Citation Nr: 21041217 Decision Date: 07/08/21 Archive Date: 07/08/21 DOCKET NO. 11-14 609 DATE: July 8, 2021 ORDER New and material evidence has been submitted sufficient to reopen a claim for gastrointestinal issues and the application to reopen the claim is granted. Entitlement to service connection for a gastrointestinal disability, to include intestinal issues, is denied. Entitlement to service connection for a respiratory disability, to include chronic obstructive pulmonary disease (COPD), is denied. Entitlement to service connection for a bilateral hearing loss disability is denied. Entitlement to service connection for a left ankle disability is denied. Entitlement to service connection for hypertension is denied. Entitlement to service connection for sleep apnea is denied. REMANDED Entitlement to service connection for an acquired psychiatric disorder, to include depression, is remanded. Entitlement to service connection for a vestibular disability, to include vertigo and dizziness, is remanded. FINDINGS OF FACT 1. An unappealed April 2012 rating decision denied a claim of entitlement to service connection for intestinal issues. 2. Evidence received since the April 2012 rating decision is new, material and probative as to previously unestablished facts necessary to substantiate the intestinal issues claim. 3. A gastrointestinal disability, including intestinal issues, was not incurred in service, was not otherwise caused by service (including as the result of herbicide exposure), and was not caused or aggravated by a service-connected disability. 4. A respiratory disability, including COPD, was not incurred in service, was not otherwise caused by service (including as the result of herbicide exposure), and was not caused or aggravated by a service-connected disability. 5. A bilateral hearing loss disability was not incurred in service and was not otherwise caused by service. 6. A left ankle disability was not incurred in service and was not otherwise caused by service. 7. Hypertension was not incurred in service, was not otherwise caused by service (including as the result of herbicide exposure) and was not caused or aggravated by a service-connected disability. 8. A sleep apnea disability was not incurred in service, was not otherwise caused by service (including as the result of herbicide exposure) and was not caused or aggravated by a service-connected disability. CONCLUSIONS OF LAW 1. The April 2012 rating decision that denied a claim for intestinal issues is final. 38 U.S.C. § 7105 (2012); 38 C.F.R. § 20.1103 (2012). 2. Evidence received since the April 2012 rating decision in relation to the Veteran's claim for entitlement to service connection for intestinal issues is new and material, and, therefore, the claim is reopened. 38 U.S.C. §§ 5108, 7105 (2012); 38 C.F.R. § 3.156 (2020). 3. The criteria for entitlement to service connection for a gastrointestinal disability have not been met. 38 U.S.C. §§ 1101, 1110, 1131, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.307, 3.309, 3.310 (2020). 4. The criteria for entitlement to service connection for a respiratory disability have not been met. 38 U.S.C. §§ 1101, 1110, 1131, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.307, 3.309, 3.310. 5. The criteria for entitlement to service connection for a hearing loss disability have not been met. 38 U.S.C. §§ 1101, 1110, 1131, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.307, 3.309, 3.385 (2020). 6. The criteria for entitlement to service connection for a left ankle disability have not been met. 38 U.S.C. §§ 1101, 1110, 1131, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.307, 3.309. 7. The criteria for entitlement to service connection for hypertension have not been met. 38 U.S.C. §§ 1101, 1110, 1131, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.307, 3.309, 3.310. 8. The criteria for entitlement to service connection for a sleep apnea disability have not been met. 38 U.S.C. §§ 1101, 1110, 1131, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty in the United States Air Force from July 1971 to July 1975. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2015 rating decision from a VA Regional Office (RO). The Board remanded the issues in February 2017 to develop additional evidence. The Veteran subsequently had a Board hearing before the undersigned Veterans Law Judge in February 2021. (The issues of entitlement to service connection for right ankle and left thigh disabilities are the subject of a separate decision by the Board.) New and Material Evidence 1. Whether new and material evidence has been submitted sufficient to reopen a claim for entitlement to service connection for intestinal issues The Veteran contends that he has intestinal problems due to some combination of in-service exposure to herbicide agents, as well as due to his service-connected diabetes mellitus and/or weight gain. The appellant has one year from notification of a Regional Officer (RO) decision to initiate an appeal by filing a notice of disagreement (NOD) with the decision, and the decision becomes final if an appeal is not perfected within the allowed time period. 38 U.S.C. § 7105(b) and (c); 38 C.F.R. §§ 3.160(d), 20.201, and 20.302(a). In an April 2012 rating decision, the RO found that while the Veteran had a single complaint of diarrhea during service there was no objective medical evidence indicating that the diarrhea because a chronic condition while in service. In addition, while the Veteran had a diagnosis of gastroparesis there was no objective medical evidence indicating that the gastroparesis was caused by or the result of service. The Veteran failed to timely appeal or otherwise express disagreement with the rating decision. As such, the April 2012 rating decision ultimately became final. 38 C.F.R. § 20.1103. As a result, the claim of entitlement to service connection for intestinal issues may now be considered if new and material evidence has been received since the time of the last final adjudication. 38 U.S.C. § 5108; 38 C.F.R. § 3.156; Manio v. Derwinski, 1 Vet. App. 140, 145 (1991); Evans v. Brown, 9 Vet. App. 273 (1996). Under 38 C.F.R. § 3.156(a), evidence is considered "new" if it was not of record at the time of the last final disallowance of the claim. 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. Finally, 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. In determining whether evidence is new and material, the "credibility of the evidence is to be presumed." Justus v. Principi, 3 Vet. App. 510, 513 (1992). Additionally, when determining whether the appellant has submitted new and material evidence to reopen a claim, consideration must be given to all the evidence since the last final denial of the claim. Evans v. Brown, 9 Vet. App. 273 (1996). Moreover, the appellant need not present evidence as to each element that was a specified basis for the last disallowance, but merely new and material evidence as to at least one of the bases of the prior disallowance. See Shade v. Shinseki, 24 Vet. App. 110 (2010) (holding that it would be illogical to require that a claimant submit medical nexus evidence when he has provided new and material evidence as to another missing element). Again, the April 2012 rating decision found that the Veteran did not have an intestinal disability that had its onset during service and that there was no objective medical evidence suggesting that the Veteran's current gastroparesis otherwise was caused by service. As will be discussed in the remand section below, since the time of the April 2012 rating decision the Veteran has contended that his intestinal problems are due to some combination of in-service exposure to herbicide agents and/or his service-connected diabetes mellitus. The Veteran had not raised a claim for secondary service connection prior to the April 2012 rating decision or stated that his intestinal problems were caused by exposure to herbicide agents. In his original December 2008 claim, he indicated only that he had intestinal problems that began during service. Pursuant to the Court's holding in Shade and presuming the credibility of the evidence for the sole purpose of determining whether the intestinal issue claim should be reopened, the Board concludes that the above evidence suggests the possibility that his intestinal issues were caused or aggravated by his service-connected diabetes mellitus or otherwise caused by in-service exposure to herbicide agents. The evidence is new and material. Having reopened the claim, the Board will adjudicate the issue on a de novo basis below. Service Connection 2. Entitlement to service connection for a gastrointestinal disability, to include intestinal issues 3. Entitlement to service connection for a respiratory disability, to include COPD 4. Entitlement to service connection for a bilateral hearing loss disability 5. Entitlement to service connection for a left ankle disability 6. Entitlement to service connection for hypertension 7. Entitlement to service connection for sleep apnea Service connection may be established for a disability resulting from personal injury suffered or disease contracted in the line of duty in the active military, naval, or air service. 38 U.S.C. §§ 1110. In addition, a "veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975, shall be presumed to have been exposed during such service to an herbicide agent, unless there is affirmative evidence to establish that the veteran was not exposed to any such agent during that service." 38 U.S.C. § 1116(f); 38 C.F.R. § 3.307(a)(6)(iii). If a veteran was exposed to an herbicide agent during active military, naval, or air service, certain diseases shall be service connected if the requirements of 38 U.S.C. § 1116 and 38 C.F.R. § 3.307(a)(6)(iii) are met, even though there is no record of such disease during service, provided further that the rebuttable presumption provisions of 38 U.S.C. § 1113; 38 C.F.R. § 3.307(d) are also satisfied. 38 C.F.R. § 3.309(e). In addition, VA has determined that there was significant use of herbicides on the fenced-in perimeters of military bases in Thailand intended to eliminate vegetation and ground cover for base security purposes as evidenced in a declassified Vietnam-era Department of Defense document titled "Project CHECO Southeast Asia Report: Base Defense in Thailand." This allows for presumptive service connection of the diseases associated with herbicide exposure to those veterans whose duties placed them on or near the perimeters of Thailand military bases. None of the Veteran's claimed disabilities are listed under section 3.309(e). As such, the presumptive provisions discussed above are not for application in this case. The Federal Circuit has held that a claimant is not precluded from establishing service connection for a disease contended to be related to herbicide exposure, as long as there is proof of direct causation. See Combee v. Brown, 34 F.3d 1039, 1043-1044 (Fed. Cir. 1994). To establish a right to compensation for a present disability, a Veteran must show: "(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service." Davidson v. Shinseki, 581 F.3d 1313, 1315-16 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). Further, service connection may not be awarded on the basis of aggravation without establishing a pre-aggravation baseline level of disability, comparing it to the current level of disability, and showing that the secondary condition was not due to the natural progression of a disease. 38 C.F.R. § 3.310(b). Service personnel records show that the Veteran served as an airframe structural repair technician. Travel documents show that the Veteran performed temporary duty in Thailand in August and September 1972. The Veteran's July 1975 Report of Medical Examination prior to separation from service included normal examinations of all systems and the Veteran's blood pressure was 130/76 mmHg. In a contemporaneous Report of Medical History, the Veteran denied a history of ear trouble, hearing loss, dizziness, asthma, shortness of breath, chronic cough, high or low blood pressure, frequent indigestion, stomach or intestinal trouble, arthritis, joint deformity, depression or excessive worry, or frequent trouble sleeping. In November 1989, the Veteran sought treatment for alcohol and cocaine addiction. At that time, the Veteran scored "in the very low range" on the Beck Depression Inventory. The only psychological symptoms of depression that the Veteran reported were mild dissatisfaction and mild disappointment with himself. In a separate November 1989 record, the Veteran denied a history of serious depression, serous anxiety, hallucinations, trouble controlling violent behavior, or serious thoughts or attempts at suicide. The electronic claims file includes private treatment records from July 2001. At that time, he denied a history of diabetes mellitus, but did report right upper quadrant and epigastric pain for several weeks after stopping tobacco use. Testing results showed abnormal liver function and the diagnosis was right upper quadrant pain. No other complaints or diagnoses were made with respect to any of his current claimed disabilities. In August 2001, the Veteran's symptoms ultimately were diagnosed as esophageal reflux. Private treatment records include reports of stomach problems, chronic respiratory failure, COPD, esophageal reflux / GERD, benign essential hypertension, asthma, and sleep apnea. In August 2003, the Veteran reported recent mental health difficulties due to the recent deaths of his wife and his mother. The assessment was adjustment disorder with depressed mood. The private treatment records indicate the Veteran was diagnosed with diabetes mellitus, type II, in January 2005, based on lab results from a previous visit. In October 2007, the Veteran denied problems of shortness of breath. The records also include a diagnosis of esophageal reflux from at least July 2007, sleep apnea in October 2007, hypertension in January 2008, chronic respiratory failure in May 2014, and gastroenteritis in March 2015. In a November 2008 statement, the Veteran reported that he flew to Cam Ranh Bay, Vietnam and Thon Son Nhut Airbase, Vietnam to repair damaged aircraft and/or to recover damaged aircraft. The Veteran indicated, "We had two helicopters shot down while I was aboard in Mid to late August 1972. These aircraft were shot down in Vietnam enroute to salvage down aircraft. During both incidents we were escorted back to friendly lines by the Marines." The Veteran sought initial treatment with VA in August 2009. At that time, the Veteran reported a history of diabetes mellitus, gastroparesis, GERD, depression, COPD, and obstructive sleep apnea. VA treatment records include a Problem List that includes obstructive sleep apnea, essential hypertension, gastroesophageal reflux disease (GERD), and COPD. In a July 2013 statement, the Veteran reported that he was stationed at George Air Force Base, in California, from around January 1972 to December 1972, and that, during that period, he was temporarily deployed to Takhli Royal Thai Air Force Base, in Thailand, from April 1972 to November 1972. He indicated that, while at Takhli, he was part of operations to salvage downed aircraft in Vietnam. An April 2014 x-ray of the chest showed possible vascular congestion and mild interstitial pulmonary edema. A May 2014 CT scan showed very mild inferior bronchial wall thickening that could reflect a mild inflammatory process and mild nonspecific airspace disease at the right lung base that was most likely infectious / inflammatory. The Veteran underwent a VA audio examination in October 2014. The Veteran reported significant in-service noise exposure from flight line noise, jet engines, sheet metal shop, generators, and pneumatic tools without hearing protection, as well as weapons training with hearing protection. The examiner diagnosed a bilateral sensorineural hearing loss disability. Following examination, the examiner concluded that it was not at least as likely as not that the right or left ear hearing loss disability was caused by or a result of service. The rationale noted that audiograms during service were within normal limits with no significant changes in threshold from entrance to separation from service. Based on the audiogram findings, the examiner concluded that there was no acoustic trauma in either ear during service. During his October 2016 Board hearing, the Veteran testified that while in service he used an MEK (methyl ethyl ketone) solvent regularly. In addition, he testified that en route to Takhli Royal Thai Air Force Base that he changed planes in Saigon. A July 2017 Report of General Information noted that the Appeals Management Office (AMO) had contacted the Record Archive section to locate VA treatment records from 1980 to 1985 previously identified by the Veteran. The Records Archive noted that in May 2009 a search for those records had been undertaken and no records were found. In July 2017 and August 2017, VA notified the Veteran that the records could not be located. The Veteran was afforded a VA examination in September 2017. The examiner diagnosed bilateral ankle degenerative arthritis. The examiner noted that the service treatment records did not document an injury to either ankle. The Veteran believed that he had been seen in service for the right ankle, but that it was not documented. The Veteran stated that he was not seen again for the right ankle until 1980, which was a reaggravation of the injury occurring in service. Specifically, the Veteran indicated that during service he rolled both ankles frequently and that they felt unstable. He did not recall any post-service injuries to either ankle. Currently, the ankles were sore and stiff from standing or walking. Following examination, the examiner concluded that it was less likely than not that the Veteran's bilateral ankle arthritis was incurred in or caused by service. The rationale noted that the Veteran's bilateral ankle degenerative arthritis was most consistent with his years of working at the post office after service. X-rays showed evidence of old trauma to the left ankle, but the Veteran claimed that his in-service injury was to the right ankle and not the left ankle. There was no evidence of complaints or treatment for either ankle during service and, "There is very little documentation for musculoskeletal injuries in greater than thirty years after the service and no chronicity was ever established and therefore the fact that he has bilateral disease makes this most likely due to occupation in post office and Not [sic] at least as likely as not service related." In addition, the examiner concluded that it was less likely than not that the bilateral ankle arthritis was proximately due to or the result of the Veteran's service-connected condition. The rationale indicated that the examiner could find no medical evidence that herbicide exposure, diabetes, or a heart disability had any relationship to the degenerative arthritis of the ankles or aggravation of the ankle disabilities. Instead, the disabilities were more consistent with the Veteran's occupation after service. The Veteran reported injuring the right ankle in service, but that report was not consistent with the service treatment records, as the records were negative for an ankle injury, the Veteran listed his health as good at separation from service, and there was no documented chronicity for decades after service. The Veteran had pain with use of the ankles, which was consistent with the level of degeneration of the ankle joints. During his January 2021 Board hearing, the Veteran testified that his depression could be due to fear of hostile military engagement. As to his hearing loss, he testified that during service he worked as a structural engineer and experienced a lot of noise exposure, to include from aircraft, riveting, and drilling. As to his hypertension, the Veteran and his representative reported that during service the Veteran sought treatment multiple times for blood pressure issues and was "given a treatment plan and then sent to a biofeedback lab." As to his sleep apnea, the Veteran believed that the sleep apnea was caused or aggravated by his service-connected diabetes mellitus. As to his respiratory problems, the Veteran asserted that they were due to some combination of Agent Orange exposure, diabetes mellitus, and weight gain. The Veteran believed that his stomach problems were secondary to his service-connected diabetes mellitus. Gastrointestinal, Respiratory, Hypertension, Sleep Apnea The Veteran believes that he has gastrointestinal, respiratory, hypertension, and sleep apnea disabilities that were caused by exposure to herbicide agents during service or were caused or aggravated by his service-connected diabetes mellitus. As to whether any of these disabilities are directly related to service or caused or aggravated by the service-connected diabetes mellitus, there is no lay or medical evidence suggesting in-service onset of any of the claimed disabilities or evidence of a continuity of symptoms from service. The Veteran contends that the above disabilities are due to some combination of in-service herbicide exposure and his service-connected diabetes mellitus. The Veteran does have recognized herbicide exposure during his service in Thailand, as discussed in the February 2017 Board decision. However, there is no medical evidence to support or suggest that any claimed disability was caused by in-service exposure to herbicide agents or was caused or aggravated by his service-connected diabetes mellitus. The sole evidence in support of such a finding are the Veteran's contentions. The Board acknowledges the Veteran's assertions that the above claimed disabilities are the result of in-service herbicide exposure and/or his service-connected diabetes mellitus. The Veteran is competent to report physically observable symptoms, but given the absence of a continuity of symptoms from service and the medical complexity of relating the claimed disabilities to the Veteran's herbicide exposure and/or his service-connected diabetes mellitus the Board does not find him competent to link the claimed disabilities to his herbicide exposure or service-connected diabetes mellitus. Cf. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007) (explaining in footnote 4 that a veteran is competent to provide a diagnosis of a simple condition such as a broken leg, but not competent to provide evidence as to more complex medical questions). In summary, the most probative evidence of record is against finding that the Veteran has gastrointestinal, respiratory, hypertension, and sleep apnea disabilities that had their onset in service, are otherwise related to service (including as due to herbicide exposure), or were caused or aggravated by a service-connected disability. Bilateral Hearing Loss Disability The Veteran contends that his current bilateral hearing loss disability was caused by acoustic trauma during service. The threshold for normal hearing is from 0 to 20 decibels. Hensley v. Brown, 5 Vet. App. 155, 157 (1993). Hearing loss disability claims are governed by 38 C.F.R. § 3.385. This regulation provides hearing loss is a disability when the auditory threshold in any of the frequencies of 500, 1000, 2000, 3000, or 4000 Hertz (Hz) is 40 decibels (dB) or greater. 38 C.F.R. § 3.385. Alternatively, a hearing loss disability can be established by auditory thresholds for at least three of those frequencies at 26 decibels or greater or by speech recognition scores under the Maryland CNC Test at less than 94 percent. 38 C.F.R. § 3.385. Post service testing shows that the Veteran has a current bilateral sensorineural hearing loss disability. The pertinent inquiry, then, is whether the bilateral hearing loss disability was caused by or is otherwise related to any incident of service, to include noise exposure from flight line noise, jet engines, sheet metal shop, generators, and pneumatic tools without hearing protection, as well as weapons training with hearing protection. The Board concludes that the hearing loss disability had its onset multiple years after service and is not otherwise caused by to service. In reaching that opinion, the Board has considered the findings and conclusions from the October 2014 VA examination report. The examiner concluded that given his normal hearing acuity at entrance and separation from service, as well as the absence of any significant threshold shift, it was less likely as not that the Veteran's current bilateral hearing loss disability was related to service. The Board finds this opinion the most probative of record, as the conclusion included a complete rationale based on all the evidence of record. The Board is aware of the provisions of 38 C.F.R. § 3.303(b), relating to chronicity and continuity of symptomatology in establishing service connection and that such provisions apply to those chronic conditions, such as hearing loss, specifically listed in 3.309(a). See Walker v. Shinseki, 708 F.3d 1331, 1340 (Fed. Cir. 2013). However, neither hearing loss nor an organic disease of the nervous system was noted during service, including at the time of examination shortly before separation from active service. As noted above, the medical evidence does not show hearing loss until multiple decades after the Veteran's separation from service. Moreover, prior to separation from service the Veteran denied any history of hearing loss, problems with his hearing, or other problems with his ears. As such, the provisions of 38 C.F.R. § 3.303(b) are not for application. As to the Veteran's general contentions that his hearing loss disability was incurred in or was otherwise caused by his service, the Board finds his opinions to be of less probative weight. Although the Veteran may be competent to report decreased hearing acuity, the Veteran has not contended that he has been experiencing decreased hearing acuity from service and, to the extent that he is making such a claim, the Board finds such contentions not credible in light of his denial of a history of hearing loss prior to separation from service. As such, the Board affords far greater probative weight to the opinions of the VA examiner. In summary, the Veteran does not contend that he experienced ongoing hearing problems from service and, to the extent that his contentions can be read as implicitly or explicitly raising such a claim, they are deemed not credible in light of his denial of hearing problems prior to separation from service. In light of the evidence, the Board concludes that the preponderance of the credible evidence is against the bilateral hearing loss claim, and that service connection for a bilateral hearing loss disability is not warranted. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt rule does not apply, and the claim must be denied. See generally Gilbert v. Derwinski, 1 Vet. App. 49 (1990); Ortiz v. Principi, 274 F.3d 1361 (Fed Cir. 2001). Left Ankle Disability The Veteran contends that he has right and left ankle disabilities that were incurred in or caused by his active service. (As noted above, the right ankle claim will be adjudicated in a separate decision.) The Veteran has not advanced any specific argument regarding his left ankle. Indeed, it is unclear from the Veteran's statements whether he actually intended to bring a claim only for his right ankle or for both ankles. Given that the February 2017 Board determination remanded a bilateral ankle disability and the subsequent July 2017 Supplemental Statement of the Case (SSOC) adjudicated both the right and left ankles, at this time the Board will do the same. The Board notes that the September 2017 VA examiner indicated that there was evidence of past trauma to the left ankle and diagnosed left ankle arthritis, but the examiner specifically concluded that the arthritis was consistent with the Veteran's post-service work activities at the post office. Moreover, the Board finds it extremely significant that during the September 2017 examination the Veteran denied any specific injury in service to the left ankle. Thus, there is nothing to link the diagnostic evidence of past trauma to the left ankle to the Veteran's time in service or any incidents therein. The Board recognizes that during the September 2017 examination the Veteran reported a history of rolling his ankles and that during service the ankles felt unstable, but there is no lay or medical evidence to suggest that these issues were the result of a chronic disability that had its onset in service. Prior to separation, the Veteran reported that he was in good health and denied a history of any symptoms that could be related to the left ankle. Moreover, the Board finds it extremely significant that at the time of the September 2017 VA examination the Veteran reported that his current symptoms regarding the left ankle were soreness and stiffness from walking and standing. Thus, to the extent that the Veteran experienced rolling ankles or feelings of instability during service, there is no continuity of such symptoms to the present and the September 2017 examiner did not find the in-service symptoms to be related to the current left ankle arthritis. Given that there is no lay or medical evidence to suggest that the Veteran has a current left ankle disability that was incurred in or otherwise was caused by service, the Board finds no basis for granting entitlement to service connection for a left ankle disability. REASONS FOR REMAND 1. Entitlement to service connection for an acquired psychiatric disorder, to include depression The Veteran contends that he has an acquired psychiatric disorder that may be due to fear of hostile military engagement. The Veteran has not been afforded a VA mental health examination. The Veteran does not have established service in the Republic of Vietnam. The February 2017 Board decision based the determination of presumed herbicide exposure on the Veteran's service in Thailand. The Veteran has claimed that during his service in Thailand he was tasked to participate in multiple efforts to recover downed aircraft in Vietnam and that during his initial transit to Thailand that he landed in Saigon. The Veteran's personnel records, including his performance evaluation for the period in question and the documentation of his travel, do not detail any period of service in Vietnam. The Veteran is competent to discuss current depression or other symptoms of an acquired psychiatric disorder and his belief that they are related to his active service is sufficient to trigger VA's duty to assist by affording him a VA examination. 2. Entitlement to service connection for a vestibular disability, to include vertigo and dizziness The Veteran contends that he has problems with vertigo / dizziness were caused or aggravated by his service-connected tinnitus and possibly the result of Agent Orange exposure. In July 2014, the Veteran testified that he felt "off balance." The Veteran was afforded a VA audio examination in October 2014. The examiner discussed the Veteran's ongoing tinnitus but did not indicate whether the Veteran had any additional symptoms or disabilities associated with the tinnitus. During his January 2021 Board hearing, the Veteran claimed that his vertigo / dizziness problems were due to his tinnitus and possibly the result of Agent Orange exposure. The Veteran is competent to report dizziness and similar physically observable symptoms. While the Veteran is not competent to diagnose a disability manifested by that dizziness or link such disability to his service-connected tinnitus, given the close association between ear problems and vestibular disabilities the Board concludes that a VA examination is necessary. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination for his claimed depression. The examiner must review the claims file. If a diagnosis cannot be provided but the Veteran's condition manifests in symptoms that cause functional impairment, then the examiner should consider them a "disability" for the purpose of providing the requested opinion(s) below. The examiner is asked to provide a response to the following: Is any diagnosed acquired psychiatric disorder, to include depression or any depressive disorder, at least as likely as not caused by service. Provide a rationale to support the opinion(s). 2. Schedule the Veteran for a VA examination for his claimed dizziness / vertigo / vestibular disability. The examiner must review the claims file. If a diagnosis cannot be provided but the Veteran's condition manifests in symptoms that cause functional impairment, then the examiner should consider them a "disability" for the purpose of providing the requested opinion(s) below. The examiner is asked to provide a response to the following: Is any diagnosed vestibular disability, including the claimed dizziness and vertigo, at least as likely as not proximately due to the Veteran's service-connected tinnitus? Is any diagnosed vestibular disability, including the claimed dizziness and vertigo, at least as likely as not aggravated, i.e., worsened beyond its natural progression, by the Veteran's service-connected tinnitus? Provide a rationale to support the opinion(s). 3. After the above is complete, readjudicate the Veteran's claims. If a complete grant of the benefits requested is not awarded, issue a supplemental statement of the case (SSOC) to the Veteran and his representative. J.W. FRANCIS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. J. Houbeck, 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.