Citation Nr: 18146923 Decision Date: 11/02/18 Archive Date: 11/01/18 DOCKET NO. 18-35 123 DATE: November 2, 2018 ORDER The application to reopen the claim for service connection for a sleep disorder is granted. The application to reopen the claim for service connection for a right knee disorder is denied. The application to reopen the claim for service connection for a left knee disorder is denied. The application to reopen the claim for service connection for bronchitis is granted. The application to reopen the claim for service connection for a lumbar spine disorder is denied. Entitlement to service connection for sleep apnea is granted. Entitlement to service connection for high cholesterol is denied. Entitlement to service connection for hypertension is denied. Entitlement to a compensable initial rating for bilateral hearing loss is denied. Entitlement to an initial rating in excess of 10 percent for tinnitus is denied. Entitlement to a rating in excess of 70 percent for post-traumatic stress disorder (PTSD) is denied. Entitlement to an effective date prior to January 25, 2018, for the award of service connection for bilateral hearing loss is denied. Entitlement to an effective date prior to October 31, 2017, for the award of service connection for tinnitus is denied REMANDED Entitlement to service connection for bronchitis is remanded. FINDINGS OF FACT 1. The evidence obtained since a July 2009 final rating decision includes a diagnosis of sleep apnea which was not shown at the time of the July 2009 final decision. The new evidence raises a reasonable possibility of substantiating the claim for service connection for a sleep disorder. 2. Evidence received since a final May 2014 rating decision is cumulative of the evidence that was of record at the time of that decision and does not raise a reasonable possibility of substantiating the claim for service connection for a right knee disorder. 3. Evidence received since a final May 2014 rating decision is cumulative of the evidence that was of record at the time of that decision and does not raise a reasonable possibility of substantiating the claim for service connection for a left knee disorder. 4. The evidence obtained since a January 2015 final rating decision includes earlier diagnoses of bronchitis than shown at the time of the January 2015 final decision. The new evidence raises a reasonable possibility of substantiating the claim for service connection for bronchitis. 5. Evidence received since a final January 2015 rating decision is cumulative of the evidence that was of record at the time of that decision and does not raise a reasonable possibility of substantiating the claim for service connection for a lumbar spine disorder. 6. The Veteran has sleep apnea and it is aggravated by the medications she takes for her service-connected post-traumatic stress disorder. 7. High cholesterol is a laboratory test result, and is not a “disability” for VA purposes. 8. The Veteran first developed hypertension many years after discharge from service and her hypertension is not related to service. 9. VA audiology reports document that the Veteran has Level I hearing loss in the right ear and Level I hearing loss in the left ear. 10. The Veteran’s tinnitus is assigned a 10 percent rating, which is the maximum rating authorized under Diagnostic Code 6260. 11. The Veteran’s PTSD does not result in such symptoms as gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; and memory loss for names of close relatives, own occupation, or own name or other symptoms of similar effect. 12. The Veteran did not indicate an intent to claim service connection for hearing loss prior to January 25, 2018. 13. Subsequent to a final July 2009 rating decision that denied service connection for tinnitus, a claim to reopen was received by VA on October 31, 2017. CONCLUSIONS OF LAW 1. New and material evidence has been received to reopen the claim for service connection for a sleep disorder. 38 U.S.C. §§ 5108, 7105 (2012); 38 C.F.R. § 3.156 (2017). 2. New and material evidence has not been received to reopen the claim of service connection for a right knee disorder, including genu valgum and osteoarthritis. 38 U.S.C. §§ 5108, 7105 (2012); 38 C.F.R. § 3.156 (2017). 3. New and material evidence has not been received to reopen the claim of service connection for a left knee disorder, including osteoarthritis. 38 U.S.C. §§ 5108, 7105 (2012); 38 C.F.R. § 3.156 (2017). 4. New and material evidence has been received to reopen the claim for service connection for bronchitis. 38 U.S.C. §§ 5108, 7105 (2012); 38 C.F.R. § 3.156 (2017). 5. New and material evidence has not been received to reopen the claim of service connection for a lumbar spine disorder, including degenerative joint disease. 38 U.S.C. §§ 5108, 7105 (2012); 38 C.F.R. § 3.156 (2017). 6. The criteria for establishing service connection for sleep apnea have been met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. § 3.310 (2017). 7. The criteria for service connection for high cholesterol have not been met. 38 U.S.C. §§ 1131, 5107(b) (2012); 38 C.F.R. § 3.303 (2017). 8. The criteria for service connection for hypertension have not been met. 38 U.S.C. §§ 1101, 1112, 1113, 1116, 1131 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2017). 9. The criteria for an initial compensable evaluation for bilateral hearing loss have not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 4.85, 4.86, Diagnostic Code 6100 (2017). 10. The criteria for a rating in excess of 10 percent for tinnitus have not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.87, Diagnostic Code 6260 (2017). 11. The criteria for a rating in excess of 70 percent for PTSD have not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.130, Diagnostic Code 9411 (2017). 12. The criteria for an effective date prior to January 25, 2018, for the grant of service connection for bilateral hearing loss, have not been met. 38 U.S.C. § 5110 (2012); 38 C.F.R. § 3.400 (2017). 13. The criteria for an effective date prior to October 31, 2017, for the grant of service connection for tinnitus, have not been met. 38 U.S.C. § 5110 (2012); 38 C.F.R. § 3.400 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1981 to September 1989. Service Connection 1. Whether new and material evidence has been submitted to reopen a claim for service connection for a sleep disorder. The Veteran seeks service connection for sleep apnea. The RO denied service connection for a sleep disorder in July 2009. The Veteran did not appeal the decision. 38 U.S.C. § 7105(c) (2012); 38 C.F.R. § 20.1103 (2017). Additionally, new and material evidence had not been received prior to the expiration of the appeal period following this rating decision. 38 C.F.R. § 3.156(b). Therefore, the January 2009 rating decision is now final, and the Veteran’s claim for service connection may only be reopened if new and material evidence is received. “New” evidence means existing evidence not previously submitted to agency decision makers. “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. See Shade v. Shinseki, 24 Vet. App. 110, 118 (2010). When evaluating the materiality of newly-submitted evidence, the Board should not focus solely on whether the evidence remedies the principal reason for denial in the last prior decision, but rather should consider whether such evidence, in its entirety, could at least trigger the duty to assist by providing a medical opinion. See Shade, 24 Vet. App. at 117. Moreover, when determining whether a claim should be reopened, the credibility of any newly submitted evidence is to be presumed. See Justus v. Principi, 3 Vet. App. 510, 513 (1992). The July 2009 rating decision denied the Veteran’s claim on the basis that the record revealed no current sleep disorder. The Veteran submitted her application to reopen her claim in November 2016. The newly received evidence includes a February 2017 polysomnogram report that includes a diagnosis of obstructive sleep apnea. As this new medical evidence indicates a current sleep disorder, which was not shown at the time of the July 2009 final rating decision, the evidence is supportive of the Veteran’s claim and it is material to her claim. As new and material evidence has been received, the claim for service connection for a sleep disorder is reopened. 2. Whether new and material evidence has been submitted to reopen a claim for service connection for a right knee disorder, including genu valgum and osteoarthritis. 3. Whether new and material evidence has been submitted to reopen a claim for service connection for a left knee disorder, including osteoarthritis. The Veteran seeks service connection for right and left knee disorders. The RO denied reopening the claim for service connection for right and left knee disorders in May 2014. The Veteran did not appeal the decision. 38 U.S.C. § 7105(c) (2012); 38 C.F.R. § 20.1103 (2017). Additionally, new and material evidence had not been received prior to the expiration of the appeal period following this rating decision. 38 C.F.R. § 3.156(b). Therefore, the May 2014 rating decision is now final, and the Veteran’s claim for service connection for right and left knee disorders may only be reopened if new and material evidence is received. The evidence of record at the time of the May 2014 final rating decision included the Veteran’s STRs. The STRs contain no knee complaints or findings of any disability of either knee. On her March 1989 Report of Medical History, the Veteran denied ever having trick or locked knee and denied ever having swollen or painful joints. VA treatment records beginning in December 2008 show complaints of bilateral knee pain. A December 2008 VA treatment record indicates that the Veteran had osteoarthritis of both knees. In May 2009, a VA clinician examined the Veteran and her medical history. The Veteran was noted to have right knee degenerative changes with genu valgum. The VA examiner opined that the Veteran does not have current disability of either knee that is related to service. The May 2014 rating decision denied the Veteran’s request to reopen her claim for service connection for based on there being no nexus between the Veteran’s current right and left knee disorders and her military service. The Veteran submitted her application to reopen her claim for service connection for right and left knee disorders in October 2017. The evidence obtained since the final May 2014 rating decision includes private and VA medical records. These records confirm that the Veteran has right and left knee disability, including osteoarthritis. However, these new records are not material to the Veteran’s right and left knee claims. None of these records indicate that the Veteran developed any disability of either knee as a result of service or within a year of discharge of service. These records also do not provide any evidence to indicate that any current disability of the right or left knee is related to service in any way. Consequently, the evidence obtained since the May 2014 final decision is duplicative of the evidence of record at the time of that decision. As new and material evidence has not been received, the Veteran’s application to reopen her claim for service connection for right knee disability and her application to reopen her claim for service connection for left knee disability are denied. 4. Whether new and material evidence has been submitted to reopen a claim for service connection for bronchitis. The Veteran seeks service connection for bronchitis. The RO denied service connection for bronchitis in January 2015. The Veteran did not appeal the decision. 38 U.S.C. § 7105(c) (2012); 38 C.F.R. § 20.1103 (2017). Additionally, new and material evidence had not been received prior to the expiration of the appeal period following this rating decision. 38 C.F.R. § 3.156(b). Therefore, the January 2015 rating decision is now final, and the Veteran’s claim for service connection for bronchitis may only be reopened if new and material evidence is received. The evidence of record at the time of the January 2015 final rating decision included the Veteran’s STRs. The STRs include a March 1984 treatment record noting that the Veteran complained of coughing and shortness of breath. Upper airway congestion was noted. The January 2015 rating decision denied the Veteran’s claim for service connection for bronchitis stating that there was insufficient evidence to confirm a current diagnosis of bronchitis or its residuals. The evidence obtained since the final January 2015 rating decision includes private treatment records dated prior to January 2015, which were not of record at the time of that decision. These records show repeated treatment for bronchitis from March 2000 to December 2014. In an April 2016 letter, the Veteran stated that she first developed bronchitis during service, that she currently has chronic bronchitis, and that she has had bouts of coughing and shortness of breath ever since service due to bronchitis. As this new medical evidence indicates evidence of a current chronic bronchitis disorder and shows much earlier records of treatment for bronchitis than was shown of record at the time of the January 2015 final rating decision, the evidence is supportive of the Veteran’s claim and it is material to her claim. As new and material evidence has been received, the claim for service connection for bronchitis is reopened. 5. Whether new and material evidence has been submitted to reopen a claim for service connection for a lumbar spine disorder. The Veteran seeks service connection for a lumbar spine disorder. The RO denied reopening a claim for service connection for a lumbar spine disorder in January 2015. The Veteran did not appeal the decision. 38 U.S.C. § 7105(c) (2012); 38 C.F.R. § 20.1103 (2017). Additionally, new and material evidence had not been received prior to the expiration of the appeal period following this rating decision. 38 C.F.R. § 3.156(b). Therefore, the January 2015 rating decision is now final, and the Veteran’s claim for service connection for a lumbar spine disorder may only be reopened if new and material evidence is received. The evidence of record at the time of the January 2015 final rating decision included the Veteran’s STRs. The STRs include complaints of low back pain in August 1983, November 1983, July 1984 and December 1988. The complaints were attributed to a urinary tract infection, to a kidney infection, to muscular low back pain, and to a lifting injury. The December 1988 assessment was possible mechanical low back pain with sciatica. No back disability was noted on discharge examination in May 1989. In May 2009, a VA clinician examined the Veteran and her medical history. The diagnosis was degenerative joint disease (DJD) of the lumbar spine. The VA examiner opined that the Veteran’s DJD of the lumbar spine was not a continuation of service and was not caused or aggravated by service. Evidence obtained since the January 2015 final rating decision includes a September 2002 private medical record showing complaints of back pain due to lifting suitcases. None of evidence obtained since the January 2015 rating decision indicates that the Veteran’s current disability of the lumbar spine developed as a result of service or within a year of discharge of service. Consequently, the evidence obtained since the January 2015 final decision is duplicative of the evidence of record at that time of that decision. As new and material evidence has not been submitted, the Veteran’s application to reopen her claim for service connection for a lumbar spine disorder, to include DJD, is denied. 6. Entitlement to service connection for sleep apnea. The Veteran asserts that she is entitled to service connection for sleep apnea disability as secondary to her service-connected PTSD. The Veteran’s medical records were reviewed by a VA nurse practitioner in February 2017. The VA reviewer opined that the Veteran’s obstructive sleep apnea (OSA) is less likely than not a result of PTSD. The VA reviewer did not address the question of aggravation. In July 2018, the Veteran was interviewed by a private physician. This physician noted that she reviewed the Veteran’s records. She opined that the Veteran’s PTSD and the medications for treatment of the Veteran’s psychiatric disability have aided in the development and permanently aggravated the Veteran’s obstructive sleep apnea. The physician noted that research has shown that PTSD and other psychiatric disorders are commonly associated with OSA and cited to a medical study that found an arousal-based mechanism initiated by post-traumatic stress disorder that promotes the development of OSA Disability which is proximately due to or the result of a service-connected disease shall be service connected. 38 C.F.R. § 3.310. A disability may be found to be service connected on a secondary basis if the claimant demonstrates that the disability is either (1) proximately due to or the result of an already service-connected disease or injury or (2) aggravated by an already service-connected disease or injury. See Allen v. Brown, 7 Vet. App. 439, 448 (1995); 38 C.F.R. § 3.310. As noted above, the VA medical opinion does not address whether the Veteran’s OSA is aggravated by service-connected disability. The private physician opined that the Veteran’s OSA is aggravated by PTSD and the Veteran’s psychiatric medications. She referred to medical research that supported her opinion. On the question of aggravation there is no medical opinion to the contrary. Based on the above, the Board finds that the Veteran has OSA that is permanently aggravated by her service connected PTSD and the medication for treatment of PTSD. Accordingly, the Veteran is entitled to service connection for her sleep apnea on a secondary basis. 38 C.F.R. § 3.310. All doubt has been held in the Veteran’s favor. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 7. Entitlement to service connection for high cholesterol. The Veteran submitted a claim for service connection for high cholesterol in October 2017. Under applicable regulations, the term “disability” means impairment in earning capacity resulting from diseases and injuries and their residual conditions. 38 C.F.R. § 4.1; Hunt v. Derwinski, 1 Vet. App. 292, 296 (1991). An elevated cholesterol level represents a laboratory finding, and not a disability in and of itself for which VA compensation benefits are payable. See 61 Fed. Reg. 20440, 20445 (May 7, 1996). A clinical finding, such as high cholesterol, without a diagnosed or identifiable underlying malady or condition, does not constitute a disability for which service connection may be granted. Thus, there is no current disability manifested by high cholesterol. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) (“Congress specifically limits entitlement to service-connected disease or injury to cases where such incidents have resulted in a disability”). The Court of Appeals for Veterans Claims (Court) has held that where the law is dispositive of the claim, the claim should be denied because of lack of entitlement under the law. Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). Therefore, as there is no basis in the law to grant the Veteran’s appeal, the claim for service connection for high cholesterol must be denied. 8. Entitlement to service connection for hypertension. The Veteran submitted a claim for service connection for high blood pressure in November 2017. A review of the claims file indicates that the Veteran has provided no assertions as to why she thinks her current hypertension is related to service. The Board concludes that, while the Veteran has a diagnosis of hypertension, the preponderance of the evidence is against finding that it began during active service, or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). The Veteran’s STRs contain no diagnosis of hypertension. There were many blood pressure readings during service and none indicated elevated blood pressure. In May 1989, in preparation for discharge from service, the Veteran filled out a Report of Medical History in which she denied having or ever having had high blood pressure. A November 2006 VA treatment record indicates that the Veteran had an elevated blood pressure, 140/90. In December 2006 she was noted to be prehypertensive. Private medical records show diagnoses of hypertension from October 2008. VA treatment records from February 2013 contain diagnoses of hypertension. Service connection may also be established for a current disability on the basis of a presumption that certain chronic diseases manifesting themselves to a certain degree within a certain time after service must have had their onset in service. 38 U.S.C. §§ 1112, 1113; 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309(a). For hypertension, the disease must have manifested to a degree of 10 percent or more within one year of service. 38 C.F.R. § 3.307(a)(3). In this case, the Veteran was not diagnosed with hypertension within one year of separation from service. As such, entitlement to service connection for hypertension on a presumptive basis is not warranted. The record does not show that the Veteran experienced hypertension during service or for many years after discharge from service. The earliest reference to hypertension in the claims file is a VA treatment record in 2006 that indicates that the Veteran was prehypertensive. To the extent that the Veteran's submission of the claim indicates her belief that she has hypertension due to active duty, the Board finds this evidence to not be competent. The determination of the etiology of hypertension is a complex medical question which the Veteran is not trained to answer. Her allegations as to the etiology of her hypertension are without probative value. Here the probative evidence indicates that the Veteran did not develop hypertension during service or for many years after discharge from service. The record contains no competent evidence linking the Veteran’s current hypertension to service. Consequently, the Board finds that the preponderance of the evidence is against the Veteran’s claim for service connection for hypertension, and that service connection is not warranted. INCREASED RATING 9. Entitlement to a compensable initial rating for bilateral hearing loss. The Veteran seeks a compensable rating for bilateral hearing loss. The May 2018 rating decision on appeal granted service connection for bilateral hearing loss. The RO assigned a noncompensable initial rating effective from January 2018. A November 2017 VA audiometric evaluation revealed right ear puretone thresholds, in decibels, of 20, 20, 25, and 45 at 1000, 2000, 3000, and 4000 Hertz, respectively, with a puretone threshold four frequency average of 28 decibels. Audiometric evaluation of the left ear revealed puretone thresholds of 15, 20, 25, and 45 decibels at 1000, 2000, 3000, and 4000 Hertz, respectively, with a puretone threshold four frequency average of 26 decibels. Speech recognition ability was 98 percent on the right and 96 percent on the left. The Veteran reported difficulty understanding speech in backgrounds of noise. VA audiometric testing in October 2014 revealed right ear puretone thresholds, in decibels, of 20, 25, 15, and 20 at 1000, 2000, 3000, and 4000 Hertz, respectively, with a puretone threshold four frequency average of 20 decibels. Audiometric evaluation of the left ear revealed puretone thresholds of 20, 20, 15, and 25 decibels at 1000, 2000, 3000, and 4000 Hertz, respectively, with a puretone threshold four frequency average of 20 decibels. Speech recognition ability was 96 percent on the right and 94 percent on the left. The Veteran reported she does not hear as well as before and sometimes it seems like people are mumbling. Hearing loss disability evaluations range from noncompensable to 100 percent based on organic impairment of hearing acuity, as measured by controlled speech discrimination tests in conjunction with the average hearing threshold, as measured by puretone audiometric tests in the frequencies 1,000, 2,000, 3,000 and 4,000 cycles per second. 38 C.F.R. § 4.85. The rating schedule establishes 11 auditory acuity levels designated from Level I for essentially normal hearing acuity, through Level XI for profound deafness. VA audiometric examinations are conducted by a controlled speech discrimination test together with the results of a puretone audiometry test. The vertical lines in Table VI (in 38 C.F.R. § 4.85) represent nine categories of the percentage of discrimination based on the controlled speech discrimination test. The horizontal columns in Table VI represent nine categories of decibel loss based on the pure tone audiometry test. The numeric designation of impaired hearing (Levels I through XI) is determined for each ear by intersecting the vertical row appropriate for the percentage of discrimination and the horizontal column appropriate to the puretone decibel loss. The percentage evaluation is found from Table VII (in 38 C.F.R. § 4.85) by intersecting the vertical column appropriate for the numeric designation for the ear having the better hearing acuity and the horizontal row appropriate to the numeric designation level for the ear having the poorer hearing acuity. For example, if the better ear has a numeric designation Level of “V” and the poorer ear has a numeric designation Level of “VII,” the percentage evaluation is 30 percent. See 38 C.F.R. § 4.85. The regulations have two provisions for evaluating veterans with certain patterns of hearing impairment that cannot always be accurately assessed under § 4.85 because the speech discrimination test may not reflect the severity of communicative functioning that these veterans experience. 38 C.F.R. § 4.86(a) indicates that if puretone thresholds in each of the specified frequencies of 1000, 2000, 3000, and 4000 Hertz are 55 decibels or more, an evaluation can be based either on Table VI or Table VIa, whichever results in a higher evaluation. 38 C.F.R. § 4.86(b) indicates that when the puretone threshold is 30 decibels or less at 1000 Hertz and 70 decibels or more at 2000 Hertz, the Roman numeral designation for hearing impairment will be chosen from either Table VI or Table VIa, whichever results in the higher numeral, and that numeral will then be elevated to the next higher Roman numeral. In this case, the Veteran’s hearing loss has not meet these criteria, and the Veteran’s disability cannot be evaluated under the alternative rating scheme. With an initial rating assigned following a grant of service connection, as here, separate ratings may be assigned for separate periods of time, based on the facts found. Fenderson v. West, 12 Vet. App. 119 (1999). The November 2017 VA audiological examination reveals that the Veteran had a puretone threshold average of 28 decibels in the right ear and 26 decibels in the left ear. She had speech discrimination of 98 percent on the right and 96 percent on the left. Using Table VI, these findings are equivalent to Level I hearing loss in right ear and Level I hearing loss in the left ear. The Board notes that the using Table VI and the findings of the February 2018 audiological examination also reveals the Veteran to have Level I hearing loss in right ear and Level I hearing loss in the left ear. Considering Table VII, when there is Level I hearing loss in both ears a noncompensable rating is the maximum rating for assignment under the schedular criteria. 38 C.F.R. § 4.87 (a), Code 6100. The Board notes that ratings for hearing impairment are derived by a mechanical application of the rating schedule to the numeric designations assigned after audiometric evaluations are rendered. Lendenmann v. Principi, 3 Vet. App. 345 (1992). As shown above, the application of the rating schedule to the numeric designations of record, show that the Veteran’s bilateral hearing loss did not meet the criteria for a compensable rating. Accordingly, the Veteran is not entitled to a compensable rating for her bilateral hearing loss disability at any time since the grant of service connection. 10. Entitlement to an initial rating in excess of 10 percent for tinnitus. The December 2017 rating decision on appeal granted the Veteran service connection and a 10 percent rating for tinnitus. The Veteran’s tinnitus is rated 10 percent under Diagnostic Code 6260. Under that diagnostic code, a single 10 percent rating is assigned for tinnitus, whether the sound is perceived as being in one ear, both ears, or in the head. The maximum schedular rating available for tinnitus is 10 percent. 38 C.F.R. § 4.87; Smith v. Nicholson, 451 F.3d. 1344 (Fed. Cir. 2006). As there is no legal basis upon which to award a higher schedular rating, or separate schedular ratings for each ear, the appeal is denied. Sabonis v. Brown, 6 Vet. App. 426 (1994). The Board further finds that referral for consideration of an extraschedular rating is not warranted as the evidence regarding the Veteran’s tinnitus does not show such an exceptional disability picture that would render the available schedular rating inadequate. Thun v. Peake, 22 Vet. App. 111 (2008). The Veteran has not alleged that her tinnitus is of such a degree that the 10 percent schedular disability rating is insufficient. The evidence does not show frequent hospitalization or marked interference with employment as a result of tinnitus. Furthermore, an audiologist stated in February 2018 that the Veteran’s tinnitus did not impact the Veteran’s ordinary conditions of daily life or her ability to work. Therefore, the Board finds that the schedular rating is adequate and no referral is required for extraschedular consideration. 38 C.F.R. § 3.321(b) (2017). 11. Entitlement to a rating in excess of 70 percent for PTSD. A May 2014 rating decision granted the Veteran service connection and a 50 percent rating for PTSD. The Veteran’s claim for an increased rating was received by VA on October 31, 2017. A June 2018 rating decision granted the Veteran an increased rating of 70 percent from October 31, 2017. The Veteran continues to seek a higher rating for her PTSD. When evaluating a mental disorder, the rating agency shall consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the Veteran’s capacity for adjustment during periods of remission. The rating agency shall assign an evaluation based upon all the evidence of record that bears on occupational and social impairment, rather than solely upon the examiner’s assessment of the level of disability at the moment of the examination. When evaluating the level of disability from a mental disorder, the rating agency will consider the extent of social impairment, but shall not assign an evaluation solely on the basis of social impairment. 38 C.F.R. § 4.126 (2017). Diagnostic Code 9411 provides that a 70 percent rating is warranted where there is occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); and inability to establish and maintain effective relationships. A 100 percent rating is warranted where there is total occupational and social impairment, due to such symptoms as gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; and memory loss for names of close relatives, own occupation, or own name. 38 C.F.R. § 4.130, Diagnostic Code 9411. Ratings are assigned according to the manifestation of particular symptoms. However, the use of the term “such as” in 38 C.F.R. § 4.130 demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list, but rather are to serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. Mauerhan v. Principi, 16 Vet. App. 436 (2002). Accordingly, the evidence considered in determining the level of impairment under § 4.130 is not restricted to the symptoms provided in the diagnostic code. Instead, VA must consider all symptoms of a Veteran’s condition that affect the level of occupational and social impairment. Id. On VA examination in November 2017, the Veteran’s reported PTSD symptoms were noted to include depressed mood, anxiety, suspiciousness, disturbances of motivation and mood, an inability ot establish and maintain effective relationships and difficulty adapting to stressful circumstances, including work or a work like setting. Examination revealed the Veteran to have poor eye contact and normal speech. Her mood and affect were depressed and tearful. Her thought process was goal directed. She was alert and oriented. She denied suicidal ideation, homicidal ideation, psychotic symptoms and safety concerns. She did not seem to be responding to internal stimuli. Her insight and judgment were fair. The Board finds that the Veteran has not met the criteria for a rating in excess of 70 percent for PTSD. The medical evidence does not show that the Veteran experienced such symptoms as gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; and memory loss for names of close relatives, own occupation, or own name, or any other symptoms of similar severity. She did not exhibit any other symptoms of PTSD of the type and degree, or their effects, that would justify a 100 percent rating. The Board finds that the Veteran is not totally impaired due to PTSD. Consequently, the criteria for a 100 percent rating for PTSD have not been met at any time during the appeal period. See Hart v. Mansfield, 21 Vet. App. 505 (2007). EFFECTIVE DATE 12. Entitlement to an effective date prior to January 25, 2018 for the award of service connection for bilateral hearing loss. The May 2018 rating decision on appeal granted the Veteran service connection for bilateral hearing loss, effective from January 25, 2018. The Veteran appealed the effective date assigned but has not provided any argument as to why she believes an earlier effective date is warranted. If a claim for disability compensation is received within one year after separation from service, the effective date of entitlement is the day following separation or the date entitlement arose. 38 U.S.C. § 5110(b)(1). The Veteran did not submit a claim for service connection for hearing loss within one year of discharge from service. Accordingly, the effective date provision regarding claims received within one year after separation from service does not apply. Otherwise, VA regulations provide that the effective date is the date of receipt of the claim or the date entitlement arose, whichever is later. 38 C.F.R. § 3.400. The evidence of record indicates that the Veteran’s initial claim for service connection for hearing loss was received on January 25, 2018. The Veteran has made no assertions indicating that she filed a claim for service connection for hearing loss prior to that date. As this date is later than the date entitlement arose, it is the appropriate effective date. Accordingly, preponderance of the evidence is against the claim, and the claim for an earlier effective date must be denied. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. 13. Entitlement to an effective date prior to October 31, 2017 for the award of service connection for tinnitus. The December 2017 rating decision on appeal granted the Veteran service connection for tinnitus, effective from October 31, 2017. The Veteran appealed the effective date assigned but has not provided any argument as to why she believes an earlier effective date is warranted. Except as otherwise provided, the effective date of the award of an evaluation based on an original claim, a claim reopened after a final disallowance, or a claim for an increase will be the date of receipt of the claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. The Veteran’s initial claim for service connection for tinnitus was received in December 2008. A July 2009 rating decision denied service connection for tinnitus. The Veteran did not appeal this decision. Additionally, new and material evidence had not been received prior to the expiration of the appeal period following this rating decision. 38 C.F.R. § 3.156(b). Therefore, the December July 2009 rating decision became final. Where a prior unappealed decision becomes final, the effective date of a subsequent award of service connection is the date of receipt of the subsequently filed application to reopen, and not the date of receipt of the original claim. Leonard v. Nicholson, 405 F.3d 1333, 1337 (Fed. Cir. 2005). Subsequent to the final July 2009 rating decision denial, no claim to reopen was received prior to October 31, 2017. In this case, pursuant to the Veteran’s October 31, 2017, request, the RO reopened the Veteran’s claim for service connection for tinnitus based on new and material evidence. When new and material evidence is received after final disallowance of a claim, the effective date of an award of service connection will be the date of receipt of the new claim or the date entitlement arose, whichever is later. 38 C.F.R. § 3.400(q). In this case, the date of receipt of claim, is later than the date entitlement arose. Accordingly, the RO properly assigned the Veteran an effective date of October 31, 2017, the date of receipt of the reopened claim. Accordingly, an effective date prior to October 31, 2017, for a grant of service connection for tinnitus is not warranted. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. REASONS FOR REMAND 1. Entitlement to service connection for bronchitis is remanded. The record contains multiple post service medical records showing treatment for bronchitis, with complaints of shortness of breath and coughing. The STRs contain a March 1984 treatment record noting that the Veteran complained of coughing and shortness of breath. Considering these records and the Veteran’s report of chronic bronchitis symptoms ever since service, the Veteran must be provided a VA examination. The threshold for determining a possibility of a nexus to service is a low one. McLendon v. Nicholson, 20 Vet. App. 79 (2006). The matter is REMANDED for the following action: 1. Obtain the Veteran’s updated VA treatment records to the extent possible. 2. Afford the Veteran an appropriate examination to determine the nature and etiology of the Veteran’s reported bronchitis disability. The examiner should provide an opinion as to whether it is at least as likely as not (a 50 percent or higher likelihood) that the Veteran has had a bronchitis disability that developed during or is otherwise a result of service. The VA examiner should discuss the March 1984 STR that documents complaints of coughing and shortness of breath during service. The VA examiner should also discuss the post service medical records showing bronchitis as early as March 2000 and the Veteran’s April 2016 assertions that she had bronchitis during service, that she currently has chronic bronchitis, and that she has had bouts of coughing and shortness of breath ever since service due to bronchitis. The examiner should provide the reasons and bases for the opinions presented. G. A. WASIK Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD R. E. Jones, Counsel