Citation Nr: 18144874 Decision Date: 10/25/18 Archive Date: 10/25/18 DOCKET NO. 14-16 256 DATE: October 25, 2018 ORDER Entitlement to an effective date earlier than June 16, 2016, for the grant of service connection for pseudofolliculitis barbae (PB) is denied. Entitlement to an effective date earlier than July 24, 2016, for the grant of service connection for bilateral hearing loss is denied. Entitlement to service connection for sleep apnea is denied. Entitlement to service connection for migraine headaches is denied. Entitlement to service connection for ingrown toenail/tinea pedis is denied. Entitlement to service connection for left lower leg deep vein thrombosis (DVT) is granted. Entitlement to a compensable disability evaluation for bilateral hearing loss is denied. REMANDED Entitlement to service connection for residuals of a left lower leg/ankle laceration is remanded. Entitlement to service connection for a psychiatric disorder, to include memory loss and temperament problems, also claimed as a result of exposure to contaminated water at Camp Lejeune, is remanded. Entitlement to an initial compensable disability evaluation for onychomycosis/nail fungus is remanded. Entitlement to an initial compensable disability evaluation for PB is remanded. FINDINGS OF FACT 1. The Veteran's claim for service connection for PB was not received until June 16, 2016. 2. A claim for service connection for PB was not received within one year of service separation. 3. The Veteran did not file his petition to reopen his claim for service connection for right ear hearing loss, with the subsequent grant resulting in service connection now being in effect for bilateral hearing loss, until July 24, 2016. 4. Any current sleep apnea is not of service origin. 5. Any current headache disorder is not of service origin. 6. The Veteran does not have ingrown toe nails or tinea pedis of service origin. 7. Left lower extremity DVT is of service origin. 8. The Veteran has been shown to have no worse than level II hearing in the right ear and level I hearing in the left ear. CONCLUSIONS OF LAW 1. The criteria for an effective date prior to June 16, 2016, for the award of service connection for PB have not been met. 38 U.S.C. §§ 5103, 5103A, 5107, 5110 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.326(a), 3.400 (2017). 2. The criteria for entitlement to an earlier effective date prior to July 24, 2016 for the award of service connection for bilateral hearing loss have not been met. 38 U.S.C. § 5110 (2012); 38 C.F.R. § 3.400 (2017). 3. The criteria for service connection for sleep apnea are not met. 38 U.S.C. § 1131 (2012); 38 C.F.R. §§ 3.102, 3.303 (2017). 4. The criteria for service connection for a headache disorder are not met. 38 U.S.C. §§ 1101, 1131 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2017). 5. The criteria for service connection for ingrown toenails/tinea pedis are not met. 38 U.S.C. § 1131 (2012); 38 C.F.R. §§ 3.102, 3.303 (2017). 6. Resolving reasonable doubt in favor of the Veteran, the criteria for service connection for left lower extremity DVT have been met. 38 U.S.C. § 1131 (2012); 38 C.F.R. §§ 3.102, 3.303 (2017). 7. The criteria for a compensable evaluation for bilateral hearing loss have not been met. 38 U.S.C. §§ 1155, 5107(b) (2012); 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.10, 4.21, 4.85, 4.86, Diagnostic Code (DC) 6100 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran, who is the appellant, had active service from July 1978 to August 1982. Effective Date Pseudofolliculitis Barbae The Veteran asserts that an effective date earlier than June 16, 2016, is warranted for the award of service connection for PB. On June 16, 2016, the Veteran requested service connection for PB. The record is devoid of any documentation dated prior to the June 2016 request which may be reasonably construed as a claim for service connection for PB. The effective date of an award based on an original claim shall be fixed in accordance with the facts found, but shall not be earlier than the date of receipt of application therefor. 38 U.S.C. § 5110(a). Title 38 of the Code of Federal Regulations clarifies that an award of direct service connection will be effective on the day following separation from active military service or the date on which entitlement arose if the claim is received within one year of separation from service. Otherwise, the effective date shall be the date of receipt of the Veteran's claim or the date on which entitlement arose, whichever is later. 38 C.F.R. § 3.400 (b)(2)(i). PB has been shown to have originated during active service. Therefore, the question to be determined is the date of receipt of the Veteran's claim for service connection for PB. The Veteran's claim for service connection was received by VA on June 16, 2016. As the claim was not received within one year of separation from service in August 1982, the appropriate effective date for the award of service connection for PB is June 16, 2016, the date of receipt of the claim for service connection for PB. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400 (b)(2)(i). The pertinent legal authority governing assignment of effective dates is clear and specific. In this case, the undisputed facts show that the Veteran separated from active service in August 1982; did not file a claim for service connection for PB within one year of service separation; and initially filed a claim for service connection for PB, which was received by VA on June 16, 2016. The applicable law and regulation provide that the proper effective date for the grant of service connection is the date of receipt of the claim. 38 C.F.R. § 5110(a); 38 C.F.R. § 3.400 (b)(2)(i). As the earliest effective date legally possible has been assigned, the instant appeal for an earlier effective date is without legal merit and must be denied. See Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). For these reasons, the Board concludes that an effective date prior to June 16, 2016, for the award of service connection for PB is not warranted. Bilateral Hearing Loss Generally, the effective date of an award of a claim is the date of receipt of the claim application or the date entitlement arose, whichever is later. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400. However, if a claim for disability compensation is received within one year after separation from service, the effective date of entitlement is the day following separation or the date entitlement arose. 38 C.F.R. § 3.400(b)(2). The Board notes that the Veteran's initial claim of entitlement to service connection for bilateral hearing loss was received in March 2011. In an October 2011 rating determination, the RO granted service connection for left ear hearing loss but denied service connection for right ear hearing loss. The Veteran did not file a timely appeal of this decision. In November 2012, service connection for right ear hearing loss was once again denied. The Veteran was notified of this decision later that month and did not file a timely appeal of this decision. Appellate review of a rating decision is initiated by the timely submission of a notice of disagreement (NOD) and, after a statement of the case (SOC) has been furnished, completed by the timely submission of a substantive appeal (VA Form 9 or equivalent). 38 U.S.C.§ 7105(a); 38 C.F.R. § 20.200. A rating decision becomes final and binding if the Veteran does not timely perfect an appeal of the decision. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.160(d), 20.200, 20.302, 20.1103. The United States Court of Appeals for Veterans Claims (Court) held in Sears v. Principi, 16 Vet. App. 244, 248 (2002) that "[t]he statutory framework simply does not allow for the Board to reach back to the date of the original claim as a possible effective date for an award of service-connected benefits that is predicated upon a reopened claim." In order for the Veteran to be awarded an effective date based on an earlier claim, he or she has to show CUE in the prior denial of the claim. Flash v. Brown, 8 Vet. App. 332, 340 (1995). 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 a 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 U.S.C. § 5110(a); 38 C.F.R. § 3.400. The effective date upon receipt of new and material evidence after a final disallowance will be the date of receipt of the new claim or the date entitlement arose, whichever is later. 38 C.F.R. § 3.400 (q)(2). For cases where an appellant seeks to reopen a claim for entitlement to an earlier effective date under 38 C.F.R. § 3.156, even assuming the presence of new and material evidence, reopening of a claim for entitlement to an earlier effective date cannot result in the actual assignment of an earlier effective date, because an award granted on a reopened claim may not be made effective prior to the date of the reopened claim. See 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400(q)(2); Leonard v. Principi, 17 Vet. App. 447 (2004), aff'd Leonard v. Nicholson, 405 F.3d 1333 (Fed. Cir. 2005); Lapier v. Brown, 5 Vet. App. 215 (1993). A review of the claims file reveals that the Veteran's petition to reopen right ear hearing loss was received on July 24, 2016, and that this is the effective date assigned to his right ear hearing loss, as specified in the October 2016 rating decision. As such, the Veteran's claim of entitlement to an earlier effective date for his service-connected right ear hearing loss, which resulted in service connection now being in effect for bilateral hearing loss, is denied. 38 U.S.C. § 5110 (2012); 38 C.F.R. § 3.400 (2017). Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Service connection may 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 C.F.R. § 3.303(d). If a condition noted during service is not shown to be chronic, then generally a showing of continuity of symptomatology after service is required for service connection if the disability is one that is listed in 38 C.F.R. § 3.309(a). 38 C.F.R. § 3.303(b); see also Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Other specifically enumerated disorders, including migraine headaches, will be presumed to have been incurred in service if they manifested to a compensable degree within the first year following separation from active duty. 38 U.S.C. §§ 1101, 1112, 1113, 1137 (2012); 38 C.F.R. §§ 3.307, 3.309 (2017). As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004); see also Hickson v. West, 12 Vet. App. 247, 253 (1999), citing Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd, 78 F.3d 604 (Fed. Cir. 1996). Generally, lay evidence is competent with regard to a disease with "unique and readily identifiable features" that is "capable of lay observation." See Barr v. Nicholson, 21 Vet. App. 303, 308-09 (2007) (concerning varicose veins); see also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (a dislocated shoulder); Charles v. Principi, 16 Vet. App. 370, 374 (2002) (tinnitus); Falzone v. Brown, 8 Vet. App. 398, 405 (1995) (flatfoot); Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a veteran is competent to report on that of which he or she has personal knowledge). Lay evidence can be competent and sufficient evidence of a diagnosis if (1) the layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). In weighing credibility, VA may consider interest, bias, inconsistent statements, bad character, internal inconsistency, facial plausibility, self-interest, consistency with other evidence of record, malingering, desire for monetary gain, and demeanor of the witness. Caluza v. Brown, 7 Vet. App. 498 (1995). When there is an approximate balance in the evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. The Court held that an appellant need only demonstrate that there is an "approximate balance of positive and negative evidence" in order to prevail. See Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). The Court has also stated, "It is clear that to deny a claim on its merits, the evidence must preponderate against the claim." Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert. Sleep Apnea Chronic obstructive sleep apnea is not a "chronic disease" listed under 38 C.F.R. § 3.309(a); therefore, 38 C.F.R. § 3.303(b) does not apply. Walker v. Shinseki, 708 F.3d 1331, 1338-40 (Fed. Cir. 2013). A review of the Veteran's service treatment records reveals no complaints or findings of any sleep problems or sleep disorders. At the time of the Veteran's July 1982 service separation examination, there were no reports or findings of sleep problems. The Veteran did not report having any sleep problems or sleep disorders at that time. Treatment records associated with the claims file reveal that the Veteran reported having been given a CPAP machine in 2002 or 2003. There was no indication that the Veteran received treatment for any sleep problems prior to this time. The Board finds that the weight of the evidence, both lay and medical, does not demonstrate that the Veteran's current sleep apnea had its onset in service. Service treatment records do not reveal any findings or diagnoses of sleep problems during service, with the Veteran not reporting having any sleep difficulties at that time. As such, the evidence does not demonstrate that sleep apnea was present at the time of separation from active service. Furthermore, as noted above, the Veteran’s post-service treatment records do not reveal that he received treatment for sleep apnea problems until 2002, more than 25 years following his separation from service. As to the Veteran's claim that he has had sleep apnea ever since his period of service, the Board finds that the contemporaneous evidence shows that the Veteran did not report having sleep problems during service or at the time of his separation from service. Furthermore, the Veteran did not file an application for compensation for sleep problems until 2013, with the first reported diagnosis, as relayed by the Veteran, not being until 2002. The above evidence is more probative than are his assertions, voiced well beyond his period of service, that any claimed sleep apnea is related to his period of service. See Curry v. Brown, 7 Vet. App. 59, 68 (1994) (noting that contemporaneous evidence has greater probative value than history as reported by a veteran). See also Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (the passage of many years between discharge from active service and the medical documentation of a claimed disability is one factor to consider as evidence against a claim of service connection). For these reasons, the Board concludes that the assertions of sleep problems since service are not credible. As to the Veteran's beliefs that his current sleep apnea is related to his period of service, the question of causation of such sleep apnea extends beyond an immediately observable cause-and-effect relationship, and, as such, the Veteran is not competent to address etiology in the present case. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007) (lay persons not competent to diagnose cancer)." In this case, the Veteran does not have the requisite training or expertise to diagnose the cause of his sleep apnea. Next, service connection may be granted when the evidence establishes a nexus between active duty service and current complaints. The Veteran was afforded the opportunity to provide medical evidence and/or an opinion relating his current sleep apnea to his period of service. He has not provided either medical evidence or an opinion to support this proposition. The medical evidence of record also does not contain any records linking the Veteran’s current sleep apnea to his period of service. As it relates to the necessity for an examination for service connection for sleep apnea, the Federal Circuit has addressed the appropriate standard to be applied in determining whether an examination is warranted. In Waters v. Shinseki, 601 F.3d 1274 (Fed. Cir. 2010) and Colantonio v. Shinseki, 606 F.3d 1378 (Fed. Cir. 2010), the Federal Circuit held that while there must be "medically competent" evidence of a current disability, "medically competent" evidence is not required to indicate that the current disability may be associated with service. Colantonio, 606 F.3d at 1382; Waters, 601 F.3d at 1277. On the other hand, a conclusory generalized lay statement suggesting a nexus between a current disability and service would not suffice to meet the standard of subsection (B), as this would, contrary to the intent of Congress, result in medical examinations being "routinely and virtually automatically" provided to all veterans claiming service connection. Waters, 601 F.3d at 1278-1279. Here, the only evidence that the Veteran's claimed disability is related to his military service is his own conculsionary generalized lay statements, which are unsupported by even speculative medical evidence. Further, there is significant evidence against this claim, including treatment records currently on file. For the foregoing reasons, the preponderance of the evidence is against the claim for service connection for sleep apnea. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Migraine Headaches A review of the Veteran's service treatment records reveals no complaints or findings of a headache disorder. At the time of the Veteran's July 1982 service separation examination, there were no reports or findings of headaches. The Veteran also did not report having any headaches at that time. Treatment records associated with the claims file reveal no reports or complaints of headaches until decades following service. The Board finds that the weight of the evidence, both lay and medical, does not demonstrate that the Veteran's current headaches had their onset in service. Service treatment records do not reveal any findings or diagnoses of a headache disorder during service, with the Veteran not reporting having a headache disorder at that time. As such, the evidence does not demonstrate that headaches were present at the time of separation from active service. Furthermore, as noted above, the Veteran’s post-service treatment records do not reveal evidence of a headache disorder until decades following his separation from service. As to the Veteran's claim that he has had headaches ever since his period of service, the Board finds that the contemporaneous evidence shows that the Veteran did not report having a headache disorder during service or at the time of his separation from service. Furthermore, the Veteran did not file an application for compensation for migraine headaches until June 2016, with the first reported diagnosis, not until decades following service. The above evidence is more probative than are his assertions, voiced well beyond his period of service, that any claimed headache disorder is related to his period of service. See Curry v. Brown, 7 Vet. App. 59, 68 (1994) (noting that contemporaneous evidence has greater probative value than history as reported by a veteran). See also Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (the passage of many years between discharge from active service and the medical documentation of a claimed disability is one factor to consider as evidence against a claim of service connection). For these reasons, the Board concludes that the assertions of a headache disorder since service are not credible. As to the Veteran's beliefs that his current headache disorder is related to his period of service, the question of causation of such headache disorder extends beyond an immediately observable cause-and-effect relationship, and, as such, the Veteran is not competent to address etiology in the present case. In this case, the Veteran does not have the requisite training or expertise to diagnose the cause of his current headache disorder. Next, service connection may be granted when the evidence establishes a nexus between active duty service and current complaints. The Veteran was afforded the opportunity to provide medical evidence and/or an opinion relating his current headache disorder to his period of service. He has not provided either medical evidence or an opinion to support this proposition. The medical evidence of record also does not contain any records linking the Veteran’s current headache disorder to his period of service. As it relates to the necessity for obtaining an opinion as to the etiology of any current headache disorder, the only evidence that the Veteran's claimed disability is related to his military service is his own conclusory generalized lay statements, which are unsupported by even speculative medical evidence. Further, there is significant evidence against this claim, including treatment records currently on file. For the foregoing reasons, the preponderance of the evidence is against the claim for service connection for headache disorder. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Ingrown Toenails/Tinea Pedis The Veteran’s service treatment records reveal that he was seen with ingrown toenails in April and July 1982. There were no additional findings of ingrown toenails in service. At the time of the Veteran’s July 1982 service separation examination, normal findings were reported for the Veteran’s feet. The Veteran did not report that he was having tinea pedis or ingrown toenails at that time. Post-service treatment records associated with the claims file reveal no findings of ingrown toenails or tinea pedis. In conjunction with his claim, the Veteran was afforded a VA examination in June 2017. While the examiner diagnosed the Veteran as having onychomycosis of the toenails at that time, for which service connection was granted, he specifically indicated that neither tinea pedis nor ingrown toenails were present. He noted that the Veteran’s past medical history was silent for ingrown toenails except during his military service that was treated and the ingrown toenail condition resolved. After reviewing all the evidence both lay and medical, service connection for residuals of ingrown toenails/tinea pedis is not warranted. Although the Veteran was treated for ingrown toenails in service, they resolved as evidenced by no findings at separation or in any post-service treatment records. There were also no findings of any tinea pedis on separation or in post-service treatment records. Congress, as a general rule, limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability. See 38 U.S.C. § 1131; and see Brammer v. Derwinski, 3 Vet. App. 223 (1992). In Degmetich v. Brown, 104 F.3d 1328 (Fed. Cir. 1997), it was observed that 38 U.S.C. § 1110, as well as other relevant statutes, only permitted payment for disabilities existing on and after the date of application for such disorders. The Federal Circuit observed that the structure of these statutes "provided strong evidence of congressional intent to restrict compensation to only presently existing conditions," and VA's interpretation of the law requiring a present disability for a grant of service connection was consistent with the statutory scheme. Degmetich, 104 F.3d at 1332; and see Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998) (holding VA's interpretation of the provisions of 38 U.S.C. § 1110 to require evidence of a present disability to be consistent with congressional intent); Rabideau v. Derwinski, 2 Vet. App. 141 (1992) (the law limits entitlement for service-related diseases and injuries to cases where the underlying in-service incident has resulted in a disability). Simply put, the general rule is that in the absence of proof of present disability there can be no valid claim. Based on the above, to the extent that the medical evidence addresses whether the Veteran has ingrown toenails/tinea pedis, it indicates that he does not. The Veteran is competent to report his current symptoms, but his reports must be weighed against the medical evidence of record. See Grover v. West, 12 Vet. App. 109, 112 (1999); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). To the extent that the Veteran has indicated that he currently has ingrown toenails/tinea pedis, the medical evidence showing an absence of such a disability is of greater probative weight than the Veteran's reports made during the course of his claim for VA benefits. Moreover, as the question of causation extends beyond an immediately observable cause-and-effect relationship he is not competent to render a diagnosis or address etiology in the present case. Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), as to the specific issue in this case, whether the Veteran currently has ingrown toenails/tinea pedis, falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Consequently, his statements, without some form of objective medical corroboration, are not probative. The weight of the evidence is against a finding that the Veteran currently has ingrown toenails/tinea pedis. A necessary element for establishing service connection-evidence of a current disability-has not been shown. For the foregoing reasons, the claim for service connection for ingrown toenails/tinea pedis is denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the Veteran's claim, that doctrine is not applicable. Left Lower Extremity Deep Vein Thrombosis As it relates to the claim of service connection for left lower extremity deep vein thrombosis, the Board notes that the Veteran was seen with complaints of left lower extremity swelling on many occasions in service, with a diagnosis of possible left lower extremity DVT being rendered during service. Post-service treatment records reveal that the Veteran has been diagnosed as having chronic left leg DVT on numerous occasions. In conjunction with his claim, the Veteran was afforded a VA examination in October 2012. Following examination, the examiner indicated that he could not render an opinion as to whether the Veteran’s left leg DVT was related to his period of service without resorting to speculation. He reported that the Veteran’s STRs were extremely difficult to read. He noted that due to the muscle spasm diagnosis, very difficult to read and follow records copied from microfiche in the service, and the official diagnosis of DVT's 13 years after separating the service, he could only speculate at best as to whether or not the claimed left leg condition (DVT) was incurred in or caused by injuries or issues in the service. At his January 2014 hearing, the Veteran testified as to the numerous left leg problems that he had in service and the various diagnoses, including a possible DVT. He noted that he had had intermittent swelling in his left leg since service. Although the Board notes that a subsequent opinion was obtained with regard to the Veteran’s claim for right DVT in March 2014, which served as the basis for the grant of the right lower extremity DVT, the examiner indicated that in the late 1970's, the Veteran had unusual issues in the lower extremities. DVT/thrombosis was clearly entertained back then, as his symptoms were unusual. Many of his findings were consistent with deep vein thrombosis (warmth, swelling, pain, 'knot'/lump). Cellulitis was also entertained as a diagnosis, which, at times, can mimic a DVT. He stated that regardless, his presentations were suspicious for DVT, and the examiners documented their concerns and impressions. He observed that over time, it appeared he had been on lifelong anticoagulation from various facilities, and had had additional DVT's. Therefore, it was at least as likely as not his right lower extremity DVT was caused by complaints in service, to include concerns of cellulitis/rule out DVT, as many times, these can be difficult to separate out, but suspicions for this were high. In addition, a May 2017 VA ankle examiner noted that the Veteran had been having long standing DVT of his left lower extremity and pain related to his condition, for which he mistakenly thought service connection was already in effect. Given the inservice findings; the Veteran’s testimony as to continuous swelling since service; the similarity of the fact patterns noted for both lower extremities by the March 2014 VA examiner when addressing the right lower extremity DVT, which resulted in the grant of service connection for the right lower extremity DVT; and the May 2017 VA examiner’s assumption that service connection was in effect for left lower extremity DVT based upon a review of the record, the Board finds that the evidence is at least in equipoise as to whether the Veteran’s left lower extremity DVT is related to his period of service. In such a case, reasonable doubt must be resolved in favor of the Veteran. Given the foregoing, service connection is warranted for left lower extremity DVT. Bilateral Hearing Loss Disability evaluations are determined by the application of the Schedule for Rating Disabilities, which assigns ratings based on the average impairment of earning capacity resulting from a service-connected disability. 38 U.S.C. § 1155; 38 C.F.R. Part 4. 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 required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Where the appeal arises from the original assignment of a disability evaluation following an award of service connection, the severity of the disability at issue is to be considered during the entire period from the initial assignment of the disability rating to the present time. See Fenderson v. West, 12 Vet. App. 119 (1999). Where entitlement to compensation has already been established, and an increase in the disability rating is at issue, the present level of disability is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Nevertheless, the Board acknowledges that a claimant may experience multiple distinct degrees of disability that might result in different levels of compensation from the time the increased rating claim was filed until a final decision is made. Hart v. Mansfield, 21 Vet. App. 505 (2007). In order to evaluate the level of disability and any changes in condition, it is necessary to consider the complete medical history of the Veteran's condition. Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991). The Veteran has been assigned a noncompensable evaluation under Diagnostic Code 6100 for his service-connected bilateral hearing loss. He contends that the severity of his condition more closely reflects the severity required for a higher disability rating. The VA rating scheme for the evaluation of hearing loss provides ratings from noncompensable to 100 percent based on the results of controlled speech discrimination tests together with the results of puretone audiometry tests which average puretone thresholds at 1000, 2000, 3000 and 4000 Hertz. 38 C.F.R. § 4.85 (2017). The evaluation of hearing impairment applies a formula which is essentially a mechanical application of the VA Schedule for Rating Disabilities to numeric designations after audiology evaluations are rendered. See Lendenmann v. Principi, 3 Vet. App. 345, 349 (1992). 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 puretone audiometry test. 38 C.F.R. § 4.85(a) (2017). Using Table VI in 38 C.F.R. § 4.85, the puretone average and speech recognition score are combined to give each ear a numeric designation for use on Table VII to determine the correct disability level. Alternatively, Table VIA uses only the puretone averages to give each ear a numeric designation. The regulations have two provisions for evaluating veterans with certain patterns of hearing impairment that cannot always be accurately assessed under § 4.85 because the speech discrimination test may not reflect the severity of communicative functioning that veterans experience. 38 C.F.R. § 4.86(a) provides that if puretone thresholds in the specified frequencies of 1000, 2000, 3000, and 4000 Hertz are each 55 decibels or more, an evaluation can be based either on Table VI or Table VIA, whichever results in a higher evaluation. This provision corrects the fact that with a 55-decibel threshold level (the level at which speech becomes essentially inaudible) the high level of amplification needed to attempt to conduct a speech discrimination test would be painful to most people, and speech discrimination tests may therefore not be possible or reliable. See 64 Fed. Reg. 25209 (May 11, 1999). Additionally, 38 C.F.R. § 4.86(b) provides that if the puretone threshold is 30 decibels or less at 1000 Hertz and 70 decibels or more at 2000 Hertz, an evaluation can be based on either Table VI or Table VIA, whichever results in a higher numeric designation, and that designation will then be elevated to the next higher Roman numeral. This provision compensates for a pattern of hearing impairment that is an extreme handicap in the presence of any environmental noise, and a speech discrimination test conducted in a quiet room with amplification of sound does not always reflect the extent of impairment experienced in the ordinary environment. The Veteran has not been shown to have either of these exceptional patterns at any time. The Veteran has argued that his hearing loss is more severe than is reflected by his assigned evaluations. Although the Veteran is competent to attest to his observations and laypeople may, in some circumstances, opine on questions of diagnosis and etiology, in this case, the Veteran is not competent to diagnose himself with a particular level of hearing impairment. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007); see also 38 C.F.R. § 3.159(a)(1)(2017) (competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions). Specifically, while the Veteran is clearly competent to describe what he experiences (diminished hearing), he is unable to provide competent evidence as the audiometry or measured level of his hearing loss to support a higher disability rating. In conjunction with his claim, the Veteran was afforded a VA examination in October 2016. At the time of the examination, the Veteran reported that his hearing loss was getting worse. Audiological evaluation revealed pure tone thresholds, in decibels, as follows: right ear 30, 40, 45, and 45, and left ear 35, 35, 35, and 60, at 1000, 2000, 3000, and 4000 Hertz, respectively. Speech audiometry testing revealed speech recognition ability of 90 percent in the right ear and of 92 percent in the left ear. The examiner rendered a diagnosis of bilateral sensorineural hearing loss. The examiner indicated that the Veteran's hearing loss impacted the ordinary conditions of life, including the Veteran’s reports of not being able to hear anything at all at times, with the volume of the hearing going all the way down. Using Table VI in 38 C.F.R. § 4.85, the Veteran's right ear corresponded with Level II hearing loss, the left ear corresponded with Level I hearing loss. These levels correspond with a noncompensable evaluation. In sum, hearing was, at worst, level II in the right ear and level I in the left ear. A comparison between these hearing levels and 38 C.F.R. § 4.85, Table VII, yields a noncompensable evaluation, consistent with the currently assigned rating. REASONS FOR REMAND Residuals of Left Lower Leg/Ankle Laceration As it relates to the claim of service connection for left lower leg/ankle laceration, the Board notes that at the time of May 2017 VA examination, the VA examiner diagnosed the Veteran as having patellofemoral pain syndrome, date of diagnosis unknown. The examiner then stated that there was no pathology for a separate diagnosis for his knees and ankle condition because current knee and ankle symptoms were most likely associated with his diagnosis of DVT. He stated that his left ankle decreased range of motion was most likely due to swelling and pain related to his DVT, for which service connection was already in effect. As noted above, the examiner was mistaken that service connection was in effect for the left lower extremity DVT; however, based upon the Board’s grant of the left lower extremity DVT, service connection is now currently in effect for such. While the examiner indicated that there was no pathology for the knee, he, at the same time, indicated that the Veteran had patellofemoral syndrome. To clear up any discrepancies, the claims folder should be returned to the VA examiner, if available, and he should be requested to identify all current diagnoses or those rendered during the course of the appeal, to include PFS, and indicate whether it is at least as likely as not (50 percent probability or greater) that any diagnosed disorder is related to his period of service and/or his service-connected left lower extremity DVT, to include by way of aggravation. Psychiatric Disorder, to Include Memory Loss and Temperament Problems, also Claimed as a Result of Exposure to Contaminated Water at Camp Lejeune As it relates to the above claims, the Board notes that the Veteran has been diagnosed as having various psychiatric disorders, to include schizophrenia, throughout the appeal period. The Board further observes that the Veteran was seen in service with acute anxiety attacks. While the Board notes that the Veteran was afforded a VA examination in March 2015, which resulted in no diagnosis being rendered, VA and private treatment records prior and subsequent to the examination contain psychiatric diagnoses, to include a July 2015 Social Security examination report, at which time the Veteran was diagnosed as having an unspecified neurocognitive disorder, an unspecified psychotic disorder, and an adjustment disorder with depressed mood. The examiner also indicated that the Veteran appeared to be having significant memory impairment and problems with psychosis that were negatively impacting his functioning. Recent treatment records also contain diagnoses of schizophrenia v. schizoaffective disorder. Given the foregoing, the Veteran should be afforded an additional VA examination to determine the etiology of any current psychiatric disorder, to include memory loss and temperament impairment, and its relationship, if any, to his period of service, to include conceded exposure to drinking contaminated water at Camp Lejeune. Pseudofolliculitis Barbae and Onychomycosis/Nail Fungus As it relates to both issues, the Board notes that during the course of this appeal, the regulations relating to skin disorders were amended. VA published in the Federal Register the proposed rule for Schedule for Rating Disabilities: Skin on August 12, 2018. The final rule implements the Secretary's proposed rule with limited revisions. The effective date of this final rule is August 13, 2018. However, for this final rule, VA's intent is that the claims pending prior to the effective date will be considered under both old and new rating criteria, and whatever criteria is more favorable to the veteran will be applied. For applications filed on or after the effective date, only the new criteria will be applied. The Veteran has not been afforded the opportunity to have his claims rated under the new criteria or informed of the new criteria. As such, a Supplemental Statement of the Case should be issued addressing the Veteran’s claims under the new rating criteria. Furthermore, as it relates to the PB claim, the Veteran was last afforded a VA examination in August 2016. As this matter is in remand status, the Veteran should be afforded a VA examination to determine the current severity of his PB. The matters are REMANDED for the following action: 1. Undertake appropriate development to obtain all outstanding VA and/or private treatment records related to the Veteran's outstanding claims. If any requested records are not available, the record should be annotated to reflect such and the Veteran notified. 2. Schedule the Veteran for a VA examination to assess the current manifestations of his service-connected pseudofolliculitis barbae. All indicated tests and studies should be performed and all findings must be reported in detail. The entire record must be furnished to the examiner. The examiner must respond to the following inquiries: (a) What percentage of the Veteran's entire body is affected by the skin disorder and what percentage of the exposed areas of the body are affected by the skin disorder? (b) The examiner must also note the types of medications that have been required for the Veteran's skin condition in the year preceding the examination. The examiner must also comment on whether the Veteran uses medications for his skin disorder and whether the manifestations of his skin disorder warrant constant or nearly constant use of medication. Detailed rationale is requested for any opinion that is rendered. 3. Schedule the Veteran for a VA examination to determine the nature and etiology of any psychiatric disorder(s) which may be present. The entire record should be made be available for review by the examiner in conjunction with the examination. The examiner must delineate all diagnoses reached to account for the Veteran's psychiatric symptomatology. The examiner must also express an opinion as to whether any psychiatric disorder(s) found on examination, is/are related to the Veteran's period of service, to include conceded exposure to contaminated water while at Camp Lejeune. Complete detailed rationale is warranted for any rendered opinions. (Continued on the next page)   4. To help avoid future remand, ensure the required actions have been accomplished (to the extent possible) in compliance with this REMAND. If any action is not undertaken, or is taken in a deficient manner, corrective action must be undertaken before the claims file is returned to the Board. See Stegall v. West, 11 Vet. App. 268 (1998). K. PARAKKAL Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T.S.Kelly, Counsel