did not have current diagnoses associated with his ankles and knees. Since the June 1994 examination, the Veteran has continued to complain of knee, ankle, and foot pain, and medical records indicate that he was diagnosed with degenerative joint disease of the left ankle and calcific achilles tendonitis of the left foot. Further, the Board notes that pain alone may constitute functional impairment for which service connection may be granted. Saunders v. Wilkie, 886 F.3d 1356, 1363-64 (Fed. Cir. 2018) (indicating that the term "disability" refers to the functional impairment of earning capacity, rather than the underlying cause of the impairment, and pain alone may be a functional impairment). Therefore, remand is required to obtain new VA examinations and medical opinions to determine diagnoses and the etiology of any conditions associated with the Veteran's knees, ankles, and feet. 6. Entitlement to service connection for a cervical spine condition is remanded. 7. Entitlement to service connection for a left shoulder condition is remanded. The Veteran contends he is entitled to service connection for cervical spine and left shoulder conditions, to include as secondary to his service-connected lumbar spine disability. At the Board hearing, the Veteran testified that he injured his neck and left shoulder during the same in-service event that caused his back injury while playing football. Service treatment records from April 1990 indicate the Veteran sought treatment for left shoulder and neck pain. The Veteran was afforded a VA spine examination in January 1995, and was diagnosed with a chronic cervical strain. At a December 2016 VA shoulder examination, the Veteran was diagnosed with osteoarthritis of the left acromioclavicular joint. The examiner opined that the Veteran's left shoulder condition was not related to service due to a lack of documentation of a left shoulder condition in the service treatment records and an opinion could not be rendered without resorting to speculation. Remand is required to obtain new VA examinations and medical opinions to determine the current diagnoses and the etiology of any cervical spine and left shoulder condition. 8. Entitlement to service connection for a sinus condition is remanded. The Veteran contends that he is entitled to service connection for sinusitis, which he believes onset during service. The Board notes that the issue on appeal has been broadened to include entitlement to service connection for any sinus condition. Clemons v. Shinseki, 23 Vet. App. 1, 9 (2009). Service treatment records indicate the Veteran sought treatment for sinus problems on multiple occasions in 1980 and 1981. Post-service VA treatment notes show that the Veteran complained of sinus pressure and had a history of sinus infections. Remand is required to obtain a VA examination and medical opinion to determine whether the Veteran has a currently diagnosed sinus condition that is related to his military service. 9. Entitlement to service connection for Meniere's syndrome is remanded. The Veteran contends he is entitled to service connection for Meniere's syndrome, to include as secondary to service-connected tinnitus. In August 2017, a VA examiner opined that the Veteran's Meniere's syndrome was less likely than not proximately due to or the result of tinnitus, because tinnitus is a symptom, not a cause, of Meniere's syndrome. However, a direct service connection opinion was not provided. Remand is required to obtain an addendum medical opinion regarding the etiology of the Veteran's Meniere's syndrome. 10. Entitlement to service connection for an acquired psychiatric disorder is remanded. The Veteran contends that he is entitled to service connection for an acquired psychiatric disorder, including posttraumatic stress disorder (PTSD), depression, and anxiety. Specifically, he believes his PTSD is related to in-service stressors, and his depression and anxiety are secondary to the physical pain caused by his disabilities. At the Board hearing and in a September 2017 lay statement, the Veteran provided details about in-service stressor events, which included the suicide of a soldier in his unit, and participating in the rescue and clean-up of fatal aircraft crashes in 1976 and 1978. In December 2020, the Veteran submitted a private psychiatric assessment. The private physician diagnosed the Veteran with PTSD, major depressive disorder, and insomnia. A review of the record shows the Veteran's reported stressors have not been verified by the RO, as the Veteran did not respond to the RO's August 2017 request that he submit a VA Form 21-0781, Statement in Support of Claim for Service Connection for PTSD. However, the Veteran did provide the relevant details in a September 2017 lay statement. Remand is required to verify the Veteran's stressors, and to obtain a VA examination and medical opinion to determine whether the Veteran's currently diagnosed psychiatric disorders are related to his military service and/or his service-connected disabilities. 11. Entitlement to service connection for a sleep disorder, to include sleep apnea, is remanded. The Veteran contends he is entitled to service connection for sleep apnea, to include as due to a psychiatric disorder. The issue on appeal has been broadened to include entitlement to service connection for any sleep disorder. Clemons, 23 Vet. App. at 9, (2009). An August 2013 VA sleep apnea Disability Benefits Questionnaire (DBQ) report shows the Veteran was diagnosed with sleep apnea in 1998. However, the examiner determined that an opinion could not be provided because the claims file lacked documentation of a diagnosis of obstructive sleep apnea. The Board notes that VA medical records from December 2006 note that the Veteran completed a sleep study in 1998, but the sleep study report is not within the claims file. Treatment notes from April 2021 indicate the Veteran required the use of a continuous positive airway pressure (CPAP) machine. Remand is required to obtain a new VA examination and medical opinion to confirm the diagnosis and determine the etiology of the Veteran's sleep apnea and/or any other sleep disorder. Further, because a decision on the remanded issue of entitlement to service connection for an acquired psychiatric disorder could significantly impact a decision on the issue of service connection for a sleep disorder, the issues are inextricably intertwined and remand is required. 12. Entitlement to service connection for angina is remanded. 13. Entitlement to service connection for a heart murmur is remanded. 14. Entitlement to service connection for tension headaches is remanded. The Veteran contends that he is entitled to service connection for angina, a heart murmur, and headaches, to include as secondary to a psychiatric disorder. Specifically, the Veteran asserts that his headaches, heart murmur and angina are aggravated by his psychiatric disorders. Service treatment records show the Veteran reported having frequent headaches, heart trouble and chest pain on his February 1993 report of medical history. He was noted to have a heart murmur, and sought treatment on multiple occasions due to headaches. A VA medical opinion regarding the Veteran's headaches was provided in December 2016. The examiner was specifically asked to opine whether the Veteran's headaches were the result of an in-service event on April 1990. The examiner opined that the Veteran's headaches were less likely than not the result of the April 1990 event, as his chronic headaches began in 1984. The examiner did not then provide an opinion as to whether the Veteran's current headaches are etiologically related to military service without consideration of the April 1990 date. Remand is required, as the Veteran has not been afforded a VA examination to ascertain whether he currently has a heart murmur and/or angina that are either related to his military service, or aggravated by other disabilities. Remand is also required to obtain new medical opinions regarding the Veteran's headaches. Further, because a decision on the remanded issue of entitlement to service connection for an acquired psychiatric disorder could significantly impact a decision on the issues of service connection for headaches, angina, and a heart murmur, the issues are inextricably intertwined and remand is required. 15. Entitlement to service connection for alcoholism, to include as secondary to service-connected disabilities, is remanded. The Veteran seeks service connection for alcoholism as secondary to his service-connected disabilities. At the Board hearing, the Veteran indicated that he consumes alcohol as a form of self-medication. The Board notes that in a claim for service connection for disability due to alcohol abuse filed after October 31, 1990, the law prohibits an award of VA compensation for such disability, whether the claim is based on a theory of direct or secondary service connection. 38 U.S.C. §§ 105 (a), 1110 (2012); 38 C.F.R. §§ 3.1 (m), (n), 3.301, 3.310(a) (2016); VAOPGCPREC 11-96 (Nov. 15, 1996); VAOPGCPREC 2-97 (Jan. 16, 1997); Libertine v. Brown, 9 Vet. App. 521, 523 (1996). A claimant may be granted service connection for purposes of obtaining VA benefits other than compensation if entitlement to secondary service connection for drug and alcohol abuse is demonstrated pursuant to 38 C.F.R. § 3.310 (a). VAOPGCPREC 2-98 (Feb. 10, 1998); VAOPGCPREC 7-99 (June 7, 1999); Barela v. West, 11 Vet. App. 280 (1998). Allen v. Principi, 237 F.3d 1368 (Fed. Cir. 2001), holds that Veterans can only recover for an alcohol or drug abuse disability secondary to a service-connected disability if they can adequately establish that their alcohol or drug abuse disability is secondary to or is caused by their primary service-connected disorder. In a December 2020 private psychiatric assessment, the private physician diagnosed the Veteran with unspecified alcohol-related disorder. No opinion has been provided regarding whether the Veteran suffers from alcoholism secondary to service-connected disabilities. Therefore, remand is required. 16. Entitlement to a compensable rating for bilateral hearing loss is remanded. 17. Entitlement to a disability evaluation in excess of 40 percent for thoracolumbar degenerative disc disease (DDD) is remanded. 18. Entitlement to a disability evaluation in excess of 10 percent for radiculopathy of the right lower extremity is remanded. 19. Entitlement to a disability evaluation in excess of 10 percent for radiculopathy of the left lower extremity is remanded. The Veteran seeks increased ratings for his service-connected bilateral hearing loss, lumbar spine DDD, and bilateral lower extremity radiculopathy. At the Board hearing, the Veteran reported that his conditions had worsened. His most recent VA examinations were nearly four years ago in May 2017. Remand is required to obtain new VA examinations to determine the current severity of the Veteran's service-connected disabilities. 20. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. Finally, because a decision on the remanded issues discussed above could significantly impact a decision on the issue of TDIU, the issues are inextricably intertwined. A remand of the claim for TDIU is required. The matters are REMANDED for the following action: 1. Obtain and associate with the claims file any outstanding VA medical records. 2. Request that the United States Army and Joint Services Records Research Center (JSRRC) provide any available information which might corroborate the Veteran's alleged in-service stressors. Forward a copy of the Veteran's DD Form 214, together with any new stressor information that has been obtained, to the JSRRC for an attempt at stressor verification. The JSRRC should be asked to provide any additional information that might corroborate any of the Veteran's alleged stressors. If the search for corroborating information leads to negative results, the RO must notify the Veteran and his representative of this fact, explain the efforts taken to obtain this information, and describe any further action to be taken. If the Veteran's described stressors lack sufficient information for verification, such should be noted in a formal finding. (a.) Note: The Veteran provided a statement in September 2017 with details for the following in-service stressors: 1) a plane crash in Guam on or around June 4, 1976; 2) a plane crash in Weymouth, Massachusetts on or around August 24, 1978; and 3) a corporal who committed suicide in 1986 in Tustin, California. 3. After the above development has been completed, schedule the Veteran for a psychiatric examination to determine the nature and etiology of any acquired psychiatric disorder, including PTSD, depression, and anxiety. The examination report must include a complete rationale for all opinions expressed. (a.) If the Veteran is diagnosed with PTSD, the examiner must explain how the diagnostic criteria are met and opine whether it is at least as likely as not (50 percent or greater probability) related to a verified in-service stressor. (b.) If any other acquired psychiatric disorders are diagnosed, the examiner must opine whether each diagnosed disorder is at least as likely as not (50 percent or greater probability) related to an in-service injury, event, or disease. 4. Schedule the Veteran for a VA examination to determine the nature and etiology of any bilateral knee condition. The examiner must note each diagnosis associated with the knees. The examination report must include a complete rationale for all opinions expressed. The examiner must opine: (a.) Whether it is at least as likely as not (50 percent or greater probability) that any current knee disability (to include pain resulting in functional impairment even absent a formal diagnosis) is related to an in-service injury, event, or disease. (b.) Whether it is at least as likely as not (50 percent or greater probability) that any current knee disability (to include pain resulting in functional impairment even absent a formal diagnosis) is proximately due to or caused by a service-connected disability, to include a lumbar spine disability. (c.) Whether it is at least as likely as not (50 percent or greater probability) that any current knee disability (to include pain resulting in functional impairment even absent a formal diagnosis) is aggravated by a service-connected disability, to include a lumbar spine disability. 5. Schedule the Veteran for a VA examination to determine the nature and etiology of any bilateral ankle condition. The examiner must note each diagnosis associated with the ankles. The examination report must include a complete rationale for all opinions expressed. The examiner must opine: (a.) Whether it is at least as likely as not (50 percent or greater probability) that any current ankle disability (to include pain resulting in functional impairment even absent a formal diagnosis) is related to an in-service injury, event, or disease. (b.) Whether it is at least as likely as not (50 percent or greater probability) that any current ankle disability (to include pain resulting in functional impairment even absent a formal diagnosis) is proximately due to or caused by a service-connected disability, to include a lumbar spine disability. (c.) Whether it is at least as likely as not (50 percent or greater probability) that any current ankle disability (to include pain resulting in functional impairment even absent a formal diagnosis) is aggravated by a service-connected disability, to include a lumbar spine disability. 6. Schedule the Veteran for a VA examination to determine the nature and etiology of any bilateral foot condition. The examiner must note each diagnosis associated with the feet. The examination report must include a complete rationale for all opinions expressed. The examiner must opine: (a.) Whether it is at least as likely as not (50 percent or greater probability) that any current foot disability (to include pain resulting in functional impairment even absent a formal diagnosis) is related to an in-service injury, event, or disease. (b.) Whether it is at least as likely as not (50 percent or greater probability) that any current foot disability (to include pain resulting in functional impairment even absent a formal diagnosis) is proximately due to or caused by a service-connected disability, to include a lumbar spine disability. (c.) Whether it is at least as likely as not (50 percent or greater probability) that any current foot disability (to include pain resulting in functional impairment even absent a formal diagnosis) is aggravated by a service-connected disability, to include a lumbar spine disability. 7. Schedule the Veteran for a VA examination to determine the nature and etiology of any cervical spine condition. The examiner must note each diagnosis associated with the cervical spine. The examination report must include a complete rationale for all opinions expressed. The examiner must opine: (a.) Whether it is at least as likely as not (50 percent or greater probability) that any current cervical spine disability (to include pain resulting in functional impairment even absent a formal diagnosis) is related to an in-service injury, event, or disease. (b.) Whether it is at least as likely as not (50 percent or greater probability) that any current cervical spine disability (to include pain resulting in functional impairment even absent a formal diagnosis) is proximately due to or caused by a service-connected disability, to include a lumbar spine disability. (c.) Whether it is at least as likely as not (50 percent or greater probability) that any current cervical spine disability (to include pain resulting in functional impairment even absent a formal diagnosis) is aggravated by a service-connected disability, to include a lumbar spine disability. 8. Schedule the Veteran for a VA examination to determine the nature and etiology of any left shoulder condition. The examiner must note each diagnosis associated with the left shoulder. The examination report must include a complete rationale for all opinions expressed. The examiner must opine: (a.) Whether it is at least as likely as not (50 percent or greater probability) that any current left shoulder disability (to include pain resulting in functional impairment even absent a formal diagnosis) is related to an in-service injury, event, or disease. (b.) Whether it is at least as likely as not (50 percent or greater probability) that any current left shoulder disability (to include pain resulting in functional impairment even absent a formal diagnosis) is proximately due to or caused by a service-connected disability, to include a lumbar spine disability. (c.) Whether it is at least as likely as not (50 percent or greater probability) that any current left shoulder disability (to include pain resulting in functional impairment even absent a formal diagnosis) is aggravated by a service-connected disability, to include a lumbar spine disability. 9. Schedule the Veteran for a VA examination to determine the nature and etiology of any sinus condition. The examiner must note each diagnosis. The examination report must include a complete rationale for all opinions expressed. The examiner must opine: (a.) Whether it is at least as likely as not (50 percent or greater probability) that any diagnosed sinus disorder is related to an in-service injury, event, or disease. 10. Arrange for a health care provider with appropriate expertise to review the Veteran's claims file with respect to the Veteran's service connection claim for Meniere's syndrome. If, after review of the claims file, the examiner determines that another VA examination is necessary, such must be scheduled, and the Veteran must be notified. (a.) The VA examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that Meniere's syndrome is related to an in-service injury, event, or disease. 11. After the Veteran has been afforded VA psychiatric disorder examinations, schedule the Veteran for a VA examination to determine the nature and etiology of any sleep disorder, to include sleep apnea. If necessary, the Veteran must be provided with a sleep study. The examiner must note each diagnosis. The examination report must include a complete rationale for all opinions expressed. The examiner must opine: (a.) Whether it is at least as likely as not (50 percent or greater probability) that any diagnosed sleep disorder is related to an in-service injury, event, or disease. (b.) Whether it is at least as likely as not (50 percent or greater probability) that any diagnosed sleep disorder is proximately due to or caused by a psychiatric disorder. (c.) Whether it is at least as likely as not (50 percent or greater probability) that any diagnosed sleep disorder is aggravated by a psychiatric disorder. 12. After the Veteran has been afforded VA psychiatric disorder examinations, schedule the Veteran for a VA examination to determine the nature and etiology of angina and a heart murmur. The examiner must note each diagnosis. The examination report must include a complete rationale for all opinions expressed. The examiner must opine: (a.) Whether it is at least as likely as not (50 percent or greater probability) that angina is related to an in-service injury, event, or disease. (b.) Whether it is at least as likely as not (50 percent or greater probability) that a heart murmur is related to an in-service injury, event, or disease. (c.) Whether it is at least as likely as not (50 percent or greater probability) that angina is proximately due to or caused by a psychiatric disorder. (d.) Whether it is at least as likely as not (50 percent or greater probability) that a heart murmur is proximately due to or caused by a psychiatric disorder. (e.) Whether it is at least as likely as not (50 percent or greater probability) that angina is aggravated by a psychiatric disorder. (f.) Whether it is at least as likely as not (50 percent or greater probability) that a heart murmur is aggravated by a psychiatric disorder. 13. After the Veteran has been afforded VA psychiatric disorder examinations, schedule the Veteran for a VA examination to determine the nature and etiology of a headache disorder. The examiner must note each diagnosis. The examination report must include a complete rationale for all opinions expressed. The examiner must opine: (a.) Whether it is at least as likely as not (50 percent or greater probability) that any diagnosed headache disorder is related to an in-service injury, event, or disease. (b.) Whether it is at least as likely as not (50 percent or greater probability) that any diagnosed headache disorder is proximately due to or caused by a psychiatric disorder. (c.) Whether it is at least as likely as not (50 percent or greater probability) that any diagnosed headache disorder is aggravated by a psychiatric disorder. 14. Arrange for a health care provider with appropriate expertise to review the Veteran's claims file with respect to the Veteran's claim for alcoholism, to include as secondary to service-connected disabilities. If, after review of the claims file, the examiner determines that a VA examination is necessary, such must be scheduled, and the Veteran must be notified. (a.) The VA examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that alcoholism is proximately due to, the result of, or chronically aggravated (permanently worsened beyond the natural progression) by, the Veteran's service-connected disabilities. (b.) The examination report must include a complete rationale for all opinions expressed. If the examiner feels that a requested opinion cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge (i.e., no one could respond given medical science and the known facts) or by a deficiency in the record or the examiner (i.e., additional facts are required, or the examiner does not have the needed knowledge or training). 15. Schedule the Veteran for an examination with an audiologist to determine the current severity of his service-connected bilateral hearing loss. A copy of the claims file and this remand must be made available to the examiner for review. (Continued on the next page) 16. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of her service-connected lumbar spine DDD and bilateral lower extremity radiculopathy. A copy of the claims file and this remand must be made available to the examiner for review. 17. After the above development has been completed, readjudicate the claims, including TDIU. If any benefit sought on appeal is not granted to the Veteran's satisfaction, send the Veteran and his representative a Supplemental Statement of the Case and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. Cynthia M. Bruce Veterans Law Judge Board of Veterans' Appeals Attorney for the Board N. Miller, Associate 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.