Citation Nr: 18148625 Decision Date: 11/07/18 Archive Date: 11/07/18 DOCKET NO. 16-43 302 DATE: November 7, 2018 ORDER As new and material evidence has been received, the claim of entitlement to service connection for posttraumatic stress disorder (PTSD) is reopened. Entitlement to service connection for major depressive disorder with anxious distress, as secondary to service-connected bilateral knee chondromalacia, is granted. Entitlement to service connection for PTSD is denied. Entitlement to service connection for a left shoulder condition is denied. Entitlement to service connection for a right shoulder condition is denied. Entitlement to service connection for a left hip condition is denied. Entitlement to service connection for a right hip condition is denied. Entitlement to an effective date earlier than August 21, 2014 for the grant of service connection for left knee chondromalacia is denied. Entitlement to an effective date earlier than August 21, 2014 for the grant of service connection for right knee chondromalacia is denied. REMANDED Entitlement to an initial increased evaluation for left knee chondromalacia, rated as 10 percent disabling, is remanded. Entitlement to an initial compensable evaluation for right knee chondromalacia is remanded. FINDINGS OF FACT 1. In an unappealed March 2010 adjudication, the RO declined to reopen a claim of service connection for PTSD. 2. Evidence received since the March 2010 last, final rating decision is not cumulative and redundant of the prior evidence, and raises a reasonable possibility of substantiating the claim of entitlement to service connection for PTSD. 3. The Veteran’s major depressive disorder with anxious distress was aggravated by his service-connected bilateral knee chondromalacia. 4. The preponderance of the evidence is against finding that the Veteran has PTSD due to a disease or injury in service, to include a specific in-service event, injury, or disease. 5. The preponderance of the evidence is against finding that a bilateral shoulder condition began during active service, or is otherwise related to an in-service injury, event, or disease. 6. The preponderance of the evidence of record is against finding that the Veteran has, or has had at any time during the appeal, a current diagnosis of a bilateral hip condition. 7. The Veteran was separated from active military service in December 1979; he did not raise a claim of entitlement to service connection for bilateral knee chondromalacia within one year after his discharge from service. 8. On August 21, 2014 the Veteran filed a claim for service connection for a bilateral knee condition. 9. By a rating decision dated January 2015, service connection for left and right knee chondromalacia was granted, effective from August 21, 2014, the date of receipt of the Veteran’s service connection claim. CONCLUSIONS OF LAW 1. Evidence received since the March 2010 RO adjudication that declined to reopen a claim of service connection for PTSD, which was the last final denial with respect to this issue, is new and material; the claim is reopened. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.156, 20.302, 20.1103. 2. The criteria for secondary service connection for major depressive disorder with anxious distress are met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.310(a). 3. The criteria for service connection for PTSD are not met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 4. The criteria for service connection for a bilateral shoulder condition are not met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 5. The criteria for service connection for a bilateral hip condition are not met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 6. The criteria for an effective date earlier than August 21, 2014, for the grant of service connection for left and right knee chondromalacia have not been met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. §§ 3.102, 3.400. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 1978 to December 1979. This matter comes before the Board on appeal from a January 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina. As a preliminary matter, in a December 2016 psychological summary, the Veteran’s private psychologist rendered the clinical assessment that the Veteran could not sustain or follow substantially gainful employment due to major depressive disorder with anxious distress and antisocial personality disorder features. In light of this, the Veteran and his representative should be contacted and informed that if the Veteran seeks to make such a claim, that effective March 24, 2015, a claimant for VA benefits must file a claim on the application form prescribed by the Secretary to be considered. See Standard Claims and Appeals Forms final action at 79 Fed. Reg. 57,660 (Sept. 25, 2014). New and Material Evidence Generally, a claim which has been denied in an unappealed rating decision may not thereafter be reopened and allowed. 38 U.S.C. §§ 7104(b), 7105(c). An exception to this rule is 38 U.S.C. § 5108, which provides that if a claim of entitlement to service connection has been previously denied and that decision became final, the claim can be reopened and reconsidered only if new and material evidence is presented with respect to that claim. 38 U.S.C. § 5108. New evidence means existing evidence not previously submitted to agency decision-makers. Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). VA must review all of the evidence submitted since the last final rating decision in order to determine whether the claim may be reopened. See Hickson v. West, 12 Vet. App. 247, 251 (1999). For the limited purpose of determining whether new and material evidence has been submitted, the credibility of the newly submitted evidence is presumed. See Justus v. Prinicipi, 3 Vet. App. 510, 513 (1992); see also Kutscherousky v. West, 12 Vet. App. 369, 371 (1999) (per curium) (holding that the “presumption of credibility” doctrine continues to be precedent). The presumption is rebuttable when the evidentiary assertion is inherently incredible or when the fact asserted is beyond the competence of the person making the assertion. King v. Brown, 5 Vet. App. 19, 21 (1993). New and material evidence has been submitted for the claim of entitlement to service connection for PTSD By way of brief procedural history, the claim of service connection for PTSD was originally denied by a February 2006 rating decision because the RO determined that the Veteran’s reported in-service stressors were insufficient to send to U.S. Army and Joint Services Records Research Center (JSRRC) for verification. In a February 28, 2006 letter, the RO notified the Veteran of its decision, and of his appellate rights, but the Veteran did not initiate an appeal of the rating decision within one year, nor was any new and material evidence received within a year. 38 C.F.R. § 3.156(b). Bond v. Shinseki, 659 F.3d 1362, 1367-68 (Fed. Cir. 2011) (finding that VA must determine whether evidence received during the appeal period after a decision contains new and material evidence per § 3.156(b) and failure to readjudicate the appeal after receipt of such evidence renders the decision non-final). The February 2006 rating decision is accordingly final. See 38 U.S.C. § 7105; 38 C.F.R. §§ 3.160(d), 20.200, 20.302, 20.1103. The Veteran subsequently sought to reopen the service connection claim for PTSD in September 2009. In a March 2010 rating decision, the RO declined to reopen the previously denied service connection claim because no new and material evidence had been received. The Veteran did not appeal the issue and did not submit any pertinent evidence within one year of the decision. The March 2010 rating decision is the last final decision of record. See 38 U.S.C. § 7105; 38 C.F.R. §§ 3.160(d), 20.200, 20.302, 20.1103. Again, the Veteran subsequently sought to reopen the service connection claim for PTSD in August 2014. In a January 2015 rating decision, the RO declined to reopen the previously denied service connection claim because no new and material evidence had been received. In an April 2015 Notice of Disagreement (NOD), the Veteran appealed the decision. Notwithstanding the RO’s characterization of the issue, in the August 2016 statement of the case, the RO essentially considered the PTSD issue on the merits as all the elements necessary to substantiate the claim of service connection were addressed. Hickson v. Shinseki, 23 Vet. App. 394 (2010). In September 2016, the Veteran filed a substantive appeal (VA Form 9) to the Board; as such, the Board must decide the threshold issue of whether the Veteran submitted evidence that is new and material before addressing the merits of the claim. See Jackson v. Principi, 265 F. 3d 1366 (Fed. Cir. 2001); Barnett v. Brown, 83 F.3d 1380 (Fed. Cir. 1996). The relevant evidence added to the record since the March 2010 rating decision (last final denial) include VA and private medical records dated from November 2014 through December 2016, a December 2016 Mental Disorders (Other than PTSD and Eating Disorders) Disabilities and Benefits Questionnaire (DBQ) and psychological summary, medical treatise evidence and statements from family members. The December 2016 DBQ indicated that the Veteran was diagnosed with major depressive disorder with anxious distress and antisocial personality disorder features. The Veteran’s private psychologist, Dr. R. W., opined that the mental health condition was aggravated by the Veteran’s service-connected bilateral knee chondromalacia. Dr. R. W. did not diagnose the Veteran with PTSD. The Court has held that a new etiological theory does not constitute a new claim. Velez v. Shinseki, 23 Vet. App. 199 (2009); Ashford v. Brown, 10 Vet. App. 120, 123 (1997); Roebuck v. Nicholson, 20 Vet. App. 307 (2006). However, while a new theory of entitlement cannot be the basis to reopen a claim under 38 U.S.C. § 7104(b), if the evidence supporting a new theory of entitlement constitutes new and material evidence, then VA must reopen the claim under § 5108. Boggs v. Peake, 520 F.3d 1330, 1336-37 (Fed. Cir. 2008). As a new theory of entitlement to service connection for PTSD has been raised, and new evidence supporting that theory has been submitted since the March 2010 last, final decision, the claim is reopened. Overall, the lay and clinical evidence suggests a new theory of entitlement for service connection for PTSD and addresses a nexus to service-connected disability. Presuming its credibility, this evidence is new as it was not previously submitted and/or considered by agency decision-makers and is material as it relates to an unestablished fact regarding the nexus/relationship of the Veteran’s diagnosed mental health condition to his service. As such, the evidence is sufficient to reopen the service connection claim. 38 C.F.R. § 3.156(a). Service Connection Service connection is warranted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in the line of duty in active military service or, if preexisting such service, was aggravated thereby. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). Generally, to establish entitlement to service connection, a veteran must show evidence of (1) a current disability, (2) in-service incurrence or aggravation of a disease or injury, and (3) a causal relationship between the current disability and an in-service injury or disease. All three elements must be proved. See generally Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). Service connection may also be established on a secondary basis for a disability which is proximately due to or the result of a service-connected disease or injury; or, any increase in severity of a nonservice-connected disease or injury which is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease or injury. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.310(a)-(b). In order to prevail on the theory of secondary service connection, there must be evidence of (1) a current disability, (2) a service-connected disability, and (3) a nexus, or link, between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the Veteran. 38 U.S.C.§ 5107 (b); 38 C.F.R. §3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Entitlement to service connection for major depressive disorder with anxious distress as secondary to service-connected bilateral knee chondromalacia The Veteran contends that he has major depressive disorder with anxious distress (claimed as PTSD), as a result of service. The Board concludes that the Veteran has a current diagnosis of major depressive disorder with anxious distress that was aggravated by his service-connected bilateral knee chondromalacia. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.303, 3.310. The Veteran is service connected for left knee chondromalacia, associated with right knee chondromalacia and right knee chondromalacia. A December 2016 Mental Disorders DBQ indicated that the Veteran was diagnosed with major depressive disorder with anxious distress and antisocial personality disorder features, aggravated by his bilateral knee condition. Specific to the Veteran’s diagnosis of an antisocial personality disorder, the law provides that personality disorders are not “diseases” or “injuries” within the meaning of applicable legislation. 38 C.F.R. §§ 3.303(c), 4.9, 4.127. However, evidence of additional disability resulting from a mental disorder that is superimposed upon and aggravates a congenital defect such as a personality disorder or mental deficiency during service may be service-connected. 38 C.F.R. §§ 3.303(c), 4.9, 4.127; see also VAOPGCPREC 82-90, 55 Fed Reg. 45,711 (July 18, 1990); Carpenter v. Brown, 8 Vet. App. 240, 245 (1995); Monroe v. Brown, 4 Vet. App. 513, 514-15 (1993). In Dr. R. W.’s clinical opinion, the Veteran’s major depressive disorder with undifferentiated and overlapping anxious distress, more likely than not began in service, continued uninterrupted and is aggravated by his service-connected knee conditions. Furthermore, Dr. R. W. expounded on medical literature that suggested a comorbidity between “chronic musculoskeletal pain conditions (knee injury/limitations) and psychiatric conditions like depression and anxiety disorders that, according to Dr. R. w., is well documented. Dr. R. W. added that the occurrence is “especially salient in studies of the U.S. military service members who are at increased risk of developing both musculoskeletal injury and psychiatric trauma symptoms during post-military service”. Dr. R. W. emphasized that “comorbid depression and chronic musculoskeletal pain conditions (knee chondromalacia) can result in significantly increased risk of severe depression and suicide in service members with traumatic injuries”. Dr. R. W. explained that according to the Rand Corporation, “one-third of the Veterans returning from the military will commonly suffer from depressive and anxiety disorders most of which are related to co-occurring physical health conditions”. In support of his theory, the Veteran submitted numerous medical articles. One article, “Veteran’s Report of Pain and Associations with Ratings of Health, Health-Risk Behaviors, Affective Distress and Use of the Healthcare System”, Journal of Rehabilitation Research and Development, Vol. 40, No.5, R. D. Kearns, et. al (September/October 2003) addressed the reported associations between pain complaints and emotional distress. The authors posited that contemporary models of chronic pain emphasized the apparent relationships between pain, disability and emotional distress suggesting that the management of pain may represent a complex challenge to primary care provider, often requiring multimodal and multidisciplinary interventions. The authors asserted that, the strong association between pain and level of emotional distress is particularly noteworthy. Considerable research has documented a high prevalence of anxiety and mood disorders among persons with persistent pain, as well as a strong positive correlation between level of pain intensity and degree of depressive symptom severity and other indexes of emotional distress. The authors further noted that “empirical support … suggests that the presence of pain is likely a contributor to subsequent emotional distress, the presence of distress may possibly magnify ‘concern’ about pain and other somatic complaints”. In the article, “Military Chronic Musculoskeletal Pain and Psychiatric Comorbidity: Is Better Pain Management the Answer?”, Multidisciplinary Digital Publishing Institute (MDPI), C. A. McGeary et. al., (June 30, 2016), the authors posited that, “comorbidity between chronic musculoskeletal pain conditions and psychiatric conditions (depression and PTSD) has been well documented in extant research literature.” The authors asserted that, “service members with a chronic musculoskeletal pain condition are likely to develop more than one psychiatric comorbidity… Patients have been found to develop depression secondary to chronic pain”. Regarding Dr. R. W.’s medical opinion, it is well established that a medical opinion “must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions.” See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). The probative value of a medical opinion is generally based on the scope of the examination or review, as well as the relative merits of the expert’s qualifications and analytical findings, and the probative weight of a medical opinion may be reduced if the examiner fails to explain the basis for an opinion. Sklar v. Brown, 5 Vet. App. 140 (1993). In this appeal, Dr. R. W. conducted an in-person evaluation and reviewed the Veteran’s claims file. As such, Dr. R. W.’s medical opinion is persuasive and probative as it speaks to the question at hand, the nexus/relationship between the Veteran’s major depressive disorder with anxious distress and his service-connected bilateral knee condition. Furthermore, the Board has also considered the articles the Veteran submitted in support of his service connection claim. Medical treatise evidence can, in some circumstances, constitute competent medical evidence. Wallin v. West, 11 Vet. App. 509, 514 (1998); see also 38 C.F.R. § 3.159(a)(1). However, the Court held that “if such [medical treatise] evidence is presented, it must demonstrate a connection between service incurrence and a present injury or condition.” Supra at 513 (citing Libertine v. Brown, 9 Vet. App. 521 (1996). In this instance, the articles address the relationship between musculoskeletal injuries, chronic pain and depression (emotional distress). The medical articles are consistent with Dr. R. W.’s medical opinion that the Veteran’s diagnosed major depressive disorder with anxious distress is related to his service-connected bilateral knee condition. As such, the medical article evidence is afforded probative value. In light of the foregoing, namely the December 2016 Mental Conditions DBQ, Dr. R. W.’s medical opinion and the medical treatise evidence, the Board is satisfied that the criteria for the establishment of secondary service connection for major depressive disorder with anxious distress, have been met. 38 U.S.C. 1110, 1113, 5107(b); 38 C.F.R. §§ 3.102, 3.310(a). Entitlement to service connection to PTSD The Veteran contends that he has PTSD because of his military service. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a current diagnosis of PTSD, the preponderance of the evidence weighs against finding that the Veteran’s diagnosis of PTSD began during service or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). The Veteran’s service treatment records (STRs) indicated that the Veteran did not complain of, was treated for, or diagnosed with PTSD or a mental health condition during active duty. His post-service medical records indicated that he was diagnosed with a mental health condition several years after separation. A July 2008, VA treatment record indicated that the Veteran was diagnosed with PTSD; history of substance abuse versus dependence and rule-out substance induced psychosis, possible schizoaffective disorder. The VA examiner remarked that the Veteran’s PTSD symptoms were related to the Veteran “directly witnessing the shooting death of his fiancé.” The Veteran reported that in 2006, while sitting in a car at a stoplight in Philadelphia, Pennsylvania, two men walked up and shot at the Veteran and his fiancé, killing his fiancé. Subsequent VA medical treatment records note the Veteran’s PTSD (witnessed fiancé’s murder) diagnosis; however, the VA examiners do not suggest that the Veteran’s PTSD is attributable to his reported in-service stressor. In several statements submitted in December 2016, the Veteran’s siblings, asserted that the Veteran displayed signs of mental illness in 1979 after his discharge from service. The Veteran was described as a “zombie”, emotionless and detached. D. J. asserted that the Veteran wore a necklace of garlic/herbs to ward off evil spirits. M. W., asserted that the Veteran appeared depressed, withdrawn, angry, controlling, had sleeping problems and abused drugs. According to M. W., since separation, the Veteran’s demeanor and facial expressions have been “different”. His siblings collectively asserted that the Veteran was not violent or aggressive towards others. A review of the evidence of record indicates that, despite the Veteran’s PTSD diagnosis, the Veteran’s reported in-service stressor, namely that he deployed to the South Korean Demilitarized Zone (DMZ) for patrol duty for three months, “lived in fear”, “slept in the same clothes for days with his weapon”, “fought his comrades”, “disobeyed orders” and “drank heavily” were insufficient to send to the U.S. Army and Joint Services Records Research Center (JSRRC) for verification. The Veteran’s military personnel records indicate that his military occupational specialty (MOS) was an Infantryman/Granadier and that he deployed to Korea in July 1979. While the Veteran believes that his PTSD is related to an in-service injury, event, or disease, including his deployment to the South Korean DMZ, he is not competent to provide a nexus opinion in this case. This issue is also medically complex, as it requires that the Veteran have specialized knowledge to provide a nexus opinion. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the medical evidence of record that does not attribute the Veteran’s PTSD to service. Overall, the evidence of record does not suggest that the Veteran’s PTSD is related to his service. The RO was unable to verify the Veteran’s in-service stressors and the medical evidence of record, including the July 2008 VA examiner’s clinical assessment, suggests that the Veteran’s PTSD is related to witnessing his fiancé’s tragic death. Notably, the Veteran did not complain of, was treated for, or diagnosed with PTSD or a mental health condition during active duty; but, was diagnosed with PTSD decades after his 1979 separation from service. For the foregoing reasons, the Board finds that service connection for PTSD must be denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert, supra. Entitlement to service connection for a bilateral shoulder condition The Veteran contends that he has a bilateral shoulder condition because of his service. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a diagnosis of diffuse osteoarthritis, shoulder, the preponderance of the evidence is against finding that it began during active service, or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, The Veteran’s STRs indicated that he did not complain of, was treated for, or diagnosed with a bilateral shoulder condition during service. His July 1977 enlistment examination indicated that his shoulders were normal. On the report of medical history, the Veteran endorsed “no” for “painful or ‘trick’ shoulder”, “swollen or painful joints”, “arthritis, rheumatism or bursitis” and “bone, joint or other deformity”. STRs indicated that the Veteran’s complaints, treatment and/or diagnoses included, but were not limited to, pseudofolliculitis barbae (received a shaving profile), knee pain, wrist pain, hammer toe, pes planus and callus/abcess on the toes of his left foot. However, there was no indication of a bilateral shoulder condition during active duty. His November 1979 separation examination indicated that his shoulders were normal. Again, on the report of medical history he again endorsed “no” for “painful or ‘trick’ shoulder”, “swollen or painful joints”, “arthritis, rheumatism or bursitis” and “bone, joint or other deformity”. His post-service medical records include an April 2014 VA treatment record that indicated that he complained of right shoulder pain. A July 2014 VA treatment record indicated that the Veteran requested an appointment with a primary care physician because of his right shoulder pain. The Veteran reported that he had difficulty reaching up or outward for the preceding two months. An October 1, 2015 VA treatment note indicated that he complained of right shoulder stiffness. The Veteran reported that he experienced right shoulder pain when lying on his right side during the night. On VA outpatient treatment on October 16, 2015, he endorsed bilateral shoulder pain. In March 2016, the Veteran was diagnosed with “diffuse osteoarthritis, shoulder”. The VA examiner did not identify the affected shoulder. Moreover, during examination the Veteran only endorsed bilateral wrist and left hand pain. There was no documented report of bilateral shoulder pain. Based on the foregoing evidence, the Board finds that service connection for a bilateral shoulder condition is not warranted. In so finding, the Board observes that the Veteran’s STRs indicate that the Veteran did not complain of, was treated for, or diagnosed with a bilateral shoulder condition during active duty. The Veteran’s November 1979 separation examination indicates that his shoulders were normal. There is no credible notation of shoulder problems in service. Furthermore, the clinical evidence of record indicates that the Veteran was diagnosed with diffuse osteoarthritis, shoulder, in March 2016. The clinical evidence indicates that the Veteran did not exhibit symptoms of, or was diagnosed with a shoulder condition until 35 years after his separation from military service. The earliest record of right shoulder pain was in April 2014, decades after separation. The evidence indicates that the Veteran’s bilateral shoulder condition did not manifest to a compensable degree within the one-year presumptive period after separation from service. Therefore, the Board finds that the evidence of record preponderates against a finding of service connection for a bilateral shoulder condition on a presumptive basis. The Board recognizes the Veteran’s belief that he is entitled to service connection for a bilateral shoulder condition. Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), as to the specific issue in this case, the Veteran is not considered competent to provide a nexus opinion. The Board highlights that competent statements are limited to that which the Veteran has actually observed and is within the realm of his personal knowledge; such knowledge comes to the Veteran through use of his senses-that which is heard, felt, seen, smelled or tasted. See Layno v. Brown, 6 Vet. App. 465 (1994). It is within the Veteran’s realm of personal knowledge whether he experienced symptoms related to the claimed disability. It is not shown, however, that the Veteran possesses the medical expertise necessary to provide a probative opinion on a complex medical matter such as the etiology of a bilateral shoulder condition. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). For the foregoing reasons, the Board finds that service connection for a bilateral shoulder condition must be denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert, supra. Entitlement to service connection for a bilateral hip condition The Veteran contends that he has a bilateral hip condition because of his service. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the Veteran does not have a current diagnosis of a bilateral hip condition and has not had one at any time during the pendency of the claim or recent to the filing of the claim. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); 38 C.F.R. § 3.303(a), (d). The Veteran’s STRs indicated that he did not complain of, was treated for, or diagnosed with a bilateral hip condition during service. His July 1977 enlistment examination indicated that his hips were normal. On the report of medical history, the Veteran endorsed “no” for “swollen or painful joints”, “arthritis, rheumatism or bursitis” and “bone, joint or other deformity”. STRs indicated that the Veteran’s complaints, treatment and/or diagnoses included, but were not limited to, pseudofolliculitis barbae (received a shaving profile), knee pain, wrist pain, hammer toe, pes planus and callus/abcess on the toes of his left foot. However, there was no indication of a bilateral hip condition during active duty. His November 1979 separation examination indicated that his hips were normal. On the report of medical history, he again endorsed “no” for “swollen or painful joints”, “arthritis, rheumatism or bursitis” and “bone, joint or other deformity”. The Veteran’s post-service medical records indicate that on VA outpatient treatment in August 2014, he endorsed right-side lumbar spine pain that radiated to the lateral left hip. Otherwise, the medical evidence of record does not suggest that the Veteran has a diagnosed bilateral hip disability. The Veteran is not service-connected for a lumbar spine disability. Based on the foregoing evidence, the Board finds that service connection for a bilateral hip condition is not warranted. In so finding, the Board observes that the Veteran’s STRs indicate that the Veteran did not complain of, was treated for, or diagnosed with a hip condition during active duty. The Veteran’s November 1979 separation examination indicates that his hips were normal. After separation, the Veteran reported lateral left hip pain; however, the medical evidence of record does not indicate that the Veteran has a diagnosed bilateral hip condition. As highlighted above, the most probative evidence fails to demonstrate that the Veteran has had a bilateral hip condition at any time during the pendency of this appeal. The medical evidence of record is silent for a current bilateral hip diagnosis during the period on appeal. The Veteran has not presented persuasive evidence showing that he has symptoms that result in any functional impairment. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018) (holding that a “disability” under 38 U.S.C. § 1110 refers to functional impairment of earning capacity). Congress specifically limited entitlement to service connection for a disease or injury to cases where the disease or injury has resulted in a disability. In the absence of a proof of present disability there can be no claim. Brammer v. Derwinski, 3 Vet. App. 223 (1992). While the Veteran believes he has a current diagnosis of a bilateral hip condition, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education. Jandreau, surpa. Consequently, the Board gives more probative weight to the medical evidence of record. For the foregoing reasons, the Board finds that service connection for a bilateral hip condition must be denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert, supra. Earlier Effective Date Unless specifically provided otherwise, the effective date for an award based on an original claim shall be fixed in accordance with the facts found, but shall not be earlier than the date of receipt of the application thereof. 38 U.S.C. § 5110(a). This statutory provision is implemented by regulation, which provides that the effective date of an award of disability compensation based on an original claim will be the date of receipt of the claim or date entitlement arose, whichever is later. 38 C.F.R. § 3.400; see also 38 C.F.R. § 3.4 (b)(1) (defining “disability compensation” as basic entitlement for a veteran who is disabled as a result of a disease or injury incurred in or aggravated in the line of duty in active service). The effective date for an award of direct service connection will be the day following separation from service or the date entitlement arose if the claim is received within one year after service separation; otherwise the date of receipt of the claim, or the date entitlement arose, whichever is later. 38 C.F.R. § 3.400. Entitlement to an earlier effective date prior to August 21, 2014 for service connection for bilateral knee chondromalacia The Veteran contends that an effective date earlier than August 21, 2014, for the grant of service connection for bilateral knee chondromalacia is warranted. The information of record does not contain any communication from the Veteran indicating his intent to file a formal or informal claim for service connection for a bilateral knee condition dated prior to August 21, 2014. In this case, the Veteran filed a claim seeking entitlement to service connection for a bilateral knee condition in August 2014, 35 years after his separation from active duty. Service connection for left knee chondromalacia and right knee chondromalacia was granted in a January 2015 rating decision, effective from August 21, 2014, the date of receipt of the claim. In January 2015, the RO sent the Veteran notice of its decision and of his appellate rights. An appeal, which challenged the August 21, 2014 effective date assigned for the award of service connection for bilateral knee chondromalacia, was initiated with an April 2015 NOD. In August 2016, a Statement of the Case (SOC) was issued. In September 2016, the Veteran filed a substantive appeal (VA Form-9). 38 U.S.C. § 7105 (a), (b)(2), (c); 38 C.F.R. §§ 20.200, 20.201. Although the evidence of record does not reveal the exact date upon which entitlement arose, the Board notes that such information is not required in order to conclude that the August 21, 2014 date assigned is the earliest date possible for which service connection may be effectuated. The reason for this is that, if entitlement arose prior to August 21, 2014, then the date of the claim would be the later of the two, and hence the correct effective date as provided by 38 C.F.R. § 3.400(b)(2). Any evidence showing that entitlement arose after the selected effective date (August 21, 2014) would not entitle the Veteran to an even earlier effective date. Put another way, the controlling law and regulation regarding effective dates are clear. The effective date of an award of compensation based on an original claim (received beyond one year after discharge), will be the date of VA receipt of the claim, or date entitlement arose, whichever is later. 38 U.S.C. § 5110(a), (b)(1); 38 C.F.R. § 3.400(b)(2). The Board notes that, even if the Veteran’s claim was received after the medical evidence demonstrated that the Veteran was experiencing bilateral knee chondromalacia, the effective date remains the date of the claim for which service connection was raised (August 21, 2014), which is the later date. In reaching this conclusion, the Board emphasizes that an effective date of an award of service connection is not based on the earliest medical evidence, but rather on the date that the application upon which service connection was eventually awarded was filed with VA, i.e., the formal application for compensation of August 21, 2014, which demonstrated the Veteran’s intent to file a claim for VA compensation benefits based on this discrete disability. As previously indicated, the information of record reflects that the Veteran did not file a formal or informal application for service connection for a bilateral knee condition prior to August 21, 2014, and that there is no evidence of any communication prior to August 21, 2014. While the Veteran maintains that he is entitled to an effective date earlier than August 21, 2014 for the grant of service connection for bilateral knee chondromalacia, the governing statutory and regulatory criteria prohibit an effective date earlier than the date of receipt of the claim, in this case, August 21, 2014. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.105(a), 3.400(a)(1)(ii), (r). Accordingly, the Board finds that an effective date earlier than August 21, 2014 is not warranted. As there is not an approximate balance of evidence on the question of whether the assignment of an effective date earlier than August 21, 2014 is warranted, the “benefit-of-the-doubt rule,” enumerated in 38 U.S.C. § 5107(b) and 38 C.F.R. § 3.102, is inapplicable. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001). REASONS FOR REMAND Entitlement to an increased initial evaluation for left knee chondromalacia, rated as 10 percent disabling and entitlement to an initial compensable evaluation for right knee chondromalacia, are remanded. The Veteran was last provided a VA examination in conjunction with his service-connected bilateral knee chondromalacia in December 2014. The Court of Appeals for Veterans Claims (Court) held in Correia v. McDonald, 28 Vet. App. 158 (2016), that the final sentence of 38 C.F.R. § 4.59 requires that VA musculoskeletal examinations include joint testing for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint. In addition, as relevant to the present case, the Court stated in Correia that knees were “undoubtedly weight-bearing.” Id. A review of the claims file reveals that the prior VA examination report includes only active range of motion findings and does not include range of motion findings for passive range of motion. It also does not specify whether the results are weight-bearing or nonweight-bearing. As the previous examination report does not fully satisfy the requirements of Correia and 38 C.F.R. § 4.59, a new examination is necessary to decide the claim. An additional relevant opinion pertaining to flare-ups was also issued by the Court in Sharp v. Shulkin, 29 Vet. App. 26 (2017). The matters are REMANDED for the following action: 1. Schedule the Veteran for an appropriate VA examination to evaluate the service-connected bilateral knee chondromalacia. The Veteran’s claims folder must be reviewed by the examiner. (a) In reporting the results of range of motion testing, the examiner should identify any objective evidence of pain, and the degree at which pain begins. (b) Pursuant to Correia v. McDonald, the examination should record the results of range of motion testing for pain in BOTH knees on BOTH active and passive motion AND in weight-bearing and nonweight-bearing. If the knees cannot be tested on “weight-bearing,” then the examiner must specifically indicate that such testing cannot be done. (c) The examiner should also express an opinion concerning whether there would be additional functional impairment on repeated use or during flare-ups assessed in terms of the degree of additional range of motion loss. In regard to flare-ups (pursuant to Sharp v. Shulkin, 29 Vet. App. 26 (2017)) if the Veteran is not currently experiencing a flare-up, based on relevant information elicited from the Veteran, review of the file, and the current examination results regarding the frequency, duration, characteristics, severity, and functional loss regarding his flares, the examiner is requested to provide an estimate of the Veteran’s functional loss due to flares expressed in terms of the degree of additional range of motion lost, or explain why the examiner cannot do so. [The Board recognizes the difficulty in making such determinations but requests that the examiner provide his or her best estimate based on the examination findings and statements of the Veteran.] (CONTINUED ON NEXT PAGE) TANYA SMITH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. Taylor, Associate Counsel