Citation Nr: 22014146 Decision Date: 03/11/22 Archive Date: 03/11/22 DOCKET NO. 19-35 547 DATE: March 11, 2022 ORDER Service connection for spine degenerative arthritis is denied. Service connection for intervertebral disc syndrome is denied. Service connection for a sacroiliac injury is denied. Service connection for spinal stenosis is denied. Service connection for spondylolisthesis is denied. Service connection for osteoarthritis is denied. Service connection for arteriosclerotic heart disease is denied. Service connection for atherosclerotic renal disease is denied. Service connection for hypertensive vascular disease is denied. Service connection for irritable bowel syndrome is denied. Service connection for prostatitis is denied. Service connection for hydronephrosis as secondary to service-connected diabetes mellitus type II is denied. Service connection for Peyronie's disease as secondary to service-connected diabetes mellitus type II is denied. Service connection for ureterolithiasis as secondary to service-connected diabetes mellitus type II is denied. Service connection for a renal disorder as secondary to service-connected diabetes mellitus type II is denied. Service connection for obstructive sleep apnea is denied. An initial rating higher than 20 percent from September 24, 2015 and continuing thereafter for diabetes mellitus type II is denied. An initial rating higher than 10 percent from September 24, 2015 to December 13, 2020 and an increased rating higher than 20 percent from December 14, 2020 and continuing thereafter for right upper extremity diabetic peripheral neuropathy is denied. An initial rating higher than 10 percent from September 24, 2015 to December 13, 2020 and an increased rating higher than 20 percent from December 14, 2020 and continuing thereafter for left upper extremity diabetic peripheral neuropathy is denied. An initial 20 percent rating from September 24, 2015 and continuing thereafter for right lower extremity diabetic peripheral neuropathy is granted. An initial 20 percent rating from September 24, 2015 and continuing thereafter for left lower extremity diabetic peripheral neuropathy is granted. An effective date earlier than September 24, 2015 for the grant of service connection for diabetes mellitus type II is denied. An effective date earlier than September 24, 2015 for the grant of service connection for right upper extremity diabetic peripheral neuropathy is denied. An effective date earlier than September 24, 2015 for the grant of service connection for left upper extremity diabetic peripheral neuropathy is denied. An effective date earlier than September 24, 2015 for the grant of service connection for right lower extremity diabetic peripheral neuropathy is denied. An effective date earlier than September 24, 2015 for the grant of service connection for left lower extremity diabetic peripheral neuropathy is denied. REMANDED The issue of service connection for chronic obstructive pulmonary disease is remanded. The issue of service connection for diverticulitis is remanded. The issue of service connection for inguinal hernia is remanded. The issue of service connection for residuals of a large intestine resection is remanded. The issue of service connection for a heart disorder, to include hypertrophic cardiomyopathy and hypertensive heart disease, to include as secondary to service-connected diabetes mellitus type II is remanded. The issue of a total disability rating based on individual unemployability (TDIU) due to service-connected disorders is remanded. FINDINGS OF FACT 1. The Appellant was not injured during a period of active duty for training (ACDUTRA) as to spinal degenerative arthritis, intervertebral disc syndrome, sacroiliac injury, spinal stenosis, spondylolisthesis, and osteoarthritis. 2. The Appellant does not have a current diagnosis of arteriosclerotic heart disease. 3. The Appellant does not have a current diagnosis of atherosclerotic renal disease. 4. The Appellant does not have a current diagnosis of hypertensive vascular disease. 5. The Appellant does not have a current diagnosis of irritable bowel syndrome. 6. The Appellant does not have a current diagnosis of prostatitis. 7. The Appellant does not have a current diagnosis of hydronephrosis. 8. The Appellant does not have a current diagnosis of Peyronie's disease. 9. The Appellant does not have a current diagnosis of ureterolithiasis. 10. The Appellant does not have a current diagnosis of a renal disorder. 11. The Appellant's obstructive sleep apnea was not caused by service. 12. For the entirety of the rating period on appeal, the Appellant's diabetes mellitus type II required treatment with a restricted diet, prescribed oral hypoglycemic agent(s), and one required insulin injection per day. 13. For the entirety of the rating period on appeal, the Appellant's right upper extremity diabetic peripheral neuropathy manifested as incomplete paralysis of mild severity. 14. For the entirety of the rating period on appeal, the Appellant's left upper extremity diabetic peripheral neuropathy manifested as incomplete paralysis of mild severity. 15. With resolution of the doubt in his favor, for the entirety of the rating period on appeal, the Appellant's right lower extremity diabetic peripheral neuropathy manifested as incomplete paralysis of moderate severity. 16. With resolution of the doubt in his favor, for the entirety of the rating period on appeal, the Appellant's left lower extremity diabetic peripheral neuropathy manifested as incomplete paralysis of moderate severity. 17. The Appellant did not submit any claim or application prior to the September 24, 2015 informal claim for compensation concerning service connection for diabetes mellitus type II, right and left upper extremity diabetic peripheral neuropathy, and right and left lower extremity diabetic peripheral neuropathy. CONCLUSIONS OF LAW 1. The Appellant does not have "veteran status" as to the periods of active duty for training, to establish service connection for spine degenerative arthritis, intervertebral disc syndrome, sacroiliac injury, spinal stenosis, spondylolisthesis, and osteoarthritis have not been met. 38 U.S.C. §§ 101(2), (22), (24), 1110; 38 C.F.R. §§ 3.6(a), (c), 3.303(d). 2. The criteria to establish service connection for arteriosclerotic heart disease have not been met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303(d), 3.309(a). 3. The criteria to establish service connection for atherosclerotic renal disease have not been met. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(d). 4. The criteria to establish service connection for hypertensive vascular disease have not been met. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(d). 5. The criteria to establish service connection for irritable bowel syndrome have not been met. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(d). 6. The criteria to establish service connection for prostatitis have not been met. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(d). 7. The criteria to establish service connection for hydronephrosis have not been met. 38 U.S.C. § 1110; 38 C.F.R. § 3.310. 8. The criteria to establish service connection for Peyronie's disease have not been met. 38 U.S.C. § 1110; 38 C.F.R. § 3.310. 9. The criteria to establish service connection for ureterolithiasis have not been met. 38 U.S.C. § 1110; 38 C.F.R. § 3.310. 10. The criteria to establish service connection for a renal disorder have not been met. 38 U.S.C. § 1110; 38 C.F.R. § 3.310. 11. The criteria to establish service connection for obstructive sleep apnea have not been met. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(d). 12. The criteria to establish an initial rating higher than 20 percent for the entirety of the rating period on appeal for diabetes mellitus type II have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.7, 4.119, Diagnostic Code (DC) 7913. 13. The criteria to establish an initial rating higher than 10 percent from September 24, 2015 to December 13, 2020 and an increased rating higher than 20 percent from December 14, 2020 and continuing thereafter for right upper extremity diabetic peripheral neuropathy have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.124a, DCs 8513, 8516. 14. The criteria to establish an initial rating higher than 10 percent from September 24, 2015 to December 13, 2020 and an increased rating higher than 20 percent from December 14, 2020 and continuing thereafter for left upper extremity diabetic peripheral neuropathy have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.124a, DCs 8513, 8516. 15. The criteria to establish a 20 percent initial rating from September 24, 2015 and continuing thereafter for right lower extremity diabetic peripheral neuropathy have been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.124a, DC 8520. 16. The criteria to establish a 20 percent initial rating from September 24, 2015 and continuing thereafter for left lower extremity diabetic peripheral neuropathy have been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.124a, DC 8520. 17. The criteria to establish effective dates prior to September 24, 2015 for the grant of service connection for diabetes mellitus type II, right and left upper extremity diabetic peripheral neuropathy, and right and left lower extremity diabetic peripheral neuropathy have not been met. 38 U.S.C. § 5101(a); 38 C.F.R. §§ 3.155(b), 3.400. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Appellant served on active duty in the U.S. Army from June 6, 1968 to December 1971. This matter comes before the Board of Veterans' Appeals (Board) on appeal from rating decisions dated May 2017 and August 2017 of the Detroit, Michigan Regional Office (RO). The Appellant is in receipt of special monthly compensation (SMC) under 38 U.S.C. § 1114(k) and 38 C.F.R. § 3.350(a) on account of loss of use of a creative organ from September 24, 2015; and SMC under 38 U.S.C. § 1114(s) and 38 C.F.R. § 3.350(i) on account of major vascular neurocognitive disorder rated 100 percent and additional service-connected disabilities of diabetic peripheral neuropathy, right upper extremity, diabetic peripheral neuropathy, left upper extremity, diabetes mellitus type II with erectile dysfunction, diabetic peripheral neuropathy, left lower extremity, diabetic peripheral neuropathy, right lower extremity, independently ratable at 60 percent or more from December 14, 2020. Veteran Status Generally, to qualify for VA benefits, a claimant must be a "veteran" under the law. Dingess v. Nicholson, 19 Vet. App. 473, 484 (2006). Under 38 U.S.C. § 101(2) a "veteran" is defined as "a person who served in the active military, naval, or air service, and who was discharged or released therefrom under conditions other than dishonorable." Under the law, the term "active military, naval, or air service" includes: (1) active duty, (2) any period of active-duty training (ACDUTRA) during which the individual concerned was disabled or died from a disease or injury incurred or aggravated in line of duty, and (3) any period of inactive duty training (INACDUTRA) during which the individual concerned was disabled or died from an injury incurred or aggravated in line of duty. ACDUTRA is defined, in part, as "full-time duty in the Armed Forces performed by reserves for training purposes." 38 U.S.C. § 101(22); 38 C.F.R. § 3.6(c). VA has not defined the term "injury" in regulations. However, the VA Office of General Counsel indicated that an injury is "harm resulting from some type of external trauma." VAOPGCPREC 1-2017; VAOPGC 6-86 (referring to injury as resulting from external trauma, i.e., application of external force or violence). Spine degenerative arthritis, intervertebral disc syndrome, sacroiliac injury, spinal stenosis, spondylolisthesis, and osteoarthritis The Appellant asserts he sustained a spinal injury during a period of ACDUTRA in 1982 resulting in degenerative arthritis, intervertebral disc syndrome (IVDS), sacroiliac injury, spinal stenosis, spondylolisthesis, and osteoarthritis. The claims will be denied because the Appellant did not undergo an "injury" during his period of ACDUTRA, and therefore, has not achieved "veteran" status during ACDUTRA. In a June 2016 statement, the Appellant alleged he had a back injury during air assault training with the Army Reserve in 1982. The Appellant indicated he had to mount and climb a rope ladder, along with tactical gear, attached to a hovering helicopter. The Appellant alleges he was 10 feet above the ground, a fellow service-member above the Appellant allegedly slipped and fell on the Appellant forcing both to the ground. The Appellant reported that "we hit the ground hard. I knew I had hurt my back." The Appellant also reported seeking medical treatment with a non-VA medical doctor, "O.D. Anderson, M.D," and the Appellant was told he had an "injury to my lower back." However, the Appellant noted that O.D Anderson has died and the medical records "are no longer available ... just my statement for your consideration." The Appellant reported having "continuous back pain over the last 30 years of my life." A May 1982 military personnel record (MPR) titled "Certificate of Training" with the 101st Airborne Division (Air Assault) reflects the Appellant completed the combat assault, rappelling, rigging, and sling loading phases of the Air Assault School. However, in the Appellant's August 1982 and September 1986 Army Reserve medical examination report, the service medical examiner found no spine abnormalities. In his August 1982 and September 1986 Army Reserve medical history report, the Appellant answered "no" to the question of whether he then had, or once had recurrent back pain or arthritis, and answered "no" to the question of whether he ever had any illness or injury other than those already noted. These medical records are highly probative both as to the Appellant's subjective reports and their resulting objective findings. They were generated with a view towards ascertaining the Appellant's then self-reported and clinically reported state of physical fitness and are akin to statements of diagnosis or treatment. Rucker v. Brown, 10 Vet.App. 67, 73 (1997) (observing that although formal rules of evidence do not apply before the Board, recourse to the Federal Rules of Evidence may be appropriate if it assists in the articulation of the reasons for the Board's decision); see also LILLY'S: AN INTRODUCTION TO THE LAW OF EVIDENCE, 2nd Ed. (1987), pp. 245-46 (many state jurisdictions, including the federal judiciary and Federal Rule 803(4), expand the hearsay exception for physical conditions to include statements of past physical condition on the rationale that statements made to physicians for purposes of diagnosis and treatment are exceptionally trustworthy since the declarant has a strong motive to tell the truth in order to receive proper care); see also AZ v. Shinseki, 731 F. 3d 1303, 1315 (Fed. Cir. 2013) (finding that the absence of an entry in a record may be considered evidence that a fact did not occur if the fact would have been recorded if present); Kahana v. Shinseki, 24 Vet.App. 428, 440 (2011) (Lance, J., concurring) (holding that silence in the STRs can constitute "contradictory" evidence weighing against the credibility of a claimant's testimony if the STRs are complete "in relevant part," and there is competent evidence that the claimed "injury, disease, or related symptoms would ordinarily have been recorded had they occurred"). The May 1982 Certificate of Training indicates that the Appellant was on ACDUTRA in May 1982. However, the Appellant's account of a back injury during ACDUTRA is not credible. The Appellant claims having "chronic low back pain since the air assault incident in 1982" and his non-VA treatment records concerning the alleged injury are not available; however, service medical examiners in 1982 and 1986 specifically found no spine abnormalities, the Appellant equally specifically denied having any recurrent back pain, and the Appellant denied having any injury other than those already noted. Curry v. Brown, 7 Vet. App. 59 (1994) (noting that contemporaneous evidence has greater probative value than history as reported by the veteran). Put plainly, either the Appellant was not telling the truth when he reported to the service department in August 1982 and September 1986 that he was physically fit and had no back abnormalities, or he is not telling the truth now when he is attempting to receive VA compensation. Although the Appellant conducted air assault training during a period of ACDUTRA in 1982, the Appellant is not credible in his account of an injury during this period of ACDUTRA resulting in his claimed back disorders. Therefore, "veteran" status has not been established for the period of ACDUTRA concerning degenerative arthritis, IVDS, sacroiliac injury, spinal stenosis, spondylolisthesis, and osteoarthritis. The Appellant has not asserted a spine injury as to his period of active duty. Service Connection Service connection may be granted for a current disability arising from a disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110. Service connection may be granted for any disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of an 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 current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Arteriosclerotic heart disease, atherosclerotic renal disease, hypertensive vascular disease, irritable bowel syndrome A veteran who, during active military, naval, or air service, served between April 1, 1968, and August 31, 1971, in a unit that, as determined by the Department of Defense (DOD), operated in or near the Korean Demilitarized Zone (DMZ) in an area in which herbicides are known to have been applied during that period, shall be presumed to have been exposed during service to an herbicide agent, unless there is affirmative evidence to establish that the veteran was not exposed to any such agent during that service. 38 C.F.R. § 3.307(a)(6)(iv). A MPR titled "Oversea Service" shows that the Appellant served in Korea from January 10, 1971 to December 5, 1971. The report of separation from the armed forces (DD Form 214) reflects the Appellant's duty specialty of infantry unit commander, and his last duty assignment and major command as Battery C, 8th Battalion, 61st Artillery, 2d Infantry Division, Korea. A MPR titled "U.S. Army Officer Efficiency Report" dated February 6, 1971 shows the Appellant's unit, organization, and station as "Headquarters Company 1st Battalion, 9th Infantry, 2d Infantry Division (Eighth U.S. Army)." The Appellant served in Korea during the presumptive period and DOD has identified the Appellant's unit 1st Battalion, 9th Infantry, 2d Infantry Division as having operated in or near the Korean DMZ in an area in which herbicide agents are known to have been applied. The Appellant is therefore presumed to have been exposed to herbicide agents. The Appellant asserts that his arteriosclerotic heart disease, atherosclerotic renal disease, hypertensive vascular disease, and irritable bowel syndrome resulted from his active-duty service. The claims will be denied. Arteriosclerotic heart disease is not listed as a disease associated with exposure to certain herbicide agents under 38 C.F.R. § 3.309(e) but arteriosclerotic heart disease, as arteriosclerosis, is listed as a chronic disease subject to presumptive service connection under § 3.309(a). Although two theories of entitlement to service connection apply presumptive service connection under § 3.309(a) and direct service connection due to presumed herbicide agent exposure the claim will be denied because the Appellant does not have a diagnosis of arteriosclerotic heart disease. Atherosclerotic renal disease, hypertensive vascular disease, and irritable bowel syndrome are not listed as chronic diseases subject to presumptive service connection nor as diseases associated with exposure to certain herbicide agents. 38 C.F.R. §§ 3.309(a), (e). A theory of direct service connection due to presumed herbicide agent exposure is applicable; however, the claims will be denied because the Appellant does not have a diagnosis of atherosclerotic renal disease, hypertensive vascular disease, or irritable bowel syndrome. STRs do not show complaints or contemporaneous reports as to arteriosclerotic heart disease, atherosclerotic renal disease, hypertensive vascular disease, or irritable bowel syndrome. In service medical history and examination reports dated August 1969, July 1978, August 1982, and September 1986, the Appellant answered "no" to the question of whether he then had, or once had chest pain or pressure, did not report symptoms pertaining to atherosclerotic renal disease, answered "no" to the question of whether he then had, or once had high or low blood pressure, answered "no" to the question of whether he then had, or once had stomach trouble and service medical examiners noted no heart abnormalities, kidney abnormalities, vascular system abnormalities, or stomach abnormalities, respectively. The STRs are highly probative evidence. Rucker, 10 Vet. App. at 73. As to atherosclerotic renal disease, an April 2003 non-VA treatment record titled "Cardiovascular Associates of Lake County, P.A." authored by Moises Fraifeld, M.D., noted "no evidence of renal artery stenosis." A June 2003 non-VA treatment record titled "Florida Hospital Waterman" authored by Dr. Fraifeld noted "no evidence of renal artery stenosis." As to arteriosclerotic heart disease, a September 2003 VA treatment record noted "no heart disease." As to irritable bowel syndrome, a May 2004 VA treatment record noted a prior medical history of irritable bowel syndrome based on the Appellant's report but the VA treating physician did not diagnose the Appellant with irritable bowel syndrome. The Appellant is not competent, as a lay person, to provide a medical diagnosis of irritable bowel syndrome and the Appellant's non-competent, unsubstantiated report of an irritable bowel syndrome diagnosis does not serve to verify the diagnosis. 38 C.F.R. § 3.159(a)(1); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Swann v. Brown, 5 Vet. App. 229, 233 (1993). During the April 2017 and January 2021 VA heart conditions examination, the Appellant was diagnosed with other heart disorders but not with arteriosclerotic heart disease. The Appellant is not competent, as a lay person, to provide a medical diagnosis of arteriosclerotic heart disease. 38 C.F.R. § 3.159(a)(1); Jandreau, 492 F.3d at 1372. The law is well settled that in the absence of proof of a current disability, there can be no valid claim. Boyer v. West, 210 F.3d 1351 (Fed. Cir. 2000); Brammer v. Derwinski, 3 Vet. App. 223 (1992). During the January 2021 VA kidney conditions examination, the Appellant was diagnosed with other kidney disorders but not with atherosclerotic renal disease. During the January 2021 VA central nervous system and neuromuscular diseases examination, the examiner noted the Appellant's diagnosis of posterior acute stroke as a vascular disease; however, the examiner did not diagnose the Appellant with hypertensive vascular disease and the Appellant's posterior acute stroke residuals are presently service connected. 38 C.F.R. § 3.159(a)(1); Jandreau, 492 F.3d at 1372; Boyer, 210 F.3d at 1351. A VA examination to determine whether the Appellant's claimed irritable bowel syndrome is related to his presumed exposure to herbicide agents is not warranted because the Appellant has not submitted competent evidence of a current diagnosis of irritable bowel syndrome. McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). The evidence is not in approximate balance between that favoring the claims and against the claims. STRs do not show complaints or contemporaneous reports pertaining to arteriosclerotic heart disease, atherosclerotic renal disease, hypertensive vascular disease, or irritable bowel syndrome and service medical examiners noted no heart, kidney, vascular system, or stomach abnormalities. The Appellant is not competent to provide a medical diagnosis of arteriosclerotic heart disease, atherosclerotic renal disease, hypertensive vascular disease, or irritable bowel syndrome. Two VA examiners indicated that the Appellant did not have a diagnosis of arteriosclerotic heart disease. The January 2021 VA examiner indicated that the Appellant did not have a diagnosis of atherosclerotic renal disease or hypertensive vascular disease. There is no reasonable doubt, and the claims are denied. Prostatitis STRs do not show complaints or contemporaneous reports pertaining to prostatitis. In service medical history and examination reports dated August 1969, July 1978, August 1982, and September 1986, the Appellant answered "no" to the question of whether he then had, or once had frequent or painful urination and service medical examiners found no genitourinary abnormalities, respectively. As discussed above, the STRs are highly probative evidence. Rucker, 10 Vet. App. at 73. A March 2003 non-VA treatment record titled "Cardiovascular Associates of Lake County, P.A." authored by Moises Fraifeld, M.D., reflects an impression of prostatitis. A May 2004 VA treatment record reflects a history of prostatitis but no diagnosis of prostatitis at that time. The Appellant submitted and VA received the Appellant's VA Form 21-526, Application for Compensation as to service connection for prostatitis in June 2016. A May 2020 non-VA treatment record titled "AdventHealth Waterman" authored by Linda Nguyen, M.D., noted the Appellant's prior medical history of prostatitis but no diagnosis of prostatitis at that time. During the January 2021 VA male reproductive organ conditions examination, the examiner noted that the Appellant did not have a current diagnosis of prostatitis. The January 2021 VA examination is adequate and highly probative because the examiner considered the Appellant's prior medical history as evidenced by referring to the lack of treatment for or a diagnosis of prostatitis during service and physically examined the Appellant. Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007); Ardison v. Brown, 6 Vet. App. 405, 407 (1994); Monzingo v. Shinseki, 26 Vet. App. 97, 105 (2012). In McClain v. Nicholson, 21 Vet. App. 319, 321 (2007), the U.S Court of Appeals for Veterans' Claims (Court) held that the current disability requirement is satisfied when the claimant has a disability at the time the claim is filed or during the pendency of the appeal even though the disability may resolve prior to adjudication. In Romanowsky v. Shinseki, 26 Vet. App. 289 (2013), the Court held that when the record contains a recent diagnosis of disability prior to a veteran filing a claim for benefits based on that disability, the report of diagnosis is relevant evidence that the Board must address in determining whether a current disability existed at the time the claim was filed or during its pendency. In footnote (3) accompanying the holding, the Court noted that "a determination that a diagnosis is sufficiently proximate to the filing of a claim so as to constitute evidence of a 'current diagnosis' is a factual finding to be made by the Board in the first instance." Romanowsky, 26 Vet App. at 289 (citing Elkins v. Gober, 229 F.3d 1369, 1377 (Fed. Cir. 2000). The Appellant's March 2003 diagnosis of prostatitis is not sufficiently proximate to the filing of his June 2016 claim so as to constitute evidence of a "current diagnosis" of prostatitis. The Board notes that in Romanowsky, the claimant was diagnosed with a psychiatric disorder in May 2008 and filed a claim for a psychiatric disorder in November 2008 approximately 6 months after the initial diagnosis. As noted, a March 2003 non-VA treatment record reflects an impression of prostatitis. The Appellant submitted and VA received the Appellant's VA Form 21-526, Application for Compensation as to service connection for prostatitis in June 2016 approximately 13 years since the March 2003 diagnosis of prostatitis. Subsequent VA and non-VA treatment records noted a history of prostatitis but no diagnosis of prostatitis was made at that time. The January 2021 VA examiner indicated that the Appellant did not have a current diagnosis of prostatitis. The evidence is not in approximate balance between that favoring the claim and against the claim. STRs do not show complaints or contemporaneous reports pertaining to prostatitis. In service medical history and examination reports dated August 1969, July 1978, August 1982, and September 1986, the Appellant answered "no" to the question of whether he then had, or once had frequent or painful urination and service medical examiners found no genitourinary abnormalities. The January 2021 VA examiner noted that the Appellant did not have a current diagnosis of prostatitis. There is no reasonable doubt, and the claim is denied. Hydronephrosis, Peyronie's disease, ureterolithiasis, and renal disorder Service connection shall be granted on a secondary basis under 38 C.F.R. § 3.310 where it is demonstrated that a service-connected disorder caused or aggravated a nonservice-connected disability. Allen v. Brown, 7 Vet. App. 439 (1995). The Appellant asserts that his hydronephrosis, Peyronie's disease, ureterolithiasis, and renal disorder was caused or aggravated by service-connected diabetes mellitus type II. The claims will be denied because the Appellant does not have a diagnosis of hydronephrosis, Peyronie's disease, ureterolithiasis, or a renal disorder. VA treatment records dated July 2007 and February 2011 noted a prior medical history of Peyronie's disease based on the Appellant's report but the VA treating physician did not diagnose the Appellant with Peyronie's disease. The Appellant is not competent, as a lay person, to provide a medical diagnosis of Peyronie's disease and the Appellant's non-competent, unsubstantiated report of a Peyronie's disease diagnosis does not serve to verify the diagnosis. 38 C.F.R. § 3.159(a)(1); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Swann v. Brown, 5 Vet. App. 229, 233 (1993). An October 2010 VA chest, abdomen, and pelvic radiograph revealed "there is no hydronephrosis." During the January 2021 VA male reproductive organ conditions examination, the examiner noted that the Appellant's penis was normal and there was no "penis deformity (such as Peyronie's disease)." During the January 2021 VA kidney conditions examination, the examiner diagnosed the Appellant with kidney disorders but indicated that the Appellant did not have a diagnosis of hydronephrosis, ureterolithiasis, or a renal disorder. The evidence is not in approximate balance between that favoring the claims and against the claims. The Appellant is not competent to provide a medical diagnosis of hydronephrosis, Peyronie's disease, ureterolithiasis, and renal disorder. The January 2021 VA examiner indicated that the Appellant did not have a diagnosis of hydronephrosis, Peyronie's disease, ureterolithiasis, or a renal disorder. There is no reasonable doubt, and the claims are denied. Obstructive sleep apnea The Appellant asserts that his obstructive sleep apnea (OSA) was caused by service. The claim will be denied. STRs do not show complaints or contemporaneous concerning the Appellant's throat or trouble sleeping. In service medical examination and history reports dated August 1969, July 1978, August 1982, and September 1986, service medical examiners found no throat abnormalities and the Appellant answered "no" to the question of whether he then had, or once had frequent trouble sleeping. In April 2003, the Appellant underwent a non-VA sleep study. The Appellant weighed 240 pounds and was diagnosed with "sleep apnea, dyspnea." During the January 2021 VA sleep apnea examination, the Appellant reported trouble sleeping, snoring, and daytime fatigue onset in 2003. The examiner diagnosed the Appellant with OSA with an initial date of diagnosis of 2003. The examiner opined that the Appellant's OSA was not caused by service for several reasons. The examiner indicated that the STRs did not show a treatment for or a diagnosis of OSA, there was no documented treatment for OSA for approximately 24 years post-service, and OSA is caused by blockage of the upper airway by soft tissue in the back of the throat during sleep and the Appellant has contributing factors of OSA, to include central obesity and suspected high body mass index (BMI). The January 2021 VA opinion is highly probative because the examiner considered the Appellant's prior medical history as evidenced by referring to the lack of treatment for or a diagnosis of OSA during service and noted that the Appellant's report of onset of symptoms and diagnosis of OSA in 2003; the examiner described the Appellant's OSA in sufficient detail as evidenced by noting that the Appellant was initially diagnosed with OSA in 2003 and attributed the Appellant's OSA to risk factors such as the Appellant's central obesity and BMI; and provided a negative etiology opinion based on an accurate and complete understanding of the Appellant's medical history with sufficient rationale. Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007); Ardison v. Brown, 6 Vet. App. 405, 407 (1994); Monzingo v. Shinseki, 26 Vet. App. 97, 105 (2012). The evidence is not in approximate balance between that favoring the claim and against the claim. STRs do not show complaints or contemporaneous concerning the Appellant's throat or trouble sleeping. In service medical examination and history reports dated August 1969, July 1978, August 1982, and September 1986, service medical examiners found no throat abnormalities and the Appellant answered "no" to the question of whether he then had, or once had frequent trouble sleeping. The January 2021 VA examiner opined that the Appellant's obstructive sleep apnea was not caused by service. Significantly, no competent medical provider has opined otherwise. There is no reasonable doubt, and the claim is denied. Initial and Increased Ratings Disability evaluations are determined by comparing the Veteran's current symptomatology with the criteria set forth in the Schedule for Rating Disabilities. 38 U.S.C. § 1155. Diagnostic Codes ("DCs") designate service-connected disorders. When there is a question as to which of two disability evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower evaluation will be assigned. 38 C.F.R. § 4.7. Diabetes mellitus type II Under DC 7913, a 20 percent rating is assigned for requiring one or more daily injection of insulin and restricted diet, or; oral hypoglycemic agent and restricted diet. 38 C.F.R. § 4.119, DC 7913. A 40 percent rating is assigned for requiring one or more daily injection of insulin, restricted diet, and regulation of activities. Id. A 60 percent rating is assigned for requiring one or more daily injection of insulin, restricted diet, and regulation of activities with episodes of ketoacidosis or hypoglycemic reactions requiring one or two hospitalizations per year or twice a month visits to a diabetic care provider, plus complications that would be compensable if separately evaluated. Id. A 100 percent rating is assigned for requiring more than one daily injection of insulin, restricted diet, and regulation of activities (avoidance of strenuous occupational and recreational activities) with episodes of ketoacidosis or hypoglycemic reactions requiring at least three hospitalizations per year or weekly visits to a diabetic care provider, plus either progressive loss of weight and strength or complications that would be compensable if separately evaluated. Id. Note (1) to DC 7913 provides that compensable complications of diabetes are to be rated separately unless they are part of the criteria used to support a 100 percent rating under DC 7913. Id. Noncompensable complications are considered part of the diabetic process under DC 7913. Id. The criteria for rating diabetes mellitus type II are conjunctive, meaning that each element of the criteria is needed to meet the requirements for the specified evaluation. Camacho v. Nicholson, 21 Vet. App. 360 (2007); Melson v. Derwinski, 1 Vet. App. 334 (1991) (use of the conjunctive "and" in a statutory provision means that all the conditions listed in the provision must be met). The Appellant's diabetes mellitus type II (DM) is rated 20 percent disabling from September 24, 2015 and continuing thereafter under DC 7913. The appellate period is from September 24, 2015. During the April 2017 VA DM examination, the examiner noted the Appellant's treatment for DM includes a restricted diet and prescribed oral hypoglycemic agent(s). The examiner noted that insulin was not required as treatment and that the Appellant did not require regulation of activities as part of medical management of DM. The Appellant visits his diabetic care provider for episodes of ketoacidosis and hypoglycemia less than two times per month. The examiner noted zero episodes of ketoacidoses and hypoglycemia that required hospitalization over the past 12 months. The Appellant had no progressive unintentional weight loss and loss of strength attributable to DM. The examiner noted diabetic peripheral neuropathy as a recognized complication of DM and the Board notes that the Appellant is service-connected for bilateral upper and lower extremity diabetic peripheral neuropathy. There were no other pertinent physical findings. During the January 2021 VA DM examination, the examiner noted the Appellant's treatment for DM includes a restricted diet and one required insulin injection per day. The examiner noted that prescribed oral hypoglycemic agent(s) was not required as treatment and that the Appellant did not require regulation of activities as part of medical management of DM. The Appellant visits his diabetic care provider for episodes of ketoacidosis and hypoglycemia less than two times per month. The examiner noted zero episodes of ketoacidoses and hypoglycemia that required hospitalization over the past 12 months. The Appellant had no progressive unintentional weight loss and loss of strength attributable to DM. The evidence is not in approximate balance between that favoring the claim and against the claim. For the entirety of the rating period on appeal, the Appellant's treatment for DM included a restricted diet, prescribed oral hypoglycemic agent(s), and one required insulin injection per day. Two VA examiners indicated that the Appellant did not require regulation of activities as part of medical management of DM and the Appellant has not submitted competent medical evidence indicating otherwise. There is no reasonable doubt, and the claim is denied. Right and left upper extremity diabetic peripheral neuropathy Under DC 8516, a 10 percent rating is assigned for incomplete paralysis of the ulnar nerve of mild severity for the minor and major extremity. 38 C.F.R. § 4.124a, DC 8516. A 20 percent rating is assigned for incomplete paralysis of the ulnar nerve of moderate severity for the minor extremity and a 30 percent rating for the major extremity. Id. A 30 percent rating is assigned for incomplete paralysis of the ulnar nerve of severe severity for the minor extremity and a 40 percent rating for the major extremity. Id. A 50 percent rating is assigned for complete paralysis of the ulnar nerve resulting in the "griffin claw" deformity, due to flexor contraction of ring and little fingers, atrophy very marked in dorsal interspace and thenar and hypothenar eminences; loss of extension of ring and little fingers cannot spread the fingers (or reverse), cannot adduct the thumb; flexion of wrist weakened for the minor extremity and a 60 percent for the major extremity. Id. Under DC 8513, a 20 percent rating is assigned for incomplete paralysis of all radicular groups of mild severity for the minor and major extremity. 38 C.F.R. § 4.124a, DC 8513. A 30 percent rating is assigned for incomplete paralysis of all radicular groups of moderate severity for the minor extremity and a 40 percent rating for the major extremity. Id. A 60 percent rating is assigned for incomplete paralysis of all radicular groups of severe severity for the minor extremity and a 70 percent rating for the major extremity. Id. An 80 percent rating is assigned for complete paralysis of all radicular groups for the minor extremity and a 90 percent rating for major extremity. Id. The term "incomplete paralysis," with this and other peripheral nerve injuries indicates a degree of lost or impaired function substantially less than the type of picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. 38 C.F.R. § 4.124a. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. Id. Neurological conditions are ordinarily to be rated in proportion to the impairment of motor, sensory, or mental function. 38 C.F.R. § 4.120. Complete or partial loss of one or more extremities, disturbances of gait, tremors, visceral manifestations, etc. are to be considered in rating such disabilities. Id. In rating peripheral nerve injuries and their residuals, attention should be given to the side and character of the injury, the relative impairment in motor function, trophic changes, or sensory disturbances. Id. Words such as "mild," "moderate," and "severe" are not defined in the Rating Schedule. Rather than applying a mechanical formula, VA must evaluate all the evidence to the end that decision will be equitable and just. 38 C.F.R. § 4.6. Although the use of similar terminology by medical professionals should be considered, such is not dispositive of an issue. Id. Instead, all evidence must be evaluated in arriving at a decision regarding a request for a higher disability rating. 38 C.F.R. §§ 4.2, 4.6. The Appellant's right and left upper extremity diabetic peripheral neuropathy is rated 10 percent disabling from September 24, 2015 to December 13, 2020 under DC 8516 and 20 percent disabling from December 14, 2020 and continuing thereafter under DC 8513. The Appellant's right upper extremity is the major extremity and left upper extremity is the minor extremity as shown in VA examinations. The appellate period for both claims is from September 24, 2015. During the April 2017 VA diabetic sensory-motor peripheral neuropathy examination, the Appellant was noted as right hand dominant. The examiner noted bilateral upper extremity symptoms of mild constant pain, no intermittent pain, mild paresthesias, and mild numbness. Muscle strength, deep tendon reflex, position sense, vibration sensation, and cold sensation testing for the Appellant's bilateral upper extremities revealed normal findings. Light touch testing for the bilateral shoulders was normal but revealed decreased findings for both forearms and hands. There was no muscle atrophy or trophic changes. The examiner noted the Appellant's right and left upper extremity diabetic peripheral neuropathy as incomplete paralysis of mild severity. During the January 2021 VA diabetic sensory-motor peripheral neuropathy examination, the Appellant was noted as right hand dominant. The examiner noted bilateral upper extremity symptoms of no constant pain, no intermittent pain, mild paresthesias, and mild numbness. Muscle strength and deep tendon reflex testing for the Appellant's bilateral upper extremities was normal. Light touch testing for the bilateral shoulders and forearms was normal but revealed decreased findings for both hands. Vibration sensation and cold sensation testing revealed decreased findings. There was no muscle atrophy or trophic changes. The examiner noted the Appellant's right and left upper extremity diabetic peripheral neuropathy as incomplete paralysis of mild severity. The evidence is not in approximate balance between that favoring the claims and against the claims. For the entirety of the rating period on appeal concerning DCs 8516 and 8513, VA examinations noted the Appellant's right and left upper extremity diabetic peripheral neuropathy as incomplete paralysis of mild severity. The Appellant has not submitted competent evidence indicating otherwise. There is no reasonable doubt, and the claims are denied. Right and left lower extremity diabetic peripheral neuropathy Under DC 8520, ratings of 10, 20, 40, and 60 percent are assigned for mild, moderate, moderately severe, and severe, with marked muscular atrophy incomplete paralysis of the sciatic nerve, respectively. 38 C.F.R. § 4.124a, DC 8520. A maximum 80 percent rating is assigned for complete paralysis of the sciatic nerve where the foot dangles and drops, no active movement is possible of muscle below the knee, and flexion of the knee is weakened or (very rarely) lost. Id. The Appellant's right and left lower extremity diabetic peripheral neuropathy is rated 10 percent disabling from September 24, 2015 and continuing thereafter under DC 8520. The appellate period for both claims is from September 24, 2015. During the April 2017 VA diabetic sensory-motor peripheral neuropathy examination, the examiner noted bilateral lower extremity symptoms of moderate constant pain, no intermittent pain, moderate paresthesias, and moderate numbness. Muscle strength, deep tendon reflex, and position sense testing revealed normal findings. Light touch, vibration sensation, and cold sensation testing revealed decreased findings. There was no muscle atrophy, trophic changes, or other pertinent physical findings. The examiner noted the Appellant's right and left lower extremity diabetic peripheral neuropathy as incomplete paralysis of moderate severity. During the January 2021 VA diabetic sensory-motor peripheral neuropathy examination, the examiner noted bilateral lower extremity symptoms of no constant pain, mild intermittent pain, mild paresthesias, and moderate numbness. Muscle strength and deep tendon reflex testing revealed normal findings. Light touch, vibration sensation, and cold sensation testing revealed decreased findings. There was no muscle atrophy, trophic changes, or other pertinent physical findings. The examiner noted the Appellant's right and left lower extremity diabetic peripheral neuropathy as incomplete paralysis of mild severity. The examiner also noted that the Appellant's bilateral lower extremity sensory neuropathy was of moderate severity. Based on the benefit-of-the-doubt doctrine, the Board will grant an initial 20 percent for the entirety of the rating period on appeal for the Appellant's right and left lower extremity diabetic peripheral neuropathy under DC 8520. The April 2017 VA examiner noted the Appellant's right and left lower extremity diabetic peripheral neuropathy as incomplete paralysis of moderate severity. Although the January 2021 VA examiner noted the Appellant's right and left lower extremity diabetic peripheral neuropathy as incomplete paralysis of mild severity, the examiner also noted that the Appellant's bilateral lower extremity sensory neuropathy was of moderate severity. The Board will resolve all reasonable doubt in favor of the Appellant. Therefore, higher initial ratings are warranted, and the claims are in part granted. Effective Date Except as otherwise provided, the effective date of an evaluation and award of pension, compensation, or dependency and indemnity compensation based on an initial claim or supplemental claim will be the date of receipt of the claim or the date entitlement arose, whichever is the later. 38 C.F.R. § 3.400. A claimant, his or her duly authorized representative, a Member of Congress, or some person acting as next friend of claimant who is not of full age or capacity may indicate a claimant's desire to file a claim for benefits by submitting an intent to file a claim to VA. An intent to file a claim must provide sufficient identifiable or biographical information to identify the claimant. Upon receipt of the intent to file a claim, VA will furnish the claimant with the appropriate application form prescribed by the Secretary. If VA receives a complete application form prescribed by the Secretary, as defined in paragraph (a) of § 3.160, appropriate to the benefit sought within 1 year of receipt of the intent to file a claim, VA will consider the complete claim filed as of the date the intent to file a claim was received. 38 C.F.R. § 3.155(b). Diabetes mellitus type II, and bilateral upper and lower extremity diabetic peripheral neuropathy On September 25, 2014, the Appellant submitted, and VA received an intent to file a claim of service connection. On October 2, 2015, VA notified the Appellant of receiving his informal claim on September 24, 2014, rather than September 25, 2014, and advised the Appellant to complete and return the enclosed VA Form 21-526, Application for Compensation within one year from the date of the letter. On June 13, 2016, the Appellant submitted, and VA received the VA Form 21-526, Application for Compensation concerning claims of service connection for diabetes mellitus type II, right and left upper extremity diabetic peripheral neuropathy, and right and left lower extremity diabetic peripheral neuropathy. The evidence is not in approximate balance between that favoring the claims and against the claims. On October 2, 2015, VA notified the Appellant of receiving his informal claim on September 24, 2015 and the Appellant submitted a complete application form on June 13, 2016 within one year from the date of the VA letter. The claims file does not show any claim or application for VA compensation submitted by the Appellant or received by VA prior to September 24, 2015. There is no basis for the assignment of earlier effective dates, no reasonable doubt, and the claims are denied. REASONS FOR REMAND The remaining matters are remanded for the following actions: 1. BACKGROUND FOR THE RO ADJUDICATOR The claims of service connection for chronic obstructive pulmonary disease, diverticulitis, inguinal hernia, and residuals of a large intestine resection are remanded under VA's duty to assist to provide a medical examination under 38 C.F.R. § 3.159(c)(4)(i) and McLendon v. Nicholson, 20 Vet. App. 79 (2006). Remand is warranted for VA examinations and medical opinions. The claim of service connection for a heart disorder, to include hypertrophic cardiomyopathy and hypertensive heart disease is remanded under Barr v. Nicholson, 21 Vet. App. 303 (2007) and El-Amin v. Shinseki, 26 Vet. App. 136 (2013). The January 2021 VA opinion was inadequate because the examiner did not provide an etiology opinion as to the Appellant's hypertrophic cardiomyopathy and did not provide an opinion as to secondary service connection. Additionally, the Appellant's diagnosed heart disorders are listed as chronic diseases subject to presumptive service connection under 38 C.F.R. § 3.309(a). Remand is warranted for adequate VA medical opinions. The issue of a TDIU is inextricably intertwined with the remanded claims of service connection because the Appellant has not met the schedular criteria under 38 C.F.R. § 4.16(a) from September 24, 2015 to December 13, 2020. Tyrues v. Shinseki, 23 Vet. App. 166 (2009) (holding that claims are inextricably intertwined where the adjudication of one claim could have significant impact on the adjudication of another claim). THE REMAND DIRECTIVES FOLLOW. 2. Schedule the Appellant for a VA examination to assist in determining whether the Appellant's chronic obstructive pulmonary disease, diverticulitis, inguinal hernia, and residuals of a large intestine resection was caused by his exposure to Agent Orange during service in Korea at any point since June 2016. Chronic obstructive pulmonary disease: the examiner must express a fully explained opinion as to the following: Was the Appellant's chronic obstructive pulmonary disease caused by exposure to Agent Orange in Korea at any point since June 2016? The examiner must review the record as found in VA treatment reports and the electronic file. However, the record in substance indicates the following: The Appellant was on active military duty from June 1968 to December 1971. His service treatment records include his May 1968 pre-entrance medical examination and history report, which found no lung abnormalities and the Appellant answered "no" to the question of whether he then had, or once had shortness of breath, respectively. In an August 1969 service medical examination and history report, the service medical examiner found no lung abnormalities and the Appellant answered "no" to the question of whether he then had, or once had shortness of breath, respectively. Military personnel records show that the Appellant served in Korea from January 10, 1971 to December 5, 1971 with a unit identified by the Department of Defense as having operated in or near the Korean Demilitarized Zone in an area in which herbicide agents are known to have been applied. THE APPELLANT IS PRESUMED EXPOSED TO AGENT ORANGE. The Appellant was discharged from active duty in December 1971. In medical examinations and history reports dated July 1978, August 1982, and September 1986 for the Army Reserve, service medical examiners found no lung abnormalities and the Appellant answered "no" to the question of whether he then had, or once had shortness of breath, respectively. In a March 2020 non-VA treatment record titled "AdventHealth Waterman," the Appellant underwent a chest radiograph that revealed no active pulmonary disease and no focal infiltrate. In a May 2020 non-VA treatment record titled "AdventHealth Waterman," the Appellant underwent a chest radiograph that revealed "mild COPD type lung change." Diverticulitis: the examiner must express a fully explained opinion as to the following: Was the Appellant's diverticulitis caused by exposure to Agent Orange in Korea at any point since June 2016? The examiner must review the record as found in VA treatment reports and the electronic file. However, the record in substance indicates the following: The Appellant was on active military duty from June 1968 to December 1971. His service treatment records include his May 1968 pre-entrance medical examination and history report, which found no abdomen and viscera abnormalities and the Appellant answered "no" to the question of whether he then had, or once had intestinal trouble, respectively. In an August 1969 service medical examination and history report, the service medical examiner found no abdomen and viscera abnormalities and the Appellant answered "no" to the question of whether he then had, or once had intestinal trouble, respectively. Military personnel records show that the Appellant served in Korea from January 10, 1971 to December 5, 1971 with a unit identified by the Department of Defense as having operated in or near the Korean Demilitarized Zone in an area in which herbicide agents are known to have been applied. THE APPELLANT IS PRESUMED EXPOSED TO AGENT ORANGE. The Appellant was discharged from active duty in December 1971. In medical examinations and history reports dated July 1978, August 1982, and September 1986 for the Army Reserve, service medical examiners found no abdomen and viscera abnormalities and the Appellant answered "no" to the question of whether he then had, or once had intestinal trouble, respectively. A January 2011 VA colonoscopy revealed diverticulosis in the sigmoid colon. A May 2014 VA abdomen and pelvic radiograph revealed scattered diverticula in the sigmoid colon. Inguinal hernia: the examiner must express a fully explained opinion as to the following: Was the Appellant's inguinal hernia caused by exposure to Agent Orange in Korea at any point since June 2016? The examiner must review the record as found in VA treatment reports and the electronic file. However, the record in substance indicates the following: The Appellant was on active military duty from June 1968 to December 1971. His service treatment records include his May 1968 pre-entrance medical examination and history report, which found no abdomen and viscera abnormalities and the Appellant answered "no" to the question of whether he then had, or once had rupture/hernia, respectively. In an August 1969 service medical examination and history report, the service medical examiner found no abdomen and viscera abnormalities and the Appellant answered "no" to the question of whether he then had, or once had rupture/hernia, respectively. Military personnel records show that the Appellant served in Korea from January 10, 1971 to December 5, 1971 with a unit identified by the Department of Defense as having operated in or near the Korean Demilitarized Zone in an area in which herbicide agents are known to have been applied. THE APPELLANT IS PRESUMED EXPOSED TO AGENT ORANGE. The Appellant was discharged from active duty in December 1971. In medical examinations and history reports dated July 1978, August 1982, and September 1986 for the Army Reserve, service medical examiners found no abdomen and viscera abnormalities and the Appellant answered "no" to the question of whether he then had, or once had rupture/hernia, respectively. In an April 2003 non-VA treatment record titled "Lake Health Care Center, Inc." authored by Paul Austin, M.D., a physical abdomen examination revealed no hernias. A March 2015 VA treatment record reflects the Appellant's report of initially noticing one month prior, a symptomatic left inguinal hernia, and a physical examination revealed a right groin bulge. In November 2015, the Appellant underwent a VA laparoscopic inguinal hernia repair. The pre-operation diagnosis was bilateral inguinal hernia. The post-operation diagnosis was left indirect inguinal hernia, and right indirect and direct inguinal hernia. Residuals of a large intestine resection: the examiner must express a fully explained opinion as to the following: Were the Appellant's residuals of a large intestine resection caused by exposure to Agent Orange in Korea at any point since June 2016? The examiner must review the record as found in VA treatment reports and the electronic file. However, the record in substance indicates the following: The Appellant was on active military duty from June 1968 to December 1971. His service treatment records include his May 1968 pre-entrance medical examination and history report, which found no abdomen and viscera abnormalities and the Appellant answered "no" to the question of whether he then had, or once had intestinal trouble, respectively. In an August 1969 service medical examination and history report, the service medical examiner found no abdomen and viscera abnormalities and the Appellant answered "no" to the question of whether he then had, or once had intestinal trouble, respectively. Military personnel records show that the Appellant served in Korea from January 10, 1971 to December 5, 1971 with a unit identified by the Department of Defense as having operated in or near the Korean Demilitarized Zone in an area in which herbicide agents are known to have been applied. THE APPELLANT IS PRESUMED EXPOSED TO AGENT ORANGE. The Appellant was discharged from active duty in December 1971. In medical examinations and history reports dated July 1978, August 1982, and September 1986 for the Army Reserve, service medical examiners found no abdomen and viscera abnormalities and the Appellant answered "no" to the question of whether he then had, or once had intestinal trouble, respectively. In a December 2010 VA treatment, the Appellant underwent a colonoscopy resulting in resection and retrieval of a polyp. A November 2011 VA treatment record noted a history of colon cancer with resection in January 2011. An August 2013 VA treatment record noted a history of a resection in January 2011 and the Appellant was advised to follow-up in one year. After review of the file, the above summary of the evidence, and any examination and clinical testing, the examiner must express FULLY EXPLAINED opinions as to whether the Appellant's chronic obstructive pulmonary disease, diverticulitis, inguinal hernia, and residuals of a large intestine resection was caused by his exposure to Agent Orange in Korea at any point since June 2016. 3. Return the file to the examiner who conducted the January 2021 VA heart conditions examination for a file review and an addendum opinion. If the examiner is not available, have the record reviewed by an equally qualified physician. Ask the examiner to review the evidence and express fully explained opinions as to the following: (a) Did the Appellant's diagnosed heart disorders, to include hypertrophic cardiomyopathy and/or hypertensive heart disease manifest during service, (b) Did the Appellant's diagnosed heart disorders, to include hypertrophic cardiomyopathy and/or hypertensive heart disease manifest to a compensable degree within one year of service separation, (c) Were the Appellant's diagnosed heart disorders, to include hypertrophic cardiomyopathy and/or hypertensive heart disease caused by exposure to Agent Orange during the Appellant's service in Korea at any point since June 2016, (d) Were the Appellant's diagnosed heart disorders, to include hypertrophic cardiomyopathy and/or hypertensive heart disease caused by service-connected diabetes mellitus type II, and/or (e) Were the Appellant's diagnosed heart disorders, to include hypertrophic cardiomyopathy and/or hypertensive heart disease aggravated (i.e., worsened) by service-connected diabetes mellitus type II since September 2015 (the effective date assigned as to the grant of service connection for diabetes mellitus type II). If necessary, the examiner or the RO may schedule the Appellant for another VA medical examination or appropriate clinical testing. The examiner must review the record as found in VA treatment reports and the electronic file. However, the record in substance indicates the following: The Appellant's diabetes mellitus type II is service connected. The Appellant was on active military duty from June 1968 to December 1971. His service treatment records include his May 1968 pre-entrance medical examination and history report, which found no heart abnormalities and the Appellant answered "no" to the question of whether he then had, or once had chest pain or pressure. In an August 1969 service medical examination and history report, the service medical examiner found no heart abnormalities and the Appellant answered "no" to the question of whether he then had, or once had chest pain or pressure. Military personnel records show that the Appellant served in Korea from January 10, 1971 to December 5, 1971 with a unit identified by the Department of Defense as having operated in or near the Korean Demilitarized Zone in an area in which herbicide agents are known to have been applied. THE APPELLANT IS PRESUMED EXPOSED TO AGENT ORANGE. The Appellant was discharged from active duty in December 1971. In medical examinations and history reports dated July 1978, August 1982, and September 1986 for the Army Reserve, service medical examiners found no heart abnormalities and the Appellant answered "no" to the question of whether he then had, or once had chest pain or pressure. The April 2017 VA examiner diagnosed the Appellant with hypertensive heart disease and hypertrophic cardiomyopathy. The January 2021 VA examiner diagnosed the Appellant with hypertensive heart disease. 4. The RO will then readjudicate the claims of service connection for chronic obstructive pulmonary disease, diverticulitis, inguinal hernia, residuals of a large intestine resection, heart disorder, and the issue of a TDIU. Vito A. Clementi Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Cohen, 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.