Citation Nr: 18147377 Decision Date: 11/06/18 Archive Date: 11/05/18 DOCKET NO. 16-26 689 DATE: November 6, 2018 ORDER New and material evidence was not submitted, the claim to reopen a claim of entitlement to service connection for a left ankle disability is denied. Entitlement to service connection for a low back disorder is denied. Entitlement to service connection for a right ankle disorder is denied. Entitlement to service connection for a sleep disorder is denied. Entitlement to service connection for an acquired psychiatric disorder is denied. Entitlement to service connection for teeth disorder, for compensation purposes, is denied. Entitlement to a rating in excess of 10 percent, on an extraschedular basis, for bilateral tinnitus, is denied. Entitlement to an initial compensable rating for bilateral hearing loss is denied. Entitlement to an effective date prior to November 17, 2014 for the grant of entitlement to service connection for hearing loss is denied. Entitlement to an effective date prior to November 17, 2014 for the grant of entitlement to service connection for tinnitus is denied. FINDINGS OF FACT 1. In a September 1984 rating decision, the Department of Veterans Affairs (VA) Regional Office (RO) denied service connection for left ankle inversion injury. The Veteran did not appeal the September 1984 decision and new and material evidence was not received within the one-year appeal period. 2. New evidence tending to prove previously unestablished facts necessary to substantiate the underlying claim of entitlement to service connection for a left ankle disability have not been received since the September 1984 decision, and does not raise a reasonable possibility of substantiating the claim. 3. The preponderance of the competent and credible evidence of record is against finding that the Veteran’s low back disability is related to his service. Evidence shows that the Veteran suffered a post-service injury to his low back on November 1, 2009. 4. The preponderance of the competent and credible evidence of record is against finding that the Veteran has a right ankle disability which is related to his military service. 5. The medical evidence of record does not include a diagnosis of a sleep disorder, and sleep disturbance has been associated with his non-service connected low back disability. 6. The Veteran has a diagnosis of somatic symptom disorder with predominant pain. The preponderance of the competent and credible evidence of record is against finding that the Veteran has an acquired psychiatric disorder related to his military service or to a service-connected disability. 7. The Veteran does not have a current dental disability for VA compensation purposes for any teeth, including tooth #8. 8. The preponderance of the competent and credible evidence of record is against finding that the Veteran’s tinnitus warrants an extraschedular evaluation. 9. The Veteran’s hearing loss manifested in no greater than Roman Numeral I for both ears. He did not have an exceptional pattern of hearing loss. 10. The Veteran was initially denied entitlement to service connection for bilateral hearing loss in a September 1984 rating decision. He did not appeal his decision and it became final. He filed the current claim of entitlement to service connection for hearing loss on November 17, 2014. The record does not include any formal or informal claims prior to the November 17, 2014 claim date. 11. The Veteran filed the current claim of entitlement to service connection for tinnitus on November 17, 2014. The record does not include any formal or informal claims prior to the November 17, 2014 claim date. CONCLUSIONS OF LAW 1. A September 1984 rating decision that denied the Veteran’s claim for service connection for left ankle inversion injury is final. 38 U.S.C. §§ 5108, 7105 (2014); 38 C.F.R. §§ 3.156, 20.200 (2017). 2. New and material evidence has not been received to reopen the claim of service connection for a left ankle disability. 38 U.S.C. § 5108 (2014); 38 C.F.R. § 3.156 (2017). 3. The criteria for service connection for a low back disability are not met. 38 U.S.C. §§ 1111, 1131, 5107(b) (2014); 38 C.F.R. §§ 3.102, 3.303(a) (2017). 4. The criteria for service connection for a right ankle disability are not met. 38 U.S.C. §§ 1111, 1131, 5107(b) (2014); 38 C.F.R. §§ 3.102, 3.303(a) (2017). 5. The criteria for service connection for a sleep disorder are not met. 38 U.S.C. §§ 1111, 1131, 5107(b) (2014); 38 C.F.R. §§ 3.102, 3.303(a), 3.310 (2017). 6. The criteria for service connection for an acquired psychiatric disorder are not met. 38 U.S.C. §§ 1111, 1131, 5107(b) (2014); 38 C.F.R. §§ 3.102, 3.303(a), 3.310 (2017). 7. A compensable dental disability was not incurred in or aggravated by active military service, including tooth #8. 38 U.S.C. §§ 1110, 5103, 5103A, 5107 (2014); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.381, 4.150, 17.161 (2017). 8. The criteria for an extraschedular rating for tinnitus have not been met. 38 U.S.C. §§ 1155, 5107(b) (2014); 38 C.F.R. §§ 3.102, 3.321(b), 4.87, DC 6260 (2017). 9. The criteria for an initial compensable rating for bilateral hearing loss have not been met. 38 U.S.C. §§ 1155, 5107(b) (2014); 38 C.F.R. §§ 3.102, 3.321(b), 4.85, 4.86, DC 6100 (2017). 10. The criteria for an effective date earlier than November 17, 2014 for a grant of service connection for bilateral hearing loss have not been met. 38 C.F.R. § 5110 (2014); 38 C.F.R. §§ 3.102, 3.155, 3.156, 3.400 (2017). 11. The criteria for an effective date earlier than November 17, 2014 for a grant of service connection for tinnitus have not been met. 38 C.F.R. § 5110 (2014); 38 C.F.R. §§ 3.102, 3.155, 3.156, 3.400 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served in the U.S. Army from July 1980 to June 1984. These matters come before the Board of Veterans’ Appeals (Board) on appeal from an April 2015 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Houston, Texas. The Veteran now resides in Oklahoma. In addition to the issues on appeal, the April 2015 rating decision granted entitlement to service connection for tooth #8 for dental treatment purposes. The Veteran was represented by an attorney for most of his appeal. The attorney filed a motion to withdraw counsel in June 2017, and the motion was granted in September 2017. The Veteran did not obtain additional representation thereafter, and his claim is continued pro se. 1. New and material evidence was not submitted, the claim to reopen a claim of entitlement to service connection for a left ankle disability is denied. A decision of the RO becomes final and is not subject to revision on the same factual basis unless a notice of disagreement is filed within one year of the notice of the decision. 38 U.S.C. § 7105; 38 C.F.R. §§ 20.302, 20.1103. If a claim of entitlement to service connection has been previously denied and that decision became final, the claim can be reopened and reconsidered only if new and material evidence is presented with respect to that claim. 38 U.S.C. § 5108; see Manio v. Derwinski, 1 Vet. App. 140, 145 (1991). 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. 38 C.F.R. § 3.156(a). The credibility of the evidence is presumed for purposes of reopening the claim. See Justus v. Principi, 3 Vet. App. 510, 513 (1992). The threshold for reopening is low. Shade v. Shinseki, 24 Vet. App. 110, 117 (2010). The United States Court of Appeals for the Federal Circuit (Federal Circuit) has indicated that evidence may be considered new and material if it contributes “to a more complete picture of the circumstances surrounding the origin of a Veteran’s injury or disability, even where it will not eventually convince the Board to alter its ratings decision.” Hodge v. West, 115 F.3d 1356, 1363 (Fed. Cir. 1998). In September 1984, the Veteran’s claim of entitlement to service connection for left ankle inversion injury (claimed as “left ankle”) was denied. The Veteran’s claim was denied because there was no indication that he suffered a chronic left ankle disability following his in-service left ankle inversion injury, and there was no current evidence of a left ankle disability. The Veteran did not perfect an appeal to the September 1984 decision, and it became final. See 38 U.S.C. § 7105; 38 C.F.R. § 20.1100. Therefore, new and material evidence is needed to reopen the claim. See 38 U.S.C. § 5108; 38 C.F.R. § 3.156; Barnett v. Brown, 83 F. 3d 1380 (Fed. Cir. 1996). Evidence before VA at the time of the September 1984 rating decision included the Veteran’s available service treatment records and August 1984 x-rays of the left ankle. Service treatment records included that in October 1981, the Veteran fell and suffered an inversion injury to his left ankle, with swelling. An x-ray showed no abnormalities, included no fractures. The Veteran was assessed with a Grade II sprain and was placed in a cast. The Veteran remained in the cast for at least 4 weeks. After November 1981, there are no further service treatment records which address the Veteran’s left ankle, although there are other service treatment records from later dates. The Veteran’s separation physical examination and medical history are missing from his service treatment records. Post-service, the Veteran underwent x-rays in connection with his 1984 claims. A July 1984 x-ray of his left ankle was negative. Evidence that has been added to the claims file since the September 1984 rating decision include treatment records obtained for the Social Security Administration (SSA), and the Veteran’s claim/notice of disagreement/substantive appeal. SSA records do not include a specific diagnosis of a left ankle disability. The Veteran was noted to have radiation of pain from his back disability to both legs, and he was noted to have left foot drop (neurological) related to his back disability. The Veteran’s claim, notice of disagreement, and substantive appeal do not include any details or arguments related to any of his claims. He has not provided any additional details related to his left ankle, to include any statements of ongoing symptoms or treatment. The Board notes that the Veteran was represented through his substantive appeal, although he is currently not represented. No arguments were made for this claim, or his other claims. Although new evidence was added to the claims file since September 1984, the SSA treatment records are not relevant to the Veteran’s claim to reopen a claim of entitlement to service connection for a left ankle disability. The Veteran’s claim was previously denied because there was no evidence of a chronic left ankle disability in service (his left ankle disability healed without further treatment), and no evidence of a current left ankle disability (his 1984 x-rays were negative). The evidence associated with the claims file since September 1984 does not relate to a diagnosis of a left ankle disability (the SSA records show neurological disorders of the bilateral lower extremities related to a low back condition, and not any disorder of the left ankle joint), does not raise a reasonable possibility of substantiating the claim were the claim to be reopened, to include not triggering the Secretary’s duty to assist as there were no statements related to onset/treatment/diagnosis, no notation of arthritis in service or within one year of separation (negative left ankle x-ray), and the Board notes that there were not statements or arguments provided which may have related to continuity of symptomatology. See Walker v. Shinseki, 708 F. 3d 1331, 1338-9 (Fed. Cir. 2013); 38 C.F.R. § 3.156 (a). The Veteran has been represented throughout the majority of his claim period and has provided no new and material medical evidence of a current disability, a nexus between a diagnosis and service, or statements that may have provided greater detail related to his claim. As new and material evidence to reopen the previously denied claim of service connection for a left ankle disability has not been received, the benefit-of-the-doubt doctrine is inapplicable. See Annoni v. Brown, 5 Vet. App. 463, 467 (1993). Service Connection 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 military service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303 (a). Establishing service connection generally requires competent evidence of three things: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009). Service connection may also be granted for a disease first diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). Service connection for certain diseases, such as arthritis, may be also be established on a presumptive basis by showing that such a disease manifested itself to a degree of 10 percent or more within one year from the date of separation from service. 38 U.S.C. § 1112; 38 C.F.R. §§ 3.307(a)(3), 3.309(a). In such cases, the disease is presumed under the law to have had its onset in service even though there is no evidence of such disease during the period of service. 38 C.F.R. § 3.307(a). The Board notes however, that in this case, there is no medical evidence of record showing a diagnosis of arthritis within one year of service, therefore, service connection on a presumptive basis would not be warranted. Service connection may be granted on a secondary basis for disability which is proximately due to or the result of a service-connected disease or injury. See 38 C.F.R. § 3.310 (a). Any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease, will be service-connected. 38 C.F.R. § 3.310 (b). The Board must determine the value of all evidence submitted, including lay and medical evidence. See Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b); see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 2. Entitlement to service connection for a low back disorder The Veteran has filed a claim of entitlement to service connection for a back disorder. He has not provided any statements or arguments related to this claim on his claim form, notice of disagreement, or substantive appeal. As noted above, the Veteran was represented by an attorney through his substantive appeal, but counsel has withdrawn, and the Veteran continues his appeals pro se. The Veteran’s service treatment records are incomplete as his separation medical history and examination are missing. The United States Court of Appeals for Veteran's Claims (Court) has held that in cases where records once in the hands of the government are lost, the Board has a heightened obligation to explain its findings and conclusions and to consider carefully the benefit-of-the-doubt rule. See O'Hare v. Derwinski, 1 Vet. App. 365, 367 (1991). The Veteran’s available service treatment records do not include any treatment specifically for his low back. The only record which appears to vaguely related to his back is from July 1983. He stated that in early June (41 days prior), he was assaulted by 4 men who struck him on the back of the head and knocked him to the ground. He was then kicked in the back, abdomen, and head. He denied loss of consciousness and was able to walk to a taxi to go home. He reported persistent pain with guarding of the posterior lateral right thorax. The pain was exacerbated by bending at the waist and deep breathing. His pain flared recently when carrying bags from the airport. He was assessed with a probable rib fracture. He had tenderness to palpation along the posterior lateral region of the 9th and 10th ribs. The physical evaluation did not include any findings related to his back. Other than the Veteran’s service treatment records, the claims file is limited to treatment records obtained through SSA. The Veteran has not indicated he has VA treatment records, and none are contained in his claims file. He did not provide private treatment records or releases for private records. SSA records show that the Veteran was granted Social Security Disability benefits. During a hearing with the SSA, the Veteran testified that he moved to Oklahoma and began building his dream house, after years of work as a master plumber. However, he testified that he suffered a work injury on November 1, 2009 with low back pain radiating into his legs and knees. He was able to work following the injury, with injections and narcotic pain medication, but that treatment over time became less effective and he was eventually no longer able to work due to pain and his impairments. He stated that he started having falls on the job and could no longer do his work. On his SSA application, the Veteran stated that he was a master plumber for 35 years, he “could do anything, everything, now [he] can’t even bath [himself] without falling.” He stated he had been “dealing with this injury for over seven years now it [is to the] point that [he] needs help” getting around. He reported prior hobbies included horseback riding, gardening, hunting, fishing, and riding his bike; however, he could not pursue any of his hobbies now, due to his back. He stated that he was no longer able to take care of his family and “now [his] life has been destroyed due to this injury.” The Veteran described his injury as occurring when he was kneeling and using a jackhammer in a confined space (“tunnel work”). He “slipped” causing several disc injuries to his back. He stated that the injury had continuously worsened and he can no longer work. He also reported that he spent more than 30 years building his plumbing specialty work. His employment as a master plumber was listed as “heavy, skilled” by SSA. The SSA medical records include several referrals to different physicians. The Board will not relay all of the records, but they have been thoroughly reviewed. The Veteran maintained throughout his private treatment that he injured his back on November 1, 2009 while jackhammering in a confined space, and suffering a twisting injury to his back. He did not report any low back symptoms prior to his 2009 injury. In July 2014, the Veteran reported to private neurosurgeon Dr. J.M.B. that his low back pain began on November 1, 2009.” On a patient medical history form, the Veteran stated his back problems began in November 2009, and to the question “have you had this problem before?” he selected “no.” His only prior medical history that he reported was elbow surgeries in 2005 and 2006. In March 2016, during the pendency of this appeal, the Veteran reported to a private physician that his medical history included bursitis of the shoulders from 2000, a neck injury in 1960, and left elbow surgery in 2005. He did not report any prior low back injuries or diagnoses. The Veteran was not provided a VA examination in connection with his low back disability claim. Under McLendon v. Nicholson, 20 Vet. App. 79 (2006), in disability compensation (service connection) claims, the VA must provide a VA medical examination when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, and (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the Veteran’s service or with another service-connected disability, but (4) insufficient competent medical evidence on file for the VA to make a decision on the claim. With respect to the third factor, the types of evidence that “indicate” that a current disorder “may be associated” with service include, but are not limited to, medical evidence that suggests a nexus but is too equivocal or lacking in specificity to support a decision on the merits, or credible evidence of continuity of symptomatology such as pain or other symptoms capable of lay observation. Id. Here, there is no evidence of an in-service injury or disease, and the credible evidence of record indicates that his low back disability began post-service, in November 2009. In adjudicating a claim, the Board must assess the competence and credibility of the Veteran. See Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006); Washington v. Nicholson, 19 Vet. App. 362, 368-69 (2005). The Board also has a duty to assess the credibility and weight given to evidence. Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997); Wensch v. Principi, 15 Vet. App. 362, 367 (2001). The Board acknowledges that the Veteran is competent to give evidence about what he experiences. See Layno v. Brown, 6 Vet. App. 465 (1994). Competency of evidence, however, must be distinguished from weight and credibility, which are factual determinations going to the probative value of the evidence. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); see also Cartwright v. Derwinski, 2 Vet. App. 24, 25 (1991) ("although interest may affect the credibility of testimony, it does not affect competency to testify"). See also Buchanan, supra (The Board cannot determine that lay evidence lacks credibility merely because it is unaccompanied by contemporaneous medical evidence. If the Board concludes that the lay evidence presented by a veteran is credible and ultimately competent, the lack of contemporaneous medical evidence should not be an absolute bar to the veteran's ability to prove his claim of entitlement to disability benefits based on that competent lay evidence.) Here, the Veteran has not provided any direct statements or arguments related to his claim of entitlement to service connection for a low back disability. However, the Veteran did file a claim of entitlement to service connection for a low back disability despite all available medical evidence showing that his disability was related to his post-service employment. In fact, the SSA records show that the Veteran worked with Worker’s Compensation to try to obtain treatment and surgery for his low back disability. On his SSA claims form, during testimony to receive SSA disability benefits, and during all private treatment care, the Veteran related that his low back symptoms began with his November 1, 2009 injury. Before and during this appeal process, the Veteran acknowledged to SSA and private treatment records that his low back disability and symptoms began in 2009, while still attempting to receive VA benefits for his low back disability. Despite not providing direct statements or arguments in support of his claim, the Board finds the Veteran claim that his low back disability was due to service to be a showing of a lack of credibility. 3. Entitlement to service connection for a right ankle disorder The Veteran has not provided any statements or arguments related to his claim of entitlement to service connection for a right ankle disorder. The Veteran’s available service treatment records do not contain a complaint, treatment, or diagnosis related to a right ankle disability. His post-service treatment records include diagnosis of bilateral lower extremity radiculopathy related to his non-service connected low back disorder. There is no indication of a right ankle joint or ligament diagnosis. The Veteran was not provided a VA examination because the evidence does not show an in-service incident/injury/diagnosis or current diagnosis related to his right ankle. In sum, there is no credible indication of an in-service diagnosis or injury, there is no current diagnosis related to the right ankle joint, and the diagnosis of radiculopathy is associated with the non-service connected low back injury from 2009. As such, entitlement to service connection for a right ankle disability is not warranted. 4. Entitlement to service connection for a sleep disorder Again, the Veteran has not provided any statements or arguments related to his claim of entitlement to service connection for a sleep disorder, to include indicating what kind of sleep disorder he was claiming. The Veteran’s available service treatment records do not include complaints related to sleep impairment, and do not include any diagnosis with sleep impairment as a symptom. The private treatment records contained in his SSA records do not include a diagnosis of a sleep impairment, to include sleep apnea or a psychiatric disorder with a symptom of sleep impairment. The records do include the Veteran’s statement that his non-service connected low back disability caused greater discomfort when he was sitting or lying down, and the least amount of discomfort when he was walking. The Veteran was not provided a VA examination for his claimed sleep disorder as there was no in-service indication of sleep impairment, no credible indication of sleep impairment which may have begun in service, and no current diagnosis of a sleep disorder. In sum, there is no current diagnosis of a sleep disorder, no credible indication of a sleep disorder which began in service, no in-service treatment for a sleep disorder, and the limited information related to difficulty sleeping was associated with pain from the Veteran’s non-service connected low back disability. Entitlement to service connection for a sleep disorder is not warranted. 5. Entitlement to service connection for an acquired psychiatric disorder The Veteran filed a claim of entitlement to service connection for a mental health disorder. He did not elaborate as to the onset, symptoms, or diagnosis. The Veteran’s available service treatment records do not include a diagnosis of or treatment for a mental health disorder. His service treatment records include a December 1982 record that the Veteran “abused alcohol (e.g. 1 case of beer per day) and soft drugs (smoking hash 3 times a week).” He was noted to have suffered an injury to his ankle after falling while drunk. The family history included that his father was shot in a fight while drunk and his three brothers were “into alcohol and drugs,” and two sisters were “into drugs,” with the youngest sister “clean.” He was assessed with alcohol and poly-drug abuse, “[probably] alcoholic.” It does not appear that the Veteran’s alcohol and poly-drug abuse were associated with an underlying psychiatric disorder, and there is no indication that he received counseling or treatment in service. His limited service personnel records do not show that he received any sanctions or warning related to alcohol or drug use, and he was honorably discharged. There are no treatment records which may be related to a mental health disorder between his separation from service in 1984 until 2014 when he attempted to obtain surgery and additional treatment for his non-service connected low back disability. A November 2014 patient medical history provided for Dr. T.J.M. included his denial of any treatment, symptoms or diagnosis related to anxiety, depression, or “other psychiatric” conditions. In April 2016, the Veteran underwent a psychiatric evaluation by a private psychologist; he was referred for a pre-operative psychological evaluation for elective back surgery. He was noted to have a long history of chronic low back pain due to a work-related injury that occurred in November 2009. Reported back pain of an 8 out of 10 on average, very dependent on activity. Due to his pain he was unable to walk, sit, or stand for long periods. Regarding his psychiatric history, the Veteran reported that he had never seen a psychologist or other mental health provider. He felt he had a possible history of Attention Deficit Disorder, although he was never formally diagnosed. Two of his children had ADHD and he admitted to problems with concentration and focus, and he had some racing thoughts. At the time of the interview, he denied any depressive symptoms, but admitted to some mild anxiety and intermittent sleep disturbance. He denied manic episodes, suicidal/homicidal ideation, mood swings, or going for 3 or more days without sleep. He denied alcohol misuse, and denied ever drinking while taking opioids. He was injured in Texas, but lives in Oklahoma. He related that he served in the Army from 1980 to 1984 as an electronics technician on a military weapons system, but did not report to the psychologist that he had any psychiatric or emotional symptoms in service. The Veteran had some odd concerns related to the psychological testing, his First and Second Amendment rights, a misunderstanding of the Affordable Care Act related to when a mental health care worker might inquire about weapons when treating a severely mentally ill or suicidal patient, and that psychological testing would somehow jeopardize his Social Security/Medicare benefits (which was not explained in the notes). He eventually decided to fully participate in the psychological testing and clinical interview and alter apologized for his behavior. Psychological testing was consistent with “a patient with a clear preoccupation with somatic complaints consistent with chronic physical condition.” He reported mild and transient depressive symptoms. The remaining results were within normal limits. He was diagnosed with “somatic symptom disorder with predominate pain.” He was noted to have some mild depressive and anxiety symptoms, but that the symptoms were not severe enough to preclude his candidacy for elective back surgery. He was not assessed with ADD or ADHD. The Veteran was not provided with a VA examination in connection with his claim for service connection for a mental health condition. The Veteran had a current disability of “somatic symptom disorder with predominate pain.” Although he was noted to have alcohol and poly-substance abuse in service, there was no diagnosis of a mental health disorder underlying his substance abuse, and he received no treatment in-service or post service. His post-service diagnosis was linked to his pain symptoms, which were associated with his non-service connected low back disability and related diagnoses. As there was no “indication that the disability or persistent or recurrent symptoms of a disability may be associated with the Veteran’s service or with another service-connected disability,” the Board finds that a VA examination was not warranted. See McLendon, supra. In sum, the Veteran was not treated for or diagnosed with a mental health condition in service, and his current somatic symptom disorder with predominate pain was linked to his pain from his non-service connected low back disability. As such, entitlement to service connection for a mental health condition is not warranted. 6. Entitlement to service connection for teeth disorder, for compensation purposes. As noted in the introduction above, the Veteran was granted entitlement to service connection for a dental disability to tooth #8 for the purpose of obtaining VA dental treatment. He has continued the appeal of entitlement to service connection for a dental disability for compensation purposes. The Board notes that the Veteran did not indicate he was appealing the finding of entitlement to service connection for dental treatment purposes limited to tooth #8. The Veteran was represented by an attorney through his substantive appeal. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). Initially, any dental disorder at issue is not an enumerated “chronic disease” listed under 38 C.F.R. § 3.309 (a); therefore, the presumptive provisions based on “chronic” symptoms in service and “continuous” symptoms since service at 38 C.F.R. § 3.303 (b) do not apply here. Walker v. Shinseki, 708 F.3d 1331, 1338-39 (Fed. Cir. 2013). Under VA regulations, VA compensation is available for certain types of dental and oral conditions listed under 38 C.F.R. § 4.150. These conditions include loss of whole or part of the mandible, nonunion or malunion of the mandible, loss of whole or part of the ramus, loss of whole or part of the maxilla, nonunion or malunion of the maxilla, limited motion of the temporomandibular articulation, loss of the condyloid or coronoid process, or loss of any part of the hard palate. See 38 C.F.R. § 4.150, Diagnostic Codes 9900-9916. Compensation is also available for loss of teeth only if such is due to loss of substance of body of maxilla or mandible. See Simington v. West, 11 Vet. App. 41 (1998). For loss of the teeth, bone loss through trauma or disease, such as osteomyelitis, must be shown for compensable purposes. The loss of the alveolar process as a result of periodontal disease is not considered disabling. See 38 C.F.R. § 4.150, Diagnostic Code 9913. In addition, to be compensable, the lost masticatory surface for any tooth cannot be restorable by suitable prosthesis. Id. Otherwise, a Veteran may be entitled to service connection for dental conditions including treatable carious teeth, replaceable missing teeth, dental or alveolar abscesses, and periodontal disease, for the sole purposes of receiving VA outpatient dental services and treatment, if certain criteria are met. 38 U.S.C. § 1712; 38 C.F.R. §§ 3.381, 17.161. A review of the Veteran’s service treatment records included that on initial dental examination he had several teeth requiring fillings and caps. He stated that he did not want tooth #18 pulled, and he was noted to have sensitivity to tooth #19. He had apical periodontitis. A week later, a July 1980 record noted he suffered a traumatic fracture to tooth #8. In March 1981, he appeared to have been provided crowns for teeth #8 and #18. By January 1982, it appeared he had a temporary crown for tooth #8 and an all metal crown for tooth #19 was provided. By July 1982 he had a crown on tooth #19, but something happened (illegible), and so he had the crown redone in November 1982. In February 1984, he fractured his temporary crown on tooth #8, and another temporary acrylic was provided. In April 1984, he lost another temporary in March 1984, so a crown had to be remade for tooth #8. The Veteran’s non-dental service treatment records included that he was assaulted in July 1984, but do not note any tooth injuries. In March 2015, the Veteran was afforded a VA Oral and Dental conditions examination. The examiner noted that the Veteran had been diagnosed with periodontal disease. The Veteran reported that in August 1980, his teeth (numbers 7, 8, and 9) were broken, with a porcelain crown on tooth # 8, and he underwent a lower right molar root canal and crown (the crown had broken off). In 1984, the Veteran had a failed root canal on tooth #19 that caused a tumor requiring surgery and loss of the tooth. The history included that during training the Veteran was struck in the mouth with a rifle, which broke teeth # 7, 8, and 9, with tooth # 8 receiving a porcelain crown placed in August 1980. The Veteran claimed the lower right molar had a root canal and crown done while in service; the crown had since broken off. The examiner noted that continuous medication was not required for control of an oral or dental condition. He did not have any anatomical loss or boney injury of the mandible or maxilla. He had suffered anatomical loss or boney injury of teeth, but the loss of teeth was not due to loss of substance of the body of the maxilla or mandible. The loss of teeth was due to trauma from being hit in the mouth with a rifle (teeth 7, 8, and 9). The masticatory surfaces could be restored by suitable prosthesis, and tooth #8 received a crown in August 1980. Under the section “extent of loss of teeth,” the examiner noted that the Veteran had not lost the number of teeth indicated in that section (all upper teeth, all right upper and lower teeth, etc.). The examiner also noted that the Veteran was additionally missing lower left teeth 18, 19, and 20. The Veteran did not have anatomical loss or injury of the mouth, lips, or tongue. He did not have osteomyelitis or osteoradionecrosis of the mandible. He did not have a benign or malignant neoplasm or metastases related to any of his diagnoses. He did not have any scars associated with his dental conditions. Although the Veteran reported breaking teeth # 7, 8, and 9, his service treatment records only note that he had a traumatic fracture of tooth #8. Additionally, his initial dental treatment included that the Veteran did not want tooth #18 pulled, and that he had sensitivity related to tooth #19 with apical periodontitis, which is an inflammatory lesion around the apex of a tooth root. Upon review of the evidence of record, the Board concludes that the Veteran is not entitled to service connection for a compensable dental disability under 38 C.F.R. § 4.150 for any teeth, including tooth #8. The evidence of record is unremarkable for any compensable dental disability (“Class I” eligibility). See 38 C.F.R. § 17.161 (a). That is, there is no diagnosis of record for loss of whole or part of the mandible, nonunion or malunion of the mandible, loss of whole or part of the ramus, loss of whole or part of the maxilla, nonunion or malunion of the maxilla, limited motion of the temporomandibular articulation, loss of the condyloid or coronoid process, or loss of any part of the hard palate, for which service-connected compensation could be granted. See 38 C.F.R. § 4.150, Diagnostic Codes 9900-9916. In addition, although the Veteran has indicated that he fractured teeth #7, 8, and 9, and that tooth #19 suffered a failed crown resulting in the loss of those teeth, the medical records do not show that these teeth are missing due to the loss of substance of body of maxilla or mandible. The 2015 VA examination failed to reveal a diagnosis for any current compensable dental disability for any of his teeth. Although the Veteran’s #8 tooth is noted to have been “lost” through traumatic fracture, it does not involve loss of the substance of the body of the maxilla or mandible, and it is replaced by a crown. And again, the loss of the alveolar process as a result of periodontal disease is not considered disabling, to the extent the Veteran may have this condition. See 38 C.F.R. § 4.150, Diagnostic Code 9913. The existence of a current disability is the cornerstone of a claim for VA disability compensation. 38 U.S.C. § 1131; see Degmetich v. Brown, 104 F. 3d 1328, 1332 (1997) (holding that interpretation of sections 1110 and 1131 of the statute as requiring the existence of a present disability for VA compensation purposes cannot be considered arbitrary). Evidence must show that the Veteran currently has a compensable dental or oral disability for which benefits are being claimed. As the evidence does not establish that the Veteran has a current compensable dental disability during the pendency of the appeal for any teeth, including #7, 8, 9, 18, and 19, the Board finds that the Veteran is not entitled to service connection for a compensable dental disability under 38 C.F.R. § 4.150. Although the Veteran is entitled to the benefit of the doubt where the evidence is in approximate balance, the benefit of the doubt doctrine is inapplicable where, as here, the preponderance of the evidence is service connection for a dental disability for the purpose of obtaining VA compensation. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Hearing Loss and Tinnitus 7. Entitlement to a rating in excess of 10 percent, on an extraschedular basis, for bilateral tinnitus The Veteran is currently in receipt of a 10 percent rating for tinnitus. Diagnostic Code 6260, for recurrent tinnitus, provides a singular 10 percent rating for tinnitus, whether the sound is perceived in one ear, both ears, or in the head. See 38 C.F.R. § 4.87, DC 6260, Note 2. As such, the Veteran’s claim for an increased rating is an extraschedular claim. Generally, disability ratings are determined by evaluating the extent to which a veteran’s service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing his symptomatology with the criteria set forth in VA’s Rating Schedule. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. However, to accord justice in the exceptional case where the criteria in VA’s Rating Schedule is found to be inadequate, an extraschedular rating that is commensurate with the average earning capacity impairment caused by the service-connected disability is warranted. 38 C.F.R. § 3.321 (b)(1). In this regard, an extra-schedular disability rating is warranted if the case presents such an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization that application of the regular schedular standards would be impracticable. 38 C.F.R. § 3.321 (b)(1). Although the Veteran did not provide any statements or argument to VA related to his extraschedular tinnitus claim, the Board notes that during his March 2015 VA examination, the Veteran reported that his tinnitus “caused headaches.” The associated examination report not only demonstrated the objective hearing test results, which measure hearing acuity and speech recognition, but also described the functional effects caused by the hearing disabilities. See Martinak v. Nicholson, 21 Vet. App. 447, 455-56 (2007). To this end, the examination reports show that the examining clinicians found that the Veteran’s bilateral hearing loss and tinnitus either did not affect his usual occupation or daily activities. He stated that his hearing only impacted his ability to hear people who were not facing him while speaking. As relates to the Veteran’s claim that his tinnitus causes headaches, the Board finds this statement to be less than credible. Private treatment records include a November 2014 report of medical history wherein the Veteran denied frequent or recurring headaches. He asserted during his VA examination that his tinnitus began in 1984. His SSA records, including his application, did not include complaints related to headaches. The Veteran also reported to the March 2015 VA examiner that he was not exposed to hazardous noise post-service, and that he used ear plugs on occasion for his post-service employment as a plumber. The Board notes that he injured his back in November 2009 while jackhammering cement in a tunnel so small he had to use the jackhammer while on his knees. As noted above, the Veteran filed a claim of entitlement to service connection for a low back disability despite the injury occurring post-service and his repeated denial of prior back problems to SSA and private treatment providers. In addition to finding the statement less than credible, the Board notes that the Veteran is not competent to associate any headaches with his diagnosed tinnitus. The Veteran has several diagnosed disorders associated with his significant low back disability, and he is on several narcotic medications. The Veteran does not have the medical expertise to determine that his tinnitus causes any headaches he may develop. And, as noted above, he did not report headache symptoms to any of his care providers or to SSA in seeking disability benefits. In Thun v. Peake, 22 Vet. App. 111, 115-16 (2008), the Court explained how the provisions of 38 C.F.R. § 3.321 are applied. Specifically, the Court stated that the determination of whether a claimant is entitled to an extra-schedular rating under § 3.321 is a three-step, or element, inquiry. First, it must be determined whether the evidence presents such an exceptional disability picture that the available schedular evaluations for that service-connected disability are inadequate. The Court indicated that there must be a comparison between the level of severity and symptomatology of the claimant’s service-connected disability with the established criteria found in the rating schedule for that disability. Under the approach prescribed by VA, if the criteria reasonably describe the claimant’s disability level and symptomatology, then the claimant’s disability picture is contemplated by the rating schedule, the assigned schedular evaluation is, therefore, adequate, and no referral is required. Second, if the schedular evaluation does not contemplate the claimant’s level of disability and symptomatology and is found inadequate, the RO or Board must determine whether the claimant’s exceptional disability picture exhibits other related factors such as “marked interference with employment” and “frequent periods of hospitalization.” Third, when an analysis of the first two steps reveals that the rating schedule is inadequate to evaluate a claimant’s disability picture and that picture has attendant thereto related factors such as marked interference with employment or frequent periods of hospitalization, then the case must be referred to the Under Secretary for Benefits or the Director of the Compensation and Pension Service to determine whether, to accord justice, the veteran’s disability picture requires the assignment of an extra-schedular rating. Id.; see also Anderson v. Shinseki, 23 Vet. App. 423 (2009) (the Thun criteria are to be interpreted as elements rather than steps). Given that the Board finds that the Veteran is not competent or credible in reporting that his tinnitus causes headaches, the Veteran’s tinnitus is contemplated by the rating schedule in that he has recurrent tinnitus (ringing in his ears). For additional argument’s sake, the Veteran also does not meet the second Thun prong as his tinnitus does not interfere with employment or result in hospitalization. In fact, the Veteran worked for 30 years with his tinnitus (reported as beginning in 1984) without complaint or treatment according to the record. And as noted above, the Veteran has never reported headaches to recent treatment care providers or to SSA when seeking disability benefits. As such, entitlement to an extraschedular rating in excess of 10 percent for tinnitus is denied. 8. Entitlement to an initial compensable rating for bilateral hearing loss The Veteran filed a notice of disagreement with the noncompensable rating provided for his service-connected hearing loss. Hearing loss is rated based on 38 C.F.R. § 4.85, Diagnostic Code 6100, which provides criteria for evaluating hearing impairment using puretone threshold averages and speech discrimination scores. Numeric designations are assigned based upon a mechanical use of tables found in 38 C.F.R. § 4.85. Scores are then matched against Table VI to find the numeric designation, then the designations are matched with Table VII to find the percentage evaluation to be assigned for the hearing impairment. To evaluate the degree of disability from defective hearing, the Rating Schedule establishes eleven auditory acuity levels from Level I for essentially normal acuity through Level XI for profound deafness. 38 C.F.R. §§ 4.85, 4.87, Tables VI, VIa, VII. Organic impairment of hearing acuity is measured by the results of controlled speech discrimination tests together with the average hearing threshold level as measured by a pure tone audiometry test in the frequencies of 1,000, 2,000, 3,000, and 4,000 cycles per second. See 38 C.F.R. § 4.85 (a), (d). Ratings of hearing loss disability involve mechanical application of the rating criteria to the findings on official audiometry. See Lendenmann v. Principi, 3 Vet. App. 345 (1992). The schedular evaluations are intended to make proper allowance for improvement by hearing aids. 38 C.F.R. § 4.86. Exceptional patterns of hearing impairment are rated under 38 C.F.R. § 4.86. Specifically, an exceptional pattern of hearing loss is hearing loss of 55 decibels or more in each of the four specified frequencies (i.e. 1000, 2000, 3000, and 4000 Hertz), and hearing loss with a pure tone threshold of 30 decibels or less at 1000 Hertz and 70 decibels or more at 2000 Hertz. 38 C.F.R. § 4.86 (a) (b). The Veteran was afforded a VA hearing loss examination in March 2015. The pure tone thresholds, in decibels, were as follows: HERTZ 1000 2000 3000 4000 AVG RIGHT 20 30 70 60 45 LEFT 15 30 65 55 43.75 Speech audiometry revealed speech recognition ability of 96 percent in the right ear and of 98 percent in the left ear. Application of 38 C.F.R. § 4.85 Table VI to the March 2015 evaluation results in assignment of a Roman Numeral I for both ears. This results in a noncompensable rating under Table VII of 38 C.F.R. § 4.85. The measurements do not meet the criteria for an exceptional pattern of hearing under 38 C.F.R. § 4.86. The Veteran reported that the functional impact of his hearing loss was that if someone was walking away from him, he would not be able to hear what was said. He would have to ask the person to turn around and repeat himself. There are no additional treatment records related to the Veteran’s hearing loss. The VA examination is the only audiogram present in the claims file during the period on appeal. The Board has considered the Veteran’s statements with regarding to his hearing loss disability. By its very nature his disability involves a difficulty with hearing acuity. He has reported difficulty with hearing acuity, specifically difficulty with conversations when the voice is projected away from him. Thus, his reported symptoms are the very symptoms considered in the rating criteria. Based on the adequate evaluation from March 2015, the Veteran’s hearing loss disability does not warrant a compensable rating for the period on appeal. He has not provided any statements or argument related to his claim for an increased rating, to include any statements of worsening of hearing acuity during the appeal. The Board is sympathetic to his position that higher ratings are warranted, but the audiometric examination results, as compared to the rating criteria, do not warrant any greater rating. Accordingly, the Board finds that the preponderance of the evidence weighs against the increased-rating claim. Thus, the benefit-of-the-doubt doctrine is not for application. 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 9. Entitlement to an effective date prior to November 17, 2014 for the grant of entitlement to service connection for hearing loss and tinnitus. On his notice of disagreement, the Veteran indicated he wished to appeal the effective date of November 17, 2014 that was assigned for his service-connected bilateral hearing loss and tinnitus. The Veteran has not provided any argument as to why he is entitled to an earlier effective date. The Veteran’s initial claim of entitlement to service connection for hearing loss was denied in an unappealed September 1984 rating decision. The Veteran submitted a formal VA claim of entitlement to service connection for hearing loss and tinnitus on November 17, 2014. Generally, and except as otherwise provided, the effective date of an evaluation and award of pension, compensation, or dependency and indemnity compensation (DIC) based on an original claim, a claim reopened after final disallowance, or a claim for increase will be the date of receipt of the claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110 (a); 38 C.F.R. § 3.400. If a claim for disability compensation, i.e., service connection, is received within one year after separation from service, the effective date of entitlement is the day following separation from service, or else, it is (at the earliest) whenever the Veteran eventually filed a claim. 38 U.S.C. § 5110 (a), (b); 38 C.F.R. § 3.400 (b)(2). The provisions of 38 U.S.C. § 5101 (a) mandate that a claim must be filed in order for any type of benefit to be paid. Jones v. West, 136 F.3d 1296, 1299 (Fed. Cir. 1998). A “claim” includes 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). The law regarding informal claims changed, effective March 24, 2015, requiring the use of formal standard claims. This is inapplicable in this case. The date of receipt of a claim is the date on which a claim, information, or evidence is received by VA. 38 C.F.R. § 3.1 (r). The effective date for an award of benefits based upon new and material evidence is the date of receipt of the new claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110; 38 C.F.R. § 3.400 (q)(2). A claim, whether “formal” or “informal,” must be “in writing” in order to be considered a “claim” or “application” for benefits. Rodriguez v. West, 189 F.3d 1351, 1354 (Fed. Cir. 1999). Moreover, the Court has explicitly stated that the “mere presence” of a diagnosis of a specific disorder in a VA medical report “does not establish an intent on the part of the Veteran” to seek service connection for that disorder. Brannon v. West, 12 Vet. App. 32, 35 (1998); see MacPhee v. Nicholson, 459 F.3d 1323 (Fed. Cir. 2006) (VA medical examination reports standing alone can constitute informal claim only with regard to claims that previously have been granted service connection); 38 C.F.R. § 3.155. Accordingly, the mere existence of medical records in a case cannot be construed as an informal claim. Id; Ellington v. Nicholson, 22 Vet. App. 141, 145-46 (2007), aff’d Ellington v. Peake, 541 F.3d 1364 (Fed. Cir. 2008). Between the time of the unappealed September 1984 rating decision denying entitlement to service connection for hearing loss and the November 17, 2014 claim for bilateral hearing loss and tinnitus (as well as the other claims on appeal), there is nothing that can represent a formal or informal claim for benefits. No private treatment records were submitted that could be considered an informal claim, and the claims file does not contain VA treatment records, nor has the Veteran indicated that he has undergone VA treatment for hearing loss or tinnitus prior to his November 2014 claim. As the record does not contain a formal or informal claim of entitlement to service connection for bilateral hearing loss or tinnitus prior to November 14, 2017, and there are no relevant records between September 1984 (prior denial) and November 14, 2017, the claims of entitlement to an earlier effective date must be denied. KRISTI L. GUNN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M.H. Stubbs, Counsel