Citation Nr: 21008656 Decision Date: 02/17/21 Archive Date: 02/17/21 DOCKET NO. 15-42 571 DATE: February 17, 2021 ORDER 1. Entitlement to an effective date earlier than May 23, 2013, for the award of service connection for postoperative scar, left side of face, is denied. 2. Entitlement to an initial compensable disability rating for postoperative scar, left side of face, is denied. REMANDED 3. Entitlement to service connection for a bilateral hearing loss disability is remanded. 4. Entitlement to service connection for tinnitus is remanded. 5. Entitlement to service connection for a right knee disability is remanded. 6. Entitlement to service connection for a right ankle disability is remanded. 7. Entitlement to service connection for a left ankle disability is remanded. 8. Entitlement to service connection for a lumbar spine disability is remanded. 9. Entitlement to service connection for a right elbow disability is remanded. 10. Entitlement to service connection for traumatic brain injury (TBI) is remanded. 11. Entitlement to service connection for a psychiatric disorder, to include posttraumatic stress disorder (PTSD), is remanded. 12. Entitlement to service connection for obstructive sleep apnea (OSA) is remanded. 13. Entitlement to service connection for residuals status post left parotidectomy, to include nerve damage, is remanded. 14. Entitlement to service connection for scar, right top of head, is remanded. 15. Entitlement to service connection for a jaw disability, to include lock jaw, is remanded. 16. Entitlement to service connection for irritable bowel syndrome (IBS) is remanded. FINDINGS OF FACT 1. The Veteran separated from active duty service on May 22, 2013. 2. Service connection for postoperative scar, left side of face, has been awarded effective May 23, 2013, the day following the Veteran’s separation from active service. 3. The Veteran’s postoperative residual scar, located on the left cheek, is neither painful nor unstable, and does not have a characteristic of disfigurement. CONCLUSIONS OF LAW 1. There is no legal entitlement to an effective date earlier than May 23, 2013, for the award service connection for postoperative scar, left side of face. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. 2. The criteria for an initial compensable disability rating postoperative scar, left side of face, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.118, Diagnostic Code 7800. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 2009 to May 2013. The Veteran’s Certificate of Release or Discharge from Active Duty (DD-214) indicates that he had service in Afghanistan from July 2010 to April 2011. As a preliminary matter, the Board notes that there is an outstanding motion to Advance on the Docket (AOD) based on financial hardship. In December 2015, the Veteran’s representative submitted a statement titled, “Request to Expedite!” A copy of a court ordered eviction notice was attached and Veteran’s representative requested that VA expedite the Veteran’s claim because of his financial hardship. A December 2015 Report of General Information indicates that the Veteran’s representative called on the Veteran’s behalf to inform VA that the Veteran is homeless and requested that his appeal be expedited. The Board considers this an informal Motion to AOD due to severe financial hardship. While the Board finds that this is good or sufficient cause to advance the case on the docket, the AOD Motion is denied because the evidence of record does not support a finding that he is currently experiencing the same financial hardship. Specifically, in an August 2017 statement, the Veteran’s representative stated that “the Veteran is now in a better place and has been able to secure employment and is no longer moving from place to place to keep a roof over his daughter’s head.” Accordingly, the Veteran’s AOD motion is denied at this time. See id. However, the Board notes that this determination does not prevent the Veteran from filing another AOD motion, and submitting relevant supporting evidence, at a later date.   1. Entitlement to an effective date earlier than May 23, 2013, for the award of service connection for postoperative scar, left side of face. The Veteran seeks an effective date earlier than May 23, 2013, for the award of service connection for postoperative scar, left side of face. See October 2020 appellate brief. Under governing law, the effective date for a grant of compensation will be the day following separation from active service, or the date entitlement arose if a claim is received within one year after separation from service. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400(b)(2)(i). Otherwise, the effective date is the date of receipt of claim or date entitlement arose, whichever is later. Id. The Veteran separated from active duty service with the U.S. Army on May 22, 2013, as indicated on his DD Form 214. Initially, a February 2015 rating decision awarded service connection for postoperative scar, left side of face, effective June 16, 2014. An October 2015 rating decision awarded an earlier effective date of May 23, 2013, the day following the Veteran’s separation from active service. The Board notes that the day following separation from active service is the earliest possible date for which service connection may be awarded. See 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400(b)(2)(i). There is no statutory or regulatory authority which would allow an award of service connection effective prior to the Veteran’s separation from active service. As such, the Veteran’s appeal must be denied as a matter of law. See Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). 2. Entitlement to an initial compensable rating for postoperative scar, left side of face. Disability ratings are determined by evaluating the extent to which a veteran’s service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing the symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). The percentage ratings in the Rating Schedule represent the average impairment in earning capacity resulting from service-connected diseases and injuries and their residual conditions in civilian occupations. The percentage ratings are generally adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the disability. Diagnostic Codes (DCs) are assigned by the rating officials to individual disabilities. DCs provide rating criteria specific to a particular disability. If two DCs are applicable to the same disability, the DC that allows for the higher disability rating applies. See 38 C.F.R. § 4.7 (2018). When a question arises as to which of two ratings apply under a particular DC, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating. See id. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of a veteran. 38 C.F.R. § 4.3. In deciding claims, it is the Board’s responsibility to evaluate the entire record on appeal. See 38 U.S.C. § 7104(a). Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss each and every piece of evidence submitted by the Veteran or on his behalf. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Rather, the Board’s analysis below will focus specifically on what evidence is needed to substantiate the claims and what the evidence in the claims file shows, or fails to show, with respect to the claims. See Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). The Veteran seeks a compensable disability rating for his service-connected postoperative scar, left side of face. The Veteran’s scar is currently rated under 38 C.F.R. § 4.118, DC 7800. Under DC 7800, for scars of the face, a compensable evaluation of 10 percent is applicable with one characteristic of disfigurement. Note (1) provides eight characteristics of disfigurement for purposes of § 4.118: (1) Scar five or more inches (13 or more centimeters) in length; (2) Scar at least one-quarter inch (0.6 centimeters) wide at widest part; (3) Surface contour of scar elevated or depressed on palpation; (4) Scar adherent to underlying tissue; (5) Skin hypo-or hyper-pigmented in an area exceeding six square inches (39 square centimeters); (6) Skin texture abnormal (irregular, atrophic, shiny, scaly, etc.) in an area exceeding six square inches (39 square centimeters); (7) Underlying soft tissue missing in an area exceeding six square inches (39 square centimeters); and (8) Skin indurated and inflexible in an area exceeding six square inches (39 square centimeters). The Board finds that the evidence does not support a finding that the Veteran’s single service-connected facial scar meets the characteristics of disfigurement provided in DC 7800, Note (1). The Veteran did not present to scheduled VA examinations in 2015 and in 2017. While the Veteran showed good cause for his failure to appear, as discussed in detail in the remand portion of this decision below, the Veteran did not request a new examination for his service-connected scar and requested that the Board proceed with adjudication. See October 2020 appellate brief. A June 2013 VA medical record reflects the presence of the Veteran’s scar over the left cheek area status-post parotidectomy. However, there are no other medical records related to the scar. Thus, there is no medical evidence that the scar meets the characteristics of disfigurement. The Veteran has not asserted any pain or instability of the scar tissue or any functional impairment. If the Veteran’s scar worsens, he may submit a new claim for an increased rating. Accordingly, as the Veteran’s service-connected postoperative scar, left side of face, bears no characteristics of disfigurement, no pain or instability of the scar tissue, nor causes the Veteran any functional impairment, a compensable evaluation is not warranted. As the preponderance of the evidence is against the claim for a higher rating, the benefit of the doubt doctrine is not for application, and the Veteran’s claim is denied. See 38 U.S.C. § 5107; 38 C.F.R. § 4.3. REASONS FOR REMAND The Board finds that remand is warranted to fully assist the Veteran with the development of his claims. In an October 2020 appellate brief, the Veteran’s representative asserted that the Veteran’s claims should be remanded because it is unclear at which locations the Veteran was stationed while serving during the Gulf War period. His representative referenced the Veteran’s DD Form 214, which as mentioned above, indicates that he served in Afghanistan and that it is possible that the Veteran also served in the Persian Gulf. Service connection may be established for a Persian Gulf Veteran who exhibits objective indications of chronic disability which cannot be attributed to any known clinical diagnosis, but which instead results from an undiagnosed illness that became manifest either during active service in the Southwest Asia theater of operations during the Persian Gulf War, or to a degree of 10 percent or more not later than December 31, 2021. 38 C.F.R. § 3.317(a)(1). A “Persian Gulf Veteran” is one who served in the Southwest Asia Theater of operations during the Persian Gulf War. Id. The Veteran’s service in Afghanistan does not qualify him as a Persian Gulf Veteran as Afghanistan is not part of the Southwest Asia theater of operations for the purposes of 38 U.S.C. § 1117. See 38 C.F.R. § 3.317(e)(2); Cox v. McDonald, 28 Vet. App. 318 (2016). The Veteran’s service treatment records (medical and dental) are associated the claims file, however, it appears that service personnel records may not have been associated with the claims file. The Board finds that the service personnel records are inherently pertinent to the Veteran’s claim due to his contention that he may have potentially served in the Southwest Asia theater of operations during the Persian Gulf War. Additionally, in the October 2020 appellate brief, the Veteran’s representative asserted that the Veteran had good cause as to why he was not present for the previously scheduled VA examinations for his claimed disabilities in March and April 2017, including the deaths of both his mother and grandmother, which happened three days apart. The Veteran specifically requested that the Board not penalize him for missing the previously scheduled examinations. See August 2017 statement. The Veteran had also missed previously scheduled VA examinations in 2015. In his December 2015 substantive appeal (VA Form 9), the Veteran explained that he was in college and working to pay bills. In subsequent December 2015 correspondence, the Veteran’s representative explained that the Veteran was evicted and living separately from his family in order to allow his daughter to stay in her current school district. The Board finds that unexpected death of the Veteran’s mother and grandmother and impending potential homelessness constitute good cause for missing the scheduled VA examinations. A remand is required to ensure that the Veteran is scheduled and properly notified for new VA examinations. The Veteran is advised to appear and participate in any scheduled VA examination as failure to do so may result in denial of the claim(s). See 38 C.F.R. §§ 3.158, 3.655. The Veteran’s representative has indicated in the October 2002 Informal Hearing Presentation that the scar on the top of the Veteran’s head is related to the parotidectomy the Veteran underwent during service. Thus, only one examination is needed for this claim involving what residuals the Veteran has as a result of the parotidectomy. Finally, the most recent VA treatment records in the file are from February 2016. Thus, a request for updated records should be made. 3. Entitlement to service connection for a bilateral hearing loss disability is remanded. 4. Entitlement to service connection for tinnitus is remanded. 5. Entitlement to service connection for a right knee disability is remanded. 6. Entitlement to service connection for a right ankle disability is remanded. 7. Entitlement to service connection for a left ankle disability is remanded. 8. Entitlement to service connection for a lumbar spine disability is remanded. 9. Entitlement to service connection for a right elbow disability is remanded. 10. Entitlement to service connection for traumatic brain injury (TBI) is remanded. 11. Entitlement to service connection for a psychiatric disorder, to include PTSD, is remanded. 12. Entitlement to service connection for OSA is remanded. 13. Entitlement to service connection for residuals status post left parotidectomy, to include nerve damage, is remanded. 14. Entitlement to service connection for scar, right top of head, is remanded. 15. Entitlement to service connection for a jaw disability, to include lock jaw, is remanded. 16. Entitlement to service connection for IBS is remanded. The matters are REMANDED for the following action: 1. Contact the appropriate records repositories to attempt to obtain and associate with the claims file all of the Veteran’s official service personnel records, from his active duty from August 2009 to May 2013. If any of the records requested are unavailable, clearly document the claims file to that effect and notify the Veteran of any inability to obtain these records, in accordance with 38 C.F.R. § 3.159(e). 2. Ascertain for the record whether the Veteran qualifies as a Persian Gulf Veteran (i.e. whether he served in the Southwest Asia Theater of Operations during active duty pursuant to 38 C.F.R. § 3.317(e)). All supportive documentation, to include personnel records, must be associated with the claims file. 3. Upload updated VA treatment records from February 2016 to the present into the Veteran’s file. 4. Schedule the Veteran for a VA audiological examination for his claimed 1) bilateral hearing loss disability and 2) tinnitus to determine the nature, extent and etiology of the claimed disabilities. The examiner should review the record and provide opinions as to whether any current disability is related to service. 5. Schedule the Veteran for a VA examination for the claimed right knee disability, to determine the nature, extent, and etiology of the claimed disability. Any indicated evaluations, studies, and tests deemed to be necessary by the examiner should be performed. The examiner should review the record and provide an opinion as to whether any current disability is related to service. 6. Schedule the Veteran for a VA examination for the claimed right and left ankle disabilities, to determine the nature, extent, and etiology of the claimed disabilities. Any indicated evaluations, studies, and tests deemed to be necessary by the examiner should be performed. The examiner should review the record and provide opinions as to whether any current disability is related to service. 7. Schedule the Veteran for a VA examination for the claimed lumbar spine (back) disability, to determine the nature, extent, and etiology of the claimed disability. Any indicated evaluations, studies, and tests deemed to be necessary by the examiner should be performed. The examiner should review the record and provide an opinion as to whether any current disability is related to service. 8. Schedule the Veteran for a VA examination for the claimed right elbow disability, to determine the nature, extent, and etiology of the claimed disability. Any indicated evaluations, studies, and tests deemed to be necessary by the examiner should be performed. The examiner should review the record and provide an opinion as to whether any current disability is related to service. 9. Schedule the Veteran for a VA examination for the claimed TBI to determine the nature, extent, and etiology, to be conducted by one of the four designated specialists (physiatrist, psychiatrist, neurologist, or neurosurgeon). A copy of the below facts should be provided to the VA examiner. The examiner is asked to review the record. Any indicated evaluations, studies, and tests deemed to be necessary by the examiner should be performed. To assist in a review of the claims file, the examiner is informed of the following facts with citations in the record, where applicable: • The Veteran served on active duty from August 2009 to May 2013 with a military occupational specialty (MOS) of infantryman. He served in Afghanistan from July 2010 to April 2011. • The Veteran contends that he sustained a traumatic brain injury (TBI) from a fall during service; however, the service treatment records do not document an in-service head injury, including the service treatment records that post-date his service in Afghanistan. • A May 2011 service treatment record shows that the Veteran was seen for completion of post-deployment screening, which was right after he returned from Afghanistan. There was no documentation of a head injury. See VBMS entry with document type, “STR – Medical,” receipt date 07/03/2014, with “#3” in the subject field, pages 59-60. • A January 2013 service treatment record shows the Veteran complained of chronic lower back pain for 4 months. The examiner documented an acute onset midline lumbosacral pain. The Veteran reported that he did not know what caused the pain and that he just woke up with it one morning. He reported a fall down 15 stairs two days prior to the onset of the back pain. He did not report a head injury. See VBMS entry with document type, “STR – Medical,” receipt date 07/03/2014, with “#3” in the subject field, pages 86-90. • A March 2013 service treatment record of a visit for military services physical (physical exam, abbreviated separation) includes the examiner documenting, “No pertinent findings upon [physical examination].” The examiner also documented that the Veteran had “no complaints.” The Veteran was cleared for separation and did not require further consults. The Veteran reported health concerns about his lower back pain and stated that he injured his right knee and had issues with it. The Veteran did not report experiencing a head injury. See VBMS entry with document type, “STR – Medical,” receipt date 07/03/2014, with “#4” in the subject field, pages 55-57. • A subsequent March 2013 service treatment record reflects pain in the lumbar and cervical regions and indicates that the Veteran was involved in what he described as a “minor vehicle collision” and that he claimed to have no additional pain or discomfort. A problem list is part of this medical record, which does not include a head injury or residuals of a head injury. See VBMS entry with document type, “STR – Medical,” receipt date 07/03/2014, with “#4” in the subject field, page 34. • April 2013 service treatment records show complaints of low back pain with some neck and upper back stiffness after the March 2013 motor vehicle accident but no pain and no change in low back complaints. The Veteran reported that the acute onset midline lumbosacral pain began in January 2013. See VBMS entry with document type, “STR – Medical,” receipt date 07/03/2014, with “#4” in the subject field, pages 34-35. • A June 2013 VA treatment record shows that a TBI screening was performed. The examiner wrote that the Veteran had not been diagnosed as having a TBI during service. The Veteran reported he had been exposed to a blast or explosion IED, RPG, Land Mine, or Grenade. He reported a blow to the head. The facts reported by the Veteran within this screening are not documented anywhere in the service treatment records. See VBMS entry with document type, “CAPRI,” receipt date 11/01/2016, page 56. • June 2013 VA treatment records show the Veteran claimed he was treated by a chiropractor for his back after an IED explosion. In a separate June 2013 entry, the examiner documented that the Veteran reported that his Stryker vehicle was hit by an IED causing his head to hit the top of the vehicle and cracked his helmet. The Veteran reported he had experienced headaches, tinnitus, difficulty sleeping, and concentration issues. To reiterate, the service treatment records do not document that the Veteran reported sustaining a head injury or being exposed to an IED explosion while in Afghanistan. See VBMS entry with document type, “CAPRI,” receipt date 11/01/2016, pages 50-52, 57-58. • September 2013 VA medical records indicate that the Veteran provided a history of one significant injury with possible loss of consciousness. He reported that the vehicle he was traveling in was hit by a large IED. He stated that he was sitting in an outside hatch during the IED incident and he was thrown around and hurt his back in the same accident. He reported that he had some dizziness and nausea as well as mild headache following the event and now has severe headaches. The Veteran described symptoms of significant headaches over 3 times a week, an aura with spots in front of his eyes and headache described as squeezing. He also reported impaired short-term memory and insomnia. See VBMS entry with document type, “CAPRI,” receipt date 10/01/2015, page 21. • As noted above, when the Veteran reported back pain in service in January 2013, he reported he did not know what caused the pain and noted he had fallen down 15 stairs 2 days prior to the onset of back pain. He did not report having sustained a back injury from an IED explosion while in Afghanistan from July 2010 to April 2011. See VBMS entry with document type, “STR – Medical,” receipt date 07/03/2014, with “#3” in the subject field, pages 86-90. • The examiner’s review of the record is NOT restricted to the evidence listed above. This list is provided in an effort to assist the examiner in locating potentially relevant evidence. While the Board has provided some of the relevant facts above, the examiner is to review the entire record, and then answer the following questions: a) Does the Veteran have a currently diagnosed TBI residuals or functional impairment? b) If residuals of a TBI are diagnosed, it at least as likely as not (50 percent or greater likelihood) that they were incurred during service from August 2009 to May 2013? Please explain your answers by citing to supporting clinical data and/or medical literature, as deemed appropriate. A full rationale must be provided for all medical opinions given. If the examiner is unable to provide an opinion without resorting to mere speculation, he or she should explain why this is so. The examiner shall then explain whether the inability to provide a more definitive opinion is the result of a need for more information and indicate what additional evidence is necessary, or whether he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). 10. Schedule the Veteran for a VA examination to evaluate the current nature and etiology of his claimed psychiatric disorder. A copy of the below facts should be provided to the VA examiner. The examiner is asked to review the record. Any indicated evaluations, studies, and tests deemed to be necessary by the examiner should be performed. To assist in a review of the claims file, the examiner is informed of the following facts with citations in the record, where applicable: • The Veteran served on active duty from August 2009 to May 2013 with a military occupational specialty (MOS) of infantryman. He served in Afghanistan from July 2010 to April 2011. • The Veteran contends that he has a psychiatric disorder that had an onset in service. • An October 2011 service treatment record includes a negative depression screen. See VBMS entry with document type, “STR – Medical,” receipt date 07/03/2014, with “#3” in the subject field, page 38. • A January 2013 service treatment record shows the Veteran reported not having been bothered by feeling down, depressed or homeless during the past month. See VBMS entry with document type, “STR – Medical,” receipt date 07/03/2014, with “#3” in the subject field, page 10. • February 2013 and March 2013 service treatment records include psychiatric therapy and an assessment of adjustment disorder with disturbance of emotions and conduct rule/out PTSD. See VBMS entry with document type, “STR – Medical,” receipt date 07/03/2014, with “#3” in the subject field, pages 10-31. • A March 2013 service treatment record shows depression and PTSD screens were negative. See VBMS entry with document type, “STR – Medical,” receipt date 07/03/2014, with “#4” in the subject field, page 53. • A March 2013 service treatment record of a visit for military services physical (physical exam, abbreviated separation) includes no pertinent findings upon physical examination. The Veteran was cleared for separation and did not require further consults. The Veteran had no complaints. The Veteran reported health concerns about his lower back pain and stated that he injured his right knee and had issues with it. The Veteran did not report experiencing a head injury. See VBMS entry with document type, “STR – Medical,” receipt date 07/03/2014, with “#4” in the subject field, pages 55-57. • A June 2013 VA treatment record shows that a TBI screening was performed. The examiner wrote that the Veteran had not been diagnosed as having a TBI during service. The Veteran reported he had been exposed to a blast or explosion IED, RPG, Land Mine, or Grenade. He reported a blow to the head. The facts reported by the Veteran within this screening are not documented anywhere in the service treatment records. See VBMS entry with document type, “CAPRI,” receipt date 11/01/2016, page 56. • A June 2013 VA mental health outpatient note indicates that the Veteran reported that he saw a mental health professional while in Germany. He stated that he was initially referred for anger management but after a session or two the mental health counselor determined that treatment was not needed, though they continued to talk. Depression and PTSD screens were negative. See VBMS entry with document type, “CAPRI,” receipt date 11/01/2016, pages 54-56. • June 2013 VA treatment records show the Veteran claimed he was treated by a chiropractor for his back after an IED explosion. In a separate June 2013 entry, the examiner documented that the Veteran reported that his Stryker vehicle was hit by an IED causing his head to hit the top of the vehicle and cracked his helmet. The Veteran reported he had experienced headaches, tinnitus, difficulty sleeping, and concentration issues. To reiterate, the service treatment records do not document that the Veteran reported sustaining a head injury or being exposed to an IED explosion while in Afghanistan. See VBMS entry with document type, “CAPRI,” receipt date 11/01/2016, pages 50-52, 57-58. • In a September 2013 VA psychosocial assessment/ intake record, the Veteran answered “yes” when asked if he believed any health or mental health problems he was having were related to his military service / combat service. He listed the medical concerns/problems as, “back pain, headaches, poor sleep, right knee pain, ankle pain.” See VBMS entry with document type, “CAPRI,” receipt date 11/01/2016, page 40. • September 2013 VA medical records indicate that the Veteran provided a history of one significant injury with possible loss of consciousness. He reported that the vehicle he was traveling in was hit by a large IED. He stated that he was sitting in an outside hatch during the IED incident and he was thrown around and hurt his back in the same accident. He reported that he had some dizziness and nausea as well as mild headache following the event and now has severe headaches. The Veteran described symptoms of significant headaches over 3 times a week, an aura with spots in front of his eyes and headache described as squeezing. He also reported impaired short-term memory and insomnia. See VBMS entry with document type, “CAPRI,” receipt date 10/01/2015, page 21. • As noted above, when the Veteran reported back pain in service in January 2013, he reported he did not know what caused the pain and noted he had fallen down 15 stairs 2 days prior to the onset of back pain. He did not report having sustained a back injury from an IED explosion while in Afghanistan from July 2010 to April 2011 or having sustained a head injury. See VBMS entry with document type, “STR – Medical,” receipt date 07/03/2014, with “#3” in the subject field, pages 86-90. • The examiner’s review of the record is NOT restricted to the evidence listed above. This list is provided in an effort to assist the examiner in locating potentially relevant evidence. While the Board has provided some of the relevant facts above, the examiner is to review the entire record, and then answer the following questions: a) What, if any, psychiatric diagnosis(es) does the Veteran have? b) For each psychiatric diagnosis offered, it at least as likely as not (50 percent or greater likelihood) that it was incurred during service from August 2009 to May 2013? Please explain your answers by citing to supporting clinical data and/or medical literature, as deemed appropriate. A full rationale must be provided for all medical opinions given. If the examiner is unable to provide an opinion without resorting to mere speculation, he or she should explain why this is so. The examiner shall then explain whether the inability to provide a more definitive opinion is the result of a need for more information and indicate what additional evidence is necessary, or whether he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). 11. Schedule the Veteran for a VA examination to evaluate the current nature and etiology of his claimed obstructive sleep apnea (OSA). Any indicated evaluations, studies, and tests deemed to be necessary by the examiner should be performed, including a sleep study. The examiner should review the record and provide an opinion as to whether any current disability is related to service. 12. Schedule the Veteran for a VA examination to evaluate the current nature and etiology of his claimed residuals status post left parotidectomy, to include nerve damage and a scar on the right top of his head. A copy of the below facts should be provided to the VA examiner. The examiner is asked to review the record. Any indicated evaluations, studies, and tests deemed to be necessary by the examiner should be performed. To assist in a review of the claims file, the examiner is informed of the following facts with citations in the record, where applicable: • The Veteran served on active duty from August 2009 to May 2013 with a military occupational specialty (MOS) of infantryman. • The Veteran states that he underwent a procedure to have an abscess removal from his left parotid gland, as well as a removal of a branch of his facial nerve in service. He asserts that there may be possible conditions that have been caused by this procedure, to include nerve damage and a residual scar on the top of his head. • March 2011 service treatment records reflect the Veteran’s complaint of an earache in the right ear. The Veteran stated that he felt that he had water in his ear for 2 weeks. He denied any tinnitus and had no dizziness or nausea. A subsequent March 2011 record shows an assessment of arthralgia of temporomandibular joint. See VBMS entry with document type, “STR – Medical,” receipt date 07/03/2014, with “#3” in the subject field, pages 64-65. • In September 2011, the Veteran complained of a mass under the left ear and that hearing loss was noted during that time for 3 days. The Veteran also stated that he had a recurrent ear infection on the left side. A review of systems for otolaryngeal symptoms documented, “no hearing loss, no tinnitus, no nasal discharge, no nasal passage blockage, and no sore throat.” The mass was noted as a 2-centimeter, tender to palpation mass just posterior to left angle of the jaw. See VBMS entry with document type, “STR – Medical,” receipt date 07/03/2014, with “#3” in the subject field, pages 45-46, 78. • A September 2011 medical record from the German ENT reflects a diagnosis of space occupying lesion under pol parotitis on the left. A cyst on the left was drained by puncture. See VBMS entry with document type, “STR – Medical,” receipt date 07/03/2014, with “#3” in the subject field, page 81. • October 2011 service treatment records indicate that the Veteran was status-post abscess removal from left parotid gland. The Veteran was doing well and noted some numbness to some parts of his face. The surgeon informed the Veteran that a branch of facial nerve was removed due to involvement in abscess. See VBMS entry with document type, “STR – Medical,” receipt date 07/03/2014, with “#3” in the subject field, pages 36-38. • The examiner’s review of the record is NOT restricted to the evidence listed above. This list is provided in an effort to assist the examiner in locating potentially relevant evidence. While the Board has provided some of the relevant facts above, the examiner is to review the entire record, and then answer the following question: Does the Veteran have any current residuals, to include nerve damage and/or a scar on the right top of his head, that are at least as likely as not (50 percent or greater likelihood) caused by or related to the left parotidectomy performed in service? The examiner should identify and describe all current symptomatology. Please explain your answer by citing to supporting clinical data and/or medical literature, as deemed appropriate. A full rationale must be provided for all medical opinions given. If the examiner is unable to provide an opinion without resorting to mere speculation, he or she should explain why this is so. The examiner shall then explain whether the inability to provide a more definitive opinion is the result of a need for more information and indicate what additional evidence is necessary, or whether he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. 13. Schedule the Veteran for a VA examination to evaluate the current nature and etiology of his claimed jaw disability, to include a locked jaw. A copy of the below facts should be provided to the VA examiner. The examiner is asked to review the record. Any indicated evaluations, studies, and tests deemed to be necessary by the examiner should be performed. To assist in a review of the claims file, the examiner is informed of the following facts with citations in the record, where applicable: • The Veteran served on active duty from August 2009 to May 2013 with a military occupational specialty (MOS) of infantryman. • The Veteran contends that he developed a jaw disability during service. • March 2011 service treatment records reflect the Veteran’s complaint of an earache in the right ear. The Veteran stated that he felt that he had water in his ear for 2 weeks. He denied any tinnitus and had no dizziness or nausea. A subsequent March 2011 record shows an assessment of arthralgia of temporomandibular joint. See VBMS entry with document type, “STR – Medical,” receipt date 07/03/2014, with “#3” in the subject field, pages 64-65. • In September 2011, the Veteran complained of a mass under the left ear and that hearing loss was noted during that time for 3 days. The Veteran also stated that he had a recurrent ear infection on the left side. A review of systems for otolaryngeal symptoms documented, “no hearing loss, no tinnitus, no nasal discharge, no nasal passage blockage, and no sore throat.” The mass was noted as a 2-centimeter tender to palpation mass just posterior to left angle of the jaw. See VBMS entry with document type, “STR – Medical,” receipt date 07/03/2014, with “#3” in the subject field, pages 45-46, 78. • A September 2011 medical record from the German ENT reflects a diagnosis of space occupying lesion under pol parotitis on the left. A cyst on the left was drained by puncture. See VBMS entry with document type, “STR – Medical,” receipt date 07/03/2014, with “#3” in the subject field, page 81. • October 2011 service treatment records indicate that the Veteran was status-post abscess removal from left parotid gland. The Veteran was doing well and noted some numbness to some parts of his face. The surgeon informed the Veteran that a branch of facial nerve was removed due to involvement in abscess. See VBMS entry with document type, “STR – Medical,” receipt date 07/03/2014, with “#3” in the subject field, pages 36-38. • The examiner’s review of the record is NOT restricted to the evidence listed above. This list is provided in an effort to assist the examiner in locating potentially relevant evidence. While the Board has provided some of the relevant facts above, the examiner is to review the entire record, and then answer the following questions: a) Does the Veteran have a current jaw disability, to include lock jaw, or any functional impairment due to jaw pain? b) For each jaw disability (or functional impairment due to jaw pain) offered, the examiner is asked to address whether it is at least as likely as not (50 percent probability or more) that such disability had its onset in service from August 2009 to May 2013, to specially include but not limited to, the documented March 2011 record shows an assessment of arthralgia of temporomandibular joint and September 2011 left parotid gland abscess (locations above). Please explain your answers by citing to supporting clinical data and/or medical literature, as deemed appropriate. A full rationale must be provided for all medical opinions given. If the examiner is unable to provide an opinion without resorting to mere speculation, he or she should explain why this is so. The examiner shall then explain whether the inability to provide a more definitive opinion is the result of a need for more information and indicate what additional evidence is necessary, or whether he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). 14. Schedule the Veteran for a VA examination for his claimed irritable bowel syndrome (IBS), to determine the nature, extent, and etiology of the claimed disability. The examiner is asked to review the record. Any indicated evaluations, studies, and tests deemed to be necessary by the examiner should be performed. The examiner is asked to answer the following questions: a) Does the Veteran have a current IBS disability, to include, or any functional impairment related to IBS? b) If the examiner finds a current diagnosis of IBS (or functional impairment), the examiner is asked to address whether it is at least as likely as not (50 percent probability or more) that such disability had its onset in service from August 2009 to May 2013. Please explain your answer by citing to supporting clinical data and/or medical literature, as deemed appropriate. A full rationale must be provided for all medical opinions given. If the examiner is unable to provide an opinion without resorting to mere speculation, he or she should explain why this is so. The examiner shall then explain whether the inability to provide a more definitive opinion is the result of a need for more information and indicate what additional evidence is necessary, or whether he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. 15. If, and only if, the Veteran is determine to qualify as a Persian Gulf Veteran, and record indicates a lack of current disability with regard to the following disorders on appeal: OSA, TBI, residuals status-post left parotidectomy with claimed nerve damage, bilateral hearing loss, tinnitus, lumbar spine, right knee, right ankle, left ankle, elbow, jaw, IBS, and acquired psychiatric disorders, the examiner(s) must provide an opinion as to whether any of these disorders constitute an undiagnosed illness or a medically unexplained chronic multisystem illness. A rationale must be provided for all opinions rendered. A. P. SIMPSON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Cheng, 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.