Citation Nr: 24031237 Decision Date: 09/27/24 Archive Date: 09/27/24 DOCKET NO. 20-19 905 DATE: September 27, 2024 ORDER New and material evidence having been received, the claim for service connection for headaches and migraines is reopened. New and material evidence having been received, the claim for service connection for an acquired psychiatric condition is reopened. New and material evidence having been received, the claim for service connection for memory loss is reopened. New and material evidence having been received, the claim for service connection for bilateral hearing loss is reopened. New and material evidence having been received, the claim for service connection for restless leg syndrome is reopened. New and material evidence having been received, the claim for service connection for a loss of sexual performance is reopened. Service connection for headaches and migraines as secondary to the Veteran's service-connected degenerative arthritis of the cervical spine status post-spinal fusion is granted. REMANDED A compensable evaluation for bilateral non-senile cataracts is remanded. An evaluation higher than 10 percent prior to August 3, 2017, and higher than 20 percent thereafter, for a lumbosacral strain with degenerative joint disease is remanded. An evaluation higher than 10 percent for degenerative arthritis of the right knee is remanded. An evaluation higher than 10 percent for degenerative arthritis of the left knee is remanded. An evaluation higher than 10 percent for radiculopathy of the right lower extremity is remanded. Service connection for bilateral hearing loss is remanded. Service connection for an acquired psychiatric condition is remanded. Service connection for memory loss is remanded. Service connection for restless leg syndrome is remanded. Service connection for a loss of sexual performance is remanded. A total disability based on individual unemployability (TDIU) due to service-connected disabilities prior to February 12, 2024, and due solely to a single service-connected disability thereafter is remanded. FINDINGS OF FACT 1. In a June 2015 rating decision, the claims for service connection for PTSD and depression were denied. The Veteran did not appeal the decision or submit new and material evidence within one year of the notification letter. 2. Evidence submitted since the June 2015 rating decision relates to an unestablished fact necessary to substantiate the claim for service connection for an acquired psychiatric condition. 3. In a June 2015 rating decision, the claim for service connection for memory loss was denied. The Veteran did not appeal the decision or submit new and material evidence within one year of the notification letter. 4. Evidence submitted since the June 2015 rating decision relates to an unestablished fact necessary to substantiate the claim for service connection for memory loss. 5. In a June 2015 rating decision, the claim for service connection for bilateral hearing loss was denied. The Veteran did not appeal the decision or submit new and material evidence within one year of the notification letter. 6. Evidence submitted since the June 2015 rating decision relates to an unestablished fact necessary to substantiate the claim for service connection for bilateral hearing loss. 7. In a June 2015 rating decision, the claim for service connection for restless leg syndrome was denied. The Veteran did not appeal the decision or submit new and material evidence within one year of the notification letter. 8. Evidence submitted since the June 2015 rating decision relates to an unestablished fact necessary to substantiate the claim for service connection for restless leg syndrome. 9. In a June 2015 rating decision, the claim for service connection for a loss of sexual performance was denied. The Veteran did not appeal the decision or submit new and material evidence within one year of the notification letter. 10. Evidence submitted since the June 2015 rating decision relates to an unestablished fact necessary to substantiate the claim for service connection for a loss of sexual performance. 11. The Veteran's headaches and migraines are secondary to his service-connected degenerative arthritis of the cervical spine status post-spinal fusion. CONCLUSIONS OF LAW 1. The June 2015 rating decision denying service connection for PTSD and depression is final. New and material evidence has been received to reopen the claim. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.156 (a), 20.1103. 2. The June 2015 rating decision denying service connection for memory loss is final. New and material evidence has been received to reopen the claim. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.156 (a), 20.1103. 3. The June 2015 rating decision denying service connection for bilateral hearing loss is final. New and material evidence has been received to reopen the claim. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.156 (a), 20.1103. 4. The June 2015 rating decision denying service connection for restless leg syndrome is final. New and material evidence has been received to reopen the claim. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.156 (a), 20.1103. 5. The June 2015 rating decision denying service connection for a loss of sexual performance is final. New and material evidence has been received to reopen the claim. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.156 (a), 20.1103. 6. The criteria for service connection for headaches and migraines as secondary to the Veteran's service-connected degenerative arthritis of the cervical spine status post-spinal fusion have been met. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S. Marine Corps from March 1995 to February 1999, and in the U.S. Army from May 1999 to May 2003. These matters come before the Board of Veterans' Appeals (Board) on appeal from a November 2017 rating decision. New and Material Evidence Rating actions are final and binding based on the evidence on file at the time the claimant is notified of the decision and may not be revised on the same factual basis except by a duly constituted appellate authority. 38 C.F.R. § 3.104 (a). The claimant has one year from notification of a RO decision to initiate an appeal by filing an NOD with the decision, and the decision becomes final if an appeal is not perfected within the allowed time period. 38 U.S.C. § 7105 (b), (c); 38 C.F.R. §§ 3.160 (d), 19.52, 20.201, 20.202, 20.203. VA may reopen and review a claim that has been previously denied if new and material evidence is submitted by or on behalf of a veteran. 38 U.S.C. § 5108; 38 C.F.R. § 3.156 (a); see Hodge v. West, 155 F.3d 1356 (Fed. Cir. 1998); see also Manio v. Derwinksi, 1 Vet. App. 140, 145 (1991). New evidence is evidence not previously submitted to agency decisionmakers. Material evidence is evidence, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last final denial of the claim sought to be reopened and must raise a reasonable possibility of substantiating the underlying claim. 38 C.F.R. § 3.156 (a). The threshold for determining whether new and material evidence raises a reasonable possibility of substantiating a claim is a low one. Shade v. Shinseki, 24 Vet. App. 110, 117 (2010). Moreover, in determining whether this low threshold is met, consideration need not be limited to whether the newly submitted evidence relates specifically to the reason why the claim was last denied but instead, should ask whether the evidence could reasonably substantiate the claim were the claim to be reopened. See id. at 117-18. The Board must review all evidence submitted by or on behalf of a claimant since the last final denial on any basis to determine whether a claim must be reopened. Evans v. Brown, 9 Vet. App. 273 (1996). For purposes of determining whether new evidence is material, the credibility of the new evidence is presumed. Justus v. Principi, 3 Vet. App. 510, 513 (1992). New and material evidence is not required as to each previously unproven element of a claim. Shade, 24 Vet. App. at 120. 1. New and material evidence having been received, the claim for service connection for headaches and migraines is reopened. 2. New and material evidence having been received, the claim for service connection for an acquired psychiatric condition is reopened. 3. New and material evidence having been received, the claim for service connection for memory loss is reopened. 4. New and material evidence having been received, the claim for service connection for bilateral hearing loss is reopened. 5. New and material evidence having been received, the claim for service connection for restless leg syndrome is reopened. 6. New and material evidence having been received, the claim for service connection for a loss of sexual performance is reopened. Here, the last prior final denial of the above claims for service connection was addressed in a June 2015 rating decision. The Veteran was notified of this decision and of his appellate rights by a letter dated June 1, 2015. He did not appeal the decision or submit new and material evidence within one year of the notification letter. Therefore, the June 2015 rating decision is final. 38 U.S.C. § 7105; 38 C.F.R. §§ 20.302, 20.1103. The June 2015 rating decision notes the medical evidence of record failed to show a headache or migraine disability had been clinically diagnosed. Evidence associated with the claims file since the June 2015 rating decision includes February 2023 and April 2024 positive nexus opinions for headaches and migraines, which also indicate the Veteran has been diagnosed with a headache and migraine condition. As to an acquired psychiatric condition, the June 2015 rating decision notes the Veteran did not meet the criteria for PTSD, and the Veteran had not been diagnosed with depression. However, throughout the Veteran's VA treatment records since that time, there are notations of PTSD and depression. Regarding the Veteran's claim for memory loss, the June 2015 rating decision notes the Veteran had not been diagnosed with memory loss. A review of December 2023 VA treatment records show "pertinent positives" include memory problems. Although a post-service May 2015 VA audiological examination report does not show a hearing loss disability in accordance with 38 C.F.R. § 3.385, the Board observes the Veteran's VA treatment records since the June 2015 rating decision show he reported mild bilateral hearing loss, which raises the possibility he now has a hearing loss disability in accordance with 38 C.F.R. § 3.385. Concerning the Veteran's claim for restless leg syndrome, the June 2015 rating decision notes the Veteran had not been diagnosed with restless leg syndrome. However, December 2023 VA treatment records show the Veteran reported restless leg symptoms. The Veteran is competent to report symptoms of his restless leg syndrome as they are capable of lay observation. See Layno v. Brown, 6 Vet. App. 465 (1994). Finally, as to the Veteran's claim for a loss of sexual performance, the June 2015 rating decision notes the Veteran had not been diagnosed with a disability. The Board observes the Veteran continues to contend he experiences a loss of sexual performance as a result of PTSD. See, e.g., March 2023 Correspondence. As the above evidence was not of record at the time of the June 2015 denial and relates to unestablished facts necessary to substantiate the Veteran's claims, the Board finds the evidence to be both new and material. 38 C.F.R. § 3.156 (a); Shade, 24 Vet. App. at 117. Therefore, the claims are reopened. Service Connection Service connection may be established on a direct basis for a disability resulting from disease or injury incurred in, or aggravated by, active military, naval, or air service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Service connection also may be granted for any disease diagnosed after service when all the evidence establishes the disease was incurred in service. 38 C.F.R. § 3.303 (d). In general, service connection requires (1) evidence of a current disability; (2) medical evidence, or in certain circumstances lay evidence, of in-service incurrence or aggravation of a disease or injury; and (3) evidence of a nexus between the claimed in-service disease or injury and the current disability. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). A claim for secondary service connection requires medical evidence that connects the asserted secondary disability to the service-connected disability. Velez v. West, 11 Vet. App. 148, 158 (1998). To establish entitlement to service connection on this secondary basis, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical evidence establishing a link between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). The United States Court of Appeals for Veterans Claims (Court) held in the case of Ward v. Wilkie, 31 Vet. App. 233 (2019), that aggravation pursuant to 38 C.F.R. § 3.310 does not require a permanent worsening of the condition. Rather, the Court explained, "aggravation" is any incremental increase in disability attributable to the service-connected disability, i.e., any additional impairment of earning capacity that is above the degree of disability existing before the increase, regardless of its permanence. Id. A claim will be denied if the evidence persuasively weighs against the claim. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc) (only when the evidence persuasively favors one side or another is the benefit of the doubt doctrine not for application). Any reasonable doubt regarding the degree of disability should be resolved in favor of the claimant. 38 C.F.R. § 3.102. 7. Service connection for headaches and migraines as secondary to the Veteran's service-connected degenerative arthritis of the cervical spine status post-spinal fusion is granted. The Board notes the record raises the theory as to whether service connection for headaches is warranted as they are secondary to the Veteran's service-connected cervical spine disability. See, e.g., February 2023 Nexus Opinion. A review of the claims file shows in April 2024, a VA neurologist notes the Veteran has been diagnosed with chronic migraines and mixed headaches, and he is service connected for degenerative arthritis of the cervical spine status post-spinal fusion, which satisfies the first and second elements of a claim for secondary service connection. Wallin, 11 Vet. App. at 512. Thus, the crux of the case concerns whether there is a nexus between the two disabilities. Regarding this, VA received a positive nexus opinion in February 2023. The examiner states it is at least as likely as not the Veteran's migraine headaches are secondary to the Veteran's service-connected cervical spine disability. For their rationale, the examiner observes the Veteran had a serious fall from a helicopter during active duty, which caused his cervical spine disability. The examiner observes imaging shows moderate disc-space narrowing of the cervical spine, which the examiner characterizes as a serious neck condition. The examiner then finds the Veteran's service-connected neck condition causes the Veteran's migraine headaches. To support their conclusion, the examiner highlights medical literature, which states that neck pain is prevalent with migraines, and neck pain can act as a trigger for a migraine attack. The study indicates the prevalence of neck pain correlates with headache frequency and is associated with treatment resistance and an increase in the disability. The Board observes VA obtained another positive nexus opinion in April 2024. The examiner notes the Veteran is followed at VA's headache clinic. The examiner indicates the Veteran has a diagnosis of chronic migraines and mixed headaches, and the Veteran's chronic neck pain worsens his migraines and headaches. The Board finds the above nexus opinions to be highly probative because they represent the informed conclusions of medical professionals and are supported by thorough explanations based on a review of the Veteran's medical history and the symptomatology reflected in the medical and lay evidence of record. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (holding, probative value of a medical opinion comes from its reasoning); Prejean v. West, 13 Vet. App. 444, 448 (2000) (holding, Board may determine the probative value of medical opinions based on their detail and persuasiveness, and the physicians' access to a Veteran's medical records). As such, the findings carry significant probative weight in the Board's determination as to whether service connection is warranted for the Veteran's claim. See Caluza v. Brown, 7 Vet. App. 498, 506 (1995). Accordingly, as the medical evidence, taken together, indicates is it at least as likely as not the Veteran's migraine headaches are secondary to his service-connected cervical spine condition, entitlement to service connection for headaches and migraines as secondary to the Veteran's service-connected degenerative arthritis of the cervical spine status post-spinal fusion is warranted. 38 C.F.R. 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). REASONS FOR REMAND 1. A compensable evaluation for bilateral non-senile cataracts is remanded. 2. An evaluation higher than 10 percent prior to August 3, 2017, and higher than 20 percent thereafter, for a lumbosacral strain with degenerative joint disease is remanded. 3. An evaluation higher than 10 percent for degenerative arthritis of the right knee is remanded. 4. An evaluation higher than 10 percent for degenerative arthritis of the left knee is remanded. 5. An evaluation higher than 10 percent for radiculopathy of the right lower extremity is remanded. The Board notes the Veteran was last afforded VA examinations to assess the severity of the above service-connected conditions almost five years ago. Thus, to ensure the record reflects the current severity of the Veteran's service-connected conditions on appeal, more contemporaneous examinations are warranted. See Caffrey v. Brown, 6 Vet. App. 377, 381 (1994) (determining, the Board should have ordered contemporaneous examination of Veteran because a 23-month-old exam was too remote in time to adequately support the decision in an appeal for an increased rating); Green v. Derwinski, 1 Vet. App. 121, 124 (1991) (holding, where the record does not adequately reveal the current state of that disability, the fulfillment of the statutory duty to assist requires a thorough and contemporaneous medical examination). 6. Service connection for bilateral hearing loss is remanded. Although a post-service May 2015 VA audiological examination report does not show a hearing loss disability in accordance with 38 C.F.R. § 3.385, the Board observes the Veteran's VA treatment records show he reported mild bilateral hearing loss, thereby raising the possibility he now has a hearing loss disability in accordance with 38 C.F.R. § 3.385. Thus, he should be scheduled for an appropriate VA examination on remand. 7. Service connection for an acquired psychiatric condition is remanded. As to his claim for an acquired psychiatric condition, VA received a negative nexus opinion in May 2015. The examiner did not find a diagnosis of PTSD and found the Veteran did not report any traumatic event that would support a diagnosis of PTSD or that would meet the DSM stressor criteria. For their rationale, the examiner indicates the Veteran reported vague and mild symptoms, but the examiner found no discernable social or occupational impairment or clinically significant distress-related symptoms. The Board does not find the May 2015 VA opinion to be probative. Regarding this, the examiner's opinion does not address all the lay evidence of record available at the time of the examination. For example, in a July 2014 statement, the Veteran indicates confinement to a ship for long periods of time in a high-stress, unfamiliar environment in the middle of the ocean was a stressor incident. Further, debarking the ship in Kuwait, which was a known hostile area was another stressor incident. The Veteran also notes comments of senior enlisted personnel and merchant Marines assigned to his same ship created a hostile work environment and resulted in hypervigilance. The Veteran concludes by stating his experiences during active service still have an impact on his sleep, attitude, and performance as a husband and father. The Board also finds a VA examination and opinion are further warranted because the current medical record indicates a diagnosis of PTSD in addition to other psychiatric diagnoses for which opinions are needed. As such, a remand is required for an adequate examination and etiological opinion consistent with the remand directives below. 8. Service connection for memory loss is remanded. 9. Service connection for restless leg syndrome is remanded. A remand is required for VA examinations and medical opinions to address whether any diagnosed memory loss or restless leg syndrome is etiologically related to the Veteran's conceded participation in toxic exposure risk activity (TERA). The SFC Heath Robinson Honoring Our PACT Act, Pub. L. 117-168, 136 Stat. 1759 ("PACT Act")) was passed in August 2022. Under the PACT Act, VA is required to provide a disability examination and medical nexus opinion when a veteran submits a compensation claim and has evidence of a disability and participation in a TERA, but the evidence is insufficient to establish service connection for the disability. See 38 U.S.C. § 1168(a) (see PACT Act, Section 303). The PACT Act defines a TERA to mean "any activity- (i) that requires a corresponding entry in an exposure tracking record system (as defined in section 1119 (c) of this title) for the veteran who carried out the activity; or (ii) that the Secretary determines qualifies for purposes of this subsection when taking into account what is reasonably prudent to protect the health of veterans." Sub-regulatory guidance provides, "Any military service that qualifies for a presumption of exposure must be considered as a TERA. This includes all locations and other/occupational exposures based on locations in the Persian Gulf War and burn pit/particulate matter exposures. If the Veteran served in a location or has an exposure based on these presumptions and submits a claim for a non-presumptive condition, a disability examination and medical opinion must be requested, unless an exception applies. VBA Letter 20-22-10 (Dec. 22, 2022) at 9 (emphasis added). Here, the Board finds the Veteran participated in a TERA. See February 2024 VA TERA Memorandum. Thus, he was presumptively exposed to identified substances, chemicals, and airborne hazards based on his verified active service in Southwest Asia after August 2, 1990. See PACT Act, Sec. 302 (adding new provision, 38 U.S.C. § 1119(b)(1), which establishes presumption of toxic exposure for members who served in certain locations; see also id. § 1119 (c)(1)(A)); see also February 2024 VA TERA Memorandum (indicating active service in service in the Southwest Asia theater of operations during the Persian Gulf War.). In addition, the Veteran's service personnel records note his military occupational specialty as an engineer equipment mechanic, which would have exposed him to oils, lubricants, solvents, and fuels. Therefore, 38 U.S.C. § 1168 (a) requires both a VA examination and a nexus opinion regarding whether any diagnosed memory loss or restless leg syndrome is etiologically related to his conceded participation in a TERA. 10. Service connection for a loss of sexual performance is remanded. The Veteran asserts service connection is warranted for a loss of sexual function to include libido as secondary to his claim for an acquired psychiatric condition. See September 2017 VA 21-526b, Veteran Supplemental Claim. Thus, this claim is inextricably intertwined with the claim for service connection for an acquired psychiatric condition, and the claim for service connection for sexual dysfunction is dependent on the outcome of the claim for an acquired psychiatric condition. Accordingly, this issue needs to be remanded pending the results of the VA psychiatric examination and opinion. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). 11. A TDIU due to service-connected disabilities prior to February 12, 2024, and due solely to a single service-connected disability thereafter is remanded. The Board observes the Veteran's VA examinations indicate his service-connected conditions impact his ability to work. See, e.g., April 2024 VA Neurologist's Letter (noting, full time employment does not appear to be a realistic possibility given the Veteran's multiple chronic medical conditions to include headaches). Thus, an inferred claim for TDIU under Rice v. Shinseki, 22 Vet. App. 447 (2009) has been raised and has not been adjudicated by the Agency of Original Jurisdiction (AOJ). In this regard, the Board observes the Veteran is in receipt of a 100-percent evaluation effective February 12, 2024. See September 2024 Codesheet. However, VA has a "well-established" duty to maximize a claimant's benefits. Buie v. Shinseki, 24 Vet. App. 242, 250 (2011); Bradley v. Peake, 22 Vet. App. 280 (2008). This duty to maximize benefits requires VA to assess all of a claimant's disabilities to determine whether any combination of disabilities establishes entitlement to special monthly compensation (SMC) under 38 U.S.C. § 1114. See Bradley at 294 (finding that SMC "benefits are to be accorded when a veteran becomes eligible without need for a separate claim"). Subsection 1114 (s) requires a disabled veteran whose disability level is determined by the ratings schedule must have at least one disability that is rated at 100 percent in order to qualify for the special monthly compensation provided by that statute. Under the law, subsection 1114 (s) benefits are not available to a veteran whose 100 percent disability rating is based on multiple disabilities, none of which is rated at 100 percent disabling. For SMC purposes, a TDIU based on a single service-connected disability satisfies the requirement of a "service-connected disability rated as total." See Buie at 251; see also Bradley at 293. Therefore, the claim of entitlement to a TDIU due to service-connected disabilities prior to February 12, 2024, and due solely to a single service-connected disability thereafter is properly before the Board. The matters are REMANDED for the following action: 1. Send the Veteran notice as to his claim of entitlement to a TDIU. 2. Send the Veteran a formal application for TDIU (VA Form 21-8940) and employment verification forms and request he complete the forms. Bilateral Non-Senile Cataracts 3. Schedule the Veteran for a VA examination to determine the current severity of his service-connected bilateral non-senile cataracts. The Veteran's claims file, including a copy of this REMAND, must be made available to and reviewed by the examiner in conjunction with the examination. The examiner must note in the examination report the evidence in the claims file has been reviewed. The appropriate Disability Benefits Questionnaire should be filled out. The examiner should describe the severity, frequency, and duration of all symptoms associated with the Veteran's service-connected bilateral non-senile cataracts. The examiner must provide a comprehensive report that includes a complete rationale for all opinions and conclusions reached. Back, Right Knee, & Left Knee 4. Schedule the Veteran for VA examinations to assess the nature and current level of severity of his service-connected orthopedic conditions. The Veteran's claims file, including a copy of this remand, must be made available to, and reviewed by the examiner in conjunction with the examinations. The examiner must note in the examination reports that the evidence in the claims file has been reviewed. The examiner must include the following: (a.) Active range-of-motion testing results, (b.) Passive range-of-motion testing results, (c.) Weightbearing range-of-motion testing results, and (d.) Non-weightbearing range-of-motion testing results. If the examiner is unable to conduct one or more of the above tests or finds that it is unnecessary, the examiner must provide an explanation. In any event, the type of test performed (i.e., active, passive, weightbearing, or nonweightbearing), must be specified. The examiner must elicit as much information as possible from the Veteran regarding the severity, frequency, and duration of flare-ups, their effect on functioning, and precipitating and alleviating factors. If the examination is not performed during a flare-up, the examiner must provide an estimate of additional loss of range of motion during a flare-up. If the examiner is unable to provide an estimate of additional loss of motion during a flare-up, the examiner must provide a specific explanation as to why the available information, including the Veteran's own statements, is insufficient to make such an estimate. If the Veteran experiences painful motion, the examiner should note where within the range of motion that pain began (in terms of degrees). If the examiner is unable to provide any requested findings, the examiner must provide an explanation. The examiner must provide a comprehensive report that includes a complete rationale for all opinions and conclusions reached. Radiculopathy 5. Schedule the Veteran for a VA examination to determine the current severity of his service-connected radiculopathy of the right lower extremity. The Veteran's claims file, including a copy of this REMAND, must be made available to and reviewed by the examiner in conjunction with the examination. The examiner must note in the examination report the evidence in the claims file has been reviewed. The appropriate Disability Benefits Questionnaire should be filled out. The examiner should describe the severity, frequency, and duration of all symptoms associated with the Veteran's service-connected radiculopathy of the right lower extremity. The examiner must provide a comprehensive report that includes a complete rationale for all opinions and conclusions reached. Bilateral Hearing Loss 6. Schedule the Veteran for a VA audiological examination, conducted by a state-licensed audiologist, to evaluate the current severity of any hearing loss disability and to obtain an opinion as to the nature and etiology of any hearing loss disability. The entire claims file, including a copy of this remand, must be made available to the examiner. All indicated tests and studies should be accomplished, and all clinical findings should be reported in detail. The examination must include a puretone audiometry test and a controlled speech discrimination test using the Maryland CNC word list unless the examiner certifies that use of a speech discrimination test is inappropriate and provides a supporting rationale. The examiner should elicit from the Veteran a complete history of his symptomatology, including any in-service symptomatology and treatment as well as his complete post-service history of symptoms and treatment. Following a complete review of the record, the examiner must address the following question: Is it approximately at least as likely as not (an approximate balance of positive and negative evidence) the Veteran's bilateral hearing loss had its onset in service or is otherwise causally or etiologically related to service? In providing their opinion, the examiner must consider the Veteran's conceded in-service noise exposure. In offering any opinion, the examiner must consider the full record, to include the Veteran's lay statements. The opinions must reflect consideration of the Veteran's reports as to his history and symptomatology. The examiner must provide a comprehensive report including complete rationales for all opinions and conclusions reached. Acquired Psychiatric Condition 7. Next, schedule the Veteran for a VA psychiatric examination regarding his service-connection claim for an acquired psychiatric condition, to include PTSD. The Veteran's entire record should be made available to and reviewed by the examiner. All indicated tests should be conducted if necessary and all findings reported in detail. The appropriate Disability Benefits Questionnaire should be filled out. The examiner should elicit from the Veteran a complete history of his symptomatology. Following a review of the record, to include the Veteran's lay statements as well as any other evidence that may be added to the record concerning onset and recurrence of symptomatology, the examiner should address the following: (a.) State whether the Veteran has a diagnosis of PTSD or another mental health disorder diagnosis. If the examiner finds no diagnosis, they must provide supporting rationale and discuss any conflicting medical evidence elsewhere within the record indicating a diagnosis or mental health-related symptoms. (b.) State is it approximately at least as likely as not (an approximate balance of positive and negative evidence) any psychiatric condition first manifested in service, is causally related to event(s) in service, or is otherwise related to service? In developing their opinion, the examiner should address the Veteran's contentions to include those from his July 2014 statement where he outlines his in-service stressors. In offering any opinion, the examiner must consider the full record, to include the Veteran's lay statements. The opinions must reflect consideration of the Veteran's reports as to his history and symptomatology. The examiner must provide a comprehensive report including complete rationales for all opinions and conclusions reached. Memory Loss 8. Obtain a VA examination and medical opinion for the Veteran's claim for memory loss. The Veteran's entire record should be made available to and reviewed by the examiner. All indicated tests should be conducted if necessary and all findings reported in detail. The appropriate Disability Benefits Questionnaire should be filled out. The examiner should elicit from the Veteran a complete history of his symptomatology. Following a review of the record, to include the Veteran's lay statements as well as any other evidence that may be added to the record concerning onset and recurrence of symptomatology, the examiner should address the following: Is it approximately at least as likely as not (an approximate balance of positive and negative evidence) any memory loss condition first manifested in service, is causally related to event(s) in service, or is otherwise related to service? In answering this question, the examiner must consider the following: The Veteran's conceded TERAs -- i.e., exposure to identified substances, chemicals, and airborne hazards during active service deployment overseas in the Southwest Asia theater of operations during the Persian Gulf War; and potential environmental exposures from his MOS duties as an engineer equipment mechanic, which would have exposed him to oils, lubricants, solvents, and fuels; the examiner must address the synergistic, combined effect of all the Veteran's TERAs. In offering any opinion, the examiner must consider the full record, to include the Veteran's lay statements. The opinions must reflect consideration of the Veteran's reports as to his history and symptomatology. The examiner must provide a comprehensive report including complete rationales for all opinions and conclusions reached. Restless Leg Syndrome 9. Obtain a VA examination and medical opinion for the Veteran's claim for restless leg syndrome. The Veteran's entire record should be made available to and reviewed by the examiner. All indicated tests should be conducted if necessary and all findings reported in detail. The appropriate Disability Benefits Questionnaire should be filled out. The examiner should elicit from the Veteran a complete history of his symptomatology. Following a review of the record, to include the Veteran's lay statements as well as any other evidence that may be added to the record concerning onset and recurrence of symptomatology, the examiner should address the following: Is it approximately at least as likely as not (an approximate balance of positive and negative evidence) any restless leg syndrome first manifested in service, is causally related to event(s) in service, or is otherwise related to service? In answering this question, the examiner must consider the following: The Veteran's conceded TERAs -- i.e., exposure to identified substances, chemicals, and airborne hazards during active service deployment overseas in the Southwest Asia theater of operations during the Persian Gulf War; and potential environmental exposures from his MOS duties as an engineer equipment mechanic, which would have exposed him to oils, lubricants, solvents, and fuels; the examiner must address the synergistic, combined effect of all of the Veteran's TERAs. In offering any opinion, the examiner must consider the full record, to include the Veteran's lay statements. The opinions must reflect consideration of the Veteran's reports as to his history and symptomatology. The examiner must provide a comprehensive report including complete rationales for all opinions and conclusions reached. Thomas English Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Buck Denton 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.