Citation Nr: 22011880 Decision Date: 03/02/22 Archive Date: 03/02/22 DOCKET NO. 17-62 762 DATE: March 2, 2022 ORDER The appeal seeking service connection for a skin disability, to include chloracne, is dismissed. New and material evidence having been received, the claim for service connection for a lumbar spine disability is reopened. New and material evidence having been received, the claim for service connection for hypothyroidism is reopened. Entitlement to service connection for hypothyroidism is granted. Entitlement to service connection for hypertension is granted. Entitlement to service connection for a heart disability is granted. The reduction in the disability rating for the Veteran's bilateral hearing loss disability from 20 percent to 0 percent, effective May 14, 2012, is void; restoration of the 20 percent disability rating is granted. For the entire period on appeal, an initial disability rating of 100 percent for posttraumatic stress disorder (PTSD) is granted. REMANDED Entitlement to service connection for a lumbar spine disability is remanded. Entitlement to service connection for radiculopathy of the bilateral lower extremities is remanded. Entitlement to service connection for sleep apnea is remanded. Entitlement to service connection for a kidney disability is remanded. Entitlement to a disability rating in excess of 20 percent for a bilateral hearing loss disability is remanded. Entitlement to a total disability rating based upon individual unemployability (TDIU) is remanded. FINDINGS OF FACT 1. During the June 2021 hearing before the Board of Veterans' Appeals (Board), prior to the promulgation of a decision in the appeal, the Veteran explicitly, unambiguously, and with a full understanding of the consequences requested that the appeal seeking service connection for a skin disability be withdrawn. 2. An unappealed October 2007 rating decision is the last final decision that denied service connection for a lumbar spine disability and hypothyroidism. 3. The evidence received since the October 2007 rating decision is new and relates to unestablished facts necessary to substantiate the claims for service connection for a lumbar spine disability and hypothyroidism. 4. The Veteran was presumptively exposed to herbicide agents during his active service based on his service in the Republic of Vietnam during the Vietnam era. 5. The Veteran's currently diagnosed hypothyroidism is presumptively related to his exposure to herbicide agents during active service. 6. The Veteran's currently diagnosed hypertension is etiologically related to his exposure to herbicide agents during active service. 7. The Veteran's current heart disability, diagnosed as atrial fibrillation, is etiologically related to his service-connected hypertension. 8. The September 2014 rating decision in which the RO reduced the disability rating for the Veteran's bilateral hearing loss disability from 20 percent to 0 percent failed to consider, and to apply, the provisions of 38 C.F.R. § 3.344. 9. Resolving all reasonable doubt in the Veteran's favor, his PTSD symptoms more nearly approximate total occupational and social impairment. CONCLUSIONS OF LAW 1. The criteria for withdrawal of the appeal seeking service connection for a skin disability are met. 38 U.S.C. § 7105; 38 C.F.R. § 19.55. 2. The October 2007 rating decision denying service connection for a lumbar spine disability and hypothyroidism is final. 38 U.S.C. § 7105(c); 38 C.F.R. §§ 3.104, 3.160(d), 20.302, 20.1103. 3. The criteria to reopen the claims for service connection for a lumbar spine disability and hypothyroidism are met. 38 U.S.C. §§ 5107, 5108; 38 C.F.R. § 3.156(a). 4. The criteria for service connection for service connection for hypothyroidism are met. 38 U.S.C. §§ 1110, 1112, 1113, 1116(a)(2), 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 5. The criteria for service connection for hypertension are met. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. 6. The criteria for service connection for a heart disability are met. 38 U.S.C. § 1110; 38 C.F.R. § 3.310. 7. The reduction in the disability rating for the Veteran's bilateral hearing loss disability from 20 percent to 0 percent, effective May 14, 2014, was improper, and restoration of the prior rating is warranted. 38 U.S.C. §§ 1155, 5107, 5112; 38 C.F.R. §§ 3.102, 3.344, 4.85, Diagnostic Code (DC) 6100. 8. For the entire period on appeal, the criteria for an initial disability rating of 100 percent for PTSD are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.130, DC 9411. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran, who is the appellant in this case, served on active duty from September 1967 to September 1969, to include service in the Republic of Vietnam. This matter comes before the Board of Veterans' Appeals (Board) on appeal from rating decisions dated September 2012, December 2012, September 2014, and November 2018 of a Department of Veterans Affairs (VA) Regional Office (RO). In June 2021, the Veteran testified at a virtual hearing before the undersigned Veterans Law Judge (VLJ). A copy of the hearing transcript is of record and has been reviewed. After reviewing the contentions and evidence of record, the Board has recharacterized and expanded the Veteran's claim for ischemic heart disease to one for a heart disability, however diagnosed. See Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009); Brokowski v. Shinseki, 23 Vet. App. 79 (2009). Additionally, at the June 2021 hearing, the Veteran's representative clarified that the claim for peripheral neuropathy of the feet should be recharacterized as radiculopathy of the bilateral lower extremities, and that the Veteran is claiming service connection for hypothyroidism, rather than hyperthyroidism. These changes are reflected on the title page of the decision. The Board observes that the Veteran submitted additional medical evidence, and additional VA treatment records were received, since the RO's adjudication in the October 2017 and January 2020 Statements of the Case (SOCs). Some of the medical evidence submitted by the Veteran contained waivers of initial RO consideration. See Honoring America's Veterans and Caring for Camp Lejeune Families Act of 2012, Public Law No. 112-154, 126 Stat. 1165 (amending 38 U.S.C. § 7105 to provide that if new evidence is submitted with or after a substantive appeal received on or after February 2, 2013, then it is subject to initial review by the Board unless the Veteran explicitly requests agency of original jurisdiction (AOJ) consideration). Nonetheless, since the Board is either granting or remanding all the Veteran's claims, and the entire claims file is to be reviewed by the VA examiners prior to rendering any opinions on remand, there is no prejudice to the Veteran. Procedural History As detailed below, this case has a complex procedural history. In an October 2007 rating decision, in pertinent part, the RO denied service connection for sleep apnea, hypertension, a lumbar spine disability, hypothyroidism, PTSD, and bilateral hearing loss. In October 2008, the Veteran filed a Notice of Disagreement (NOD) as to the denials of service connection for sleep apnea, hypertension, a lumbar spine disability, hypothyroidism, PTSD, and bilateral hearing loss. In a January 2011 Statement in Support of Claim, the Veteran withdrew the October 2008 NOD as to his claims for service connection for a lumbar spine disability, PTSD, and bilateral hearing loss. In a March 2011 SOC, in pertinent part, the RO denied service connection for hypothyroidism. In a July 2011 rating decision, in pertinent part, the RO granted service connection for bilateral hearing loss and assigned a 20 percent rating, effective December 10, 2010. In a September 2012 rating decision, in pertinent part, the RO denied service connection for chloracne and ischemic heart disease and granted service connection for PTSD and assigned a 50 percent rating, effective October 18, 2006. In a December 2012 rating decision, the RO denied service connection for a lumbar spine disability and for neuropathy of the bilateral feet. In September 2013, the Veteran filed a NOD as to the denials of service connection for chloracne, ischemic heart disease, a lumbar spine disability, and neuropathy of the bilateral feet, asserted that an initial disability rating in excess of 50 percent for PTSD was warranted, and asserted entitlement to a TDIU. In a September 2014 rating decision, the RO denied service connection for sleep apnea and hypertension, decreased the Veteran's disability rating for bilateral hearing loss from 20 percent to 0 percent, effective May 14, 2014, and denied entitlement to a TDIU. In November 2014, the Veteran filed a NOD as to the denials of service connection for sleep apnea and hypertension, the denial of a TDIU, and the reduction of his disability rating for bilateral hearing loss to 0 percent, effective May 14, 2014. In September 2016, the Veteran filed a Supplemental Claim Application asserting entitlement to an increased rating for bilateral hearing loss. In an October 2017 SOC, the RO denied service connection for ischemic heart disease, chloracne, a lumbar spine disability, peripheral neuropathy of the feet, sleep apnea, and hypertension, denied entitlement to an initial disability rating in excess of 50 percent for PTSD, denied entitlement to a compensable rating for bilateral hearing loss, and denied entitlement to a TDIU. In November 2017, the Veteran filed a VA Form 9 as to all issues in the October 2017 SOC. In a November 2018 rating decision, the RO denied service connection for hypothyroidism and a kidney condition. In December 2018, the Veteran filed a NOD as to the November 2018 rating decision. In January 2020, the RO issued a SOC that denied service connection for hypothyroidism and a kidney condition. In February 2020, the Veteran filed a VA Form 9 as to all issues in the January 2020 SOC. As an aside, the Board finds that the October 2007 rating decision did not become final as to the Veteran's original claims for service connection for sleep apnea and hypertension because he was not provided procedural due process. The Veteran filed a timely Notice of Disagreement (NOD) in October 2008, but the RO failed to provide a Statement of the Case (SOC) as to these claims. Tablazon v. Brown, 8 Vet. App. 359, 361 (1995) (finding that a rating decision did not become final because no SOC was issued after a NOD was timely submitted). The March 2011 SOC did not address these claims, and the October 2017 SOC was issued in response to the September 2014 rating decision and November 2014 NOD. Since the October 2007 rating decision did not become final as to the Veteran's original claims for service connection for sleep apnea and hypertension, the Board will adjudicate the claims on a de novo basis, rather than on the basis of whether new and material evidence has been received. 1. Entitlement to service connection for a skin disability The Board may dismiss any appeal which fails to allege specific error of fact or law in the determination being appealed. 38 U.S.C. § 7105. An appeal may be withdrawn as to any or all issues involved in the appeal at any time before the Board promulgates a decision. 38 C.F.R. § 19.55. Withdrawal may be made by the appellant or by his or her authorized representative. 38 C.F.R. § 19.55. In DeLisio v. Shinseki, 25 Vet. App. 45 (2011), the Federal Circuit Court clarified what constitutes an effective verbal withdrawal of an appeal. Specifically, a verbal withdrawal of an appeal at a hearing is effective "only where it is (1) 'explicit'; (2) 'unambiguous'; and (3) 'done with a full understanding of the consequences of such action on the part of the [veteran].'" See Acree v. O'Rourke, 891 F.3d 1009, 1012-1013 (Fed. Cir. 2018) (quoting DeLisio v. Shinseki, 25 Vet. App. 45, 57 (2011)) (explaining that the Board must consider all three prongs of the DeLisio standard when determining whether a verbal withdrawal of a claim is effective). At the beginning of the June 2021 hearing, the Veteran's representative said, "As a preliminary matter we are respectfully withdrawing the issue of service connection for the skin condition/acne." The undersigned VLJ asked the Veteran, "And with regard to the skin condition [name], I just want to let you know that once you have asked to withdraw the claim and so, once I dismiss that issue it is no longer in my jurisdiction, okay? So, if you would like to pursue it in the future you will have to file a new claim. Okay?" The Veteran responded, "Okay." The Board finds that the Veteran's withdrawal of his claim for service connection for a skin disability was explicit, unambiguous, and done with a full understanding of the consequences of such action on the part of the Veteran. As such, the Veteran's verbal withdrawal of the claim during the hearing meets all three prongs of the DeLisio standard and is therefore an effective withdrawal. As the Veteran withdrew his appeal seeking service connection for a skin disability, there remain no allegations of errors of fact or law for appellate consideration. Accordingly, the Board does not have jurisdiction to review the claim and it is dismissed. 2. Whether new and material evidence has been received to reopen the claims for service connection for a lumbar spine disability and hypothyroidism Rating decisions are final, and binding based on evidence on file at the time the claimant is notified of the decision and may not be revised on the same factual basis except by a duly constituted appellate authority. 38 C.F.R. § 3.104(a). The claimant has one year from notification of a 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; 38 C.F.R. §§ 3.160, 20.201, 20.302. If the Board issues a decision on appeal confirming the RO's decision, then the Board's decision subsumes the RO's decision on the same issue at hand. 38 C.F.R. § 20.1104. Moreover, if the Board's decision is not timely appealed, then it, too, is final and binding based on the evidence then of record. 38 C.F.R. § 20.1100. VA may reopen a claim that has been previously denied if new and material evidence is submitted by or on behalf of the claimant. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). Regarding applications for reopening, 38 C.F.R. § 3.156(a) defines "new" evidence as evidence not previously submitted to agency decision makers and "material" evidence as 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 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). When determining whether the claim should be reopened, the credibility of the newly submitted evidence is to be presumed. Fortuck v. Principi, 17 Vet. App. 173, 179 (2003). In order to reopen a claim, it is not necessary that new and material evidence be received regarding each previously unproven element of a claim. Indeed, newly submitted evidence need not be overwhelming as a "low threshold" standard is applied. Shade v. Shinseki, 24 Vet. App. 110, 121 (2010). In this matter, the Veteran's claims for service connection for a lumbar spine disability and hypothyroidism were denied by the RO in an October 2007 rating decision because there was no nexus to service. The Veteran filed a Notice of Disagreement (NOD) as to the October 2007 rating decision. However, in a January 2011 Statement in Support of Claim, the Veteran withdrew his appeal seeking service connection for a lumbar spine disability. Additionally, while the RO issued a SOC in March 2011 regarding the claim for service connection for hypothyroidism, the Veteran did not file a substantive appeal. New and material evidence was not received within a year of notification of the rating decision for either claim. Therefore, the October 2007 rating decision became final for both claims. 38 U.S.C. § 7105(c); 38 C.F.R. § 3.104(a). Thus, the question before the Board is whether the evidence received after the final October 2007 rating decision is both new and material. The record reflects that when the RO issued the October 2007 rating decision, the Veteran's claims file contained service treatment records (STRs), an October 2006 claim application, Statements in Support of Claim dated October 2006 and March 2007, private treatment records, and October 2007 Correspondence. Evidence received since the October 2007 rating decision includes a November 2010 letter from Dr. L.J., a December 2010 Physician's Statement from Dr. J.W., a January 2012 letter from Dr. K.S., a June 2021 letter and Lumbar Spine Service-Connected Questionnaire from Dr. K.S., and the June 2021 Board hearing testimony. The statements from the Veteran's private treatment providers dated November 2010 to June 2021 indicate that the Veteran's current lumbar spine disability had its onset during or is otherwise related to his military service. During the June 2021 Board hearing, the Veteran's representative noted that the National Defense Authorization Act for Fiscal Year 2021 added hypothyroidism as a condition presumed to be caused by in-service herbicide agent exposure. The Board finds that the foregoing evidence is new as it was not previously submitted to the RO and it is material because it relates to unestablished facts necessary to substantiate the claims for service connection for a lumbar spine disability and hypothyroidism; namely, a nexus to service. Accordingly, the Board concludes that the evidence received since the last final decision is new and material and, for these reasons, the petitions to reopen are granted. Service Connection Claims Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Establishing service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Service connection may also be granted for any injury or disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d). Service connection may alternatively be established on a secondary basis for a disability which is proximately due to, or the result of, a service-connected disability. 38 C.F.R. § 3.310(a). Secondary service connection may also be established for a disorder which is aggravated by a service-connected disability; compensation may be provided for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation. See 38 C.F.R. § 3.310(b); Allen v. Brown, 8 Vet. App. 374 (1995). Any amount of aggravation is sufficient to establish secondary service connection; permanent aggravation or worsening of a non-service-connected disability is not required. See Ward & Neal v. Wilkie, 31 Vet. App. 233 (2019). Relevant here, cardiovascular-renal disease, including hypertension, is listed as a "chronic disease" under 38 C.F.R. § 3.309(a); therefore, the presumptive provisions of 38 C.F.R. § 3.303(b) for "chronic" in-service symptoms and "continuous" post-service symptoms apply. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). For the showing of chronic diseases in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. With chronic disease as such in service, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. If a condition noted during service is not shown to be chronic, then generally, a showing of continuity of symptoms after service is required for service connection. 38 C.F.R. § 3.303(b). In addition, the law provides that where a veteran served ninety days or more of active service, and certain chronic diseases become manifest to a degree of 10 percent or more within one year after the date of separation from such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309(a). While the disease need not be diagnosed within the presumption period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. Certain diseases are associated with herbicide agent exposure and shall be service connected if a veteran was exposed to an herbicide agent during active military, naval, or air service, if the requirements of 38 C.F.R. § 3.307(a)(6) are met, even though there is no record of such disease during service, provided further that the rebuttable presumption provisions of 38 C.F.R. § 3.307(d) are also satisfied. See 38 C.F.R. § 3.309(e). Even if a disease is not listed under 38 C.F.R. § 3.309(e), service connection may still be established with proof of direct causation. Combee v. Brown, 34 F.3d 1039, 1041-42 (Fed. Cir. 1994). In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive and provide the reasons for its rejection of any material favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994). When considering whether lay evidence is competent, the Board must determine, on a case-by-case basis, whether a veteran's particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). A veteran is competent to report symptoms because this requires only personal knowledge, not medical expertise, as it comes to her through her senses. See Layno, 6 Vet. App. 465, 469. Lay testimony is competent to establish the presence of observable symptomatology, where the determination is not medical in nature and is capable of lay observation. Barr v. Nicholson, 21 Vet. App. 303 (2007). Lay evidence may establish a diagnosis of a simple medical condition, a contemporaneous medical diagnosis, or symptoms that later support a diagnosis by a medical professional. Jandreau, 492 F.3d 1372, 1377. When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with a veteran prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 3. Entitlement to service connection for hypothyroidism The Veteran asserts he is entitled to service connection for hypothyroidism, to include as due to exposure to herbicide agents during active service. As an initial matter, the Board finds that the Veteran has a current diagnosis of hypothyroidism. See February 2021 private treatment record. Therefore, a current disability is established. Next, the Board finds that the Veteran was presumptively exposed to herbicide agents during his active service in the Republic of Vietnam during the Vietnam era. See DD-214. Accordingly, an in-service event is established. Thus, the remaining question before the Board is whether there is competent evidence of a nexus between the Veteran's in-service exposure to herbicide agents and his currently diagnosed hypothyroidism. Recently, the National Defense Authorization Act for Fiscal Year 2021 was enacted on January 1, 2021. Part of this Act amended 38 U.S.C. § 1116(a)(2) to add hypothyroidism to the list of diseases presumptively associated with exposure to herbicide agents. See National Defense Authorization Act for Fiscal Year 2021, Pub L. 116-283 § 9109 (January 1, 2021); 38 U.S.C. § 1116(a)(2) (2021). As the Veteran is presumed to have been exposed to herbicide agents during service and hypothyroidism is a disease presumed to be due to exposure to herbicide agents, the Board finds that service connection is warranted. The appeal is therefore granted. 4. Entitlement to service connection for hypertension The Veteran asserts he is entitled to service connection for hypertension, to include as due to exposure to herbicide agents during active service. As an initial matter, the Board finds that the Veteran has a current diagnosis of hypertension. See June 2021 Hypertension Questionnaire. Therefore, a current disability is established. Next, as discussed above, the Board finds that the Veteran was presumptively exposed to herbicide agents during his active service in the Republic of Vietnam during the Vietnam era. See DD-214. Accordingly, an in-service event is established. Thus, the remaining question before the Board is whether there is competent evidence of a nexus between the Veteran's in-service exposure to herbicide agents and his currently diagnosed hypertension. First, the Board notes that no VA medical opinion has been obtained as to whether the Veteran's hypertension is directly related to his active service. The July 2014 VA medical opinions only addressed the theories of secondary causation and aggravation by the Veteran's service-connected PTSD. Second, while VA regulations do not provide hypertension as a presumptive disability associated with herbicide exposure, in the "Veterans and Agent Orange: Update 11 (2018)," the National Academies of Science, Engineering, and Medicine (NAS) found that there was "sufficient" evidence of an association between hypertension and exposure to herbicides used during the Vietnam War. Third, in a June 2021 Hypertension Questionnaire, Dr. R.H., the Veteran's private treating physician, opined that the Veteran's current hypertension was as likely as not a direct result of his exposure to herbicides/Agent Orange in Vietnam, reasoning that his review of records, research, and experience makes it likely that Agent Orange is causative of hypertension. The Board finds Dr. R.H.'s opinion to be adequate and highly probative given his expertise as a medical doctor and his review of the 2018 NAS Update. For these reasons, the Board finds that service connection for hypertension is warranted. The appeal is therefore granted. 5. Entitlement to service connection for a heart disability The Veteran asserts he is entitled to service connection for a heart disability, to include as secondary to his now service-connected hypertension. As an initial matter, the Board finds that the Veteran has a current diagnosis of atrial fibrillation. See June 2021 Heart Questionnaire. Therefore, a current disability is established. Thus, the remaining question before the Board is whether the Veteran's currently diagnosed atrial fibrillation is etiologically related to his service-connected hypertension. In April 2012, the Veteran was provided a VA examination to determine the nature of his claimed heart disability. However, it does not appear that a VA medical opinion was obtained in relation to this examination. In a June 2021 Heart Questionnaire, Dr. R.H., the Veteran's private treating physician, opined that the Veteran's current heart condition was as likely as not a direct result of his hypertension, reasoning that based on the Veteran's history, examination, and his experience, atrial fibrillation is related to hypertension. The Board finds Dr. R.H.'s opinion to be adequate and highly probative given his expertise as a medical doctor and opportunities to examine the Veteran over time as his treating physician. For these reasons, the Board finds that service connection for a heart disability is warranted. The appeal is therefore granted. 6. Whether the reduction in the disability rating for the Veteran's bilateral hearing loss disability from 20 percent to 0 percent, effective May 14, 2014, was proper In a September 2014 rating decision, the RO reduced the disability rating for the Veteran's bilateral hearing loss disability from 20 percent to 0 percent, effective May 14, 2014. The Veteran asserts that this reduction was improper and that he is entitled to a higher rating. In rating reductions, when VA contemplates reducing an evaluation for a veteran's service-connected disability or disabilities, it must follow specific procedural steps prior to such discontinuance. 38 C.F.R. § 3.105(e). As enumerated in 38 C.F.R. § 3.105(e), "[w]here the reduction in evaluation of a service-connected disability or employability status is considered warranted and the lower evaluation would result in a reduction or discontinuance of compensation payments currently being made, a rating proposing the reduction or discontinuance will be prepared setting forth all material facts and reasons." Id. In addition, "[t]he beneficiary will be notified at his or her latest address of record of the contemplated action and furnished detailed reasons therefore and will be given 60 days for the presentation of additional evidence to show that compensation payments should be continued at their present level." Id. The beneficiary also will receive notification that "he or she will have an opportunity for a pre-determination hearing," 38 C.F.R. § 3.105(i), and thereafter, a "final rating action will be taken, and the award will be reduced or discontinued effective the last day of the month in which a 60-day period from the date of notice to the beneficiary of the final rating action expires." See 38 C.F.R. §§ 3.105(e); 3.500(r). However, where there is no reduction in the amount of compensation payable to a beneficiary, 38 C.F.R. § 3.105(e) does not apply. See VAOPGCPREC 71-91. In this matter, the reduction of the Veteran's disability rating for his bilateral hearing loss disability from 20 percent to 0 percent, effective May 14, 2014, did not result in a reduction of compensation payments currently being made to the Veteran. This is because the Veteran's combined disability rating remained 60 percent after the reduction, and the reduction did not otherwise affect his compensation payments. As such, the provisions of 38 C.F.R. § 3.105(e) do not apply. Even so, the Board must still consider the propriety of the rating reduction itself. Generally, a disability rating will not be reduced unless an improvement in the disability is shown to have occurred. See 38 U.S.C. § 1155. When a RO makes a rating reduction without following the applicable regulations, the reduction is void ab initio (i.e., at their inception). Greyzck v. West, 12 Vet. App. 288, 292 (1999). As pertinent here, for ratings in effect for less than five years, adequate reexamination that discloses improvement in the disability warrants reduction in rating. See 38 C.F.R. § 3.344(c). The evidence must reflect an actual change in the Veteran's condition and not merely a difference in the thoroughness of the examination or in the use of descriptive terms. 38 C.F.R. § 4.13. The evidence must show that the improvement in the disability actually reflects an improvement in the Veteran's ability to function under the ordinary conditions of life and work. 38 C.F.R. §§ 4.2, 4.10. In considering the propriety of a reduction, the Board must focus on the evidence available to the RO at the time the reduction was effectuated, although post-reduction evidence may be considered to determine whether the condition had demonstrated actual improvement. See Dofflemyer v. Derwinski, 2 Vet. App. 277, 281-82 (1992). Furthermore, rating reduction cases must be based upon a review of the entire history of the Veteran's disability. 38 C.F.R. §§ 4.1, 4.2; Brown v. Brown, 5 Vet. App. 413, 420-21 (1993). Upon review, the Board finds that the RO failed to consider, and to apply, the provisions of 38 C.F.R. § 3.344 in the September 2014 rating decision. Specifically, the RO did not discuss whether there was an actual improvement in the Veteran's ability to function under the ordinary conditions of life and work. In the May 2014 VA audiological examination report, the VA examiner opined that the Veteran's hearing loss impacts the ordinary conditions of daily life, including his ability to work. When asked to describe the impact of his hearing loss, the Veteran reported that he had difficulty understanding conversational speech. As a lay person, the Veteran is considered competent to report what comes to him through his senses, including hearing difficulties, and the Board has no reason to doubt his credibility. The Board acknowledges that there was some improvement in speech discrimination scores between the May 2011 and May 2014 VA audiological examinations. However, based on the Veteran's probative lay reports of the impacts of his hearing difficulties, which do not materially differ between the May 2011 and May 2014 VA examinations, the Board finds that there was not an actual improvement in the Veteran's ability to function under the ordinary conditions of life and work. For these reasons, and with resolution of all reasonable doubt in the Veteran's favor, the Board finds that there was no actual improvement in the Veteran's ability to function under the ordinary conditions of life and work. Thus, the RO did not properly apply the provisions of 38 C.F.R. § 3.344 in the September 2014 rating decision. As noted previously, when a RO makes a rating reduction without following the applicable regulations, the reduction is void ab initio. Greyzck, 12 Vet. App. at 292. In this case, the appropriate remedy is a restoration of the 20 percent disability rating for the Veteran's bilateral hearing loss disability effective the date of the reduction, May 14, 2014. See Hayes v. Brown, 9 Vet. App. 67, 73 (improper reduction reinstated effective date of reduction). The Board will address the Veteran's claim for a rating in excess of 20 percent for his bilateral hearing loss disability in the Remand section below. 7. Entitlement to an initial disability rating in excess of 50 percent for PTSD Disability evaluations are determined by comparing a veteran's present symptoms with the criteria set forth in the VA Schedule for Rating Disabilities, which is based upon average impairment in earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. When a question arises as to which of two ratings applies under a particular diagnostic code, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt is resolved in favor of the veteran. 38 C.F.R. § 4.3. The veteran's entire history is to be considered when making disability evaluations. See generally 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Staged ratings are appropriate for any initial rating claim when the factual findings show distinct time periods during the appeal period where the service-connected disability exhibits symptoms that would warrant different ratings. Fenderson v. West, 12 Vet. App. 119, 126 (1999). The criteria for rating psychiatric disabilities, other than eating disorders, are set forth in the General Rating Formula for Mental Disorders (General Rating Formula). 38 C.F.R. § 4.130. Under the General Rating Formula, a 50 percent rating is warranted if there is occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. Id. A 70 percent rating is warranted if the evidence establishes there is occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately, and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work like setting); inability to establish and maintain effective relationships. Id. A 100 percent rating (total occupational and social impairment) is warranted due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. Id. Effective August 4, 2014, VA amended the portion of the Rating Schedule dealing with mental disorders and its adjudication regulations that define the term "psychosis" to remove outdated references to the DSM-IV and replace them with references to the updated Fifth Edition (DSM-5). See 79 Fed. Reg. 149, 45094. The provisions of the interim final rule apply to all applications for benefits that are received by VA or that were pending before the Agency of Original Jurisdiction on or after August 4, 2014. Id. VA adopted as final, without change, the interim final rule and clarified that the provisions of this interim final rule do not apply to claims that have been certified for appeal to the Board or are pending before the Board as of August 4, 2014. See 80 Fed. Reg. 53, 14308 (March 19, 2015). In this matter, the RO certified the Veteran's appeal to the Board after August 4, 2014; therefore, the PTSD claim is governed by DSM-5 and the GAF scores are not relevant for consideration. See Golden v. Shulkin, 29 Vet. App. 221, 225-26 (2018) (holding that the Board errs when it uses GAF scores to assign a psychiatric rating in cases where DSM-5 applies). When determining the appropriate disability evaluation to assign, the Board's primary consideration is the veteran's symptoms, but it must also make findings as to how those symptoms impact a veteran's occupational and social impairment. Vazquez-Claudio v. Shinseki, 713 F.3d 112 (Fed. Cir. 2013). The use of the term "such as" in the rating criteria demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list, but rather are to serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. Mauerhan v. Principi, 16 Vet. App. 436 (2002). Thus, the Board need not find the presence of all, most, or even some, of the enumerated symptoms to award a specific rating. Id. at 442. Nevertheless, all ratings in the General Rating Formula are also associated with objectively observable symptomatology and the plain language of the regulation makes it clear that the veteran's impairment must be "due to" those symptoms; a veteran may only qualify for a given disability rating by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration. Vazquez-Claudio, 713 F.3d at 118. The Board recognizes that the Court in Mauerhan, 16 Vet. App. 436, stated that the symptoms listed in VA's General Rating Formula is not intended to constitute an exhaustive list, but rather are to serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. However, the Court further indicated that without those examples, differentiating between rating evaluations would be extremely ambiguous. In this matter, the Veteran is currently in receipt of an initial disability rating of 50 percent for PTSD for the entire period on appeal. He asserts that a higher rating is warranted. On review, the Board finds that the evidence is at least in equipoise as to whether the Veteran's PTSD symptoms and level of impairment more nearly approximate the criteria for a 100 percent disability rating. First, the Veteran has had persistent hallucinations during the period on appeal. In an April 2009 VA mental health initial evaluation note, the Veteran reported hearing voices talk in the background. On mental status examination, the treatment provider determined that the Veteran had perceptual disturbances of auditory hallucinations. In a September 2009 VA mental health medication management note, the Veteran described hypnagogic hallucinations that occurred intermittently but were not particularly distressing. The September 2014 VA examiner found that the Veteran had symptoms including persistent delusions or hallucinations, noting that the Veteran heard voices he could not understand and sometimes heard his name, and that he also saw shadows. Second, the Veteran has posed at least some danger of hurting others. In an October 2007 Statement in Support of Claim, the Veteran wrote that when he returned from active service, he almost killed his spouse by choking her in his sleep. During the February 2011 and May 2014 VA examinations, the Veteran reported that he had tried to choke and beat his spouse several times when he thought she was a Viet Cong soldier he was fighting in his sleep. In a January 2018 private treatment record, the Veteran endorsed awakening with violent attacks and expressed concern that he might harm his spouse during his sleep. Third, the evidence demonstrates that the Veteran's PTSD symptoms have resulted in a high degree of occupational and social impairment. In a March 2010 letter, Dr. N.M., the Veteran's treating psychologist, stated that the Veteran had symptoms of intrusive memories, nightmares, extreme distress upon exposure to reminders of his traumatic experiences, social avoidance and isolation, diminished interest in once valued activities, hypervigilance, insomnia, and difficulty concentrating. Dr. N.M. wrote, "As a result, [the Veteran's] ability to handle stressors, to be around others, and to work has been impaired, and he suffers serious functional deficits crossing multiple domains (personal, social, occupational). While he has been compliant with medications and intensive psychotherapy, [the Veteran's] symptoms remain severe, and PTSD is often a chronic condition." In letters dated August 2010, November 2015, February 2018, and May 2021, Dr. M.W., the Veteran's treating psychiatrist since September 2009, opined that the Veteran cannot function effectively in a work environment because of his PTSD. Dr. M.W. wrote, "As a consequence of this disorder, you avoided places and situations that exacerbated your anxiety included crowded places or new environments. You have described significant trouble with sleep, which negative impacts mood, cognition, and energy. You have been prescribed every possible known sleep aid available with very minimal benefit. You have also completed a course of psychotherapy specifically designed to assist with improving sleep, which afforded minimal benefit. Your insomnia persists and results in ongoing struggles with low energy, poor concentration, and low mood. You have described an intense sense of vigilance which significantly impairs your ability to function in work and social environments. You also suffer from physiologic arousal, which is distressing emotionally and draining physically. Other significant symptoms of PTSD which you experience include increased worry, decreased focus and concentration, which limit your 'on the job' performance. Your condition is chronic and severe." See May 2021 letter from Dr. M.W. The Board affords great probative value to the opinions authored by Drs. N.M. and M.W. given their expertise as a psychologist and psychiatrist, respectively, and their opportunities to examine the Veteran over time as his treatment providers. Based on the foregoing, and after resolution of all reasonable doubt in the Veteran's favor, the Board finds that his PTSD has resulted in total occupational and social impairment for the entire period on appeal, as the rating criteria specifically contemplate his symptoms of persistent hallucinations and persistent danger of hurting others. For these reasons, the Board finds that the Veteran's PTSD symptoms more nearly approximate the criteria for an initial disability rating of 100 percent for the entire period on appeal. A 100 percent rating is the maximum schedular rating allowed under the General Rating Formula. Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 369-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). REASONS FOR REMAND 1. Entitlement to service connection for a lumbar spine disability is remanded The Veteran asserts that he currently has a lumbar spine disability that is related to, or caused by, his active service. The Board finds that additional development is necessary prior to appellate review of this claim. In February 2011 and November 2012, the Veteran was provided VA examinations to determine the nature and likely etiology of his claimed lumbar spine disability. The VA examiners provided negative nexus opinions, and the Board finds both medical opinions to be inadequate for the following reasons. First, the February 2011 VA examiner impermissibly relied on the absence of evidence in the Veteran's service treatment records (STRs) to provide a negative opinion. Dalton v. Nicholson, 21 Vet. App. 23 (2007). Second, the November 2012 VA examiner misstated the Veteran's history of back complaints during active service, noting that there was no complaint of back pain or any diagnosis of a back condition since 1966. As the opinion is based upon an inaccurate factual premise, the Board finds it to be inadequate and of no probative value. Reonal v. Brown, 5 Vet. App. 458, 461 (1993). Thus, an adequate etiology opinion should be obtained on remand. Furthermore, the Board notes that in an August 1966 Report of Medical History obtained for "pre-induction" purposes, the Veteran reported back trouble, and the examining physician wrote "Back strain since age 12 [co]mplaint persists." In the August 1966 Report of Medical Examination obtained for "pre-induction" purposes, the examiner seems to have marked that the Veteran's spine was both "normal" and "abnormal" on clinical evaluation and referred to an orthopedic consultant's report which showed that the lumbo-sacral spine was negative. In the September 1967 Report of Medical History at service entrance (induction), the Veteran endorsed recurrent back pain, and in the September 1967 Report of Medical Examination, the spine was found to be normal on clinical evaluation. The Board finds that the presumption of soundness attaches here, since no spinal condition was recorded on the September 1967 Report of Medical Examination at service entrance. However, based on the Veteran's competent endorsement of a pre-service history of back strain, on remand, the VA examiner should provide an opinion as to whether the Veteran's lumbar spine disability clearly and unmistakably existed prior to his entrance to service and, if so, whether it clearly and unmistakably was not aggravated by his active service. If the lumbar spine disability did not clearly and unmistakably exist prior to service, the VA examiner should provide an opinion as to whether it at least as likely as not had its onset during or is otherwise related to the Veteran's active service. 2. Entitlement to service connection for radiculopathy of the bilateral lower extremities The Veteran asserts that he is entitled to service connection for radiculopathy of the bilateral lower extremities as secondary to his claimed lumbar spine disability. The Board finds that the Veteran's claim for service connection for radiculopathy of the bilateral lower extremities is inextricably intertwined with the remanded claim for service connection for a lumbar spine disability. Therefore, the matter must be remanded. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (stating that two issues are "inextricably intertwined" when they are so closely tied together that a final Board decision on one issue cannot be rendered until the other issue has been considered). 3. Entitlement to service connection for sleep apnea is remanded. The Veteran asserts he is entitled to service connection for sleep apnea, to include as secondary to his service-connected PTSD. The Board finds that additional development is necessary prior to appellate review of this claim. In July 2014, the Veteran was provided a VA examination to determine the nature and likely etiology of his claimed sleep apnea. The July 2014 VA examiner provided negative opinions as to the theories of secondary causation and aggravation, reasoning, in part, that "there is no direct causality of PTSD causing or leading to sleep apnea. Although sleeping difficulty is one of the many symptoms of PTSD, however PTSD is not a contributing factor[] or cause[] of sleep apnea or definitely associated to sleep apnea." On review, the Board finds the July 2014 VA medical opinions inadequate. The VA examiner seemed to apply the incorrect evidentiary standard in the rationale for the medical opinion regarding secondary causation (i.e., definitely associated). Additionally, in the rationale for the medical opinion regarding secondary aggravation, the VA examiner improperly discussed the theory of secondary causation (i.e., "there is no direct causality of PTSD causing or leading to sleep apnea"). On remand, the VA examiner should ensure to apply the correct evidentiary standard and should clearly, and separately, address the theories of secondary causation and aggravation. 4. Entitlement to service connection for a kidney disability is remanded. The Veteran asserts he is entitled to service connection for a kidney disability, to include as secondary to his now service-connected hypothyroidism. The Board finds that additional development is necessary prior to appellate review of this claim. In May 2018, the Veteran underwent a partial nephrectomy of his left kidney due to lesions that were suspicious for renal cell carcinoma but were ultimately found to be benign. See private treatment records dated April 2018 to January 2021. He also has a current diagnosis of chronic kidney disease. See January 2021 private treatment record. During the June 2021 Board hearing, the Veteran was asked whether his doctor told him that his kidney issue developed secondary to his thyroid condition, and he responded, "It could be." To date, VA has not obtained a competent medical examination and opinion addressing this claim. Based on the foregoing, and with resolution of all reasonable doubt in the Veteran's favor, the Board finds that a VA examination should be afforded to him. McClendon v. Nicholson, 20 Vet. App. 79 (2006). 5. Entitlement to a disability rating in excess of 20 percent for a bilateral hearing loss disability is remanded. The Veteran asserts he is entitled to a disability rating in excess of 20 percent for his bilateral hearing loss disability. The Board finds that additional development is necessary prior to appellate review of this claim. The Veteran was last provided a VA audiological examination in May 2014, which revealed speech discrimination scores of 94 percent, bilaterally. More recently, in May 2021, the Veteran underwent private audiological testing which revealed speech discrimination scores of 44 percent on the right and 52 percent on the left. It is unclear whether the private audiologist used the Maryland CNC word list. Even so, given the suggestion of possible worsening, a new VA examination is necessary. Snuffer v. Gober, 10 Vet. App. 400, 403 (1997). 6. Entitlement to a TDIU is remanded. As to the Veteran's claim for a TDIU, this benefit contemplates a schedular rating less than total for the disability or disabilities on which the TDIU would be based. See 38 C.F.R. § 4.16(a). A TDIU is considered a lesser benefit than a 100 percent schedular rating, and the grant of a 100 percent rating generally renders moot the issue of entitlement to a TDIU for the period when the 100 percent rating is in effect. An exception to this is that a TDIU predicated on a single disability (perhaps not ratable at the schedular 100 percent level) when considered with another disability separately rated at 60 percent or more may warrant payment of special monthly compensation (SMC) under 38 U.S.C. § 1114(s) (2018). Bradley v. Peake, 22 Vet. App. 280 (2008). VA's duty to maximize benefits requires VA to assess all the claimant's disabilities to determine whether any combination of disabilities establishes entitlement to SMC under 38 U.S.C. § 1114. See Bradley, 22 Vet. App. at 294 (finding that SMC "benefits are to be accorded when a Veteran becomes eligible without need for a separate claim"). Here, the Veteran is in receipt of a total (100 percent) disability rating for his PTSD for the entire period on appeal. The Veteran has not yet been assigned initial disability ratings for his now service-connected hypothyroidism, hypertension, and heart disability, and several service connection claims, as well as the claim for an increased rating for a bilateral hearing loss disability, are remanded for additional development. There is some evidence that these disabilities might affect the Veteran's ability to work. See, e.g., VA examination reports dated November 2012 and May 2014; September 2013 VA Form 21-8940 Veterans Application for Increased Compensation Based on Unemployability; May 2021 Employability Questionnaire. As such, entitlement to a TDIU based on one of the Veteran's service-connected disabilities (other than PTSD), for the purpose of establishing entitlement to SMC under 38 U.S.C. § 1114(s), must be remanded as inextricably intertwined with the remanded issues and the assignment of initial ratings for the Veteran's newly service-connected disabilities. Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (stating that two issues are "inextricably intertwined" when they are so closely tied together that a final Board decision on one issue cannot be rendered until the other issue has been considered). Accordingly, the matters are REMANDED for the following action: 1. Provide the Veteran a VA examination, if possible, to determine the nature and likely etiology of his lumbar spine disability. The claims file, including a copy of this Remand, must be made available to, and be reviewed by, the examiner. ** IF an in-person examination is not feasible given the circumstances surrounding the recent pandemic, refer the case to an appropriate examiner for a thorough review of the record, possible telephone/virtual interview of the Veteran, and medical opinion(s). After a thorough review of the claims file and examination of the Veteran (if possible), the examiner is asked to: (a) Elicit from the Veteran and the record the history of his lumbar spine symptoms before, during, and after his active service. (b) Identify all currently diagnosed lumbar spine disabilities. (c) For each currently diagnosed lumbar spine disability, provide an opinion as to the following: a. Did the lumbar spine disability clearly and unmistakably exist prior to the Veteran's entrance to service? b. If the lumbar spine disability clearly and unmistakably existed prior to service, opine whether such disability was clearly and unmistakably NOT AGGRAVATED beyond its natural progression by the Veteran's service. c. If the lumbar spine disability did not clearly and unmistakably exist prior to service, opine whether it at least as likely as not (50 percent probability or greater) had its onset during active service or is otherwise related to it. 2. Obtain an addendum VA medical opinion regarding the nature and likely etiology of the Veteran's sleep apnea. The claims file, including a copy of this Remand, must be made available to, and be reviewed by, the examiner. If another examination is indicated, one should be provided to the Veteran. After a thorough review of the claims file, the examiner is asked to respond to the following: (a) Provide an opinion as to whether the Veteran's sleep apnea is at least as likely as not (50 percent probability or greater) proximately due to his service-connected PTSD. (b) Provide an opinion as to whether the Veteran's sleep apnea is at least as likely as not (50 percent probability or greater) aggravated by his service-connected PTSD. * Any amount of aggravation is sufficient to establish secondary service connection; permanent aggravation/worsening of a non- service-connected disability is not required. See Ward & Neal v. Wilkie, 31 Vet. App. 233 (2019). 3. Provide the Veteran a VA examination, if possible, to determine the nature and likely etiology of his kidney disability. The claims file, including a copy of this Remand, must be made available to, and be reviewed by, the examiner. ** IF an in-person examination is not feasible given the circumstances surrounding the recent pandemic, refer the case to an appropriate examiner for a thorough review of the record, possible telephone/virtual interview of the Veteran, and medical opinion(s). After a thorough review of the claims file and examination of the Veteran (if possible), the examiner is asked to: (a) Identify all currently diagnosed kidney disabilities. (b) For each currently diagnosed kidney disability, provide an opinion as to the following: a. Is the Veteran's kidney at least as likely as not (50 percent probability or greater) proximately due to his service-connected hypothyroidism? b. Is the Veteran's kidney disability at least as likely as not (50 percent probability or greater) aggravated by his service-connected hypothyroidism? * Any amount of aggravation is sufficient to establish secondary service connection; permanent aggravation/worsening of a non- service-connected disability is not required. See Ward & Neal v. Wilkie, 31 Vet. App. 233 (2019). 4. Provide the Veteran an additional VA examination, if possible, to determine the current severity of his bilateral hearing loss disability. The claims file, including a copy of this Remand, must be made available to, and be reviewed by, the examiner. ** IF an in-person examination is not feasible given the circumstances surrounding the recent pandemic, refer the case to a VA audiologist for a thorough review of the record, possible telephone/virtual interview of the Veteran, and medical opinion. (Continued on the next page) 5. Following the assignment of initial disability ratings for the Veteran's newly service-connected disabilities, readjudicate the remanded claims on appeal. S. B. MAYS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. M. Gill, 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.