Citation Nr: 18150025 Decision Date: 11/15/18 Archive Date: 11/14/18 DOCKET NO. 16-29 609 DATE: November 15, 2018 ORDER Entitlement to service connection for degenerative bone disease is denied. Entitlement to service connection for ischemic heart disease, to include as due to exposure to herbicides is denied. Entitlement to service connection for chloracne, to include as due to exposure to herbicides is denied. Entitlement to service connection for an acquired psychiatric disability, to include an unspecified anxiety disorder, is granted, subject to the law and regulations governing the payment of monetary benefits. Entitlement to an initial rating in excess of 10 percent for tinnitus is denied. Entitlement to an initial rating in excess of 30 percent for bilateral hearing loss is denied. Entitlement to an initial rating in excess of 20 percent for type II diabetes mellitus is denied. Entitlement to an initial rating of 40 percent for right lower extremity peripheral neuropathy of the sciatic nerve is granted, subject to the law and regulations governing the payment of monetary benefits. Entitlement to an initial rating of 40 percent for left lower extremity peripheral neuropathy of the sciatic nerve is granted, subject to the law and regulations governing the payment of monetary benefits. Entitlement to an initial rating of 30 percent for right lower extremity peripheral neuropathy of the femoral nerve is granted, subject to the law and regulations governing the payment of monetary benefits. Entitlement to an initial rating of 30 percent for left lower extremity peripheral neuropathy of the femoral nerve is granted, subject to the law and regulations governing the payment of monetary benefits. Entitlement to an effective date earlier than February 25, 2016 for the grant of service connection for type II diabetes mellitus is denied. Entitlement to an effective date earlier than February 25, 2016 for the grant of service connection for sciatic and peripheral neuropathy of each lower extremity is denied. REMANDED Entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities is remanded. FINDINGS OF FACT 1. A degenerative bone disease did not begin during active service, arthritis of any joints did not manifest to a compensable degree within a year of separation from service, and degenerative bone disease is not otherwise related to an in-service injury or disease. 2. The Veteran served in Vietnam and is presumed to have been exposed to herbicides, including Agent Orange. 3. The Veteran does not have a current ischemic heart disease disability. 4. The Veteran does not have a current chloracne disability. 5. The Veteran does not have a current post-traumatic stress disorder disability. 6. The evidence is at least evenly balanced as to whether the Veteran’s current anxiety disorder had its initial onset during military service. 7. The Veteran is in receipt of the maximum schedular rating for tinnitus. 8. Since service connection was established, the Veteran’s bilateral hearing loss has been manifested by no worse than Level IX hearing impairment in his right ear, including consideration of his exception pattern of right ear hearing impairment, and Level IV hearing impairment in his left ear. 9. Since service connection was established, the Veteran’s type II diabetes mellitus has required oral hypoglycemic agent and restricted diet, but has not required regulation of his activities. 10. Since service connection was established, the Veteran’s right lower extremity peripheral neuropathy of the sciatic nerve has been manifested by moderately severe incomplete paralysis. 11. Since service connection was established, the Veteran’s left lower extremity peripheral neuropathy of the sciatic nerve has been manifested by moderately severe incomplete paralysis. 12. Since service connection was established, the Veteran’s right lower extremity peripheral neuropathy of the femoral nerve has been manifested by severe incomplete paralysis. 13. Since service connection was established, the Veteran’s left lower extremity peripheral neuropathy of the femoral nerve has been manifested by severe incomplete paralysis. 14. Type II diabetes mellitus was diagnosed in October 2015; VA received the original claim for entitlement to service connection for type II diabetes mellitus on February 25, 2016. 15. Idiopathic peripheral neuropathy of the bilateral lower extremities was diagnosed in 2005 after initially manifesting in 2004, more than 35 years after the Veteran’s last exposure to herbicides in Vietnam and separation from service; diabetes mellitus, which was not diagnosed until October 2015, was excluded as an underlying cause of the idiopathic peripheral neuropathy. 16. VA received the Veteran’s claim of entitlement to service connection for peripheral neuropathy on June 21, 2012, and his claim of entitlement to service connection for type II diabetes mellitus on February 25, 2016; a June 2016 rating decision attributed the Veteran’s sciatic and peripheral neuropathy of each lower extremity to service-connected diabetes mellitus based on a June 2016 VA examination report. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a degenerative bone disease have not been met. 38 U.S.C. §§ 1110, 1112, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2017). 2. The criteria for entitlement to service connection for ischemic heart disease have not been met. 38 U.S.C. §§ 1110, 1112, 1116, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2017). 3. The criteria for entitlement to service connection for chloracne have not been met. 38 U.S.C. §§ 1110, 1112, 1116, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2017). 4. The criteria for entitlement to service connection for posttraumatic stress disorder have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2017). 5. Resolving all reasonable doubt in favor of the Veteran the criteria for entitlement to service connection for anxiety disorder have been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2017). 6. The criteria for entitlement to an initial rating in excess of 10 percent for tinnitus have not been met. 38 U.S.C. §§ 1155, 5017 (2012); 38 C.F.R. §§ 3.102, 4.87, Diagnostic Code 6260 (2017). 7. The criteria for entitlement to an initial rating in excess of 30 percent for bilateral hearing loss have not been met. 38 U.S.C. §§ 1155, 5017 (2012); 38 C.F.R. §§ 3.102, 4.85, 4.86 Diagnostic Code 6100 (2017). 8. The criteria for entitlement to an initial rating in excess of 20 percent for type II diabetes mellitus have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.7, 4.10, 4.119, Diagnostic Code 7913 (2017). 9. The criteria for entitlement to an initial rating of 40 percent for right lower extremity peripheral neuropathy of the sciatic nerve have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.3, 4.7, 4.10, 4.124a, Diagnostic Code 8620 (2017). 10. The criteria for entitlement to an initial rating of 40 percent for left lower extremity peripheral neuropathy of the sciatic nerve have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.3, 4.7, 4.10, 4.124a, Diagnostic Code 8620 (2017). 11. The criteria for entitlement to an initial rating of 30 percent for right lower extremity peripheral neuropathy of the femoral nerve have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.3, 4.7, 4.10, 4.124a, Diagnostic Code 8626 (2017). 12. The criteria for entitlement to an initial rating of 30 percent for left lower extremity peripheral neuropathy of the femoral nerve have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.3, 4.7, 4.10, 4.124a, Diagnostic Code 8626 (2017). 13. The criteria for entitlement to an effective date earlier than February 25, 2016 for the grant of service connection for type II diabetes mellitus have not been met. 38 U.S.C. § 5110 (2012); 38 C.F.R. §§ 3.151, 3.155, 3.400, 3.816 (2017). 14. The criteria for entitlement to an effective date earlier than February 25, 2016 for the grant of service connection for sciatic and peripheral neuropathy of each lower extremity have not been met. 38 U.S.C. § 5110 (2012); 38 C.F.R. §§ 3.151, 3.155, 3.400 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1967 to June 1969, including service in the Republic of Vietnam. This matter comes before the Board of Veterans’ Appeals (Board) from March 2014 and June 2016 rating decisions. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110 (2012); 38 C.F.R. § 3.303 (2017). In addition, service connection may be granted for any disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). To establish direct service connection, there must be: the existence of a present disability; in-service incurrence or aggravation of a disease or injury; and a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). 1. Entitlement to service connection for degenerative bone disease The Veteran contends he has a degenerative bone disease related to his military service. The question for the Board is whether he has a current disability that began during service or is at least as likely as not related to an in-service injury or disease. The Board concludes that, while the Veteran has a diagnosis of degenerative joint disease of the spine, left knee, and the bilateral shoulders and hips, the preponderance of the evidence is against finding that his arthritis of any joints began during active service, manifested to a compensable degree within one year of separation from service, or is otherwise related to an in-service injury or disease. 38 U.S.C. §§ 1110, 1112, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. §§ 3.303(a), (d), 3.307(a)(3), 3.309(a). The Veteran’s service personnel and treatment records indicate he did not participate in combat with the enemy. Similarly, among statements made in support of his claim, including argument from his attorney, he has not described any particular injury, disease, or chronic musculoskeletal symptoms during his military service. Rather, his service treatment records are entirely silent for complaints, diagnosis, or treatment for degenerative bone problems. In a June 1969 separation report of medical history, he denied currently or ever having swollen or painful joints, back trouble of any kind, bone deformity, arthritis or rheumatism, trick or locked knee, or painful or trick shoulder. On separation examination the same day, his spine and other musculoskeletal function, upper extremities, and lower extremities were reported as normal on clinical evaluation. Post-service VA treatment records dated from 1996 to 2017 document numerous reports by the Veteran that he injured his back at work in the early 1980s and had a long history of chronic back pain and other musculoskeletal pain since that time. He described his occupational history to include working briefly for the post office and as a carpenter, working in maintenance and track repair for the railroad for six years until he hurt his back and “medically retired.” After “staying home” for three years, he worked for a roofing company from 1986 until 1996, followed by work as a carpenter and painter until 2007. During a January 2001 VA mental health visit, he indicated he was looking for a less-physical job because it was becoming more difficult to do physical work as he aged. Imaging studies revealed degenerative joint disease in numerous locations, including the cervical spine in February 1999, both shoulders in September 2002, the left knee in 2006, and the bilateral hips in March 2011. During a January 2014 VA physical medicine and rehabilitation consultation, the Veteran complained of chronic mid-thoracic back pain near T5 for 34 years (1980) since he was “impacted by the windshield of a backhoe.” He identified his occupation as retired carpenter. MRI studies revealed nonspecific mild to moderate degenerative changes throughout the thoracolumbar disc spaces. In this case, there is no evidence of an injury or disease in service related to the Veteran’s spine, left knee, shoulders, or hips. Post-service medical and lay evidence of record indicates that the Veteran’s arthritis in each affected joint began many years after separation from service, including after at least one on-the-job back injury around 1980. He has not asserted, and the evidence does not show, that any arthritis manifested to a compensable degree within a year of separation from service. Moreover, he has not described any continuity of musculoskeletal symptoms such as pain since separation from service to the present and has not provided or identified any medical opinion to suggest that any current arthritis disability affecting multiple joints had its onset in service or is otherwise related to an injury or disease in service. In summary, the preponderance of the evidence is against the Veteran’s claim. Therefore, the benefit-of-the-doubt doctrine is not applicable and the service connection claim for a degenerative bone disease must be denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 2. Entitlement to service connection for ischemic heart disease, to include as due to exposure to herbicides 3. Entitlement to service connection for chloracne, to include as due to exposure to herbicides The Veteran contends he has ischemic heart disease and chloracne due to exposure to herbicides during his military service in Vietnam. His service personnel records reflect he served in Vietnam from July 1968 to June 1969. Therefore, absent affirmative evidence to the contrary, he is presumed to have been exposed to herbicide agents, including Agent Orange. 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307(a)(6), 3.309(e). A veteran is entitled to a presumption of service connection if he is diagnosed with certain enumerated diseases, including ischemic heart disease and chloracne, associated with exposure to certain herbicide agents if he served in the Republic of Vietnam during the applicable time period. 38 C.F.R. §§ 3.307(a)(6), 3.309(e). These diseases shall have become manifest to a degree of 10 percent or more at any time after service, except that chloracne or other acneform disease consistent with chloracne…shall have become manifest to a degree of 10 percent or more within a year after the last date on which the veteran was exposed to an herbicide agent during active military service. 38 C.F.R. § 3.307(a)(6)(ii). Ischemic heart disease includes, but is not limited to, acute, subacute, and old myocardial infarction; atherosclerotic cardiovascular disease including coronary artery disease (including coronary spasm and coronary bypass surgery; and stable, unstable and Prinzmetal’s angina). 38 C.F.R. § 3.309(e). Ischemic heart disease does not include hypertension or peripheral manifestations of arteriosclerosis such as peripheral vascular disease or stroke. Id. at Note 2. The Federal Circuit has held that even if a veteran is found not to be entitled to a regulatory presumption of service connection, the claim must still be reviewed to determine if service connection can be established on a direct basis. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). The question for the Board is whether the Veteran has a current ischemic heart disease disability that began any time after military service or a current chloracne disability that manifested to a degree of 10 percent or more by June 1970, which is the one-year period following his last in-service exposure to an herbicide agent. The Board finds the Veteran does not have a current diagnosis of either ischemic heart disease or chloracne and has not had either at any time during the appeal. 38 U.S.C. §§ 1110, 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 January 2014 VA examiner evaluated the Veteran and determined that while myocardial perfusion scanning in December 2007 revealed a thoracic aortic aneurysm and aortic stenosis, he did not have a diagnosis of ischemic heart disease then or now. Further, VA treatment records dated from 1996 to July 2017 reflect that the Veteran had been diagnosed with aortic stenosis, which is a valvular heart disease, after a February 1999 cervical spine x-ray study included an incidental finding of questionable tortuous aorta versus aortic aneurysm. However, the records do not reflect any ischemic heart disease. In fact, cardiac catheterization and angiogram studies in July 2017 confirmed the Veteran had normal coronary arteries and normal left ventricular function. Because the Veteran does not have a current ischemic heart disease disability, service connection must be denied. Regarding the service connection claim for chloracne, the Veteran’s service treatment records were silent for any complaints, diagnosis, or treatment for skin problems with two exceptions. In March 1968 while stationed at Fort Belvoir before beginning his tour in Vietnam, he was diagnosed with contact dermatitis. In a June 1969 separation report of medical history, he denied currently or ever having a history of skin diseases; however, he endorsed having an illness or injury other than those already noted. The examiner elaborated the Veteran had experienced tinea cruris in Vietnam, but did not currently have symptoms. On examination the same day, the Veteran’s skin, lower extremities, genitourinary system, and anus and rectum were reported as normal on clinical evaluation. Among post-service VA treatment records dating since November 1996, the Veteran complained of skin lesions on his legs during December 2004 and January 2005 primary care visits. The impression was possible psoriasis. He presented for a dermatology consultation later in January 2005 and described having lesions on his lower legs for approximately one year with some lesions on his arms for four to five months. A skin biopsy from the left leg revealed lichenoid spongiotic [dermatitis]. The dermatologist prescribed clobetasol and Dovonex ointment. Primary care and dermatology follow-up visits reflect ongoing evaluation and improvement of the Veteran’s probable psoriasis. A December 2006 dermatology note documents the Veteran’s subjective report and objective findings of no skin eruptions on either leg. The assessment was status post probable psoriasis on legs. During a January 2007 mental health visit, the Veteran reported a history of chloracne; the psychiatrist referred him for an Agent Orange examination. In February 2007, the Veteran presented for an Agent Orange program examination. He described a “burned out” psoriasis disorder that affected his legs, dating back around six years. He also stated that he had been “riddled with an acneiform condition affecting his back that began in service and persisted for 15 years.” He added, however, that the disorder had also “burned out” and no longer required treatment. Following an examination, the impression included burned out psoriasis and acneiform disorder with vestiges of scars on the upper back. Subsequent VA treatment records dating to July 2017 noted the Veteran’s history of psoriasis. During a January 2014 VA examination to evaluate his claimed chloracne disability, the Veteran reported he was “told a few years ago during an Agent Orange exam that he probably had had chloracne” after discharge from the military, stating that it developed on his back while he was in Vietnam and lasted ten years, but the disorder had since resolved. The examiner remarked it was unclear why the separation examination report from June 1969 did not describe any chloracne. Physical examination revealed the Veteran did not have any current chloracne disability and the examiner commented that the “chloracne ha[d] long since resolved.” The Board finds that service connection for chloracne is not warranted because the Veteran does not have a current chloracne disability and has not had chloracne at any time during the appeal. Where, as here, there is competent and persuasive medical evidence establishing that the Veteran does not have current chloracne disability, there can be no valid claim for service connection. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The Board acknowledges that the Veteran’s service treatment records document an episode of contact dermatitis and indicate he had tinea cruris during his service in Vietnam. These skin disorders, however, did not continue after service and are not shown by the medical evidence to be present now. Similarly, although post-service treatment records indicate the Veteran had symptoms of psoriasis from approximately January 2004 until December 2006, the medical evidence of record indicates that psoriasis was not present during active duty service and has not been present during the current appeal. Finally, although the Veteran described a history of chloracne to a VA psychiatrist and dermatologist, the fact remains that even if the Veteran was relating a prior diagnosis, he does not have chloracne now. In reaching the above conclusions, 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 service connection claims for ischemic heart disease and chloracne, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 4. Entitlement to service connection for an acquired psychiatric disability, to include posttraumatic stress disorder (PTSD) and unspecified anxiety disorder As an initial matter, although the Veteran claimed entitlement to service connection for PTSD, the claim is appropriately broadened to include the diagnosed anxiety disorder and depressive disorder disabilities noted in post-service treatment records. See Clemons v. Shinseki, 23 Vet. App. 1, 4-5 (2009), (holding that although a claim identifies only a single diagnosed disorder, it must be considered a claim for any disability that may reasonably be encompassed by that claim). Therefore, the question for the Board is whether the Veteran has a current psychiatric disability that began during service or is at least as likely as not related to an in-service injury, disease, or event. The requirements for establishing service connection for PTSD are separate and distinct from those for establishing service connection generally. Arzio v. Shinseki, 602 F.3d 1343, 1347 (Fed. Cir. 2010). Service connection for PTSD requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a); a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the in-service stressor occurred. 38 C.F.R. § 3.304(f). The Veteran contends he has a current acquired psychiatric disability, claimed as PTSD, related to events during his military service in Vietnam. Specifically, he described his “greatest fear during [his] year in Vietnam” involving living in a canvas Quonset hut and having a “morbid fear of having [his] throat slashed.” He also described an event shortly after arriving in Vietnam in July 1968 in which he was dropped off at a bunker and was alone without any ammunition while he waited out a firefight. The Veteran’s identified military stressors are the sort that involve fear of hostile military activity. For purposes of establishing service connection for PTSD, fear of hostile military or terrorist activity means that a veteran experienced, witnessed, or was confronted with an event or circumstance that involved actual or threatened death or serious injury, or a threat to the physical integrity of the veteran or others, such as from an actual or potential improvised explosive device; vehicle-imbedded explosive device; incoming artillery, rocket, or mortar fire; grenade; small arms fire, including suspected sniper fire; or attack upon friendly military aircraft, and the veteran’s response to the event or circumstance involved a psychological or psycho-physiological state of fear, helplessness, or horror. 38 C.F.R. § 3.304(f)(3). Consequently, if a VA psychiatrist or psychologist, or a psychiatrist or psychologist with whom VA has contracted, confirms that a claimed stressor is adequate to support a diagnosis of PTSD and that a veteran’s symptoms are related to the claimed stressor, in the absence of clear and convincing evidence to the contrary, and provided the claimed stressor is consistent with the places, types, and circumstances of the veteran’s service, the veteran’s lay testimony alone may establish the occurrence of the claimed in-service stressor. Id. Turning to the evidence, the Veteran’s service treatment records are silent for complaints, diagnosis, or treatment for psychiatric problems. In reports of medical history at enlistment and separation in July 1967 and June 1969, respectively, he denied currently or ever having depression or excessive worry, nervous trouble of any sort, frequent trouble sleeping, frequent or terrifying nightmares, or loss of memory or amnesia. In corresponding examination reports, his psychiatric function was reported as normal on clinical evaluation. Among post-service VA treatment records dating since November 1996, the records demonstrate a long history of anxiety. An April 1999 note records a past medical history to include panic attacks and reflects the physician’s comment that the Veteran usually appeared “very anxious.” During an initial VA psychiatry visit in September 2000, the Veteran described feeling nervous his entire life and feeling particularly bothered by writing in public and meeting others for the first time. Current symptoms included worrying and a tense feeling accompanied by back spasm, chest pain, and startling easily. The diagnosis was social phobia, generalized anxiety disorder, depression not otherwise specified (NOS), and alcohol abuse in remission over 20 years. The psychiatrist prescribed a trial of Prozac (fluoxetine) and an increased dose of alprazolam (Xanax). He continued to receive treatment for anxiety and depression symptoms. An August 2004 primary care treatment record notes the Veteran had a positive screen for PTSD and depression and continued to report problems with anxiety. The physician ordered a psychiatry consultation. During a September 2004 consultation with the psychiatrist who had previously evaluated and treated him in September 2000, the Veteran reported misunderstanding the questions on the PTSD screen, clarifying that he only experiences nightmares a couple times per month and they were not about a traumatic event. The diagnosis included generalized anxiety disorder, depression NOS, and alcohol abuse with current status difficult to assess. In October 2004, he presented to the outpatient mental health clinic for medication management. He described his history of anxiety and having “trouble writing when people are watching him.” He reported frequent worry and sometimes feeling depressed. He indicated he worked as a generator repairman during military service and stated he was “involved in combat” in Vietnam, adding that he “used to hear guns, helicopters, and shooting at night.” The diagnosis was generalized anxiety disorder, depressive disorder NOS, and alcohol abuse. The psychiatrist prescribed sertraline (Zoloft) and continued use of Xanax. Subsequent VA treatment records reflect ongoing medication management for anxiety symptoms. The Veteran was afforded a VA examination in January 2014. He stated he had always been a “somewhat nervous and introverted person,” but recalled he first experienced his “most distressing symptom,” which he identified as trembling hands resulting in anxiety and inability to sign his name in front of other people, shortly before he went to Vietnam. He reported feeling more nervous after returning from Vietnam. He described the circumstances of his first days in Vietnam as being very confusing and anxiety-provoking, including the incident in which he was alone in a bunker without ammunition during a firefight. However, he stated that his living conditions in the canvas hut bothered him most. He noted the hut was very penetrable and he always was afraid to sleep because he feared and imagined someone would slit his throat. The Veteran reported having military-related dreams in the early years after service in Vietnam, but stated he no longer had those dreams. He indicated that seeing war news on TV or talking with other veterans reminded him of his military experiences, but these experiences were not personally upsetting to him. He denied any avoidance symptoms and did not endorse symptoms of negative alterations in cognition or mood associated with his military traumas. Regarding detachment from others, he stated he had always been introverted, even prior to his military service. Following a review of the claims file and examination, the psychologist explained that while the Veteran’s reported military stressors were adequate to support a diagnosis of PTSD, he did not meet the remaining criteria for a PTSD diagnosis. Instead, the diagnosis was unspecified anxiety disorder. The examiner opined that the Veteran’s most distressing symptoms did not appear to be directly related to his Vietnam service, some of them having begun prior to his military service and others having largely resolved over time. The examiner explained that it was possible that a predisposition to anxiety was exacerbated by the Veteran’s Vietnam service, contributing to his current anxiety disorder. The AOJ requested an addendum medical opinion from the January 2014 VA examiner. In the opinion request, the AOJ asked the examiner to “state whether it is at least as likely as not that the Veteran’s unspecified anxiety disorder (which clearly and unmistakably existed prior to service) was aggravated beyond its natural progression by his service in Vietnam.” In March 2016, the January 2014 VA psychologist reviewed the Veteran’s claims file again and provided a supplemental medical opinion. The examiner explained there was not enough information available to provide an opinion as to whether the Veteran’s unspecified anxiety disorder was aggravated beyond its natural progression by his military service. The examiner emphasized that there was no specific documentation that a mental disorder existed prior to military service other than the Veteran’s self-report that he had always been nervous and introverted and no evidence to support an aggravation of the anxiety disorder other than the Veteran’s report that his nervousness got “worse” after Vietnam. The examiner reiterated that the current anxiety disorder did not appear to have been caused by the Veteran’s Vietnam service. Finally, acknowledging that the prior opinion was not sufficiently clear, the examiner opined that it was at least as likely as not that the Veteran’s predisposition to anxiety was exacerbated by his Vietnam service, contributing to his current anxiety disorder. Having considered the medical and lay evidence of record, the Board finds that the claim for service connection for PTSD must be denied because the preponderance of the evidence demonstrates the Veteran does not have a current PTSD disability. However, the Board also concludes that the Veteran does have a current diagnosis of unspecified or generalized anxiety disorder that began during his military service and continued to the present. 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). In this regard, while he is not competent to diagnose a particular psychiatric disability, he is competent to describe symptoms he has experienced such as anxiety and phobia related to signing his name in front of others. The Board finds his account regarding the onset of this symptom beginning shortly before his tour in Vietnam to be credible because it is generally consistent with the remaining evidence of record, including prior statements to made to treatment providers. Considering the medical opinion evidence, the Board finds the March 2016 VA opinion is persuasive and probative in support of the claim for service connection because it was based on a review of the claims file and supported by an articulated medical explanation that is consistent with the remaining records. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008). As detailed, the Veteran had a generally anxious disposition his entire life, his anxiety first caused psychiatric impairment when he was unable to sign his name in the presence of others shortly before leaving for Vietnam, and he described increased anxiety after returning from Vietnam that has generally persisted to the present. Accordingly, the Board concludes that the evidence of record is at least in equipoise as to whether the Veteran’s current diagnosis of unspecified or generalized anxiety disorder began during his military service and continued to the present. As the reasonable doubt created by the relative equipoise in the evidence must be resolved in favor of the Veteran, entitlement to service connection for anxiety disorder is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Increased Ratings Disability ratings are determined by applying the criteria set forth in VA’s Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.1 (2017). The basis of disability evaluations is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. Where there is a question as to which of two ratings should be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. In determining the severity of a disability, the Board is required to consider the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the Veteran, as well as the entire history of the veteran’s disability. 38 C.F.R. §§ 4.1, 4.2; Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). Generally, when an increase in the disability rating is at issue, the present level of disability is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). When the appeal arises from an initial assigned rating, consideration must be given to whether staged ratings should be assigned to reflect entitlement to a higher rating at any point during the pendency of the claim. Fenderson v. West, 12 Vet. App. 119 (1999). Staged ratings are also for consideration in any increased rating claim in which distinct time periods with different ratable symptoms can be identified. Hart v. Mansfield, 21 Vet. App. 505, 510 (2007). Analysis in this decision has therefore been undertaken with consideration of the possibility that different ratings may be warranted for different time periods. 5. Entitlement to an initial rating in excess of 10 percent for tinnitus The Veteran believes his tinnitus disability warrants an initial rating in excess of 10 percent. Since service connection was established effective June 21, 2012, the Veteran’s tinnitus has been rated 10 percent disabling pursuant to 38 C.F.R. § 4.87, Diagnostic Code 6260, which provides a maximum rating of 10 percent for recurrent tinnitus whether the sound is perceived in one ear, both ears, or in the head. 38 C.F.R. § 4.87, Diagnostic Code 6260, Note (2). During a January 2014 VA audiological examination, the Veteran described intermittent tinnitus in both ears since the 1970s or earlier. Applying the facts in this case to the criteria set forth above, the Board finds that the preponderance of the evidence is against the assignment of an initial rating in excess of 10 percent for tinnitus. The Veteran’s service-connected tinnitus has been assigned the maximum schedular rating available from the effective date of the award of service connection. See Smith v. Nicholson, 451 F.3d 1344 (Fed. Cir. 2006) (affirming VA’s long-standing interpretation of Diagnostic Code 6260 as authorizing only a single 10 percent rating for tinnitus, whether unilateral or bilateral). Accordingly, no higher schedular evaluation is warranted. Moreover, because the rating criteria reasonably describe the Veteran’s disability level and symptomatology, his disability picture is contemplated by the Rating Schedule, such that the assigned schedular rating is adequate and no referral is required for consideration on an extraschedular basis. 38 C.F.R. § 3.321; Thun v. Peake, 22 Vet. App. 111, 115-16 (2008); VAOPGCPREC 6-96. The evidence does not show anything unique or unusual about the Veteran’s tinnitus that would render the schedular criteria inadequate. Indeed, neither he nor his attorney has contended otherwise. 6. Entitlement to an initial rating in excess of 30 percent for bilateral hearing loss Since service connection was established effective June 21, 2012, the Veteran’s bilateral hearing loss disability has been rated 30 percent disabling pursuant to 38 C.F.R. §§ 38 C.F.R. § 4.85, 4.86, Diagnostic Code 6100. He believes a higher initial rating is warranted. The assignment of disability ratings for hearing impairment is derived by a mechanical application of the rating schedule to the numeric designations assigned after audiometric evaluations are rendered. Lendenmann v. Principi, 3 Vet. App. 345 (1992). The disability rating of a hearing loss disorder is determined by applying the criteria set forth at 38 C.F.R. § 4.85. Under these criteria, evaluations of bilateral hearing loss range from noncompensable to 100 percent based on organic impairment of hearing acuity as measured by the results of controlled speech discrimination tests together with the average pure tone hearing threshold level, as measured by pure tone audiometric tests in the frequencies 1,000, 2,000, 3,000 and 4,000 Hertz (Hz), or cycles per second, divided by four. This average is used in all cases to determine the Roman numeral designation for hearing impairment from Table VI or VIa. 38 C.F.R. § 4.85(a), (d). Table VI, “Numeric Designation of Hearing Impairment Based on Pure tone Threshold Average and Speech Discrimination,” is used to determine a Roman numeral designation (I through XI) for hearing impairment based on a combination of the percent of speech discrimination (horizontal rows) and the pure tone threshold average (vertical columns). The Roman numeral designation is located at the point where the percentage of speech discrimination and pure tone threshold average intersect. 38 C.F.R. § 4.85(b). Table VII, “Percentage Evaluations for Hearing Impairment,” is used to determine the percentage evaluation by combining the Roman numeral designations for hearing impairment of each ear. The horizontal rows represent the ear having the better hearing, while the vertical columns represent the ear having the poorer hearing. The percentage evaluation is located at the point where the row and column intersect. 38 C.F.R. § 4.85(e). Where impaired hearing is service connected in only one ear, the non-service connected ear will be assigned a Roman numeral I rating purposes. 38 C.F.R. § 4.85(f). In addition, 38 C.F.R. § 4.86 applies to exceptional patterns of hearing impairment. Under its provisions, when the pure tone threshold at each of the four specified frequencies (1,000, 2,000, 3,000, and 4,000 Hertz) is 55 decibels or more, the rating specialist will determine the Roman Numeral designation for hearing impairment from either Table VI or Table VIa, whichever results in the higher numeral. Each ear will be evaluated separately. When the pure tone threshold is 30 decibels or less at 1,000 Hertz, and 70 decibels or more at 2,000 Hertz, the rating specialist will determine the Roman numeral 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 numeral. 38 C.F.R. § 4.86. An examination for the evaluation of hearing impairment for VA purposes must be conducted by a state-licensed audiologist, and must contain a pure tone audiometry test and a controlled speech discrimination test, utilizing the Maryland CNC word list. 38 C.F.R. § 4.85(a). The Veteran was afforded a VA audiological examination in January 2014. He described military noise exposure related to his occupational specialty as a gas turbine generator repairman and his service in Vietnam. He denied any functional impact from his hearing loss on his daily life or ability to work. Objectively, right ear puretone thresholds in the frequencies 1000, 2000, 3000, and 4000 Hz were reported as 20, 75, 75 and 70 dB, respectively. For the left ear, puretone thresholds in the same frequencies were recorded as 40, 85, 105, and 100 dB, respectively. The average puretone threshold was 60 dB in the right ear and 83 dB in the left. Using the Maryland CNC test, speech recognition ability was 88 percent in the right ear and 52 percent in the left ear. Applying the above results to Table VI, a puretone threshold average of 60 dB and a speech discrimination of 88 percent in the right ear results in Level VIII hearing for that ear. In addition, because the right ear has a pure tone threshold of 30 decibels or less at 1,000 Hertz, and 70 decibels or more at 2,000 Hertz, the right ear demonstrates an exceptional pattern of hearing impairment. 38 C.F.R. § 4.86. As a result, the Board will also apply the right ear testing results to Table VIa, which results in a Level IV hearing impairment based on the average puretone threshold of 60 dB in the right ear. Comparing the results for the right ear when applied to Table VI and Table VIa, a higher numeral for the right ear results by applying Table VI. In turn, elevating the level VIII hearing impairment to the next higher level to account for the Veteran’s exceptional pattern of hearing impairment in the right ear, results in level IX hearing for that ear. Considering the results for the left ear, which does not demonstrate an exceptional pattern of hearing impairment, a puretone threshold average of 83 dB and a speech discrimination of 52 percent results in Level IV hearing for that ear. Finally, under Table VII, a Level IX for the right ear combined with a Level IV for the left ear results in a 30 percent evaluation. VA treatment records reflect the Veteran has a hearing loss disability and document audiological visits to maintain his hearing aids. Having considered the medical and lay evidence of record, the Board finds that an initial rating in excess of 30 percent for bilateral hearing loss is not warranted. The Board notes that the January 2014 VA examination was conducted in accordance with 38 C.F.R. § 4.85(a) and is highly probative. The Board acknowledges that in Martinak v. Nicholson, 21 Vet. App. 447, 455-56 (2007), the Court) noted that VA had revised its hearing examination worksheets to include the effect of a claimant’s hearing loss disability on occupational functioning and daily activities. The VA examiner’s report elicited effects of the Veteran’s hearing loss on his daily functioning, but the Veteran denied any specific impact on his daily life or ability to work during the January 2014 examination. In summary, the VA examination provided the requisite information concerning the functional impact of his hearing loss and included objective examination data in accordance with the requirements set forth in 38 C.F.R. § 4.85(a). The Board acknowledges the Veteran’s belief that a higher rating is warranted for his bilateral hearing loss disability, but the assignment of disability ratings for hearing impairment is derived from a mechanical formula based on levels of puretone threshold average and speech discrimination. The objective findings are more probative than the lay contentions as to the extent of hearing loss. In summary, the most probative evidence indicates that the Veteran’s hearing loss clearly falls within the criteria for a 30 percent rating for the duration of the claim. The Board has considered staged ratings under Fenderson v. West, 12 Vet. App. 119 (1999), but concludes they are not warranted because the medical and lay evidence of record does not support a higher rating than that already assigned. Therefore, the 30 percent rating for bilateral hearing loss is proper throughout the appeal period and a higher rating is denied. 7. Entitlement to an initial rating in excess of 20 percent for type II diabetes mellitus Since receipt of his service connection claim on February 25, 2016, the Veteran’s type II diabetes mellitus has been rated 20 percent disabling pursuant to 38 C.F.R. § 4.119, Diagnostic Code 7913. Under these criteria, a 20 percent rating is assigned for diabetes mellitus requiring one or more daily injection of insulin and restricted diet, or; oral hypoglycemic agent and restricted diet. 38 C.F.R. § 4.119, Diagnostic Code 7913. Higher ratings of 40, 60, or 100 percent all require regulation of activities, which is defined as avoidance of strenuous occupational and recreational activities. Id. In addition, the regulations stipulate that compensable complications of diabetes are to be evaluated separately, with noncompensable complications to be considered as part of the diabetic process under Diagnostic Code 7913. Id., Note (1). The medical evidence of record, including VA treatment records dating to July 2017, indicates the Veteran was diagnosed with type II diabetes mellitus in October 2015 and managed on prescribed oral hypoglycemic agents and restricted diet. The records indicate his physical activity was limited by his back pain; however, he was not directed to regulate his activities. Instead, he was encouraged to gradually increase his physical activity. During a June 2016 VA examination, the Veteran reported he continued to use prescribed oral hypoglycemic agents. The examination report detailed he had not required regulation of activities for management of his diabetes mellitus; he had not had any hospitalizations for episodes of ketoacidosis or hypoglycemic reactions over the past 12 months; and he had not experienced progressive unintentional weight loss and loss of strength due to diabetes mellitus. The examiner identified diabetic peripheral neuropathy as a complication of the Veteran’s diabetes mellitus. The Board has considered the evidence of record in its entirety and finds that an initial rating in excess of 20 percent for type II diabetes mellitus is not warranted at any time during the appeal. The preponderance of the evidence indicates the Veteran’s diabetes mellitus has been managed by an oral hypoglycemic agent and a restricted diet; it has not required regulation of his activities. 8. Entitlement to an initial rating in excess of 20 percent for right lower extremity peripheral neuropathy of the sciatic nerve 9. Entitlement to an initial rating in excess of 20 percent for left lower extremity peripheral neuropathy of the sciatic nerve 10. Entitlement to an initial rating in excess of 20 percent for right lower extremity peripheral neuropathy of the femoral nerve 11. Entitlement to an initial rating in excess of 20 percent for left lower extremity peripheral neuropathy of the femoral nerve Effective from February 25, 2016, service connection was established for right and left lower extremity peripheral neuropathy involving the sciatic and femoral nerves as secondary to the Veteran’s service-connected type II diabetes mellitus. He contends that higher initial ratings are warranted for sciatic and femoral peripheral neuropathy of each lower extremity. For clarity, because the Veteran’s peripheral neuropathy disabilities of the sciatic and femoral nerves have been examined at the same time, the Board presents the examination findings concurrently, but analyzes the peripheral neuropathy attributable to each nerve separately according to the applicable rating criteria. The Veteran’s sciatic nerve peripheral neuropathy is rated 20 percent disabling in each lower extremity pursuant to 38 C.F.R. § 4.124a, Diagnostic Code 8620. For incomplete paralysis of the sciatic nerve, a 20 percent rating is warranted for moderate paralysis, 40 percent for moderately severe paralysis, and 60 percent for severe incomplete paralysis with marked muscular atrophy. An 80 percent rating is warranted for complete paralysis of the sciatic nerve in which the foot dangles and drops, no active movement is possible of muscles below the knee, and flexion of the knee is weakened or (very rarely) lost. The Veteran’s femoral or anterior crural nerve peripheral neuropathy is rated 20 percent disabling in each lower extremity pursuant to 38 C.F.R. § 4.124a, Diagnostic Code 8626. For incomplete paralysis of the femoral nerve, a 20 percent rating is warranted for moderate paralysis and a 30 percent rating is assigned for severe incomplete paralysis. A 40 percent rating is warranted for complete paralysis of the quadriceps extensor muscles. The Veteran was afforded a VA examination in March 2016. The examiner noted the Veteran had symptoms of peripheral neuropathy in 2005 with no etiology identified and was found to be hyperglycemic ten years later in October 2015. The Veteran described right lower extremity symptoms of severe constant pain, severe intermittent dull pain, severe paresthesias and/or dysesthesias, and moderate numbness. Left lower extremity symptoms included moderate constant and intermittent dull pain, severe paresthesias and/or dysesthesias, and moderate numbness. He indicated that the burning was his most severe and distressing symptom and was worse on the right than left lower extremity. Reported examination findings included normal strength testing; normal deep tendon reflexes; absent sensation on ankle and foot monofilament testing; absent vibration sensation and decreased cold sensation of the bilateral lower extremities; no muscle atrophy; and trophic changes to the legs bilaterally. The examiner characterized the severity of the sciatic nerve peripheral neuropathy as moderately severe incomplete paralysis in each lower extremity and described the severity of the femoral nerve peripheral neuropathy as severe incomplete paralysis in each lower extremity. The examiner indicated the Veteran’s bilateral diabetic peripheral neuropathy had impacted his ability to work because he retired early due to his symptoms. VA treatment records reflect the Veteran was diagnosed with idiopathic (etiology unknown) peripheral neuropathy of the bilateral lower extremities in 2005 and has been managed on medications since that time. The Board finds that higher initial ratings are warranted for sciatic and femoral nerve peripheral neuropathy of the right and left lower extremities. Since service connection was established, sciatic nerve peripheral neuropathy has been manifested by moderately severe incomplete paralysis in the right and left lower extremity. These findings are consistent with a 40 percent rating for each lower extremity under Diagnostic Code 8620. Similarly, since service connection was established, femoral nerve peripheral neuropathy has been manifested by severe incomplete paralysis bilaterally. These findings are consistent with a 30 percent rating for each lower extremity under Diagnostic Code 8626. The Board observes that the AOJ assigned 20 percent ratings for sciatic peripheral neuropathy of each lower extremity under Diagnostic Codes 8620 because “[a]lthough the examiner indicated there is moderately severe incomplete paralysis based on your subjective reports, objective findings show only a moderate evaluation is warranted.” The AOJ assigned 20 percent ratings for femoral peripheral neuropathy of each lower extremity based on similar reasoning, observing the examiner had indicated there was “severe incomplete paralysis based on [] subjective reports,” but “objective findings show only a moderate evaluation is warranted.” The Board, however, finds the VA examiner’s assessment that the Veteran’s sciatic peripheral neuropathy was manifested by moderately severe incomplete paralysis and that his femoral peripheral neuropathy was manifested by severe incomplete paralysis was based on objective findings and are consistent with the Veteran’s subjective reports. Notably, the examination worksheet itself records the Veteran’s subjective symptoms before the “neurologic exam” section and the “severity” section appears to be part of the examination itself because additional examination categories, including “other pertinent physical findings” and “diagnostic testing,” immediately follow the space provided for the examiner to assess the severity of the Veteran’s peripheral neuropathy. In summary the Board finds the January 2014 VA examination report supports the higher initial rating granted herein. Finally, the Board finds that even higher ratings than those granted herein are not warranted because the medical evidence demonstrates the Veteran’s sciatic nerve peripheral neuropathy is not manifested by severe incomplete paralysis with marked muscular atrophy in either lower extremity, which is the criteria required for a 60 percent rating under Diagnostic Code 8620. Also, his femoral nerve peripheral neuropathy is not manifested by complete paralysis of the quadriceps extensor muscles in either lower extremity, which is the criteria for a 40 percent rating under Diagnostic Code 8626. Earlier Effective Dates The assignment of effective dates of awards is generally governed by 38 U.S.C. § 5110 and 38 C.F.R. § 3.400. Unless specifically provided otherwise, the effective date of an award based on an original claim or a claim reopened after final adjudication “shall be fixed in accordance with the facts found, but shall not be earlier than the date of receipt of application therefor.” 38 U.S.C. § 5110(a). The implementing regulation clarifies this to mean that the effective date of service connection and compensation based on an original claim or a reopened claim will be the “[d]ate of receipt of claim or date entitlement arose, whichever is later.” 38 C.F.R. § 3.400. The “date of the claim” means the date of the application based upon which benefits are awarded, not the original claim for service connection. Sears v. Principi, 16 Vet. App. 244, 246-47 (2002), aff’d, 349 F.3d 1326 (Fed. Cir. 2003). In this context, it should be noted that the provisions of 38 U.S.C. § 5110 also refer to the date an application is received. Although the term “application” is not defined in the statute, the regulations use the terms “claim” and “application” interchangeably, and they are defined broadly to include “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), 3.155; Servello v. Derwinski, 3 Vet. App. 196, 198 (1992). The Board notes that VA amended its adjudication regulations on March 24, 2015, to require that all claims governed by VA’s adjudication regulations be filed on standard forms prescribed by the Secretary, regardless of the type of claim or posture in which the claim arises. See 79 Fed. Reg. 57660 (Sept. 25, 2014). The amendments are only effective for claims and appeals filed on or after March 24, 2015. As the appeal in this case was filed after that date, the amendments are applicable in this instance and the regulations in effect prior to March 24, 2015 will not be applied in this case. 12. Entitlement to an effective date earlier than February 25, 2016 for the grant of service connection for type II diabetes mellitus In this case, VA received the Veteran’s original claim for entitlement to service connection for type II diabetes mellitus on February 25, 2016. Treatment records dating since 1996 reflect the Veteran was diagnosed with type II diabetes mellitus in October 2015. During an October 2015 optometry visit, he related that a friend had measured his blood sugar the previous night. The optometrist noted the Veteran had not been diagnosed with diabetes mellitus and advised him to consult with his primary care physician. Subsequent evaluation confirmed he had type II diabetes mellitus and he was started on oral medication. Applying the law to the facts of this case, the proper effective date for the grant of service connection to type II diabetes mellitus is February 25, 2016. Entitlement to service connection arose in October 2015 when medical evidence demonstrated a diabetes mellitus disability. The date of receipt of the claim was February 25, 2016. The later of these two dates in February 25, 2016. Therefore, an effective date earlier than February 25, 2016 is not warranted for the grant of service connection to type II diabetes mellitus. 38 C.F.R. § 3.400. The Board also considered whether an earlier effective date may be warranted under particular provisions that entitle certain veterans to an effective date one year prior to the date of receipt of the claim. In this regard, VA regulations provide that the effective date of an award of service connection granted pursuant to a liberalizing law or VA administrative issue is the effective date of the liberalizing law or administrative issue, if the claim is received within one year after such date. 38 U.S.C. § 5110(g); 38 C.F.R. § 3.114. The effective date of the regulation that added diabetes mellitus as a disease presumptively due to in-service exposure to herbicides is May 8, 2001. See Liesegang v. Sec’y of Veterans Affairs, 312 F.3d 1368 (Fed. Cir. 2002). Here, the Veteran’s claim was not received by VA until February 25, 2016, and he does not contend otherwise. Thus, this provision does not avail the Veteran of an earlier effective date. In addition, the Board considered the regulations regarding effective dates for VA compensation benefits involving veterans with a covered herbicide disease who qualify as a member of the Nehmer class under 38 C.F.R. § 3.816. Nehmer v. U.S. Dep’t of Veterans Affairs, 712 F. Supp. 1404 (N.D. Cal. 1989). An effective date earlier than February 25, 2016, however, is not warranted under these provisions because a compensation claim had not previously been denied between September 25, 1985, and May 3, 1989. 38 C.F.R. § 3.816(c)(1). Also, a disability compensation claim for diabetes mellitus was not pending before VA on May 3, 1989, or received by VA between that date and the effective date of the statute or regulation establishing a presumption of service connection for the covered herbicide disease. 38 C.F.R. § 3.816(c)(2). Therefore, the provisions of 38 C.F.R. § 3.816(c)(1) and (2) do not apply. Thus, the correct effective date of February 25, 2016 has been assigned for the award of service connection for type II diabetes mellitus and the claim for an earlier effective date must be denied. 13. Entitlement to an effective date earlier than February 25, 2016 for the grant of service connection for sciatic and femoral peripheral neuropathy of each lower extremity The Veteran contends that an effective date earlier than February 25, 2016 is warranted for the grant of service connection for sciatic and femoral peripheral neuropathy of each lower extremity. The medical evidence of record reflects the Veteran first reported symptoms of peripheral neuropathy in September 2004. He underwent further evaluation, including neurological consultation and EMG/NCS studies and was diagnosed with idiopathic (etiology unknown) peripheral neuropathy of the bilateral lower extremities. He was started on Nortriptyline in April 2005. A June 2005 treatment record reflects that the neurologist explained that exposure to Agent Orange has been shown to cause an acute to subacute reversible neuropathy, but it had not been linked to chronic neuropathy. The impression was peripheral neuropathy, etiology unknown. A March 2010 internal medicine note indicated that the Veteran had worsening pain from bilateral lower extremity peripheral neuropathy of unknown cause and that diabetes, alcohol, and other causes had been excluded by neurologists. Subsequent records show continued treatment with gabapentin. On June 21, 2012, VA received the Veteran’s original claim of service connection for peripheral neuropathy. He indicated that his disability began in 2006. In January 2014, the Veteran was afforded a VA examination. The medical evidence of record at that time demonstrated he did not have diabetes mellitus. According, the examination was conducted using a VA “Peripheral Nerves Conditions (not including Diabetic Sensory-Motor Peripheral Neuropathy) Disability Benefits Questionnaire (DBQ).” He described his history of peripheral neuropathy symptoms that began approximately 10 years earlier. He denied having any peripheral neuropathy while in Vietnam or in the initial years after his return from Vietnam. The examiner observed that EMG (electromyography) testing in October 2010 revealed bilateral peripheral neuropathy of the legs. The diagnosis was peripheral neuropathy. In March 2014, the AOJ denied the claim for service connection because peripheral neuropathy of either lower extremity was not manifested in service or manifested to a compensable degree within the applicable time period after separation from service to qualify for the presumption of service connection, and peripheral neuropathy was not otherwise shown to be related to service. The Veteran disagreed with that determination and perfected a timely appeal. VA treatment records document the Veteran was diagnosed with type II diabetes mellitus in October 2015. VA received the Veteran’s service connection claim for diabetes mellitus on February 25, 2016. In a May 2016 statement of the case (SOC), the AOJ also explained that service connection was not warranted for the Veteran’s lower extremity peripheral neuropathy on the basis of his presumed exposure to herbicides because the evidence showed he did not have early-onset peripheral neuropathy that manifested to a degree of 10 percent or more within a year after the last date on which he was exposed to an herbicide agent during military service. 38 C.F.R. §§ 3.307(a)(6)(ii), 3.309(e). In June 2016, the Veteran was afforded a VA examination to evaluate his claimed diabetes mellitus disability. The examiner indicated the Veteran had diabetic peripheral neuropathy of each lower extremity and conducted a peripheral nerves VA examination on the same day using a VA “Diabetic Sensory-Motor Peripheral Neuropathy DBQ.” The examiner reviewed the computerized patient record system (CPRS) and observed that the Veteran had been diagnosed in 2005 with peripheral neuropathy “without etiology identified” and was found to be hyperglycemic and diagnosed with diabetes mellitus ten years later. The examiner did not provide a medical opinion addressing any medical nexus between the current peripheral neuropathy disabilities of the lower extremities and the diabetes diagnosed ten year later. Also, the examiner did not provide a medical opinion addressing whether the Veteran’s service-connected diabetes mellitus disability aggravated the Veteran’s pre-existing peripheral neuropathy, which was not yet service-connected. In a June 2016 rating decision, the AOJ granted service connection for sciatic and femoral peripheral neuropathy of each lower extremity, indicating that each had “been established as related to the service-connected disability of diabetes mellitus type II.” Having considered the medical and lay evidence of record, the Board finds that an effective date earlier than February 25, 2016 is not warranted for peripheral neuropathy of the lower extremities as secondary to service-connected type II diabetes mellitus because the evidence of record does not reflect a factually ascertainable disability of diabetic peripheral neuropathy prior to that date. Notably, although VA medical providers had ruled out diabetes mellitus as a cause of the Veteran’s peripheral neuropathy and instead characterized it as idiopathic, the June 2016 rating decision associated the Veteran’s peripheral neuropathy with his diabetes mellitus, which was diagnosed ten years after the onset of his peripheral neuropathy in 2005. In turn, because service connection was granted for peripheral neuropathy as secondary to service-connected type II diabetes mellitus, the Board finds the proper effective date can be no earlier than February 25, 2016, the date VA received his service connection claim for diabetes mellitus. In this regard, the Board emphasizes that compensable complications of diabetes mellitus are to be rated separately. 38 C.F.R. § 4.119, Diagnostic Code 7913, Note 1. Entitlement to service connection arose in June 2016 when the AOJ interpreted the June 2016 VA examination report to demonstrate peripheral neuropathy associated with diabetes mellitus. The date of receipt of the claim, upon which secondary service connection for peripheral neuropathy was established, was February 25, 2016. The later of these two dates is June 2016. Nevertheless, because the June 2016 examination report apparently confirmed bilateral lower extremity peripheral neuropathy associated with service-connected diabetes, the Board resolves reasonable doubt in favor of the Veteran and finds that the February 25, 2016 effective date is proper for the grant of service connection for sciatic and femoral peripheral neuropathy of each lower extremity. 38 C.F.R. § 3.400. An effective date of June 21, 2012, which is the date VA received the Veteran’s original claim of service connection for peripheral neuropathy, is not warranted however, because his peripheral neuropathy was not shown to be related to service or to a service-connected disability. In particular, his peripheral neuropathy was not shown to have manifested during military service, manifested to a compensable degree within one year of his last exposure to herbicides in Vietnam, manifested to a compensable degree within one year of separation from service, or otherwise shown to be related to military service. Instead, the medical evidence of record demonstrates his peripheral neuropathy initial manifested in 2004 more than 35 years after separation from service and was characterized by VA medical providers as idiopathic after extensive evaluation. In conclusion, for the reasons and bases set for above, the Board finds that the effective date for the grant of service connection for sciatic and femoral peripheral neuropathy of each lower extremity is no earlier than the currently assigned date of February 25, 2016. REASONS FOR REMAND 14. Entitlement to a TDIU due to service-connected disabilities is remanded. In a notice of disagreement received on September 19, 2016, the Veteran’s attorney asserted on his behalf that he was unable to maintain gainful employment due to his service-connected disabilities and that his appeal for higher initial ratings should include an implied claim for a TDIU under Rice v. Shinseki, 22 Vet. App. 447 (2009), and should be part and parcel of the pending claim. The evidence of record indicates the Veteran completed two years of college, earning an associate’s degree in applied science. After military service, his usual occupation generally involved physical labor, working in railroad track maintenance and repair for six years, roofing, and carpentry and painting until he stopped working in 2007. The Veteran meets the threshold schedular criteria for the award of a TDIU effective February 25, 2015. However, because the Board has granted service connection for an anxiety disorder from the date VA received his claim on June 21, 2012, the claim for a TDIU is being remanded for initial adjudication. The matters are REMANDED for the following action: After rating the Veteran’s anxiety disorder disability granted herein, effective June 21, 2012, adjudicate the Veteran’s claim of entitlement to a TDIU, which was raised in the context of his original service connection claims and his appeal for higher initial ratings. JAMES L. MARCH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD L. Kirscher Strauss, Counsel