Citation Nr: 18146588 Decision Date: 10/31/18 Archive Date: 10/31/18 DOCKET NO. 16-58 245 DATE: October 31, 2018 ORDER Service connection for a dental disability for Department of Veterans Affairs (VA) compensation purposes is denied. Service connection for a noncompensable dental disability for purposes of eligibility for VA outpatient dental treatment is granted. A separate 100 percent initial rating for an acquired psychiatric disorder under Diagnostic Code 9434 is granted from March 31, 2017, to June 5, 2018. An initial rating in excess of 10 percent for traumatic brain injury (TBI) is denied prior to June 5, 2018. Entitlement to an effective date earlier than March 31, 2017, for the grant of service connection for TBI is denied. Entitlement to an effective date earlier than March 31, 2017, for the grant of service connection for scars is denied. Entitlement to an effective date earlier than March 31, 2017, for the grant of service connection for painful scars is denied. FINDINGS OF FACT 1. The Veteran’s dental disorder, described as loss of teeth, is not considered a disability for VA compensation purposes. 2. The Veteran receives a 100 percent schedular rating and is a Class IV beneficiary entitled to any needed outpatient dental treatment as defined in 38 U.S.C. § 1712, 38 C.F.R. § 17.161(h). 3. Prior to June 5, 2018, the Veteran’s diagnoses of depressive disorder due to another medical condition with mixed features and insomnia disorder were intimately intertwined with TBI and resulted in total occupational and social impairment. 4. Prior to June 5, 2018, the Veteran’s facets of cognitive impairment and other TBI residuals not otherwise classified include the subjective symptom of jaw pain that does not interfere with instrumental activities of daily living and resulted in, at most, level 0 impairment for each facet. All other manifestations of TBI cannot be clearly separated from a comorbid mental disorder; the separate evaluation for the acquired psychiatric disability better assesses the Veteran’s overall impaired functioning due to the conditions. 5. In March 1993, the Veteran filed an initial claim for service connection for a head injury with facial scars. 6. In an unappealed June 1996 rating decision, the Regional Office (RO) denied service connection for scars related to a head injury. No new and material evidence was received within one year of the notice of that decision. 7. In an unappealed November 2010 rating decision, the RO also denied service connection for a skull fracture. No new and material evidence was received within one year of the notice of that decision. 8. On March 31, 2017, VA received a claim from the Veteran for service connection for residuals of a TBI; service connection for a TBI and related facial scars was granted in an August 2017 rating decision. There are no communications between the November 2010 rating decision and March 2017 submission which may be considered a formal or informal claim for service connection. CONCLUSIONS OF LAW 1. The criteria for service connection for a dental disorder for purposes of compensation have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.303, 3.381, 4.150 (2018). 2. The criteria for service connection for a noncompensable dental disability for purposes of eligibility for outpatient dental treatment have been met. 38 U.S.C. §§ 1110, 1712, 5107 (2012); 38 C.F.R. §§ 3.303, 3.381, 17.161 (2018). 3. The criteria for an initial 100 percent rating for an acquired psychiatric disorder have been met from March 31, 2017, to June 5, 2018. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.7, 4.124a, Diagnostic Code 8045, 4.130, Diagnostic Code 9434 (2018). 4. The criteria for an initial rating in excess of 10 percent for TBI have not been met prior to June 5, 2018. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. § 4.124a, Diagnostic Code 8045 (2018). 5. The June 1996 rating decision denying entitlement to service connection for facial scars is final. 38 U.S.C. § 7105; 38 C.F.R. § 20.201, 20.300, 20.302, 20.1103. 6. The November 2010 rating decision denying entitlement to service connection for a skull fracture is final. 38 U.S.C. § 7105; 38 C.F.R. § 20.201, 20.300, 20.302, 20.1103. 7. The criteria for an effective date earlier than March 31, 2017, for the award of service connection for scars, to include the separate rating for painful scars, have not been met. 38 U.S.C. 5110 (2012); 38 C.F.R. 3.155, 3.156, 3.157 (in effect prior to March 24, 2015); 38 C.F.R. 3.400 (2018). 8. The criteria for an effective date earlier than March 31, 2017, for the award of service connection for TBI have not been met. 38 U.S.C. 5110 (2012); 38 C.F.R. 3.155, 3.156, 3.157 (in effect prior to March 24, 2015); 38 C.F.R. 3.400 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served a period of active duty training from July 1991 to December 1991 and had active service from March 1993 to March 1996, with additional service in the Army National Guard through June 1999. These matters are on appeal from December 2015 and August 2017 rating decisions. In March 2018, the Veteran and his spouse testified at a Board of Veterans’ Appeals (Board) hearing before the undersigned. A transcript of the hearing is associated with the record. An August 2018 rating decision increased the evaluation for the Veteran’s TBI to 100 percent, effective June 5, 2018, and recharacterized the disability as major depressive disorder, recurrent, severe, with insomnia disorder and TBI associated with TBI. As the RO assigned the maximum disability rating possible, the remaining appeal for a higher initial evaluation for a TBI is limited to the period prior to June 5, 2018. See AB v. Brown, 6 Vet. App. 35 (1993). Further, even though additional VA treatment records have been received since the Agency of Original jurisdiction (AOJ) last considered the appeal for a TBI, initial review of the evidence by the Board is appropriate as the Veteran’s attorney waived review by the AOJ in October 2018. See 38 U.S.C. § 7105(e). With regard to the claim for service connection for a dental disability, the Board notes that a claim for service connection for a dental disability includes a claim for service connection for purposes of outpatient dental treatment. See Mays v. Brown, 5 Vet. App. 302 (1993). Although the December 2015 rating decision limited the issue on appeal to service connection for dental treatment purposes, the Board concludes that both compensation and treatment aspects of the claim are before the Board as each issue has been initially adjudicated by the AOJ. The October 2016 statement of the case (SOC) considered the claim as it relates to compensation and a January 2017 correspondence reported that the VA Medical Center at Battle Creek determined the Veteran was ineligible for dental treatment. With regard to VA’s duty to assist the Veteran, the Board notes the Veteran challenged the competency of his June 2017 VA examination for the TBI because the examination was completed by a psychiatrist, rather than a neurologist, and reported that the examiner focused on his dental injury rather than manifestations of TBI, to specifically include memory complaints. The Board concludes that the examiner may be presumed competent despite the Veteran’s general assertions that a psychiatrist was not qualified to provide an opinion on TBI as psychiatrists are appropriate specialists for making an initial diagnosis of TBI and there are no other bases set forth to contest the examiner’s qualifications to offer such an opinion. See Cox v. Nicholson, 20 Vet. App. 563 (2007); Rizzo v. Shinseki, 580 F.3d 1288 (Fed. Cir. 2009). Further, the Veteran was afforded an additional examination in August 2017 and, upon review, the Board finds the examiner reviewed the Veteran’s relevant medical history and lay testimony, completed a physical examination, and addressed all applicable rating criteria. Accordingly, the Board finds that VA’s duty to assist with respect to obtaining a VA examination or opinion has been met. 38 C.F.R. § 3.159(c)(4). Neither the Veteran nor his representative has raised any other issues with the duty to notify or duty to assist. 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.”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). Lastly, the Board notes that a March 2018 rating decision initially denied a claim for special monthly compensation (SMC) based on aid and attendance/housebound. That claim has been reconsidered several times, most recently in September 2018. In April 2018, entitlement to a total rating based on individual unemployability (TDIU) was granted. The Veteran has one year from the notice of these decisions to file an appeal with regard to the denial of SMC or the effective date of the TDIU. Moreover, it appears that the RO is still working the claim for SMC as an October 2018 correspondence reflects that a hearing has been scheduled for December 2018 in connection with the Veteran’s request for reconsideration of that decision. Service connection for a dental disability The Veteran initiated a claim for service connection for teeth issues in May 2011 and an application was also received in August 2015 for entitlement to service connection for dental. In addition, he contends that in-service head trauma resulted in cracked teeth that were filled but not properly treated, which led to subsequent tooth extractions and ill-fitting dentures. He reports that his current dental condition is detrimental to his health. Service treatment records (STRs) reflect dental treatment for pulpectomies, tooth pain, caries, and extractions, to include therapeutic wisdom teeth extractions. A November 1994 emergency care STR notes pain in gums due to wisdom teeth growing out; a January 1996 sick slip noted a toothache with several cracked, center-filled teeth; and a December 1995 separation report of medical history was positive for severe tooth or gum trouble. A VA disability benefits questionnaire (DBQ) was completed in November 2013 that found loss of teeth not due to loss of substance of body of maxilla or mandible. The examiner explained that loss of teeth was due to a hard impact injury in active service with incorrect repair by fillings rather than crowns and that replacement with dentures caused soreness and difficulty speaking. A November 2016 post-service statement by a private dentist opined that dentures were necessary due to prior military trauma based on 2013 X-ray reports finding bone loss due to normal shrinkage after teeth were removed. An additional letter from another private dentist compared Panorex X-rays from 1991 and 2016 for bone loss and found alveolar bone loss of varying degrees and a swollen lesion along the mucogingival line. Initially, the Board notes the Veteran submitted a statement requesting the December 2015 rating decision’s denial of entitlement to service connection for a dental disability be revised on the basis of clear and unmistakable error (CUE); however, the Veteran has not submitted a valid CUE claim as this rating is currently on appeal and not final. Livesay v. Principi, 15 Vet. App. 165, 178 (2001); Simmons v. Principi, 17 Vet. App. 104, 109 (2003). 1. A dental disability for compensation purposes. The Board concludes the Veteran does not have an eligible dental disability for compensation purposes. The preponderance of the evidence weighs against a finding that any of the Veteran’s missing teeth or bone and tissue loss constitutes loss of substance of body of the maxilla or the mandible due to trauma or disease such as osteomyelitis. See 38 C.F.R. § 4.150 (noting that current legal authority only allows compensation for certain types of dental and oral conditions, such as impairment of the mandible, loss of a portion of the ramus, and loss of a portion of the maxilla.). Notably, the November 2013 VA DBQ found loss of teeth were not due to loss of substance of body of mandible or maxilla and there was no evidence of malunion or nonunion of the mandible or maxilla or loss of mandible, maxilla, ramus, condyloid or coronoid processes, or palates. Although the Veteran has indicated that his dental disorder includes bone loss, the Board affords his lay statements little probative value as the determination regarding the nature of his bone loss requires medical expertise. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Rather, the Board finds the November 2016 statements by the private dentists to be highly probative evidence in support of a finding that the Veteran’s bone loss constituted loss of alveolar process, for which service connection is not warranted. See Note, 38 C.F.R. § 4.150, Diagnostic Code 9913 (explaining that compensation is only paid for loss of teeth due to loss of substance of the body of maxilla or mandible without loss of continuity (as a result of trauma) or disease such as osteomyelitis, and not the loss of alveolar process as a result of periodontal disease). In summary, service connection for compensation purposes is precluded for treatable carious teeth, replaceable missing teeth, dental or alveolar abscesses, and periodontal disease. See 38 U.S.C. § 1712; 38 C.F.R. §§ 3.381, 4.150, Diagnostic Code 9913. As such, service connection for a dental disorder for compensation purposes must be denied. 2. A noncompensable dental disability for treatment purposes. As explained above, the Veteran does not have a compensable dental disability. However, he may still be eligible for VA outpatient treatment for a noncompensable dental disability. See 38 U.S.C. § 1712; 38 C.F.R. §§ 3.381, 4.150, Diagnostic Code 9913 (treatable carious teeth, replaceable missing teeth, dental or alveolar abscesses, and periodontal disease may be considered service-connected for the purpose of establishing eligibility for outpatient dental treatment). Initially, the Veteran indicated that he was seeking entitlement to VA outpatient dental treatment based on the provisions for beneficiaries with a noncompensable dental disability due to service trauma (Class IIa) due to cracked and broken teeth related to an in-service head injury. See 38 C.F.R. § 17.161(c) (Class II(a) beneficiaries for noncompensable dental conditions resulting from combat wounds or service trauma may be authorized any treatment indicated as reasonably necessary for the correction of such service-connected noncompensable condition or disability). However, as the Veteran was granted service connection and a 100 percent rating for major depressive disorder, insomnia disorder, and TBI in an August 2018 rating decision, he meets the provisions for a Class IV beneficiary of outpatient dental treatment. 38 C.F.R. § 17.161(h). The Board notes that the Veteran is authorized to receive any needed dental treatment as a Class IV beneficiary, the maximum dental treatment benefit, such that consideration of the remaining beneficiary classes is unnecessary. Service connection for a noncompensable dental disability for purposes of outpatient treatment is granted. 38 C.F.R. §§ 3.381, 17.161(h). Increased Rating for TBI Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule) and are intended to represent the average impairment of earning capacity resulting from disability. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.1 (2018). Service connection for TBI and a 10 percent rating were granted in the August 2017 rating decision on appeal. The Veteran disagreed and also filed a January 2018 VA 21-526EZ for mental disorder, memory loss, and sleep disturbances secondary to the TBI. As noted above, an August 2018 rating decision recharacterized the TBI disability as major depressive disorder, recurrent, severe, with insomnia disorder (also claimed as anxiety and depression due to chronic pain) and TBI (also claimed as loss of consciousness, sleep impairments, headaches, and memory problems), effective June 5, 2018. The Veteran’s residuals of TBI prior to June 5, 2018, are evaluated under Diagnostic Code 8045. Diagnostic Code 8045 assigns ratings based on three main areas of dysfunction: cognitive, emotional/behavioral, and physical and dictates that each area of dysfunction may require evaluation. 38 C.F.R. § 4.124a, Diagnostic Code 8045 (Cognitive impairment is defined as decreased memory, concentration, attention, and executive functions of the brain. Subjective symptoms may be the only residual of a TBI or may be associated with cognitive impairment or other areas of dysfunction.). Cognitive impairment, subjective symptoms that are residuals of a TBI, whether or not they are part of cognitive impairment, and emotional/behavioral dysfunction when there is no diagnosis of a mental disorder should be evaluated under the table titled “Evaluation of Cognitive Impairment and Other Residuals of a Traumatic Brain Injury Not Otherwise Classified.” VA is to evaluate emotional/behavioral dysfunction under 38 C.F.R. § 4.130 (Schedule of ratings - Mental disorders) when there is a diagnosis of a mental disorder. VA must also separately evaluate any residual with a distinct diagnosis that may be evaluated under another diagnostic code, such as migraine headache or Meniere’s disease, even if that diagnosis is based on subjective symptoms, rather than under the “Evaluation of Cognitive Impairment and Other Residuals of a Traumatic Brain Injury Not Otherwise Classified” table. Physical (including neurological) dysfunction shall be evaluated based on the following list, under an appropriate diagnostic code: Motor and sensory dysfunction, including pain, of the extremities and face; visual impairment; hearing loss and tinnitus; loss of sense of smell and taste; seizures; gait, coordination, and balance problems; speech and other communication difficulties, including aphasia and related disorders, and dysarthria; neurogenic bladder; neurogenic bowel; cranial nerve dysfunctions; autonomic nerve dysfunctions; and endocrine dysfunctions. Any physical dysfunction not listed above is to be evaluated under the most appropriate diagnostic code and is to be evaluated separately, as long as the same signs and symptoms are not used to support more than one evaluation, and combine the evaluations for each separately rated condition under 38 C.F.R. § 4.25. The rating criteria direct the evaluation assigned based on the “Evaluation of Cognitive Impairment and Other Residuals of a Traumatic Brain Injury Not Otherwise Classified” table will be considered the evaluation for a single condition for purposes of combining with other disability evaluations. The “Evaluation of Cognitive Impairment and Other Residuals of a Traumatic Brain Injury Not Otherwise Classified” table contains ten important facets of TBI related to cognitive impairment and subjective symptoms. It provides criteria for levels of impairment for each facet, as appropriate, ranging from 0 to 3, and a 5th level, the highest level of impairment, labeled “total.” However, not every facet has every level of severity. A 100 percent evaluation is assigned if “total” is the level of evaluation for one or more facets. If no facet is evaluated as “total,” the overall percentage evaluation is assigned based on the level of the highest facet as follows: 0 = 0 percent; 1 = 10 percent; 2 = 40 percent; and 3 = 70 percent. For example, a 70 percent evaluation is assigned if 3 is the highest level of evaluation for any facet. There may be an overlap of manifestations of conditions evaluated under the “Evaluation of Cognitive Impairment and Other Residuals of a Traumatic Brain Injury Not Otherwise Classified” table with manifestations of a comorbid mental or neurologic or other physical disorder that can be separately evaluated under another diagnostic code. In such cases, more than one evaluation based on the same manifestations may not be assigned. If the manifestations of two or more conditions cannot be clearly separated, assign a single evaluation under whichever set of diagnostic criteria allows the better assessment of overall impaired functioning due to both conditions. However, if the manifestations are clearly separable, assign a separate evaluation for each condition. 38 C.F.R. § 4.124a, Diagnostic Code 8045, Note (1). Initially, the Board resolves all reasonable doubt in favor of the Veteran to assign a separate 100 percent evaluation under the Schedule of Ratings – Mental disorders for the entire appeal period (March 31, 2017, to June 5, 2018). See 38 C.F.R. § 4.124a, Diagnostic Code 8045 (directing emotional/behavioral dysfunction to be evaluated under 38 C.F.R. § 4.130, the Schedule of Ratings - Mental disorders, when there is a diagnosis of a mental disorder). At an August 2017 VA mental disorders examination, the examiner diagnosed an acquired psychiatric disorder, described as depressive disorder due to another medical condition with mixed features and insomnia disorder; the examiner noted that the other medical condition was the TBI and that the symptomatology resulted in total occupational and social impairment. The examination revealed the Veteran to be neatly groomed and fully oriented with clear speech, cooperative attitude, flattened affect, and bland mood with no interest or energy. The examiner explained the Veteran had intact attention but was unable to do serial 7’s and could not spontaneously recall any words after delay with unremarkable thought process. The examiner noted an inconsistent pattern of sleep resulted in impairment that included sweating and shaking, an inability to comprehend reading unless it was immediately after he woke up, and limitations on work for less than four hours before losing the ability to concentrate or remember. Additional symptoms included anxiety, depressed mood, mild memory loss and impaired short- and long-term memory, impaired judgment, difficulty establishing and maintaining effective relationships and adapting to stressful circumstances, passive suicidal thought, poor impulse control manifested by verbal and physical violence that was directed towards physical things that prevented daily activities including household chores, shopping, driving, and severely affected exercise, recreational activities, feeding, bathing, dressing and grooming. The examiner concluded that the depressive disorder and insomnia disorder were related to military service and noted that although additional neuropsychological testing was considered, testing would more likely than not yield invaluable results due to the Veteran’s emotional distress from intertwined dynamics such as sleep, memory, mood, thinking, and judgment. Further, the examiner explained that it would not be possible to differentiate the psychiatric symptomatology attributable to each diagnosis because they were intimately intertwined and explained that problems of memory and executive functioning may be one of the consequences of TBI, a component of depression, and a consequence of insomnia while memory problems can be exacerbated as the three conditions impact one another in a self-reinforcing cycle. The other evidence of record during the period on appeal is generally consistent with the above. Specifically, an August 2017 addendum medical opinion reviewed the Veteran’s records and concluded that the evidence supported a mood disorder due to military service, to include the concussive injuries. VA treatment record indicate ongoing treatment for a diagnosis of severe depression and symptoms of anxiety, anger responses, decreased energy, difficulty focusing, some thoughts of self-harm, and poor sleep. A September 2017 VA treatment record indicated the Veteran was slow to respond to mental health questions and had difficulty describing symptoms of anxiety, sleep disturbance, poor energy, lost appetite, and suicidal ideation while a March 2018 VA treatment record noted cognitive difficulties, anxiety attacks, sleep difficulties, and the Veteran’s reports that his wife had to check throughout the day that he was taking care of himself. Further, a November 2017 VA neuropsychology consultation found the Veteran met the criteria for diagnoses of insomnia disorder and major depressive disorder, recurrent, moderate, with anxious distress. Based on the above, the Board resolves all reasonable doubt in favor of the Veteran and finds a separate 100 percent rating under Diagnostic Code 9434 for total occupational and social impairment is warranted throughout the appeal period (March 31, 2017, to June 5, 2018). To the extent that the Veteran has reported TBI residuals other than the symptomatology associated with the acquired psychiatric disorders, the Board initially notes that he is in receipt of separate evaluations for scars, low back, cervical spine arthritis, a left scrotal mass, and bilateral knee disabilities. Such conditions are not for consideration in evaluating his TBI. See 38 C.F.R. § 4.14 (the evaluation of the same manifestation or disability under different diagnoses is to be avoided); see also 38 C.F.R. § 4.124, Diagnostic Code 8045, Note (1). With the regard to the remaining symptomatology, the June 2017 VA TBI examination noted a complaint of mild memory loss and occasionally inappropriate social interaction. Examination testing revealed no objective evidence of impaired memory and the examiner reported that judgment, orientation, communication, consciousness, and visual-spatial orientation were all normal. The examiner found the Veteran’s subjective symptoms of some anxiety and jaw pain did not interfere with work or activities of daily living, neurobehavioral effects occasionally interfered with workplace or social interaction, and concluded that the residuals of TBI centered around his dental condition. The other evidence of record is consistent with the above. The August 2017 addendum medical opinion found evidence of a mild TBI but explained that residuals could not be confirmed because there was no atrophy on a computed tomography (CT) scan, headaches were not a main complaint, the reported accidents affected the teeth, and the Veteran completed his military service with no specific complaints immediately after the injuries other than some memory loss. Further, a November 2017 VA neuropsychology consultation completed neurocognitive testing and concluded that the Veteran’s pattern and level of cognitive performances did not suggest the presence of a neurocognitive disorder. Based on the foregoing, the Board finds that a rating in excess of 10 percent is not warranted for residuals of TBI not otherwise classified throughout the appeal period. The Board finds the evaluation under Diagnostic Code 9434 provides the better assessment of overall impaired functioning due to the comorbid conditions of an acquired psychiatric disorder and TBI such that the overlapping manifestations of mild memory loss, occasionally inappropriate social interaction, and anxiety cannot be evaluated under Diagnostic Code 8045. 38 C.F.R. § 4.124a, Diagnostic Code 8045, Note (1). As noted above, the August 2017 VA examination report indicates these symptoms are accounted for with the rating assigned for his acquired psychiatric disorder. Further, the June 2017 examiner explained that dental problems, which reasonably includes his remaining subjective symptom of jaw pain, were the extent of the Veteran’s TBI residuals. As the Veteran’s cognitive and emotional/behavioral manifestations are addressed in the comorbid diagnosis and rating for an acquired psychiatric disorder, the June 2017 examination and medical opinion is probative evidence in support of a finding that the Veteran’s impairment for his remaining subjective symptom of jaw pain is level 0 because it was not found to interfere with work or activities of daily living. 38 C.F.R. § 4.124a, Diagnostic Code 8045. Based on the above, a separate 100 percent rating is granted from March 31, 2017, to June 5, 2018 and the claim for an initial rating in excess of 10 percent for residuals of TBI prior to June 5, 2018, must be denied. Finally, the Board notes that the Veteran has asserted that an extraschedular rating in excess of 10 percent for a TBI is warranted due to findings of total occupational and social impairment due to a mental health disorder. See 38 C.F.R. § 3.321(b)(1); Thun v. Peake, 22 Vet. App. 111 (2008). As noted above, a separate 100 percent disability rating for emotional/behavioral symptomatology due to a diagnosed mental disorder is granted for the entire period of the appeal. Therefore, the effects of the Veteran’s TBI on employment has been appropriately recognized though assignment of a total schedular rating and further consideration of an extraschedular rating is not warranted. Effective Dates The Veteran contends that he is entitled to earlier effective dates for the grants of entitlement to service connection for a TBI and residual scars, to include the combined rating for painful scars, because his initial March 1996 application included a claim for a TBI that remained pending. The statutory guidelines for the determination of an effective date of an award are set forth in 38 U.S.C. § 5110. Except as otherwise provided, the effective date of an evaluation and award of 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 later. 38 C.F.R. § 3.400. For an award of service connection predicated upon a claim to reopen, the statutory framework does not allow for an effective date for the award of service-connected benefits to reach back to the date of the original claim. Sears v. Principi, 16 Vet. App. 244, 248 (2002). Rather, a veteran may not obtain an effective date earlier than the reopened claim’s application date. See Leonard v. Nicholson, 405 F.3d 1333, 1336-37 (Fed. Cir. 2005) (explaining that disability payments may not be awarded for a time frame earlier than an application date of a claim to reopen, even with new evidence supporting an earlier disability date absent a showing of clear and unmistakable error (CUE)). Under 38 C.F.R. 3.400(b)(2)(i), the effective date for a grant of direct service connection will be the day following separation from active service or the date entitlement arose if the claim is received within one year after separation from service. Otherwise, the effective date is the date of receipt of claim, or date entitlement arose, whichever is later. VA amended its adjudication regulations on March 24, 2015, to require that all claims governed by VA’s adjudication regulations be filed on standard forms prescribed by the Secretary, regardless of the type of claim or posture in which the claim arises. See 79 Fed. Reg. 57660 (Sept. 25, 2014). The amendments, however, are only effective for claims and appeals filed on or after March 24, 2015. As the claims in this case were filed prior to that date, the amendments are not applicable in this instance and the regulations in effect prior to March 24, 2015, will be applied. Under the old regulations, any communication or action, indicating an intent to apply for one or more benefits under laws administered by VA, from a claimant or the claimant’s representative, may be considered an informal claim. Such informal claim must identify the benefit sought. Upon receipt of an informal claim, if a formal claim has not been filed, an application form will be forwarded to the claimant for execution. If received within one year from the date it was sent to the claimant, it will be considered filed as of the date of receipt of the informal claim. 38 C.F.R. 3.155(a) (in effect prior to March 24, 2015). There is no set form that an informal written claim must take. All that is required is that the communication indicates an intent to apply for one or more benefits under the laws administered by VA, and identify the benefits sought. Rodriguez v. West, 189 F.3d 1351 (1999). Case law explains that this means the claimant must describe the nature of the disability for which he is seeking benefits, such as by describing a body part or symptom of the disability. Brokowski v. Shinseki, 23 Vet. App. 79, 86-87 (2009). 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. §§ 3.104(a), 3.160(d), 20.200, 20.302, 20.1103. Previous determinations that are final and binding, including decisions of service connection, will be accepted as correct in the absence of CUE. 38 C.F.R. § 3.105(a). The Board notes that there are no communications from the Veteran or his representative specifically asserting CUE on the prior June 1996 or November 2010 rating decisions; therefore, such a claim has not been raised. Historically, the Veteran submitted a VA Form 21-526, application for compensation or pension in March 1996, within one year of separation from active, that included a claim for service connection for a head injury with a permanent facial scar. A June 1996 rating decision denied entitlement to service connection for scars, the Veteran did not file an NOD, and no new and material evidence was received within one year of the June 1996 notice of the rating decision. See 38 C.F.R. § 3.103(b)(1). In February 2010, the Veteran filed a claim for service connection for a skull fracture. That claim was denied in a November 2010 rating decision due to lack of evidence of a nexus between any skull fracture and active service. Although additional evidence was received within one year of the December 2010 notice of the November 2010 rating decision, none was relevant to the claim for a skull fracture or head injury. Moreover, the Veteran did not file an NOD with the decision. See generally 38 C.F.R. § 3.156(a). On March 31, 2017, VA received an additional claim for service connection for TBI with residuals from a tank accident to include loss of consciousness, sleep impairment, headaches, and memory problems. An August 2017 rating decision granted service connection for (1) TBI; (2) scars, residual of TBI; and (3) scars, painful/tender, all effective March 31, 2017. The Veteran disagreed with the effective dates assigned. 1. Scars, to include a separate combined evaluation for five or more painful scars Initially, the Board acknowledges the Veteran’s contentions that his initial claim for service connection for a head injury that was filed in March 1996 remained pending; however, the June 1996 rating decision did adjudicate the issue of entitlement to service connection for a facial scar due to an in-service head injury. The Veteran did not submit any timely notice of disagreement with the June 1996 rating decision nor was any new and material evidence received within one year of the notification letter of the denial. As such, the June 1996 rating decision’s denial of a facial scar became final. See 38 U.S.C. § 7105; 38 C.F.R. §§ 3.104, 3.156, 20.1103; see also Bond v. Shinseki, 659 F.3d 1362, 1367-68 (Fed. Cir. 2011). In light of this final decision, the Board’s inquiry is therefore limited to whether the Veteran filed a claim of entitlement to service connection for scars after the June 1996 rating decision and before the current effective date of the award in question. See Sears, 16 Vet. App. at 248 (explaining that a veteran may not obtain an effective date earlier than the reopened claim’s application date). However, the Board finds that March 31, 2017, is the earliest possible effective date for which the Veteran can receive the grant of service connection for scars, residuals of a TBI. The Veteran filed a claim for service connection for residuals of TBI that was received on March 31, 2017, which has been construed as a request to reopen the previously denied claim for a facial scar, as it was based on the same in-service head injuries. See Brokowski, 23 Vet. App. at 86-87. Review of the record fails to identify any document dated between June 1996 and March 2017 that may be construed as a request to reopen the claim for service connection for scars. Moreover, neither the Veteran nor his representative has argued that he filed a claim to reopen prior to March 31, 2017. The effective date of the original claim in March 1996 cannot be granted because the Veteran cannot obtain an effective date earlier than the reopened claim’s application date and, as noted above, no claim of CUE has been proffered in this case. Therefore, the Board concludes that an effective date prior to March 31, 2017, may not be assigned for service connection for scars, residuals of a TBI, to include the separate rating for painful scars. Sears, 16 Vet. App. at 248; Leonard, 405 F.3d at 1336-37. 2. TBI Initially, the Board concedes that the issue of entitlement to service connection for a head injury remained pending from the Veteran’s initial March 1996 claim for service connection because it was not adjudicated in the subsequent June 1996 rating decision. However, the Board finds the claim was addressed when a claim for service connection for a skull fracture, due to the same in-service head injuries noted in the March 1996 claim, was adjudicated and denied in a November 2010 rating decision. See Brokowski, 23 Vet. App. at 86-87. The Veteran did not submit any timely notice of disagreement with the November 2010 rating decision nor was any new and material evidence received within one year of the December 2010 notification letter of the denial. As such, the November 2010 rating decision became final and the pending March 1996 claim for service connection for a head injury was resolved. See 38 U.S.C. § 7105; 38 C.F.R. §§ 3.104, 3.156, 20.1103; see also Bond, 659 F.3d at 1367-68. As such, the Board’s inquiry is again limited to whether the Veteran filed a claim of entitlement to service connection for a head injury, alternatively described as a skull fracture or TBI, after the November 2010 rating decision and before March 31, 2017. A claim for service connection for residuals of TBI was received on March 31, 2017, which has been construed as a request to reopen the previously denied claim for a skull fracture as it describes a similar disability due to the same in-service head injuries. See Brokowski, 23 Vet. App. at 86-87. The record does not include any document dated between November 2010 and March 31, 2017, that may be construed as a request to reopen the claim for service connection for the TBI and neither the Veteran nor his representative has argued that he filed a claim to reopen prior to March 31, 2017. Accordingly, March 31, 2017, is the earliest possible effective date for which the Veteran can receive the grant of service connection for a TBI. As explained above, the Board finds that there were no outstanding unadjudicated claims due to the November 2010 rating decision and the initial March 1996 filing cannot be the basis for an effective date. The Board concludes that an effective date prior to March 31, 2017, may not be assigned for service connection for a TBI. Sears, 16 Vet. App. at 248; Leonard, 405 F.3d at 1336-37. S. HENEKS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Odya-Weis, Associate Counsel