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Citation Nr: 1716934
Decision Date: 05/18/17    Archive Date: 06/05/17

DOCKET NO.  09-39 131	)	DATE
	)
	)

On appeal from the
Department of Veterans Affairs Regional Office in Waco, Texas

THE ISSUES

1.  Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), depression, and anxiety.

2.  Entitlement to service connection for bilateral pes planus.

3.  Entitlement to service connection for a lumbar spine disability.

4.  Entitlement to service connection for brain aneurysm and stroke.

5.  Entitlement to service connection for left eye impaired vision.

6.  Entitlement to service connection for a bilateral hip disability.

7.  Entitlement to service connection for bilateral hearing loss.

8.  Entitlement to service connection for tinnitus.

9.  Entitlement to an initial evaluation in excess of 10 percent prior to March 24, 2010, and in excess of 20 percent since March 24, 2010, for right knee degenerative joint disease.

10.  Entitlement to an initial evaluation in excess of 10 percent prior to March 24, 2010, and in excess of 20 percent since March 24, 2010, for left knee degenerative joint disease.

11.  Entitlement to a total disability evaluation based on individual unemployability due to service-connected disabilities (TDIU).

12. Entitlement to special monthly compensation (SMC) based on aid and attendance (A&A) or housebound (HB) status.

REPRESENTATION

Appellant represented by:	Disabled American Veterans

WITNESSES AT HEARING ON APPEAL

Appellant and spouse

ATTORNEY FOR THE BOARD

P. Olson, Counsel

INTRODUCTION

The Veteran had active duty for training from October 1975 to March 1976 active duty in the Marine Corps from June 1977 to September 1989.

The issues come before the Board of Veterans' Appeals (Board) on appeal from rating decisions of the Appeals Management Center in Washington, DC, and by the Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas.  The Waco RO otherwise has jurisdiction of the claims folder.

In February 2017, the Veteran testified at a videoconference hearing.  A transcript of that hearing is of record.

The claims file is now entirely in VA's secure electronic processing systems, Virtual VA and Veterans Benefits Management System (VBMS).

This appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2016).  38 U.S.C.A. § 7107(a)(2) (West 2014).

The issues of entitlement to service connection for an acquired psychiatric disorder other than PTSD, a lumbar spine disability, brain aneurysm and stroke, left eye impaired vision, a bilateral hip disability, bilateral hearing loss, tinnitus; entitlement to initial higher ratings for right and left knee degenerative joint disease; entitlement to a TDIU, and entitlement to SMC based on A&A or HB status are addressed in the REMAND portion of the decision below and are REMANDED to the Agency of Original Jurisdiction (AOJ).

FINDINGS OF FACT

1.  The Veteran did not engage in combat with the enemy, his claimed stressor event is not related to hostile or terrorist activity and is not verified, and he does not currently have a diagnosis of PTSD in accordance with DSM-IV that is related to a verified stressor event.

2.  The Veteran evidenced pes planus prior to active duty for training and it was not made worse by active duty training or service.  There was some treatment of foot complaints in service that appear to have resolved.  Later examinations revealed normal feet.

CONCLUSIONS OF LAW

1.  The Veteran does not have PTSD that was incurred in or aggravated by active service.  38 U.S.C.A. §§ 1131, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.303, 3.304 (2016).

2.  The Veteran does not have pes planus was not incurred in or aggravated by active duty service.  38 U.S.C.A. §§ 1131, 1153, 5103, 5103A, 5107; 38 C.F.R. §§ 3.303, 3.306 (2016).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

Preliminary Matter

As provided for by the Veterans Claims Assistance Act of 2000 (VCAA), the United States Department of Veterans Affairs (VA) has a duty to notify and assist claimants in substantiating a claim for VA benefits.  38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2014); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2015).

The requirements of 38 U.S.C.A. §§ 5103 and 5103A have been met as to the issues decided herein.  There is no issue as to providing an appropriate application form or completeness of the application.  VA notified the Veteran in May 2008 and November 2013 of the information and evidence needed to substantiate and complete a claim, to include notice of what part of that evidence is to be provided by the claimant, what part VA will attempt to obtain, and how disability ratings and effective dates are determined.  VA fulfilled its duty to assist the Veteran in obtaining identified and available evidence needed to substantiate a claim.  There is no evidence that additional records have yet to be requested.

The Veteran was not provided with a VA examination and opinion to assess the current nature and etiology of his claimed PTSD and pes planus; however, VA need not conduct an examination with respect to these claims as information and 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. 79 (2006), in disability compensation (service connection) claims, VA must provide a medical 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 the VA to make a decision on the claim.  In this case, the standards of McLendon are not met in this case as there is no current diagnosis of either PTSD or pes planus.  As such, remand for a VA examination is not necessary.

Service Connection

The Veteran seeks service connection for PTSD and pes planus.

Service connection means that the facts establish that a particular injury or disease resulting in disability was incurred in the line of duty in the active military service or, if pre-existing such service, was aggravated during service.  38 U.S.C.A. § 1131; 38 C.F.R. § 3.303(a).  Generally, to prevail on the issue of service connection there must be evidence of a current disability, in-service incurrence or aggravation of a disease or injury; and a causal relationship between the present disability and the disease or injury incurred or aggravated during service.  See Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004).

PTSD

The service treatment records are absent complaints, findings, or diagnoses of any psychiatric condition during service.  On Reports of Medical History completed by the Veteran in June 1984, August 1985, and June 1989 he denied ever having depression, excessive worry, and nervous trouble of any sort.  In August 1986, the Veteran indicated that he did not know if he had depression or excessive worry and initially began to place an "x" in the box associated with not knowing if he had nervous trouble of any sort, but he scratched it out.  On clinical examinations in June 1984, August 1985, and June 1989, the Veteran's psychiatric health was evaluated as normal.  Thus, there is no medical evidence that shows that the Veteran suffered from any psychiatric disorders during service.

To establish entitlement to service connection for there must be medical evidence diagnosing PTSD; a link, established by medical evidence, between current symptoms of PTSD and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred.  38 C.F.R. § 3.304 (f).  A diagnosis of PTSD must be established in accordance with 38 C.F.R. § 4.125(a), which simply mandates that, for VA purposes, all mental disorder diagnoses must conform to the criteria of the American Psychiatric Association's Diagnostic and Statistical Manual for Mental Disorders, Fifth edition, (DSM-V).  See 79 Fed. Reg. 45099 (August 4, 2014).

Initially, the Board notes that the Veteran does not contend, and the evidence does not demonstrate, that his PTSD stressors are related to combat or to fear of hostile military or terrorist activity.  Thus the provisions of 38 U.S.C.A. § 1154 (b) (2014) and 38 C.F.R. § 3.304 (f)(2), (3) (2016) do not apply.  Instead, in December 2013, the Veteran reported on his Statement in Support of Claim for Service Connection for PTSD that while he was stationed at Camp Foster in Okinawa, Japan, an individual became really upset when the Veteran became eligible for a promotion to sergeant.  At a bar, the individual and two of his friends hit the Veteran in the head and face over and over again.  The Veteran stated that the commanding officer gave NJP (nonjudicial punishment).  At his February 2017 hearing, the Veteran testified that he was in Okinawa downtown and that when he got back to base, some guys jumped him and beat him up.  He also testified that he saw some guy get shot by the Filipino marines.

In this case, the Board finds that there is no credible supporting evidence that the claimed in-service stressors occurred.  The Veteran has not submitted any information or evidence to corroborate his contentions that either event occurred in service; nor has he provided sufficient detail to allow for proper research or verification.  No pertinent medical treatment is shown to be provided during service.

The Board finds that the RO made reasonable efforts to obtain information to enable it to verify the claimed stressor events.  The RO obtained service personnel records and provided a VA Form 21-0781, Statement in Support of Claim for PTSD, and VA Form 21-0781a, Statement in Support of Claim for PTSD Secondary to Personal Assault.  The Veteran was advised that VA needed specific details. The Veteran provided information concerning the stressor event in which he was assaulted while stationed at Camp Foster in Okinawa, Japan, by three individuals at a bar; and that the commanding officer gave NJP.  The Veteran indicated that the incident happened in 1985 but noted that he had an aneurysm and lost his memory.  In this case, however, the contemporary evidence of record is inconsistent with the Veteran's statement of a head injury during his active duty service.  On Reports of Medical History completed by the Veteran in June 1984, August 1985, August 1986 and June 1989, he denied ever having a head injury.

In short, the Veteran's claimed stressor of being attacked and hit in the head over and over is not credible.  Far from being verified, this stressor has, in fact, been contradicted by the objective evidence of record.

In addition, there is no current diagnosis of PTSD of record.  In September 2006, May 2009, July 2011, screens for PTSD were negative; screen for PTSD in June 2013 was positive.  In addition, two PTSD screens administered on the same day in May 2009, resulted in one administered by a psychiatrist being negative and one administered by a nurse being positive.  A September 2009, Axis I diagnosis included "r/o PTSD."

Although some treatment records reference a diagnosis of PTSD, none of the PTSD diagnoses are made in conformance with the DSM-IV or V criteria, and as noted above, the single Axis I diagnosis including PTSD is recorded as "r[ule] o[ut] PTSD."  Subsequent Axis I diagnoses included mood disorder due to medical condition and major depressive disorder in addition to alcohol abuse, cannabis abuse, and tobacco use disorder.  Thus, the Board finds that the reference to "r/o PTSD" and the noted "cva with PTSD" in the VA treatment records cannot be interpreted as a finding that PTSD is a current disability, or that it has been present at any specific time pertinent to the appeal.

In summary, the Board finds that the most competent, credible, and probative evidence of record does not show that the Veteran currently or at any point during the appeal period has received a valid diagnosis of PTSD.  The Board further finds that the Veteran's claimed stressor of being hit in the head over and over is not credible and neither stressor has been verified.

The weight of the competent evidence shows that the Veteran does not have a current diagnosis of PTSD, and there is no independent evidence corroborating the Veteran's statement as to the occurrence of his claimed stressors.  As such, the evidence of record does not establish a DSM-V diagnosis of PTSD based upon a verified stressor event.

Thus, for the foregoing reasons, the claim for service connection for PTSD must be denied.  In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine; however, as the preponderance of the evidence is against the Veteran's claim, that doctrine is not applicable.

Pes Planus

On his Report of Medical Examination in September 1975 for the purpose of enlistment, the Veteran's feet were noted to be abnormal and he was diagnosed as having "pes planus 2§, asymptomatic."  On the Report of Medical History completed by the Veteran in conjunction with his entrance physical, he denied ever having foot trouble.

Every veteran shall be taken to have been in sound condition when examined, accepted, and enrolled for service, except as to defects, infirmities, or disorders noted at the time of the examination, acceptance, and enrollment, or where clear and unmistakable evidence demonstrates that the injury or disease existed before acceptance and enrollment and was not aggravated by such service.  38 U.S.C.A. § 1111 (West 2014).  The Board notes that the presumption of soundness applies only when a disease or injury not noted upon entry to service manifests in service, and a question arises as to whether it preexisted service.  Gilbert v. Shinseki, 26 Vet. App. 48, 55 (2012).  In this case, as pes planus was noted on his entrance examination, the presumption of soundness does not apply.

As the pes planus was noted upon entry into duty, and hence active service, the question becomes whether the disability was aggravated beyond natural progression during service.  38 U.S.C.A. § 1153.  Where a preexisting disease or injury is noted on the entrance examination, 38 U.S.C.A. § 1153 provides that "[a] preexisting injury or disease will be considered to have been aggravated by active military, naval, or air service, where there is an increase in disability during such service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease."  38 U.S.C.A. § 1153; 38 C.F.R. § 3.306(a).  For veterans who served during a period of war or after December 31, 1946, clear and unmistakable evidence is required to rebut the presumption of aggravation where the pre-service disability underwent an increase in severity during service.  Clear and unmistakable evidence includes medical facts and principles which may be considered to determine whether the increase is due to the natural progress of the disability at issue.  38 C.F.R. § 3.306 (b).  Temporary or intermittent flare-ups of symptoms of a preexisting condition, alone, do not constitute sufficient evidence for a noncombat veteran to show increased disability for the purposes of determinations of service connection based on aggravation under 38 U.S.C.A. § 1153 unless the underlying condition worsened.  Aggravation may not be conceded where the disability underwent no increase in severity during service on the basis of all the evidence of record pertaining to the manifestations of the disability prior to, during, and subsequent to service.  38 C.F.R. § 3.306 (b).

In January 1978, the Veteran presented with complaint of pain in bottom of feet to both calves for three days and bottom of feet for one week.  He denied any trauma, and the provider noted that he had been in repeatedly for the same problem.  Assessment was muscle strains.  In March 1978, the Veteran presented with complaint of painful feet with edema and cramping for approximately 1 1/2 years.  The Veteran stated that the symptoms were severe enough to interfere with his performance of military duty and that past treatment with over-the-counter arches gave no relief.  Examination revealed grade II pes planus with adequate but painful subtalar joint  and midtarsal joint range of motion.  The Veteran also noted pain with palpation of plantar aponeurosis, and mild triceps equinous.  Diagnosis was pes planus syndrome.  He was placed on light duty and issued arch supports.  The provider noted, "if no results, possible Med[ical] Board."  In July 1980, the Veteran presented with complaint of pain right side of foot with pain radiating to arch.  The Veteran was provided exercises to increase strength in arch area.  An undated treatment record, barely legible, indicates assessment of mild inflammation of Achilles tendon.

On Report of Medical History completed by the Veteran in June 1984, he noted foot trouble; in response, the examiner noted soft tissue strain both knees and ankles after joining Marine Corps during boot camp which resolved after boot camp.  On Reports of Medical History completed by the Veteran in August 1985, August 1986, and June 1989, he denied ever having foot trouble.  On clinical examinations in June 1984, August 1985, August 1986, and June 1989, the Veteran's feet were evaluated as normal.

The Board finds that the record lacks competent evidence that demonstrates that the Veteran's bilateral pes planus underwent a permanent worsening during his active duty service.

In addition, there is no current diagnosis of pes planus of record.  Private treatment records and VA treatment records indicate that the Veteran was seen numerous times for diabetic foot care.  At no time during any of these appointments was the Veteran diagnosed as having pes planus.

The weight of the competent evidence shows that the Veteran does not have a current diagnosis of pes planus.  Thus, for the foregoing reasons, the claim for service connection for pes planus must be denied.  In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine; however, as the preponderance of the evidence is against the Veteran's claim, that doctrine is not applicable.

ORDER

Entitlement to service connection for PTSD is denied.

Entitlement to service connection for bilateral pes planus is denied.

REMAND

As noted above, the issues of entitlement to service connection for an acquired psychiatric disorder other than PTSD, a lumbar spine disability, brain aneurysm and stroke, left eye impaired vision, a bilateral hip disability, bilateral hearing loss, tinnitus; entitlement to initial higher ratings for right and left knee degenerative joint disease; entitlement to a TDIU; and entitlement to SMC based on A&A or HB status are being remanded to the AOJ.

The Veteran testified in February 2017 that his service-connected knees caused his legs to give way and he fell and hit his head on cement which caused the aneurysm and the stroke which also resulted in left eye visual impairment.  The Veteran's spouse testified, "at the moment that he fell, his both hips were broken."

The record includes medical records from Sierra Medical Center from July 5, 2003; however, the information from the hospital reveals that the Veteran was seen initially at the Sierra Medical Center emergency department for chest pain, nausea, vomiting, and headache and later diagnosed with closed head injury and later with subarachnoid hemorrhage on the left due to an aneurysm, status post craniotomy and clipping of the aneurysm on July 18, 2003.

It is clear from the record that on July 5, 2003, the Veteran hit his head, was brought to the emergency room, was found to have subarachnoid hemorrhage, and  underwent craniotomy.  There is a question of whether the aneurysm ruptured before the Veteran fell or whether the fall caused the ruptured aneurysm.

The emergency department records do not appear to be in the file; as such, an attempt to obtain them should be made.

The Veteran has also identified outstanding medical records for the issues on appeal.  He testified in February 2017 that he was currently being treated by a private physician, Dr. Jackson, for his knees and hips.  The Veteran also testified that the prior year, Dr. Viesca had injected him 30 times in his back.  The Veteran further testified that eight months prior to the hearing, he saw a private physician for his hearing and for his eyes.

As such, prior to adjudication, an attempt to obtain all outstanding medical evidence should be made.

In addition, the record indicates that the Veteran has left upper lid ptosis due to CVA as well as depression and anxiety due to stroke.  As such these issues are inextricably intertwined with the issue of entitlement to service connection for brain aneurysm/stroke.  Further, entitlement to a TDIU and SMC are inextricably intertwined with the claims being remanded, as the outcome may impact the TDIU and SMC claims.  See Harris v. Derwinski, 1 Vet. App. 180, 183   (1991) (issues are "inextricably intertwined" when a decision on one issue would have a "significant impact" on a Veteran's claim for the second issue).

Accordingly, the case is REMANDED for the following action:

(Please note, this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c).  Expedited handling is requested.)

1.  The Veteran should be requested to indicate if he has received any VA or non-VA medical treatment for his psychiatric disorders, lumbar spine disability, brain aneurysm and stroke, left eye impaired vision, a bilateral hip disability, bilateral hearing loss, tinnitus, and right and left degenerative joint disease that is not evidenced by the current record.  If so, the Veteran should be provided with the necessary authorizations for the release of any treatment records not currently on file, to include the private medical records of Dr. Jackson since February 2008 and Dr. Viesca since July 2010, and the Emergency Department at Sierra Medical Center on July 5, 2003.  These records should then be obtained and associated with the claims folder.  The Veteran should be advised that he may also submit any evidence or further argument relative to the claim at issue.

2.  The case should be reviewed on the basis of the additional evidence.  If the benefit sought is not granted in full, the Veteran and his representative should be furnished a Supplemental Statement of the Case and be afforded a reasonable opportunity to respond before the record is returned to the Board for further review.

The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded.  Kutscherousky v. West, 12 Vet. App. 369 (1999).

This claim must be afforded expeditious treatment.  The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner.  See 38 U.S.C.A. §§ 5109B, 7112 (West 2014).

______________________________________________
MICHAEL D. LYON
Veterans Law Judge, Board of Veterans' Appeals

Department of Veterans Affairs

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text: R

text: REASONS

text: AND

text: BASES

text: FOR

text: FINDINGS

text: AND

text: CONCLUSIONS

text: Preliminary

text: Matter

text: As

text: provided

text: for

text: by

text: the

text: Veterans

text: Claims

text: Assistance

text: Act

text: of

text: VCAA

text: the

text: United

text: States

text: Department

text: of

text: Veterans

text: Affairs

text: VA

text: has

text: a

text: duty

text: to

text: notify

text: and

text: assist

text: claimants

text: in

text: substantiating

text: a

text: claim

text: for

text: VA

text: benefits

text: U

text: S

text: C

text: A

text: A

text: West

text: C

text: F

text: R

text: a

text: a

text: The

text: requirements

text: of

text: U

text: S

text: C

text: A

text: and

text: A

text: have

text: been

text: met

text: as

text: to

text: the

text: issues

text: decided

text: herein

text: There

text: is

text: no

text: issue

text: as

text: to

text: providing

text: an

text: appropriate

text: application

text: form

text: or

text: completeness

text: of

text: the

text: application

text: VA

text: notified

text: the

text: Veteran

text: in

text: May

text: and

text: November

text: of

text: the

text: information

text: and

text: evidence

text: needed

text: to

text: substantiate

text: and

text: complete

text: a

text: claim

text: to

text: include

text: notice

text: of

text: what

text: part

text: of

text: that

text: evidence

text: is

text: to

text: be

text: provided

text: by

text: the

text: claimant

text: what

text: part

text: VA

text: will

text: attempt

text: to

text: obtain

text: and

text: how

text: disability

text: ratings

text: and

text: effective

text: dates

text: are

text: determined

text: VA

text: fulfilled

text: its

text: duty

text: to

text: assist

text: the

text: Veteran

text: in

text: obtaining

text: identified

text: and

text: available

text: evidence

text: needed

text: to

text: substantiate

text: a

text: claim

text: There

text: is

text: no

text: evidence

text: that

text: additional

text: records

text: have

text: yet

text: to

text: be

text: requested

text: The

text: Veteran

text: was

text: not

text: provided

text: with

text: a

text: VA

text: examination

text: and

text: opinion

text: to

text: assess

text: the

text: current

text: nature

text: and

text: etiology

text: of

text: his

text: claimed

text: PTSD

text: and

text: pes

text: planus

text: however

text: VA

text: need

text: not

text: conduct

text: an

text: examination

text: with

text: respect

text: to

text: these

text: claims

text: as

text: information

text: and

text: evidence

text: of

text: record

text: contains

text: sufficient

text: competent

text: medical

text: evidence

text: to

text: decide

text: the

text: claim

text: See

text: C

text: F

text: R

text: c

text: Under

text: McLendon

text: v

text: Nicholson

text: Vet

text: App

text: in

text: disability

text: compensation

text: service

text: connection

text: claims

text: VA

text: must

text: provide

text: a

text: medical

text: examination

text: when

text: there

text: is

text: competent

text: evidence

text: of

text: a

text: current

text: disability

text: or

text: persistent

text: or

text: recurrent

text: symptoms

text: of

text: a

text: disability

text: and

text: evidence

text: establishing

text: that

text: an

text: event

text: injury

text: or

text: disease

text: occurred

text: in

text: service

text: or

text: establishing

text: certain

text: diseases

text: manifesting

text: during

text: an

text: applicable

text: presumptive

text: period

text: for

text: which

text: the

text: claimant

text: qualifies

text: and

text: an

text: indication

text: that

text: the

text: disability

text: or

text: persistent

text: or

text: recurrent

text: symptoms

text: of

text: a

text: disability

text: may

text: be

text: associated

text: with

text: the

text: Veteran

text: s

text: service

text: or

text: with

text: another

text: service

text: connected

text: disability

text: but

text: insufficient

text: competent

text: medical

text: evidence

text: on

text: file

text: for

text: the

text: VA

text: to

text: make

text: a

text: decision

text: on

text: the

text: claim

text: In

text: this

text: case

text: the

text: standards

text: of

text: McLendon

text: are

text: not

text: met

text: in

text: this

text: case

text: as

text: there

text: is

text: no

text: current

text: diagnosis

text: of

text: either

text: PTSD

text: or

text: pes

text: planus

text: As

text: such

text: remand

text: for

text: a

text: VA

text: examination

text: is

text: not

text: necessary

text: Service

text: Connection

text: The

text: Veteran

text: seeks

text: service

text: connection

text: for

text: PTSD

text: and

text: pes

text: planus

text: Service

text: connection

text: means

text: that

text: the

text: facts

text: establish

text: that

text: a

text: particular

text: injury

text: or

text: disease

text: resulting

text: in

text: disability

text: was

text: incurred

text: in

text: the

text: line

text: of

text: duty

text: in

text: the

text: active

text: military

text: service

text: or

text: if

text: pre

text: existing

text: such

text: service

text: was

text: aggravated

text: during

text: service

text: U

text: S

text: C

text: A

text: C

text: F

text: R

text: a

text: Generally

text: to

text: prevail

text: on

text: the

text: issue

text: of

text: service

text: connection

text: there

text: must

text: be

text: evidence

text: of

text: a

text: current

text: disability

text: in

text: service

text: incurrence

text: or

text: aggravation

text: of

text: a

text: disease

text: or

text: injury

text: and

text: a

text: causal

text: relationship

text: between

text: the

text: present

text: disability

text: and

text: the

text: disease

text: or

text: injury

text: incurred

text: or

text: aggravated

text: during

text: service

text: See

text: Shedden

text: v

text: Principi

text: F

text: d

text: Fed

text: Cir

text: PTSD

text: The

text: service

text: treatment

text: records

text: are

text: absent

text: complaints

text: findings

text: or

text: diagnoses

text: of

text: any

text: psychiatric

text: condition

text: during

text: service

text: On

text: Reports

text: of

text: Medical

text: History

text: completed

text: by

text: the

text: Veteran

text: in

text: June

text: August

text: and

text: June

text: he

text: denied

text: ever

text: having

text: depression

text: excessive

text: worry

text: and

text: nervous

text: trouble

text: of

text: any

text: sort

text: In

text: August

text: the

text: Veteran

text: indicated

text: that

text: he

text: did

text: not

text: know

text: if

text: he

text: had

text: depression

text: or

text: excessive

text: worry

text: and

text: initially

text: began

text: to

text: place

text: an

text: x

text: in

text: the

text: box

text: associated

text: with

text: not

text: knowing

text: if

text: he

text: had

text: nervous

text: trouble

text: of

text: any

text: sort

text: but

text: he

text: scratched

text: it

text: out

text: On

text: clinical

text: examinations

text: in

text: June

text: August

text: and

text: June

text: the

text: Veteran

text: s

text: psychiatric

text: health

text: was

text: evaluated

text: as

text: normal

text: Thus

text: there

text: is

text: no

text: medical

text: evidence

text: that

text: shows

text: that

text: the

text: Veteran

text: suffered

text: from

text: any

text: psychiatric

text: disorders

text: during

text: service

text: To

text: establish

text: entitlement

text: to

text: service

text: connection

text: for

text: there

text: must

text: be

text: medical

text: evidence

text: diagnosing

text: PTSD

text: a

text: link

text: established

text: by

text: medical

text: evidence

text: between

text: current

text: symptoms

text: of

text: PTSD

text: and

text: an

text: in

text: service

text: stressor

text: and

text: credible

text: supporting

text: evidence

text: that

text: the

text: claimed

text: in

text: service

text: stressor

text: occurred

text: C

text: F

text: R

text: f

text: A

text: diagnosis

text: of

text: PTSD

text: must

text: be

text: established

text: in

text: accordance

text: with

text: C

text: F

text: R

text: a

text: which

text: simply

text: mandates

text: that

text: for

text: VA

text: purposes

text: all

text: mental

text: disorder

text: diagnoses

text: must

text: conform

text: to

text: the

text: criteria

text: of

text: the

text: American

text: Psychiatric

text: Association

text: s

text: Diagnostic

text: and

text: Statistical

text: Manual

text: for

text: Mental

text: Disorders

text: Fifth

text: edition

text: DSM

text: V

text: See

text: Fed

text: Reg

text: August

text: Initially

text: the

text: Board

text: notes

text: that

text: the

text: Veteran

text: does

text: not

text: contend

text: and

text: the

text: evidence

text: does

text: not

text: demonstrate

text: that

text: his

text: PTSD

text: stressors

text: are

text: related

text: to

text: combat

text: or

text: to

text: fear

text: of

text: hostile

text: military

text: or

text: terrorist

text: activity

text: Thus

text: the

text: provisions

text: of

text: U

text: S

text: C

text: A

text: b

text: and

text: C

text: F

text: R

text: f

text: do

text: not

text: apply

text: Instead

text: in

text: December

text: the

text: Veteran

text: reported

text: on

text: his

text: Statement

text: in

text: Support

text: of

text: Claim

text: for

text: Service

text: Connection

text: for

text: PTSD

text: that

text: while

text: he

text: was

text: stationed

text: at

text: Camp

text: Foster

text: in

text: Okinawa

text: Japan

text: an

text: individual

text: became

text: really

text: upset

text: when

text: the

text: Veteran

text: became

text: eligible

text: for

text: a

text: promotion

text: to

text: sergeant

text: At

text: a

text: bar

text: the

text: individual

text: and

text: two

text: of

text: his

text: friends

text: hit

text: the

text: Veteran

text: in

text: the

text: head

text: and

text: face

text: over

text: and

text: over

text: again

text: The

text: Veteran

text: stated

text: that

text: the

text: commanding

text: officer

text: gave

text: NJP

text: nonjudicial

text: punishment

text: At

text: his

text: February

text: hearing

text: the

text: Veteran

text: testified

text: that

text: he

text: was

text: in

text: Okinawa

text: downtown

text: and

text: that

text: when

text: he

text: got

text: back

text: to

text: base

text: some

text: guys

text: jumped

text: him

text: and

text: beat

text: him

text: up

text: He

text: also

text: testified

text: that

text: he

text: saw

text: some

text: guy

text: get

text: shot

text: by

text: the

text: Filipino

text: marines

text: In

text: this

text: case

text: the

text: Board

text: finds

text: that

text: there

text: is

text: no

text: credible

text: supporting

text: evidence

text: that

text: the

text: claimed

text: in

text: service

text: stressors

text: occurred

text: The

text: Veteran

text: has

text: not

text: submitted

text: any

text: information

text: or

text: evidence

text: to

text: corroborate

text: his

text: contentions

text: that

text: either

text: event

text: occurred

text: in

text: service

text: nor

text: has

text: he

text: provided

text: sufficient

text: detail

text: to

text: allow

text: for

text: proper

text: research

text: or

text: verification

text: No

text: pertinent

text: medical

text: treatment

text: is

text: shown

text: to

text: be

text: provided

text: during

text: service

text: The

text: Board

text: finds

text: that

text: the

text: RO

text: made

text: reasonable

text: efforts

text: to

text: obtain

text: information

text: to

text: enable

text: it

text: to

text: verify

text: the

text: claimed

text: stressor

text: events

text: The

text: RO

text: obtained

text: service

text: personnel

text: records

text: and

text: provided

text: a

text: VA

text: Form

text: Statement

text: in

text: Support

text: of

text: Claim

text: for

text: PTSD

text: and

text: VA

text: Form

text: a

text: Statement

text: in

text: Support

text: of

text: Claim

text: for

text: PTSD

text: Secondary

text: to

text: Personal

text: Assault

text: The

text: Veteran

text: was

text: advised

text: that

text: VA

text: needed

text: specific

text: details

text: The

text: Veteran

text: provided

text: information

text: concerning

text: the

text: stressor

text: event

text: in

text: which

text: he

text: was

text: assaulted

text: while

text: stationed

text: at

text: Camp

text: Foster

text: in

text: Okinawa

text: Japan

text: by

text: three

text: individuals

text: at

text: a

text: bar

text: and

text: that

text: the

text: commanding

text: officer

text: gave

text: NJP

text: The

text: Veteran

text: indicated

text: that

text: the

text: incident

text: happened

text: in

text: but

text: noted

text: that

text: he

text: had

text: an

text: aneurysm

text: and

text: lost

text: his

text: memory

text: In

text: this

text: case

text: however

text: the

text: contemporary

text: evidence

text: of

text: record

text: is

text: inconsistent

text: with

text: the

text: Veteran

text: s

text: statement

text: of

text: a

text: head

text: injury

text: during

text: his

text: active

text: duty

text: service

text: On

text: Reports

text: of

text: Medical

text: History

text: completed

text: by

text: the

text: Veteran

text: in

text: June

text: August

text: August

text: and

text: June

text: he

text: denied

text: ever

text: having

text: a

text: head

text: injury

text: In

text: short

text: the

text: Veteran

text: s

text: claimed

text: stressor

text: of

text: being

text: attacked

text: and

text: hit

text: in

text: the

text: head

text: over

text: and

text: over

text: is

text: not

text: credible

text: Far

text: from

text: being

text: verified

text: this

text: stressor

text: has

text: in

text: fact

text: been

text: contradicted

text: by

text: the

text: objective

text: evidence

text: of

text: record

text: In

text: addition

text: there

text: is

text: no

text: current

text: diagnosis

text: of

text: PTSD

text: of

text: record

text: In

text: September

text: May

text: July

text: screens

text: for

text: PTSD

text: were

text: negative

text: screen

text: for

text: PTSD

text: in

text: June

text: was

text: positive

text: In

text: addition

text: two

text: PTSD

text: screens

text: administered

text: on

text: the

text: same

text: day

text: in

text: May

text: resulted

text: in

text: one

text: administered

text: by

text: a

text: psychiatrist

text: being

text: negative

text: and

text: one

text: administered

text: by

text: a

text: nurse

text: being

text: positive

text: A

text: September

text: Axis

text: I

text: diagnosis

text: included

text: r

text: o

text: PTSD

text: Although

text: some

text: treatment

text: records

text: reference

text: a

text: diagnosis

text: of

text: PTSD

text: of

text: the

text: PTSD

text: diagnoses

text: are

text: made

text: in

text: conformance

text: with

text: the

text: DSM

text: IV

text: or

text: V

text: criteria

text: and

text: as

text: noted

text: above

text: the

text: single

text: Axis

text: I

text: diagnosis

text: including

text: PTSD

text: is

text: recorded

text: as

text: r

text: ule

text: o

text: ut

text: PTSD

text: Subsequent

text: Axis

text: I

text: diagnoses

text: included

text: mood

text: disorder

text: due

text: to

text: medical

text: condition

text: and

text: major

text: depressive

text: disorder

text: in

text: addition

text: to

text: alcohol

text: abuse

text: cannabis

text: abuse

text: and

text: tobacco

text: use

text: disorder

text: Thus

text: the

text: Board

text: finds

text: that

text: the

text: reference

text: to

text: r

text: o

text: PTSD

text: and

text: the

text: noted

text: cva

text: with

text: PTSD

text: in

text: the

text: VA

text: treatment

text: records

text: cannot

text: be

text: interpreted

text: as

text: a

text: finding

text: that

text: PTSD

text: is

text: a

text: current

text: disability

text: or

text: that

text: it

text: has

text: been

text: present

text: at

text: any

text: specific

text: time

text: pertinent

text: to

text: the

text: appeal

text: In

text: summary

text: the

text: Board

text: finds

text: that

text: the

text: most

text: competent

text: credible

text: and

text: probative

text: evidence

text: of

text: record

text: does

text: not

text: show

text: that

text: the

text: Veteran

text: currently

text: or

text: at

text: any

text: point

text: during

text: the

text: appeal

text: period

text: has

text: received

text: a

text: valid

text: diagnosis

text: of

text: PTSD

text: The

text: Board

text: further

text: finds

text: that

text: the

text: Veteran

text: s

text: claimed

text: stressor

text: of

text: being

text: hit

text: in

text: the

text: head

text: over

text: and

text: over

text: is

text: not

text: credible

text: and

text: neither

text: stressor

text: has

text: been

text: verified

text: The

text: weight

text: of

text: the

text: competent

text: evidence

text: shows

text: that

text: the

text: Veteran

text: does

text: not

text: have

text: a

text: current

text: diagnosis

text: of

text: PTSD

text: and

text: there

text: is

text: no

text: independent

text: evidence

text: corroborating

text: the

text: Veteran

text: s

text: statement

text: as

text: to

text: the

text: occurrence

text: of

text: his

text: claimed

text: stressors

text: As

text: such

text: the

text: evidence

text: of

text: record

text: does

text: not

text: establish

text: a

text: DSM

text: V

text: diagnosis

text: of

text: PTSD

text: based

text: upon

text: a

text: verified

text: stressor

text: event

text: Thus

text: for

text: the

text: foregoing

text: reasons

text: the

text: claim

text: for

text: service

text: connection

text: for

text: PTSD

text: must

text: be

text: denied

text: In

text: reaching

text: this

text: conclusion

text: the

text: Board

text: has

text: considered

text: the

text: applicability

text: of

text: the

text: benefit

text: of

text: the

text: doubt

text: doctrine

text: however

text: as

text: the

text: preponderance

text: of

text: the

text: evidence

text: is

text: against

text: the

text: Veteran

text: s

text: claim

text: that

text: doctrine

text: is

text: not

text: applicable

text: Pes

text: Planus

text: On

text: his

text: Report

text: of

text: Medical

text: Examination

text: in

text: September

text: for

text: the

text: purpose

text: of

text: enlistment

text: the

text: Veteran

text: s

text: feet

text: were

text: noted

text: to

text: be

text: abnormal

text: and

text: he

text: was

text: diagnosed

text: as

text: having

text: pes

text: planus

text: asymptomatic

text: On

text: the

text: Report

text: of

text: Medical

text: History

text: completed

text: by

text: the

text: Veteran

text: in

text: conjunction

text: with

text: his

text: entrance

text: physical

text: he

text: denied

text: ever

text: having

text: foot

text: trouble

text: Every

text: veteran

text: shall

text: be

text: taken

text: to

text: have

text: been

text: in

text: sound

text: condition

text: when

text: examined

text: accepted

text: and

text: enrolled

text: for

text: service

text: except

text: as

text: to

text: defects

text: infirmities

text: or

text: disorders

text: noted

text: at

text: the

text: time

text: of

text: the

text: examination

text: acceptance

text: and

text: enrollment

text: or

text: where

text: clear

text: and

text: unmistakable

text: evidence

text: demonstrates

text: that

text: the

text: injury

text: or

text: disease

text: existed

text: before

text: acceptance

text: and

text: enrollment

text: and

text: was

text: not

text: aggravated

text: by

text: such

text: service

text: U

text: S

text: C

text: A

text: West

text: The

text: Board

text: notes

text: that

text: the

text: presumption

text: of

text: soundness

text: applies

text: only

text: when

text: a

text: disease

text: or

text: injury

text: not

text: noted

text: upon

text: entry

text: to

text: service

text: manifests

text: in

text: service

text: and

text: a

text: question

text: arises

text: as

text: to

text: whether

text: it

text: preexisted

text: service

text: Gilbert

text: v

text: Shinseki

text: Vet

text: App

text: In

text: this

text: case

text: as

text: pes

text: planus

text: was

text: noted

text: on

text: his

text: entrance

text: examination

text: the

text: presumption

text: of

text: soundness

text: does

text: not

text: apply

text: As

text: the

text: pes

text: planus

text: was

text: noted

text: upon

text: entry

text: into

text: duty

text: and

text: hence

text: active

text: service

text: the

text: question

text: becomes

text: whether

text: the

text: disability

text: was

text: aggravated

text: beyond

text: natural

text: progression

text: during

text: service

text: U

text: S

text: C

text: A

text: Where

text: a

text: preexisting

text: disease

text: or

text: injury

text: is

text: noted

text: on

text: the

text: entrance

text: examination

text: U

text: S

text: C

text: A

text: provides

text: that

text: a

text: preexisting

text: injury

text: or

text: disease

text: will

text: be

text: considered

text: to

text: have

text: been

text: aggravated

text: by

text: active

text: military

text: naval

text: or

text: air

text: service

text: where

text: there

text: is

text: an

text: increase

text: in

text: disability

text: during

text: such

text: service

text: unless

text: there

text: is

text: a

text: specific

text: finding

text: that

text: the

text: increase

text: in

text: disability

text: is

text: due

text: to

text: the

text: natural

text: progress

text: of

text: the

text: disease

text: U

text: S

text: C

text: A

text: C

text: F

text: R

text: a

text: For

text: veterans

text: who

text: served

text: during

text: a

text: period

text: of

text: war

text: or

text: after

text: December

text: clear

text: and

text: unmistakable

text: evidence

text: is

text: required

text: to

text: rebut

text: the

text: presumption

text: of

text: aggravation

text: where

text: the

text: pre

text: service

text: disability

text: underwent

text: an

text: increase

text: in

text: severity

text: during

text: service

text: Clear

text: and

text: unmistakable

text: evidence

text: includes

text: medical

text: facts

text: and

text: principles

text: which

text: may

text: be

text: considered

text: to

text: determine

text: whether

text: the

text: increase

text: is

text: due

text: to

text: the

text: natural

text: progress

text: of

text: the

text: disability

text: at

text: issue

text: C

text: F

text: R

text: b

text: Temporary

text: or

text: intermittent

text: flare

text: ups

text: of

text: symptoms

text: of

text: a

text: preexisting

text: condition

text: alone

text: do

text: not

text: constitute

text: sufficient

text: evidence

text: for

text: a

text: noncombat

text: veteran

text: to

text: show

text: increased

text: disability

text: for

text: the

text: purposes

text: of

text: determinations

text: of

text: service

text: connection

text: based

text: on

text: aggravation

text: under

text: U

text: S

text: C

text: A

text: unless

text: the

text: underlying

text: condition

text: worsened

text: Aggravation

text: may

text: not

text: be

text: conceded

text: where

text: the

text: disability

text: underwent

text: no

text: increase

text: in

text: severity

text: during

text: service

text: on

text: the

text: basis

text: of

text: all

text: the

text: evidence

text: of

text: record

text: pertaining

text: to

text: the

text: manifestations

text: of

text: the

text: disability

text: prior

text: to

text: during

text: and

text: subsequent

text: to

text: service

text: C

text: F

text: R

text: b

text: In

text: January

text: the

text: Veteran

text: presented

text: with

text: complaint

text: of

text: pain

text: in

text: bottom

text: of

text: feet

text: to

text: both

text: calves

text: for

text: three

text: days

text: and

text: bottom

text: of

text: feet

text: for

text: one

text: week

text: He

text: denied

text: any

text: trauma

text: and

text: the

text: provider

text: noted

text: that

text: he

text: had

text: been

text: in

text: repeatedly

text: for

text: the

text: same

text: problem

text: Assessment

text: was

text: muscle

text: strains

text: In

text: March

text: the

text: Veteran

text: presented

text: with

text: complaint

text: of

text: painful

text: feet

text: with

text: edema

text: and

text: cramping

text: for

text: approximately

text: years

text: The

text: Veteran

text: stated

text: that

text: the

text: symptoms

text: were

text: severe

text: enough

text: to

text: interfere

text: with

text: his

text: performance

text: of

text: military

text: duty

text: and

text: that

text: past

text: treatment

text: with

text: over

text: the

text: counter

text: arches

text: gave

text: no

text: relief

text: Examination

text: revealed

text: grade

text: II

text: pes

text: planus

text: with

text: adequate

text: but

text: painful

text: subtalar

text: joint

text: and

text: midtarsal

text: joint

text: range

text: of

text: motion

text: The

text: Veteran

text: also

text: noted

text: pain

text: with

text: palpation

text: of

text: plantar

text: aponeurosis

text: and

text: mild

text: triceps

text: equinous

text: Diagnosis

text: was

text: pes

text: planus

text: syndrome

text: He

text: was

text: placed

text: on

text: light

text: duty

text: and

text: issued

text: arch

text: supports

text: The

text: provider

text: noted

text: if

text: no

text: results

text: possible

text: Med

text: ical

text: Board

text: In

text: July

text: the

text: Veteran

text: presented

text: with

text: complaint

text: of

text: pain

text: right

text: side

text: of

text: foot

text: with

text: pain

text: radiating

text: to

text: arch

text: The

text: Veteran

text: was

text: provided

text: exercises

text: to

text: increase

text: strength

text: in

text: arch

text: area

text: An

text: undated

text: treatment

text: record

text: barely

text: legible

text: indicates

text: assessment

text: of

text: mild

text: inflammation

text: of

text: Achilles

text: tendon

text: On

text: Report

text: of

text: Medical

text: History

text: completed

text: by

text: the

text: Veteran

text: in

text: June

text: he

text: noted

text: foot

text: trouble

text: in

text: response

text: the

text: examiner

text: noted

text: soft

text: tissue

text: strain

text: both

text: knees

text: and

text: ankles

text: after

text: joining

text: Marine

text: Corps

text: during

text: boot

text: camp

text: which

text: resolved

text: after

text: boot

text: camp

text: On

text: Reports

text: of

text: Medical

text: History

text: completed

text: by

text: the

text: Veteran

text: in

text: August

text: August

text: and

text: June

text: he

text: denied

text: ever

text: having

text: foot

text: trouble

text: On

text: clinical

text: examinations

text: in

text: June

text: August

text: August

text: and

text: June

text: the

text: Veteran

text: s

text: feet

text: were

text: evaluated

text: as

text: normal

text: The

text: Board

text: finds

text: that

text: the

text: record

text: lacks

text: competent

text: evidence

text: that

text: demonstrates

text: that

text: the

text: Veteran

text: s

text: bilateral

text: pes

text: planus

text: underwent

text: a

text: permanent

text: worsening

text: during

text: his

text: active

text: duty

text: service

text: In

text: addition

text: there

text: is

text: no

text: current

text: diagnosis

text: of

text: pes

text: planus

text: of

text: record

text: Private

text: treatment

text: records

text: and

text: VA

text: treatment

text: records

text: indicate

text: that

text: the

text: Veteran

text: was

text: seen

text: numerous

text: times

text: for

text: diabetic

text: foot

text: care

text: At

text: no

text: time

text: during

text: any

text: of

text: these

text: appointments

text: was

text: the

text: Veteran

text: diagnosed

text: as

text: having

text: pes

text: planus

text: The

text: weight

text: of

text: the

text: competent

text: evidence

text: shows

text: that

text: the

text: Veteran

text: does

text: not

text: have

text: a

text: current

text: diagnosis

text: of

text: pes

text: planus

text: Thus

text: for

text: the

text: foregoing

text: reasons

text: the

text: claim

text: for

text: service

text: connection

text: for

text: pes

text: planus

text: must

text: be

text: denied

text: In

text: reaching

text: this

text: conclusion

text: the

text: Board

text: has

text: considered

text: the

text: applicability

text: of

text: the

text: benefit

text: of

text: the

text: doubt

text: doctrine

text: however

text: as

text: the

text: preponderance

text: of

text: the

text: evidence

text: is

text: against

text: the

text: Veteran

text: s

text: claim

text: that

text: doctrine

text: is

text: not

text: applicable

text: ORDER

text: Entitlement

text: to

text: service

text: connection

text: for

text: PTSD

text: is

text: denied

text: Entitlement

text: to

text: service

text: connection

text: for

text: bilateral

text: pes

text: planus

text: is

text: denied

text: REMAND

text: As

text: noted

text: above

text: the

text: issues

text: of

text: entitlement

text: to

text: service

text: connection

text: for

text: an

text: acquired

text: psychiatric

text: disorder

text: other

text: than

text: PTSD

text: a

text: lumbar

text: spine

text: disability

text: brain

text: aneurysm

text: and

text: stroke

text: left

text: eye

text: impaired

text: vision

text: a

text: bilateral

text: hip

text: disability

text: bilateral

text: hearing

text: loss

text: tinnitus

text: entitlement

text: to

text: initial

text: higher

text: ratings

text: for

text: right

text: and

text: left

text: knee

text: degenerative

text: joint

text: disease

text: entitlement

text: to

text: a

text: TDIU

text: and

text: entitlement

text: to

text: SMC

text: based

text: on

text: A

text: A

text: or

text: HB

text: status

text: are

text: being

text: remanded

text: to

text: the

text: AOJ

text: The

text: Veteran

text: testified

text: in

text: February

text: that

text: his

text: service

text: connected

text: knees

text: caused

text: his

text: legs

text: to

text: give

text: way

text: and

text: he

text: fell

text: and

text: hit

text: his

text: head

text: on

text: cement

text: which

text: caused

text: the

text: aneurysm

text: and

text: the

text: stroke

text: which

text: also

text: resulted

text: in

text: left

text: eye

text: visual

text: impairment

text: The

text: Veteran

text: s

text: spouse

text: testified

text: at

text: the

text: moment

text: that

text: he

text: fell

text: his

text: both

text: hips

text: were

text: broken

text: The

text: record

text: includes

text: medical

text: records

text: from

text: Sierra

text: Medical

text: Center

text: from

text: July

text: however

text: the

text: information

text: from

text: the

text: hospital

text: reveals

text: that

text: the

text: Veteran

text: was

text: seen

text: initially

text: at

text: the

text: Sierra

text: Medical

text: Center

text: emergency

text: department

text: for

text: chest

text: pain

text: nausea

text: vomiting

text: and

text: headache

text: and

text: later

text: diagnosed

text: with

text: closed

text: head

text: injury

text: and

text: later

text: with

text: subarachnoid

text: hemorrhage

text: on

text: the

text: left

text: due

text: to

text: an

text: aneurysm

text: status

text: post

text: craniotomy

text: and

text: clipping

text: of

text: the

text: aneurysm

text: on

text: July

text: It

text: is

text: clear

text: from

text: the

text: record

text: that

text: on

text: July

text: the

text: Veteran

text: hit

text: his

text: head

text: was

text: brought

text: to

text: the

text: emergency

text: room

text: was

text: found

text: to

text: have

text: subarachnoid

text: hemorrhage

text: and

text: underwent

text: craniotomy

text: There

text: is

text: a

text: question

text: of

text: whether

text: the

text: aneurysm

text: ruptured

text: before

text: the

text: Veteran

text: fell

text: or

text: whether

text: the

text: fall

text: caused

text: the

text: ruptured

text: aneurysm

text: The

text: emergency

text: department

text: records

text: do

text: not

text: appear

text: to

text: be

text: in

text: the

text: file

text: as

text: such

text: an

text: attempt

text: to

text: obtain

text: them

text: should

text: be

text: made

text: The

text: Veteran

text: has

text: also

text: identified

text: outstanding

text: medical

text: records

text: for

text: the

text: issues

text: on

text: appeal

text: He

text: testified

text: in

text: February

text: that

text: he

text: was

text: currently

text: being

text: treated

text: by

text: a

text: private

text: physician

text: Dr

text: Jackson

text: for

text: his

text: knees

text: and

text: hips

text: The

text: Veteran

text: also

text: testified

text: that

text: the

text: prior

text: year

text: Dr

text: Viesca

text: had

text: injected

text: him

text: times

text: in

text: his

text: back

text: The

text: Veteran

text: further

text: testified

text: that

text: eight

text: months

text: prior

text: to

text: the

text: hearing

text: he

text: saw

text: a

text: private

text: physician

text: for

text: his

text: hearing

text: and

text: for

text: his

text: eyes

text: As

text: such

text: prior

text: to

text: adjudication

text: an

text: attempt

text: to

text: obtain

text: all

text: outstanding

text: medical

text: evidence

text: should

text: be

text: made

text: In

text: addition

text: the

text: record

text: indicates

text: that

text: the

text: Veteran

text: has

text: left

text: upper

text: lid

text: ptosis

text: due

text: to

text: CVA

text: as

text: well

text: as

text: depression

text: and

text: anxiety

text: due

text: to

text: stroke

text: As

text: such

text: these

text: issues

text: are

text: inextricably

text: intertwined

text: with

text: the

text: issue

text: of

text: entitlement

text: to

text: service

text: connection

text: for

text: brain

text: aneurysm

text: stroke

text: Further

text: entitlement

text: to

text: a

text: TDIU

text: and

text: SMC

text: are

text: inextricably

text: intertwined

text: with

text: the

text: claims

text: being

text: remanded

text: as

text: the

text: outcome

text: may

text: impact

text: the

text: TDIU

text: and

text: SMC

text: claims

text: See

text: Harris

text: v

text: Derwinski

text: Vet

text: App

text: issues

text: are

text: inextricably

text: intertwined

text: when

text: a

text: decision

text: on

text: one

text: issue

text: would

text: have

text: a

text: significant

text: impact

text: on

text: a

text: Veteran

text: s

text: claim

text: for

text: the

text: second

text: issue

text: Accordingly

text: the

text: case

text: is

text: REMANDED

text: for

text: the

text: following

text: action

text: Please

text: note

text: this

text: appeal

text: has

text: been

text: advanced

text: on

text: the

text: Board

text: s

text: docket

text: pursuant

text: to

text: C

text: F

text: R

text: c

text: Expedited

text: handling

text: is

text: requested

text: The

text: Veteran

text: should

text: be

text: requested

text: to

text: indicate

text: if

text: he

text: has

text: received

text: any

text: VA

text: or

text: non

text: VA

text: medical

text: treatment

text: for

text: his

text: psychiatric

text: disorders

text: lumbar

text: spine

text: disability

text: brain

text: aneurysm

text: and

text: stroke

text: left

text: eye

text: impaired

text: vision

text: a

text: bilateral

text: hip

text: disability

text: bilateral

text: hearing

text: loss

text: tinnitus

text: and

text: right

text: and

text: left

text: degenerative

text: joint

text: disease

text: that

text: is

text: not

text: evidenced

text: by

text: the

text: current

text: record

text: If

text: so

text: the

text: Veteran

text: should

text: be

text: provided

text: with

text: the

text: necessary

text: authorizations

text: for

text: the

text: release

text: of

text: any

text: treatment

text: records

text: not

text: currently

text: on

text: file

text: to

text: include

text: the

text: private

text: medical

text: records

text: of

text: Dr

text: Jackson

text: since

text: February

text: and

text: Dr

text: Viesca

text: since

text: July

text: and

text: the

text: Emergency

text: Department

text: at

text: Sierra

text: Medical

text: Center

text: on

text: July

text: These

text: records

text: should

text: then

text: be

text: obtained

text: and

text: associated

text: with

text: the

text: claims

text: folder

text: The

text: Veteran

text: should

text: be

text: advised

text: that

text: he

text: may

text: also

text: submit

text: any

text: evidence

text: or

text: further

text: argument

text: relative

text: to

text: the

text: claim

text: at

text: issue

text: The

text: case

text: should

text: be

text: reviewed

text: on

text: the

text: basis

text: of

text: the

text: additional

text: evidence

text: If

text: the

text: benefit

text: sought

text: is

text: not

text: granted

text: in

text: full

text: the

text: Veteran

text: and

text: his

text: representative

text: should

text: be

text: furnished

text: a

text: Supplemental

text: Statement

text: of

text: the

text: Case

text: and

text: be

text: afforded

text: a

text: reasonable

text: opportunity

text: to

text: respond

text: before

text: the

text: record

text: is

text: returned

text: to

text: the

text: Board

text: for

text: further

text: review

text: The

text: appellant

text: has

text: the

text: right

text: to

text: submit

text: additional

text: evidence

text: and

text: argument

text: on

text: the

text: matter

text: or

text: matters

text: the

text: Board

text: has

text: remanded

text: Kutscherousky

text: v

text: West

text: Vet

text: App

text: This

text: claim

text: must

text: be

text: afforded

text: expeditious

text: treatment

text: The

text: law

text: requires

text: that

text: all

text: claims

text: that

text: are

text: remanded

text: by

text: the

text: Board

text: of

text: Veterans

text: Appeals

text: or

text: by

text: the

text: United

text: States

text: Court

text: of

text: Appeals

text: for

text: Veterans

text: Claims

text: for

text: additional

text: development

text: or

text: other

text: appropriate

text: action

text: must

text: be

text: handled

text: in

text: an

text: expeditious

text: manner

text: See

text: U

text: S

text: C

text: A

text: B

text: West

text: MICHAEL

text: D

text: LYON

text: Veterans

text: Law

text: Judge

text: Board

text: of

text: Veterans

text: Appeals

text: Department

text: of

text: Veterans

text: Affairs