Citation Nr: 0812624 Decision Date: 04/16/08 Archive Date: 05/01/08 DOCKET NO. 06-03 388 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Manila, the Republic of the Philippines THE ISSUES 1. Entitlement to an effective date earlier than October 7, 2004, for service connection for atherosclerotic heart disease. 2. Entitlement to an effective date earlier than October 7, 2004, for a total disability rating due to Individual Unemployability (TDIU). ATTORNEY FOR THE BOARD Dan Brook, Associate Counsel INTRODUCTION The veteran had service during World War II. He was a prisoner of war from April 1942 to September 1942. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2005 rating decision of the Manila, Philippines Regional Office (RO) of the Department of Veterans Affairs (VA), which granted service connection for atherosclerotic heart disease (rated 60 percent) effective October 7, 2004 and entitlement to a total disability rating due to individual unemployability also effective October 7, 2004. In his June 2005 Notice of Disagreement the veteran sought earlier effective dates for the grant of both benefits. FINDINGS OF FACT 1. It is not established that the veteran had localized edema while he was a POW. 2. The veteran's heart disease was not shown to be manifest in service or for many years thereafter and is not shown to be directly related to service. 3. It is not shown that the veteran was unable to engage in substantial gainful activity prior to October 7, 2004, due to his service-connected disabilities at the time of upper and lower extremity neuropathy and scar of the left foot. CONCLUSION OF LAW 1. The criteria for an effective date earlier than October 7, 2004, for service connection for heart disease have not been met. 38 U.S.C.A. § 1110, 1112, 1113, 5110, 7105 (West 2002); 38 C.F.R. §§ 3.1(p), 3.155(a), 3.303, 3.304, 3.307, 3.309, 3.400 (2007). 2. The criteria for effective date earlier than October 7, 2004 for TDIU have not been met. 38 U.S.C.A. § 1110, 1155, 5110, 7105 (West 2002); 38 C.F.R. §§ 3.1(p), 3.155(a), 3.303, 3.304, 3.307, 3.309, 3.400, 4.16 (2007). REASONS AND BASES FOR FINDINGS AND CONCLUSION I. VCAA The Veterans Claims Assistance Act of 2000 (VCAA) describes VA's 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 2002 & Supp. 2007); 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a) (2007). Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the claimant and his or her representative, if any, of any information, and any medical or lay evidence, that is necessary to substantiate the claim. 38 U.S.C.A. § 5103(a) (West 2002); 38 C.F.R. § 3.159(b) (2007); Quartuccio v. Principi, 16 Vet. App. 183 (2002). Proper VCAA notice must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; (3) that the claimant is expected to provide; and (4) must ask the claimant to provide any evidence in her or his possession that pertains to the claim in accordance with 38 C.F.R. § 3.159(b)(1). VCAA notice should be provided to a claimant before the initial unfavorable agency of original jurisdiction (AOJ) decision on a claim. Pelegrini v. Principi, 18 Vet. App. 112 (2004). The veteran has been advised of VA's duties to notify and assist in the development of his claims. A November 2001 letter explained the evidence necessary to substantiate the veteran's underlying claim for service connection for heart disease. It also explained that VA would make reasonable efforts to help him obtain evidence necessary to support his claim, including medical records, employment records or records from other federal agencies but that it was ultimately his responsibility to ensure that records were received by VA. A subsequent May 2004 letter clarified that VA was responsible for obtaining relevant records from any federal agency, and that VA would make reasonable efforts to obtain records not held by a federal agency, but that it was the veteran's responsibility to make sure that VA received all requested records not in the possession of a federal department or agency. This letter also advised the veteran to submit any evidence in his possession pertaining to his claim. A July 2004 letter from the RO explained what the evidence needed to show to substantiate his claim for TDIU. It also explained that VA was responsible for obtaining relevant records from any federal agency, and that VA would make reasonable efforts to obtain records not held by a federal agency, but that it was the veteran's responsibility to make sure that VA received all requested records not in the possession of a federal department or agency. This letter also advised the veteran to submit any evidence in his possession pertaining to his claim. An August 2007 letter provided a general advisement regarding criteria for rating disabilities at issue and effective dates of awards in accordance with Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006)). The Board notes that the appellant did not receive a separate notice letter specifically advising him of the evidence necessary to establish his claim for an earlier effective date for service connection for heart disease or for entitlement to TDIU. The Board finds, however, that under governing case law, such notice is not required. In Dingess v. Nicholson, 19 Vet. App. 473 (2006), the U.S. Court of Appeals for Veterans Claims held that in cases where a disability rating (in this case a 60 percent rating for heart disease and a TDIU rating) and effective date (in this case October 7, 2004) have been assigned, the underlying claim has been proven, thereby rendering section 5103(a) notice no longer required because the purpose that the notice is intended to serve has been fulfilled. Id. at 490-91. Thus, under Dingess, the notice the veteran was provided before entitlement to service connection for heart disease and entitlement to TDIU were granted (and the effective date of October 7, 2004 assigned) was legally sufficient and satisfied VA's notice requirements in relation to appellant's claim for earlier effective dates. Id. Although complete VCAA notice was not given prior to the rating on appeal, the appellant had ample opportunity to respond to the notice letters and to supplement the record after notice was given. He is not prejudiced by any technical notice deficiency that may have occurred along the way, and no further notice is required. See Conway v. Principi, 353 F.3d 1369 (Fed. Cir. 2004). Regarding VA's duty to assist, the RO has obtained the veteran's service medical records, along with available VA and private medical evidence. Additionally, the veteran was provided with a VA examination in regard to his claim for service connection for heart disease and VA attempted to afford the veteran with a VA examination in conjunction with his TDIU claim but he failed to report. The veteran has not identified any additional evidence pertinent to this claim. VA's assistance obligations are met. The veteran is not prejudiced by the Board's proceeding with appellate review. II. Factual Background Service medical records do not reveal any findings of beriberi, beriberi heart disease, localized edema or other cardiovascular problems. On September 1945 physical examination the veteran's cardiovascular system was found to be normal. On subsequent June 1946 separation examination the veteran's cardiovascular system was also found to be normal. On June 1962 VA medical examination, no cardiovascular abnormalities were noted. The veteran was found to have normal thrust, regular sinus rhythm, good tones and no murmurs. with no enlargement. The point of maximal impulse was the 5th left intercostal space at the midcostal linem and peripheral vessels were soft. An April 1988 letter from a treating physician, Dr. T, indicated that the veteran had been under Dr. Ts care since January 1986. Working diagnoses were angina pectoris, psychoses, recurrent rheumatoid arthritis, and general debility. In a July 1988 POW medical history the veteran indicated that he did not experience swelling in the joints or swelling of the legs and/or feet while he was a POW but that he did experience beriberi and a vitamin deficiency. A July 1988 Social work evaluation noted that the veteran indicated that he had experienced the death march and incarceration in Camp O'Donnell. For the most part he refused to elaborate on his experiences, only recalling that he was not fed or given medicines despite his illnesses such as beriberi, dysentery and severe headache. He did report that he was released on September 5, 1942 and recuperated until March 1943. At a July 1988 neuropsychiatric evaluation the veteran reported that he participated in the death march form Bataan to Capas, which lasted for five days. Inside the POW camp he was assigned to the grave and burial detail and he contracted dysentery, beriberi, malaria and malnutrition. After his release from the POW camp he was transferred to Laoag where he was detained in a Japanese garrison, in the "Mission Hospital" for another 9 months. After his release from the hospital, he went home, recuperated and later joined the guerilla movement. He was finally discharged in 1946. A July 1988 electrocardiogram found sinus brachycardia with testing otherwise within normal limits. A July 1988 chest X- ray showed slight prominence of the thoracic aorta without transverse cardiomegaly. An August 1988 VA POW protocol examination found no residual evidence of malnutrition, avitaminosis, beriberi, dysentery, anemia, malaria or helminthiasis. On an April 1998 VA POW medical history the veteran indicated that he did have swelling in the joints, swelling of the legs and/or feet, swelling of the muscles, beriberi and a vitamin deficiency while he was a POW. An April 1998 chest X-ray produced a diagnostic impression of arteriosclerosis. It was noted that the examination was generally unchanged since July 1988 except for a calcific plaque in the aortic knob. At an April 1998 social work survey the veteran reported that during his time as a POW malnutrition had made him easy prey for malaria, beriberi, stomach pains and swollen feet. The Social Worker noted that although the ailments of malaria, beriberi, malnutrition, stomach pains had affected the veteran's health, the veteran subsequently recovered and gained good health, which enabled him to earn a living as a farmer until two years prior, when he had to refrain from farming due to body weakness and knee pains. On April 1998 VA examination the pertinent diagnosis was no residuals of beriberi. A subsequent May 1998 VA examination showed no evidence of heart disease. In a January 1999 letter the veteran reported that he experienced localized edema and swelling of the feet, arms and ankle joints while he was a POW. In a January 1999 statement the veteran claimed that he had beriberi heart disease and that he experienced a lot of localized edema and swelling of the feet, arms and ankle joints while he was a POW. On August 1999 VA examination the diagnostic impressions were atherosclerotic heart disease and cardiomegaly due to left ventricular heart disease. Physical examination showed no abdominal hepatomegaly and no edema of the extremities. In an April 2000 statement the veteran indicated that he initially indicated on his July 1988 POW medical history that he had had beriberi (but did not indicate that he had swelling of the legs) because beriberi was the disease term he knew best, regardless of the presence of swelling of the legs. Later in his April 1998 medical history he did indicate that he had had swelling of the legs and feet during captivity. In an August 2000 affidavit, two fellow servicemen of the veteran, SB and FA, indicated that they were POWs with the veteran at the O'Donnell concentration camp. They also indicated that they knew that the veteran suffered from beriberi, dysentery, malaria, swollen legs, arms and feet, and many other diseases during their captivity in 1942. At his February 2001 DRO hearing the veteran indicated that the POW medical history from 1988 was actually filled out by a Mr. JP, who was helping the veteran with his claim. JP did not ask the veteran anything in relation to the form but simply filled it out and had him sign it. On the other hand, the 1998 form was filled out at the VA outpatient clinic when he had his VA POW protocol examination. The veteran was assisted by his daughter in law in filling out the form and she specifically went through the questions one by one in the Ilocano dialect. Thus, this second form was answered with complete knowledge on the part of the veteran while on the first one the veteran did not know what answers were filed. The veteran noted that because of his lack of understanding English and poor educational background, he was not able to understand what was written on the first form. He added that he only had a first grade education. On August 2001 VA examination, the diagnosis was peripheral neuropathy. The veteran complained of numbness of the feet and joint pain. Physical examination showed that the veteran could move all extremities; that he did not have any gross sensory deficit and that his deep tendon reflexes were obtunded on all fours. In July 2002 the veteran filed a claim for TDIU, which was received by the RO on August 2, 2002. A September 2002 Field Investigation attempted to examine the credibility of the August 2000 affidavit filed by SB and FA. After interviewing SB and SB's daughter-in-law, the Field Investigator determined that SB's had been senile and bedridden for three years and that his mental condition would have made it impossible for him to understand the August 2000 affidavit to which he affixed his thumbprint. The Field Investigator also interviewed FA, who insisted that he did see the veteran inside the concentration camp in service with swollen legs and suffering from malaria. FA also admitted, however, that the same claims fixer who had prepared the August 2000 affidavit, RS, had assisted FA in obtaining service connected compensation and that the affidavit had already been written up when he signed it. FA did indicate that he read the affidavit before signing it. Additionally, the Field Investigator interviewed the veteran who indicated that RS had prepared the affidavit and that he accompanied RS to the respective houses of SB and FA to have them sign the affidavit. The affidavit was already prepared when SB and FA signed it and the veteran never read the affidavit. The veteran commented that he was innocent of whatever wrongdoing was committed in his claim and that it was his claims fixer who made the affidavit. He also indicated that he believed that his current heart condition was indeed a result of his incarceration. A February 2003 letter and a March 2003 letter show that the veteran was notified that he was to report for VA compensation and pension examinations on March 4, 2003, and March 13, 2003, respectively. The examinations were scheduled to assess whether the veteran was unemployable due to his service connected disabilities. The veteran failed to report, however, and there is no indication in the record that he provided the RO with a reason for this failure. On June 2004 VA examination the diagnosis was atherosclerotic heart disease, not in failure. Physical examination showed swelling of the right leg with reddish and tight skin and slight tenderness, right ankle edema, and normal pulses with no edema in the left leg and ankle. The January 2005 rating decision granted service connection for atherosclerotic heart disease and assigned a 60 percent rating effective October 7, 2004. The basis for the grant was the new regulations governing presumptive service connection for POWs (which became effective October 7, 2004), which allow for a grant of service connection for a former POW who develops ischemic heart disease after service. The decision also granted entitlement to TDIU effective October 7, 2004, finding that with the grant of service connection for atherosclerotic disease, the veteran's combination of service connected disabilities (i.e. atherosclerotic heart disease, rated 60 percent, peripheral neuropathy of the left lower extremity, rated 20 percent, peripheral neuropathy of the right lower extremity, rated 20 percent, peripheral neuropathy of the left upper extremity, rated 20 percent, peripheral neuropathy of the right upper extremity, rated 10 percent and scar, left foot, rated noncompensable) made the veteran unemployable. The October 7, 2004, effective date was assigned on the basis that prior to that date the veteran was not service connected for atherosclerotic heart disease and his combination of service connected disabilities did not make him unemployable. III. Law and Regulations Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303. Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d). In order to establish service connection for a claimed disorder, there must be (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. Hickson v. West, 12 Vet. App. 247, 253 (1999). The determination as to whether these requirements are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. Baldwin v. West, 13 Vet. App. 1 (1999); 38 C.F.R. § 3.303(a). Certain listed, chronic disabilities, including heart disease, are presumed to have been incurred in service if they become manifest to a compensable degree within one year of discharge from service. 38 U.S.C.A. §§ 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. Prior to October 7, 2004, service connection was available on a presumptive basis for former POWs who developed beriberi, beriberi heart disease or ischemic heart disease (with localized edema during captivity) which became manifest to a compensable degree at any time after service. This provision applied only to POWs detained not less than 30 days. 38 C.F.R. § 3.309(c) (2004). From October 7, 2004, service connection is available on a presumptive basis for former POWs who develop atherosclerotic heart disease or hypertensive vascular disease (including hypertensive heart disease) and their complications (including myocardial infarction, congestive heart failure, arrhythmia). No minimum period of internment is required under the revised regulations, and localized edema in captivity need not be shown. The requirement that the condition become manifest to a compensable degree at any time after discharge has remained. See 38 C.F.R. § 3.309(c) (2007); see also 69 Fed. Reg. 60,083, 60,083- 60,090 (Oct. 7, 2004). Total disability ratings for compensation may be assigned, where the schedular rating is less than total, when the veteran is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities, provided that if there is only one such disability, such disability shall be ratable as 60 percent or more and if there are two or more disabilities, there shall be at least one disability ratable at 40 percent or more and sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16(a). For the purpose of one 60 percent disability, or one 40 percent disability as part of a combination of disabilities, the following will be considered as one disability: (1) Disabilities of one or both upper extremities, or of one or both lower extremities, including the bilateral factor, if applicable, (2) disabilities resulting from common etiology or a single accident, (3) disabilities affecting a single body system, e.g. orthopedic, digestive, respiratory, cardiovascular- renal, neuropsychiatric, (4) multiple injuries incurred in action, or (5) multiple disabilities incurred as a prisoner of war. Id. A specific claim in the form prescribed by the Secretary of Veterans Affairs must be filed in order for benefits to be paid to any individual under the laws administered by VA. 38 C.F.R. § 3.151(a). The term "claim" or "application" means a formal or informal communication in writing requesting a determination of entitlement or evidencing a belief of entitlement, to a benefit. 38 C.F.R. § 3.1(p). "Date of receipt" generally means the date on which a claim, information or evidence was received by VA. 38 C.F.R. § 3.1(r). The applicable statutory and regulatory provisions require that VA look to all communications from the appellant, which may be interpreted as applications or claims - formal and informal - for benefits. In particular, VA is required to identify and act on informal claims for benefits. 38 C.F.R. §§ 3.1(p), 3.155(a); see Servello v. Derwinski, 3 Vet. App. 196 (1992). An informal claim must identify the benefit sought. 38 C.F.R. § 3.155(a). Upon receipt of an informal claim, if a formal claim has not been filed, an application form will be forwarded to the claimant for execution. If received within one year from the date it was sent to the claimant, it will be considered filed as of the date of receipt of the formal claim. Id. The statutory guidelines for the determination of an effective date of an award of disability compensation are set forth in 38 U.S.C.A. § 5110. Except as otherwise provided, the effective date of an evaluation and award of compensation based on an original claim, a claim reopened after final disallowance, or a claim for increase will be the date of receipt of the claim or the date entitlement arose, whichever is the later. 38 C.F.R. § 3.400. It is the policy of VA to administer the law under a broad interpretation, consistent with the facts in each case with all reasonable doubt to be resolved in favor of the claimant; however, the reasonable doubt rule is not a means for reconciling actual conflict or a contradiction in the evidence. 38 C.F.R. § 3.102. When all of the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the appellant prevailing in either event, or whether a fair preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). IV. Analysis As both service connection for atherosclerotic heart disease and entitlement to TDIU have already been granted, and as the veteran did not appeal the 60 percent rating assigned for the heart disease, the only issues left for the Board to decide are whether the veteran is entitled to earlier effective dates for the grants of service connection for heart disease and TDIU. As mentioned above, the effective date of an evaluation and award of compensation based on an original claim (such as the veteran's claim for service connection for heart disease) or a claim for increase (such as the veteran's claim for TDIU) will be the date of receipt of the claim or the date entitlement arose, whichever is the later. 38 C.F.R. § 3.400. In the instant case, the RO appropriately determined that the veteran was entitled to service connection for atherosclerotic heart disease as of October 7, 2004, the date that entitlement arose under the new provisions governing presumptive service for POWs, which allow for service connection for a POW who subsequently develops ischemic (i.e. atherosclerotic) heart disease. 38 C.F.R. § 3.307, 3.309(c). The RO then determined that the veteran was entitled to TDIU effective October 7, 2004, finding that the addition of atherosclerotic heart disease (rated 60 percent) to the veteran's other service connected disabilities made him unemployable. 38 C.F.R. § 4.16. The Board must now determine whether any other provisions (i.e. the POW presumptive provision in effect prior to October 7, 2004, the chronic disease presumptive provision or the provisions governing direct service connection) would allow for an earlier effective date for atherosclerotic heart disease. Based on this determination, and any other applicable considerations, the Board must then determine whether an earlier effective date for TDIU is warranted. Earlier Effective date for service connection for heart disease As alluded to above, in order for the veteran to qualify for the POW presumption for heart disease prior to October 7, 2004, it must be shown that beriberi, beriberi heart disease or ischemic heart disease (with localized edema in captivity) became manifest to a degree of 10 percent after service. 38 C.F.R. § 3.307, 3.309(c) (2004). There is no evidence of record showing that either beriberi or beriberi heart disease has been manifest after service. None of the medical examinations or medical reports shows any findings of beriberi or beriberi heart disease and the April 1998 VA examination specifically found that the veteran had no residuals of beriberi. The veteran has affirmatively contended that he does have beriberi heart disease. As a layperson, however, the veteran, although competent to testify regarding symptoms he experienced that could be indicative of beriberi or beriberi heart disease, is not competent to make a diagnosis of beriberi or beriberi heart disease. See Espiritu v. Derwinski, 2 Vet. App. 492, 494 (1992). Thus, because none of the medical evidence of record shows that the symptoms reported by the veteran and observed by medical professionals have led to a medical diagnosis of beriberi or beriberi heart disease, the Board has no basis for finding that either of these diseases has been manifest after service. Regardless of whether the veteran has had beriberi or beriberi heart disease after service, he could still qualify for POW presumptive service connection for ischemic heart disease prior to October 7, 2004, if it is shown that such disease is manifest to a degree of 10 percent and that localized edema was present during the veteran's captivity. Id. The evidence of record clearly establishes that the veteran has ischemic heart disease as the most recent June 2004 VA examination produced a diagnosis of atherosclerotic heart disease. There is conflicting evidence pertaining to whether the veteran had localized edema during captivity, however. Service medical records do not document whether or not the veteran had any health problems to include beriberi and localized edema during his time as a POW. Further, the veteran himself, in his 1988 POW history, indicated that he did not have any swelling in the joints or swelling in the legs and/or feet while he was a POW but that he did experience beriberi. On the other hand, in his 1998 POW history the veteran indicated that he experienced both beriberi and swelling of the joints, muscles and legs and/or feet while in captivity. Also, the August 2000 affidavit from the two fellow servicemen indicated that the veteran had beriberi and swelling of the legs, arms and feet while in captivity. The Board finds that the August 2000 affidavit lacks credibility. The results of the field investigation clearly show that SB's mental condition was such that he was unable to attest to whether or not he was with the veteran at the O'Donnell concentration camp and observed that the veteran had beriberi and swelling of the legs. FA did insist that the statements in the affidavit (including his attestation as to the veteran's beriberi and swelling) were accurate but the Board does not find FA credible. Notably, there is no evidence or record that the claims fixer, RS ( who was assisting the veteran and who had also assisted FA) interviewed FA in regard to his knowledge of the veteran's health condition while in captivity and then subsequently drew up the August 2000 affidavit in accordance with the responses provided by FA. Instead, it appears that RS simply drew up an affidavit in the first instance and asked FA to sign it. Further the veteran was not aware of what the affidavit said and there is no evidence of record that the claims fixer, RS, interviewed the veteran in the first instance to determine whether FA was actually a witness who could testify regarding the health condition of the veteran while he was in captivity. Thus, the Board does not find a credible basis in the record for concluding that the veteran and FA were accurately reporting that they were together at the POW camp and that the veteran incurred beriberi and localized edema there. Rather, it appears that the claims fixer simply arranged for the two of them to testify that they had been together at the POW camp and that the veteran did have beriberi and localized edema while he was there. The Board also finds that the veteran's own conflicting medical history reports (in July 1988 and April 1998) pertaining to whether he had swelling of the legs (i.e. edema) at the POW camp, and his inconsistent explanations for these conflicting statements, impugn his credibility. In his April 2000 statement the veteran indicated that he only mentioned that he had beriberi (and did not mention swelling of the legs) on his July 1988 medical history because beriberi was the medical term with which he was most familiar. Subsequently, at his February 2001 DRO hearing the veteran testified that he actually did not fill out the July 1988 medical history form at all. Instead, it was filled out by his claims fixer, after which the veteran signed the form without attempting to read it or to get anyone to translate it for him. Given that these explanations are clearly inconsistent, the Board cannot find either credible in explaining the more central inconsistency of the veteran's reporting in 1988 vs. 1998 regarding the presence or absence of localized edema (i.e. swelling) in service. Further, the veteran's latter 1998 explanation also hurts his credibility as it tends to indicate that he was simply concerned with the claims fixer being able to secure veteran's benefits for him and not concerned with ensuring that he presented a truthful medical history. The Board does sympathize with the veteran's lack of scholastic education and recognizes that this may have affected his interactions with his claims fixer. In the absence of a consistent explanation as to why the veteran's reporting concerning the presence or absence of edema as a POW changed, however, the Board cannot find the veteran credible as to whether he actually did have localized edema in service. Thus, given that neither the veteran's statements nor the affidavit from his fellow servicemen have been found credible regarding the presence of localized edema while the veteran was a POW, the Board cannot assign any probative value to either of them. Consequently, given that neither the service medical records nor any other evidence of record show the presence of localized edema while the veteran was a POW, it is not established that the veteran had localized edema while he was a POW and service connection based on the POW presumption in effect prior to October 7, 2004, is not warranted. 38 C.F.R. § 3.307, 3.309(c) (2004). Regarding the chronic disease presumption and direct service connection, there is no competent evidence of record that the veteran's heart disease became manifest in service or within the first post service year (so as to warrant service connection based on the chronic disease presumption) or that current heart disease is directly related to service. 38 C.F.R. § 3.303, 3.307, 3.309. Service medical records show no evidence of a diagnosis or symptoms of heart disease, with the veteran's separation examination showing normal cardiovascular functioning. Subsequent to service, there is no evidence of heart disease until January 1986, some 40 years after service. Such a lengthy interval of time between service and initial postservice manifestation of a "disability" for which service connection is sought is, of itself, a factor against a finding that the disability was incurred or aggravated in service. See Maxson v. Gober, 230 F.3d 1330 (Fed. Cir. 2000). Although the veteran may believe that his current heart disease did become manifest in service and is related to service, his beliefs are not competent evidence of a medical diagnosis or nexus. Espiritu, 2 Vet. App. 492, 494 (1992). In summary, given that service connection has not been established based on the POW presumption in effect prior to October 7, 2004, the chronic disease presumption or the provisions governing direct service connection, the lone basis for the grant of service connection for the veteran's heart disease is the POW presumption that went into effect on October 7, 2004. 38 C.F.R. § 3.307, 3.309(c). As this provision does not have any retroactive applicability, an effective date earlier than October 7, 2004 for service connection for heart disease is not warranted. Id., 38 C.F.R. § 3.400. The preponderance of the evidence is against this claim and it must be denied. Earlier effective date for TDIU As the veteran has already been assigned an October 7, 2004, effective date for TDIU, the only remaining question is whether he is entitled to an earlier effective date. Just as in a claim for service connection, the effective date for a grant of TDIU is generally either the date entitlement arose of the date of the veteran's claim, whichever is later. 38 C.F.R. § 3.400. In the instant case the veteran's claim was received on August 2, 2002, and the RO determined that entitlement arose October 7, 2004. Consequently, the Board must now determine whether the veteran is entitled to an earlier effective date sometime between August 2, 2002, and October 7, 2004 (The Board notes that under 38 C.F.R. § 3.157 a medical report can sometimes be considered an informal claim for increase, to include TDIU, if followed up within a year by a formal claim. In the instant case, however, the record does not contain a medical report within the year prior to the veteran's August 2, 2002 claim, which would meet these criteria. Id.). Between August 2, 2002, and October 7, 2004, the veteran was service connected for peripheral neuropathy of the right and left lower extremities and the right and left upper extremities and for scar of the left foot (rated noncompensable). The combined rating for the disabilities was 60 percent, which did meet the minimum disability percentage requirements needed in order for the veteran to be eligible to potentially receive a TDIU rating. 38 C.F.R. § 4.16. The veteran was scheduled for VA examinations on both March 3, 2003, and March 13, 2003, but failed to report on both occasions and did not provide any reason, good cause or otherwise, for this failure. The Board notes that under pertinent regulations, in the absence of good cause, failure to report for a VA examination in conjunction with a claim for increase (to include a claim for TDIU) warrants denial of the veteran's claim. 38 U.S.C.A. § 3.655(b). Consequently, the Board's analysis need not proceed any further. The Board further notes, however, that there is no medical or even lay evidence of record showing that the veteran was unemployable based on his service connected disabilities between August 2, 2002, and October 7, 2004. The veteran himself only made a bare allegation that he was unemployable and did not explain how his peripheral neuropathy and scar of the left foot in and of themselves made him unable to engage in substantial gainful employment. Also, the most recent VA examination of record pertaining to peripheral neuropathy from August 2001 showed only that the veteran had been diagnosed with the disorder; that he complained of numbness of both feet and joint pain; that he could move all extremities and had no gross sensory deficit; and that his deep tendon reflexes were obtunded on all fours. It did not show that the peripheral neuropathy made him unemployable. As the veteran, without showing good cause, failed to report for VA examinations on March 4, 2003, and March 13, 2003, and as the evidence of record does not otherwise show that he was unemployable due to his service connected disabilities between August 2, 2002, and October 7, 2004, entitlement to an earlier effective date for TDIU is not warranted. 38 C.F.R. § 3.400, 3.416. The preponderance of the evidence is against this claim and it must be denied. ORDER Entitlement to an effective date earlier than October 7, 2004, for service connection for heart disease is denied. Entitlement to an effective date earlier than October 7, 2004, for a total disability rating due to Individual Unemployability (TDIU) is denied. ____________________________________________ James L. March Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs