Citation Nr: A23031991 Decision Date: 11/14/23 Archive Date: 11/14/23 DOCKET NO. 200311-73806 DATE: November 14, 2023 ORDER Entitlement to a compensable rating for chronic fatigue syndrome (CFS) is dismissed. Entitlement to a compensable rating for fibromyalgia is dismissed. Entitlement to service connection for irritable bowel syndrome (IBS) is denied. Entitlement to service connection for a respiratory disability is denied. Entitlement to service connection for a right shoulder disability is denied. Entitlement to service connection for a prostate disability is denied. Entitlement to service connection for a left knee disability is denied. Entitlement to service connection for a right knee disability is denied. Entitlement to an initial rating of 50 percent for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), is granted. REMANDED Entitlement to service connection for a heart disability is remanded. Entitlement to service connection for vertigo is remanded. FINDINGS OF FACT 1. The Veteran's entitlement to service connection for CFS was severed in a March 2020 rating decision. 2. The Veteran's entitlement to service connection for fibromyalgia was severed in a March 2020 rating decision. 3. The Veteran's IBS was not incurred in or due to his time in service. 4. The Veteran does not have a respiratory disability that was incurred in or due to his time in service. 5. The Veteran's right shoulder disability was not incurred in or due to his time in service. 6. The Veteran's prostate disability was not incurred in or due to his time in service. 7. The Veteran's left knee disability was not incurred in or due to his time in service. 8. The Veteran's right knee disability was not incurred in or due to his time in service. 9. Granting the benefit of the doubt to the Veteran, his PTSD is manifested by occupation and social impairment with reduced reliability and productivity. CONCLUSIONS OF LAW 1. The criteria for dismissal of a compensable rating for CFS have been met. 38 U.S.C. § 7105; 38 C.F.R. § 19.55. 2. The criteria for dismissal of a compensable rating for fibromyalgia have been met. 38 U.S.C. § 7105; 38 C.F.R. § 19.55. 3. The criteria for service connection for IBS are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. § 3.303, 3.307, 3.309, 3.310. 4. The criteria for service connection for a respiratory disability are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. § 3.303, 3.307, 3.309, 3.310. 5. The criteria for service connection for a right shoulder disability are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. § 3.303, 3.307, 3.309, 3.310. 6. The criteria for service connection for a prostate disability are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. § 3.303, 3.307, 3.309, 3.310. 7. The criteria for service connection for a left knee disability are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. § 3.303, 3.307, 3.309, 3.310. 8. The criteria for service connection for a right knee disability are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. § 3.303, 3.307, 3.309, 3.310. 9. The criteria for a rating of 50 percent, but no higher, for PTSD have not been met. 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.7, 4.14, 4.130, Diagnostic Code (DC) 9411. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from January 1976 to January 1979 and from September 1990 to August 1991, to include service in Southwest Asia. These matters are on appeal from a February 2020 rating decision by a Department of Veterans Affairs (VA) regional office (RO). In the March 2020 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Evidence Submission docket. Therefore, the Board may only consider the evidence of record at the time of the February 2020 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or his representative with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303. If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the date the Board received the VA Form 10182, or (2) more than 90 days following the date the Board received the VA Form 10182, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 20.801. However, because the Board is remanding the claims of a heart disability and vertigo, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii). If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim[s], considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. Dismissed Claims The matter of entitlement to compensable ratings for CFS and fibromyalgia are moot because these two service connected disabilities were severed in a June 2020 rating decision and are not appealed in this claim. Therefore, there is no presently service connected disability to increase. Thus, further appellate review is moot, and the claims are dismissed. Service Connection Claims Generally, to prevail on a claim of service connection on the merits, there must be competent evidence of (1) 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 or other competent evidence of a nexus between the claimed in-service disease or injury and the present disease or injury. See Hickson v. West, 12 Vet. App. 247 (1999); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). To establish service connection on a secondary basis, the evidence must show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. 38 C.F.R. § 3.310(a)(b) (2016), Allen v. Brown, 7 Vet. App. 439 (1995) (en banc). Service connection can also be established through continuity of symptomatology. Walker v. Shinseki, 708 F.3d 1331 (2013); 38 C.F.R. §§ 3.303 (b), 3.309. For chronic diseases shown as such in service or within the applicable presumptive period, subsequent manifestations of the same chronic disease at any later date are service connected unless attributable to an intercurrent cause. 38 C.F.R. § 3.303 (b). For a chronic disease to be considered to have been "shown in service," there must be a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings. When the condition noted in service or within the presumptive period is not a chronic disease, a showing of continuity of symptomatology after discharge is required. Id. Bilateral Knee, Right Shoulder, Prostate, IBS Claims The Veteran contends he has a bilateral knee, right shoulder, prostate, and IBS disabilities that was incurred in and due to his time in service. The Veteran has been diagnosed with a bilateral knee disability, an enlarged prostate disability, IBS, and a right shoulder disability. The Veteran's service treatment records (STRs) show that he was seen for cramps in his legs and a January 2020 examiner noted the in-service complaint of left knee trouble was acute. However, the STRs do not indicate the Veteran had any trouble with his prostate, right shoulder, or intestinal problems while in service and his May 1991 separation examination does not indicate ongoing knee, prostate, right shoulder, or IBS trouble. In a September 2019 private consultation regarding his knees, the examiner said the Veteran's left knee condition was documented in his separation examination and that he continued to have knee trouble to present. The examiner said the "onset of this condition which persists to the present during active duty should qualify said condition for service connection." The examiner also stated the Veteran's right knee pain was noted on separation and that the Veteran continued to have symptoms and that again, his condition persists to present and should qualify for service connection. The examiner also said the Veteran was diagnosed with an enlarged prostate during service and that the onset of the condition during service should qualify for service connection. In the September 2019 private consultation, the examiner reported the Veteran developed right shoulder pain after unloading and loading equipment onto a military vehicle. The Veteran was seen by a private doctor and continued to have trouble. The examiner said the documented onset of his condition which persisted to present should qualify for service connection. Here, however, the examiner did not indicate the Veteran's file had been reviewed. In this case, had the Veteran's file been reviewed, the examiner would have known the Veteran's separation examination did not note ongoing knee problems. Additionally, the examiner is a chiropractor, who, while dealing with joints, does not have expertise in prostate or IBS conditions. Lastly, this examiner did not offer a medical opinion that meets the etiology requirements of being at least as likely as not due to his time in service and no rationale for the opinions was offered. Therefore, the Board places little probative weight on his examination letter. January 2020 imaging tests showed no radiographic evidence of a right or left knee acute fracture or dislocation or joint effusion. The Veteran had an examination for his knees in January 2020. The examiner reviewed his file, saw him in person, and reported the Veteran had a diagnosis of bilateral knee degenerative arthritis and a right knee meniscus tear. The Veteran denied trauma but reported he developed right knee pain in 2016 and development left knee pain in 2018. The Veteran reported bilateral knee pain, clicking, popping, occasional swelling in the left knee, and that his left knee gave out. The examiner opined it was less likely than not the Veteran's left and right knee disabilities were due to his time in service, saying during service, his left leg pain was acute only with one complaint. There was no evidence of chronicity of care. The Veteran also had an examination for his prostate in January 2020. The examiner saw the Veteran in person, reviewed his file, and noted the diagnosis of an enlarged prostate. The Veteran said he had symptoms that continued over the years and he sought treatment in 2011. The examiner opined it was less likely than not the Veteran's enlarged prostate was incurred in or due to his time in service, saying during service, the Veteran reported acute groin pain only and there was no evidence of an enlarged prostate. Additionally, there was no chronicity of care. The Veteran had an examination for his IBS in January 2020. The examiner saw the Veteran in person, reviewed his file, and noted the diagnosis of IBS. The Veteran said the date of onset was in 1992 when he began to have abdominal pain, constipation alternating with diarrhea with no treatment at the time. The Veteran said the symptoms have continued over the years with symptoms improving a little with probiotics. A January 2020 Gulf War examination did not note any knee problems, prostate, or IBS problems as a result of the Veteran's service in Southwest Asia. The Board has also reviewed the Veteran's medical treatment records but those records do not provide evidence linking the Veteran's claimed conditions to his time in service or show that he was treated for such while in service. Here, the Board acknowledges that showing treatment from separation to present is not a requirement for a finding of service connection. However, when considering all evidence of record, the Board does not find service connection is warranted for a bilateral knee disability or an enlarged prostate disability. The Veteran himself reported he did not develop knee pain until, at the earliest, 2016, over 20 years after his time in service. Additionally, the Veteran's May 1991 separation examination does not show the Veteran complained of ongoing knee trouble or prostate problems. Indeed, the Veteran himself reported the start of his knee pain, his prostate, and his IBS began after his separation from service. The Board notes the Veteran was not provided a separate examination and opinion as to the current nature and etiology of his claimed right shoulder disability. However, VA need not conduct an examination with respect to the claim on appeal, as information and the evidence of record contains sufficient competent medical evidence to decide the claim. See 38 C.F.R. § 3.159(c)(4). Under McLendon v. Nicholson, 20 Vet. App. 76 (2006), VA must provide an examination when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, and (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the Veteran's service or with another service connected disability, but (4) insufficient competent medical evidence on file for VA to make a decision on the claim. Simply stated, the standards of McLendon are not met in this case as the Veteran is not shown to have suffered an ongoing right shoulder disability while in service and there is no other competent medical evidence suggesting an association to service. The United States Court of Appeals for Veterans Claims (Court) has indicated that normal medical findings at the time of separation from service, as well as the absence of any medical records of a diagnosis or treatment for many years after service is probative evidence against the claim. See Mense v. Derwinski, 1 Vet. App. 354, 356 (1991) (affirming Board where it found that Veteran failed to account for the lengthy time period after service for which there was no clinical documentation of low back condition). The Board understands, as stated above, that absence of medical treatment is not a reason to deny a claim. However, the Board finds the decades of no reported knee trouble or prostate problems tends to weigh against the Veteran's claims. For these many reasons, service connection for a bilateral knee disability, a prostate disability, a right shoulder disability, and IBS is denied. Respiratory Claim The Veteran contends he has a respiratory disability that was incurred in and due to his time in service. Indeed, the Veteran's STRs show that he complained of shortness of breath and he reported ongoing problems on his separation examination. (See e.g. May 1991, June 1991 STRs.) However, after a review of the Veteran's records, while he self-reported symptoms of shortness of breath and respiratory problems, there has been no objective diagnosis made. The Veteran had a respiratory workup but no diagnosis was made and other records indicate the Veteran did not have a respiratory condition, to include asthma. (See e.g. July 2006, July 2007, June 2009 treatment records.) The September 2019 private examiner said the Veteran was diagnosed with respiratory deficiency to include dyspnea. The examiner stated this condition began in service in Southwest Asia and that it is as likely as not the same was caused by his service in Southwest Asia. However, again as discussed above, the examiner did not review the Veteran's file and did not offer supporting evidence for his conclusory opinion. This examiner is also a chiropractor, who, while possessing knowledge of the skeletal system, does not deal with respiratory conditions. Therefore, the Board places little probative weight on this examination. A January 2020 examiner opined the Veteran did not have any diagnosed respiratory condition. The examiner noted and considered the Veteran's statements that the onset was after service in 1992 and 1993 and that he noticed shortness of breath with exertion such as climbing stairs but did not get treatment at the time. The Veteran reported the condition stayed the same over the years and sought treatment in 1998-2000 when he was worked up for a respiratory condition. The January 2020 examiner opined it was less likely than not the Veteran had a respiratory condition as symptoms were subjective only and objective examination was normal. In a January 2020 Gulf War examination, after reviewing the Veteran's file, the examiner noted the Veteran had a respiratory condition, a heart condition, a digestive condition, knee conditions, and fibromyalgia. However, out of all the conditions identified, only fibromyalgia and CFS were reported to have no etiology established. Regarding the other stated conditions, the examiner did not note if those were made based on objective evidence or the Veteran's subjective complaints. The Board, after reviewing the Veteran's entire file, to include his medical treatment records, does not find evidence indicating the Veteran has a respiratory condition that was incurred in or due ot his time in service. The most probative examinations of record do not indicate a diagnosed respiratory condition due to service and the Veteran's objective medical treatment records also do not suggest such. Therefore, the claim is denied. Increased Rating Claim Disability evaluations (ratings) are determined by evaluating the extent to which a veteran's service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing the symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. §§ 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. In evaluating a disability, the Board considers the current examination reports in light of the whole recorded history to ensure that the current rating accurately reflects the severity of the condition. The Board has a duty to acknowledge and consider all regulations that are potentially applicable. Schafrath v. Derwinski, 1 Veteran. App. 589 (1991). The medical as well as industrial history is to be considered, and a full description of the effects of the disability upon ordinary activity is also required. 38 C.F.R. §§ 4.1, 4.2, 4.10. The Veteran contends his PTSD is worse than indicated by his 30 percent rating. The Veteran's PTSD is rated under DC 9411. Under DC 9411, a 30 percent evaluation for PTSD requires occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events.) A 50 percent evaluation requires 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; and, difficulty in establishing and maintaining effective work and social relationships. A 70 percent rating is prescribed when there is evidence of 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); and inability to establish and maintain effective relationships. A 100 percent rating is prescribed when there is evidence of total occupational and social impairment 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 as to time or place; and memory loss for names of close relatives, own occupation, or own name. The list of symptoms under the rating criteria are meant to be examples of symptoms that would warrant the rating, but are not meant to be exhaustive, and the Board need not find all or even some of the symptoms to award a specific rating. Mauerhan v. Principi, 16 Vet. App. 436, 442-3 (2002). However, a veteran may only qualify for a given disability rating under § 4.130 by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration, and that such symptoms have resulted in the type of occupational and social impairment associated with that percentage. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 117-18 (Fed. Cir. 2013). A private September 2019 examiner stated the Veteran had symptoms of insomnia, sleep deprivation, anxiety, isolation, memory loss, hypervigilance, depression, and agoraphobia. However, the Board notes this examiner is a chiropractor who is not trained in psychological matters. Therefore, the Board places less probative weight on this opinion. In September 2019, the Veteran also submitted a mental health evaluation from a licensed social worker. The examiner conducted an interview and reviewed a patient health questionnaire and a few other documents, but did not review the Veteran's entire claims file. The Veteran was currently employed with DoD as a supervisor and that he had been at that job since 1983. The Veteran said he had some difficulties with his role due to his military experience. The Veteran said he could be controlling and at time intolerant. Regarding his family relationships, the Veteran said he had a distant relationship with his adult son and that his second marriage ended due to difficulty with communication and disconnection. The Veteran attributed this to his deployment to Southwest Asia. The Veteran was reported to be well groomed and communicated openly. The Veteran was oriented and had good insight. The Veteran's concentration, memory and motivation were within normal limits and he had no problems with speech. The Veteran reported not enjoying social events and avoiding social situations with the examiner stating the Veteran was likely to be introverted. The Veteran also reported anxiety, being on edge, and being unable to relax. This social worker examiner also completed a PTSD Disability Benefits Questionnaire. The examiner opined the Veteran's PTSD led to occupational and social impairment with deficiencies in most areas. The Veteran's symptoms included hypervigilance, flashbacks, nightmares, racing thoughts, intrusive thoughts, excessive worry, fatigue, apathy, problems with motivation, and lack of interest. The examiner also reported the Veteran socially withdrew. The Veteran was employed full -time and was a supervisor. The Veteran had an examination for his PTSD in January 2020. The examiner opined the Veteran's PTSD led to occupational and social impairment due to mild or transient symptoms. The examiner reviewed the Veteran's file and took a detailed history. The Veteran was married twice and had children from his marriages. The Veteran lived alone but had a good relationship with his living sister and children, though he didn't see them often. The Veteran was employed at a grocery store prior to his time in service. The Veteran had a high school education and participated in all educational opportunities for him while in service. The Veteran had been employed with DoD for 40 years and denied significant work related difficulties. The Veteran's symptoms included depressed mood, anxiety, chronic sleep impairment, and difficulty establishing and maintaining effective work and social relationships. The Veteran also exhibited isolative and detached behaviors. The Board has also reviewed the Veteran's medical records. The Veteran was routinely found to be oriented. (See e.g. January 2001 treatment records.) Here, the Board notes that the two most probative examiners had vastly different opinions as to the severity of the Veteran's PTSD. Regarding his social impairment, both examiners stated the Veteran had been married and divorced twice. In one examination, the Veteran reported a distant relationship with his son and in another, he said his relationship with his children was good. The Veteran in one examination reported difficulties at work while in another examination denied significant work related difficulties. The Veteran did not report any hallucinations, delusions, or suicidal ideations in any examination or treatment record. Additionally, most other symptoms did not approximate the severity of those warranting a 70 percent evaluation. For example, the Veteran and examiners did not report obsessional rituals, problems with speech, near continuous panic attacks, disorientation, impaired impulse control, or neglect of personal appearance and hygiene. Thus, the Board finds the Veteran's PTSD would most accurately be reflected by a 50 percent rating due to his reports of two divorces, with one being because of his difficulties after his deployment and his reported issues at work and symptoms such as difficulty establishing and maintaining effective work and social relationships, some memory issues, and some memory issues. The Board finds this rating most accurately accounts for the more severe and less severe symptoms reported in the differing examinations. Neither the Veteran nor his representative has identified any other rating criteria that would provide a higher rating or an additional rating. However, the potential applications of various provisions of Title 38 of the Code of Federal Regulations (2016) have been considered as required by the holding of the Court in Schafrath v. Derwinski, 1 Vet. App. 589, 593 (1991). Regarding the claims above, the Board acknowledges and has considered the Veteran's statements that his conditions bother him and they are due to his time in service. However, while the Veteran is competent to report the symptoms of his disabilities, he is not competent to opine on matters requiring medical knowledge, such as the nature and etiology of his complex medical conditions. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Thus, while the Board has carefully considered the Veteran's statements about his symptoms, these statements must be weighed against the objective evidence of record, which does not indicate the Veteran has a diagnosis of his claimed conditions that are due to his time in service. It is important for the Veteran to understand that these medical findings provide highly probative evidence against this claim that the Board cannot, unfortunately, ignore, outweighing the Veteran's beliefs that his conditions are due to his time in service. Regarding all the above, the Board has considered the applicability of the benefit of the doubt doctrine. Except as otherwise noted, because the evidence is not in approximate balance or nearly equal, the benefit of the doubt doctrine does not apply. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990), Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc). REASONS FOR REMAND Entitlement to service connection for a heart disability The Board finds a remand is warranted in the above-listed claim to correct a pre-decisional duty to assist error because the Veteran was not provided with an adequate examination. Here, the Veteran has been diagnosed with a heart disability and his STRs show multiple instances of the Veteran complaining of palpations while in service. January 2020 imaging tests showed no radiographic evidence of acute cardiopulmonary disease. February 2020 echocardiogram results showed mild eccentric LVH with mild mitral and tricuspid valve regurgitations. The Veteran also had mild aortic and pulmonic valve regurgitations. The Veteran had an examination for his heart in January 2020. The examiner reviewed the Veteran's file, saw him in person, and reported he had been diagnosed with diastolic dysfunction and a first degree AV block. The Veteran said while in Southwest Asia, he began to have a pounding heart and went to medical but the symptoms subsided. The Veteran also said he had palpations which had been continuing over the years. The examiner opined it was less likely than not the Veteran's heart disability was incurred in or due to his time in service. The examiner noted the Veteran's diagnosed heart conditions would not have caused him to feel palpitations and medical literature did not support this. The examiner opined it was less likely than not the Veteran's heart disabilities were due to his time in service. The examiner also explained he was not diagnosed with palpitations. The Veteran's diagnoses were caused by other underlying conditions and not by service in Southwest Asia. Here, the Board finds the January 2020 examination to be inadequate. While the examiner noted the Veteran's heart diagnoses were caused by other underlying conditions, the examiner did not indicate what those underlying conditions were and if those conditions were incurred during the Veteran's time in service. Additionally, the examiner noted the Veteran's diagnosed diastolic dysfunction and first degree AV block but did not discuss his other February 2020 echocardiogram results of valve regurgitations. Therefore, a remand is warranted to obtain an adequate examination. Barr v. Nicholson, 21 Vet. App. 303 (2007). Entitlement to service connection for vertigo The Board finds a remand is warranted in the above-listed claim to correct a pre-decisional duty to assist error because the Veteran was not provided with an examination for his vertigo. The Veteran's record indicates he has been seen for vertigo and it has remained on his problem list. The Veteran's STRs show he was treated for dizziness while in service. While on his separation examination, the Veteran denied dizziness, the Veteran has also been seeking treatment for such. The Board finds there is sufficient evidence in the Veteran's file to trigger the duty to assist and obtain an examination, but the RO failed to do so. Therefore, a remand is warranted in order to provide the Veteran with an etiology examination for his vertigo. The matters are REMANDED for the following action: 1. Obtain and associate with the record any outstanding medical treatment records. The Veteran is invited to submit any outstanding records himself. 2. Schedule the Veteran for an examination for his 1) heart disability and his 2) Vertigo disability. The examiner should opine as to the following: (a) List and report all diagnoses related to the Veteran's claimed disability. If the Veteran does not have a diagnosis of his claimed disability, the examiner must reconcile the evidence of record that states he does have such a diagnosis. (b) Whether it is at least as likely as not the Veteran's disability was incurred in or due to his time in service? (c) Whether it is at least as likely as not the Veteran's disability is proximately due to any of his service connected disabilities. (d) Whether it is at least as likely as not the Veteran's disability was aggravated by any of his service connected disabilities. NOTE: Aggravation in this context does not mean a permanent worsening. Any incremental or temporary worsening constitutes aggravation. ? *The examiner must consider and take into account the Veteran's lay statements about what happened to him while in service and his current symptoms. *The examiner may not rely solely on a lack of treatment as a reason for a negative etiology opinion. *The examiner must discuss all of the Veteran's heart diagnoses. 3. Readjudicate the Veteran's claim on remand. John J. Crowley Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Snoparsky, A. 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.