Citation Nr: 18151406 Decision Date: 11/19/18 Archive Date: 11/16/18 DOCKET NO. 16-02 682 DATE: November 19, 2018 ORDER The previously-denied service connection claim for a left hip disorder is reopened. The previously-denied service connection claim for a right hip disorder is reopened. The previously-denied service connection claim for a left knee disorder is reopened. The previously-denied service connection claim for a right knee disorder is reopened. The previously-denied service connection claim for a left foot disorder is not reopened. The previously-denied service connection claim for a right foot disorder is not reopened. Service connection for a left shoulder disorder is denied. Service connection for a right arm disorder, claimed as right arm bone growth with numbness, is denied. Service connection for bilateral hearing loss is denied. Service connection for a prostate disorder is denied. Service connection for a left hand disorder is denied. Service connection for a right hand disorder is denied. A disability rating higher than 10 percent for service-connected gastroesophageal reflux disease (GERD) is denied. An initial compensable (higher than 0 percent) disability rating for service-connected left little finger fracture residuals is denied. An initial disability rating higher than 10 percent for service-connected tinnitus is denied. An initial compensable disability rating for service-connected right great toe fracture residuals is denied. An initial compensable disability rating for service-connected right shoulder scars is denied. An effective date prior to July 1, 2014 for additional compensation based on the addition of the Veteran's spouse as his dependent is denied. REMANDED The reopened service connection claim for a left hip disorder is remanded. The reopened service connection claim for a right hip disorder is remanded. The reopened service connection claim for a left knee disorder is remanded. The reopened service connection claim for a right knee disorder is remanded. The claim seeking service connection for vertigo is remanded. The claim seeking service connection for hypertension is remanded. The claim seeking service connection for a psychiatric disorder is remanded. The claim seeking a disability rating higher than 10 percent for a service-connected lumbar spine disability is remanded. The claim seeking an initial compensable rating for service-connected tonsillectomy residuals is remanded. The claim seeking entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities is remanded. The claim seeking an effective date prior to August 31, 2011 for the assignment of an increased rating of 10 percent for service-connected GERD is remanded. The claim seeking an effective date prior to August 31, 2011 for the grant of service connection for right shoulder scars is remanded. The claim seeking an effective date prior to August 15, 2013 for the grant of service connection for the residuals of a left fifth finger fracture is remanded. The claim seeking an effective date prior to August 15, 2013 for the grant of service connection for the residuals of a right great toe fracture is remanded. The claim seeking an effective date prior to August 15, 2013 for the grant of service connection for tinnitus is remanded. FINDINGS OF FACT 1. The August 2002 rating decision that denied the Veteran’s initial service connection claims for bilateral hip, knee, and foot disorders is final. 2. The evidence associated with the record more than one year after the issuance of the August 2002 rating decision relates to the reason that the bilateral hip and knee disorders initial service connection claims were initially denied, but not to the reason the bilateral foot disorder initial service connection claims were denied. 3. At no time during the pendency of the Veteran’s service connection claims for bilateral hearing loss and left shoulder, right arm, and prostate disorders has the Veteran been diagnosed with a disability referable to these claims, and the record does not contain a recent diagnosis of such disability prior to his filing of these claims. 4. The Veteran has not reported experiencing any in-service hand impairment, other than his (largely asymptomatic, service-connected) left little finger fracture, and no such in-service hand complaints or treatment is of record. 5. The Veteran’s GERD does not produce substernal arm or shoulder pain and does not cause a significant impairment of his health. 6. The Veteran’s right shoulder scars are deep and nonlinear and do not affect an area of 6 square inches (or 39 square centimeters). 7. The Veteran’s service-connected tinnitus is assigned a 10 percent rating, which is the maximum rating authorized for tinnitus under Diagnostic Code 6260, for either a unilateral or bilateral disability. 8. The Veteran’s left little finger has not been amputated, and an examination revealed no significant residual disability stemming from his in-service fracture. 9. The Veteran’s right great toe disability is largely asymptomatic; moderate impairment has not been demonstrated. 10. The Veteran first informed VA of his remarriage to his current spouse in June 2014, more than year after the August 2012 remarriage date, and related additional dependency compensation was awarded effective July 1, 2014, the first day of the month following the notification. CONCLUSIONS OF LAW 1. The August 2002 rating decision is final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. 2. The criteria for reopening the previously-denied service connection claim for a left hip disorder have been met. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. 3. The criteria for reopening the previously-denied service connection claim for a right hip disorder have been met. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. 4. The criteria for reopening the previously-denied service connection claim for a left knee disorder have been met. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. 5. The criteria for reopening the previously denied service connection claim for a right knee disorder have been met. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. 6. The criteria for reopening the previously-denied service connection claim for a left foot disorder have not been met. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. 7. The criteria for reopening the previously-denied service connection claim for a right foot disorder have not been met. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. 8. The criteria for service connection for a left shoulder disorder have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 9. The criteria for service connection for a right arm disorder, claimed as right arm bone growth with numbness, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 10. The criteria for service connection for bilateral hearing loss have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 4.85. 11. The criteria for service connection for a prostate disorder have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 12. The criteria for service connection for a left hand disorder have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 13. The criteria for service connection for a right hand disorder have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 14. The criteria for an initial disability rating higher than 10 percent for service-connected tinnitus have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1-4.14, 4.87, Diagnostic Code 6260; Smith v. Nicholson, 451 F.3d 1344 (Fed. Cir. 2006). 15. The criteria for a disability rating higher than 10 percent for service-connected gastroesophageal reflux disease (GERD) have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.114, Diagnostic Code 7346. 16. The criteria for an initial compensable (higher than 0 percent) rating for service-connected left fifth finger fracture residuals have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.71a, Diagnostic Codes 5225, 5227, 5229, 5230. 17. The criteria for an initial compensable rating for service-connected right great toe fracture residuals have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5284. 18. The criteria for an initial compensable disability rating for service-connected right shoulder scars have not been met. 38 U.S.C. § 1155, 5107(b); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.20, 4.118, Diagnostic Codes 7801-7805. 19. The criteria for an effective date prior to July 1, 2014 for additional compensation based on the addition of the Veteran's spouse as his dependent have not been met. 38 U.S.C. §§ 5101, 5110, 7104; 38 C.F.R. §§ 3.4, 3.204, 3.213, 3.401. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1982 to March 2002, and he is appealing the Regional Office (RO)’s decisions regarding the aforementioned claims, as reflected in an October 2014 rating decision and dependency decision. The Board has consolidated the separately certified appeals seeking service connection for posttraumatic stress disorder (PTSD) and service connection for depression, insomnia, and alcohol abuse into a single service connection claim for a psychiatric disorder, per Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009). The Board has also assumed jurisdiction of the service connection and increased rating earlier effective claims, which have not yet been perfected for appeal, for the limited purpose of remanding these claims to ensure the issuance of related statements of the case, per Manlincon v. West, 12 Vet. App. 238, 240-41 (1999). While additional evidence relevant to the claims certified for appellate review has been submitted by the Veteran since the RO’s most recent adjudicative actions, the Veteran’s attorney specifically waived initial RO review of this evidence, and such a waiver would have nevertheless been implied based on the date the Veteran perfected his appeals. See 38 U.S.C. § 7105(e)(1); 38 C.F.R. § 20.1304(c). Claims to Reopen Previously-Denied Service Connection Claims 1. The previously-denied service connection claim for a left hip disorder is reopened. 2. The previously-denied service connection claim for a right hip disorder is reopened. 3. The previously-denied service connection claim for a left knee disorder is reopened. 4. The previously-denied service connection claim for a right knee disorder is reopened. 5. The previously-denied service connection claim for a left foot disorder is not reopened. 6. The previously-denied service connection claim for a right foot disorder is not reopened. The RO denied the Veteran’s initial service connection claims for bilateral hip, knee, and foot disorders in an August 2002 rating decision, which was accompanied by an advisory of the Veteran’s appellate rights, and the Veteran did not appeal this decision, nor was any new and material evidence relevant to these claims associated within the year following its issuance. Thus, the August 2002 rating decision became final. 38 U.S.C. § 7105(c); Bond v. Shinseki, 659 F.3d 1362 (Fed. Cir. 2011); 38 C.F.R. §§ 3.104, 3.156(a)-(b), 20.302, 20.1103. Nevertheless, a final denial of a service connection claim may be reopened by the submission of new and material evidence. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). New evidence is defined as evidence not previously submitted to agency decision-makers. Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). In Shade v. Shinseki, 24 Vet. App. 110, 118 (2010), the United States Court of Appeals for Veterans Claims (Court) stated that when determining whether the submitted evidence meets the definition of new and material evidence, VA must consider whether the new evidence could, if the claim were reopened, reasonably result in substantiation of the claim. Id. at 118. Thus, pursuant to Shade, evidence is new if it has not been previously submitted to agency decision-makers and is material if, when considered with the evidence of record, it would at least trigger VA’s duty to assist by providing a medical opinion, which might raise a reasonable possibility of substantiating the claim. Id. As reflected in the August 2002 rating decision, the RO denied the Veteran’s initial service connection claims for bilateral hip, knee, or foot disorders based on the lack of current diagnoses related to these claimed disabilities. Specifically, during the July 2002 VA examination conducted in conjunction with his claims, no hip, knee, foot pathology was noted, and no related diagnoses were rendered. Evidence associated with the record in more than one year after the issuance of the August 2002 rating decision includes diagnoses of bilateral hip ostearthritis, bilateral knee tendonitis, right patellofemoral degenerative joint disease, as well as slight degenerative changes noted on a left knee x-ray, all rendered during the Veteran’s May 2014 VA examination. However, no foot pathology was detected during this examination, and no foot disorder diagnosis was rendered. Likewise, the Veteran’s subsequent treatment of record fails to reflect a diagnosed foot disorder, nor has the Veteran reported that he has been diagnosed with a foot disorder. The Board finds that this newly-associated evidence of bilateral hip and knee disorders directly relates to the reason the Veteran’s related claims were initially denied. Moreover, when considered with in-service hip and knee treatment of record, the evidence triggers VA’s duty to obtain a legally sufficient medical opinion regarding the potential relationship between these disorders and service, thereby rendering this new evidence material. Shade, 24 Vet. App. at 118. (Notably, while the record contains a VA medical opinion regarding the Veteran’s hip and knee disorders, the opinion is not legally adequate, as further addressed below.) Given this submission of new and material evidence, the Veteran’s previously-denied service connection claims for bilateral hip and knee disorders are reopened, and the Veteran’s appeal is granted to this extent only. These reopened service connection claims are further addressed in the remand portion of this decision, below. However, with regard to the Veteran’s claims to reopen his previously-denied service connection claims for a bilateral foot disorder, the newly-associated evidence of record fails to reflect or suggest that the Veteran has been diagnosed with a bilateral foot disorder. Thus, the Board concludes that the newly-associated evidence as it relates to this claim is not material, as it cannot establish evidence of the threshold element for service connection, namely evidence of a current diagnosis of the claimed disorder. For this reason, the Veteran’s petition to reopen these claims is denied. Service Connection Claims Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury. Id.; see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff’d, 78 F.3d 604 (Fed. Cir. 1996). Pertinent to a claim for service connection, such a determination requires a finding of a current disability that is related to an injury or disease in service. Watson v. Brown, 4 Vet. App. 309 (1993); see also Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); Rabideau v. Derwinski, 2 Vet. App. 141, 143 (1992). Under applicable regulation, the term “disability” means impairment in earning capacity resulting from diseases and injuries and their residual conditions. 38 C.F.R. § 4.1; see also Hunt v. Derwinski, 1 Vet. App. 292, 296 (1991); Allen v. Brown, 7 Vet. App. 439 (1995); Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018) (the term “disability” as used in 38 U.S.C. § 1110 “refers to the functional impairment of earning capacity, not the underlying cause of said disability,” and held that “pain alone can serve as a functional impairment and therefore qualify as a disability”). In McClain v. Nicholson, 21 Vet. App. 319, 321 (2007), the United States Court of Appeals for Veterans Claims (Court) held that the requirement of the existence of a current disability is satisfied when a claimant has a disability at the time he files his claim for service connection or during the pendency of that claim, even if the disability resolves prior to adjudication of the claim. However, in Romanowsky v. Shinseki, 26 Vet. App. 289 (2013), the Court held that when the record contains a recent diagnosis of disability prior to a claimant filing a claim for benefits based on that disability, the report of diagnosis is relevant evidence that the Board must address in determining whether a current disability existed at the time the claim was filed or during its pendency. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 7. Service connection for a left shoulder disorder is denied. 8. Service connection for a right arm disorder, claimed as right arm bone growth with numbness, is denied. 9. Service connection for bilateral hearing loss is denied. 10. Service connection for a prostate disorder is denied. Upon review of the evidence, the Board finds that, at no time during the pendency of the claim does the Veteran have a diagnosis of bilateral hearing loss, as defined by VA regulation, see 38 C.F.R. § 4.85, or a disability referable to a left shoulder, right arm, or prostate disorder, and the record does not contain a recent diagnosis of such a disability prior to his filing of a claim. See 38 U.S.C. § 4.85. Specifically, the June 2014 VA audiological examination report reflects the examiner’s conclusion that the Veteran does not currently have hearing loss as defined by VA regulation; and no right arm impairment (including an abnormal bone growth or numbness) or a left shoulder impairment was detected during the orthopedic portion of the Veteran’s May 2014 VA examination. Further, aside from his assertion of service connection for a prostate disorder, the Veteran has made no assertions of the presence of a current prostate disorder, and the Veteran’s submitted medical treatment records fail to indicate the presence of a current prostate disorder. Rather, the treatment records reflect that his Prostate Specific Antigen (PSA) levels were within normal parameters, further failing to suggest evidence of a current prostate disorder. There is also no persuasive evidence showing that he has symptoms that result in any functional impairment of earning capacity. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018) (holding that a “disability” under 38 U.S.C. § 1110 refers to functional impairment of earning capacity). Absent evidence of a current disability, the preponderance of the evidence is against the Veteran’s service connection claims for bilateral hearing loss, and left shoulder, right arm, or prostate disorders. Therefore, there is no reasonable doubt to resolve on his behalf, and service connection for these claimed disorders is not warranted. 11. The claim seeking service connection for a left hand disorder is denied. 12. The claim seeking service connection for a right hand disorder is denied. With regard to the Veteran’s service connection claims for bilateral hand disorders, the Board acknowledges that while no bilateral hand disorders have been diagnosed during the appeal period, including during the Veteran’s May 2014 VA examination (at which time bilateral hand x-rays were interpreted as normal), the May 2014 VA examiner noted evidence of bilateral hand pain and mild carpometacarpal joint grinding, and the Board notes that medical literature states that the latter finding is often deemed indicative of thumb synovitis or arthrosis. However, assuming arguendo that these clinical findings are indicative of a diagnosable hand disorder, the Board concludes that the evidence of record nevertheless fails to suggest a potential relationship between any such hand disorder and service. In that regard, other than the Veteran’s in-service left little finger fracture, for which the Veteran has been service-connected, and which (as discussed below) has been deemed to have created no residual hand impairment, the Veteran did not report or seek treatment for any hand problems during service. Moreover, the Veteran has not reported any such in-service hand impairment. Thus, the Board concludes that the preponderance of the evidence is against a conclusion that any current hand disorder is related to service. Accordingly, there is no reasonable doubt to resolve on the Veteran’s behalf, and service connection for a bilateral hand disorder is not warranted. Increased Rating Claims Ratings are based on a schedule of reductions in earning capacity from specific injuries or combination of injuries. The ratings shall be based, as far as practicable, upon the average impairments of earning capacity resulting from such injuries in civil occupations. 38 U.S.C. § 1155. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher evaluation 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. When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3. 13. A disability rating higher than 10 percent for service-connected gastroesophageal reflux disease (GERD) is denied. Aside from his claim seeking an increased rating for his service-connected GERD, the Veteran has made no assertions regarding the severity of this disability nor any contentions regarding why this disability warrants an increased rating. The Veteran’s GERD has been rated pursuant to Diagnostic Code 7346, which states that a 10 percent evaluation is warranted when there is evidence of persistently recurrent epigastric distress manifested by two or more of the following symptoms (adding the qualifier that they be symptoms of “less severity”): dysphagia (difficulty swallowing), pyrosis (heartburn), and regurgitation, accompanied by substernal arm or shoulder pain which is productive of considerable impairment of health. A 30 percent evaluation is assigned based on evidence of all of these symptoms. A 60 percent evaluation is warranted for symptoms of pain, vomiting, material weight loss and hematemesis or melena with moderate anemia; or other symptom combinations productive of severe impairment of health. See 38 C.F.R. § 4.114, Diagnostic Code 7346. The evidence of record fails to reflect that the Veteran has demonstrated sufficient GERD symptoms so as to warrant the assignment of the next higher 30 percent rating, as the Veteran’s GERD is not productive of substernal arm or shoulder pain, and has not resulted in a considerable impairment of his health; therefore, his GERD is not productive of all of the symptoms outlined in the 10 percent rating criteria, which is required for the assignment of a 30 percent rating. In that regard, when reporting his GERD symptoms during his June 2014 VA gastrointestinal examination, the Veteran did not report any substernal arm or shoulder pain, nor are any such symptoms documented in his medical treatment or submitted statements of record. Moreover, the Board finds that the VA examiner’s notation that the Veteran had no functional impact resulting from his GERD indicates that the Veteran’s GERD symptoms do not result in a considerable impairment of his health. Given the foregoing, the Board concludes that the Veteran’s GERD does not produce substernal arm or shoulder pain or result in a considerable impairment of his health; thus, the record fails to reflect a basis for awarding a rating higher than 10 percent for his service-connected GERD. Accordingly, the preponderance of the evidence is against the claim for an increased rating for GERD; there is no reasonable doubt to resolve on his behalf, and such an increased rating is not warranted. 14. An initial compensable (higher than 0 percent) disability rating for service-connected right shoulder scars is denied. The Veteran has made no specific assertions regarding the severity of his shoulder scars, to include any contentions as to why his currently-assigned rating is inadequate. Pursuant to the rating criteria applicable for scars affecting areas other than the head, face, or neck, burn scar(s) or scar(s) due to other causes, not affecting the head, face, or neck, that are deep and nonlinear in an area or areas of at least 6 square inches (39 sq. cm.) but less than 12 square inches (77 sq. cm.) will be assigned a 10 percent rating. A scar in an area or areas of at least 12 square inches (77 sq. cm.) but less than 72 square inches (465 sq. cm.) will be assigned a 20 percent rating. A scar in an area or areas of at least 72 square inches (465 sq. cm.) but less than 144 square inches (929 sq. cm.) will be assigned a 30 percent rating. A scar in an area or areas of at least 144 square inches (929 sq. cm.) or greater will be assigned a 40 percent rating. Note (1) indicates that a deep scar is one associated with underlying soft tissue damage. 38 C.F.R. § 4.118, Diagnostic Code 7801. Diagnostic Code 7802, pertains to burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are superficial and nonlinear in an area or areas of 144 square inches (929 sq. cm.) or greater will be assigned a 10 percent rating. Note (1) indicates that a superficial scar is one not associated with underlying soft tissue damage. 38 C.F.R. § 4.118, Diagnostic Code 7802 (2013). Diagnostic Code 7804 pertains to unstable or painful scars. One or two scars that are unstable or painful are rated at 10 percent disabling. Three or four scars that are unstable or painful are rated at 20 percent disabling. Five or more scars that are unstable or painful are 30 percent disabling. Note (1) to Diagnostic Code 7804 provides that an unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. Note (2) states that additional ratings may be awarded based on evidence of scars that are both painful and unstable. 38 C.F.R. § 4.118, Diagnostic Code 7804. Diagnostic Code 7805 provides that any other scars (including linear scars) and other disabling effects of scars should be evaluated even if not considered in a rating provided under diagnostic codes 7801-04 under an appropriate diagnostic code. 38 C.F.R. § 4.118, Diagnostic Code 7805. The Veteran’s right shoulder scars, which stem from his in-service right shoulder surgeries (and thus are not burn-related), were evaluated during a June 2014 VA examination. This examination comprises the only clinical assessment of the Veteran’s right shoulder scar performed during the instant rating period. The examiner noted that the Veteran has three surgical scars, which were described as non-painful, stable, deep and non-linear, and no related limitation of right shoulder function was noted. As such, of the rating criteria set forth above, only Diagnostic Code 7801 is applicable to an assessment of the Veteran’s scars. Per the examiner’s measurements, the first scar is 2.0 by 0.2 centimeters (cm); the second scar is 1.5 by 0.2 cm; and the third scar is 2.0 by 0.1 cm; with a combined total area of 0.9 square centimeters. As this total measurement is far less than the thirty-nine square centimeters required for a compensable rating for deep, non-linear scars per Diagnostic Code 7801, the preponderance of the evidence is against the Veteran’s claim seeking an initial increased rating. Therefore, there is no reasonable doubt to resolve on the Veteran’s behalf, and an initial compensable rating for service-connected right shoulder scars is not warranted. 15. An initial disability rating higher than 10 percent for service-connected tinnitus is denied. Tinnitus is rated under Diagnostic Code 6260, which was revised effective June 13, 2003, to codify existing VA practice of assigning a single 10 percent rating for recurrent tinnitus, whether the sound is perceived as being in one ear, both ears, or in the head. 38 C.F.R. § 4.87, Diagnostic Code 6260, Note (2). As the Veteran’s service-connected tinnitus has been assigned the maximum schedular rating available pursuant to 38 C.F.R. §4.87, Diagnostic Code 6260, and as there is no legal basis upon which to award separate schedular evaluations for tinnitus in each ear, there is no legal basis upon which to award a higher schedular rating. Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). Further, as the Veteran has not asserted any extraschedular manifestations of his service-connected tinnitus (other than that to assert that his tinnitus, along with his service-connected hearing loss, renders him unemployable, an assertion encompassed within his TDIU claim, also on appeal), referral for consideration for an extraschedular evaluation is not warranted.   16. An initial compensable (higher than 0 percent) rating for service-connected left fifth finger fracture residuals is denied. The Veteran’s left little finger disability, which stems from his in-service fracture of his left little finger (referred to as a Boxer’s fracture) has been evaluated as noncompensably disabling throughout the rating period, and the Veteran is seeking an initial compensable rating, although he has made no specific assertions regarding the severity of this disability and his related impairment. VA’s rating criteria outlines evaluations for impairment of individual digits, including based on evidence of amputation, ankylosis, or limitation of individual digits. 38 C.F.R. § 4.71a, Diagnostic Codes 5152-5156, 5224-5230. However, only noncompensable evaluations are awarded based on evidence of any limitation of motion of the little, or fifth, finger. 38 C.F.R. § 4.71a, Diagnostic Codes 5227, 5230. The only means of warranting a compensable rating for a little finger impairment is based on evidence of amputation, which warrants the assignment of 10 or 20 percent, depending upon the location of the amputation. 38 C.F.R. § 4.71a, Diagnostic Code 5156. However, the Veteran does not report, and the evidence of record fails to reflect, that the Veteran’s left little finger has been amputated. Rather, the May 2014 VA examiner noted no significant abnormalities of the Veteran’s left little finger, stating that the finger evidenced very minimal angulation and that no residual disability resulted from the Veteran’s in-service finger fracture. Based on the foregoing, the Board finds that the preponderance of the evidence is against the Veteran’s claim seeking an increased rating for his little finger disability. See Sowers v. McDonald, 27 Vet. App. 472, 480 (2016) (noting that “[a] 0% disability rating for ‘any limitation of motion’ indicates that there is no reduction in earning capacity from a right ring finger disability, irrespective of impairment of motion” and that “[b]ecause no impairment of motion warrants a compensable rating under DC 5230, reading § 4.59 in conjunction with DC 5230, [the veteran] is not entitled to a compensable disability rating under his assigned DC”). Accordingly, there is no reasonable doubt to resolve on the Veteran’s behalf, and the award of an initial compensable rating is not warranted. 17. An initial compensable (higher than 0 percent) disability rating for service-connected right great toe fracture residuals is denied. The Veteran’s right great toe disability has been evaluated as noncompensably disabling pursuant to 38 C.F.R. § 4.71a, Diagnostic Code 5284, which outlines the rating criteria for foot injuries. Pursuant to Diagnostic Code 5284, the criterion for a compensable, 10 percent rating is a moderate foot injury. However, the evidence of record throughout the appeal period indicates that the Veteran’s right great toe disability has been largely asymptomatic. The Veteran has not reported any right great toe symptomatology, and no related abnormalities were clinically assessed during his May 2014 VA examination. Rather, the Veteran demonstrated no tenderness to palpation of his right great toe, full range of motion of right great toe joints, and no pain when performing this range of motion testing. Moreover, no other right foot pathology was detected, which could in turn potentially be attributed to the Veteran’s right great toe disability. Given the lack of a reported or observed right great toe impairment, the Board concludes that the preponderance of the evidence is against the Veteran’s claim seeking an initial increased rating for this foot disability. Thus, there is no reasonable doubt to resolve on the Veteran’s behalf, and an increased rating is not warranted. Earlier Effective Date Claim 18. An effective date prior to July 1, 2014 for additional compensation based on the addition of the Veteran's spouse as his dependent is denied. The Veteran first informed VA of his remarriage to his current spouse in June 2014, and he was awarded dependency benefits as of July 1, 2014, the first day of the month following receipt of this notice. (The Veteran had previously been married to and divorced his current spouse, and he remarried her in August 2012.) The Veteran appealed this decision, stating that he should be awarded dependency benefits retroactively, commensurate with the date of his marriage in August 2012. Unless specifically provided otherwise, the effective date of an award based on an original claim, a claim reopened after final adjudication, or a claim for increase, of compensation, dependency and indemnity compensation, or pension, 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). An award of additional compensation on account of dependents based on the establishment of a disability rating in the percentage evaluation specified by law for the purpose shall be payable from the effective date of such rating; but only if proof of dependents is received within one year from the date of notification of such rating action. 38 U.S.C. § 5110(f). An additional amount of compensation may be payable for a spouse, child, and/or dependent parent where a Veteran is entitled to compensation based on disability evaluated as 30 percent or more disabling. 38 U.S.C. § 1115; 38 C.F.R. § 3.4(b)(2). The purpose of the statute is “to defray the costs of supporting the Veteran’s … dependents” when a service-connected disability is of a certain level hindering the veteran’s employment abilities. Sharp v. Shinseki, 23 Vet. App. 267, 272 (2009). Regarding an award of additional compensation for dependents, the effective date will be the latest of the following dates: (1) date of claim; (2) date the dependency arises; (3) effective date of the qualifying disability rating provided evidence of dependency is received within 1 year of notification of such rating action; or (4) date of commencement of the service member’s award. 38 C.F.R. § 3.401(b). The “date of claim” for additional compensation for dependents is the date of the Veteran’s marriage or birth/adoption of a child, if evidence of the event is received within a year of the event; otherwise, the date notice is received of the dependent’s existence, if evidence is received within a year of notification of such rating action. 38 U.S.C. § 5110; 38 C.F.R. § 3.401. VA will accept, for the purpose of determining entitlement to benefits under laws administered by VA, the statement of a claimant as proof of marriage, dissolution of a marriage, birth of a child, or death of a dependent, provided that the statement contains: the date (month and year) and place of the event; the full name and relationship of the other person to the claimant; and, where the claimant’s dependent child does not reside with the claimant, the name and address of the person who has custody of the child. In addition, a claimant must provide the social security number of any dependent on whose behalf he or she is seeking benefits (see § 3.216). 38 C.F.R. § 3.204. The earliest date that an additional award of compensation for a dependent spouse can occur is the first day of the calendar month following the month in which the award became effective. 38 C.F.R. § 3.31. The Veteran has been in receipt of a combined disability rating in excess of 30 percent since August 2011; thus, he was eligible for the award of additional compensation for his dependents as of the date of his remarriage to his current spouse in August 2012. However, as he did not inform VA of this marriage until June 2014, more than one year after the marriage, the effective date of his dependency award can only be the date he notified VA of this remarriage. As set forth above, the Veteran would have had to inform VA of this marriage within the year after the marriage was performed in order to warrant an effective date commensurate with the marriage date. Thus, the RO appropriately awarded dependency compensation effective as of July 1, 2014, the first day of the calendar month following the receipt of the marriage notice. The Board acknowledges the Veteran’s assertion that the delay in informing VA of his current remarriage stems from his unawareness that he should inform VA of this life event, and he only notified VA after he determined on his own that he was entitled to additional compensation for his wife as a dependent. However, while the Board is sympathetic to the Veteran’s argument, the record reflects that he was twice advised of the need to promptly inform VA of any change in marital status, as reflected in December 2007 and December 2008 compensation notices provided to him. Accordingly, while VA recognizes that the Veteran’s spouse was his dependent for several years prior to his notification to VA of his remarriage to her, there is no basis for awarding an effective date for additional dependency compensation prior to July 1, 2014. Thus, the claim must be denied as a matter of law. See Sabonis v. Brown, 6 Vet. App. 426 (1994). REASONS FOR REMAND 19. The reopened service connection claim for a left hip disorder is remanded. 20. The reopened service connection claim for a right hip disorder is remanded. 21. The reopened service connection claim for a left knee disorder is remanded. 22. The reopened service connection claim for a right knee disorder is remanded. As discussed above, the Veteran is currently-diagnosed with bilateral hip and knee disorders, namely bilateral hip ostearthritis, bilateral knee tendonitis, and right patellofemoral degenerative joint disease, and slight degenerative changes have been detected on a VA left knee x-ray. Further, his service treatment records reference instances of in-service hip and knee complaints and related treatment. However, when rendering the opinion concluding there is no nexus between these current orthopedic disorders and service in May 2014, the VA examiner did not comment on or consider any of this in-service treatment. Accordingly, the Board finds that these 2014 VA medical opinions are legally inadequate, and new medical opinions addressing the etiology of these hip and knee disorders are required. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (holding that when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate). 23. The claim seeking service connection for vertigo is remanded. The Veteran was afforded a VA examination in conjunction with this claim in July 2014, and diagnostic testing performed during the examination failed to reveal evidence of peripheral vestibulopathy. The record reflects that the RO denied the Veteran’s claim after determining that the Veteran does not currently have vertigo. However, in the examination report, the examiner recorded the Veteran’s in-service diagnosis of vertigo, and during the examination, the Veteran reported that he intermittently experiences vertigo symptomatology. As symptoms of vertigo are capable of lay observation, coupled with the Veteran’s in-service treatment for dizziness after sustaining a concussion, and subsequent in-service treatment for vertigo, the Board concludes that a VA medical opinion is required to determine the potential relationship between the Veteran’s current symptoms and service. See McLendon v. Nicholson, 20 Vet. App. 79 (2006) (holding that an examination is necessary if, inter alia, evidence indicates that the disability or persistent or recurrent symptoms of a disability may be associated with the Veteran’s service or service-connected disability). 24. The claim seeking service connection for hypertension is remanded. With regard to the Veteran’s service connection claim for hypertension, the RO denied this claim based on the lack of evidence of a current disability, and the Veteran was not afforded a related VA examination. However, a January 2013 private medical treatment record includes an assessment of “high blood pressure,” and the Veteran’s service treatment records include an elevated blood pressure reading (as defined by VA regulation), which was recorded in March 2001, approximately one year prior to his separation from service. See 38 C.F.R. § 4.104, Diagnostic Code 7101. Accordingly, a VA examination is required to determine whether the Veteran does indeed currently have hypertension, as defined by VA, and if so, whether his hypertension had its onset in or is otherwise related to service. See McLendon, 20 Vet. App. 79. 25. The claim seeking service connection for a psychiatric disorder is remanded. Although the Veteran’s service treatment records do not document any in-service psychiatric symptoms or treatment, the Veteran has submitted lay statements from himself, his friends, and his family members recounting observations of the Veteran’s in-service psychiatric symptoms. Further, private medical treatment and evaluations of record reflect diagnoses of a depressive disorder and posttraumatic stress disorder (PTSD), although the latter diagnosis was not rendered per the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), as required per VA regulation. See 38 C.F.R. §§ 3.304(f); 4.125(a); see also 80 Fed. Reg. 14308 (March 19, 2015) (stating that DSM-5 is applicable to appeals certified to the Board after August 4, 2014). Moreover, the October 2015 private medical opinion concluding the Veteran’s current depressive disorder had its onset in service is not supported by any rationale, and the medical history outlined in the narrative accompanying the opinion does not recount the in-service onset of depressive symptoms. Rather, the narrative seems to suggest that the Veteran’s depressive disorder is related to the current severity of his various service-connected disabilities. Given these inconsistencies in the record, the Board determines that a VA psychiatric examination is warranted to reconcile these discrepancies and determine the nature and etiology of the Veteran’s current psychiatric disorders. See McLendon, 20 Vet. App. 79. 26. The claim seeking a disability rating higher than 10 percent for a service-connected lumbar spine disability is remanded. Since the Veteran was last afforded a VA examination to assess the severity of his service-connected lumbar spine disability in May 2014, the Veteran received private treatment in October 2014, at which time the Veteran evidenced a change in his symptoms. Specifically, during his May 2014 VA examination, the Veteran demonstrated forward lumbar flexion of 90 degrees or greater. However, at the time of his October 2014 private treatment, the practitioner noted the ranges of motion recorded during a recent pain clinic visit, at which time the Veteran demonstrated 45 degrees of forward lumbar flexion. Given this evidence suggesting a material change in the Veteran’s lumbar spine disability since it was last assessed by VA, a new VA examination is warranted to determine the current severity of the Veteran’s service-connected lumbar spine disability. 27. The claim seeking an initial compensable disability rating for service-connected tonsillectomy residuals is remanded. Throughout the appeal period, the Veteran’s service-connected residuals of a tonsillectomy has been assigned a noncompensable (0 percent) rating by analogy pursuant to Diagnostic Code 6516, which outlines the rating criteria for chronic laryngitis, as VA rating criteria do not specifically include a provision for tonsillectomy residuals. Pursuant to Diagnostic Code 6516, a 10 percent rating is warranted based on evidence of hoarseness, with inflammation of cords or mucous membranes, and a maximum 30 percent rating is warranted where there is evidence of hoarseness, with thickening or nodules of cords, polyps, submucous infiltration, or pre-malignant changes on biopsy. 38 C.F.R. § 4.97. However, while the Veteran was afforded a VA otolaryngological examination in May 2014, presumably to assess his residual disability from his in-service tonsillectomy, the examination report fails to reference the Veteran’s tonsillectomy history or provide any findings relevant to the aforementioned rating criteria. As the Veteran’s medical treatment of record also fails to include any such relevant findings, there is no medical evidence upon which to rate this disability, and a remand is required to obtain a new, adequate VA examination. 28. The claim seeking entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities is remanded. Given the aforementioned requested development, the Veteran’s claim seeking a TDIU should be deferred pending this development and readjudication of the related claims. See 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.). 29. The claim seeking an effective date prior to August 31, 2011 for the assignment of an increased rating of 10 percent for service-connected GERD is remanded. 30. The claim seeking an effective date prior to August 31, 2011 for the grant of service connection for right shoulder scars is remanded. 31. The claim seeking an effective date prior to August 15, 2013 for the grant of service connection for the residuals of a left fifth finger fracture is remanded. 32. The claim seeking an effective date prior to August 15, 2013 for the grant of service connection for the residuals of a right great toe fracture is remanded. 33. The claim seeking an effective date prior to August 15, 2013 for the grant of service connection for tinnitus is remanded. With regard to the above earlier effective date claims, the RO granted the related increased rating and service connection claims in an October 2014 rating decision, and in his November 2014 notice of disagreement, the Veteran indicated that he was disagreeing with the assigned effective dates (as well as the assigned ratings). However, these earlier effective claims were not addressed in the subsequent May 2017 statement of the case. Accordingly, the claims must be remanded to the RO for the issuance of such, per Manlincon v. West, 12 Vet. App. 238, 240-41 (1999). The matters are REMANDED for the following action: 1. Issue a statement of the case adjudicating the Veteran’s claims seeking earlier effective dates for the grant of an increased rating for GERD and for the grant of service connection for his left fifth finger and right great toe disorders, right shoulder scars, and tinnitus. Inform the Veteran that if he wishes to have the Board further consider these claims, he must file a timely VA Form 9 to perfect his appeal. 2. Obtain the Veteran’s VA treatment records created since December 2014, and request that the Veteran either submit any relevant private treatment not of record or submit completed release form(s) to allow VA to request these records on his behalf. 3. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s currently-diagnosed bilateral hip and knee disabilities (bilateral hip ostearthritis, bilateral knee tendonitis, and right patellofemoral degenerative joint disease, as well as slight degenerative changes noted on a left knee x-ray, as noted in the May 2014 VA examination report) are at least as likely as not related to service. When rendering this opinion, the examiner is asked to specifically consider and comment on the clinical significance of the following evidence: • February 1989 treatment for a left knee injury and knee pain, with a notation that a medial meniscal tear should be ruled out; • January 1993 treatment for bilateral knee pain while running, diagnosed as due to quadriceps tendonitis; • September 1994 treatment for hip soreness (unspecified whether bilateral, left or right hip) when running for the past 6 months, with pain occurring three to four times per week; • January 1996 treatment for intermittent right hip pain for the past one and a half years, diagnosed as possible PSOAS bursitis; • December 1999 treatment for low back pain radiating into the right hip; • April 2000 treatment for sub-gluteal right hip pain; • March 2001 treatment for right hip pain; and • March 2003 treatment for right hip pain. All medical opinions must be accompanied by a detailed rationale. 4. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s current complaints of intermittent vertigo are at least as likely as not related to service, to specifically include consideration of the Veteran’s in-service treatment in August 1990 for a mild concussion, accompanied by dizziness, nausea; and his November 1999 vertigo work-up. 5. Schedule the Veteran for an examination by an appropriate clinician to determine the presence and etiology of any current hypertension. (a.) The examiner should determine whether the Veteran currently has hypertension, as defined by VA regulation; (b.) If the examiner determines that the Veteran currently has hypertension, then the examiner is asked to opine whether it is at least as likely as not that his current hypertension: 1. began during active service, considering the March 2001 blood pressure reading of 118/96; or 2. manifested within one year after discharge from service. 6. Schedule the Veteran for a VA psychiatric examination to determine the nature and etiology of the Veteran’s currently-diagnosed depressive disorder and the presence of any other psychiatric disorders, to specifically include a determination as to whether the Veteran has posttraumatic stress disorder (PTSD) that meets the DSM-5 criteria. If the Veteran is diagnosed with PTSD, the examiner must explain how the diagnostic criteria are met and opine whether his PTSD is at least as likely as not related to the Veteran’s in-service experiences as a drill sergeant, as recounted in detail in a statement received in July 2014. With regard to the Veteran’s depressive disorder diagnosed during the appeal period, or any other psychiatric disorder other than PTSD diagnosed in conjunction with this examination, the examiner is asked to opine whether any such disorder: 1. Had its onset in or is otherwise directly related to service; 2. Proximately caused his various service-connected disabilities; or 3. Aggravated, i.e. made worse by his service-connected disabilities. When rendering these opinions, the examiner should consider and comment on the clinical significance of: • The Veteran’s reports of his in-service stressful experiences when training to become and serving as a drill sergeant, as outlined in detail in a statement received in July 2014; • The lay statements regarding the Veteran’s in-service and post-service behavior, as recounted in submitted statements of record; • The private evaluations noting a correlation between the Veteran’s physical and mental disorders; and • The October 2015 DBQ completed by a private practitioner and the accompanying medical opinion. A complete rationale must be provided for all opinions expressed. 7. Schedule the Veteran for an examination of the current severity of his service-connected lumbar spine disability, to include any related neurological impairments. The examiner must test the Veteran’s lumbar spine active motion, passive motion, and pain with weight-bearing and without weight-bearing, and note all neurological manifestations of his lumbar spine disability and their related severity. The examiner should also express an opinion concerning whether there would be additional functional impairment on repeated use or during flare-ups assessed in terms of the degree of additional range of motion loss. In regard to flare-ups (pursuant to Sharp v. Shulkin, 29 Vet. App. 26 (2017)) if the Veteran is not currently experiencing a flare-up, based on relevant information elicited from the Veteran, review of the file, and the current examination results regarding the frequency, duration, characteristics, severity, and functional loss regarding his flares, the examiner is requested to provide an estimate of the Veteran’s functional loss due to flares expressed in terms of the degree of additional range of motion lost, or explain why the examiner cannot do so. [The Board recognizes the difficulty in making such determinations but requests that the examiner provide his or her best estimate based on the examination findings and statements of the Veteran.] 8. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected tonsillectomy residuals. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. Specifically, the examiner should state whether the Veteran’s tonsillectomy residuals are productive of hoarseness, with inflammation of cords or mucous membranes; or hoarseness, with thickening or nodules of cords, polyps, submucous infiltration, or pre-malignant changes on biopsy. TANYA SMITH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Nicole L. Northcutt, Counsel