Citation Nr: 18150429 Decision Date: 11/15/18 Archive Date: 11/15/18 DOCKET NO. 16-32 924 DATE: November 15, 2018 ORDER Entitlement to service connection for gout is denied. Entitlement to service connection for hypertriglyceridemia is denied. Entitlement to service connection for erectile dysfunction is denied. Entitlement to service connection for diabetes mellitus is denied. Entitlement to an initial rating in excess of 30 percent for coronary artery disease is denied. Entitlement to an initial rating in excess of 10 percent for hypertension is denied. Entitlement to an initial rating in excess of 10 percent for scar, left nipple is denied. Entitlement to an initial compensable rating for scar, right thigh is denied. Entitlement to an initial compensable rating for scars, chest is denied. Entitlement to an effective date earlier than August 10, 2011, for the award of service connection for coronary artery disease is denied. Entitlement to an effective date earlier than August 10, 2011, for the award of service connection for hypertension is denied. REMANDED Entitlement to service connection for an acquired psychiatric disorder (to include major depressive disorder and generalized anxiety disorder) is remanded. Entitlement to service connection for a sleep disorder is remanded. FINDINGS OF FACT 1. Gout did not have its onset in service or within one year of service and is not otherwise related to service. 2. Hypertriglyceridemia is a laboratory finding and not a recognized disability. 3. Erectile dysfunction did not have its onset in service and is not otherwise related to service. 4. The Veteran’s diabetes mellitus was not caused or related to his active duty or ACDUTRA, or is it shown to have initially manifested within a year of discharge from active duty. 5. Throughout the appeal period, the Veteran’s coronary artery disease has been productive of cardiac hypertrophy; a history of congestive heart failure, a workload of greater than 3 metabolic equivalent (METs) but not greater than 5 METs, and left ventricular ejection fraction of 30 to 50 percent were not found. 6. Throughout the appeal period, the Veteran’s hypertension has been manifested by diastolic pressures of 100 or more and requires continuous medication for control; diastolic pressures predominantly 110 or more, or systolic pressures predominantly 200 or more, were not found. 7. Throughout the appeal period, the Veteran’s left nipple scar is manifested by one painful scar. 8. Throughout the appeal period, the Veteran’s right medial thigh scar has not been manifested by pain or instability. 9. Throughout the appeal period, the Veteran’s mid and left lateral chest scars have not been manifested by pain or instability. 10. The Veteran did not submit a claim, either formal or informal, for service connection for coronary artery disease prior to August 10, 2011. 11. The Veteran did not submit a claim, either formal or informal, for service connection for hypertension prior to August 10, 2011. CONCLUSIONS OF LAW 1. The criteria for service connection for gout have not been met. 38 U.S.C. §§ 1110, 1112, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria for service connection for hypertriglyceridemia have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for service connection for erectile dysfunction have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for service connection for diabetes mellitus have not been met. 38 U.S.C. §§ 1110, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 5. The criteria for an initial rating in excess of 30 percent for coronary artery disease have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.104, Diagnostic Codes 7006, 7007. 6. The criteria for an initial rating in excess of 10 percent for hypertension have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.104, Diagnostic Code 7101. 7. The criteria for an initial rating in excess of 10 percent for scar, left nipple, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.7, 4.118, Diagnostic Code 7804. 8. The criteria for an initial compensable rating for scar, right medial thigh, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.7, 4.118, Diagnostic Codes 7804, 7805. 9. The criteria for an initial compensable rating for scars, mid- and left lateral chest, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.7, 4.118, Diagnostic Codes 7804, 7805. 10. Entitlement to an effective date prior to August 10, 2011, for the grant of service connection for coronary artery disease is not warranted. 38 U.S.C. §§ 5101 (a), 5110; 38 C.F.R. §§ 3.155 (as in effect prior to March 24, 2015); 38 C.F.R. §§ 3.1(p), 3.400. 11. Entitlement to an effective date prior to August 10, 2011, for the grant of service connection for hypertension is not warranted. 38 U.S.C. §§ 5101 (a), 5110; 38 C.F.R. §§ 3.155 (as in effect prior to March 24, 2015); 38 C.F.R. §§ 3.1(p), 3.400. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Navy from January 1987 to March 1994. He also had a period of active duty for training (ACDUTRA) in the United States Air Force from June 2006 to October 2006. These matters come before the Board of Veterans’ Appeals (Board) on appeal from May 2013 and May 2014 rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO). Service Connection Service connection will be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Service connection for certain chronic diseases, including arthritis and diabetes mellitus, may be presumed to have been incurred in service by showing that the disease manifested itself to a degree of 10 percent or more within one year. 38 U.S.C. §§ 1101, 1112, 1137; 38 C.F.R. §§ 3.307(a)(3), 3.309(a). Such a chronic disease is presumed under the law to have had its onset in service even though there is no evidence of that disease during the period of service. 38 C.F.R. § 3.307(a). The term “chronic disease” refers to those diseases listed under section 1101(3) of the statute and section 3.309(a) of VA regulations. 38 U.S.C. § 1101(3); 38 C.F.R. § 3.309(a); Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). For such diseases, the second and third elements of service connection may be established by demonstrating (1) that a condition was “noted” during service; (2) post-service continuity of symptoms; and (3) medical or, in certain circumstances, lay evidence of a link between the present disability and the continuity of symptoms. 38 C.F.R. § 3.303(b); see Walker, 708 F.3d at 1340. If a chronic condition is noted during service or during the presumptive period, but the chronic condition is not “‘shown to be chronic or where the diagnosis of chronicity may be legitimately questioned’, i.e., ‘[w]hen the fact of chronicity in service is not adequately supported’, then a showing of continuity of symptomatology after discharge is required to support a claim for disability compensation for the chronic disease. Proven continuity of symptomatology establishes the link, or nexus, between the current disease and serves as the evidentiary tool to confirm the existence of the chronic disease while in service or a presumptive period during which existence in service is presumed.” See Walker at 1336 (citing 38 C.F.R. § 3.303(b)). The term “active military service” includes active duty, any period of active duty for training (ACDUTRA) during which the individual concerned was disabled or died from a disease or injury incurred or aggravated in line of duty. 38 C.F.R. § 3.6(a). Presumptive service connection provisions do not apply to ACDUTRA. Biggins v. Derwinski, 1 Vet. App. 474 (1991). Thus, service connection may be granted for disability resulting from disease or injury incurred or aggravated while performing active duty or ACDUTRA, but the appellant is not entitled to the application of the presumption of soundness, presumption of aggravation except or presumption service connection for chronic disease except for his active duty. 38 U.S.C. §§ 101 (24), 106, 1110; Smith v. Shinseki, 24 Vet. App. 40 (2010). In order to establish service connection for the claimed disorder, there must be evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal connection between the claimed in-service disease or injury and the current disability. See Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). 1. Entitlement to service connection for gout. The Veteran has a current diagnosis of gout. See, e.g., January 2011 VA treatment record. The Veteran has not asserted, nor does the evidence so indicate, that his gout had its onset in service or within the one year presumptive period for chronic disease or is otherwise related to service. Indeed, the Veteran has proffered no theory of entitlement to service connection for gout. Notably, there is no indication of any complaints, findings, treatment, or diagnosis relating to gout during service or within one year of separation, and the Veteran has not indicated otherwise. Critically, the earliest indication of gout was in July 2007, at which time the Veteran stated he had the disability for one-and-a-half months. See July 2007 VA treatment record. The Veteran noted an onset date of June 2007 in his application for benefits. See August 2011 VA Form 21-526. Thus, there is no probative evidence indicating that gout was incurred in service, and presumptive service connection for chronic disease is not warranted, as the condition did not manifest to a compensable degree within one year of discharge in 1994 and this presumptive provision does not apply to his 2006 ACDUTRA service. Even upon a liberal reading of the evidence, there is otherwise no indication of a nexus to service or a service-connected disability, and it is not asserted that the Veteran’s gout is related to (caused and/or aggravated by) a service-connected disability. As such, the Board analysis of the Veteran’s claim is limited to the theory advanced (or not advanced as in this case) by the Veteran. See Robinson v. Mansfield, 21 Vet. App. 545, 553 (2008) (concluding “that the Board is not required sua sponte to raise and reject ‘all possible’ theories of entitlement in order to render a valid opinion” and “commits error only in failing to discuss a theory of entitlement that was raised either by the appellant or by the evidence of record.”), aff’d sub nom. Robinson v. Shinseki, 557 F.3d 1355, 1361 (Fed. Cir. 2009) (stating that “[w]here a fully developed record is presented to the Board with no evidentiary support for a particular theory of recovery, there is no reason for the Board to address or consider such a theory”). On the basis of this record, the evidence does not indicate a nexus to service or a service-connected disability. Therefore, the claim for service connection for gout is denied. See 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.303, 3.307, 3.309; see also Fagan v. Shinseki, 573 F.3d 1282, 1287-88 (Fed. Cir. 2009). 2. Entitlement to service connection for hypertriglyceridemia. The Veteran seeks service connection for hypertriglyceridemia. He has presented no particular theory of entitlement for such disability. Based on a thorough review of the record, the Board finds that the preponderance of the evidence is against service connection for hypertriglyceridemia, as this condition is not a disability for VA purposes. Hypertriglyceridemia is defined as excess of triglycerides in the blood. See Dorland’s Illustrated Medical Dictionary 897 (32d ed. 2012). This laboratory finding is not a disability for which VA compensation benefits are payable. See 61 Fed. Reg. 20,440, 20,445 (May 7, 1996) (diagnoses of hyperlipidemia, elevated triglycerides, and elevated cholesterol are laboratory results and are not, in and of themselves, disabilities). The term “disability,” as used for VA purposes, refers to impairment of earning capacity and Congress specifically limits entitlement to service connection for diseases or injuries that have resulted in a disability. See 38 U.S.C. §§ 1110, 1131. In this case, despite the Veteran’s diagnosis of hypertriglyceridemia, this is not a disease or disability for purposes of VA compensation. Service connection for hypertriglyceridemia is not warranted. 3. Entitlement to service connection for erectile dysfunction. The Veteran has a current diagnosis of impotence. See, e.g., September 2013 VA treatment record. The Veteran has not asserted, nor does the evidence so indicate, that his erectile dysfunction/impotence had its onset in or is related to service. Indeed, the Veteran has proffered no theory of entitlement to service connection for erectile dysfunction. Notably, there is no indication of any complaints, findings, treatment, or diagnosis relating to impotence or erectile dysfunction during service, and the Veteran has not indicated otherwise. Critically, the earliest indication of impotence was in 2013, approximately 19 years after his active military service (and approximately 7 years after his period of ACDUTRA). Thus, there is no probative evidence indicating that erectile dysfunction/impotence was incurred in service. Even upon a liberal reading of the evidence, there is otherwise no indication of a nexus to service or a service-connected disability, and it is not asserted that the Veteran’s erectile dysfunction/impotence is related to (caused and/or aggravated by) a service-connected disability. As such, the Board analysis of the Veteran’s claim is limited to the theory advanced (or not advanced as in this case) by the Veteran. See Robinson, supra. On the basis of this record, the evidence does not indicate a nexus to service or a service-connected disability. Therefore, the claim for service connection for erectile dysfunction/impotence is denied. See 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.303, 3.304; see also Fagan v. Shinseki, 573 F.3d 1282, 1287-88 (Fed. Cir. 2009). 4. Entitlement to service connection for diabetes mellitus. The Veteran states that he is entitled to service connection for diabetes mellitus as such had its onset during his period of ACDUTRA. Specifically, he has stated that he was diagnosed with diabetes during his ACDUTRA and placed on medical leave for the diabetes. See April 2013 VA heart conditions examination. The Veteran’s treatment records reflect a diagnosis of diabetes mellitus as early as January 2007. See March 2007 VA treatment records. The service treatment records for the Veteran’s period of service from January 1987 to March 1994 document no complaints, history or findings consistent with diabetes mellitus. The service treatment records for the period of ACDUTRA from June 2006 to October 2006 are also negative for any complaints, history, or findings consistent with diabetes mellitus. See, e.g., November 2006 dental patient medical history report (denying being under the care of a physician during the past year, denying taking any medicines or drugs, and denying suffering from any of the conditions listed above on the report, including diabetes). The Board acknowledges that the Veteran’s diabetes mellitus was initially diagnosed in January 2007, within a year after his period of ACDUTRA. Moreover, under 38 C.F.R. § 3.309(a), diabetes may be presumptively service connected as a chronic disease if manifested to a degree of 10 percent or more within one year from the date of separation from active military service. 38 U.S.C. § 1112(a). However, the Court has held that it is clear based on the language of sections 101 and 1112, “a claimant whose claim is based on a period of active duty for training can never be entitled to the presumption of service.” Smith v. Shinseki, 24 Vet. App. 40, 47 (2010) (emphasis in original). Thus, to the extent the Veteran may be seeking entitlement to service connection for diabetes on a presumptive basis based on his period of ACDUTRA, such theory of entitlement has no merit as the presumptive theories of entitlement are not applicable. Although lay persons are competent to provide opinions on some medical issues, as to the specific issue in this case, diabetes mellitus falls outside the realm of common knowledge of a lay person. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). In this regard, diabetes mellitus requires objective testing to diagnose, and can have many causes. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n. 4 (Fed. Cir. 2007). To the extent the Veteran believes that he has diabetes mellitus that is due to service, as a lay person, he is not shown to possess any specialized training in the medical field. The Veteran’s opinion as to the etiology of his current diabetes mellitus is not competent evidence, as the nexus question involved in this case requires medical expertise to determine. Id. While the Veteran is competent to report what his physician reportedly told him, such as that he was diagnosed with diabetes mellitus in service, the Board finds any such reports to be not credible based on the contemporaneous evidence and his express denial of treatment or diagnosis of diabetes on his November 2006 dental patient medical history report. Therefore, there is no indication that diabetes mellitus began during a period of active duty service or ACDUTRA. As the preponderance of the evidence is against the claim for service connection for diabetes mellitus is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). Increased Rating Disability evaluations are determined by the application of a schedule of ratings, which is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. The percentage ratings in VA’s Schedule for Rating Disabilities (Rating Schedule) represent as far as can practicably be determined the average impairment in earning capacity resulting from such disabilities and their residual conditions in civil occupations. 38 C.F.R. § 4.1. Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability more closely approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3. Where entitlement to compensation has already been established and increase in disability is at issue, the present level of disability is of primary concern. See Francisco v. Brown, 7 Vet. App. 55 (1994). However, “staged” ratings are appropriate where the factual findings show distinct time periods when the service-connected disability exhibits symptoms that would warrant different ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007); see also Fenderson v. West, 12 Vet. App. 119 (1999). 5. Entitlement to an initial rating in excess of 30 percent for coronary artery disease. The Veteran’s coronary artery disease is rated 30 percent disabling, effective August 10, 2011, under Diagnostic Codes 7007-7006 (for hypertensive heart disease/myocardial infarction). See 38 C.F.R. § 4.104. Under Diagnostic Codes 7006 and 7007, a 30 percent rating is warranted for a workload of greater than 5 metabolic equivalents (METs) but not greater than 7 METs resulting in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of cardiac hypertrophy or dilation on electrocardiogram, echocardiogram, or X-ray. A 60 percent rating is warranted for more than one episode of acute congestive heart failure in the past year, or; workload of greater than 3 METs but not greater than 5 METs resulting in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of 30 to 50 percent. A 100 percent rating is warranted for chronic congestive heart failure, or; workload of 3 METs or less resulting in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of less than 30 percent. 38 C.F.R. § 4.104. A 100 percent rating is also warranted during and for three months following myocardial infarction. However, the Veteran’s MI occurred in November 2010, which is more than three months before his effective date of service connection in August 2011; thus, a 100 percent rating is not warranted under this provision. After review of the evidence of record, the Board finds that the preponderance of the evidence is against an initial rating in excess of 30 percent for coronary artery disease throughout the appeal period. In this regard, a February 2013 VA stress test consult report found the Veteran had a workload of 10.1 METs. April 2013 VA heart conditions examination noted no evidence of congestive heart failure, cardiac arrhythmia, or heart valve condition, and the Veteran denied experiencing symptoms with any level of physical activity. The examiner noted that echocardiogram in February 2011 found left ventricular ejection fraction of 62 percent, but also found evidence of cardiac hypertrophy. There are no other pertinent findings during the appeal period. Accordingly, for the reasons provided above, the Board finds that an initial rating in excess of 30 percent for coronary artery disease is not warranted. 6. Entitlement to an initial rating in excess of 10 percent for hypertension. Hypertension is evaluated under Diagnostic Code 7101. 38 C.F.R. § 4.104. Under Diagnostic Code 7101, a 10 percent rating is warranted for hypertensive vascular disease with diastolic pressure predominantly 100 or more, or systolic pressure predominantly 160 or more, or a history of diastolic pressure predominantly 100 or more who requires continuous medication for control. Id. A 20 percent rating is warranted for hypertensive vascular disease with diastolic pressure predominantly 110 or more, or systolic pressure predominantly 200 or more. Id. Higher ratings are available for diastolic pressures predominantly 120 or more. Id. After a review of the evidence of record, the Board finds that the Veteran’s disability picture is consistent with, or reflective of, the currently assigned 10 percent rating, throughout the appeal period. The evidence consistently shows diastolic pressure readings of 100 or more and the Veteran requires continuous medication for control. However, the evidence is not consistent with, or reflective of, diastolic pressures predominantly 110 or more, or systolic pressure predominantly 200 or more. The Board acknowledges elevated diastolic pressure readings in May 2012 (153/112, 166/111). The rest of the blood pressure readings throughout the appeal period fail to show either diastolic pressures of 110 or more, or systolic pressures of 200 or more. See, e.g., November 2011 VA treatment records (115/72, 139/101, 129/90); January 2013 VA treatment record (148/99, 154/105, 172/108); February 2013 VA treatment records (144/104); March 2013 VA treatment records (144/103, 156/108); April 2013 (125/88, 122/84, 126/86, 149/103); June 2013 VA treatment record (130/84); August 2013 VA treatment records (134/93, 125/79); January 2014 VA treatment records (138/84, 150/101, 139/97); March 2014 (132/91); April 2014 (135/92); May 2014 VA treatment record (132/92); December 2015 VA treatment record (149/92); April 2015 VA treatment records (132/87); July 2015 VA treatment record (133/80); May 2016 VA treatment records (140/93); June 2016 VA treatment record (144/90). Accordingly, while the evidence shows two elevated diastolic pressure readings in May 2012, the remainder of the blood pressure readings throughout the appeal period fail to meet the criteria for an increased (20 percent) rating, and thus the preponderance of the evidence is against a finding that the Veteran’s hypertension has been manifested by diastolic pressures predominantly 110 or more, or systolic pressures predominantly 200 or more. Accordingly, for the reasons provided above, the Board finds that an initial rating in excess of 10 percent for hypertension is not warranted. 7. Entitlement to an initial rating in excess of 10 percent for scar, left nipple. 8. Entitlement to an initial compensable rating for scar, right thigh. 9. Entitlement to an initial compensable rating for scars, chest. The Board notes that the Veteran’s scars in question are all secondary to his coronary artery bypass grafting times four surgery in November 2010. See November 2010 St. Rose Dominican Hospital operative report. The Veteran’s scar of the left nipple is rated 10 percent disabling under Diagnostic Code 7804 (for painful or unstable scars). The Veteran’s scar of the right medial thigh and his scars of the mid-chest and left lateral chest are rated noncompensable (0 percent) under Diagnostic Code 7805 (for scars, other). 38 C.F.R. § 4.118. The Board notes that scars may be rated under Diagnostic Codes 7800 (for scars of the head, face, or neck); 7801 (for scars not of the head, face, or neck that are associated with underlying soft tissue damage); and 7802 (for scars not of the head, face, or neck that cover an area or areas of 144 square inches (929 sq. cm.) or greater). Inasmuch as the Veteran’s scars do not involve the head, face, or neck, do not have underlying soft tissue damage, and do not cover an area of 144 square inches or greater, Diagnostic Codes 7800, 7801, and 7802 are not applicable to the Veteran’s claim, and will not be addressed further. Diagnostic Code 7804 provides that five or more scars that are unstable or painful warrant a 30 percent rating, three or four scars that are unstable or painful warrants a 20 percent rating, one or two scars that are unstable or painful warrant a 10 percent rating. Note (1): An unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. 38 C.F.R. § 4.118, Diagnostic Code 7804. Note (2): If one or more scars are both unstable and painful, add 10 percent to the evaluation that is based on the total number of unstable or painful scars. Diagnostic Code 7805 provides that other scars, including linear scars, and other effects of scars, are evaluated under diagnostic codes 7800, 7801, 7802, and 7804 and an appropriate diagnostic code, if there are any effects not considered under diagnostic codes 7800-04. After careful review of the evidence of record, the Board finds that a rating in excess of 10 percent for scar of the left nipple, and compensable ratings for scar of the right medial thigh and scars of the mid-chest and left lateral chest, are not warranted at any point during the appeal period. The Veteran was afforded a VA examination in April 2014. The examiner noted that none of the scars were unstable. The examiner further noted that only one of the scars was painful (the left nipple scar). The reported that the left nipple scar is tender and sometimes wakes him up at night. The right medial thigh scar was found to be 1.0 centimeters (cm.) x 0.2 cm. The left nipple scar was found to be 10.5 cm. x 0.2 cm. The mid-chest scar was indicated to be 2.0 cm. x 0.2 cm. And the left lateral chest was found to be 1.0 cm. x 0.2 cm. All scars were described as linear. The examiner reported only functional loss for the left nipple scar, noting that it was sensitive to palpation, resulting in occasional minor lifting limitations. After a review of the evidence of record, given the clinical findings during the appeal period, the evidence shows one scar (of the left nipple) that was painful, and any minor lifting limitations resulting from that pain are contemplated in the current rating assigned. Accordingly, inasmuch as there is no evidence of three or more total scars that are painful (so as to warrant an initial increased 20 percent rating for the scars cumulatively), or any functional impact of the right medial thigh or mid- and left lateral chest scars, there is no basis to award an initial rating in excess of 10 percent for the scar of the left nipple, or a compensable rating for the scars of the right medial thigh or mid- and left lateral chest. Effective Date Generally, the effective date of an evaluation and award of pension, compensation or dependency and indemnity compensation based on an original claim, a claim reopened after final disallowance, or a claim for increase will be the date of receipt of the claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400. 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 by the Secretary, regardless of the type of claim or posture in which the claim arises. See 79 Fed. Reg. 57,600 (Sept. 25, 2014). The amendments are effective for claims and appeals filed on or after March 24, 2015. Inasmuch the current claim was filed before such date, the amendments are inapplicable to the Veteran’s appeal. Under the old regulations, any communication or action, indicating an intent to apply for one or more benefits under laws administered by VA, from a veteran or his representative, may be considered an informal claim. Such informal claim must identify the benefit sought. 38 C.F.R. § 3.155(a) (as in effect prior to March 24, 2015). 10. Entitlement to an effective date earlier than August 10, 2011, for the award of service connection for coronary artery disease. 11. Entitlement to an effective date earlier than August 10, 2011, for the award of service connection for hypertension. In this case, the basic facts are not in dispute. The Veteran initially filed a formal claim for service connection for hypertension and coronary artery disease (claimed as myocardial infarction and coronary artery bypass graft surgery) on August 10, 2011. See August 10, 2011 VA Form 21-526 (Veteran’s Application for Compensation and/or Pension). In a May 2013 rating decision, the RO granted service connection for coronary artery disease and hypertension, and assigned an effective date of August 10, 2011. Thus, the RO granted service connection for coronary artery disease and hypertension effective the date the Veteran’s original claim of service connection for coronary artery disease and hypertension were filed with VA. An effective date of an award of service connection is not based on the earliest medical evidence showing a causal connection, but on the date that the application upon which service connection was eventually awarded was filed with VA. Lalonde v. West, 12 Vet. App. 377, 382 (1999). There is no evidence of a formal or informal application for service connection for hypertension or coronary artery disease prior to August 10, 2011, and the Veteran does not assert otherwise. VA is precluded, as a matter of law, from granting an effective date prior to August 10, 2011, for service connection for coronary artery disease or hypertension. As such, these appeals must be denied because the RO has already assigned the earliest possible effective dates provided by law. REASONS FOR REMAND 12. Entitlement to service connection for an acquired psychiatric disorder (to include major depressive disorder and generalized anxiety disorder) is remanded. 13. Entitlement to service connection for a sleep disorder is remanded. The Veteran asserts that his psychiatric disorder is directly related to service, and/or secondary to his service-connected disabilities. See, e.g., August 2017 lay statement from V.C., the Veteran’s mother, stating that after service the Veteran’s temperament and personality was altered. Moreover, in April 2018, the Veteran submitted an August 2017 VA mental disorders Disability Benefits Questionnaire (DBQ) wherein he was diagnosed with major depressive disorder, and the examiner opined that the service-connected coronary artery disease, hypertension and painful nipple scar have aggravated his major depressive disorder, and that more likely than not began in military service. As the examiner did not address the lack of complaints, findings, treatment or diagnosis for a psychiatric disorder during service or provide any rationale to support the opinion, this matter must be remanded for a VA examination to determine the nature and etiology of the Veteran’s acquired psychiatric disorder. Additionally, because the Veteran’s sleep disorder claim is inextricably intertwined with the acquired psychiatric disorder claim remaining on appeal, appellate consideration of entitlement to a sleep disorder is deferred pending resolution of the acquired psychiatric disorder on appeal. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991); see also Tyrues v. Shinseki, 23 Vet. App. 166, 177 (2009) (en banc) (explaining that claims are inextricably intertwined where the adjudication of one claim could have a significant impact on the adjudication of another claim). Outstanding treatment records should also be secured.   The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records. 2. With any necessary assistance from the Veteran, obtain any outstanding relevant private treatment records. 3. Then schedule the Veteran for a VA psychiatric examination to determine the nature and etiology of the Veteran’s psychiatric disorders. The claims file should be made available to and reviewed by the examiner. All appropriate psychological tests deemed necessary should be administered. The examiner should provide an opinion that responds to the following: (a) Please identify (by medical diagnosis) each of the Veteran’s psychiatric disorders present since August 2013, including major depressive disorder and generalized anxiety disorder. If the examiner finds the Veteran does not meet the criteria for major depressive disorder or generalized anxiety disorder, the examiner should address the diagnoses of such in post-service treatment records, and discuss whether those diagnoses were in error. (b) For each disorder so identified, please opine whether it is at least as likely as not (50 percent or greater probability) that such disorder: (1) had its onset in service, or is otherwise related to service. (2) is proximately due to his service-connected coronary artery disease, hypertension, and/or scars of the left nipple, right thigh and chest. (3) has been aggravated (worsened beyond natural progression) by his service-connected coronary artery disease, hypertension, and/or scars of the left nipple, right thigh and chest. Please discuss the favorable April 2018 DBQ opinion in this regard. (c) If a psychiatric disorder is related to service or a service connected disability, please also opine as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran has a separate and distinct sleep disorder that is (1) proximately due to or (2) aggravated (worsened beyond natural progression) by such disability. If so, please identify the disorder. The examiner should provide a detailed rationale for any opinion expressed. In addressing secondary service connection, please note that it is not necessary that a disability be service-connected, or even diagnosed, at the time a claimed disability is incurred, and reliance on this fact in support of a negative opinion will render it inadequate. If an opinion cannot be rendered without resorting to speculation, the examiner should provide a rationale for that conclusion. S. BUSH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Marley, Counsel