Citation Nr: 18146870 Decision Date: 11/01/18 Archive Date: 11/01/18 DOCKET NO. 17-22 411A DATE: November 1, 2018 ORDER Entitlement to a rating greater than 20 percent for a cervical strain is denied. Entitlement to a rating greater than 20 percent for a lumbosacral strain is denied. Entitlement to a rating greater than 60 percent for prostate cancer status post radiation therapy is denied. Entitlement to a rating greater than 10 percent for hypertension is denied. Entitlement to a compensable rating for erectile dysfunction is denied. Entitlement to an initial rating greater than 50 percent for sleep apnea is denied. Entitlement to a total disability rating based on individual unemployability due to service-connected disorders is granted, subject to the laws and regulations governing the award of monetary benefits. The reduction from 60 percent to 30 percent for bowel incontinence effective March 3, 2017 was proper. New and material evidence has been submitted to reopen a claim of entitlement to service connection for allergic rhinitis. New and material evidence has been submitted to reopen a claim of entitlement to service connection for arthralgia of the hands and wrists. New and material evidence has not been submitted to reopen a claim of entitlement to service connection for arthritis. New and material evidence has not been submitted to reopen a claim of entitlement to service connection for bronchitis. New and material evidence has been submitted to reopen a claim of entitlement to service connection for chest pain. New and material evidence has not been submitted to reopen a claim of entitlement to service connection for defective vision. New and material evidence has not been submitted to reopen a claim of entitlement to service connection for hearing loss. New and material evidence has not been submitted to reopen a claim of entitlement to service connection for hypercholesterolemia. New and material evidence has been submitted to reopen a claim of entitlement to service connection for sinusitis. New and material evidence has not been submitted to reopen a claim of entitlement to service connection for residuals of a vasectomy. New and material evidence has been submitted to reopen a claim of entitlement to service connection for tinea manus. New and material evidence has not been submitted to reopen a claim of entitlement to service connection for tuberculin skin test conversion. Entitlement to service connection for acid reflux is denied. Entitlement to an effective date prior to October 6, 2015 for the grant of entitlement to service connection for sleep apnea is denied. Entitlement to an effective date prior to July 6, 1999 for a 20 percent rating for a cervical strain is dismissed. Entitlement to an effective date prior to June 1, 1992 for a 20 percent rating for lumbosacral strain is dismissed. Entitlement to an effective date prior to June 1, 1992 for a 10 percent rating for hypertension with erectile dysfunction is dismissed. Entitlement to an effective date prior to July 21, 1998 for a 10 percent rating for tinea cruris, tinea pedis and eczematous dermatitis of the hands is dismissed. Entitlement to an effective date prior to June 1, 1992 for a noncompensable rating for genital herpes is dismissed. Entitlement to an effective date prior to November 1, 2013 for a 60 percent rating for prostate cancer is dismissed. REMANDED Entitlement to service connection for allergic rhinitis is remanded. Entitlement to service connection for arthralgia of the hands and wrists is remanded. Entitlement to service connection for a disorder manifested by chest pain is remanded. Entitlement to service connection for sinusitis is remanded. Entitlement to service connection for tinea manus is remanded. Entitlement to service connection for an acquired psychiatric disorder to include generalized anxiety disorder and major depressive disorder is remanded. Entitlement to a rating greater than 10 percent for tinea cruris, tinea pedis, and eczematous dermatitis of the hands is remanded. Entitlement to a compensable rating for genital herpes is remanded. Entitlement to service connection for cervical radiculopathy is remanded. Entitlement to service connection for lumbar radiculopathy is remanded. Entitlement to a rating greater than 10 percent for tinnitus with vertigo is remanded. FINDINGS OF FACT 1. The Veteran’s cervical strain is not manifested by forward flexion limited to 15 degrees or less, or favorable ankylosis of the entire cervical spine. 2. The Veteran’s lumbosacral strain is not manifested by forward flexion limited to 30 degrees or less, or favorable ankylosis of the entire thoracolumbar spine. 3. The Veteran’s prostate cancer status post radiation therapy is in remission; there is no evidence of renal dysfunction and the predominant disability is voiding dysfunction for which the Veteran is currently receiving the maximum schedular rating based on urine leakage. 4. The Veteran’s hypertension is not manifested by a diastolic pressure predominantly 110 or more, or systolic pressure predominantly 200 or more. 5. The Veteran’s erectile dysfunction is not manifested by penile deformity with loss of erectile power. 6. The Veteran’s sleep apnea is not manifested by chronic respiratory failure with carbon dioxide retention or cor pulmonale, and he does not require a tracheostomy. 7. The Veteran meets the schedular requirements for individual unemployability and the preponderance of the probative evidence shows his service-connected disabilities are of such severity so as to preclude substantially gainful employment. 8. The March 3, 2017 VA examination demonstrated improvement in the Veteran’s bowel incontinence such that it is now manifested by occasional involuntary bowel movements and leakage necessitating wearing of a pad. 9. A December 1992 rating decision denied entitlement to service connection for allergic rhinitis, arthralgia of hands and wrists, arthritis, bronchitis, chest pain, defective vision, hearing loss, hypercholesterolemia, sinusitis, status post vasectomy with residual tenderness of left epididymis, tinea manus, and a positive tuberculin skin test conversion; the Veteran disagreed with the decision and a statement of the case was furnished in July 1993, but he did not submit a timely substantive appeal. 10. New evidence associated with the record since the December 1992 rating decision relates to an unestablished fact and raises a reasonable possibility of substantiating a claim of entitlement to service connection for allergic rhinitis. 11. New evidence associated with the record since the December 1992 rating decision relates to an unestablished fact and raises a reasonable possibility of substantiating a claim of entitlement to service connection for arthralgia of the hands and wrists. 12. New evidence associated with the record since the December 1992 rating decision does not relate to an unestablished fact and does not raise a reasonable possibility of substantiating a claim of entitlement to service connection for arthritis. 13. New evidence associated with the record since the December 1992 rating decision does not relate to an unestablished fact and does not raise a reasonable possibility of substantiating a claim of entitlement to service connection for bronchitis. 14. New evidence associated with the record since the December 1992 rating decision relates to an unestablished fact and raises a reasonable possibility of substantiating a claim of entitlement to service connection for chest pain. 15. New evidence associated with the record since the December 1992 rating decision does not relate to an unestablished fact and does not raise a reasonable possibility of substantiating a claim of entitlement to service connection for defective vision. 16. New evidence associated with the record since the December 1992 rating decision does not relate to an unestablished fact and does not raise a reasonable possibility of substantiating a claim of entitlement to service connection for hearing loss. 17. New evidence associated with the record since the December 1992 rating decision does not relate to an unestablished fact and does not raise a reasonable possibility of substantiating a claim of entitlement to service connection for hypercholesterolemia. 18. New evidence associated with the record since the December 1992 rating decision relates to an unestablished fact and raises a reasonable possibility of substantiating a claim of entitlement to service connection for sinusitis. 19. New evidence associated with the record since the December 1992 rating decision does not relate to an unestablished fact and does not raise a reasonable possibility of substantiating a claim of entitlement to service connection for residuals of a vasectomy. 20. New evidence associated with the record since the December 1992 rating decision relates to an unestablished fact and raises a reasonable possibility of substantiating a claim of entitlement to service connection for tinea manus. 21. New evidence associated with the record since the December 1992 rating decision does not relate to an unestablished fact and does not raise a reasonable possibility of substantiating a claim of entitlement to service connection for tuberculin skin test conversion. 22. The preponderance of the evidence is against finding that the Veteran has acid reflux related to active service or events therein. 23. In an unappealed March 2010 rating decision, VA denied entitlement to service connection for sleep apnea; on October 6, 2015 the Veteran submitted an intent to file a claim for compensation followed by a timely application for sleep apnea, and there are no applications, communications, or other evidence prior to this date that constitute a claim for sleep apnea. 24. In a July 2000 rating decision, VA increased the evaluation for cervical degenerative disc disease to 20 percent effective July 6, 1999; the Veteran did not perfect a timely appeal to this decision and did not challenge the effective date of the increase until February 2017. 25. In December 1992, VA granted entitlement to service connection for a recurrent lumbar strain and assigned a 20 percent rating effective June 1, 1992, the date following discharge from active duty; the Veteran did not perfect a timely appeal to that decision and did not challenge the effective date of the award until February 2017. 26. In December 1992, VA granted entitlement to service connection for hypertension and assigned a 10 percent rating effective July 1, 1992, the date following discharge from active duty; the Veteran did not perfect an appeal of this decision and did not challenge the effective date of the award until February 2017. 27. In July 2000, VA assigned a 10 percent rating for tinea cruris, tinea pedis, and eczematous dermatitis of hands effective July 21, 1998; the Veteran did not perfect an appeal of this decision and did not challenge the effective date of the award until February 2017. 28. In December 1992, VA granted service connection for genital herpes and assigned a noncompensable rating effective June 1, 1992, the date following discharge from active duty; the Veteran did not perfect an appeal of this decision and did not challenge the effective date of the award until February 2017. 29. In October 2014, VA granted entitlement to service connection for prostate cancer status post radiation therapy and assigned a 100 percent rating from September 17, 2012 and a 60 percent rating from November 1, 2013; the Veteran did not perfect a timely appeal to that decision and did not challenge the effective date of the 60 percent rating until February 2017. CONCLUSIONS OF LAW 1. The criteria for a rating greater than 20 percent for a cervical strain are not met. 38 U.S.C. § 1155, 5107; 38 C.F.R. § 4.71a, Diagnostic Code 5237. 2. The criteria for a rating greater than 20 percent for a lumbosacral strain are not met. 38 U.S.C. § 1155, 5107; 38 C.F.R. § 4.71a, Diagnostic Code 5237. 3. The criteria for a rating greater than 60 percent for prostate cancer status post radiation therapy are not met. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 4.115a, 4.115b, Diagnostic Code 7528. 4. The criteria for a rating greater than 10 percent for hypertension are not met. 38 U.S.C. § 1155, 5107; 38 C.F.R. § 4.104, Diagnostic Code 7101. 5. The criteria for a compensable rating for erectile dysfunction are not met. 38 U.S.C. § 1155, 5107; 38 C.F.R. § 4.115b, Diagnostic Code 7522. 6. The criteria for an initial rating greater than 50 percent for sleep apnea are not met. 38 U.S.C. § 1155, 5107; 38 C.F.R. § 4.104, Diagnostic Code 6847. 7. The criteria for a total disability rating based on individual unemployability due to service-connected disorders are met. 38 U.S.C. § 1155, 5107; 38 C.F.R. § 4.16(a). 8. The reduction for bowel incontinence from 60 to 30 percent effective March 3, 2017 was proper. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 3.344(c), 4.114, Diagnostic Code 7332. 9. The December 1992 rating decision is final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. 10. New and material evidence has been submitted to reopen a claim of entitlement to service connection for allergic rhinitis. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 11. New and material evidence has been submitted to reopen a claim of entitlement to service connection for arthralgia of the hands and wrists. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 12. New and material evidence has not been submitted to reopen a claim of entitlement to service connection for arthritis. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 13. New and material evidence has not been submitted to reopen a claim of entitlement to service connection for bronchitis. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 14. New and material evidence has been submitted to reopen a claim of entitlement to service connection for chest pain. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 15. New and material evidence has not been submitted to reopen a claim of entitlement to service connection for defective vision. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 16. New and material evidence has not been submitted to reopen a claim of entitlement to service connection for hearing loss. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 17. New and material evidence has not been submitted to reopen a claim of entitlement to service connection for hypercholesterolemia. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 18. New and material evidence has been submitted to reopen a claim of entitlement to service connection for sinusitis. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 19. New and material evidence has not been submitted to reopen a claim of entitlement to service connection for residuals of a vasectomy. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 20. New and material evidence has been submitted to reopen a claim of entitlement to service connection for tinea manus. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 21. New and material evidence has not been submitted to reopen a claim of entitlement to service connection for tuberculin skin test conversion. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 22. Acid reflux was not incurred during active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. 23. The criteria for an effective date prior to October 6, 2015 for the grant of service connection for sleep apnea are not met. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.155, 3.400. 24. The claim of entitlement to an effective date prior to July 6, 1999 for a 20 percent rating for a cervical strain is dismissed as a matter of law. 38 U.S.C. § 5110; 38 C.F.R. § 3.400; Rudd v. Nicholson, 20 Vet. App. 296 (2006). 25. The claim of entitlement to an effective date prior to June 1, 1992 for a 20 percent rating for a lumbosacral strain is dismissed as a matter of law. 38 U.S.C. § 5110; 38 C.F.R. § 3.400; Rudd. 26. The claim of entitlement to an effective date prior to June 1, 1992 for a 10 percent rating for hypertension is dismissed as a matter of law. 38 U.S.C. § 5110; 38 C.F.R. § 3.400; Rudd. 27. The claim of entitlement to an effective date prior to July 21, 1998 for a 10 percent rating for tinea cruris, tinea pedis and eczematous dermatitis of hands is dismissed as a matter of law. 38 U.S.C. § 5110; 38 C.F.R. § 3.400; Rudd. 28. The claim of entitlement to an effective date prior to June 1, 1992 for a noncompensable rating for genital herpes is dismissed as a matter of law. 38 U.S.C. § 5110; 38 C.F.R. § 3.400; Rudd v. Nicholson, 20 Vet. App. 296 (2006). 29. The claim of entitlement to an effective date prior to November 1, 2013 for a 60 percent rating for prostate cancer status post radiation therapy is dismissed as a matter of law. 38 U.S.C. § 5110; 38 C.F.R. § 3.400; Rudd. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1972 to May 1992. In April 2018, the attorney submitted additional argument and evidence with a waiver of RO jurisdiction. Increased Ratings Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (rating schedule), found in 38 C.F.R. Part 4. Disability ratings are intended to compensate impairment in earning capacity due to a service-connected disorder. 38 U.S.C. § 1155, 5107. VA regulations, set forth at 38 C.F.R. §§ 4.40, 4.45, 4.59 provide for consideration of functional impairment due to pain on motion when evaluating the severity of a musculoskeletal disability. The United States Court of Appeals for Veterans Claims (Court) has held that a higher rating can be based on “greater limitation of motion due to pain on use.” DeLuca v. Brown, 8 Vet. App. 202, 206 (1995). Any such functional loss must be “supported by adequate pathology and evidenced by the visible behavior of the claimant.” 38 C.F.R. § 4.40. Entitlement to a rating greater than 20 percent for a cervical strain In November 2016, the Veteran submitted a claim for increase. In February 2017, VA issued a rating decision increasing the evaluation for cervical strain to 20 percent effective November 2, 2016. The Veteran disagreed and perfected this appeal. VA subsequently determined that the 20 percent evaluation had been warranted since July 6, 1999. The Veteran generally contends an increased rating is warranted for his service-connected cervical strain. Under 38 C.F.R. § 4.71a, a 20 percent rating is assigned when there is forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; or, the combined range of motion of the cervical spine is not greater than 170 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spine contour such as scoliosis, reversed lordosis, or abnormal kyphosis. 38 C.F.R. § 4.71a, Diagnostic Code 5237. A 30 percent rating is assigned when there is forward flexion of the cervical spine to 15 degrees or less; or favorable ankylosis of the entire cervical spine. Id. In December 2016, the Veteran underwent a VA cervical spine examination. He reported flare-ups requiring pain medications and physical therapy. He reportedly could not sleep in bed or move his neck and hands due to the pain for 6 plus months and had to get trigger point injections. On physical examination, forward flexion was from 0 to 30 degrees; extension was from 0 to 30 degrees; right and left lateral flexion were from 0 to 30 degrees; and right and left lateral rotation were from 0 to 60 degrees. He had pain in all ranges of motion. The Veteran was able to perform repetitive use testing and there was no additional loss of function or range of motion after three repetitions. There was no localized cervical tenderness, guarding, or muscle spasm. There was no evidence of cervical ankylosis. The examiner stated that pain would limit functional ability with repeated use over a period of time or during flare-ups, but he could not describe in terms of range of motion as pain precluded accurate measurement. On review, the criteria for a 30 percent rating are not met or more nearly approximated. Forward flexion of the cervical spine is not limited to 15 degrees or less and there is no ankylosis. The Board has considered the Veteran’s complaints of functional impairment but does not find adequate pathology sufficient to warrant a higher rating based on pain on motion or other factors. The Board has also considered the March 2018 statements from the Veteran’s spouse and daughter describing his limitations, but does not find these statements more probative than the objective evidence of record. It bears repeating that the general rating formula evaluates diseases and injuries of the spine based upon limitation of motion, and that those criteria are controlling regardless whether there are symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease. 38 C.F.R. § 4.71a. The preponderance of the evidence is against the claim and the doctrine of reasonable doubt is not for application. 38 C.F.R. § 3.102. Entitlement to a rating greater than 20 percent for a lumbosacral strain In November 2016, the Veteran submitted a claim for increase. In February 2017, VA continued a 20 percent rating for a lumbosacral strain. The Veteran disagreed and perfected this appeal. The Veteran generally contends a higher rating is warranted. A 20 percent rating is assigned when there is forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or the combined range of motion of the thoracolumbar spine is not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. 38 C.F.R. § 4.71a, Diagnostic Code 5237. A 40 percent rating is assigned when forward flexion of the thoracolumbar spine is 30 degrees or less or when there is favorable ankylosis of the entire thoracolumbar spine. Id. The Veteran underwent a VA thoracolumbar examination in December 2016. He reported flare-ups that he described as not being able to bend or sit up for months. Regarding overall functional impairment, the Veteran stated he could not bend or make sharp turns. On physical examination, range of thoracolumbar motion was forward flexion from 0 to 60 degrees; and extension, bilateral lateral flexion, and bilateral lateral rotation from 0 to 20 degrees. There was pain in all ranges of motion. The Veteran was able to perform repetitive-use testing and there was no additional loss of function or range of motion after three repetitions. The examiner stated that pain would limit functional ability with repeated use over a period of time or with flare-ups, but the examiner was not able to describe in terms of range of motion as pain precluded accurate testing. On review, the criteria for a 40 percent rating are not met or more nearly approximated. The Veteran’s lumbosacral strain is not manifested by either forward flexion limited to 30 degrees or less, or favorable thoracolumbar ankylosis. The Board has considered the Veteran’s complaints of functional impairment, but does not find adequate pathology sufficient to warrant a higher rating based on pain on motion or other factors. The Board has also considered the March 2018 statements from the Veteran’s spouse and daughter describing his limitations, but these statements are less probative than the objective evidence of record. It bears repeating that the general rating formula evaluates diseases and injuries of the spine based upon limitation of motion, and that those criteria are controlling regardless whether there are symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease. 38 C.F.R. § 4.71a. The preponderance of the evidence is against the claim and the doctrine of reasonable doubt is not for application. 38 C.F.R. § 3.102. Entitlement to a rating greater than 60 percent for prostate cancer status post radiation therapy In November 2016, the Veteran filed a claim for increase. In February 2017, VA continued a 60 percent rating for prostate cancer. The Veteran disagreed and perfected this appeal. He generally contends that a rating greater than 60 percent is warranted. The Veteran’s residuals of prostate cancer are evaluated under Diagnostic Code 7528 (malignant neoplasms of the genitourinary system), which provides for a 100 percent rating for six months after therapeutic procedure. Then, if there has been no local reoccurrence or metastasis, residuals are rated as voiding dysfunction or renal dysfunction, whichever is predominant. 38 C.F.R. § 4.115b. A 60 percent rating is assigned for voiding dysfunction when there is urine leakage requiring the use of an appliance or the wearing of absorbent materials which must be changed more than 4 times a day. 38 C.F.R. § 4.115a. No higher schedular evaluation is available for voiding dysfunction. Renal dysfunction with constant albuminuria with some edema; or, definite decrease in kidney function; or, hypertension at least 40 percent disabling under Diagnostic Code 7101 warrants a 60 percent rating. Renal dysfunction with persistent edema and albuminuria with BUN 40 to 80 mg percent or creatinine 4 to 8 mg percent or generalized poor health characterized by lethargy, weakness, anorexia, weight loss or limitation of exertion warrants an 80 percent rating. 38 C.F.R. § 4.115a. The Veteran underwent a VA prostate cancer examination in December 2016. The disease remained in remission. The Veteran continued report voiding dysfunction with urine leakage requiring absorbent material which must be changed 2 to 4 times a day. He had urinary frequency with a daytime voiding interval between one and two hours and nighttime awakening to void five or more times. There were no symptoms of obstructed voiding. The Veteran did not have a history of recurrent symptomatic urinary tract or kidney infections. A December 2016 VA male reproductive organ examination specifically found no evidence of renal dysfunction. In March 2018, the Veteran’s spouse and daughter submitted statements indicating he had an overactive bladder and was using over-the-counter undergarments. On review, the Veteran continues to experience voiding dysfunction. Clearly, this is the predominant disability as there is no competent evidence of renal dysfunction due to residuals of prostate cancer. The Veteran is currently receiving a 60 percent rating which is the maximum rating for voiding dysfunction based on urine leakage. There is simply no basis for assigning a higher rating. The preponderance of the evidence is against the claim and the doctrine of reasonable doubt is not for application. 38 C.F.R. § 3.102. Entitlement to a rating greater than 10 percent for hypertension In November 2016, the Veteran submitted a claim for increase. In February 2017, VA continued the 10 percent rating for hypertension. The Veteran disagreed and perfected this appeal. He generally contends that an increased rating is warranted. A 10 percent rating is assigned for hypertension when diastolic pressure is predominantly 100 or more, or systolic pressure predominantly 160 or more, or minimum evaluation with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control. 38 C.F.R. § 4.104, Diagnostic Code 7101. A 20 percent rating is assigned for hypertension when diastolic pressure is predominantly 110 or more, or systolic pressure is predominantly 200 or more. Id. The Veteran underwent a VA hypertension examination in December 2016. The Veteran reported that his blood pressure continued to worsen and he takes several medications. On physical examination, blood pressure readings were recorded as 142/70, 140/74, and 136/76. The average blood pressure reading was 140/74. Chest x-ray and electrocardiogram were both within normal limits. Regardless of the above results, the Veteran has been in receipt of a 10 percent rating for hypertension since June 1, 1992 and this rating is protected. 38 C.F.R. § 3.951(b). Review of the examination as well as extensive VA treatment records does not show diastolic pressure predominantly 110 or more or systolic pressure predominantly 200 or more and the criteria for a 20 percent rating are not met or more nearly approximated. Indeed, the Veteran has not identified any treatment records which would demonstrate this level of disability. Hence, the claim is denied. As the preponderance of the evidence is against the claim and the doctrine of reasonable doubt is not for application. 38 C.F.R. § 3.102. Entitlement to a compensable rating for erectile dysfunction In March 2010, VA granted entitlement to service connection for erectile dysfunction secondary to hypertension. This disability was assigned a noncompensable rating but included with hypertension on the code sheet. In February 2017, VA continued the 10 percent rating for hypertension with erectile dysfunction. The Veteran disagreed and perfected this appeal. As discussed above, the 10 percent evaluation is for hypertension. For purposes of clarity, the Board will list the issues separately. The Veteran is not prejudiced by this action. Bernard v. Brown, 4 Vet. App. 384 (1993). The Veteran generally contends that a compensable rating is warranted for erectile dysfunction. A 20 percent rating is assigned for deformity of the penis with loss of erectile power. 38 C.F.R. § 4.115b, Diagnostic Code 7522. In a recent case, the Court held that deformity, as described in that Diagnostic Code, means “a distortion of the penis, either internal or external.” See Williams v. Wilkie, No. 16-3252; 2018 U.S. App. Vet. Claims LEXIS 1037 (August 7, 2018). VA prostate cancer examinations show erectile dysfunction. On VA male reproductive organ examination in December 2016, the Veteran reported his disorder began due to blood pressure medication and became worse following radiation treatment for prostate cancer. There was no retrograde ejaculation. On physical examination, the penis was normal and there was no indication of any deformity. On review, the evidence of record does not show loss of erectile power with deformity and the overall impairment is not analogous to deformity. In making this determination, the Board notes that the evidence shows that with medication the Veteran can achieve penetration and ejaculation. The preponderance of the evidence is against the claim and the doctrine of reasonable doubt is not for application. 38 C.F.R. § 3.102. Entitlement to a rating greater than 50 percent for sleep apnea In June 2017, VA granted entitlement to service connection for sleep apnea and assigned a 50 percent rating. The Veteran disagreed and perfected this appeal. He generally contends that a higher initial rating is warranted. A 50 percent rating is assigned for sleep apnea that requires use of breathing assistance device such as continuous airway pressure machine. 38 C.F.R. § 4.104, Diagnostic Code 6847. A 100 percent rating is assigned when there is chronic respiratory failure with carbon dioxide retention or cor pulmonale, or requires tracheostomy. Id. In May 2017, VA obtained a medical opinion relating currently diagnosed sleep apnea to active service. VA records show sleep apnea treated with a continuous airway pressure machine. The record contains no evidence showing that the Veteran’s sleep apnea is so severe that it causes chronic respiratory failure or cor pulmonale, and he does not have a tracheostomy. The criteria for a 100 percent rating are not met or more nearly approximated. The preponderance of the evidence is against the claim and the doctrine of reasonable doubt is not for application. 38 C.F.R. § 3.102. Entitlement to a total disability rating based on individual unemployability In an unappealed March 2015 decision, VA denied entitlement to a total disability rating based on individual unemployability. In November 2016, the Veteran submitted multiple claims for increase. In April 2018, the attorney argued that a total disability rating based on individual unemployability should be granted. Although not specifically perfected, the Board will address the claim as part of the current appeal. Rice v. Shinseki, 22 Vet. App. 447, 453-54 (2009) (When evidence of unemployability is submitted during the course of an appeal from an assigned disability rating, a claim for entitlement to a total disability rating based on individual unemployability will be considered “part and parcel” of the claim for benefits for the underlying disability.) VA will grant a total rating for compensation purposes based on unemployability when the evidence shows that the Veteran is precluded, by reason of his service-connected disabilities alone, from obtaining and maintaining any form of substantial gainful employment consistent with his education and occupational experience. 38 C.F.R. §§ 3.340, 3.341, 4.16. The Veteran is currently service-connected for residuals of a cerebella hemorrhage with cerebral infarction (100 percent disabling from April 25, 2018 to October 1, 2018); residuals of prostate cancer (100 percent disabling from September 17, 2012; 60 percent disabling from November 1, 2013); sleep apnea (50 percent disabling from October 6, 2015); bowel incontinence (60 percent disabling from November 1, 2013; 30 percent disabling from March 3, 2017); cervical strain (10 percent disabling from June 1, 1992; 20 percent disabling from July 6, 1999); lumbosacral strain (20 percent disabling from June 1, 1992); right upper extremity weakness status post stroke (20 percent disabling from October 1, 2018); hypertension with erectile dysfunction (10 percent disabling from June 1, 1992); tinea cruris and pedis and eczematous dermatitis of hands (rated as noncompensable from June 1, 1992; 10 percent disabling from July 21, 1998); tinnitus with a history of vertigo (rated as noncompensable from June 1, 1992; 10 percent disabling from July 6, 1999); right lower extremity weakness status post stroke (10 percent disabling from October 1, 2018); and genital herpes (rated as noncompensable from June 1, 1992). On review, the Veteran has met the schedular requirements throughout the pendency of the appeal. 38 C.F.R. § 4.16(a). Information from the Veteran’s former employers indicates that he retired from an office job in August 2009. Thereafter, he worked for another organization from April to May 2010 when he left due to lack of work. The attorney submitted several evaluations in support of the claim. An April 2018 residual functional capacity evaluation completed by the Veteran’s private physician, Dr. H.S., indicates that he had had a stroke with resulting limitations in standing, walking and sitting. He cannot lift or carry any weight and needed assistance with almost all activities of daily living. The physician further stated that the Veteran needs constant supervision and is unable to maintain substantially gainful employment. In an April 2018 statement, Dr. H.S. discussed various pieces of evidence from the record. Based on his interview with the Veteran’s wife and daughter, review of the claims folder and statements from the Veteran’s wife and daughter, it was his opinion on a more likely than not basis, that the claimant was not capable of substantially gainful employment and had been unable to maintain substantially gainful employment since he stopped working in 2010 due to limitations from service-connected conditions. Also submitted was an April 2018 evaluation by a private vocational consultant. She discussed relevant evidence in detail and concluded that the Veteran was incapable of doing his prior work. He could not perform prolonged sitting due to rectal pain and excessive need for bathroom breaks. He was also unable to perform other work for which he was qualified by education and training due to the same limitations and absences/concentration issues opined by Dr. S. In summary, she found the Veteran totally and permanently precluded from performing work at a substantial gainful level due to the severity of service-connected disabilities. On review, the above evidence is probative and supports the claim. The Board does not find probative evidence to the contrary. Hence, entitlement to a total disability rating based on individual unemployability is warranted.   Propriety of Reduction In March 2015, VA granted entitlement to service connection for bowel incontinence and assigned a 60 percent rating effective November 1, 2013. The 60 percent rating was assigned based on fairly frequent involuntary bowel movements and leakage necessitating the wearing of a pad. In May 2017, VA reduced the rating for bowel incontinence to 30 percent from March 3, 2017. The Veteran disagreed and perfected this appeal. Because the disagreement stems from a reduction, the Board will consider whether the reduction was proper as opposed to whether an increase is warranted. Dofflemeyer v. Derwinski, 2 Vet. App. 277, 279-280 (1992). The Veteran also disagreed with the effective date of the reduction and the issue was separately perfected. The Board notes, however, that consideration as to the propriety of the reduction necessarily includes a determination as to the effective date. A separate discussion is not required. At the outset, the Board observes that the reduction did not result in a reduction of compensation payments being made. That is, prior to the reduction the combined evaluation was 90 percent. Effective the date of the reduction, the 90 percent rating continued. Accordingly, the notice requirements set forth at 38 C.F.R. § 3.105(e) are not for application. The question then is whether the reduction to a 30 percent rating was warranted. In this case, the 60 percent rating was in effect for less than 5 years. Thus, the disorder is not considered to have stabilized and it is subject to improvement. Reexamination disclosing improvement will warrant a reduction in rating. 38 C.F.R. § 3.344(c). The Veteran’s bowel incontinence is evaluated as impairment of sphincter control. A 60 percent rating is assigned when there is extensive leakage and fairly frequent involuntary bowel movements. 38 C.F.R. § 4.114, Diagnostic Code 7332. A 30 percent rating is assigned for occasional involuntary bowel movements necessitating wearing of a pad. Id. The Veteran underwent a VA rectum and anus examination in September 2014. He reported stool incontinence following radiation therapy for prostate cancer. The incontinence occurred after eating, with stool leaking 3-4 times per day. The examiner indicated that the leakage necessitated wearing of a pad and he had fairly frequent involuntary bowel movements. The Veteran underwent a VA intestinal conditions examination in December 2016. The examiner noted diarrhea and abdominal distention with pain. The diagnosis of bowel incontinence was described as active. On March 3, 2017, the Veteran underwent an additional VA rectum and anus examination. He reported continued episodes of fecal incontinence requiring him to wear diapers on a daily basis. He also experienced associated anal/rectal pain and episodes of anorectal bleeding. The examiner stated there was slight impairment of sphincter control without leakage, yet also stated that there were occasional involuntary bowel movements and that leakage necessitated wearing of pads. The Board acknowledges the March 2017 examination appears to contain contradictory findings regarding leakage. Reviewing the findings in the light most favorable to the Veteran, he still has occasional involuntary bowel movements and experiences leakage that necessitates using a pad. The March 3, 2017 VA examination, however, shows improvement in the condition and the overall disability picture more nearly approximates the criteria for a 30 percent rating. Hence, the reduction was appropriate as of the date of the examination and the appeal is denied. New and Material In December 1992, VA denied entitlement to service connection for allergic rhinitis, arthralgia of hands and wrists, arthritis, bronchitis, chest pain, defective vision, hearing loss, hypercholesterolemia, sinusitis, status post vasectomy with residual tenderness of left epididymis, tinea manus, and tuberculin skin test conversion. The Veteran disagreed with the decision and a statement of the case was furnished in July 1993. The Veteran did not file a timely substantive appeal and hence, the December 1992 rating decision is final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. In November 2016, the Veteran submitted a claim to reopen. A claimant may reopen a finally adjudicated claim by submitting new and material evidence. 38 U.S.C. § 5108; 38 C.F.R. § 3.156 (a). “New” evidence means existing evidence not previously submitted to agency decisionmakers. “Material” evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). Evidence that is merely cumulative of other evidence in the record cannot be new and material even if that evidence had not been previously presented to the Board. Anglin v. West, 203 F.3d 1343 (Fed. Cir. 2000). In determining whether evidence is new and material, the credibility of the new evidence is to be presumed. Justus v. Principi, 3 Vet. App. 510, 513 (1992). In Shade v. Shinseki, 24 Vet. App. 110 (2010), the United States Court of Appeals for Veterans Claims interpreted the language of 38 C.F.R. § 3.156 (a) as creating a low threshold. Allergic Rhinitis The December 1992 rating decision denied entitlement to service connection for allergic rhinitis because it was a constitutional or developmental abnormality and not related to service. Evidence at the time of the December 1992 rating decision included a July 1992 VA examination showing a diagnosis of allergic rhinitis. Evidence submitted since that time includes VA records showing continued treatment for environmental allergies. The Board finds this evidence new and material and the claim is reopened. 38 C.F.R. § 3.156; Shade. In making this determination, the Board notes that VA’s rating schedule includes a diagnostic code specifically for allergic rhinitis. This disorder is NOT a constitutional or developmental abnormality. Arthralgia of the hands and wrists The December 1992 rating decision denied entitlement to service connection for arthralgia of the hands and wrists because no organic cause was found on VA examination. Pertinent evidence at the time of the December 1992 decision included the July 1992 VA general medical examination. At that time, the Veteran reported a several years history of morning stiffness and pain in the wrists and hands. On physical examination, there was no deformity in the hands or wrists and range of motion was full. X-rays of the hands and wrists showed no evidence of trauma or significant arthritis. The diagnosis was arthralgia of hands and wrists. Evidence submitted since the December 1992 rating decision includes extensive medical records. An August 2014 record shows the Veteran was seen in occupational therapy as a walk-in for bilateral wrist carpal tunnel braces for possible carpal tunnel syndrome in addition to cervical radiculopathy. On review, this evidence is new and material and the claim is reopened. 38 C.F.R. § 3.156; Shade. Arthritis The December 1992 rating decision denied entitlement to arthritis because it was not found on VA examination. Pertinent evidence at the time of the December 1992 decision included service treatment records which were negative for evidence of arthritis. As noted, a diagnosis of arthritis was not shown on VA general medical examination in July 1992. Evidence submitted since the final December 1992 decision includes extensive medical records. While these records note degenerative arthritis of the spine, the Veteran is already service-connected for both the lumbar and cervical spines. The records do not, however, show arthritis in any nonservice-connected joints or indicate a relationship between any such diagnosis and active service. The Veteran has not provided any argument on this issue and the Board is unable to determine which joint or joints he is attempting to claim. On review, the above evidence is new. It is not, however, material as it does not relate to an unestablished fact or raise a reasonable possibility of substantiating the claim. Accordingly, the appeal to reopen the claim must be denied. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. Bronchitis The December 1992 rating decision denied entitlement to service connection for bronchitis because it was not found on VA examination. Pertinent evidence at the time of the December 1992 rating decision included service treatment records which showed he was treated in January 1988 for bronchitis with eustachian tube dysfunction. At a VA general medical examination in July 1992, the Veteran reported recurrent episodes of bronchitis in the 1970’s. He has not had any bronchitis since he quit smoking in 1980. The diagnosis was bronchitis by history. Pulmonary function tests showed normal spirometry, lung volumes and diffusion capacity. Evidence submitted since the December 1992 decision includes extensive medical records. These records do not show complaints or findings related to bronchitis. The above evidence is new. It is not, however, material as it does not relate to an unestablished fact or raise a reasonable possibility of substantiating the claim. That is, it does not show current bronchitis or indicate that such disorder is related to active service or events therein. Accordingly, the appeal to reopen the claim must be denied. 38 U.S.C. § 5108; 38 C.F.R. § 3.156.   Chest pain The December 1992 rating decision denied entitlement to service connection for chest pain because no organic cause for chest pain was found on the recent VA examination. Evidence at the time of the December 1992 decision included service treatment records which showed the Veteran was seen for complaints of chest wall pain and possible angina. Record dated in August 1981 indicates no evidence of cardiac pathology. On VA examination in July 1992, he reported chest pain in 1987 which radiated to the left upper extremity, as well as two episodes of chest pain since. Diagnostic testing was negative and diagnosis was chest pain, non-cardiac origin. Evidence submitted since the December 1992 decision includes a May 2016 statement from the Veteran’s spouse, wherein she stated that the Veteran had a mild heart attack when they were stationed at Ramstein Air Base in Germany and that this was never discussed or recorded in his VA records. This statement arguably suggests in-service cardiac pathology and is considered new and material. Thus, the claim is reopened. 38 C.F.R. § 3.156; Shade. Defective vision The December 1992 rating decision denied entitlement to service connection for defective vision because the condition was a constitutional or developmental abnormality. The Board notes that VA regulations specifically prohibit service connection for congenital and developmental defects and refractive error of the eye unless such defect was subjected to a superimposed disease or injury which created additional disability. See VAOPGCPREC 82-90; 55 Fed. Reg. 45711 (1990). Evidence of record at the time of the December 1992 rating decision included service treatment records which show the Veteran was given eyeglasses to correct a refractive error. The July 1992 VA vision examination showed refractive error diagnosed as myopia with myopic disk and presbyopia. Evidence submitted since the December 1992 rating decision includes extensive medical records. VA records show the Veteran is followed in the optometry clinic for refractive error and complaints of dry eyes associated with radial keratotomy surgery (which was used to correct myopia). This evidence is new. It is not, however, material in that it does not relate to an unestablished fact or raise a reasonable possibility of substantiating the claim. That is, the new evidence neither shows any in-service superimposed eye injury nor does it show an eye disorder other than refractive error. Accordingly, the appeal to reopen the claim must be denied. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. Hearing Loss The December 1992 decision denied entitlement to service connection for hearing loss because it was not shown by the evidence of record. Evidence at the time of the December 1992 rating decision included service treatment records which did not show a hearing loss disability for VA purposes. The July 1992 audiogram also did not show a hearing loss disability for VA purposes. 38 C.F.R. § 3.385. Evidence submitted since the December 1992 rating decision includes extensive medical records and examinations. On VA examination in August 1999, the Veteran’s hearing was within normal limits in both ears. A June 2005 VA audiogram indicated that hearing was normal from 250-8000 Hertz. The Veteran most recently underwent a VA hearing loss evaluation in March 2017. At that time, no diagnosis was provided as the results were invalid. On review, the above evidence is new. It is not, however, material in that it does not relate to an unestablished fact or raise a reasonable possibility of substantiating the claim. That is, the newly submitted evidence does not establish a current hearing loss disability for VA purposes. Accordingly, the appeal to reopen the claim must be denied. 38 U.S.C. § 5108; 38 C.F.R. § 3.156.   Hypercholesterolemia The December 1992 rating decision denied entitlement to service connection for hypercholesterolemia (high cholesterol) because this was a laboratory finding only and not a ratable disability under the law. The Board notes that hyperlipidemia and elevated cholesterol are laboratory findings and are not disabilities in and of themselves for VA purposes. 61 Fed. Reg. 20,440, 20,445 (May 7, 1996). Evidence of record at the time of the December 1992 rating decision includes service treatment records showing elevated cholesterol values. VA general medical examination in July 1992 noted a history of high cholesterol for three years. The diagnosis was hypercholesterolemia. Evidence submitted since the December 1992 rating decision includes extensive medical records. VA records show continued hyperlipidemia treated with statins. The above evidence is new. It is not, however, material in that it does not relate to an unestablished fact and does not raise a reasonable possibility of substantiating the claim. That is, none of the records show the Veteran’s high cholesterol is a manifestation of an underlying disorder. Accordingly, the appeal to reopen the claim must be denied. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. Sinusitis The December 1992 rating decision denied entitlement to service connection for sinusitis because the condition was not found on VA examination. Evidence of record at the time of the December 1992 rating decision included June 1992 x-rays showing normal paranasal sinuses. On VA examination in July 1992, the Veteran reported seasonal sinus problems since the mid 1970’s. A diagnosis of sinusitis was not provided. Evidence submitted since the December 1992 rating decision includes extensive medical records. Records dated in March and September 1993 showed treatment for sinusitis and probable sinusitis. A December 2016 record shows recurring sinus infections. The above evidence is new. It is also material as it relates to an unestablished fact and raises a reasonable possibility of substantiating the claim. That is, it shows treatment for sinusitis in close proximity to discharge as well as evidence of recent recurring sinus infections. Thus, the claim is reopened. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. Residuals of vasectomy The December 1992 rating decision denied entitlement to service connection for a vasectomy with residual tenderness of left epididymis because this was elective surgery. Evidence of record at the time of the December 1992 rating decision included service treatment records showing the Veteran underwent elective sterilization (bilateral vasectomy) in November 1979. On VA examination in July 1992, he reported an intermittent sharp left testicular pain. The diagnosis was status post vasectomy with residual tenderness of left epididymis. Evidence submitted since the December 1992 rating decision includes extensive medical records. While these records show numerous genitourinary issues, to include voiding dysfunction and erectile dysfunction, these are related to already service-connected prostate cancer and hypertension. During a male reproductive organ examination in December 2016, the Veteran’s testicles and epididymis were evaluated as normal on physical examination. The records do not show any present disability as a residual of the in-service elective vasectomy. Thus, while the evidence is new, it is not material as it does not relate to an unestablished fact or raise a reasonable possibility of substantiating the claim. Accordingly, the appeal to reopen is denied. 38 U.S.C. § 5108; 38 C.F.R. § 3.156.   Tinea manus The December 1992 rating decision denied entitlement to service connection for tinea manus because the condition was not found on VA examination. Evidence at the time of the December 1992 rating decision included service treatment records showing complaints of intermittent problems with rashes on the hands, trunk and groin. On VA examination in July 1992, there was no evidence of rash on the hands and diagnosis was tinea manus by history. Evidence since the December 1992 rating decision includes extensive medical records. A May 2014 VA dermatology note indicates the Veteran had erythematous plaques that was worse on the palms with minor fissuring and cracking. The clinical assessment included hand dermatitis most likely due to acquired palmoplantar keratoderma versus eczematous dermatitis/dyshidrotic eczema versus psoriasis versus allergic contact dermatitis. As the Veteran had a history of prostate cancer, it was opined that keratoderma could potentially be a sequela of that disease process. The examiner also noted that the Veteran had exposure to chemicals while in Thailand during the Vietnam war so could have chemical associated acquired keratoderma. The above evidence is new. It is also material in that it relates to an unestablished fact and raises a reasonable possibility of substantiating the claim. That is, it shows a current skin condition of the hands possibly related to service or service-connected disability. Thus, the claim is reopened. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. Tuberculin Skin Test Conversion The December 1992 rating decision denied entitlement to service connection for a positive tuberculosis reaction because there was no evidence of positive active disease during service or following discharge. Evidence at the time of the December 1992 rating decision included service treatment records which showed a positive purified protein derivative test in April 1988. It was noted, however, that this was doubtful and a repeat test in June 1988 was negative. On VA examination in June 1992, the Veteran reported a converted tuberculin skin test in the late 1980’s without treatment. Following examination, diagnosis was tuberculin skin test conversion with no evidence of disease. Evidence submitted since the December 1992 rating decision includes extensive medical records. These records do not show an active tuberculosis infection or any residuals thereof. Thus, while this evidence is new, it is not material as it does not relate to an unestablished fact or raise a reasonable possibility of substantiating the claim. Accordingly, the appeal to reopen the claim is denied. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. Service Connection Entitlement to service connection for acid reflux In February 2017, VA denied entitlement to service connection for acid reflux. The Veteran disagreed with the decision and perfected this appeal. Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service, even if the disability was initially diagnosed after service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. VA records show a current diagnosis of gastroesophageal reflux disease. On review, however, there is no competent evidence of this disorder during service or for many years after. Additionally, the record does not contain probative evidence relating this disorder to active service or events therein. To the extent the Veteran is generally arguing that his current acid reflux is related to service, he is not competent to provide an opinion on etiology. Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). Given the absence of any pertinent pathology inservice, and the absence of any competent evidence linking this disorder to service, the claim is denied. As the preponderance of the evidence is against the claim and the doctrine of reasonable doubt is not for application. 38 C.F.R. § 3.102. Effective Date The effective date of an award based on an original claim or a claim reopened after final adjudication 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); 38 C.F.R. § 3.400. The effective date of an award of disability compensation to a Veteran is the day following the date of discharge or release if the application therefor is received within one year from such date of discharge or release. 38 U.S.C. § 5110(b)(1). A specific claim in the form prescribed by the Secretary must be filed in order for benefits to be paid or furnished to any individual under the laws administered by VA. 38 U.S.C. § 5101(a); 38 C.F.R. § 3.151(a). Prior to March 24, 2015, a “claim” or “application” was a formal or informal communication in writing requesting a determination of entitlement or evidencing a belief in entitlement to a benefit. 38 C.F.R. § 3.1(p). An informal claim was any communication indicating intent to apply for one or more benefits. The benefit being sought must be identified. 38 C.F.R. § 3.155. Effective March 24, 2015, the law no longer allows for informal claims but the pertinent regulation allows a claimant to submit an intent to file a claim, and VA may recognize the receipt date of the intent to file a claim as the date of claim so long as VA receives the successfully completed claim form within a year. 38 C.F.R. § 3.155(b) (“Upon receipt of the intent to file a claim, VA will furnish the claimant with the appropriate application form prescribed by the Secretary. If VA receives a complete application form... [for the] benefit sought within 1 year of receipt of the intent VA will consider the complete claim filed as of the date the intent to file a claim was received.”). However, if submitted in writing, the intent to file must be on a standardized form. Id. at 38 § C.F.R. § 3.155(b)(1)(ii) (mandating that the claim must be “[w]ritten on an intent to file a claim form. The submission to an agency of original jurisdiction of a signed and dated intent to file a claim, on the form prescribed by the Secretary for that purpose, will be accepted an intent to file a claim.”). If not on a standardized Intent to File form, then any communication “is considered a request for an application form for benefits” and has no impact on effective dates, which is governed based upon when the formal claim is received. Id. at § 3.155(a). Significantly, once a decision assigning an effective date becomes final, that assignment cannot be challenged through a freestanding claim for entitlement to an earlier effective date. Rudd v. Nicholson, 20 Vet. App. 296, 299-300 (2006). Thus, the Board is required to dismiss freestanding claims for entitlement to earlier effective dates. Id; see also DiCarlo v. Nicholson, 20 Vet. App. 52 (2006) (stating there is no such procedure as a freestanding challenge to the finality of a VA decision). In other words, if there is disagreement as to the effective date assigned in a given rating action, it must be timely appealed (within one year of notice of the rating decision assigning the effective date). Earlier effective date for service connection for sleep apnea In June 2017, VA granted entitlement to service connection for sleep apnea effective October 6, 2015. The Veteran disagreed with the effective date and perfected this appeal. By way of history, in March 2010 VA denied entitlement to service connection for sleep apnea. The Veteran did not appeal this decision and it is final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. On October 6, 2015, VA received the Veteran’s intent to file a claim for compensation. In June 2016, within the one-year period, the Veteran submitted a VA Form 21-526EZ for sleep apnea. On review, a claim for compensation for sleep apnea was not received at any time between the final March 2010 rating decision and prior to the October 6, 2015 intent to file. Thus, there is no legal basis for assigning an earlier effective date. In considering this claim, the Board acknowledges the lay statements from the Veteran and fellow soldiers suggesting he had symptoms of sleep apnea during service. The Board also acknowledges the May 2016 statement from the Veteran’s spouse wherein she said VA made an error in finding his disorder did not begin until many years following service. The Veteran, however, has not specifically raised a claim for clear and unmistakable error in the May 2010 rating decision, and such a claim is not reasonably raised. Thus, the Board does not find it necessary to defer the effective date issue. The claim is dismissed. Rudd. Earlier effective date for a 20 percent rating for a cervical spine disorder In February 2017, VA issued a decision increasing the rating for a cervical spine disorder to 20 percent effective November 12, 2016. The Veteran disagreed with the effective date and perfected this appeal. In May 2017, VA changed the effective date for the 20 percent rating to July 9, 1999. The May 2017 rating decision indicates that a review of the file shows that in July 2000, a 20 percent rating was granted from July 9, 1999 and that a subsequent rating decision failed to backfill the appropriate evaluation. Given the foregoing, the 20 percent rating for a cervical spine disorder has been in effect since July 9, 1999. The Veteran did not perfect an appeal to this rating decision and it is final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. This decision cannot be challenged through a freestanding claim and the issue is dismissed. Rudd. Earlier effective date for a 20 percent rating for lumbosacral strain In February 2017, VA continued a 20 percent rating for a lumbosacral strain. The Veteran disagreed with the effective date and perfected this appeal. Review of the claims folder shows that in December 1992, VA granted entitlement to service connection for recurrent lumbar sprain and assigned a 20 percent rating effective June 1, 1992. The Veteran did not perfect an appeal to this rating decision and it is final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. Thus, it cannot be challenged through a freestanding claim and must be dismissed. Rudd. The Board further notes that the 20 percent rating was assigned the date following discharge from active duty. As a matter of law, this is the earliest date that can be assigned. Earlier effective date for a 10 percent rating for hypertension with erectile dysfunction In February 2017, VA continued a 10 percent rating for hypertension with erectile dysfunction. The Veteran disagreed with the effective date and perfected this appeal. Review of the claims folder shows that in December 1992, VA granted entitlement to service connection for hypertension and assigned a 10 percent rating effective June 1, 1992. Erectile dysfunction was subsequently added as a noncompensable complication. The Veteran did not perfect an appeal to this rating decision and it is final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. Thus, it cannot be challenged through a freestanding claim and must be dismissed. Rudd. The Board further notes that the 10 percent rating was assigned the date following discharge from service and as a matter of law, this is the earliest date that can be assigned. Earlier effective date for a 10 percent rating for tinea cruris, tinea pedis and eczematous dermatitis of the hands In February 2017, VA continued a 10 percent rating for tinea cruris, tinea pedis and eczematous dermatitis. The Veteran disagreed with the effective date and perfected this appeal. Review of the claims folder shows that in July 2000, VA added tinea pedis and eczematous dermatitis of the hands to the already service-connected tinea cruris and assigned a 10 percent rating from July 21, 1998. The Veteran did not perfect an appeal to this rating decision and it is final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. Thus, it cannot be challenged through a freestanding claim and must be dismissed. Rudd. Earlier effective date for a noncompensable rating for genital herpes In February 2017, VA continued a noncompensable rating for genital herpes. The Veteran disagreed with the effective date and perfected this appeal. Review of the claims folder shows that in December 1992, VA granted entitlement to service connection for genital herpes and assigned a noncompensable rating effective June 1, 1992. The Veteran did not perfect an appeal to this rating decision and it is final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. Thus, it cannot be challenged through a freestanding claim and must be dismissed. Rudd. The Board further notes that the award of service connection and noncompensable rating was assigned the date following discharge from service and as a matter of law, this is the earliest date that can be assigned. Earlier effective date for a 60 percent rating for prostate cancer status post radiation therapy In February 2017, VA continued a 60 percent rating for prostate cancer status post radiation therapy. The Veteran disagreed with the effective date and perfected this appeal. Review of the claims folder shows that in October 2014, VA granted entitlement to service connection for prostate cancer status post radiation therapy and assigned a 100 percent rating from September 17, 2012 and a 60 percent rating from November 1, 2013. The Veteran did not perfect an appeal to this rating decision and it is final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. Thus, it cannot be challenged with a freestanding claim. Rudd. The Board further notes that an earlier date for the 60 percent rating would not benefit the Veteran as he was in receipt of a 100 percent rating for active cancer prior to that date. REASONS FOR REMAND As to all issues remanded, updated VA records should be obtained. 38 C.F.R. § 3.159(c)(2). Entitlement to increased ratings for tinea cruris, tinea pedis, and eczematous dermatitis; and for genital herpes In November 2016, the Veteran submitted a claim for increase. In February 2017, VA continued the 10 percent rating assigned for tinea cruris, tinea pedis, and eczematous dermatitis; and continued a noncompensable rating for genital herpes. The Veteran disagreed and perfected this appeal. In December 2016, the Veteran underwent a VA skin diseases examination. On physical examination, no visible skin disorders were noted and the genital herpes was noted to be quiescent. Review of VA records shows continued treatment related to chronic dermatitis and the Board finds that additional examination is warranted. 38 C.F.R. § 3.327; Ardison v. Brown, 6 Vet. App. 405, 408 (1994) (to the extent the Veteran’s claimed condition involves active and inactive stages, the examination should be conducted during the active stage). Entitlement to service connection for allergic rhinitis and sinusitis Evidence of record shows that the Veteran reported a history of occasional sinus infections and seasonal allergic rhinitis on examination in July 1992, shortly after discharge. VA records show continued treatment for environmental allergies and recurring sinus infections. On review, a VA examination is needed to determine whether current findings are related to active service or events therein. 38 C.F.R. § 3.159(c)(4).   Entitlement to service connection for arthralgia of the hands and wrists On VA examination in July 1992, the Veteran reported a several-year history of morning stiffness and pain in both wrists and hands. VA records indicate possible carpal tunnel syndrome and cervical radiculopathy. Hence, a VA examination is needed to determine whether the Veteran has a current disorder of the hands and wrists related to service or to any service-connected disability. 38 C.F.R. § 3.159(c)(4). Entitlement to service connection for chest pain VA most recently denied entitlement to service connection for chest pain because new and material evidence had not been submitted. As discussed, this claim is reopened herein. As the RO has not considered the claim on the merits, a remand is necessary. Hickson v. Shinseki, 23 Vet. App. 394 (2010). Entitlement to service connection for tinea manus VA records show the Veteran is treated for a skin condition of the hands that is possibly related to service or service-connected disability. On review, a VA examination is warranted. 38 C.F.R. § 3.159(c)(4). The Board further notes that the Veteran is already service-connected for eczematous dermatitis of the hands and it is unclear whether the claimed tinea manus is part of or otherwise related to that disorder. Entitlement to service connection for an acquired psychiatric disorder, to include generalized anxiety disorder and major depressive disorder VA records show treatment for anxiety and depression. A July 2017 record indicates he experiences fear and anxiety over his cancer returning. The Veteran is service-connected for prostate cancer and hence, an examination is needed to determine whether he has a current psychiatric disorder related to service-connected disability. 38 C.F.R. § 3.159(c)(4). Entitlement to separate compensable ratings for cervical and/or lumbar radiculopathy The Veteran is service-connected for cervical and lumbar disorders with each disability rated as 20 percent disabling. Per the General Rating Formula for Diseases and Injuries of the Spine, associated objective neurologic abnormalities are to be separately evaluated under an appropriate diagnostic code. Id. at Note (1). VA records show complaints related to the upper and lower extremities. An October 2015 VA record indicates evidence of bilateral C6 radiculopathy, and a bilateral L5 radiculopathy by history. The Veteran underwent VA cervical and lumbar spine examinations in December 2016. Both examinations indicated that the Veteran does not have radicular pain or symptoms due to radiculopathy. This is inconsistent with the outpatient records. Hence, additional examination is needed to determine the severity of any current cervical and/or lumbar radiculopathy. 38 C.F.R. § 3.327. Entitlement to a rating greater than 10 percent for tinnitus with vertigo In November 2016, the Veteran filed a claim for increase. In May 2017, VA continued the 10 percent rating for tinnitus with vertigo. The Veteran disagreed and perfected this appeal. He generally contends that a higher rating is warranted. Recurrent tinnitus is assigned a 10 percent rating. 38 C.F.R. § 4.87, Diagnostic Code 6260. A separate evaluation for tinnitus may be combined with an evaluation under diagnostic codes 6100, 6200, 6204, or other diagnostic code, except when tinnitus supports an evaluation under one of those diagnostic codes. Id. at Note 1. Only a single evaluation for recurrent tinnitus may be assigned, whether the sound is perceived in one ear, both ears, or in the head. Id. at Note 2. Peripheral vestibular disorders are rated as follows: occasional dizziness (10 percent); and dizziness and occasional staggering (30 percent). 38 C.F.R. § 4.87, Diagnostic Code 6204. Note to this provision indicates that objective findings supporting the diagnosis of vestibular disequilibrium are required before a compensable evaluation can be assigned under this code. Hearing impairment or suppuration shall be separated rated and combined. Id. At a March 2017 VA hearing loss examination the Veteran reported continued tinnitus that sometimes interfered with his sleep. At a VA ear conditions examination conducted that month the Veteran reported vertigo which started during service. He described episodes of nausea associated with dizziness and tinnitus. He reported hearing impairment with vertigo more than once weekly lasting less than one hour. On physical examination, the ear and tympanic membrane were normal. The appellant’s gait was normal and Romberg test was negative. The Dix Hallpike test was abnormal with the Veteran reporting vertigo. The diagnosis was listed as benign paroxysmal positional vertigo. In April 2017, the RO requested clarification noting they had reviewed all VA records and found only one acute complaint of dizziness in October 2002. All subsequent complaints of dizziness were related to Terazosin. The examiner again reviewed the electronic record and opined that the current complaints were at least as likely as not associated with Terazosin and less likely related to benign paroxysmal positional vertigo. The examiner indicated that the medication was well known to cause dizziness and that the diagnosis rendered on the March 2017 examination was in error. While the Veteran is currently receiving the maximum schedular rating for tinnitus, and while the Veteran’s complaints of dizziness do not appear to be related to vertigo, because Terazosin is a medication used for to treat urinary retention and hypertension, and because the appellant is service connected for both hypertension and a urinary disorder due to residuals of a prostatectomy further development is in order. The matters are REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records for the period from April 2018 to present. If the AOJ cannot locate any Federal records requested herein, it must specifically document the attempts that were made to locate them, and explain in writing why further attempts to locate or obtain any government records would be futile. The AOJ must then: (a) notify the claimant of the specific records that it is unable to obtain; (b) explain the efforts VA has made to obtain that evidence; and (c) describe any further action it will take with respect to the claim. The claimant must then be given an opportunity to respond. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected tinea cruris, tinea pedis, eczematous dermatitis of the hands, and genital herpes. If possible, the examination should be scheduled while the conditions are active. The Veteran’s VBMS and Virtual VA/Legacy folders must be available for review. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. The examiner must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. To the extent possible, the examiner should identify any symptoms and functional impairments due to the skin disorders alone and discuss the effect of the Veteran’s disability on any occupational functioning and activities of daily living. The examiner is to opine whether it is at least as likely as not that tinea manus is related to active service, or otherwise related to service-connected disability. If tinea manus cannot be distinguished from or is part of the already service-connected eczematous dermatitis of the hands, the examiner should so state. A complete, well-reasoned rationale must be provided for any opinion offered. If the requested opinion cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge, i.e., no one could respond given medical science and the known facts, or by a deficiency in the record or the examiner, i.e., additional facts are required, or the examiner does not have the needed knowledge or training. 3. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any allergic rhinitis and sinusitis. The Veteran’s VBMS and Virtual VA/Legacy folders must be available for review. The examiner must opine whether allergic rhinitis and sinusitis are at least as likely as not related to active service or events therein. In making this determination, the examiner is advised that the Veteran is competent to report that he experienced seasonal allergies and sinus infections during his period of service. If there is a medical basis to doubt the reported history, the examiner should explain why. A complete, well-reasoned rationale must be provided for any opinion offered. If the requested opinion cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge, i.e., no one could respond given medical science and the known facts, or by a deficiency in the record or the examiner, i.e., additional facts are required, or the examiner does not have the needed knowledge or training. 4. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any arthralgia of the hands and wrists. The Veteran’s VBMS and Virtual VA/Legacy folders must be available for review. The examiner must opine whether any diagnosed disorder is at least as likely as not related to active service or service-connected disability to include any cervical radiculopathy. In making this determination, the examiner is advised that the Veteran is competent to report that he experienced morning stiffness and pain in both wrists and hands during service. If there is a medical basis to doubt the reported history, the examiner should explain why. A complete, well-reasoned rationale must be provided for any opinion offered. If the requested opinion cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge, i.e., no one could respond given medical science and the known facts, or by a deficiency in the record or the examiner, i.e., additional facts are required, or the examiner does not have the needed knowledge or training. 5. Schedule the Veteran for a psychiatric examination to determine the nature and etiology of any acquired psychiatric disorder, to include anxiety and depression. The Veteran’s VBMS and Virtual VA/Legacy folder must be available for review. The examiner must opine whether any diagnosed psychiatric disorder is at least as likely as not related to service-connected disability, to include his fear of cancer returning. A complete, well-reasoned rationale must be provided for any opinion offered. If the requested opinion cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge, i.e., no one could respond given medical science and the known facts, or by a deficiency in the record or the examiner, i.e., additional facts are required, or the examiner does not have the needed knowledge or training. 6. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of any cervical and or lumbar radiculopathy. The Veteran’s VBMS and Virtual VA/Legacy folder must be available for review. The examiner must provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disabilities under the rating criteria. The examiner must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. To the extent possible, the examiner should identify any symptoms and functional impairments due to cervical and lumbar radiculopathy alone and discuss the effect of the disability on any occupational functioning and activities of daily living. If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, or functional impairment without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). 7. Provide an examiner access to the appellant’s VBMS and Virtual VA/Legacy files to address whether he is using Terazosin to treat a service connected disorder to include any disorder manifested by hypertension and voiding dysfunction. If so, the examiner must address whether it is at least as likely as not that the Veteran’s complaints of dizziness are associated with his use of Terazosin. If so, the examiner must address the frequency, nature and extent of any disability caused by dizziness associated with the use of Terazosin. A complete, well-reasoned rationale must be provided for any opinion offered. If the requested opinion cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge, i.e., no one could respond given medical science and the known facts, or by a deficiency in the record or the examiner, i.e., additional facts are required, or the examiner does not have the needed knowledge or training. 8. Adjudicate the reopened claim of entitlement to service connection for chest pain on the merits. DEREK R. BROWN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Carsten, Counsel