Citation Nr: 18148095 Decision Date: 11/06/18 Archive Date: 11/06/18 DOCKET NO. 17-36 014A DATE: November 6, 2018 ORDER Entitlement to service connection for a left-hand disability is denied. Entitlement to service connection for a sleep disorder (claimed as sleeplessness and cessation of breathing while snoring and sleeping) is denied. Entitlement to service connection for a skin disorder (claimed as hives) is denied. Entitlement to service connection for a psychiatric disorder (claimed as hypervigilance) is denied. Entitlement to an initial 20 percent rating for the service-connected left ankle lateral collateral ligament sprain is granted. Entitlement to an initial 20 percent rating for right ankle lateral collateral ligament sprain is granted. Entitlement to an initial disability evaluation in excess of 50 percent for bilateral pes planus with plantar fasciitis is denied. Entitlement to an initial 10 percent rating for residuals of coccyx spine fracture is granted. Entitlement to an initial compensable disability evaluation for bilateral hearing loss is denied. Entitlement to an initial disability evaluation in excess of 10 percent for the tinnitus is denied. Entitlement to an effective date prior to December 05, 2013 for the grant of service connection for left hip degenerative arthritis with trochanteric bursitis (including all three separate grants of disability evaluations for the left hip) is denied. Entitlement to an effective date prior to December 05, 2013 for the grant of service connection for right knee degenerative osteoarthritis is denied. Entitlement to an effective date prior to December 05, 2013 for the grant of service connection for left knee degenerative osteoarthritis is denied. Entitlement to an effective date prior to December 05, 2013 for the grant of service connection for left ankle lateral collateral ligament sprain is denied. Entitlement to an effective date prior to December 05, 2013 for the grant of service connection for right ankle lateral collateral ligament sprain is denied. Entitlement to an effective date prior to December 05, 2013 for the grant of service connection for residuals of coccyx spine fracture is denied. Entitlement to an effective date prior to December 05, 2013 for the grant of service connection for bilateral pes planus with plantar fasciitis is denied. Entitlement to an effective date prior to December 05, 2013 for the grant of service connection for bilateral hearing loss is denied. Entitlement to an effective date prior to December 05, 2013 for the grant of service connection for tinnitus is denied. Entitlement to an effective date prior to December 05, 2013 for the grant of service connection for right hip degenerative arthritis with trochanteric bursitis (including all three separate grants of disability evaluations for the right hip) is denied. REMANDED Entitlement to service connection for a right hand disability is remanded. Entitlement to service connection for a right shoulder disability is remanded. Entitlement to service connection for a left shoulder disability is remanded. Entitlement to service connection for a cervical spine disability is remanded. Entitlement to service connection for a lumbar spine disability is remanded. Entitlement to service connection for shin splints of the right leg is remanded. Entitlement to service connection for shin splints of the left leg is remanded. Entitlement to service connection for a ruptured ear drum of the right ear is remanded. Entitlement to service connection for a sinus condition is remanded. Entitlement to service connection for hemorrhoids is remanded. Entitlement to service connection for gastroesophageal reflux disorder (GERD) is remanded. Entitlement to service connection for headaches is remanded. Entitlement to service connection for a right upper extremity nerve disorder (claimed as arm and finger numbness) is remanded. Entitlement to service connection for a left upper extremity nerve disorder (claimed as arm and finger numbness) is remanded. Entitlement to an initial compensable disability evaluation for left hip degenerative arthritis with trochanteric bursitis, limitation of extension is remanded. Entitlement to an initial compensable disability evaluation for right hip degenerative arthritis with trochanteric bursitis, limitation of extension is remanded. Entitlement to an initial compensable disability evaluation for left hip degenerative arthritis with trochanteric bursitis, limitation of thigh flexion is remanded. Entitlement to an initial compensable disability evaluation right hip degenerative arthritis with trochanteric bursitis, limitation of thigh flexion is remanded. Entitlement to an initial disability evaluation in excess of 10 percent for the left hip degenerative arthritis with trochanteric bursitis, impairment of thigh is remanded. Entitlement to an initial disability evaluation in excess of 10 percent for the right hip degenerative arthritis with trochanteric bursitis, impairment of thigh is remanded. Entitlement to an initial disability evaluation in excess of 10 percent for right knee degenerative osteoarthritis is remanded. Entitlement to an initial disability evaluation in excess of 10 percent for left knee degenerative osteoarthritis is remanded. FINDINGS OF FACT 1. The most probative evidence of record indicates that the Veteran’s claimed left-hand disability is not related to service, has not been associated with any underlying diagnosis and is not otherwise accompanied by objective indications of a chronic undiagnosed disability. 2. The probative evidence of record does not show a diagnosis of a sleep disorder, (claimed as sleeplessness and cessation of breathing while snoring and sleeping) during the course of the Veteran’s claim, the Veteran’s complained of sleeplessness and cessation of breathing has not been associated with any underlying diagnosis and is not otherwise accompanied by objective indications of a chronic undiagnosed disability. 3. The probative evidence of record does not show a diagnosis of a skin condition due to dengue fever manifested by hives and/or rashes during the course of the Veteran’s claim, the Veteran’s complained of skin condition due to dengue fever has not been associated with any underlying diagnosis and is not otherwise accompanied by objective indications of a chronic undiagnosed disability. 4. The probative evidence of record does not show a diagnosis of a psychiatric disorder, to include hypervigilance during the course of the Veteran’s claim. 5. Throughout the entire period on appeal, the Veteran’s service-connected left ankle sprain more nearly approximated marked limitation of motion 6. Throughout the entire period on appeal, the Veteran’s service-connected right ankle sprain more nearly approximated marked limitation of motion. 7. The Veteran is in receipt of the maximum schedular disability evaluation for his service-connected bilateral pes planus with plantar fasciitis. 8. Throughout the entire period on appeal, the Veteran’s residuals of a coccyx spine fracture are manifested by pain and difficulty standing, sitting, twisting, lifting, walking, and bending. 9. Throughout the entire period on appeal, the Veteran’s service-connected bilateral hearing loss was manifested by no worse than Level I hearing loss bilaterally. 10. The Veteran is in receipt of the maximum schedular disability rating for his tinnitus. 11. On December 05, 2014, the Veteran filed a full developed claim, which included claims for service connection for disabilities of the bilateral feet, left knee, right knee, left hip, right hip, left ankle, right ankle, tail bone, bilateral hearing loss, and tinnitus. 12. A July 2015 rating decision granted service connection for bilateral pes planus; right hip degenerative arthritis with trochanteric bursitis, thigh impairment; right hip degenerative arthritis with trochanteric bursitis, limitation of thigh extension; right hip degenerative arthritis with trochanteric bursitis, limitation of thigh flexion; left hip degenerative arthritis with trochanteric bursitis, thigh impairment; left hip degenerative arthritis with trochanteric bursitis, limitation of thigh extension; left hip degenerative arthritis with trochanteric bursitis, limitation of thigh flexion; right knee degenerative osteoarthritis; left knee degenerative osteoarthritis; left ankle lateral collateral ligament sprain; right ankle lateral collateral ligament sprain; and residuals of coccyx spine fracture, all effective December 05, 2013. 13. An August 2015 rating decision granted service connection for bilateral hearing loss and tinnitus, effective December 05, 2013. 14. No claim for service connection for any disability, to include disabilities of the feet, hips, knees, ankles, tail bone, and hearing loss and tinnitus was received prior CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for left hand strain have not been met. 38 U.S.C. §§ 1110, 1117, 1131, 5107; 38 C.F.R. §§ 3.303, 3.317. 2. The criteria for entitlement to service connection for a sleep disorder (claimed as sleeplessness and cessation of breathing while snoring and sleeping) have not been met. 38 U.S.C. §§ 1110, 1117, 1131, 5107; 38 C.F.R. §§ 3.303, 3.317. 3. The criteria for entitlement to service connection for a skin condition (claimed as hives) have not been met. 38 U.S.C. §§ 1110, 1117, 1131, 5107; 38 C.F.R. §§ 3.303, 3.317. 4. The criteria for entitlement to service connection for a psychiatric disorder (claimed as hypervigilance) have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. 5. Throughout the appeal period, the criteria for an initial disability evaluation of 20 percent for left ankle lateral collateral ligament sprain have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.10, 4.71a, Diagnostic Code 5271. 6. Throughout the appeal period, the criteria for an initial disability evaluation of 20 percent for right ankle lateral collateral ligament sprain have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.10, 4.71a, DC 5271. 7. Throughout the entire period on appeal, the criteria for an initial disability evaluation in excess of 50 percent for bilateral pes planus with plantar fasciitis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71a, DC 5276. 8. Throughout the entire period on appeal, the criteria for an initial disability evaluation of 10 percent for residuals of coccyx spine fracture have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.10, 4.71a, DC 5298. 9. Throughout the entire period on appeal, the criteria for an initial compensable disability evaluation for bilateral hearing loss have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.85, DC 6100. 10. Throughout the entire period on appeal, the criteria for an initial disability evaluation in excess of 10 percent for tinnitus have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.87, DC 6260. 11. Throughout the entire period on appeal, the criteria for an initial disability evaluation in excess of 50 percent for bilateral pes planus with plantar fasciitis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71a, DC 5276. 12. The criteria for entitlement to an effective date prior to December 05, 2013, for the grant of service connection for left hip degenerative arthritis and trochanteric bursitis (including all three separate grants of disability evaluations for the left hip) have not been met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. § 3.400. 13. The criteria for entitlement to an effective date prior to December 05, 2013 for the grant of service connection for right knee degenerative arthritis have not been met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. § 3.400. 14. The criteria for entitlement to an effective date prior to December 05, 2013 for the grant of service connection for left knee degenerative arthritis have not been met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. § 3.400. 15. The criteria for entitlement to an effective date prior to December 05, 2013 for the grant of service connection for left ankle sprain have not been met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. § 3.400. 16. The criteria for entitlement to an effective date prior to December 05, 2013 for the grant of service connection for right ankle sprain have not been met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. § 3.400. 17. The criteria for entitlement to an effective date prior to December 05, 2013 for the grant of service connection for coccyx spine fracture have not been met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. § 3.400. 18. The criteria for entitlement to an effective date prior to December 05, 2013 for the grant of service connection for bilateral pes planus with plantar fasciitis have not been met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. § 3.400. 19. The criteria for entitlement to an effective date prior to December 05, 2013 for the grant of service connection for bilateral hearing loss have not been met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. § 3.400. 20. The criteria for Entitlement to an effective date prior to December 05, 2013 for the grant of service connection for tinnitus have not been met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. § 3.400. 21. The criteria for entitlement to an effective date prior to December 05, 2013, for the grant of service connection for right hip arthritis and trochanteric bursitis (including all three separate grants of disability evaluations for the right hip) have not been met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. § 3.400. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from March 1987 to March 2007. The Veteran served in the Special Forces, including in Iraq and Afghanistan. For his lengthy and meritorious service, the Veteran was awarded (among numerous other decorations and awards) the Bronze Star Medal, the Meritorious Service Medal, the Army Commendation Medal, the Expert Infantryman Badge, and the Master Parachutist Badge These matters come before the Board of Veterans’ Appeals (Board) on appeal from July and August 2015 rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO). This appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. §20.900(c) (2018). 38 U.S.C. § 7107(a)(2) (2012). Service Connection Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110, 1131; 38 C.F.R. § 3.303. Evidence of continuity of symptomatology from the time of service until the present is required where the chronicity of a chronic condition manifested during service either has not been established or might reasonably be questioned. 38 C.F.R. § 3.303(b); see also Walker v. Shinseki, 708 F.3d 1331, 1340 (Fed. Cir. 2013) (holding that only conditions listed as chronic diseases in § 3.309(a) may be considered for service connection under 38 C.F.R. § 3.303(b)). Regulations also provide that service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d). Generally, in order to prove service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). Moreover, where a veteran served continuously for 90 days or more during a period of war, or during peacetime service after December 31, 1946, and arthritis becomes manifest to a degree of 10 percent within one year from the date of termination of such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. See Fountain v. McDonald, 27 Vet. App. 258, 271 (2015). This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. Service connection may also be established for a Persian Gulf veteran who exhibits objective indications of a qualifying chronic disability which became manifest either during active service in the Southwest Asia theater of operations during the Persian Gulf War, or to a degree of 10 percent or more not later than December 31, 2021; and by history, physical examination, and laboratory tests cannot be attributed to any known clinical diagnosis. 38 U.S.C. § 1117; 38 C.F.R. § 3.317(a)(1). A “qualifying chronic disability” includes an undiagnosed illness or a medically unexplained chronic multisymptom illness that is defined by a cluster of signs or symptoms. 38 C.F.R. § 3.317(a)(2)(i). “Objective indications of chronic disability” include both “signs,” in the medical sense of objective evidence perceptible to an examining physician, and other, non-medical indicators that are capable of independent verification. Disabilities that have existed for 6 months or more and disabilities that exhibit intermittent episodes of improvement and worsening over a 6-month period will be considered chronic. The 6-month period of chronicity will be measured from the earliest date on which the pertinent evidence establishes that the signs or symptoms of the disability first became manifest. 38 C.F.R. § 3.317(a)(3), (4). The term “medically unexplained chronic multisymptom illness” means a diagnosed illness without conclusive pathophysiology or etiology, that is characterized by overlapping symptoms and signs and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities. Chronic multisymptom illnesses of partially understood etiology and pathophysiology, such as diabetes and multiple sclerosis, will not be considered medically unexplained. 1. Entitlement to service connection for a left-hand disability The Veteran contends that his left-hand disability is a result of his service. The Veteran has been diagnosed with a left-hand finger contusion as shown on the July 2015 VA hand and finger examination. Accordingly, the first element of service connection, a current disability, is met. Thus, to establish service connection, competent evidence linking the current disability with service is needed. However, on this question, the preponderance of the competent and probative evidence is against the claim. The Veteran’s service treatment records show in May 1989, he injured his fingers of his left hand after he ran into a wall while playing racquetball. The assessment was left hand sprain. Per a June 1989 follow-up treatment for his left hand, x-rays were negative for fracture. The assessment was probable old fracture. However, the Veteran’s October 2006 separation examination revealed no abnormalities of the left hand. Following service, as mentioned above, the Veteran was diagnosed with a left-hand finger contusion in July 2015, approximately 8 years after the Veteran’s separation from service. Pursuant to the July 2015 VA examination, the examiner opined that it was less likely than not that the Veteran’s left-hand finger contusion was due to his service in the Gulf War because this condition has a known cause. In addition, the examiner opined that the it was less likely than not that the Veteran’s left-hand finger contusion was etiologically related to service. As his reasoning, the examiner explained that there was no evidence of treatment for the left hand beyond the acute phase of healing in the Veteran’s service treatment records and there was no evidence or treatment for the condition following separation. Due to a lack of evidence and an inability to establish chronicity, it is less likely than not that the Veteran’s chronic left-hand strain is related to service. Finally, to the extent that the Veteran believes that his current left-hand disability is related to service, as a lay person, the Veteran has not shown that he has specialized training sufficient to render such an opinion. In this regard, the etiology of left-hand finger contusions is a matter that requires medical training and expertise to determine. Accordingly, his opinion as to the diagnosis or etiology of a left-hand disability is not competent evidence. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis). Thus, the Board finds the opinion of the VA examiner to be significantly more probative than the Veteran’s lay assertions. There is no medical opinion linking the Veteran’s current left-hand disability with his military service. In sum, the preponderance of the probative evidence is against a finding that the Veteran’s current left-hand disability arose during service or within the year following service, or is otherwise related to service. Accordingly, service connection is denied. In reaching the above conclusion, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claim, that doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 56 (1990). 2. Entitlement to service connection for a sleep disorder (claimed as sleeplessness and cessation of breathing while snoring and sleeping) Upon review of the record, the Board finds that there is no competent evidence showing that the Veteran has a current diagnosis of a sleep disorder, to include sleep apnea claimed as sleeplessness and cessation of breathing while snoring and sleeping during the course of his claim. Service treatment records show no complaints of or treatment for a sleep disorder during service, and an October 2006 separation examination indicates no sleep disorders. On VA examination in July 2015, a diagnosis for a chronic condition with symptoms of sleeplessness and cessation of breathing while snoring and sleeping was not provided. The VA examination indicates that there were no chronic illness conditions found upon examination that have no known cause or etiology as a result of the Veteran’s conceded exposure to environmental hazards in Southwest Asia while in service. Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability. See 38 U.S.C. §§ 1110; 1131. In the absence of proof of present disability there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); see also Degmetich v. Brown, 104 F.3d 1328 (1997) (38 U.S.C. § 1131 requires existence of present disability for VA compensation purposes); see also Wamhoff v. Brown, 8 Vet. App. 517, 521 (1996). Accordingly, service connection for a sleep disorder is denied. 3. Entitlement to service connection for a skin disorder (claimed as hives due to dengue fever) Upon review of the record, the Board finds that there is no competent evidence showing that the Veteran has a current diagnosis of a skin disability claimed as hives during the course of his claim. The Veteran underwent a VA skin examination in July 2015, during which he reported developing pruritic rash on his back and shoulders, urticaria, and contact dermatitis type rashes in 2003 while deployed in Afghanistan. He stated he has had multiple recurrences, mostly when hot and sweating. A physical examination revealed no diagnosis of a skin condition. Based on the Veteran’s reported symptoms, the examiner noted the Veteran described a rash consistent with urticaria and/or contact dermatitis, but indicated that there was no current rash reported or noted during the examination. There are no other post-service medical records contained in the claims file. The VA examination in July 2015 indicates that there were no conditions identified that have been diagnosed without a known cause that are a result of the Veteran’s presumed exposure to the environmental hazards while serving in Southwest Asia, or in Afghanistan. The examiner concluded that there was no pathology to render a diagnosis for hives, claimed as skin condition associated with dengue fever. Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability. See 38 U.S.C. §§ 1110; 1131. In the absence of proof of present disability there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); see also Degmetich v. Brown, 104 F.3d 1328 (1997) (38 U.S.C. § 1131 requires existence of present disability for VA compensation purposes); see also Wamhoff v. Brown, 8 Vet. App. 517, 521 (1996). Accordingly, service connection for hives is denied. 4. Entitlement to service connection for a psychiatric disorder (claimed as hypervigilance) Upon review of the record, the Board finds that there is no competent evidence showing that the Veteran has a current diagnosis of a psychiatric disability claimed as hypervigilance during the course of his claim. The Veteran underwent a VA mental health examination in June 2015, during which he reported difficulty initiating sleep as his mind does not stop running, reoccurring dream of IEDs, and incidents that occurred in Afghanistan. He stated he has was involved in numerous firefights that were very stressful, there were many injuries and deaths on his teams, he has the dreams about three to four times a week, occurring since 2004. However, upon examination, the examiner reported there was no diagnosis of a mental disorder. The examiner opined that the Veteran’s claimed mental health disorder was less likely than not related to his claimed hypervigilance, sleep disorder during service. Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability. See 38 U.S.C. §§ 1110; 1131. In the absence of proof of present disability there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); see also Degmetich v. Brown, 104 F.3d 1328 (1997) (38 U.S.C. § 1131 requires existence of present disability for VA compensation purposes); see also Wamhoff v. Brown, 8 Vet. App. 517, 521 (1996). Accordingly, service connection for hypervigilance is denied. Increased Rating Disability ratings are determined by applying the criteria set forth in the VA Schedule of Rating Disabilities (Rating Schedule) and are intended to represent the average impairment of earning capacity resulting from disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1 (2018). Separate diagnostic codes identify the various disabilities. Disabilities must be reviewed in relation to their history. 38 C.F.R. § 4.1. Other applicable general policy considerations are: interpreting reports of examination in light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating many accurately reflect the elements of disability; resolving any reasonable doubt regarding the degree of disability in favor of the claimant; where there is a questions as to which of two evaluations apply, assigning a higher of the two where the disability pictures more nearly approximates the criteria for the next higher rating; and, evaluating functional impairment on the basis of lack of usefulness, and the effects of the disability upon the person’s ordinary activity. See 38 C.F.R. §§ 4.2, 4.3, 4.7, 4.10 (2018); see also Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Disability of the musculoskeletal system is primarily the inability, due to damage or inflammation in parts of the system, to perform normal working movements of the body with normal excursion, strength, speed, coordination and endurance. The functional loss may be due to absence of part or all of the necessary bones, joints and muscles, or associated structures, or to deformity, adhesions, defective innervation, or other pathology, or may be due to pain, supported by adequate pathology and evidenced by visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part which becomes painful on use must be regarded as disabled. See DeLuca v. Brown, 8 Vet. App. 202 (1995); 38 C.F.R. § 4.40 (2018); see also 38 C.F.R. §§ 4.45, 4.59 (2018). Although pain may be a cause or manifestation of functional loss, limitation of motion due to pain is not necessarily rated at the same level as functional loss where motion is impeded. See Mitchell v. Shinseki, 25 Vet. App. 32 (2011). 5. Entitlement to an initial disability evaluation in excess of 10 percent for the service-connected left ankle lateral collateral ligament sprain The Veteran’s service-connected left ankle lateral collateral ligament sprain has been rated pursuant to Diagnostic Code 5271, which addresses limited motion of the ankle. Under Diagnostic Code 5271, disability evaluations of 10 and 20 percent are assignable for limited motion of the ankle that is moderate or marked, respectively. 38 C.F.R. § 4.71a, Diagnostic Code 5271. Descriptive words such as “moderate” and “marked” are not defined in the Rating Schedule. Rather than applying a mechanical formula, the Board must evaluate all of the evidence to the end that its decisions are “equitable and just.” 38 C.F.R. § 4.6. The use of descriptive terminology by medical examiners, although an element of evidence to be considered by the Board, is not dispositive of an issue. All evidence must be evaluated in arriving at a decision. 38 C.F.R. §§ 4.2, 4.6. The Veteran is seeking a higher initial rating for his service-connected left ankle sprain, which is rated as 10 percent disabling effective from December 05, 2013. The Veteran underwent a VA examination in July 2015. He did not report flare-ups of the ankle, but did report functional loss of decreased ability to stand or walk for prolonged periods and difficulty with stairs or maneuvering over uneven ground. Physical examination revealed abnormal painful range of motion of the ankle, to include pain on weight bearing, and tenderness of the anterior talofibular, deltoid, and calcaneoclavicular ligaments. In this regard, physical examination showed left ankle dorsiflexion to 10 degrees and plantar flexion to 25 degrees. There was no evidence of crepitus. However, repetitions did not cause any limitations, to include additional loss of function or range of motion. Muscle strength of the left ankle was rated as a 5/5 for plantar flexion and dorsiflexion. No muscle atrophy or ankylosis was noted. However, the examiner noted instability of the left ankle with laxity under the Talar Tilt test. The examiner reported that the Veteran did have shin splints on the left side but that this condition did not affect range of motion of the ankle or knee. The Veteran reported using a brace occasionally, but it was for his low back. X-rays at that time revealed an impression of no acute osseous abnormality of the ankle. Moreover, the examiner stated that imaging studies did not reveal arthritis. The examiner diagnosed left ankle lateral collateral ligament sprain. Further, the examiner stated that the functional impact of the Veteran’s left ankle disability was that it affected his ability to stand or walk for prolonged periods and caused him difficulty with stairs or maneuvering over uneven ground. The Board finds that symptomatology consistent with an evaluation of 20 percent for the Veteran’s left ankle lateral collateral sprain has been more nearly approximated during the course of the appeal. In this regard, his dorsiflexion was limited by half of normal and his plantar flexion was limited by nearly half of normal and the examiner noted instability. Additionally, the Veteran stated that he has difficulty standing or walking for long periods. Thus, after resolving all doubt in the Veteran’s favor, the Board find that his limitation of motion and functional impairment more nearly approximate a finding of marked limitation of motion. The Board notes a 20 percent rating is the maximum rating assignable under Diagnostic Code 5271. As ankylosis has not been shown, a higher rating pursuant to Diagnostic Code 5270 is not warranted. 6. Entitlement to an increased disability evaluation in excess of 10 percent for the service-connected right ankle lateral collateral ligament sprain The Veteran’s service-connected right ankle lateral collateral ligament sprain has been rated pursuant to Diagnostic Code 5271, which addresses limited motion of the ankle. Under Diagnostic Code 5271, disability evaluations of 10 and 20 percent are assignable for limited motion of the ankle that is moderate or marked, respectively. 38 C.F.R. § 4.71a, Diagnostic Code 5271. The Veteran is seeking a higher initial rating for his service-connected right ankle sprain, which is rated as 10 percent disabling effective from December 05, 2013. The Veteran underwent a VA examination in July 2015. He did not report flare-ups of the ankle, but did report functional loss of decreased ability to stand or walk for prolonged periods and difficulty with stairs or maneuvering over uneven ground. Physical examination revealed abnormal painful range of motion of the ankle, to include pain on weight bearing, and tenderness of the anterior talofibular, deltoid, and calcaneoclavicular ligaments, and tender posterior portion of the deltoid ligament. In this regard, physical examination showed right ankle dorsiflexion to 5 degrees and plantar flexion to 15 degrees. There was no evidence of crepitus. However, repetitions did not cause any limitations, to include additional loss of function or range of motion. Muscle strength of the right ankle was rated as a 5/5 for plantar flexion and dorsiflexion. No muscle atrophy or ankylosis was noted. However, the examiner noted instability of the right ankle with laxity. The examiner reported that the Veteran did have shin splints on the right side but that this condition did not affect range of motion of the ankle or knee. The Veteran reported using a brace occasionally, but it was for his low back. X-rays at that time revealed an impression of no acute osseous abnormality of the ankle. Moreover, the examiner stated that imaging studies did not reveal arthritis. The examiner diagnosed right ankle lateral collateral ligament sprain. Further, the examiner stated that the functional impact of the Veteran’s right ankle disability was that it affected his ability to stand or walk for prolonged periods and caused him difficulty with stairs or maneuvering over uneven ground. The Board finds that symptomatology consistent with an evaluation of 20 percent for the Veteran’s right ankle lateral collateral sprain has been more nearly approximated during the course of the appeal. In this regard, his dorsiflexion and his plantar flexion were limited by more than half of normal and the examiner noted instability. Additionally, the Veteran stated that he has difficulty standing or walking for long periods. Thus, after resolving all doubt in the Veteran’s favor, the Board find that his limitation of motion and functional impairment more nearly approximate a finding of marked limitation of motion. The Board notes a 20 percent rating is the maximum rating assignable under Diagnostic Code 5271. As ankylosis has not been shown, a higher rating pursuant to Diagnostic Code 5270 is not warranted. 7. Entitlement to an initial disability evaluation in excess of 50 percent for the service-connected bilateral pes planus with plantar fasciitis The Veteran’s service-connected bilateral pes planus with plantar fasciitis has been rated pursuant to Diagnostic Code 5276, which addresses flatfoot. Under Diagnostic Code 5276, a 50 percent evaluation is warranted for pronounced bilateral pes planus, with marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo achilles on manipulation, not improved by orthopedic shoes or appliances. 38 C.F.R. § 4.71a, Diagnostic Code 5276. The words “moderate,” “severe,” and “pronounced” are not defined in Diagnostic Code 5276. Rather than applying a mechanical formula, the Board must evaluate all of the evidence to the end that its decisions are “equitable and just.” 38 C.F.R. § 4.6. The use of descriptive terminology by medical examiners, although an element of evidence to be considered by the Board, is not dispositive of an issue. All evidence must be evaluated in arriving at a decision. 38 C.F.R. §§ 4.2, 4.6. The Veteran is seeking a higher initial rating for his service-connected bilateral pes planus with plantar fasciitis, which is rated as 50 percent disabling effective from December 05, 2013. However, upon consideration of the record the Board finds that the preponderance of the evidence is against a determination that a rating in excess of 50 percent is warranted for the Veteran’s bilateral pes planus with plantar fasciitis. On VA examination in July 2015, the Veteran reported chronic intermittent moderate pain, worse with prolonged standing or prolonged walking. He also reported that flare-ups did not impact the function of the feet. Although, he did report functional loss described as decreased ability to stand or walk for prolonged periods. The examiner indicated that pain on use of the feet was accentuated on use and on manipulation of the feet. The Veteran was noted as having characteristic calluses on both sides. Symptoms were not relieved with arch supports on either side. The Veteran was noted to have extreme tenderness of the plantar surface of both feet. There was decreased longitudinal arch height on weight-bearing on both feet. There was no objective evidence of marked deformity of the feet or marked pronation of the feet. For either foot, weight-bearing line did not fall over or medial to the great toe. The Veteran did not have “inward” bowing of the achilles tendon of either foot nor did he have marked inward displacement and severe spasm of the achilles tendon on manipulation of either foot. The examiner noted that the Veteran also had moderate bilateral tender plantar fasciae, from calcaneal origin through the mid arches. However, the condition did not compromise weight-bearing, but did require arch supports, custom orthotic inserts or shoe modifications. Pain on weight-bearing was noted upon physical examination which contributed to disturbance of locomotion for both feet. The examiner reported that pain, weakness, fatigability, or incoordination did not significantly limit functional ability during flare-ups or when the foot is used repeatedly over a period of time for both feet. X-rays at the time revealed findings of no displaced fracture, dislocation, abnormal periarticular soft tissue calcifications or substantial changed of erosive or degenerative arthritis. Skin marker was noted overlying the proximal end of the second metatarsal. The impression was no osseous abnormality of the bilateral feet. The examiner reported that there was no evidence of degenerative arthritis. The examiner noted that the functional impact of the condition on the Veteran’s ability to perform occupational tasks was a decreased ability to stand or walk for prolonged periods. The 50 percent disability evaluation assigned accounts for more severe symptomology than the Veteran’s pes planus symptomatology as detailed on the 2015 examination. In this regard, while the Veteran was noted with extreme tenderness and pain, there was no evidence of marked pronation, marked inward displacement and severe tendo achilles spasms on manipulation. In fact, the 50 percent disability evaluation accounts for the plantar fasciitis associated with the pes planus. Plantar fasciitis would be considered as other foot injury and if separately rated, would be rated analogously pursuant to Diagnostic Code 5284. Under that code, 10, 20, and 30 percent disability ratings are assigned for moderate, moderately severe, and severe foot injuries, respectively. A 40 percent rating is assigned for actual loss of use of the foot. 38 C.F.R. § 4.71a, Diagnostic Code 5284 (2018). Here, the 2015 examiner described the Veteran’s plantar fasciitis as moderate, which corresponds to a 20 percent disability evaluation. Accordingly, the single 50 percent disability evaluation pursuant to Diagnostic Code 5276 most appropriately accounts for the Veteran’s symptomology of bilateral pes planus with plantar fasciitis as detailed on the 2015 examination. The Board has also considered whether the Veteran’s disability would warrant a higher disability rating under other diagnostic codes pertaining to the foot but finds that the criteria pertaining to bilateral weak foot, claw feet (pes cavus), metatarsalgia, hallux rigidus, hammer toe, or malunion or nonunion of the tarsal or metatarsal bones, under Diagnostic Codes 5277, 5278, 5279, 5281, 5282, and 5283, respectively are either not applicable or would not provide a higher rating. Therefore, the Board finds that as the Veteran has been receiving the maximum schedular rating for bilateral pes planus with plantar fasciitis under Diagnostic Code 5276, an initial rating in excess of 50 percent for bilateral pes planus with plantar fasciitis is not warranted. 8. Entitlement to an initial compensable disability evaluation for the service-connected residuals of coccyx spine fracture The Veteran seeks an initial compensable rating for his service-connected residuals of coccyx spine fracture, which are currently evaluated as noncompensable under 38 C.F.R. § 4.71a, Diagnostic Code 5299-5298. Pursuant to 38 C.F.R. § 4.27, hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the evaluation assigned; the additional code is shown after the hyphen; unlisted disabilities requiring rating by analogy will be coded first with the numbers of the most closely related body part and “99.” Hence, the Veteran’s residuals of coccyx spine fracture have been evaluated by analogy, using the criteria for removal of the coccyx under 38 C.F.R. § 4.71a, DC 5298. Under Diagnostic Code 5298, a noncompensable evaluation is assigned for partial or complete removal of the coccyx, without painful residuals, and a maximum 10 percent evaluation is assigned for removal of the coccyx with painful residuals. 38 C.F.R. § 4.71a, DC 5299-5298. During the Veteran’s July 2015 VA thoracolumbar spine examination, the Veteran reported persistent paresthesias over coccyx and moderate to severe pain, worse with prolonged sitting, standing, twisting, lifting weights, walking, and bending which had gotten progressively worse since his separation from service, and difficulty sitting, standing, and bending. The RO has assigned a noncompensable rating under Diagnostic Codes 5298, because the Veteran’s disability is considered analogous to removal of the coccyx. Although the Veteran has not had a partial or complete removal of his coccyx, the Board finds that he does have a disability of the coccyx with residual pain. A noncompensable disability evaluation is assigned under 5298 when there are no painful residuals but, in this case, the Veteran does experience pain as well as difficulty sitting, standing, and bending. Accordingly, the Board finds that the disability picture more nearly approximates the schedular criteria for the (maximum) 10 percent rating under Code 5298. 9. Entitlement to an initial compensable disability evaluation for the service-connected bilateral hearing loss Evaluations of defective hearing range from noncompensable to 100 percent based on organic impairment of hearing acuity as measured by the results of a controlled speech discrimination test (Maryland CNC) together with the average hearing threshold level measured by pure tone audiometry tests in the frequencies of 1000, 2000, 3000, and 4000 Hertz (“specified frequencies”). To evaluate the degree of disability from service-connected defective hearing, the rating schedule establishes 11 auditory hearing acuity levels designated from Level I, for essentially normal hearing acuity, through Level XI, for profound deafness. 38 C.F.R. § 4.85, Tables VI and VII, Diagnostic Code 6100. Disability ratings for hearing loss are derived from a mechanical application of the rating schedule to the numeric designations resulting from audiometric testing. See Lendenmann v. Principi, 3 Vet. App. 345 (1992). Audiological examinations used to measure impairment must be conducted by a state-licensed audiologist and must include both a controlled speech discrimination test (Maryland CNC) and pure tone audiometric tests. 38 C.F.R. § 4.85(a). Under 38 C.F.R. § 4.86, when the pure tone threshold at each of the four specified frequencies (1000, 2000, 3000, and 4000 Hertz) is 55 decibels or more, the rating specialist will determine the Level designation for hearing impairment from either Table VI or Table VIA, whichever results in the higher numeral. 38 C.F.R. § 4.86 (2018). Further, when the pure tone threshold is 30 decibels at 1000 Hertz and 70 decibels or more at 2000 Hertz, the rating specialist will determine the Level designation for hearing impairment from either Table VI or Table VIA, whichever results in the higher numeral. That numeral will then be elevated to the next higher Level. 38 C.F.R. § 4.86(b). Each ear is considered separately. 38 C.F.R. § 4.86. The use of Table VIA is also appropriate when an examiner certifies that use of a speech discrimination test is not appropriate. 38 C.F.R. § 4.85. The Veteran is seeking an initial compensable rating for his service-connected bilateral hearing loss. Service connection for bilateral hearing loss was established in an August 2015 rating decision. In conjunction with his claim, a VA examination was conducted in August 2015. Audiometric testing showed pure tone thresholds of 20, 20, 25, and 55 decibels in the Veteran’s right ear and 20, 20, 30, and 35 decibels in his left ear at the specified frequencies. Average pure tone thresholds were 30 decibels in the right ear and 26 decibels in the left ear. Speech recognition scores were 96 percent in the right ear and 92 percent in the left ear. The examining audiologist noted the significant effects from the Veteran’s bilateral hearing loss on his usual occupation and activities of daily living included the Veteran not being able to understand what people are saying to him, especially in the presence of background noise, that he often needs people to repeat what they have said to him, having a hard time hearing over the telephone, and that his wife tells him he “talks too loud.” Applying the results of the audiological testing to Table VI yields a finding of Level I hearing loss bilaterally. Accordingly, a noncompensable evaluation is warranted under Table VII. The Board sympathizes with the Veteran’s complaints regarding the functional impact of his hearing loss on his daily life. However, the assignment of disability ratings for hearing impairment is derived from a mechanical formula based on levels of pure tone threshold average and speech discrimination. Thus, the medical evidence of record is more probative than lay contentions as to the extent of the Veteran’s hearing loss. The Board finds the VA examination in particular, to be highly probative, and notes that it was conducted in accordance with 38 C.F.R. § 4.85(a). Moreover, the VA examiner addressed the effects of the Veteran’s hearing loss on his daily activities and occupational functioning. Martinak v. Nicholson, 21 Vet. App. 447, 455-56 (2007). In sum, the most probative evidence of record reflects findings consistent with a noncompensable rating for bilateral hearing loss throughout the period on appeal. Accordingly, entitlement to an initial compensable rating for bilateral hearing loss is not warranted. 10. Entitlement to an initial disability evaluation in excess of 10 percent for the service-connected tinnitus The Veteran contends that tinnitus should be rated higher than the currently assigned 10 percent disability rating. Service connection for tinnitus was granted by the RO in an August 2015 rating decision. Tinnitus is rated under 38 C.F.R. § 4.87, Diagnostic Code 6260, which provides a maximum 10 percent evaluation for recurrent tinnitus. 38 C.F.R. § 4.87, Diagnostic Code 6260. Note (2) provides that a single evaluation for recurrent tinnitus is to be assigned, whether tinnitus is present in one or both ears. Id. A higher evaluation for tinnitus is not available in the Rating Schedule. The Board has reviewed the evidence of record and finds that a disability rating in excess of 10 percent for tinnitus is not warranted during the appeal. Specifically, the Veteran is already in receipt of the maximum schedular disability rating for his tinnitus. During the August 2015 VA audiology examination, the examiner noted the Veteran with tinnitus associated with hearing loss. The Veteran reported that he felt he does not hear as well when his ears are ringing. In sum, as 10 percent is the maximum schedular rating for tinnitus, a higher evaluation for that disability is denied. Effective Date An award of service connection will be effective on the day following separation from active military service or the date on which entitlement arose if the claim is received within one year of separation from service. Otherwise, except as provided, the effective date of an evaluation and award for pension, compensation, or dependency and indemnity compensation based on an original claim, a claim reopened after a final disallowance, or a claim for increase will be the date of receipt of the claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400 (2018). 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) (2018). A formal claim is a specific claim in the form prescribed by the Secretary. 38 C.F.R. § 3.151 (2018). Also, any communication or action indicating the intent to apply for a benefit under the laws administered by the VA may be considered an informal claim, provided that it identifies generally, although not necessarily with specificity, the benefit sought. 38 C.F.R. §§ 3.1(p), 3.155. The term “date entitlement arose” is not defined in the current statute or regulation. However, the United States Court of Appeals for Veterans Claims (Court) has interpreted it as the date when the claimant met the requirements for the benefits sought. This is determined on a “facts found” basis. See 38 U.S.C. § 5110(a). Under the provisions of Public Law No. 112-154, Section 506, now codified at 38 U.S.C. § 5010, an effective date for an original application may be backed up for one year prior to the receipt of the application, providing other pertinent conditions are met. See 38 U.S.C. § 5010. 11. Entitlement to an effective date prior to December 05, 2013 for the grant of service connection for left hip degenerative arthritis with trochanteric bursitis (including all three separate grants of disability evaluations for the left hip) The record reveals that the Veteran submitted a fully developed claim which was received by VA on December 05, 2014, which included the claim for service connection for a left hip disability. The Veteran was awarded service connection for left hip arthritis and trochanteric bursitis (to include limitation of flexion, limitation of extension, and thigh impairment) from December 05, 2013, which was one year prior to the date the Veteran’s application form was received. He was informed that this effective date was awarded pursuant to Section 506 of Public Law 112-154. Those provisions, now codified at 38 U.S.C. § 5010, provide for a one-year retroactive award from the date of the receipt of the application. Thus, the date of December 05, 2013 is properly assigned. Accordingly, the Veteran is not entitled to an effective date of prior to December 05, 2013. 12. Entitlement to an effective date prior to December 05, 2013 for the grant of service connection for right knee degenerative osteoarthritis The record reveals that the Veteran submitted a fully developed claim which was received by VA on December 05, 2014, which included the claim for service connection for a right knee disability. The Veteran was awarded service connection for right knee degenerative osteoarthritis from December 05, 2013, which was one year prior to the date the Veteran’s application form was received. He was informed that this effective date was awarded pursuant to Section 506 of Public Law 112-154. Those provisions, now codified at 38 U.S.C. § 5010, provide for a one-year retroactive award from the date of the receipt of the application. Thus, the date of December 05, 2013 is properly assigned. Accordingly, the Veteran is not entitled to an effective date of prior to December 05, 2013. 13. Entitlement to an effective date prior to December 05, 2013 for the grant of service connection for left knee degenerative osteoarthritis The record reveals that the Veteran submitted a fully developed claim which was received by VA on December 05, 2014, which included the claim for service connection for a left knee disability. The Veteran was awarded service connection for left knee degenerative osteoarthritis from December 05, 2013, which was one year prior to the date the Veteran’s application form was received. He was informed that this effective date was awarded pursuant to Section 506 of Public Law 112-154. Those provisions, now codified at 38 U.S.C. § 5010, provide for a one-year retroactive award from the date of the receipt of the application. Thus, the date of December 05, 2013 is properly assigned. Accordingly, the Veteran is not entitled to an effective date of prior to December 05, 2013. 14. Entitlement to an effective date prior to December 05, 2013 for the grant of service connection for left ankle lateral collateral ligament sprain The record reveals that the Veteran submitted a fully developed claim which was received by VA on December 05, 2014, which included the claim for service connection for a left ankle disability. The Veteran was awarded service connection for left ankle lateral collateral ligament sprain from December 05, 2013, which was one year prior to the date the Veteran’s application form was received. He was informed that this effective date was awarded pursuant to Section 506 of Public Law 112-154. Those provisions, now codified at 38 U.S.C. § 5010, provide for a one-year retroactive award from the date of the receipt of the application. Thus, the date of December 05, 2013 is properly assigned. Accordingly, the Veteran is not entitled to an effective date of prior to December 05, 2013. 15. Entitlement to an effective date prior to December 05, 2013 for the grant of service connection for right ankle lateral collateral ligament sprain The record reveals that the Veteran submitted a fully developed claim which was received by VA on December 05, 2014, which included the claim for service connection for a right ankle disability. The Veteran was awarded service connection for right ankle lateral collateral ligament sprain from December 05, 2013, which was one year prior to the date the Veteran’s application form was received. He was informed that this effective date was awarded pursuant to Section 506 of Public Law 112-154. Those provisions, now codified at 38 U.S.C. § 5010, provide for a one-year retroactive award from the date of the receipt of the application. Thus, the date of December 05, 2013 is properly assigned. Accordingly, the Veteran is not entitled to an effective date of prior to December 05, 2013. 16. Entitlement to an effective date prior to December 05, 2013 for the grant of service connection for residuals of coccyx spine fracture The record reveals that the Veteran submitted a fully developed claim which was received by VA on December 05, 2014, which included the claim for service connection for a tailbone disability. The Veteran was awarded service connection for residuals of coccyx spine fracture from December 05, 2013, which was one year prior to the date the Veteran’s application form was received. He was informed that this effective date was awarded pursuant to Section 506 of Public Law 112-154. Those provisions, now codified at 38 U.S.C. § 5010, provide for a one-year retroactive award from the date of the receipt of the application. Thus, the date of December 05, 2013 is properly assigned. Accordingly, the Veteran is not entitled to an effective date of prior to December 05, 2013. 17. Entitlement to an effective date prior to December 05, 2013 for the grant of service connection for bilateral pes planus with plantar fasciitis The record reveals that the Veteran submitted a fully developed claim which was received by VA on December 05, 2014, which included the claim for service connection for a bilateral foot disability. The Veteran was awarded service connection for bilateral pes planus with plantar fasciitis from December 05, 2013, which was one year prior to the date the Veteran’s application form was received. He was informed that this effective date was awarded pursuant to Section 506 of Public Law 112-154. Those provisions, now codified at 38 U.S.C. § 5010, provide for a one-year retroactive award from the date of the receipt of the application. Thus, the date of December 05, 2013 is properly assigned. Accordingly, the Veteran is not entitled to an effective date of prior to December 05, 2013. 18. Entitlement to an effective date prior to December 05, 2013 for the grant of service connection for bilateral hearing loss The record reveals that the Veteran submitted a fully developed claim which was received by VA on December 05, 2014, which included the claim for service connection for bilateral hearing loss. The Veteran was awarded service connection for bilateral hearing loss from December 05, 2013, which was one year prior to the date the Veteran’s application form was received. He was informed that this effective date was awarded pursuant to Section 506 of Public Law 112-154. Those provisions, now codified at 38 U.S.C. § 5010, provide for a one-year retroactive award from the date of the receipt of the application. Thus, the date of December 05, 2013 is properly assigned. Accordingly, the Veteran is not entitled to an effective date of prior to December 05, 2013. 19. Entitlement to an effective date prior to December 05, 2013 for the grant of service connection for tinnitus The record reveals that the Veteran submitted a fully developed claim which was received by VA on December 05, 2014, which included the claim for service connection for tinnitus. The Veteran was awarded service connection for tinnitus from December 05, 2013, which was one year prior to the date the Veteran’s application form was received. He was informed that this effective date was awarded pursuant to Section 506 of Public Law 112-154. Those provisions, now codified at 38 U.S.C. § 5010, provide for a one-year retroactive award from the date of the receipt of the application. Thus, the date of December 05, 2013 is properly assigned. Accordingly, the Veteran is not entitled to an effective date of prior to December 05, 2013. 20. Entitlement to an effective date prior to December 05, 2013 for the grant of service connection for right hip degenerative arthritis with trochanteric bursitis (including all three grants of disability evaluations for the right hip) The record reveals that the Veteran submitted a fully developed claim which was received by VA on December 05, 2014, which included the claim for service connection for a right hip disability. The Veteran was awarded service connection for right hip arthritis and trochanteric bursitis (to include limitation of flexion, limitation of extension, and thigh impairment) from December 05, 2013, which was one year prior to the date the Veteran’s application form was received. He was informed that this effective date was awarded pursuant to Section 506 of Public Law 112-154. Those provisions, now codified at 38 U.S.C. § 5010, provide for a one-year retroactive award from the date of the receipt of the application. Thus, the date of December 05, 2013 is properly assigned. Accordingly, the Veteran is not entitled to an effective date of prior to December 05, 2013. REASONS FOR REMAND 1. Entitlement to service connection for a right-hand disability is remanded. Although not noted on his December 1986 enlistment examination, the Veteran reported that he broke his right little finger as a child. Moreover, although the Veteran underwent VA hand and finger examination in 2015, in providing the medical opinion, the examiner failed to address the Veteran’s reported preexisting broken right little finger. Accordingly, the Board finds an addendum medical opinion is needed. 2. Entitlement to service connection for a right upper extremity nerve disorder (claimed as arm and finger numbness) is remanded. 3. Entitlement to service connection for a left upper extremity nerve disorder (claimed as arm and finger numbness) is remanded. The Veteran reported paresthesias during his 2006 separation examination. Moreover, although the Veteran underwent VA peripheral nerve examination in 2015, in providing the medical opinion, the examiner failed to address the Veteran’s reported paresthesias. Accordingly, the Board finds an addendum medical opinion is needed. 4. Entitlement to service connection for a right shoulder disability is remanded. 5. Entitlement to service connection for a left shoulder disability is remanded. The Veteran underwent VA shoulder examination in 2015. However, while the medical opinion is of record, the physical examination is not. Accordingly, on remand, the 2015 VA examination should be associated with the claims file. 6. Entitlement to service connection for a cervical spine disability (claimed as upper back and neck) is remanded. The Veteran underwent VA spine examination in 2015. While the medical opinion is of record, the physical examination is not. Accordingly, on remand, the 2015 VA physical examination should be associated with the claims file. 7. Entitlement to service connection for a lumbar spine disability is remanded. The Veteran underwent a VA spine examination in July 2015. However, in providing the opinion, the examiner failed to address the Veteran’s in-service complaints of lower back pain. In this regard, in April 1989, he complained of lower back pain after participating in a road march. Further, upon his October 2006 separation examination, lower back pain with sacral paresthesias was noted. The Veteran was diagnosed with lumbago in 2006. In light of the above, the Board finds an addendum medical opinion is needed. 8. Entitlement to service connection for shin splints of the right leg is remanded. The Veteran underwent VA knee examination in 2015. While the medical opinion is of record, the physical examination is not. Accordingly, on remand, the 2015 VA physical examination should be associated with the claims file. 9. Entitlement to service connection for shin splints of the left leg is remanded. The Veteran underwent a VA knee examination in 2015. While the medical opinion is of record, the physical examination is not. Accordingly, on remand, the 2015 VA physical examination should be associated with the claims file. 10. Entitlement to service connection for a ruptured ear drum of the right ear is remanded. The Veteran underwent VA ear conditions examination in 2015. While the medical opinion is of record, the physical examination is not. Accordingly, on remand, the 2015 VA examination should be associated with the claims file. 11. Entitlement to service connection for a sinus condition is remanded. The Veteran contends his sinus condition is related to service. His service treatment records show that in May 1988, the Veteran presented for treatment of a head cold and the clinician noted that he also had a sinus problem for the past two days. In September 1994 after being deployed to Rwanda, he reported that he developed fever and chills. The assessment was “FUO (fever of unknown origin)/rule out sinusitis.” Thereafter, a March 1995 sinus series revealed an impression of maxillary mucosal retention cyst sinusitis. The Veteran has not been provided a VA examination in connection with his claim for service connection and the Board finds such would be helpful in adjudicating his claim. Accordingly, the Veteran should be afforded VA sinus examination upon remand. 12. Entitlement to service connection for hemorrhoids is remanded. The Veteran contends his hemorrhoids are related to service. His service treatment records show that upon his October 2006 separation examination, he was diagnosed with hemorrhoids. The Veteran has not been provided a VA examination in connection with his claim for service connection and the Board finds such would be helpful in adjudicating his claim. Accordingly, the Veteran should be afforded a VA examination upon remand. 13. Entitlement to service connection for gastroesophageal reflux disorder (GERD) is remanded. The 2015 examiner provided a negative nexus opinion regarding the Veteran’s claim. In this regard, the examiner opined in pertinent part, that there was no evidence of heartburn with reflux in the Veteran’s service treatment records. However, the Board notes that during service the Veteran was treated for and diagnosed with GERD in September 1989 and gastrointestinal spasm in May 1991. In light of the above, an addendum opinion should be obtained to address the in-service treatment for and diagnoses of GERD and gastrointestinal spasm. 14. Entitlement to service connection for headaches is remanded. The 2015 examiner provided a negative nexus opinion regarding the Veteran’s claim. In this regard, the examiner opined in pertinent part, that there was no evidence of headaches in the Veteran’s service treatment records. However, the Board notes that the Veteran complained of headaches in September 1989. In light of the above, an addendum opinion should be obtained to address the in-service complaints of headaches. 15. Entitlement to an initial compensable disability evaluation for the service-connected left hip degenerative arthritis with trochanteric bursitis, limitation of extension is remanded. 16. Entitlement to an initial compensable disability evaluation for the service-connected right hip degenerative arthritis with trochanteric bursitis, limitation of extension is remanded. 17. Entitlement to an initial compensable disability evaluation for the service-connected left hip degenerative arthritis with trochanteric bursitis, limitation of thigh flexion is remanded. 18. Entitlement to an initial compensable disability evaluation for the service-connected right hip degenerative arthritis with trochanteric bursitis, limitation of thigh flexion is remanded. 19. Entitlement to an initial disability evaluation in excess of 10 percent for the service-connected left hip degenerative arthritis with trochanteric bursitis, impairment of thigh is remanded. 20. Entitlement to an initial disability evaluation in excess of 10 percent for the service-connected right hip degenerative arthritis with trochanteric bursitis, impairment of thigh is remanded. Regarding the Veteran’s claims for increased ratings of his left and right hip (to include all three separate evaluations granted for each hip), the Board notes that the Veteran underwent VA hip examination in 2015. However, while the medical opinion is of record, the physical examination is not. Accordingly, on remand, the 2015 VA hip physical examination should be associated with the claims file. 21. Entitlement to an initial disability evaluation in excess of 10 percent for the service-connected right knee degenerative osteoarthritis is remanded. 22. Entitlement to an initial disability evaluation in excess of 10 percent for the service-connected left knee degenerative osteoarthritis is remanded. The Board notes that the Veteran underwent VA knee examination in 2015. However, while the medical opinion is of record, the physical examination is not. Accordingly, on remand, the 2015 VA physical examination should be associated with the claims file. The matters are REMANDED for the following actions: 1. Associate the 2015 VA examinations with the claims file, to specifically include the VA hip, shoulder, knee, ear conditions, and cervical spine physical examinations. 2. Schedule the Veteran for an appropriate VA examination to determine the nature of his claimed hemorrhoids and to obtain an opinion as to whether such is possibly related to service. The claims file should be reviewed by the examiner in conjunction with the examination. All necessary tests should be conducted and the results reported. Following review of the claims file and examination of the Veteran, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that any current rectal disability, to include hemorrhoids arose during service or is otherwise related to service. A rationale for all opinions expressed should be provided, to include explaining the significance, if any of the hemorrhoids diagnosed on the Veteran’s October 2006 separation examination. 3. Schedule the Veteran for a VA sinus examination to determine the nature of his claimed sinus condition and to obtain an opinion as to whether such is possibly related to service. The claims file should be reviewed by the examiner in conjunction with the examination. All necessary tests should be conducted and the results reported. Following review of the claims file and examination of the Veteran, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that any current sinus condition arose during service or is otherwise related to service. A rationale for all opinions expressed should be provided, to include explaining the significance, if any of the May 1988, September 1994, and March 1995 in-service treatment for and diagnoses of a sinus condition. 4. Send the claims file to the VA examiner who conducted the July 2015 VA lumbar spine examination, if available, to obtain an addendum opinion with respect to the Veteran’s claim for a lumbar spine disability. If an examination is deemed necessary to respond the questions, one should be scheduled. Following review of the claims file, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that any current lumbar spine disability arose during service or is otherwise related to service. A rationale for all opinions expressed should be provided, to include explaining the significance, if any of the in-service complaints of lower back pain in April 1989 and lumbago diagnosed on the Veteran’s October 2006 separation examination. 5. Send the claims file to the VA examiner who conducted the July 2015 VA hand/finger examination, if available, to obtain an addendum opinion with respect to the Veteran’s claim for a right-hand disability. If an examination is deemed necessary to respond the questions, one should be scheduled. Following review of the claims file, the examiner should provide an opinion as to the following: (a.) Does the record reflect that the Veteran undebatably had a right hand/finger disability that existed prior to his entry into active duty service? Please explain why or why not, to include addressing the Veteran’s reported broken right little finger as noted on his December 1986 enlistment medical history report. (b.) If it is undebatable that the right hand/finger disability preexisted active duty service, did the disability undergo a permanent worsening during his period of active duty? The examiner should explain why or why not. (c.) If the examiner concludes a preexisting right hand/finger disability was worsened, the examiner should explain whether the worsening was undebatably the result of natural progression rather than the result of activities and/or incidents of active service. (d.) For any preexisting right hand/finger disability that was permanently worsened beyond normal progression (aggravated) during service, please opine whether any current cervical spine disability is at least as likely as not (50 percent or greater probability) related to that in-service aggravation. Please explain the reason for the conclusion. 6. Send the claims file to the VA examiner who conducted the July 2015 VA peripheral nerve examination, if available, to obtain an addendum opinion with respect to the Veteran’s service-connection claim for a bilateral nerve disorder (claimed as arm and finger numbness). If an examination is deemed necessary to respond the questions, one should be scheduled. Following review of the claims file, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that any current bilateral nerve disorder arose during service or is otherwise related to service. A rationale for all opinions expressed should be provided, to include explaining the significance, if any of the in-service October 2006 complaint of paresthesias. 7. Send the claims file to the VA examiner who conducted the July 2015 VA esophageal examination, if available, to obtain an addendum opinion with respect to the Veteran’s claim for GERD. If an examination is deemed necessary to respond to the questions, one should be scheduled. Following review of the claims file, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that any current esophageal disability, to include GERD arose during service or is otherwise related to service. A rationale for all opinions expressed should be provided, to include explaining the significance, if any of the in-service September 1989 and May 1991 diagnoses of GERD and GI spasm, respectively. 8. Send the claims file to the VA examiner who conducted the July 2015 VA headaches examination, if available, to obtain an addendum opinion with respect to the Veteran’s claim for headaches. If an examination is deemed necessary to respond to the questions, one should be scheduled. Following review of the claims file, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that any current headache disability arose during service or is otherwise related to service. A rationale for all opinions expressed should be provided, to include explaining the significance, if any of the in-service September 1989 complaint of headaches. The rationales for all opinions expressed must be set forth. Evan M. Deichert Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. Medina, Associate Counsel