Citation Nr: 18148207 Decision Date: 11/07/18 Archive Date: 11/07/18 DOCKET NO. 16-56 592 DATE: November 7, 2018 ORDER New and material evidence has been received to reopen a previously denied claim of service connection for a sleep disorder, and the application to reopen is allowed; to this extent only, the claim is granted. New and material evidence has been received to reopen a previously denied claim of service connection for polycythemia, and the application to reopen is allowed; to this extent only, the claim is granted. Entitlement to service connection for depression is granted. Entitlement to an initial compensable rating for pseudofolliculitis barbae (PFB) is denied. Entitlement to increased rating for migraine headaches on schedular and extraschedular basis is denied. An effective date of February 19, 2014, but not earlier, for the grant of service connection for PFB, is granted. REMANDED Entitlement to service connection for a sleep disorder, to include as secondary to service-connected disabilities, is remanded. Entitlement to service connection for polycythemia, also claimed as blood cancer, to include as secondary to possible exposure to benzene, is remanded. Entitlement to a total rating based on individual unemployability (TDIU) due to service-connected disabilities is remanded. FINDINGS OF FACT 1. In an unappealed December 2008 rating decision, the RO denied the Veteran’s original claims for service connection for polycythemia and sleep disorder. 2. Evidence received since the final December 2008 rating decision is new and material, and raises a reasonable possibility of substantiating the claims of service connection for polycythemia and sleep disorder. 3. The Veteran’s currently diagnosed depressive disorder is related to his service-connected migraine headaches disability. 4. The Veteran’s PFB covers less than 5 percent of the entire body, less than 5 percent of the exposed area affected, and required no more than topical therapy during the past 12-month period. 5. The Veteran’s service-connected migraine headaches is assigned a 50 percent disability rating, which the maximum is rating authorized for migraine headaches under Diagnostic Code 8100, and referral for extraschedular consideration is not warranted. 6. On February 19, 2015, VA received the Veteran’s fully developed claim for compensation for PFB, and an effective date of February 19, 2014, is assigned for the award of service connection for PFB, which corresponds to the one-year prior to the date of receipt of the claim for compensation. CONCLUSIONS OF LAW 1. The December 2008 rating decision denying service connection for polycythemia and sleep disorder is final. 38 U.S.C. § 7105(c) (2012); 38 C.F.R. §§ 3.104, 3.105(a), 20.302, 20.1103 (2017). 2. The additional evidence received since the December 2008 rating decision is new and material, and the claims of service connection for polycythemia and sleep disorder are reopened. 38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156 (2017). 3. The criteria to establish service connection for depressive disorder secondary to service-connected migraine headaches disability are met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.310 (2017). 4. The criteria for an initial compensable rating for PFB are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.10, 4.118, Diagnostic Code (DC) 7899-7806. 5. The criteria for a rating in excess of 50 percent for migraine headaches are not met. 38 C.F.R. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 3.321, 4.1-4.14, 4.21, 4.87, Diagnostic Code 8100 (2017). 6. The criteria for an effective date of February 19, 2014, but no earlier, for the grant of service connection for PFB are met. 38 U.S.C. §§ 5107, 5110 (2012); 38 C.F.R. §§ 3.102, 3.400 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty September 1989 to September 1993. The Board has limited the discussion below to the relevant evidence required to support its finding of fact and conclusion of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016). New and Material Evidence—Laws and Analysis Rating decisions are final and binding based on evidence on file at the time the claimant is notified of the decision and may not be revised on the same factual basis except by a duly constituted appellate authority. 38 C.F.R. § 3.104(a). The claimant has one year from notification of a RO decision to initiate an appeal by filing a NOD with the decision, and the decision becomes final if an appeal is not perfected within the allowed time period. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.160, 20.201, 20.302 (2017). If the Board issues a decision on appeal, confirming the RO’s decision, then the Board’s decision subsumes the RO’s decision on the same issue at hand. 38 C.F.R. § 20.1104. Moreover, if the Board’s decision is not timely appealed, then it, too, is final and binding based on the evidence then of record. 38 C.F.R. § 20.1100. An exception to the finality rule is found in 38 U.S.C. § 5108, which provides that, if new and material evidence is received with respect to a claim which has been disallowed, VA shall reopen the claim and review the former disposition of the claim. New evidence is defined as existing evidence not previously submitted to agency decision makers. Material evidence means 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 previously of record, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). In determining whether evidence is new and material, the credibility of the evidence is generally presumed. Justus v. Principi, 3 Vet. App. 510, 512-513 (1992). The United States Court of Appeals for the Federal Circuit (Federal Circuit) has held, however, that evidence that is merely cumulative of other evidence in the record cannot be new and material even if that evidence had not been previously presented. Anglin v. West, 203 F.3d 1343, 1347 (2000). In deciding whether new and material evidence has been received, the Board looks to the evidence submitted since the last final denial of the claim on any basis. Evans v. Brown, 9 Vet. App. 273, 285 (1996). The threshold for determining whether new and material evidence raises a reasonable possibility of substantiating a claim is “low.” Shade v. Shinseki, 24 Vet. App. 110, 117 (2010). Here, the RO denied the Veteran’s service connection claim for polycythemia and sleep disorder in a December 2008 rating decision, finding that the Veteran submitted no evidence of treatment for the claimed conditions, and that there was no in-service event or experience in-service that was shown to have caused these conditions. The evidence considered at the time included the Veteran’s original application for compensation, his service treatment records, and a June 2008 letter requesting evidence in support of his claim. The Veteran did not appeal the decision, and new and material evidence was not received within one year of the decision. Thus, the December 2008 rating decision became final. See 38 U.S.C. § 7105 (d)(3); Bond v. Shinseki, 659 F.3d 1362 (Fed. Cir. 2011); 38 C.F.R. §§ 3.104, 3.156(a)-(b), 20.302, 20.1103. Relevant evidence received since the December 2008 denial of the claims, includes the Veteran’s July 2012 petition to reopen his claim for polycythemia and October 2013 petition to reopen his claim for a sleep disorder, September 2012 lay assertions regarding his exposure to chemicals in-service, evidence of diagnosis of insomnia, and VA and private treatment records. This evidence, specifically medical evidence of current diagnoses of a sleep disorder as well as polycythemia, along with the Veteran’s competent lay reports of how those relate to service, relates to the unestablished element of a current disability and nexus in the prior denial. The additional evidence received since the December 2008 final denial is therefore new and material, and the criteria for reopening the claims for service connection for polycythemia and sleep disorder are therefore met. Service Connection—Laws and Regulations Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may also be granted for any injury or disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d). 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 alternatively be established on a secondary basis for a disability which is proximately due to, or the result of, a service-connected disability. 38 C.F.R. § 3.310(a) (2017). Secondary service connection may also be established for a disorder which is aggravated by a service-connected disability; compensation may be provided for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation. See 38 C.F.R. § 3.310(b) (2017); Allen v. Brown, 8 Vet. App. 374 (1995). The Board must analyze the credibility and probative value of the evidence, account for the evidence that it finds persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. Kahana v. Shinseki, 24 Vet. App. 428, 433 (2011). This includes weighing the credibility and probative value of lay evidence against the remaining evidence of record. See King v. Shinseki, 700 F.3d 1339 (Fed. Cir. 2012); Kahana, 24 Vet. App. at 433-34. A Veteran bears the evidentiary burden to establish all elements of a service connection claim, including the nexus requirement. Fagan v. Shinseki, 573 F.3d 1282, 1287 (Fed. Cir. 2009). In making its ultimate determination, the Board must give a veteran the benefit of the doubt on any issue material to the claim when there is an approximate balance of positive and negative evidence. Id. at 1287 (quoting 38 U.S.C. § 5107 (b)). Depressive Disorder The Veteran asserts that his depressive disorder is related to service or, alternatively, to his service-connected migraine headaches. The Veteran is currently diagnosed with unspecified depressive disorder. See e.g., August 2014 VA mental disorders examination report. After review of all the evidence, lay and medical, the Board finds that service connection for depression secondary to service-connected migraine headache disability is warranted. During a December 1997 VA examination for neurological disorders, the examiner diagnosed migraine headaches and depression. An opinion as to the etiology of the depression was not provided. The Veteran underwent a VA examination for mental disorders in August 2014, at which time the examiner rendered a diagnosis of unspecified depressive disorder. It was noted that the Veteran reported his first depressive episode occurred in 2004 after he was diagnosed with blood cancer. Symptoms were reportedly exacerbated in 2009 following his divorce, due to financial difficulties, and loss of his home/property. The examiner stated that the depressive symptomatology was associated with bereavement/coping with a terminal illness, and being unable to do things that he was able to do previously. The Veteran reported that previously he experienced intermittent depressive symptoms, typically occurring three to four days per week, but now it was multiple depressive episodes occurring weekly and lasting three to four days at a time. The described symptoms were referred to as “moderately to severely distressing” and were noted to interfere with relationships, work, and leisure activities. The examiner stated that no service treatment records were available on VBMS, but the Veteran denied any mental health treatment during his military service, but noted a psychiatric evaluation by two psychiatrists in 1993, due to what “reportedly sounded like” an anger outburst/conflict with chain of command, after he was denied a half a day of leave to attend a lamaze class with his wife. The examiner further noted that medical diagnoses relevant to the understand or management of the mental health disorder included migraine headaches. The examiner then opined that the currently diagnosed unspecified depressive disorder was not related to service, because the Veteran himself attributed it to a later diagnosis of blood cancer. The Veteran submitted a private June 2015 mental health disability benefits questionnaire (DBQ) authored by a clinical psychologist, who confirmed a diagnosis of depressive disorder due to another medical condition with depressed mood. After interviewing the Veteran and reviewing the claims file, the psychologist opined that it was more likely than not that the Veteran’s depressive disorder began in the military and was caused by his migraine headaches. The psychologist acknowledged that the blood cancer also contributed to the Veteran’s depression, but opined that this was not the cause of it. In support of this opinion, the psychologist referenced the December 1997 VA examination report for headaches, which also diagnosed depression, and noted that the migraine headache disability was diagnosed prior to the blood cancer. The psychologist concluded that it was impossible to speculate as to the effect of each disability on the Veteran’s mental health. The private psychologist also referenced medical literature that support the causal relationship between physical disabilities and mental health. In support of his claim, the Veteran also submitted a September 2017 letter authored by a friend who reported knowing the Veteran prior to his time in the navy. The friend stated that they used to refer to the Veteran as “The Master Craftsman” because of all the wood working he used do. He also noted that he was very social, active, and had a lot of friends. The friend further noted that they kept in touch while the Veteran was in-service, and that toward the end of his enlistment, he realized something was wrong, because the Veteran was on leave but seemed withdrawn and down. He noted that he did not want to see his buddies or go out, and complained about having headaches. After a careful review of all the evidence, lay and medical, the Board finds that it supports the Veteran’s service connection claim for depression secondary to his service-connected migraine headache disability. In reaching this conclusion, the Board weighed the probative value of the August 2014 VA examination report and June 2015 private DBQ. Here, the Board finds the August 2014 VA examination report inadequate. First, the examiner noted that the first-time depression was noted was not until 2004, and although this conclusion was noted based on the Veteran’s lay reports, the evidence in the claims file clearly show a diagnosis as early as 1997. Second, the examiner stated that the STRs were unavailable, although it was noted that the record was reviewed. The Board acknowledges that the STRs may not have been scanned into VBMS at the time, but despite recognizing some reports of mental health symptoms in-service, the examiner merely noted those, but did not address them in the opinion. Accordingly, to the extent that the August 2014 VA opinion misstates the onset of the Veteran’s symptom and medical history, it is based upon an inaccurate factual premise and is of no probative value. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993). On the contrary, the private psychologist reviewed the claims file, interviewed the Veteran, made references to evidence of record, to include the simultaneous diagnosis of migraine headaches and depression in 1997, and acknowledged the Veteran’s competent lay assertions. In addition, the psychologist supported the opinion by citing to numerous medical literature. Based on the foregoing, the Board finds that the weight of the competent and credible evidence specifically relates the Veteran’s depression to the physical impairments resulting from his service-connected migraine headache disability. Therefore, service connection for major depressive disorder on a secondary basis is granted. Increased Rating Claims—Laws and Regulations Disability evaluations are determined by comparing a veteran’s present symptoms with the criteria set forth in the VA Schedule for Rating Disabilities, which is based upon average impairment in earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. When a question arises as to which of two ratings applies under a particular diagnostic code, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt is resolved in favor of the Veteran. 38 C.F.R. § 4.3. A disability rating may require re-evaluation in accordance with changes in a veteran’s condition. Thus, it is essential that the disability be considered in the context of the entire recorded history when determining the level of current impairment. See 38 C.F.R. § 4.1. See also Schafrath v. Derwinski, 1 Vet. App. 589 (1991). When a claimant is awarded service connection and assigned an initial disability rating, separate disability ratings may be assigned for separate periods of time in accordance with the facts found. Where the veteran is appealing the rating for an already established service-connected condition, her present level of disability is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Staged ratings are appropriate for an increased rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007). PFB Throughout the initial rating period on appeal, the Veteran’s PFB is rated under 38 C.F.R. § 4.118, Diagnostic Codes 7899-7806. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the specific basis for the evaluation assigned. 38 C.F.R. § 4.27. Under Diagnostic Code 7806, a non-compensable rating is warranted where less than 5 percent of the entire body or less than 5 percent of exposed areas are affected, and; no more than topical therapy was required during the past 12-month period. A 10 percent rating will be assigned where at least 5 percent, but less than 20 percent, of the entire body, or at least 5 percent, but less than 20 percent, of exposed areas are affected, or; intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs were required for a total duration of less than six weeks during the past 12-month period. A 30 percent rating is warranted where 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas are affected, or; systemic therapy such as corticosteroids or other immunosuppressive drugs were required for a total duration of six weeks or more, but not constantly, during the past 12-month period. A 60 percent rating is warranted where more than 40 percent of the entire body or more than 40 percent of the exposed areas are affected, or; constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs were required during the past 12-month period. 38 C.F.R. § 4.118, Diagnostic Code 7806 (2017). In Johnson v. Shulkin, the Federal Circuit held that the operative terms of Diagnostic Code 7806 were “systemic therapy” and “topical therapy,” but not the exemplary reference (“such as”) to corticosteroids. 862 F.3d 1351, 1354 (Fed. Cir. 2017). In that case the Federal Circuit determined that “systemic therapy” means “treatment pertaining to or affecting the body as a whole,” whereas topical therapy means “treatment pertaining to a particular surface area, as a topical Antiinfective applied to a certain area of the skin and affecting only the area to which it is applied.” Id. at 1355. The Veteran contends that his PFB is more severe than the currently assigned noncompensable rating. The Veteran underwent a VA examination for skin diseases in June 2015, at which time the examiner confirmed a diagnosis of PFB since service. The Veteran reported that he developed significant facial bumps on his face, anterior neck, and on the back of his neck after shaving and was given a “shaving chit,” and later after being evaluated by dermatology was placed on a permanent no shaving profile. He stated that he kept his beard trimmed short, but only shaved once or twice a month, using “magic shave.” On the back of his neck, he kept the hair short, but did not shave the area, and at times ingrown hairs had to be removed with tweezers. The examiner noted that the PFB did not cause any scarring or disfigurement of the head, face, or neck and the Veteran did not have any benign or malignant skin neoplasms or systemic manifestations due to his PFB. It was further noted that the Veteran was treated with topical medication, identified as “magic shave,” for less than six weeks in the previous twelve months. No other treatment or procedure was required, and he did not have any debilitating or non-debilitating episodes due to PFB in the previous twelve months. On physical examination the examiner noted a few small papules on the left check (within the beard) as well as a cluster of small brown papules consistent with PFB, but indicated that it covered less than 5 percent of both his total and exposed skin. Lastly, the examiner noted that PFB does not impact the Veteran’s ability to work. VA treatment records throughout the period on appeal continuously show no rash, itching, skin lesions, or “no significant skin lesions,” and the Veteran’s active medication list does not show any prescribed medication for his PFB. Based on the evidence of record, the Board finds that the record does not show that the Veteran’s PFB affected at least 5 percent, but less than 20 percent, of the entire body or exposed area, and it did not require the use of intermittent systemic therapy required for any duration during the past 12-month period. Significantly, the evidence does not show that the condition required intermittent systemic therapy or other immunosuppressive drug at any time during the appeal period. Johnson v. Shulkin, 862 F.3d 1351, 1354 (Fed. Cir. 2017). The Board acknowledges the Veteran’s assertion that he is entitled to a compensable rating; however, the lay and medical evidence show that his symptomatology, including his complaints of recurrent PFB, are contemplated by the criteria under which his disability is currently rated. As the preponderance of the evidence is against the claim, the claim must be denied. Migraine Headaches The Veteran’s migraine headache disability is rated pursuant to DC 8100. Under such code, migraine headaches with less frequent attacks than the criteria for a 10 percent rating are rated as non-compensable. Migraine headaches with characteristic prostrating attacks averaging one in two months over the last several months are rated 10 percent disabling. Migraine headaches with characteristic prostrating attacks occurring on an average once a month over last several months are rated 30 percent disabling. Migraine headaches with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability are rated 50 percent disabling. The term “prostrating attack” is not defined in regulation or case law, but can be defined as extreme exhaustion or powerlessness. Fenderson v. West, 12 Vet. App. 119, 126-127 (1999) (quoting Diagnostic Code 8100 verbatim but not specifically addressing the definition of a prostrating attack); DORLAND’S ILLUSTRATED MEDICAL DICTIONARY 1531 (32d ed. 2012). Further, “severe economic inadaptability” is also not defined in VA law. See Pierce v. Principi, 18 Vet. App. 440, 446 (2004). In addition, the Court has held that nothing in DC 8100 requires that the claimant be completely unable to work in order to qualify for a 50 percent rating. Id. It was explained by the Court that if “economic inadaptability” were read to import unemployability, the appellant, should he or she meet the economic-inadaptability criterion, would then be eligible for a TDIU rather than just a 50 percent rating. Id. citing 38 C.F.R. § 4.16. The Court discussed the notion that consideration must also be given as to whether the disability was capable of producing severe economic inadaptability, regardless of whether the condition was actually causing such inadaptability. See Pierce, 18 Vet. App. at 446. In this regard, VA conceded that the words “productive of” could be read to mean either “producing” or “capable of producing.” Id. at 446-447. The Board may not deny entitlement to a higher rating on the basis of relief provided by medication when those effects are not specifically contemplated by the rating criteria. Jones v. Shinseki, 26 Vet. App. 56, 63 (2012). The Veteran’s service-connected migraine headaches are rated as 50 percent disabling under Diagnostic Code 8100 since September 1993, a day after his discharge from service. In an April 2018 brief in support of the Veteran’s appeal, his attorney stated that “increased rating to include individual unemployability for service connected migraine headaches” is warranted due to his in ability to maintain gainful employment as a result of the disability. While the Board agrees that entitlement to a TDIU is raised by the medical evidence of record, to include as a result of the service-connected migraine headaches, this issue is remanded below for further development consistent with the Board’s decision herein. Although neither the Veteran nor his representative explicitly raised the issue of entitlement for increase on an extraschedular basis, the Board finds that such was raised by the claim for increase given the fact that the maximum schedular criteria is already in effect. As noted above, maximum scheduler evaluation of 50 percent is assigned for very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. 38 C.F.R. § 4.124a, Diagnostic Code 8100. The Veteran is currently in receipt of the maximum schedular rating for migraine headaches under Diagnostic Code 8100 and a higher rating is not possible under this diagnostic code. The Board has considered whether there is any other schedular basis for granting a higher rating, but has found none. As the maximum schedular rating for migraine headaches under Diagnostic Code 8100 has already been assigned, a higher schedular rating is not available, and the Veteran’s claim for a disability rating in excess of 50 percent for migraine headaches must be denied. See Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). In exceptional cases an extraschedular rating may be provided. 38 C.F.R. § 3.321. The Court has set out a three-part test, based on the language of 38 C.F.R. § 3.321(b)(1), for determining whether a veteran is entitled to an extraschedular rating: (1) the established schedular criteria must be inadequate to describe the severity and symptoms of the claimant’s disability; (2) the case must present other indicia of an exceptional or unusual disability picture, such as marked interference with employment or frequent periods of hospitalization; and (3) the award of an extra-schedular disability rating must be in the interest of justice. Thun v. Peake, 22 Vet. App. 111 (2008), aff’d, Thun v. Shinseki, 572 F.3d 1366 (Fed. Cir. 2009). The Board may not assign an extraschedular rating in the first instance, but must specifically adjudicate whether to refer a case for extraschedular evaluation when the issue either is raised by the claimant or reasonably raised by the evidence of record. Barringer v. Peake, 22 Vet. App. 242 (2008); see also See Yancy v. McDonald, 27 Vet. App. 484 (2016) (the Board is not obligated to analyze whether extraschedular referral is warranted in all cases, but only if the issue is argued or raised by the record). In this case, the Board finds that the evidence in support of the claim reasonably raise the issue of an extraschedular rating. With respect to the first prong of Thun, the evidence in this case does not show such an exceptional disability picture that renders the available schedular evaluations for the service-connected headaches inadequate. A comparison between the symptomatology of the Veteran’s migraine headaches and the rating criteria reasonably describe his disability level and symptomatology. The medical and lay evidence before the Board, including records of VA examinations, VA treatment, and a September 2015 private DBQ, establish that he experiences nausea, occasional vomiting, light and sound sensitivity, reduced concentration, and dizziness during a headache that requires him to lie down in a dark quiet room, and causes him to miss eight days of work per month as well as requires frequent unscheduled breaks throughout the day, which prevent him from obtaining and maintaining gainful employment. These manifestations, including “severe economic inadaptability” are specifically contemplated in the schedular criteria pertaining to migraine headaches. Thus, the Veteran’s reports of severe impairment to occupational functioning are contemplated by the schedular criteria under Diagnostic Code 8100. The Board has determined that referral is not warranted as the first element of the Thun analysis is not satisfied, and it therefore need not address the second and third elements. See Doucette v. Shulkin, 28 Vet. App. 366 (2017); see also Yancy at 494 (“Although the first and second Thun elements are interrelated, they ‘involve separate and distinct analysis,’ and ‘[i]f either element is not met, then referral for extraschedular consideration is not appropriate.’”). Notwithstanding the Board’s denial of increased rating on schedular basis and extraschedular basis, as will be discussed in detail below, the Board remands the issue of entitlement to a TDIU for further development. Finally, neither the Veteran nor his attorney has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 69-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). Earlier Effective Date for PFB In February 2015, the Veteran filed a claim for service connection for PFB using the Fully Developed Claim (FDC) process; the claim is date stamped February 19, 2015. Under the FDC framework, a claim is submitted in a “fully developed” status, limiting the need for further development of the claim by VA. According to 38 U.S.C. § 5110 (b)(2)(A), “the effective date of an award of disability compensation to a veteran who submits an application therefor that sets forth an original claim that is fully-developed as of the date of submittal shall be fixed in accordance with the facts found, but shall not be earlier than the date that is one year before the date of receipt of the application.” A claim for service connection submitted through the FDC process by definition meets the statutory requirement of “an original claim that is fully-developed.” See 38 U.S.C. § 5110. This statutory provision is implemented by a VA regulation, which provides that the effective date of an evaluation and award of compensation based on an original claim or a claim reopened after final disallowance will be the date of receipt of the claim or the date entitlement arose, whichever is the later. See 38 C.F.R. § 3.400. However, 38 U.S.C. § 5110 (b)(2)(A) does not establish that the effective date for claims filed under the FDC process is automatically one year prior to the date of the filing of the formal claim for service connection. Instead, the statute states that the effective date shall be fixed in accordance with the facts found, so long as the date established by the facts is not earlier than one year prior to the date of the receipt of the application for service connection. Here, neither the Veteran nor his representative provided any argument or evidence in support of his claim for an earlier effective date for PFB. Nevertheless, given that his application was under the FDC program, an earlier effective date of February 19, 2014 is warranted. Namely, one year before the date of receipt of the application. During the June 2015 VA examination, it was noted that the Veteran experienced PFB continuously since his time in the military. In essence, this supports that the disability was present a year prior to the date of his claim under the FDC program. Based on the foregoing, the Board will assign an effective date of February 19, 2014, which corresponds to the one-year period prior to the date of receipt of the claim. The fact that a diagnosis of PFB was present more than one-year prior to the receipt of the February 19, 2015 claim is not relevant to the assignment of an effective date in this matter, as the date shall not be earlier than the date that is one year before the date of receipt of the application. 38 U.S.C. § 5110(b)(2)(A). The mere presence of medical evidence of a disability does not show an intent on the Veteran’s part to seek service connection and therefore does not constitute a claim; rather, the Veteran must assert a claim either expressly or impliedly. VA is not required to conjure up issues not raised by the claimant. See Brannon v. West, 12 Vet. App. 32 (1998); Talbert v. Brown, 7 Vet. App. 352, 356-57 (1995) (noting that although VA must interpret a claimant’s submissions broadly, VA is not required to conjure up issues not raised by claimant). Therefore, the Board declines to view any references to PFB in medical records prior to February 19, 2014, as a claim for VA compensation. There is otherwise no legal basis for the assignment of an effective date earlier than February 19, 2014, for the grant of service connection for PFB. REASONS FOR REMAND The Board finds that a remand is necessary to provide the Veteran with VA examinations for his claims for polycythemia, to include blood cancer, and a sleep disorder, as well as to further develop his claim for a TDIU. Polycythemia/Blood Cancer The Veteran asserts that he was exposed to radiation and other chemicals, identified as “benzene” during service, which he believed caused his polycythemia/blood cancer. In this regard, a December 2016 response from the Department of Navy indicated that a review of the exposure registry revealed no reports of occupational exposure to ionizing radiation pertaining to this Veteran, but stated that because the official exposure record was maintained in the individual’s medical record, it would be prudent to compare that record with this report. Although the Board does not find evidence of exposure to ionizing radiation, it appeared from the Veteran’s September 2012 statements that he was exposed to other chemicals, such as benzene. Specifically, the Veteran asserted that he was stationed on the USS Detroit AOE-4, an “oiler,” and while replenishing at sea, several hoses burst, which resulted in spilling of jet fuels and diesel fuel marine (DFM) and JP-5 fuel. He stated that on several occasions, these spills doused him with these agents. He further indicated that his military occupation was a signalman and was “exposed to radiation day in and day out.” While there is no confirmation for exposure to ionizing radiation, the Veteran is competent to report exposure to other chemicals as described above; however, he was not provided with a VA examination in connection with his claim. Significantly, blood results dated in October 1993 contain high levels of red cell distribution range (RDW). Accordingly, the Board finds that a remand is necessary to provide him with a VA examination to determine the nature and etiology of his claimed disabilities. Sleep Disorder The Veteran asserts that he has a sleep disorder that is related to his active duty service. The Board notes that the August 2014 VA examiner noted symptoms of insomnia or hypersomnia, but did not render an actual diagnosis of a sleeping disorder. Nevertheless, given the Veteran’s lay reports, the Board finds that a remand is necessary to determine whether the Veteran has a diagnosis of a sleep disorder that is separate and distinct of insomnia/hypersomnia related to his already service-connected depression and migraine headaches. Notably, an in-service Report of Medical Board dated in April 1993 indicates that some of the medications prescribed for the Veteran’s headaches caused increased sleepiness. Lastly, active outpatient medications show that the Veteran is prescribed medication for insomnia. Accordingly, the Board finds that a remand is necessary to determine the nature and etiology of any currently diagnosed sleep disorder. TDIU Potential entitlement to a total disability rating based on individual unemployability (TDIU) is an element of all rating issues. Rice v. Shinseki, 22 Vet. App. 447 (2009). The Veteran is seeking entitlement to a TDIU based on his service-connected disabilities, which now includes depressive disorder. As such, the TDIU claim is inextricably intertwined with the Board’s grant of service connection for depressive disorder and the pending assignment of the corresponding rating percentage by the AOJ. The issue of a TDIU is also intertwined with the issues being remanded. Consideration of the TDIU must be deferred pending implementation of the awards granted herein. The matters are REMANDED for the following actions: 1. Ensure that all outstanding VA treatment records since December 2016 are associated with the claims file. 2. Contact the Veteran and ask him to provide any information regarding any outstanding private medical treatment that he received for a sleeping disorder and/or polycythemia/blood cancer. Then provide him VA Forms 21-4142, Authorization and Consent to Release Information to the VA, for any identified outstanding and relevant private treatment records. Advise him that he may submit such records if he so chooses. 3. Send the Veteran the appropriate notice as to how to substantiate his request for a TDIU, including a VA Form 21-8940, Veteran’s Application for Increased Compensation Based on Unemployability, for completion, with instructions to return the form to the RO. 4. Contact all pertinent records repositories to determine whether any documentation is available regarding the chemicals present abroad the USS Detroit AOE-4, to include DFM and JP-5 fuel between September 1989 and September 1993. 5. Then, regardless if new evidence is received, provide the Veteran with a VA examination by an appropriate examiner to determine the nature and etiology of his polycythemia/blood cancer. The claims file and a copy of this Remand must be made available to the examiner, and the examiner shall indicate in the examination report that the claims file was reviewed. The examiner should address the following: (a) To the extent possible, determine the date of onset of the Veteran’s polycythemia/blood cancer. In doing so, please review blood test results dated in October 1993, VBMS entry 09/10/1993, titled “Medical Treatment Record – Government Facility” in addition to any other pertinent evidence of record. (b) Provide an opinion as to whether it is at least as likely as not (a 50 percent probability or greater) that the Veteran’s polycythemia/blood cancer had its onset in service or is otherwise etiologically related to his period of service, including his competent reports of exposure to spillage of DFM and JP-5 fuels. The examiner should provide a complete rationale for all opinions. 6. Provide the Veteran with a VA examination to determine the nature and etiology of his claimed sleep disorder. The claims file and a copy of this Remand must be made available to the examiner, and the examiner shall indicate in the examination report that the claims file was reviewed. The examiner should then address the following: (a) Identify whether the Veteran has a currently diagnosed sleep disorder. In doing so, please address evidence of insomnia and hypersomnia. (b) If a sleep disorder is diagnosed, the examiner is asked to provide an opinion as to whether it is at least as likely as not (a 50 percent probability or greater) had its onset in service or is otherwise etiologically related to his period of service. (c) If a sleep disorder is diagnosed, the examiner is asked to provide an opinion as to whether it is at least as likely as not (a 50 percent probability or greater) was caused by or aggravated by a service-connected disability, to include migraine headaches and depressive disorder. The examiner should provide a complete rationale for all opinions, on direct, causation, AND aggravation. 7. Thereafter, readjudicate the claims on appeal, to include entitlement to a TDIU. ROMINA CASADEI Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Yaffe, Associate Counsel