Citation Nr: 1044698 Decision Date: 11/30/10 Archive Date: 12/03/10 DOCKET NO. 03-33 094 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Atlanta, Georgia THE ISSUES 1. Entitlement to service connection for a chronic acquired psychiatric disorder to include depression. 2. Entitlement to service connection for a chronic chest disorder to include muscle strain. 3. Entitlement to service connection for chronic right ear hearing loss disability. 4. Entitlement to service connection for a chronic right foot disorder. 5. Entitlement to service connection for a chronic left thumb disorder to include tendonitis. 6. Entitlement to service connection for a chronic back disorder to include injury residuals. 7. Entitlement to service connection for drug and alcohol abuse. 8. Entitlement to an initial compensable disability evaluation for the Veteran's left ear hearing loss disability. 9. Entitlement to an effective date prior to August 22, 2003, for the award of service connection for tinnitus. REPRESENTATION Appellant represented by: Kenneth Lavan, attorney ATTORNEY FOR THE BOARD Anthony M. Flamini, Associate Counsel INTRODUCTION The Veteran had active service from March 1980 to March 1983. This matter came before the Board of Veterans' Appeals (Board) on appeal from a July 2002 rating decision of the Denver, Colorado, Regional Office which, in pertinent part, denied service connection for hearing loss disability, back injury residuals, right ankle swelling, right foot pain, chest pain, and drug and alcohol abuse. In September 2003, the Denver, Colorado, Regional Office established service connection for left ear hearing loss disability; assigned a 10 percent evaluation for that disability; effectuated the award as of October 10, 2001; and denied service connection for tinnitus and depression. In December 2007, the Board remanded the Veteran's appeals to the RO in order to schedule the Veteran for a hearing before a Veterans Law Judge. In January 2008, the Denver, Colorado, Regional Office granted service connection for tinnitus; assigned a 10 percent evaluation for that disability; and effectuated the award as of August 22, 2003. In May 2008, the Board remanded the Veteran's appeal to the Denver, Colorado, Regional Office for additional action. In May 2008, the Veteran informed the Department of Veterans Affairs (VA) that he had moved to Georgia. The Veteran's claims files were subsequently transferred to the Atlanta, Georgia, Regional Office (RO). In February 2009, the RO granted service connection for right ankle and subtalar joint arthritis; assigned a 10 percent evaluation for that disability; and effectuated the award as of October 10, 2001. FINDINGS OF FACT 1. An acquired psychiatric disorder was not manifest during service; psychiatric pathology was not identified until 2004; the current major depressive disorder is unrelated to service or to any service-connected disability. 2. A chronic disability manifested by chest pain was not manifest during service; chest pathology was not identified until 2008; the current costochondritis is unrelated to service. 3. There is no evidence of current right ear hearing loss as defined by VA regulation. 4. There is no evidence of a current right foot disability separate and distinct from the Veteran's service-connected right ankle disability. 5. A left thumb disorder was not manifest during service; left thumb pathology was not identified until 2003; the current left thumb tendonitis is unrelated to service. 6. A chronic low back disorder was not manifest during service; lumbar spine pathology was not identified until 2003; the current low back disorder is unrelated to service. 7. There is no evidence of current drug and/or alcohol abuse. 8. The Veteran's hearing loss is manifested by Level I hearing in his left ear. 9. The August 22, 2003, VA examination, afforded in development of the Veteran's formal claim of entitlement to service connection for bilateral hearing loss, served as an informal claim of entitlement to service connection for tinnitus. 10. No communication or medical record prior to the August 22, 2003, VA examination may be interpreted as a formal or informal claim of entitlement to service connection for tinnitus. CONCLUSIONS OF LAW 1. An acquired psychiatric disorder was not incurred in or aggravated by service or by any service-connected disability. 38 U.S.C.A. §§ 1131, 5103(a), 5103A (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.159, 3.303 (2010). 2. A chronic disability manifested by chest pain was not incurred in or aggravated by service. 38 U.S.C.A. §§ 1131, 5103(a), 5103A (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.159, 3.303 (2010). 3. Right ear hearing loss was not incurred in or aggravated by service. 38 U.S.C.A. §§ 1131, 5103(a), 5103A (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.159, 3.303 (2010). 4. A right foot disability was not incurred in or aggravated by service. 38 U.S.C.A. §§ 1131, 5103(a), 5103A (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.159, 3.303 (2010). 5. Left thumb tendonitis was not incurred in or aggravated by service. 38 U.S.C.A. §§ 1131, 5103(a), 5103A (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.159, 3.303 (2010). 6. A chronic low back disorder was not incurred in or aggravated by service. 38 U.S.C.A. §§ 1131, 5103(a), 5103A (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.159, 3.303 (2010). 7. Drug and/or alcohol abuse was not incurred in or aggravated by service or by any service-connected disability. 38 U.S.C.A. §§ 1131, 5103(a), 5103A (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.159, 3.303 (2010). 8. The criteria for an initial compensable evaluation for service-connected left ear hearing loss have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.7, 4.10, 4.85, 4.86, Diagnostic Code 6100 (2010). 9. The criteria for an effective date prior to August 22, 2003, for the award of service connection for tinnitus have not been met. 38 U.S.C.A. §§ 5103(a), 5103A, 5107(b), 5110 (West 2002); 38 C.F.R. §§ 3.102, 3.155, 3.159, 3.400 (2010). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Duty to Assist As provided for by the Veterans Claims Assistance Act of 2000 (VCAA), 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 2002 & Supp. 2009); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2010). Proper notice from VA must inform the claimant of any information and medical or lay evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; and (3) that the claimant is expected to provide. Quartuccio v. Principi, 16 Vet. App. 183 (2002). This notice must be provided prior to an initial unfavorable decision on a claim by the RO. Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); Pelegrini v. Principi, 18 Vet. App. 112 (2004). When VCAA notice is delinquent or erroneous, the "rule of prejudicial error" applies. See 38 U.S.C.A. § 7261(b)(2). In the event that a VA notice error occurs regarding the information or evidence necessary to substantiate a claim, VA bears the burden to show that the error was harmless. However, the appellant bears the burden of showing harm when not notified whether the necessary information or evidence is expected to be obtained by VA or provided by the appellant. See Shinseki v. Sanders, 556 U.S. ___ (2009). In addition, the notice requirements of the VCAA apply to all five elements of a service-connection claim, including: (1) veteran status; (2) existence of a disability; (3) a connection between the veteran's service and the disability; (4) degree of disability; and (5) effective date of the disability. See Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). Further, this notice must include information that a disability rating and an effective date for the award of benefits will be assigned if service connection is awarded. Id. at 486. Here, the VCAA duty to notify was satisfied by way of letters sent to the Veteran in March 2002, April 2002, and July 2003 that fully addressed all notice elements and were sent prior to the initial RO decisions in this matter. The letters informed him of what evidence was required to substantiate the claims and of his and VA's respective duties for obtaining evidence. Under these circumstances, the Board finds that the notification requirements of the VCAA have been satisfied as to both timing and content. With respect to the Dingess requirements, in September 2009, the RO provided the Veteran with notice of what type of information and evidence was needed to establish disability ratings, as well as notice of the type of evidence necessary to establish an effective date. With that letter, the RO effectively satisfied the remaining notice requirements with respect to all issues on appeal. Therefore, adequate notice was provided to the Veteran prior to the transfer and certification of his case to the Board and complied with the requirements of 38 U.S.C.A.. § 5103(a) and 38 C.F.R. § 3.159(b). Next, VA has a duty to assist a veteran in the development of the claim. This duty includes assisting him or her in the procurement of service treatment records and other pertinent records, and providing an examination when necessary. See 38 U.S.C.A. § 5103A (West 2002); 38 C.F.R. § 3.159 (2010). After a careful review of the file, the Board finds that all necessary development has been accomplished, and therefore appellate review may proceed without prejudice to the Veteran. See Bernard v. Brown, 4 Vet. App. 384 (1993). First, the RO has obtained service treatment records and VA treatment records. Further, the Veteran submitted additional treatment records as well as written lay statements in support of his claims. Next, specific VA medical opinions pertinent to the issues on appeal were obtained in August 2003, July 2006, and October 2008. The Board finds that these examinations were adequate for evaluation purposes. Specifically, the examiners interviewed the Veteran and conducted physical examinations. There is no indication that the VA examiners were not fully aware of the Veteran's past medical history or that they misstated any relevant fact. Therefore, the Board finds the VA examiners' opinions to be of great probative value. The Board notes that a VA medical examination specific to the issue of entitlement to service connection for an acquired psychiatric disorder was not obtained. In determining whether a medical examination be provided or medical opinion obtained, there are four factors to consider: (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) evidence establishing an in-service event, injury, or disease, or manifestations during the presumptive period; (3) an indication that the disability or symptoms may be associated with service; and (4) whether there otherwise is sufficient competent medical evidence of record to make a decision on the claim. With respect to the third factor, the types of evidence that "indicate" that a current disorder "may be associated" with service include, but are not limited to, medical evidence that suggests a nexus but is too equivocal or lacking in specificity to support a decision on the merits, or credible evidence of continuity of symptomatology such as pain or other symptoms capable of lay observation. McLendon v. Nicholson, 20 Vet. App. 79 (2006). Here, however, the Board finds that a VA examination specific to the issue of entitlement to service connection for an acquired psychiatric disorder is not warranted. Given the absence of in- service evidence of chronic manifestations of the disorder on appeal, the absence of identified symptomatology for many years after separation, and no competent evidence of a nexus between service and the Veteran's claim, a remand for a VA examination would unduly delay resolution. Therefore, the available records and medical evidence have been obtained in order to make adequate determinations as to these claims. Significantly, neither the Veteran nor his representative has identified, and the record does not otherwise indicate, any additional existing evidence that is necessary for a fair adjudication of the claims that has not been obtained. Hence, no further notice or assistance is required to fulfill VA's duty to assist in the development of the claims. Smith v. Gober, 14 Vet. App. 227 (2000), aff'd, 281 F.3d 1384 (Fed. Cir. 2002); Dela Cruz v. Principi, 15 Vet. App. 143 (2001); see also Quartuccio v. Principi, 16 Vet. App. 183 (2002). II. Service Connection Claims Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C.A. §§ 1131 (West 2002). If a chronic disease is shown in service, subsequent manifestations of the same chronic disease at any later date, however remote, may be service connected, unless clearly attributable to intercurrent causes. 38 C.F.R. § 3.303(b) (2010). However, continuity of symptoms is required where a condition in service is noted but is not, in fact, chronic or where a diagnosis of chronicity may be legitimately questioned. 38 C.F.R. § 3.303(b) (2010). Further, service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 U.S.C.A. § 1113(b) (West 2002); 38 C.F.R. § 3.303(d) (2010). The Board must determine whether the evidence supports the claim or is in relative equipoise, with the appellant prevailing in either case, or whether the preponderance of the evidence is against the claim, in which case, service connection must be denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Acquired Psychiatric Disorder The Veteran seeks service connection for an acquired psychiatric disorder. Specifically, he initially alleged that his currently- diagnosed depression began during his military service in Germany due to the culture change as well as the mental and physical demands imposed upon him. However, the Veteran later alleged that he developed depression in approximately April 2007 as a result of his left ear hearing loss, bilateral foot swelling, tendonitis, and chest pains. As such, he sought service connection for the disorder on a secondary basis. In addition to the regulations cited above, service connection is warranted for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury. 38 C.F.R. § 3.310 (2010). Any additional impairment of earning capacity resulting from an already service-connected condition, regardless of whether or not the additional impairment is itself a separate disease or injury caused by the service-connected condition, should also be compensated. Allen v. Brown, 7 Vet. App. 439 (1995). When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. Id. Service treatment records reflect no complaints of, treatment for, or a diagnosis related to a psychiatric disorder or any symptoms reasonably attributed thereto. Significantly, in a January 1983 Health Questionnaire conducted three months prior to his separation from service, the Veteran reported that there had not been a change in his health within the last 2 years. Therefore, no chronic psychiatric disorder was noted in service. Next, post-service evidence does not reflect psychiatric symptomatology for many years after service discharge. Specifically, the Veteran was discharged from the University of Colorado Health Sciences Center Peer I Therapeutic Community in May 1998 with diagnoses of social/coping issues, family issues, and grief and loss. However, a clinical diagnosis of depression was not rendered until a positive depression screening by the VA in January 2004. This is the first recorded symptomatology related to psychiatric disorder, coming approximately 20 years after discharge. Therefore, the competent evidence does not reflect continuity of symptomatology. In addition to the absence of documented post-service symptomatology related to the low back for many years, the evidence includes the Veteran's statements asserting continuity of symptoms. The Board acknowledges that lay evidence concerning continuity of symptoms after service, if credible, is ultimately competent, regardless of the lack of contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency of evidence differs from weight and credibility. The former is a legal concept determining whether testimony may be heard and considered by the trier of fact, while the latter is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) ("although interest may affect the credibility of testimony, it does not affect competency to testify"). In this case, the Veteran is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses. Layno, 6 Vet. App. at 470. He has indicated that he continued to experience depression since he was stationed in Germany while in service. In determining whether statements submitted by a veteran are credible, the Board may consider internal consistency, facial plausibility, and consistency with other evidence submitted on behalf of the claimant. Caluza v. Brown, 7 Vet. App. 498 (1995). The Board is not required to accept an appellant's uncorroborated account of his active service experiences. Wood v. Derwinski, 1 Vet. App. 190 (1991). In this case, the Board finds that the Veteran's reported history of continued symptomatology since active service, while competent, is nonetheless not credible. The Board emphasizes the multi-year gap between discharge from active duty service in 1983 and initial reported symptoms related to depression in approximately 2004, over a 20-year gap. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (lengthy period of absence of medical complaints for condition can be considered as a factor in resolving claim); see also Mense v. Derwinski, 1 Vet. App. 354, 356 (1991) (affirming Board's denial of service connection where veteran failed to account for lengthy time period between service and initial symptoms of disability). Significantly, the Board finds that the Veteran's reported history of continued depression since active service is inconsistent with the other evidence of record. Indeed, while he stated that his disorder began in service, the January 1983 Health Questionnaire was absent of any complaints. Moreover, the Veteran has given conflicting accounts as to the etiology of his depression. For instance, he has also claimed that the onset of his depression was in April 2007 as a result of physical pain. This is supported by VA treatment records, such as a February 2008 progress note in which the Veteran related that he suffered from depressive symptoms without suicidal or homicidal plan or intent for only the past 10 months. Madden v. Gober, 125 F.3d 1477, 1481 (Board entitled to discount the credibility of evidence in light of its own inherent characteristics and its relationship to other items of evidence). The Board has weighed the Veteran's statements as to continuity of symptomatology and finds his current recollections and statements made in connection with a claim for benefits to be of lesser probative value. See Pond v. West, 12 Vet. App. 341 (1999) (although Board must take into consideration the veteran's statements, it may consider whether self-interest may be a factor in making such statements). Therefore, continuity has not here been established, either through the competent evidence or through his statements. Next, service connection may be granted when the evidence establishes a medical nexus between active duty service and current complaints. In this case, the Board finds that the weight of the competent evidence does not attribute the Veteran's major depressive disorder to active duty, despite his contentions to the contrary. To that end, the Board places significant probative value on the Veteran's VA treatment records which attribute his psychiatric problems to a multitude of factors, to include numerous chronic physical ailments and pain, as well as psychosocial stressors such as unemployment and financial concerns. However, there is no medical opinion of record attributing the Veteran's psychiatric condition to service or to his service-connected disabilities (tinnitus, left ear hearing loss, and right ankle arthritis). To the contrary, VA treatment notes primarily relate the Veteran's depressive disorder to his low back pain, which, as discussed in further detail below, is not service connected. The Board has also considered the Veteran's statements asserting a nexus between his currently-diagnosed disorder and active duty service. While the Board reiterates that the Veteran is competent to report symptoms as they come to him through his senses, psychiatric disorders, such as major depressive disorder, are not the types of disorders that a lay person can provide competent evidence on questions of etiology or diagnosis. Such competent evidence has been provided by the medical personnel who have examined the Veteran during the current appeal and by service records obtained and associated with the claims file. Here, the Board attaches greater probative weight to the clinical findings than to his statements. See Cartright, 2 Vet. App. at 25. In light of the above discussion, the Board concludes that the preponderance of the evidence is against the claim for service connection and there is no doubt to be otherwise resolved. As such, the appeal is denied. Chronic Disability Manifested by Chest Pain The Veteran seeks service connection for a chronic disability manifested by chest pain. Specifically, he alleges that the disability first manifested while he was stationed in Germany and most likely results from "heavy lifting, gunnery, company road marches that had diesel fumes and dust coming from the movement of tanks and armor personnel carriers." Service treatment records reflect that the Veteran was initially treated for complaints of chest pain that had lasted three days on May 13, 1981, at which time the pains were diagnosed as muscle spasm. On March 25, 1981, he again complained of a dull, steady pain centered in his chest which did not radiate. His respiratory system appeared normal and he was diagnosed with sore muscles. He next complained of a pulled muscle on the right side of his chest in October 1981. He was diagnosed with a pulled muscle accompanied by decreased range of motion and instructed not to lift over 15 pounds while recuperating. As the Veteran reported that this incident of chest pain was only of one-day duration, it appears to be a separate incident unrelated to his prior complaints of chest pain in March 1981. There is no further mention of the injury in the service treatment records. Significantly, in a January 1983 Health Questionnaire conducted three months prior to his separation from service, the Veteran reported that there had not been a change in his health within the last 2 years. As such, his earlier complaints of pulled chest muscles appear to be acute and transitory rather than chronic in nature. Next, post-service evidence does not reflect chest symptomatology for several years after service discharge. Specifically, he was afforded a VA examination in August 2003, at which time there was no bony abnormality found on X-ray and the examiner indicated that there was insufficient evidence to diagnose a medical condition. He was eventually diagnosed with costochondritis by a VA heart examiner in October 2008. This is the first recorded post-service diagnosis of a chest disorder, coming approximately 25 years after discharge. Therefore, the competent evidence does not reflect continuity of symptomatology. In addition to the absence of documented post-service symptomatology related to the chest for many years, the evidence includes the Veteran's statements asserting continuity of symptoms. In this case, the Veteran is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses. Layno, 6 Vet. App. at 470. He has indicated that he continued to experience symptoms relating to the chest after he was discharged from the service. In this case, the Board finds that the Veteran's reported history of continued symptomatology since active service, while competent, is nonetheless not credible. The Board emphasizes the multi-year gap between discharge from active duty service in 1983 and the initial diagnosis related to a chest disorder in approximately 2008, an approximately 25-year gap. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (lengthy period of absence of medical complaints for condition can be considered as a factor in resolving claim); see also Mense v. Derwinski, 1 Vet. App. 354, 356 (1991) (affirming Board's denial of service connection where veteran failed to account for lengthy time period between service and initial symptoms of disability). The Board has weighed the Veteran's statements as to continuity of symptomatology and finds his current recollections and statements made in connection with a claim for benefits to be of lesser probative value. Therefore, continuity has not here been established, either through the competent evidence or through his statements. Next, service connection may be granted when the evidence establishes a medical nexus between active duty service and current complaints. In this case, the Board finds that the weight of the competent evidence is against a conclusion that attributes the Veteran's chest disorder to active duty, despite his contentions to the contrary. To that end, the Board places significant probative value on the October 2008 VA heart examination undertaken specifically to address the issue on appeal. At that time, the Veteran reported chest pain and pressure that occurs two-to-three times per month and lasts three-to-four minutes. The examiner diagnosed the Veteran with costochondritis (reproducible muscle chest pain), and noted that it is a self-limited condition that resolves with symptomatic therapy. The examiner opined that it is less likely than not that the Veteran's costochondritis is related to the documented complaints of chest pain in service or any other incident of military service. The examiner further reflected that the chest condition he was seen for in service was presumptively resolved, as he was seen twice for chest pain dung the early part of his military service and not seen again for the condition during the remainder of his service. The Board has also considered the Veteran's statements asserting a nexus between his currently-diagnosed disorder and active duty service. While the Board reiterates that the Veteran is competent to report symptoms as they come to him through his senses, costochondritis is not the type of disorder that a lay person can provide competent evidence on questions of etiology or diagnosis. Such competent evidence has been provided by the medical personnel who have examined the Veteran during the current appeal and by service records obtained and associated with the claims file. Here, the Board attaches greater probative weight to the clinical findings than to his statements. See Cartright, 2 Vet. App. at 25. In light of the above discussion, the Board concludes that the preponderance of the evidence is against the claim for service connection and there is no doubt to be otherwise resolved. As such, the appeal is denied. Right Ear Hearing Loss The Veteran seeks service connection for right ear hearing loss. Specifically, he believes that his auditory acuity in his right ear is worsening due to acoustic trauma sustained while in service due to operating heavy equipment. Service connection for impaired hearing shall only be established when hearing status as determined by audiometric testing meets specified pure tone and speech recognition criteria. Audiometric testing measures threshold hearing levels (in decibels) over a range of frequencies (in Hertz). See Hensley v. Brown, 5 Vet. App. 155, 158 (1993). The determination of whether a veteran has a disability based on hearing loss is governed by 38 C.F.R. § 3.385. For the purposes of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. See 38 C.F.R. § 3.385. Service connection for sensorineural hearing loss may be established based on a legal presumption by showing that it manifested itself to a degree of 10 percent or more within one year from the date of separation from service. See 38 U.S.C.A. §§ 1112 and 1137; 38 C.F.R. §§ 3.307 and 3.309(a); see also VA Under Secretary for Health letter dated October 4, 1995 (it is appropriate for VA to consider sensorineural hearing loss as an organic disease of the nervous system and, therefore, a presumptive disability). As detailed above, in order to establish service connection for the claimed condition, there must be (1) medical evidence of a current disability; (2) evidence of the in-service incurrence or aggravation of a disease or injury or evidence of a service- connected disability; and (3) evidence of a nexus between (1) and (2). See Hickson, supra. With respect to Hickson element (1), current disability, an August 2003 VA audiology examination report noted the following pure tone thresholds, in decibels: HERTZ 500 1000 2000 3000 4000 RIGHT -- 25 25 35 25 LEFT -- -- -- -- -- His speech recognition score was 96 percent in the right ear. In addition, a July 2006 VA audiology examination report noted the following pure tone thresholds, in decibels: HERTZ 500 1000 2000 3000 4000 RIGHT 5 5 5 25 20 LEFT -- -- -- -- -- His speech recognition score was 100 percent in the right ear. The examiner noted that the Veteran's right ear hearing acuity was within normal limits between 250 and 8000 Hertz. Based on the evidence, the Board finds that Hickson element (1) is not met as to right ear hearing loss because the Veteran has not been shown to have a hearing loss disability in the right ear that meets the standards of 38 C.F.R. § 3.385. Congress has specifically limited entitlement to service-connected benefits to cases where there is a current disability. The Board fully recognizes that the Veteran is competent to state that he presently experiences hearing loss. However, the question of whether his hearing loss rises to the level to show hearing loss for VA purposes under 38 C.F.R. § 3.385 is well beyond the level of his competence. See 38 C.F.R. § 4.85(a) (2010) (an examination for hearing impairment for VA purposes must be conducted by a state licensed audiologist). Thus, in the absence of proof of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Therefore, service connection for right ear hearing loss is not warranted. Right Ankle and Foot Disability The Veteran seeks service connection for a right ankle and foot disability. Specifically, he alleges that the disability first manifested while in service. Service treatment records reflect that the Veteran was initially treated for complaints of right foot pain due to direct trauma by twisting in September 1981. The pain had only lasted one day, and there was little swelling and slight discoloration noted. In February 1982, he complained of right ankle pain due to twisting his ankle while walking down the stairs. Pain was worse when applying pressure, and the physician noted slight swelling and temperature but no discoloration. As the Veteran reported that this incident of ankle pain had merely a three-day duration, it appears to be a separate incident unrelated to his prior complaints of right foot pain in September 1981. There is no further mention of the injury in the service treatment records. Significantly, in a January 1983 Health Questionnaire conducted three months prior to his separation from service, the Veteran reported that there had not been a change in his health within the last 2 years. As such, his earlier complaints of pain in his right lower extremity appear to be acute and transitory rather than chronic in nature. Next, post-service evidence does not reflect foot or ankle symptomatology for several years after service discharge. Specifically, he was afforded a VA examination in August 2003, at which time the examiner opined that his right ankle pain and swelling was not likely related to any military injury and by history would seem to be more of a monoarticular arthritis, perhaps a gout-type syndrome. Significantly, there was no separate diagnosis of a right foot disorder at this time. He was afforded a VA feet examination in October 2008, at which time the examiner diagnosed him with right ankle and subtalar joint arthritis, but found no evidence to suggest a right foot disorder. The examiner opined that the arthritic changes of the right ankle were at least as likely as not causally related to his active service. Based on this examination report, in a February 2009 rating decision, the RO granted service connection for right ankle and subtalar joint arthritis, and assigned a 10 percent disability evaluation under Diagnostic Codes 5010-5271. Although the Veteran filed a notice of disagreement with this 10 percent evaluation, that issue is not before the Board at this time. The Board notes that service connection may only be granted for a current disability; when a claimed condition is not shown, there may be no grant of service connection. See 38 U.S.C.A. § 1110 (West 2002); Rabideau v. Derwinski, 2 Vet. App. 141 (1992) (Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability). "In the absence of proof of a present disability there can be no valid claim." See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Furthermore, pyramiding, or the evaluation of the same disability under various diagnoses, is to be avoided. 38 C.F.R. § 4.14 (2010). As there is no evidence of a current right foot disorder separate and distinct from the Veteran's service-connected right ankle disorder, service connection cannot be established for a right foot disorder. Left Thumb Tendonitis The Veteran seeks service connection for left thumb tendonitis. Specifically, he asserts that the disability first manifested in service as a result of long hours operating an armored personnel carrier. Service treatment records reflect no complaints of, treatment for, or a diagnosis related to the left thumb or any symptoms reasonably attributed thereto. Significantly, in a January 1983 Health Questionnaire conducted three months prior to his separation from service, the Veteran reported that there had not been a change in his health within the last 2 years. Therefore, no chronic left thumb disorder was noted in service. Next, post-service evidence does not reflect chest symptomatology for several years after service discharge. Specifically, he was afforded a VA examination in August 2003, at which time X-rays revealed geode formation within the proximal scaphoid, but no other bony or joint abnormalities. The examiner diagnosed his intermittent swelling and pain at the base of the left thumb as De Quervain tendonitis. This is the first recorded post-service diagnosis of a left thumb disorder, coming approximately 20 years after discharge. Therefore, the competent evidence does not reflect continuity of symptomatology. In addition to the absence of documented post-service symptomatology related to the left thumb for many years, the evidence includes the Veteran's statements asserting continuity of symptoms. In this case, the Veteran is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses. Layno, 6 Vet. App. at 470. He has indicated that he continued to experience symptoms relating to the left thumb after he was discharged from the service. In this case, the Board finds that the Veteran's reported history of continued symptomatology since active service, while competent, is nonetheless not credible. The Board emphasizes the multi-year gap between discharge from active duty service in 1983 and the initial diagnosis related to a chest disorder in approximately 2003, an approximately 20-year gap. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (lengthy period of absence of medical complaints for condition can be considered as a factor in resolving claim); see also Mense v. Derwinski, 1 Vet. App. 354, 356 (1991) (affirming Board's denial of service connection where veteran failed to account for lengthy time period between service and initial symptoms of disability). The Board has weighed the Veteran's statements as to continuity of symptomatology and finds his current recollections and statements made in connection with a claim for benefits to be of lesser probative value. Therefore, continuity has not here been established, either through the competent evidence or through his statements. Next, service connection may be granted when the evidence establishes a medical nexus between active duty service and current complaints. In this case, the Board finds that the weight of the competent evidence does not attribute the Veteran's left thumb disorder to active duty, despite his contentions to the contrary. To that end, the Board places significant probative value on the August 2003 and October 2008 VA examinations undertaken specifically to address the issue on appeal. The August 2003 examiner opined that the Veteran's diagnosed De Quervain tendonitis "would not be attributable to any service injury." At the October 2008 spine examination, the Veteran reported left thumb pain and associated forearm pain. However, the examiner diagnosed the Veteran with tenosynovitis of the left thumb and wrist, and opined that the disorder was less likely than not related to service because there was no evidence of any injury to his left upper extremity during his military career. The Board has also considered the Veteran's statements asserting a nexus between his currently-diagnosed disorder and active duty service. While the Board reiterates that the Veteran is competent to report symptoms as they come to him through his senses, tendonitis and tenosynovitis are not the types of disorders that a lay person can provide competent evidence on questions of etiology or diagnosis. Such competent evidence has been provided by the medical personnel who have examined the Veteran during the current appeal and by service records obtained and associated with the claims file. Here, the Board attaches greater probative weight to the clinical findings than to his statements. See Cartright, 2 Vet. App. at 25. In light of the above discussion, the Board concludes that the preponderance of the evidence is against the claim for service connection and there is no doubt to be otherwise resolved. As such, the appeal is denied. Back Disorder The Veteran seeks service connection for a back disorder. Specifically, he alleges that he sustained a back injury while picking up an ammunition crate at Fort Bliss, Texas, in 1982 or 1983 that has been bothering him ever since. Service treatment records reflect that the Veteran was initially treated for complaints of sharp, non-radiating, lower back pain in May 1981. The pain had lasted for 2 weeks and it was noted that the Veteran did a lot of heavy lifting. Light muscle spasm was noted and the Veteran was diagnosed with pulled back muscles. The Veteran next complained of back pain in August 1981 after running into a sharp object during a fight. As the Veteran reported that this incident of back pain was merely of one-day duration, it appears to be a separate incident unrelated to his prior complaint of back pain in May 1981. There is no further mention of the injury in the service treatment records. Significantly, in a January 1983 Health Questionnaire conducted three months prior to his separation from service, the Veteran reported that there had not been a change in his health within the last 2 years. As such, his earlier complaints of low back pain appear to be acute and transitory rather than chronic in nature. Next, post-service evidence does not reflect chest symptomatology for several years after service discharge. Specifically, he was afforded a VA examination in August 2003, at which time X-rays revealed no bony or joint abnormalities. Noting that the Veteran suffered from stiffness with no neurological symptoms of the lower extremities, the examiner diagnosed him with lumbar sprain/strain. This is the first recorded post-service diagnosis of a low back disorder, coming approximately 20 years after discharge. Therefore, the competent evidence does not reflect continuity of symptomatology. In addition to the absence of documented post-service symptomatology related to the left thumb for many years, the evidence includes the Veteran's statements asserting continuity of symptoms. In this case, the Veteran is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses. Layno, 6 Vet. App. at 470. He has indicated that he continued to experience symptoms relating to the low back after he was discharged from the service. In this case, the Board finds that the Veteran's reported history of continued symptomatology since active service, while competent, is nonetheless not credible. The Board emphasizes the multi-year gap between discharge from active duty service in 1983 and the initial diagnosis related to a low back disorder in approximately 2003, an approximately 20-year gap. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (lengthy period of absence of medical complaints for condition can be considered as a factor in resolving claim); see also Mense v. Derwinski, 1 Vet. App. 354, 356 (1991) (affirming Board's denial of service connection where veteran failed to account for lengthy time period between service and initial symptoms of disability). The Board has weighed the Veteran's statements as to continuity of symptomatology and finds his current recollections and statements made in connection with a claim for benefits to be of lesser probative value. Therefore, continuity has not here been established, either through the competent evidence or through his statements. Next, service connection may be granted when the evidence establishes a medical nexus between active duty service and current complaints. In this case, the Board finds that the weight of the competent evidence does not attribute the Veteran's disorder to active duty, despite his contentions to the contrary. To that end, the Board places significant probative value on the August 2003 and October 2008 VA examinations undertaken specifically to address the issue on appeal. The August 2003 examiner opined that the Veteran's diagnosed lumbar sprain/strain "would not likely be related to any lower back strains evaluated while in the military service." At the October 2008 spine examination, the examiner diagnosed the Veteran with degenerative arthritis of the lumbar spine. He emphasized that the Veteran worked in heavy construction for approximately 6 years following his separation from service, and then started work in a furniture factory where heavy-lifting activity was required in approximately 2000, when his back pain began to increase. As such, the October 2008 examiner opined that in the intervening years following his in-service back complaints, the Veteran had a functioning back that allowed him to carry out his heavy duties during the remainder of his military career and at his subsequent civilian construction job. As there was no evidence of treatment for the back until the last few years, the examiner opined that the Veteran's current low back condition is less likely than not related to his military career and any documented incidents of back pain in May 1981 and August 1981. The examiner's suggestion that the Veteran's current back pain is more attributable to heavy lifting at his civilian furniture- moving job is supported by a July 2009 VA emergency room note which indicated that the Veteran suffered an acute worsening of his back pain after lifting a sofa two days prior. The Veteran also submitted a private magnetic resonance imaging report dated in April 2006 that noted multilevel bulging discs an diagnosed mild multilevel facet degenerative joint disease, but did not opine as to the condition's onset or etiology. The Board has also considered the Veteran's statements asserting a nexus between his currently-diagnosed disorder and active duty service. While the Board reiterates that the Veteran is competent to report symptoms as they come to him through his senses, degenerative arthritis is not the type of disorder that a lay person can provide competent evidence on questions of etiology or diagnosis. Such competent evidence has been provided by the medical personnel who have examined the Veteran during the current appeal and by service records obtained and associated with the claims file. Here, the Board attaches greater probative weight to the clinical findings than to his statements. See Cartright, 2 Vet. App. at 25. In light of the above discussion, the Board concludes that the preponderance of the evidence is against the claim for service connection and there is no doubt to be otherwise resolved. As such, the appeal is denied. Drug and Alcohol Abuse The Veteran seeks service connection for drug and alcohol abuse. Specifically, he seems to imply that he began abusing drugs and alcohol to deal with in-service depression and physical pain because there were no Army support groups to help him cope. He asserts that if he were afforded a formal examination upon his separation from service, his disabilities would have been identified and he would not have spent years abusing drugs and alcohol. Section 8052 of the Omnibus Budget Reconciliation Act (OBRA) of 1990, Pub. L. No. 101-508, § 8052, 104 Stat. 1388, 1388- 91, prohibits, effective for claims filed as in the instant case after October 31, 1990, payment of compensation for a disability that is a result of a veteran's own alcohol or drug abuse. Moreover, Section 8052 also amended 38 U.S.C.A. § 105(a) to provide that, with respect to claims filed after October 31, 1990, an injury or disease incurred during active service will not be deemed to have been incurred in line of duty if the injury or disease was a result of the person's own willful misconduct, including abuse of alcohol or drugs. See 38 U.S.C.A. § 105; 38 C.F.R. §§ 3.1(m), 3.301(d). Notwithstanding the foregoing, the United States Court of Appeals for the Federal Circuit (Federal Circuit), in Allen v. Principi, 237 F.3d 1368 (Fed. Cir. 2001), held that there can be service connection for compensation for an alcohol or drug abuse disability acquired as secondary to, or as a symptom of, a service-connected disability. The Federal Circuit also indicated that veterans could only recover if they can "adequately establish that their alcohol or drug abuse disability is secondary to or is caused by their primary service-connected disorder." The Federal Circuit stated that such compensation would only result "where there is clear medical evidence establishing that the alcohol or drug abuse disability is indeed caused by a veteran's primary service-connected disability, and where the alcohol or drug abuse disability is not due to willful wrongdoing." In addition, the Federal Circuit found that 38 U.S.C.A. § 1110 permits a veteran to received compensation for an alcohol-abuse or drug-abuse disability acquired as secondary to, or as a symptom of, a veteran's service-connected disability. Compensation is precluded in only two situations: (1) for primary alcohol abuse disabilities; and (2) for secondary disabilities (such as cirrhosis of the liver) that result from primary alcohol abuse. The Federal Circuit defined "primary" as meaning an alcohol abuse disability arising during service from voluntary and willful drinking to excess. However, that is not the case here. The Veteran has indicated that while in Germany, his non-commissioned officers promoted the use of alcohol, cannabis, and amphetamines in order to overcome fear, loneliness, and pain. As discussed above, there is no documented diagnosis of depression in service, and he is not service connected for any psychiatric disorder. As such, service connection for drug and alcohol abuse as secondary to a service- connected disorder must be denied. Furthermore, there is no evidence that the Veteran currently suffers from drug or alcohol abuse. His VA treatment records repeatedly indicate that he has been free from drugs and alcohol for over ten years. Thus, in the absence of proof of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). III. Increased Rating for Left Ear Hearing Loss The Veteran also seeks an increased rating for his service- connected left ear hearing loss. He was initially granted service connection for left ear hearing loss in a September 2003 rating decision and granted a noncompensable evaluation effective from October 10, 2001. He filed a notice of disagreement seeking a higher initial evaluation in October 2003. Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4. The rating schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. 38 C.F.R. § 4.7. In considering the severity of a disability, it is essential to trace the medical history of the Veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41. Consideration of the whole-recorded history is necessary so that a rating may accurately reflect the elements of disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Where a Veteran appeals the initial rating assigned for a disability when a claim for service connection for that disability has been granted, evidence contemporaneous with the claim for service connection and with the rating decision granting service connection would be most probative of the degree of disability existing at the time that the initial rating was assigned and should be the evidence "used to decide whether an [initial] rating on appeal was erroneous . . . ." Fenderson v. West, 12 Vet. App. 119, 126 (1999). If later evidence obtained during the appeal period indicates that the degree of disability increased or decreased following the assignment of the initial rating, "staged" ratings may be assigned for separate periods of time based on facts found. Id. In evaluating service-connected hearing loss, disability ratings are derived by a mechanical application of the rating schedule to the numeric designations assigned after audiometric evaluations are performed. Lendenmann v. Principi, 3 Vet. App. 345, 349 (1992). Evaluations of bilateral hearing loss range from noncompensable to 100 percent based on an organic impairment of hearing acuity, as measured by controlled speech discrimination tests in conjunction with the average hearing threshold, as measured by pure tone audiometric tests in the frequencies of 1000, 2000, 3000 and 4000 cycles per second. The rating schedule establishes 11 auditory acuity Levels designated from Level I for essentially normal hearing acuity through Level XI for profound deafness. VA audiological evaluations are conducted using a controlled speech discrimination test together with the results of pure tone audiometry tests. The vertical line in Table VI (printed in 38 C.F.R. § 4.85) represents nine categories of the percentage of discrimination based on a controlled speech discrimination test. The horizontal columns in Table VI represent 9 categories of decibel loss based on the pure tone audiometry test. The numeric designation of impaired hearing (Levels I through XI) is determined for each ear by intersecting the vertical row appropriate to the pure tone decibel loss. The percentage evaluation is found from Table VII in 38 C.F.R. § 4.85 by intersecting the vertical column appropriate for the numeric designation for the ear having the better hearing acuity and the horizontal row appropriate for the numeric designation for the level for the ear having the poorer hearing acuity. For example, if the better ear had a numeric designation of Level "V" and the poorer ear had a numeric designation of Level "VII" the percentage evaluation is 30 percent. See 38 C.F.R. § 4.85. Regulations also provide that in cases of exceptional hearing loss, i.e., when the pure tone threshold at each of the four specified frequencies (1000, 2000, 3000 and 4000 hertz) is 55 decibels or more, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIA, whichever results in the higher numeral. Each ear will be evaluated separately. 38 C.F.R. § 4.86(a). The provisions of 38 C.F.R. § 4.86(b) further provide that when the pure tone threshold is 30 decibels or less at 1000 hertz and 70 decibels or more at 2000, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIA, whichever results in the higher numeral. That numeral will then be evaluated to the next higher Roman numeral. An examination for hearing impairment for VA purposes must be conducted by a state-licensed audiologist and must include a controlled speech discrimination test (Maryland CNC) and a pure tone audiometric test. Examinations will be conducted without the use of hearing aids. 38 C.F.R. § 4.85 (a). Furthermore, in Martinak v. Nicholson, 21 Vet. App. 447 (2007), the Court held that in addition to dictating objective test results, a VA audiologist must fully describe the functional effects caused by a hearing disability in his or her final report. Martinak, 21 Vet. App. at 455. The Court also noted, however, that even if an audiologist's description of the functional effects of the Veteran's hearing disability was somehow defective, the Veteran bears the burden of demonstrating any prejudice caused by a deficiency in the examination. Id. Here, in considering the evidence of record under the laws and records as set forth above, the Board concludes that the Veteran is not entitled to an initial compensable evaluation for his bilateral ear hearing loss under 38 C.F.R. §§ 4.85 or 4.86, Diagnostic Code 6100. In this regard, the Veteran was afforded a VA audiology examination in August 2003. On the authorized audiological evaluation, pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT -- -- -- -- -- LEFT -- 25 35 50 50 The Veteran's average pure tone threshold was 40 decibels and speech audiometry revealed speech recognition ability of 96 percent in the left ear. The results of the July 2006 VA audiology examination correspond to Level I hearing in the left ear pursuant to Table VI. 38 C.F.R. § 4.85(b). When that values is applied to Table VII, a noncompensable rating is assigned. 38 C.F.R. § 4.85. The Veteran was subsequently afforded a VA audiology examination in July 2006. On the authorized audiological evaluation, pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT -- -- -- -- -- LEFT 10 15 30 50 50 The Veteran's average pure tone threshold was 36 decibels and speech audiometry revealed speech recognition ability of 100 percent in the left ear. The results of the July 2006 VA audiology examination correspond to Level I hearing in the left ear pursuant to Table VI. 38 C.F.R. § 4.85(b). When that values is applied to Table VII, a noncompensable rating is assigned. 38 C.F.R. § 4.85. The Board has also considered the provision of 38 C.F.R. § 4.86. However, at the August 2003 and July 2006 VA examinations, the Veteran did not have puretone threshold findings at each of the four specified frequencies (1000, 2000, 3000 and 4000 Hertz) of 55 decibels or more. 38 C.F.R. § 4.86(a). Likewise, the Veteran did not have puretone threshold findings of 30 decibels or less at 1000 Hertz and 70 decibels or more at 2000 Hertz. 38 C.F.R. § 4.86(b). Therefore, the results of the August 2003 and July 2006 VA examinations do not show that the Veteran is entitled to a higher rating pursuant to 38 C.F.R. § 4.86. Thus, it is apparent that the assigned noncompensable disability evaluation for the Veteran's left ear hearing loss is accurate and appropriately reflected his hearing loss under the provisions of 38 C.F.R. §§ 4.85 and 4.86. Although the Veteran contends that his left ear hearing loss is more severe, and therefore warrants a higher evaluation, the assignment of disability evaluations for hearing impairment is a purely mechanical application of the rating criteria from which the Board cannot deviate. Lendenmann v. Principi, 3 Vet. App. 345, 349 (1992). Additionally, the record contains no evidence showing the Veteran was entitled to an initial compensable rating at any point during the period on appeal. Therefore, no staged ratings are appropriate. See Fenderson, supra. Thus, as the criteria for an initial compensable disability evaluation for the Veteran's service-connected left ear hearing loss have not been met, the appeal is denied. In essence, the preponderance of the evidence is against an initial compensable evaluation for left ear hearing loss. Because the preponderance of the evidence is against the Veteran's claim, the benefit of the doubt provision does not apply. As such, entitlement to an initial compensable evaluation for service-connected left ear hearing loss must be denied. The above determinations are based upon application of the pertinent provisions of VA's rating schedule. The Board finds that the record does not reflect that the Veteran's hearing loss is so exceptional or unusual as to warrant the assignment of a higher rating on an extra-schedular basis. See 38 C.F.R. § 3.321(b)(1) (2009). The threshold factor for extraschedular consideration is a finding that the evidence before VA presents such an exceptional disability picture that the available schedular evaluations for that service-connected disability are inadequate. See Thun v. Peake, 22 Vet. App. 111 (2008). In this regard, there must be a comparison between the level of severity and symptomatology of the claimant's service-connected disability with the established criteria found in the rating schedule for that disability. If the criteria reasonably describe the claimant's disability level and symptomatology, then the claimant's disability picture is contemplated by the rating schedule and the assigned schedular evaluation is therefore adequate, and no extraschedular referral is required. Id., see also VAOGCPREC 6-96 (Aug. 16, 1996). Otherwise, if the schedular evaluation does not contemplate the claimant's level of disability and symptomatology and is found inadequate, VA must determine whether the claimant's exceptional disability picture exhibits other related factors, such as those provided by the extraschedular regulation (38 C.F.R. § 3.321(b)(1)) as "governing norms" (which include marked interference with employment and frequent periods of hospitalization). In this case, the Veteran has not contended that his service- connected hearing loss has caused frequent periods of hospitalization. The Veteran reports that he was unemployed due to his service-connected left ear hearing loss as well as his non-service-connected low back, right foot, and left thumb disorders. Cf. Martinak v. Nicholson, 21 Vet. App. 447 (2007). However, the Board finds that the rating criteria to evaluate hearing loss reasonably describe the claimant's disability level and symptomatology. Furthermore, there is no indication that the Veteran's left ear hearing loss alone precludes employment, and the Veteran is currently attempting to reenter the employment sector. Therefore, the Veteran's disability picture is contemplated by the rating schedule and no extraschedular referral is required. 38 C.F.R. § 3.321(b)(1); Bagwell v. Brown, 9 Vet. App. 337 (1996); Shipwash v. Brown, 8 Vet. App. 218 (1995). IV. Earlier Effective Date for Tinnitus A January 2008 rating decision granted a 10 percent evaluation for tinnitus, effective August 22, 2003. The Veteran contends that he is entitled to an earlier effective date for this award of service connection. Specifically, he argues that he is entitled to an effective date of March 4, 1983, his Expiration of Term of Service (ETS) date from the Army, because he was never afforded a separation examination. Except as otherwise provided, the effective date of an evaluation and award of pension, compensation or dependency and indemnity compensation based on an original claim, a claim reopened after final disallowance, or a claim for increase will be on the date of receipt of the claim or the date entitlement arose, whichever is the later. 38 U.S.C.A. § 5110(a); 38 C.F.R. §§ 3.400, 3.400(b)(2). The effective date of an evaluation and award of compensation on an original claim for compensation will be the day following separation from active duty service or the date entitlement arose if claim is received within 1 year after separation from service; otherwise, date of receipt of claim or the date entitlement arose, whichever is later. 38 U.S.C.A. § 5110(a); 38 C.F.R. § 3.400(b)(2). In the present case, the Veteran separated from active service on August 4, 1983. He filed a claim for service connection for bilateral hearing loss on October 10, 2001; significantly, however, this application did not include a claim for tinnitus. It was not until the Veteran was afforded a VA examination on August 22, 2003, that he reported suffering from tinnitus approximately 2 to 3 times per month. In a September 2003 rating decision, the RO considered the issue of entitlement to service connection for tinnitus, but denied the claim. The Veteran appealed the claim to the Board, which found that the evidence was at least in equipoise as to whether the Veteran's tinnitus was caused by his service-connected left ear hearing loss. As such, the RO granted service connection for tinnitus in a January 2008 rating decision, assigning an effective date of August 22, 2003, the date of the VA examination which first revealed the presence of tinnitus. The relevant regulations provide that the effective date of an award of pension, compensation, or dependency and indemnity compensation based on an original claim, a claim reopened after a final disallowance (where the reopening is not due to new service medical records), or a claim for increase will be the day of receipt of the claim or the date entitlement arose, whichever is later. 38 C.F.R. § 3.400. The Board has considered whether any evidence of record prior to August 22, 2003, could serve as an informal claim in order to entitle the Veteran to an earlier effective date. In this regard, any communication or action, indicating an intent to apply for one or more benefits under the laws administered by VA, from a claimant, his or her duly authorized representative, a Member of Congress, or some person acting as next friend of a claimant who is not sui juris may be considered an informal claim. Such informal claim must identify the benefit sought. 38 C.F.R. § 3.155 (2009). After reviewing the record, the Board concludes that there were no testimonial documents submitted prior to August 22, 2003, indicating an intent to submit a claim for entitlement to service connection for tinnitus. It is further noted that, under 38 C.F.R. § 3.157, a report of examination or hospitalization will be accepted as an informal claim for benefits. However, the provisions of 38 C.F.R. § 3.157 only apply once a formal claim for compensation or pension has been allowed or compensation disallowed because the disability is not compensable. Here, the Veteran's formal claim for service connection for bilateral hearing loss was initially denied in a July 2002 rating decision which predated the August 2003 VA examination. As such, that regulation affords a basis for finding that his August 22, 2003, VA examination could be accepted as an informal claim for benefits. However, that regulation does not afford a basis for finding that any claim, be it formal or informal, of entitlement to service connection for tinnitus was filed earlier than the current effective date of August 22, 2003. 38 C.F.R. § 3.157; Crawford v. Brown, 5 Vet. App. 33 (1993). In sum, the presently-assigned effective date of August 22, 2003, is appropriate and there is no basis for an award of service connection for tinnitus prior to that date. As the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. ORDER Entitlement to service connection for an acquired psychiatric disorder, claimed as depression, is denied. Entitlement to service connection for a chronic disability manifested by chest pain is denied. Entitlement to service connection for right ear hearing loss is denied. Entitlement to service connection for a right ankle and foot disability, claimed as right ankle swelling and foot pain, is denied. Entitlement to service connection for left thumb tendonitis is denied. Entitlement to service connection for a back disorder is denied. Entitlement to service connection for drug and alcohol abuse is denied. Entitlement to an initial compensable rating for service connected left ear hearing loss is denied. Entitlement to an effective date prior to August 22, 2003, for a grant of service connection for tinnitus is denied. ____________________________________________ MICHAEL MARTIN Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs