Citation Nr: 18145568 Decision Date: 10/29/18 Archive Date: 10/29/18 DOCKET NO. 16-06 724 DATE: October 29, 2018 ORDER Entitlement to service connection for a sleep disorder is denied. Entitlement to service connection for a heart disorder is denied. Entitlement to service connection for hypertension is denied. Entitlement to service connection for hypothyroidism and a benign neoplasm of the thyroid is denied. Entitlement to a rating in excess of 70 percent for service-connected posttraumatic stress disorder (PTSD) is denied. Entitlement to an effective date earlier than November 19, 2010, for PTSD is denied. REMANDED Entitlement to service connection for headaches is remanded. FINDINGS OF FACT 1. Any sleeping impairments the Veteran currently experiences are already associated with his service-connected PTSD; he has not been separately diagnosed with a sleep disorder. 2. The competent and credible evidence of record does not establish a current diagnosis of a heart disorder. 3. The preponderance of the evidence is against finding that hypertension began during active service, or is otherwise related to an in-service injury, event, or disease. 4. The preponderance of the evidence is against finding that hypothyroidism and a benign neoplasm of the thyroid began during active service, or is otherwise related to an in-service injury, event, or disease. 5. The Veteran’s PTSD has been manifested by symptoms of the type and extent, frequency, and/or severity (as appropriate) that are indicative of no more than occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, and/or mood. 6. The VA received the Veteran’s original claim for service connection for PTSD on November 19, 2010; the Veteran was granted service connection for PTSD effective November 19, 2010. CONCLUSIONS OF LAW 1. The criteria for service connection for a sleep disorder have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 2. The criteria for service connection for a heart disorder have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 3. The criteria for service connection for hypertension have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 4. The criteria for service connection for hypothyroidism and benign neoplasm of the thyroid have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 5. The criteria for a disability rating in excess of 70 percent for PTSD have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.159, 4.3, 4.7, 4.130, Diagnostic Code 9411. 6. The criteria for an effective date earlier than November 19, 2010, for the award of service connection for PTSD have not been met. 38 U.S.C. §§ 5103, 5103A, 5110; 38 C.F.R. §§ 3.400 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 1974 to January 1977, and from August 1977 to August 1980. The Veteran is appealing a September 2014 rating decision that denied service connection for a sleep condition, heart condition, hypertension, hypothyroidism and benign neoplasm of the thyroid, and headaches. The Board notes that the Veteran was granted service connection for PTSD in an October 2015 Board decision. In the subsequent rating decision that followed in November 2015 to implement the Board’s decision, the Regional Office (RO) assigned the Veteran’s PTSD a disability rating of 50 percent effective November 19, 2010. The Veteran appealed the RO’s November 2015 rating decision, claiming he is entitled to a higher disability rating and an earlier effective date. While the appeal was pending, in an January 2018 rating decision, the RO increased the disability rating for PTSD to 70 percent with the same effective date of November 19, 2010. As the disability rating assigned does not represent a total grant of benefits sought on appeal, the claim for an increase remains before the Board. AB v Brown, 6 Vet. App. 35, 39 (1993). The Board notes that the Veteran had also raised the issue of a total disability rating for compensation based upon individual unemployability (TDIU) based on multiple service-connected disabilities, and he has filed an application for TDIU that was received in January 2018. However, this issue has not yet been adjudicated by the RO, and the record indicates the RO is actively conducting development of the issue in order to properly adjudicate the claim. As such, the issue of TDIU is not addressed by the Board in this decision. Duty to notify and assist The Veteran has not raised any issues with the duty to notify. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board . . . to search the record and address procedural arguments when the veteran fails to raise them before the Board”). The Board also finds that the duty to assist requirements have been fulfilled. All relevant, identified, and available evidence has been obtained, and VA has notified the appellant of any evidence that could not be obtained. Also of record are VA examinations conducted in May 2011, September 2014, and February 2016. The Veteran has not referred to any additional, unobtained, relevant, available evidence. Thus, the Board finds that VA has satisfied the duty to assist. No further notice or assistance to the Veteran is required to fulfill VA’s duty to assist in development. Smith v. Gober, 14 Vet. App. 227 (2000); Dela Cruz v. Principi, 15 Vet. App. 143 (2001); Quartuccio v. Principi, 16 Vet. App. 183 (2002). 1. Entitlement to service connection for a sleep disorder To prevail on a direct service connection claim, there must be competent evidence of (1) a current disability, (2) in-service incurrence or aggravation of a disease or injury, and (3) a nexus between the in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). The Veteran contends that he is entitled to service connection for a sleep disorder. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that while the Veteran currently has problems sleeping, the medical evidence of record associates his sleep impairment with PTSD, for which he is already service connected. Service treatment records are silent for any complaint, diagnosis, or treatment of a sleep disorder. The January 1974 entrance report of medical examination reflects the Veteran had a normal physical examination with no defects or diagnosis noted, and he was determined to be fit for duty. The May 1980 exit report of medical examination from the Veteran’s second tour of duty reflects that he had a normal physical examination. The companion May 1980 exit report of medical history reflects the Veteran checked “no” when asked if he had or ever had frequent trouble sleeping. Post service VA treatment records show the Veteran’s complaints of sleep problems have always been addressed in the context of his PTSD. For example, an October 2010 mental health note from the Albuquerque VAMC reflects the Veteran was diagnosed with PTSD and reported “I have problems sleeping and I don’t socialize well with people.” A June 2011 psychotherapy record reflects the Veteran was receiving treatment for PTSD, that he complained his anxiety and irritability had increased and his insomnia worsened, and that he was started on a medication to take at bedtime as needed for insomnia. A December 2013 social work note reflects the Veteran reported that his sleep has been very bad lately, his anxiety has risen, and his hypervigilance causes him to get up at night. A February 2014 record reflects the Veteran came into the clinic for scheduled appointment and reported his sleep is still disturbed, his mood is still depressed, and there was little change in his symptoms. A VA examination was conducted in May 2011. Although the examination was for PTSD, the examiner noted the Veteran’s symptoms included pervasive problems with sleep initiation and maintenance, which had been helped somewhat with recent medication. When describing the link between the Veteran’s PTSD symptoms and impairment, the examiner opined that the Veteran’s sleep impairment causes considerable fatigue and further decreases ability to manage stress. A private evaluation using a Disability Benefits Questionnaire (DBQ) was conducted in February 2016. Although the examination was for PTSD, the examiner noted the Veteran was diagnosed with PTSD and his symptoms included chronic sleep impairment. Upon review of the medical evidence of record, including the VA treatment records and VA examinations referenced above, the Board acknowledges the Veteran has problems sleeping, but finds that the medical evidence of record—to include specifically the VA and private examiners—have associated these problems with his PTSD, for which the Veteran is already service connected. In reaching this conclusion, the Board relies heavily on the May 2011 examiner, who opined that the Veteran’s current sleep condition is linked to his PTSD; and, the February 2016 private examiner who also opined that the Veteran’s sleep impairment is a symptom of his PTSD. In short, the Board finds that the Veteran’s sleep impairment is associated with his PTSD, which is already service-connected. He has not been diagnosed with a separate sleep disorder. Further, his chronic sleep impairment has been specifically discussed by the RO as a symptom considered in the evaluation of his PTSD. To separately grant service connection for a sleep disorder when the symptomatology is already considered in the rating for the Veteran’s service-connected PTSD would be impermissible pyramiding. See C.F.R. § 4.14 (2017) (noting that the evaluation of the same disability, or the same manifestation of a disability, under different diagnostic codes is to be avoided when evaluating a veteran’s service-connected disability). The Board has considered the Veteran’s lay statements. However, although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), the specific issue in this case, the diagnosis and etiology of a sleep disorder, 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) (lay persons not competent to diagnose cancer). While the Veteran is competent to report having experienced symptoms of a sleep disorder, he is not competent to provide a diagnosis in this case or determine the etiology of his symptoms. The issue is medically complex, as it requires knowledge and interpretation of complicated diagnostic medical testing. Id. In reaching this conclusion, the Board has considered the benefit-of-the-doubt doctrine; however, as the preponderance of the evidence is against the claim of entitlement to service connection for a sleep disorder, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 2. Entitlement to service connection for a heart disorder The Veteran contends he is entitled to service connection for a heart disorder. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the Veteran does not have a current diagnosis of a heart disorder. Service treatment records are silent for any complaint, diagnosis, or treatment of a heart disorder. The January 1974 entrance report of medical examination reflects the Veteran had a normal physical examination with no defects or diagnosis noted, and the Veteran was determined to be fit for duty. The May 1980 exit report of medical examination from the Veteran’s second tour of duty reflects the Veteran had a normal physical examination with the only defect or diagnosis noted as bilateral hearing loss. The companion May 1980 exit report of medical history, reflects the Veteran checked the box “no” when asked if he had or ever had heart trouble. Post service VA treatment records are silent as to any complaint, treatment, or diagnosis of a heart disorder. The most recent record, dated in December 2017, reflects the Veteran reported for a routine check-up, with no acute complaints, for a list of health conditions that did not include a heart disorder. Upon review of the record, the Board finds that the competent and credible evidence of record does not establish a current diagnosis of a heart disorder, as available VA treatment records are silent with respect to a current diagnosis of a heart disorder. The Board notes that the existence of a current disability at any time during the current appeal period is the cornerstone of a claim for VA disability compensation. 38 U.S.C. § 1131; see Degmetich v. Brown, 104 F.3d 1328, 1332 (1997) (holding that sections 1110 and 1131 of the statute as requiring the existence of a present disability for VA compensation purposes cannot be considered arbitrary). Evidence must show that, at some time during the current appeal period, the Veteran has the disability for which benefits are being claimed. Here, however, as noted above, the competent and credible evidence of record does not establish that, at any time during the current appeal period, the Veteran had a diagnosis of a heart disorder. In this regard, the Board notes that Congress has specifically limited service connection to instances where there is current disability (during the current appeal period) that has resulted from disease or injury. 38 U.S.C. § 1110. In the absence of a current disability during the current appeal period, the analysis ends, and the claim for service connection for a heart disorder cannot be granted. See Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998). The Board has considered the Veteran’s lay statements. However, although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), the specific issue in this case, the diagnosis and etiology of a heart disorder, 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) (lay persons not competent to diagnose cancer). While the Veteran is competent to report having experienced symptoms of a heart disorder, he is not competent to provide a diagnosis in this case or determine the etiology of his symptoms. The issue is medically complex, as it requires knowledge and interpretation of complicated diagnostic medical testing. Id. In reaching this conclusion, the Board has considered the benefit-of-the-doubt doctrine; however, as the preponderance of the evidence is against the claim of entitlement to service connection for a heart disorder, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 3. Entitlement to service connection for hypertension The Veteran contends he is entitled to service connection for hypertension, claiming it is related to his military service. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board has closely reviewed the medical and lay evidence in the Veteran’s claims file and finds no evidence that may serve as a medical nexus between the Veteran’s service and his hypertension. A review of the Veteran’s service treatment records indicates there was no complaint of hypertension at any point while on active duty. The January 1974 entrance report of medical examination reflects there were no abnormalities regarding hypertension noted at the time, and the Veteran’s blood pressure reading was 108/84. Likewise, the May 1980 separation report of medical examination reflects there were no abnormalities regarding hypertension noted at the time, and the Veteran’s blood pressure reading was 126/80. Post service VA treatment records from the Albuquerque VAMC are associated with the claims file. In summary, these records reflect a diagnosis of hypertension for which the Veteran takes daily medication. A May 2012 record reflects the Veteran underwent treadmill testing, which had to be stopped for hypertension. His resting blood pressure was 152/90 and rose to 216/104 with exercise. A December 2017 active outpatient medications list includes medication for blood pressure. However, none of these records provide a nexus or link between the Veteran’s hypertension and his military service. The Board concedes that the Veteran has a current diagnosis of hypertension, but none of his treatment providers have provided an opinion that any such disability is related to military service. There is simply no competent medical evidence of record to suggest that the Veteran’s hypertension is in any way related to his time on active duty. Thus, in this case, when weighing the evidence of record, the Board finds compelling the lack of evidence linking the Veteran’s hypertension to his military service. In this case, the only evidence in favor of the Veteran’s claim is his own statements concerning his belief that his hypertension, diagnosed 30 years after service, is due to service. With regard to the Veteran’s contentions, 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, it falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Although the Veteran is competent to report symptoms of hypertension such as dizziness, the claimed disability is not the type of condition that is amenable to lay determination regarding its etiology, as specific findings are needed to properly determine etiology. Id,; see Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). Thus, the Veteran’s own assertions as to the etiology of his hypertension have little probative value. As such, the Board finds that, other than the Veteran’s unsupported contentions, there is simply no evidence in the record of any etiological relationship between the Veteran’s hypertension and his time in service. Further, there is simply no mention in VA treatment records of a relationship between the Veteran’s service and his current hypertension, or any other competent evidence of record to suggest an etiological relationship between the Veteran’s service and his hypertension. Thus, the criteria for service connection for hypertension have not been met. The evidence weighs against the Veteran’s claim. Service connection for hypertension must be denied. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). 4. Entitlement to service connection for hypothyroidism and a benign neoplasm of the thyroid The Veteran contends he is entitled to service connection for hypothyroidism and a benign neoplasm of the thyroid, claiming it is related to his military service. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board has closely reviewed the medical and lay evidence in the Veteran’s claims file and finds no evidence that may serve as a medical nexus between the Veteran’s service and his hypothyroidism and a benign neoplasm of the thyroid. Service treatment records reflect the Veteran had a single complaint of swollen glands in April 1976. The May 1980 exit report of medical examination reflects the Veteran had a normal physical examination with the only defect or diagnosis noted as bilateral hearing loss. The corresponding May 1980 exit report of medical history reflects the Veteran checked the box “no” when asked if he had or ever had thyroid trouble. Post service VA treatment records from the Albuquerque VAMC are associated with the Veteran’s case file. In summary, these records reflect the Veteran was diagnosed with hypothyroidism in 2012. The Veteran continues to have his thyroid monitored as an ongoing health concern. The Veteran underwent a VA examination for his thyroid in September 2014. The examiner noted a diagnosis of hypothyroidism in 2012, and a diagnosis of a benign neoplasm of the thyroid in July 2012. The examiner opined that the claimed condition was less likely than not incurred in or caused by service. As rationale, the examiner stated the Veteran was diagnosed with tonsillitis and an upper respiratory infection in April 1976. He had reactive lymphadenopathy at that time. The examiner found, however, that there was no medical evidence to support a role for lymphadenopathy in the later development of a thyroid condition. Therefore, the examiner concluded, the Veteran’s thyroid nodule and hypothyroidism, which were diagnosed 32 years after separation from service, were less likely than not incurred in or caused by the complaint of neck swelling and tenderness, jaw stiffness, and lymph node swelling in April 1976 during service. In light of the above discussion, the Board concludes that the preponderance of the evidence is against the claim for service connection for a thyroid disorder, and there is no doubt to be otherwise resolved. There is no nexus or link between the Veteran’s service and his current hypothyroidism and a benign neoplasm of the thyroid. As such, the appeal is denied. The Board has considered the Veteran’s lay statements. However, although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), the specific issue in this case, the diagnosis and etiology of a thyroid disorder, 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) (lay persons not competent to diagnose cancer). While the Veteran is competent to report having experienced symptoms of a thyroid disorder, he is not competent to provide a diagnosis in this case or determine the etiology of his symptoms. The issue is medically complex, as it requires knowledge and interpretation of complicated diagnostic medical testing. Id. 5. Entitlement to a rating in excess of 70 percent for service-connected PTSD Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities. 38 C.F.R. Part 4 (2017). The 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 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. § 1155 (2012); 38 C.F.R. § 4.1 (2017). 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 (2017). Consideration of the whole recorded history is necessary so that a rating may accurately compensate the elements of disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Although the regulations do not give past medical reports precedence over current findings, the Board is to consider the Veteran’s medical history in determining the applicability of a higher rating for the entire period in which the appeal has been pending. Powell v. West, 13 Vet. App. 31 (1999). PTSD is rated using the General Rating Formula for Mental Disorders. 38 C.F.R. § 4.130, Diagnostic Code 9411 (2017). Under the General Rating Formula, a 70 percent rating is warranted for occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking or mood, due to such symptoms as: suicidal ideations; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of the veteran’s personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work like setting); inability to establish and maintain effective relationships. A 100 percent rating is warranted for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform the activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation or own name. 38 C.F.R. § 4.130, Diagnostic Code 9411, General Rating Formula for Mental Disorders. Post service VA treatment records from the Albuquerque VAMC are associated with the claims file. These records reflect the Veteran has received ongoing treatment for PTSD. A June 2011 record notes the Veteran has been occasionally smoking cannabis to help relieve his symptoms; his last alcohol use was four months ago; and his major psychosocial stressors include the death of his sister from diabetes and multiple system organ failure last week, his wife having a liver transplant about a year and a half ago, and responsibility for his 90-year-old mother whom his sister had helped care for previously. It was noted the Veteran presented with anxious and depressed mood with insomnia. A February 2014 record reflects little changes in the Veteran’s symptoms. A VA examination was conducted in May 2011. The examiner noted that the Veteran presented with symptoms including anxiety; depression; and sleep impairment. He was noted to be lethargic; anxious but cooperative; constricted affect; anxious and depressed mood; no delusions; clearly fatigued. The Veteran reported he becomes highly fearful in certain situations, particularly crowds. He has a history of some periods of suicidal ideation, but no attempts. The examiner noted the Veteran’s current psychosocial functional status is very poor, stating he is in a stressful situation, caring for family members who are elderly and ill; he is unemployed, and not able to work; he is completely socially isolated outside his wife, mother and sister; his mood is quite depressed and he is very anxious; and, he has no recreational activities. The examiner diagnosed the Veteran with PTSD, and opined that his prognosis for improvement is poor. A private evaluation for PTSD was conducted via DBQ in February 2016. The examiner noted a diagnosis of PTSD with current symptoms that included depressed mood; anxiety; suspiciousness; panic attacks more than once per week; chronic sleep impairment; mild memory loss; flattened affect; disturbances of motivation and mood; difficulty establishing and maintaining effective work and social relationships; difficulty adapting to stressful circumstances; and, inability to establish and maintain effective relationships. It was noted that the Veteran has never been married, but he is in a significant relationship with a woman for 36 years, and he has no children. He remarked that he can no longer enjoy the simplest of activities. The examiner opined that the Veteran had occupational and social impairment with deficiencies in most areas. A review of the May 2011 VA examination, the February 2016 private DBQ, and the VA treatment records establishes that the Veteran’s symptoms have been consistent throughout the appellate period. In addition, the evidence makes clear that most of the Veteran’s symptoms have been similar in severity, frequency, and duration throughout the entire period at issue. See Vasquez-Claudio v Shinseki, 713 F.3d 112, 116-17 (Fed. Cir. 2013). Common symptoms are documented in each record cited above – namely that the Veteran has suffered with depressed mood, anxiety, and chronic sleep impairment; has difficulty in his relationship with family; and has been prescribed medication for his mental health disability. Based upon the May 2011 VA examination, February 2016 private DBQ and VA treatment records, the Board finds that the Veteran’s symptoms are substantially similar to those enumerated in the 70 percent rating for the entire period at issue. The Board finds that a rating of 100 percent is not appropriate in this case at any point during the appeal period. This is so because the record does not reflect a time when the Veteran exhibited symptoms of the type, extent, frequency, or severity indicative of those identified as warranting a 100 percent rating, such as gross impairment in thought process or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; or memory loss for names of close relatives, own occupation, or own name. The treatment records during the period in question support the finding that, although he experienced serious symptoms of PTSD, the Veteran was simply not totally occupationally and socially impaired due to PTSD. Thus, a 100 percent rating is not warranted for the Veteran’s PTSD at any point during the period on appeal. Upon review of the evidence of record, including the May 2011 VA examination and the more recent February 2016 private evaluation, the Board finds that, for the period on appeal, the Veteran’s PTSD symptoms demonstrated occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood. Total social and occupational impairment has simply not been shown. Therefore, a rating in excess of 70 percent for PTSD is not warranted. 38 C.F.R. § 4.130, Diagnostic Code 9411. 6. Entitlement to an effective date earlier than November 19, 2010, for the grant of service connection for PTSD Generally, 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 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. In deciding this case based on its application of the law to the pertinent facts, the Board notes that the “date of receipt” of claim means the date on which the claim was received by VA, except as to specific provisions for claims received in the State Department, the Social Security Administration, or the Department of Defense. 38 C.F.R. § 3.1(r). In this case, the Veteran seeks an effective date earlier than November 19, 2010, for the grant of service connection for PTSD. The Board finds that there is no basis to grant an effective date prior to November 19, 2010, for the award of service connection for PTSD. In fact, the Board concludes that an effective date prior to November 19, 2010, is legally precluded. The law is clear that the effective date for an original claim is the date of receipt of the claim or the date entitlement arose, whichever is the later. The Veteran’s original claim for service connection was received by VA on November 19, 2010. The earliest medical record in evidence noting a PTSD diagnosis is August 6, 2004. Thus, the later date is the date the claim for service connection for PTSD was received by the VA – November 19, 2010. This is the earliest effective date possible based upon the facts in this case and the law and regulations. The Board finds that there was no formal claim, informal claim, or written intent to file a claim for service connection for PTSD prior to November 19, 2010. As the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). An effective date earlier than November 19, 2010 for service connection for PTSD is not warranted. REASONS FOR REMAND 1. Entitlement to service connection for headaches is remanded. The Board finds that additional development is warranted in this case before a decision may be rendered. Specifically, the Veteran must be afforded a VA examination to determine whether his headaches are related to his active service. 38 U.S.C. § 5103A(d); McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). Service treatment records dated in April 1976 reflect the Veteran complained of headaches during service. Post service VA treatment records dated in January 2010 and July 2010 reflect the Veteran complained of headaches. However, there is no medical evidence in the file addressing whether there is a connection between any current headaches and the headaches the Veteran reported during service. The matter is REMANDED for the following action: Schedule the Veteran for a VA examination to determine the nature and etiology of his headaches, or any headache disorder found to be present. The entire claims file, to include a complete copy of this remand, must be made available to, and reviewed by, the designated examiner. The examiner must offer an opinion as to whether it is at least as likely as not (i.e., there is at least a 50 percent or greater probability) that the Veteran’s headaches, or any diagnosed headache disorder, began in or is otherwise etiologically linked to service. In providing each opinion, the examiner must specifically comment on the Veteran’s lay statements, as the Veteran is competent to report history and symptoms, as well as the April 1976 in-service treatment for headaches. If the examiner rejects the Veteran’s reports, the examiner should provide a rationale for doing so. CAROLINE B. FLEMING Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Jiggetts, Associate Counsel