Citation Nr: 18151914 Decision Date: 11/20/18 Archive Date: 11/20/18 DOCKET NO. 16-11 776 DATE: November 20, 2018 ORDER Whether new and material evidence has been submitted to reopen a claim of entitlement to service connection for hypertension is denied. Entitlement to service connection for elevated cholesterol is denied. Entitlement to service connection for erectile dysfunction is denied. Entitlement to service connection for diabetes mellitus, type II is denied. Entitlement to service connection for bilateral upper extremity neuropathy secondary to lumbar spine disorder is denied. Entitlement to service connection for right lower extremity radiculopathy is denied. Entitlement to an initial rating in excess of 10 percent for tinnitus on an extraschedular basis pursuant to 38 C.F.R. § 3.321 is denied. Entitlement to an initial compensable rating for bilateral hearing loss is denied. Entitlement to a compensable rating for gastroesophageal reflux disease (GERD) is denied. Entitlement to an initial rating in excess of 20 percent for left lower extremity radiculopathy is denied. Entitlement to an effective date earlier than October 2, 2006 for a grant of service connection for DDD lumbar spine is dismissed. Entitlement to an effective date earlier than October 2, 2006 for the grant of service connection for GERD is dismissed. Entitlement to an effective date earlier than December 31, 2012 for the grant of service connection for hearing loss is denied. Entitlement to an effective date earlier than December 31, 2012 for the grant of service connection for left lower extremity radiculopathy is denied. REMANDED Entitlement to service connection for an acquired psychiatric disorder, including adjustment disorder and major depressive disorder, is remanded. Entitlement to a rating in excess of 20 percent for degenerative disc disease (DDD) lumbar spine is remanded. FINDINGS OF FACT 1. In an April 2007 rating decision, the RO denied the Veteran's claim of entitlement to service connection for hypertension. The Veteran was notified of the decision and his appellate rights, but did not initiate an appeal within one year of notification of the decision. 2. The evidence received since April 2007 does not, by itself or when considered with previous evidence of record, relate to an unestablished fact necessary to substantiate the claim for service connection for hypertension. 3. High/elevated cholesterol is a laboratory finding and not a disease or disability under VA law and regulations. 4. The Veteran's erectile dysfunction is not etiologically related to active service, and is not otherwise etiologically related to service-connected DDD of the lumbar spine. 5. Diabetes mellitus did not manifest during the Veteran's active service or to a compensable degree within one year after active service, and the current diabetes mellitus has not been otherwise linked to service. 6. The Veteran does not have current neuropathy of the upper extremities. 7. The Veteran does not have current radiculopathy of the right lower extremity radiculopathy. 8. Throughout the appeal period, the Veteran's bilateral tinnitus has been assigned a 10 percent rating, the maximum schedular rating authorized under Diagnostic Code 6260; an unusual or exceptional disability picture is not presented by this disability. 9. In July 2013, audiometric testing showed an average 35-decibel loss, with a speech recognition score of 95 percent, in the right ear (Level I); and, for the left ear, an average 25-decibel loss with a speech recognition score of 100 percent (Level I). 10. The most recent Audiological examination in April 2016 revealed an average 35 decibel loss in the right ear, with speech recognition of 92 percent, corresponding to Level I hearing; and, for the left ear, an average of 26 decibel loss with a speech recognition score of 92 percent, corresponding to Level I hearing. 11. The evidence of record throughout the appeal period demonstrates that the Veteran's GERD has, at worst, manifested symptoms of pyrosis and/or reflux, but without dysphagia, regurgitation, and substernal arm or shoulder pain. 12. The Veteran's left lower extremity radiculopathy has been productive of no more than moderate incomplete paralysis of the sciatic nerve. 13. Service connection for DDD of the lumbar spine was granted, effective October 2, 2006, in an April 2007 rating decision. The Veteran was notified of that decision in correspondence issued that same month, but he did not appeal the effective date of the award and has not asserted that the April 2007 rating decision was clearly and unmistakably erroneous. 14. Service connection for GERD was granted, effective October 2, 2006, in an April 2007 rating decision. The Veteran was notified of that decision in correspondence issued that same month, but he did not appeal the effective date of the award and has not asserted that the April 2007 rating decision was clearly and unmistakably erroneous. 15. The Veteran filed his first and only claim for service connection for bilateral hearing loss in December 2012. The Veteran first filed a claim of entitlement to service connection for radiculopathy of the left lower extremity on December 31, 2012. CONCLUSIONS OF LAW 1. The April 2007 rating decision denying the claim for service connection for hypertension is final. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. § 20.1103. 2. The criteria for reopening a claim of entitlement to service connection for hypertension have not been met. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 3. The criteria for service connection for elevated/high cholesterol have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for service connection for erectile dysfunction, secondary to service-connected degenerative disc disease (DDD) of the lumbar spine, have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 5. The criteria for service connection for type II diabetes mellitus have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 6. The criteria for service connection for neuropathy of the upper extremities, to include as secondary to DDD of the lumbar spine disorder, have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.313. 7. The criteria for service connection for right lower extremity radiculopathy have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.313. 8. The criteria for an initial rating in excess of 10 percent for tinnitus, including on an extraschedular basis pursuant to 38 C.F.R. § 3.321 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.87, Diagnostic Code 6260. 9. The criteria for an initial compensable rating for bilateral hearing loss have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.7, 4.10, 4.16, 4.85, 4.86, Diagnostic Code 6100. 10. The criteria for an initial compensable rating for GERD have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.7, 4.10, 4.114, Diagnostic Code 7346. 11. The criteria for a rating in excess of 20 percent for radiculopathy of the left lower extremity have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.40, 4.45, 4.7, 4.124a, Diagnostic Code 8520. 12. The claim of entitlement to an effective date prior to October 2, 2006, for an award of service connection for DDD of the lumbar spine, is dismissed. 38 U.S.C. §§ 5107, 5110(a), 7105; 38 C.F.R. §§ 3.400, 20.302; Rudd v. Nicholson, 20 Vet. App. 296 (2006). 13. The claim of entitlement to an effective date prior to October 2, 2006 for an award of service connection for GERD is dismissed. 38 U.S.C. §§ 5107, 5110(a), 7105; 38 C.F.R. §§ 3.400, 20.302; Rudd v. Nicholson, 20 Vet. App. 296 (2006). 14. The criteria for an effective date earlier than December 31, 2012, for the grant of service connection for hearing loss are not met. 38 U.S.C. §§ 5101, 5110; 38 C.F.R. §§ 3.1, 3.151, 3.155, 3.400. 15. The criteria for an effective date earlier than December 31, 2012, for the grant of service connection for left lower extremity radiculopathy are not met. 38 U.S.C. §§ 5101, 5110; 38 C.F.R. §§ 3.1, 3.151, 3.155, 3.400. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 1982 to June 1995 with additional service in the National Guard. This matter comes before the Board of Veterans’ Appeals (hereinafter Board) on appeal from rating decision of the St. Louis, Missouri Regional Office (RO). By a rating action in July 2013, the RO granted service connection for right ear hearing loss, and assigned a 0 percent rating effective December 31, 2012. The RO also granted service connection for tinnitus, evaluated as 10 percent rating, effective December 31, 2012. That rating action denied the Veteran’s claims of entitlement to service connection for bilateral upper and bilateral lower extremity neuropathy, and service connection for erectile dysfunction. In that rating action, the RO denied the claim for a rating in excess of 20 percent for DDD of the lumbar spine. A rating action in March 2014 confirmed the denial of an increased rating for DDD of the lumbar spine. Subsequently, in a rating action in October 2014, the RO denied the Veteran’s attempt to reopen a claim of entitlement to service connection for hypertension; that rating action also denied entitlement to service connection for elevated cholesterol, service connection for depression, service connection for type II diabetes mellitus, and entitlement to a compensable rating for GERD. By a DRO rating decision in April 2016, the RO granted service connection for left ear hearing loss and confirmed a 0 percent evaluation for bilateral hearing loss; that rating action granted service connection for left lower extremity radiculopathy, and assigned a 20 percent rating, effective December 31, 2012. Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1110, 1131 (2012); 38 C.F.R. § 3.303 (a) (2017). "To establish a right to compensation for a present disability, a Veteran must show: "(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service"- the so-called "nexus" requirement." Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). For a showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "chronic." Continuity of symptomatology is required where the condition noted during service is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. If the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. 38 C.F.R. § 3.303 (b) (2017). Certain chronic diseases, including diabetes mellitus, may be presumed to have been incurred in or aggravated by service if manifest to a compensable degree within one year of discharge from service, even though there is no evidence of such disease during service. 38 U.S.C. §§ 1101, 1112, (2012); 38 C.F.R. §§ 3.307, 3.309(a) (2017). Service connection may be granted for a condition on a "secondary" theory of entitlement if the condition is shown to have been caused or aggravated by a condition for which service connection has already been established. See 38 C.F.R. § 3.310 (2017). The term "aggravated" in this context means that, although the secondary condition was not caused by the service-connected condition, the secondary condition was chronically worsened by the service-connected condition. The Veteran can provide competent reports of factual matters of which he has first-hand knowledge, such as experiencing pain in service, reporting to sick call, being placed on limited duty, and undergoing physical therapy. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005). Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a lay person is competent to identify the medical condition (noting that sometimes the lay person will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer), (2) the lay person is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. See Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007). Similarly, laypersons are competent to diagnose and provide nexus opinions to some extent, notably where the diagnosis or opinion is not of a complex nature. Id., see also Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). 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. Generally, a claim which has been denied in an unappealed RO decision is final and may not thereafter be reopened and allowed. 38 U.S.C. § 7105 (c) (2012); 38 C.F.R. § 20.1100 (2017). If an RO decision is appealed to the Board and the Board issues a decision, that Board decision subsumes the underlying decision. 38 C.F.R. § 20.1104 (2017). Unless the Chairman of the Board orders reconsideration of a Board decision, the Board decision is final on the date of mailing stamped on the face of the decision. 38 U.S.C. § 7103 (a); 38 C.F.R. § 20.1100. The exception to this rule of not reviewing the merits of a finally disallowed claim is 38 U.S.C. § 5108, which provides that if new and material evidence is presented or secured with respect to a claim which has been disallowed, the Secretary shall reopen the claim and review the former disposition of the claim. New evidence means existing evidence not previously submitted to agency decisionmakers. 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). The determination of whether newly submitted evidence raises a reasonable possibility of substantiating the claim should be considered a component of the question of what is new and material evidence, rather than a separate determination to be made after the Board has found that evidence is new and material. See Shade v. Shinseki, 24 Vet. App. 110 (2010). For the purpose of establishing whether new and material evidence has been received, the credibility of the evidence, although not its weight, is to be presumed. Justus v. Principi, 3 Vet. App. 510, 513 (1992). 1. Whether new and material evidence has been submitted to reopen a claim of entitlement to service connection for hypertension As noted above, the Veteran's claim for hypertension was initially denied in April 2007. Historically, the Veteran initially filed a claim for service connection for hypertension in October 2006. At that time, the record included the Veteran's service treatment records (STRs); service personnel records; treatment reports from Hershey Medical Center from May 1999 to May 2006; VA examination report dated in March 2007; and lay statements from the Veteran. The STRs indicate that, at his enlistment examination on January 19, 1982, the Veteran’s blood pressure readings were 170/80, 168/90, and 140/100. On January 20, 1982 the readings were 130/100, 130/100, and 140/100. Repeat blood pressure readings on January 21, 1982 were 120/80, 126/80, and 120/90. Reenlistment/extension examination on June 20, 1988 noted blood pressure readings were 136/80, 136/82, and 140/84. At his discharge examination in January 1995, the Veteran’s blood pressure reading was 122/84. National guard treatment records, dated from May 2001 to May 2006 reflect that the Veteran was diagnosed with hypertension and on medication. During a VA examination in March 2007, it was noted that the Veteran was taking two antihypertensive medications with good response to his blood pressure and no observed side effects. His blood pressure reading was 126/83. The diagnosis was hypertension; the examiner noted that the Veteran’s hypertension appeared to be well-controlled on Lisinopril/Hydrochlorothiazide and Metroprolol. By a rating action in April 2007, the RO denied the claim for service connection for hypertension. The RO found that the Veteran’s hypertension preexisted his period of active service, and there was no evidence that the condition was aggravated by his active service. The Veteran was provided notice of this decision and his appellate rights by letter dated April 30, 2007, but he did not appeal the decision or submit new and material evidence within one year of the decision. Consequently, as no timely NOD or new and material evidence was received during the appeal period following the April 2007 notice of determination, that decision became final. See 38 C.F.R. § 3.156 (b); Buie v. Shinseki, 24 Vet. App. 242, 252 (2010); 38 C.F.R. §§ 20.200, 20.201, 20.1103 (2017). New and material evidence is therefore required to reopen the claim of service connection for hypertension. See 38 U.S.C. § 5108 (2012); Jackson v. Principi, 265 F.3d 1366 (Fed. Cir. 2001); 38 C.F.R. § 3.156. In a statement in support of claim (VA Form 21-4138), dated in December 2012, the Veteran indicated that he was seeking to establish a claim for service connection for high blood pressure. The evidence received since the April 2007 denial consists of the Veteran's lay statements, VA progress notes dated from January 2007 to July 2007 reflecting diagnoses of hypertension. Also received were additional VA progress notes, dated from August 2012 to March 2013, reflecting diagnoses of essential hypertension; treatment records from Social Security Administration (SSA) dated from August 2010 to June 2013, reflecting diagnoses of hypertension. The evidence received since the April 2007 rating decision shows continued treatment for hypertension, but does not show aggravation of the Veteran's hypertension during a period of active service. Although the evidence received since the April 2007 rating decision may be considered new in the sense that it was not previously before agency decisionmakers, the evidence is not material because it does not relate to unestablished facts necessary to substantiate the claim. The evidence does not indicate that the Veteran's hypertension was aggravated by a period of active service or that it did not preexist service. For these reasons, the Board finds that the evidence is not new and material because it does not raise a reasonable possibility of substantiating the claim. 2. Entitlement to service connection for elevated/high cholesterol The Veteran contends that his elevated (high) cholesterol is directly related to service. Service connection can only be granted for a disability resulting from disease or injury. See 38 U.S.C. §§ 1110, 1113. High cholesterol is a laboratory finding that manifests itself only in laboratory test results and is not a disability for which service connection can be granted. Laboratory test results are, therefore, not appropriate entities for the rating schedule. 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). The Board concludes that although chronic high cholesterol may be present, there is no evidence of record suggesting high cholesterol, on its own, has caused any impairment of earning capacity or other disease or injury for which service connection may be granted. In the absence of proof of a current disability from high cholesterol, service connection for high cholesterol is not warranted. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); Rabideau v. Derwinski, 2 Vet. App. 141, 43-144 (1992). Accordingly, there is no basis for awarding service connection for high cholesterol, and the appeal is denied. 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 3. Entitlement to service connection for erectile dysfunction, secondary to service-connected DDD of the lumbar spine The Veteran maintains that his erectile dysfunction developed as a result of military service, primarily due to his service-connected lumbar spine disorder. The question for the Board is whether the Veteran has a current disability that is proximately due to or the result of, or was aggravated by a service-connected disability. The Board concludes that, while the Veteran has a current diagnosis of erectile dysfunction. the preponderance of the evidence is against finding that the Veteran's erectile dysfunction is proximately due to or the result of, or aggravated by a service-connected disability. 38 U.S.C. §§ 1110, 1131; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc); 38 C.F.R. § 3.310 (a). Significantly, following a DBQ examination in April 2016, the examiner reported a diagnosis of erectile dysfunction. The April 2016 examiner opined that the Veteran's erectile dysfunction is less likely than not proximately due to or the result of his service-connected condition. The rationale was that erectile dysfunction is a common side effect of many antihypertensive medications and is a well-known complication of diabetes mellitus type II. The examiner noted that examination findings and symptom complaints were not consistent with L1 radiculopathy; therefore, he concluded that Veteran’s erectile dysfunction is less likely than not proximately due to or the result of his service-connected DDD of the lumbar spine. While the Veteran believes his erectile dysfunction is proximately due to or the result of his service-connected DDD of the lumbar spine, he is not competent to provide a nexus opinion in this case. The issue is medically complex, as it requires knowledge of the interaction between multiple organ systems in the body. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the April 2016 examiner's opinion. Service connection may also be granted on a direct basis, but the preponderance of the evidence is also against finding that the Veteran's erectile dysfunction is related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303 (a), (d). Notably, service treatment records do not contain any complaints of or treatment for erectile dysfunction. At his discharge examination in January 1995, clinical evaluation of the genitourinary system was normal. Moreover, as noted above, erectile dysfunction was not documented until December 2012, more than 17 years following Veteran’s discharge from service. The absence of any clinical evidence for decades after service weighs the evidence against a finding that the Veteran's erectile dysfunction was present in service. Maxson v. Gober, 230 F.3d 1330 (Fed. Cir. 2000). Moreover, there is no probative evidence that the Veteran's ED is shown to be causally or etiologically related to service. Given that the competent medical evidence against the claim, for the Board to conclude that the Veteran’s erectile dysfunction is either related to service or a service-connected disability would be contrary to the greater weight of the evidence. 38 C.F.R. § 3.102 (2017); Obert v. Brown, 5 Vet. App. 30, 33 (1993). In conclusion, the Board finds that preponderance of evidence weighs against the Veteran's claim of entitlement to service connection for erectile dysfunction, both as directly due to active service and as secondary to his service-connected DDD of the lumbar spine. As the preponderance of the probative evidence is against the Veteran's claim, there is no reasonable doubt to be resolved, and the claim must be denied. 38 U.S.C. § 5107 (b) (2012); 38 C.F.R. § 3.102 (2017); see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 4. Entitlement to service connection for diabetes mellitus, type II The Veteran is seeking service connection for diabetes mellitus, type II, which he claims developed as a result of military service. After careful review of the evidentiary record, the Board finds that the preponderance of the evidence is against the claim of service connection for diabetes mellitus, type II. In this case, the Veteran does not contend that his diabetes or related symptoms had its onset during service. Indeed, the Veteran's STRs are completely silent with respect to any complaints, treatment or diagnosis related to diabetes mellitus. Further, the Veteran's January 1995 service examination prior to discharge was silent with respect to any findings of diabetes mellitus. Lay and medical evidence show that the Veteran was diagnosed with diabetes mellitus, type II, in July 2007, more than 12 years following the Veteran's discharge from active duty. Maxson v. Gober, 230 F.3rd 1330, 1333 (Fed. Cir. 2000). Therefore, as the Veteran did not manifest diabetes mellitus within one year of his period of active duty service in June 1995, he is not entitled to presumptive service connection for such diseases. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. Moreover, while the Veteran's VA medical records reflect that he is currently diagnosed with diabetes mellitus, type II, the records do not reflect that any medical professional has ever indicated that his diagnosed condition may have been related to active duty service. Indeed, the only evidence in support of his claim is the Veteran's own statements that his diabetes developed as a result of his military service. The Board acknowledges the Veteran's belief that his diabetes mellitus is related to his military service and/or his service-connected disabilities. The Board notes that the Veteran is competent to testify as to a condition within his knowledge and personal observation. See Barr v. Nicholson, 21 Vet. App. 303, 308-10 (2007). However, it is clear, based on a detailed review of the statements overall, that the Veteran has no actual specialized knowledge of medicine and that he is merely speculating as to whether his diabetes mellitus was incurred in service. In this regard, he is not competent to diagnose this condition or symptoms, as such diagnosis involve complex questions the answers to which require specialized medical knowledge and specific testing. As such, the Veteran's statements to this effect are lacking in probative value. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine; however, because the preponderance of the evidence is against the claim, that doctrine does not apply. See 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet App. 49 (1990); 38 C.F.R. § 3.102. 5. Entitlement to service connection for bilateral upper extremity and right lower extremity neuropathy secondary to lumbar spine disorder The Veteran maintains that service connection is warranted for neuropathy of the upper extremities and right lower extremities because he developed these problems as a result of his active service. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the Veteran does not have a current diagnosis of neuropathy of the upper and right lower extremities and has not had one at any time during the pendency of the claim or recent to the filing of the claim. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); 38 C.F.R. § 3.303 (a), (d). In this regard, the Board notes that the STRs during active service are completely silent with respect to any complaints or clinical findings of any radiculopathy or neuropathy of the upper or lower extremities. Post service treatment records, including VA as well as private treatment reports, do not reflect any complaints or clinical findings of neuropathy of the left upper extremity. Significantly, while the report of an EMG study, dated in November 2004, reported findings of left carpal tunnel syndrome v. ulnar neuropathy, it was noted that the Veteran had evidence of a mild improving left ulnar neuropathy at the elbow joint probably due to trauma a month ago when he hit his elbow in a door. In addition, a VA examination of July 2013 does not reflect a diagnosis of radiculopathy or peripheral neuropathy of the upper or lower extremities. The examiner noted that the Veteran has a history of diabetes and reported getting cramps in his hands, however, he did not have any symptoms attributable to diabetic peripheral neuropathy. The examiner noted that the Veteran does not have a diagnosis of diabetic peripheral neuropathy of the upper extremities; the examiner did not show a diagnosis of radiculopathy of the lower extremities due to the Veteran’s lumbar spine condition. Moreover, a March 2014 VA examination report does not reflect a diagnosis of radiculopathy or peripheral neuropathy of the upper or right lower extremities. Sensory examination was normal. Lacking a current diagnosis for peripheral neuropathy of the upper and right lower extremities, the cornerstone element of service connection has not been met. Brammer v. Derwinski, 3 Vet. App. at 225. As such, service connection is not warranted on any basis. While the Board acknowledges the Veteran’s belief that he has a current disability of peripheral neuropathy of the upper extremities and the right lower extremity, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education/knowledge of the neurological system. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). As the evidence does not show the Veteran has any expertise in medical matters involving complex medical questions, the Board concludes that the Veteran’s assertions in this regard are not competent and therefore not probative of whether he currently has peripheral neuropathy of the upper and right lower extremities that is related to service. Consequently, the Board gives more probative weight to the competent medical evidence. The Board has considered the Veteran’s description of symptoms but finds that he does not have a current disability of the upper extremities and right lower extremity described as peripheral neuropathy due to disease or injury, either disease or injury at the time of service, or since. As the Board finds that the requirement of a current disability has not been met, the Board need not address the other elements of service connection. See, e.g., Gilpin v. West, 155 F. 3d 1353 (Fed. Cir. 1998). The preponderance of the evidence is against the claims, thus the benefit-of-the-doubt doctrine is not for application and the claim must be denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. Increased Rating Disability evaluations are determined by the application of a schedule of ratings which is based upon average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. 38 C.F.R. § 4.1 requires that each disability be viewed in relation to its history, and that there be emphasis upon the limitation of activity imposed by the disabling condition. 38 C.F.R. § 4.2 requires that medical reports be interpreted in light of the entire recorded history, and that each disability must be considered from the point of view of the veteran's working or seeking work. Separate diagnostic codes identify the various disabilities. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. 38 C.F.R. § 4.7. Otherwise, the lower rating is to be assigned. Because the Veteran is appealing the original assignment of a disability rating following an award of service connection, the severity of her radiculopathy of the left lower extremity is to be considered during the entire period from the initial assignment of the rating to the present. See Fenderson v. West, 12 Vet. App. 119 (1999). In deciding this appeal, the Board has considered whether separate ratings for different periods of time, based on the facts found, are warranted, a practice of assigning ratings referred to as "staging the ratings." Id. In determining the appropriate evaluation for musculoskeletal disabilities, particular attention is focused on functional loss of use of the affected part. Under 38 C.F.R. § 4.40, functional loss may be due to pain, supported by adequate pathology and evidenced by visible behavior on motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. Under 38 C.F.R. § 4.45, factors of joint disability include increased or limited motion, weakness, fatigability, or painful movement, swelling, deformity or disuse atrophy. Under 38 C.F.R. § 4.59, painful motion is an important factor of joint disability and actually painful joints are entitled to at least the minimum compensable rating for the joint. Where functional loss is alleged due to pain upon motion, the provisions of 38 C.F.R. § 4.40 and § 4.45 must be considered. DeLuca v. Brown, 8 Vet. App. 202, 207-08 (1995). Within this context, a finding of functional loss due to pain must be supported by adequate pathology, and evidenced by the visible behavior of the claimant. Johnston v. Brown, 10 Vet. App. 80, 85 (1997). Pain itself does not rise to the level of functional loss as contemplated by § 4.40 and § 4.45, but may result in functional loss only if it limits the ability to perform the normal working movements of the body with normal excursion, strength, coordination or endurance. Mitchell v. Shinseki, 25 Vet. App. 32, 43 (2011). 6. Entitlement to a rating in excess of 10 percent for tinnitus, including extraschedular rating The Veteran is seeking an increased rating for bilateral tinnitus. The RO assigned the Veteran a 10 percent rating for his bilateral tinnitus from December 31, 2012, which is the maximum schedular allowance under Diagnostic Code 6260. There is no provision for assignment of a separate 10 percent evaluation for tinnitus of each ear. In Smith v. Nicholson, 451 F.3d 1344 (Fed. Cir. 2006), the United States Court of Appeals for the Federal Circuit found that 38 C.F.R. § 4.25 (b) and 38 C.F.R. § 4.87, Diagnostic Code 6260 limit a Veteran to a single disability rating for tinnitus, regardless of whether the tinnitus is unilateral or bilateral. The Board has also considered whether the Veteran's disability presents an exceptional or unusual disability picture as to render impractical the application of the regular schedular standards such that referral to the appropriate officials for consideration of extraschedular ratings is warranted. See 38 C.F.R. § 3.321 (b)(1); Bagwell v. Brown, 9 Vet. App. 337, 338-39 (1996). The threshold factor for extraschedular consideration is a finding that the established schedular criteria are inadequate to describe the severity and symptoms of the claimant's disability. See Thun v. Peake, 22 Vet. App. 111, 118 (2008). Here, the Veteran's bilateral tinnitus is manifested by ringing in his ears. The Veteran's tinnitus is contemplated by the rating criteria under Diagnostic Code 6260. To the extent that it is asserted that the tinnitus interferes with the Veteran's daily activities, the functional effects of his tinnitus are how the disability impacts him in his ordinary activities. Even though these effects may not be explicitly written in the diagnostic code, the rating schedule for tinnitus is written so broadly and inclusively so as to compensate for all associated symptoms and functional effects. See 38 C.F.R. § 4.87. Notably, in Doucette v. Shulkin, the United States Court of Appeals for Veterans Claims has made clear that a diagnostic code need not list every word or type of symptom to contemplate a type of functional effect. For instance, problems with hearing sounds in crowds, televisions or telephones are not listed in the diagnostic code for hearing loss but are nonetheless contemplated because they are the actual effects of the hearing loss in daily life. See 28 Vet. App. 366 (2017). Here, although in the context of a tinnitus extraschedular rating claim, the Doucette decision by extension shows that the symptoms of the Veteran's tinnitus, and their functional effects, are contemplated by the rating schedule for evaluating the disability. It is noteworthy that, during the July 2013 VA audio examination, the Veteran reported that the tinnitus is annoying and bothersome, but does not distract from his daily life. The examiner stated that the Veteran’s tinnitus does not impact his ordinary conditions of daily life including his ability to work. Similarly, in April 2016, the DBQ examiner stated that the Veteran’s tinnitus does not impact ordinary conditions of daily life, including his ability to work. The Board finds that the rating criteria adequately describe the Veteran's disability level and symptomatology. Thus, his disability picture is contemplated by the rating schedule, and the assigned schedular evaluation is, therefore, adequate. See Thun v. Peake, 22 Vet. App. at 115. Consequently, referral for extraschedular consideration is not warranted. The Veteran's service-connected tinnitus has been assigned the maximum schedular rating available for tinnitus of 10 percent. 38 C.F.R. § 4.87, Diagnostic Code 6260. As there is no legal basis upon which to award separate schedular evaluations for tinnitus in each ear or a higher evaluation overall, the Veteran's appeal must be denied. Sabonis v. Brown, 6 Vet. App. 426 (1994). 7. Entitlement to an initial compensable rating for bilateral hearing loss The Veteran maintains that his bilateral hearing loss is more disabling than reflected by the currently assigned noncompensable rating. Service connection was established for right ear hearing loss in a July 2013 rating decision, and a noncompensable rating was assigned, effective December 31, 2012. The Veteran filed a notice of disagreement with the 0 percent rating. Subsequently, a DRO decision in April 2016 granted service connection for left ear hearing loss and continued the 0 percent rating for the combined bilateral hearing loss, effective December 31, 2012. The Veteran's bilateral hearing loss has been rated under the provisions of Diagnostic Code 6100. In evaluating hearing impairment, disability ratings are derived by a mechanical application of the ratings schedule to the numeric designations assigned after audiometric evaluations are conducted. See Lendenmann v. Principi, 3 Vet. App. 345, 349 (1992). The ratings schedule provides a table for ratings purposes (Table VI) to determine a Roman numeral designation (I through XI) for hearing impairment. Table VII is used to determine the percentage evaluation by combining the Roman numeral designations for hearing impairment in both ears. 38 C.F.R. § 4.85. When the puretone threshold at each of the four specified frequencies (1000, 2000, 3000, and 4000 Hertz) is 55 decibels or more, Table VI or Table VIa is to be used, whichever results in the higher numeral. 38 C.F.R. § 4.86 (a). Additionally, when the puretone threshold is 30 decibels or less at 1000 Hertz, and 70 decibels or more at 2000 Hertz, Table VI or Table VIa is to be used, whichever results in the higher numeral. Thereafter, that numeral will be elevated to the next higher numeral. 38 C.F.R. § 4.86 (b). The evidence of record herein indicates that the Veteran's bilateral hearing loss pattern does not fit the requirements of an unusual pattern of hearing impairment. The record reflects that the Veteran was afforded a VA audiological evaluation in July 2013. At that time, pure tone thresholds were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 25 30 40 45 LEFT 15 25 25 35 Speech audiometry revealed speech recognition ability of 95 percent in the right ear and of 100 percent in the left ear. The pertinent diagnosis was sensorineural hearing loss in the frequency range of 500 to 4000 Hertz levels in both ears. The examiner indicated that the Veteran’s hearing loss does not impact ordinary conditions of daily life, including ability to work. The results of the July 2013 examination correspond to Level I hearing in the right ear, and Level I hearing in the left ear. 38 C.F.R. § 4.85 (b). When these values are applied to Table VII, a noncompensable disability rating is assigned. 38 C.F.R. § 4.85. The Board has also considered whether a compensable evaluation for hearing loss is warranted under 38 C.F.R. § 4.86. Based on the July 2013 audiometric findings, however, the Veteran's disability did not meet the requirements of 38 C.F.R. § 4.86. In this regard, the Veteran did not have puretone thresholds of 55 decibels or more at each of the frequencies of 1000, 2000, 3000 and 4000 hertz or a puretone threshold of 30 decibels or less at 1000 hertz and 70 decibels or more at 2000 hertz. As such, it is apparent that the noncompensable disability evaluation for the Veteran's bilateral hearing loss is accurate and appropriately reflects his hearing loss under the provisions of 38 C.F.R. §§ 4.85 and 4.86(a). The Veteran underwent his most recent DBQ/VA audiological evaluation in April 2016. Pure tone thresholds, in decibels, were as follows HERTZ 500 1000 2000 3000 4000 RIGHT 15 25 50 50 LEFT 15 15 40 35 Speech audiometry revealed speech recognition ability of 92 percent in the right ear and of 92 percent in the left ear. The pertinent diagnosis was sensorineural hearing loss in the frequency range of 500 to 4000 Hertz levels in both ears. The examiner indicated that the Veteran’s hearing loss does not impact ordinary conditions of daily life, including ability to work. The results of the April 2016 examination correspond to Level I hearing in the right ear, and a level I hearing in the left ear. See 38 C.F.R. § 4.85 (b). When those values are applied to Table VII, a noncompensable disability rating is assigned. 38 C.F.R. § 4.85. The Board has also considered whether a compensable rating for hearing loss is warranted under 38 C.F.R. § 4.86. Based on the April 2016 audiometric findings, however, the Veteran’s disability did not meet the requirements of 38 C.F.R. § 4.86. In this regard, the Veteran did not have puretone thresholds of 55 decibels or more at each of the frequencies of 1000, 2000, 3000 and 4000 hertz or a puretone threshold of 30 decibels or less at 1000 hertz and 70 decibels or more at 2000 hertz. As such, it is apparent that the noncompensable disability evaluation for the Veteran’s bilateral hearing loss is accurate and appropriately reflects his hearing loss under the provisions of 38 C.F.R. §§ 4.85 and 4.86(a). Based on these results, the Board concludes that a compensable rating for the Veteran's bilateral hearing loss is not warranted. Although the VA examinations and treatment record show that the Veteran clearly has hearing loss, the audiometric test results do not support entitlement to an increased evaluation for bilateral hearing impairment. The Board has reviewed all the medical records in the claims file and found that there is no evidence related to hearing loss that supports a higher rating. It is apparent that the assigned noncompensable disability evaluation for the appeal period for the Veteran's bilateral hearing loss is accurate and appropriately reflects his hearing loss under the provisions of 38 C.F.R. §§ 4.85 and 4.86. The Board has considered the statements made by the Veteran in which he asserted that his bilateral hearing loss disability warrants a compensable rating. However, the Board is bound in its decisions by the VA regulations for the rating of hearing loss. 38 U.S.C. § 7104 (c). Rating hearing loss requires the use of the Maryland CNC speech discrimination test and the pure tone threshold average determined by an audiometry test. Application of the schedule to the facts of this case shows that the noncompensable disability evaluation presently assigned accurately reflects the degree of the Veteran's service-connected hearing impairment for rating purposes. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. Part 4, § 4.85, Diagnostic Code 6100. The Board has considered whether referral for an extraschedular rating under 38 C.F.R. § 3.321 (b) (1) is warranted in this case. The Board finds that the Veteran's symptoms of bilateral hearing loss are contemplated by the schedular rating criteria. Neither the facts of the case nor the Veteran's allegations raise the issue of extraschedular consideration. Thus, no analysis is required. See Yancy v. McDonald, 27 Vet. App. 484, 494 (2016) (holding that an extraschedular analysis is not warranted where it is not "specifically sought by the claimant nor reasonably raised by the facts found by the Board") (citing Dingess v. Nicholson, 19 Vet. App. 473, 499 (2006), aff'd, 226 Fed. Appx. 1004 (Fed. Cir. 2007). See also Doucette v. Shulkin, 28 Vet. App. 366, 369 (2017) (explaining that the Board had no obligation to analyze whether referral is warranted for extraschedular consideration if an extraschedular rating is not specifically sought by the claimant or reasonably raised by the facts found by the Board). Similarly, the Board recognizes that a claim for a total rating based on individual unemployability (TDIU) may be raised as a separate claim, or in the context of an initial rating or a claim for an increase. See Rice v. Shinseki, 22 Vet. App. 447, 452-53 (2009). While acknowledging the impact his bilateral hearing loss has on his employment, the record does not reflect that the Veteran is unable to obtain and/or maintain another form of employment as a result of his service-connected disabilities. Furthermore, the Veteran has not contended, and the evidence of record does not reflect, that he is unable obtain employment as a result of his disabilities. As such, the Board does not find that a claim for a TDIU has been reasonably raised by the record with regard to his bilateral hearing loss and thus the Board finds it unnecessary to consider entitlement at this juncture. 8. Entitlement to a compensable rating for gastroesophageal reflux disease (GERD) The Veteran essentially contends that his GERD is more disabling than reflected by the noncompensable rating currently assigned. A non-compensable rating is currently assigned for the Veteran's GERD under Diagnostic Code (DC) 7346, pertaining to hernia hiatal. Under DC 7346, a 10 percent rating is warranted where the evidence shows two or more of the symptoms for the 30 percent rating of less severity. A 30 percent rating is warranted where there is persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health. A 60 percent rating contemplates a level of impairment which includes symptoms of pain, vomiting, material weight loss and hematemesis or melena with moderate anemia; or other symptom combinations productive of severe impairment of health. In conjunction with the Veteran’s claim for an increased rating (VA Form 21-4138), received in December 2012, he was afforded a DBQ examination in October 2014. At that time, the Veteran indicated that he did not seem to have any problems with his GERD. He noted that the only symptom he was experiencing at that time was reflux. No esophageal stricture, spasm or diverticulum of the esophagus was noted. It was noted that an endoscopy, performed in February 2014, was positive for Barrett’s esophagus, but was negative for malignancy or other abnormality. The examiner stated that the Veteran’s GERD did not impact his ability to work. The Veteran was afforded another examination for evaluation of his GERD in April 2016. At that time, he noted that his condition had not changed much, and that it was not really giving him much trouble. The Veteran reported that his symptoms include pyrosis and reflux. No esophageal stricture, spasm or diverticulum of the esophagus was noted. It was noted that the abdomen was soft, non-distended, and bowel sounds were active in all quadrants. There was epigastric tenderness with palpation, but no HSM, masses or hernias. The examiner stated that the Veteran’s GERD did not impact his ability to work. Upon careful review of the record, the Board finds that assignment of a compensable initial rating for GERD is not warranted based on the evidence currently of record. Here, the evidence shows pyrosis and reflux controlled by medication. The records do not contain complaints of dysphagia or regurgitation and do not demonstrate that substernal, arm, or shoulder pain is due to GERD. Without evidence of two or more of the symptoms for the 30 percent rating of less severity, entitlement to a compensable rating is not warranted. The Board acknowledges that the Veteran takes over-the-counter medication to control his symptoms and that the Board may not deny entitlement to a higher rating on the basis of relief provided by medication when those effects are not specifically contemplated by the rating criteria. See Jones v. Shinseki, 26 Vet. App. 56, 63 (2012). The evidence, however, does not demonstrate additional symptomatology that would substantiate a compensable rating without medication. The Board has also considered rating of the Veteran's GERD under other diagnostic criteria for gastrointestinal disabilities. See 38 C.F.R. § 4.114, Diagnostic Codes 7301-54. The Veteran's GERD, however, has not been shown to have resulted in any symptomatology which would, in the context of different diagnostic criteria, result in a higher rating. In considering whether a compensable rating is warranted, the Board has considered the benefit-of-the-doubt rule. Because the preponderance of the evidence is against the claim, the benefit-of-the-doubt rule does not apply, and the claim must be denied. 38 U.S.C. § 5107 (b) (2012); Gilbert, 1 Vet. App. at 55. 9. Entitlement to an initial rating in excess of 20 percent for left lower extremity radiculopathy The Veteran essentially contends that his left lower extremity condition is more severe than reflected by the rating currently assigned; therefore, a higher rating is warranted. The Veteran's left lower extremity radiculopathy is currently rated under Diagnostic Code 8520 which provides ratings for paralysis of the sciatic nerve. Diagnostic Code 8520 provides that mild incomplete paralysis is rated 10 percent disabling; moderate incomplete paralysis is rated 20 percent disabling; moderately severe incomplete paralysis is rated 40 percent disabling; and severe incomplete paralysis, with marked muscular atrophy, is rated 60 percent disabling. Complete paralysis of the sciatic nerve, the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost, is rated 80 percent disabling. 38 C.F.R. § 4.124a, Diagnostic Code 8520 (2017). The term "incomplete paralysis" with this and other peripheral nerve injuries indicates a degree of lost or impaired function substantially less than the type pictured for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. The ratings for the peripheral nerves are for unilateral involvement; when there is bilateral involvement, the VA adjudicator is to combine the ratings for the peripheral nerves, with application of the bilateral factor. 38 C.F.R. § 4.124a. The Board notes that words such as "slight," "moderate," and "severe" are not defined in the Rating Schedule. Rather than applying a mechanical formula, the Board must evaluate all of the evidence to the end that its decisions are "equitable and just." 38 C.F.R. § 4.6. Use of terminology such as "severe" by VA examiners and others, although evidence to be considered by the Board, is not dispositive of an issue. 38 C.F.R. §§ 4.2, 4.6 (2017). On examination in July 2013, the Veteran reported that the balls of his feet go numb by bedtime for a couple of years. The Veteran indicated that he can’t sit or stand for very long. He noted that sometimes pain shoots down the medial and lateral aspects of the left leg. The balls of his feet feel numb by bedtime; it gets worse when he tries to relax. He denied any flare-ups. Muscle strength testing was normal and deep tendon reflexes were normal. It was noted that the Veteran had decreased sensation in his left ankle and toes. The examiner stated that the Veteran did not have any signs or symptoms of radiculopathy in the lower extremities. The examiner stated that the pattern of numbness on today's exam is consistent with tarsal tunnel syndrome and is not suggestive of numbness related to a back problem or of diabetes. Tarsal tunnel is an entrapment neuropathy at the ankle or in the foot. The Veteran was afforded another examination for evaluation of his lumbar spine in March 2014. Muscle strength testing was normal. Sensory examination was normal in the lower extremities. Deep tendon reflexes were absent in the ankles. The examiner noted that the Veteran had difficulty or apparent pain. The examiner noted that all ranges of motion were within functional limits, tandem walk intact. Sensation was intact for light touch and pinprick for dermatomes L2-S2 bilaterally, proprioception and vibration intact in bilateral lower extremities. Muscle strength testing in the lower extremities 5/5 for: hip flexors, hip abductors, hip adductor, quadriceps, hamstrings, dorsiflexors, plantarflexors, and EHL. Deep tendon reflexes were 2+ bilaterally in L4 and not elicited bilaterally in S1, limb musculature girth grossly symmetrical in bilateral lower extremities. No atrophy or fasciculations in either lower extremity or trunk. The Veteran was able to heel and toe walk, bilaterally. Babinski was negative bilaterally. Straight leg raising was negative bilaterally. The examiner noted that the Veteran does not have any signs or symptoms of radiculopathy in the lower extremities. On the occasion of a DBQ examination in April 2016, it was noted that the Veteran had decreased sensation to light touch in the left ankle and foot. The examiner noted that the Veteran had mild paresthesias and numbness in the left lower extremity. The examiner indicated that the Veteran had mild radiculopathy of the left sciatic nerve. The examiner noted that the Veteran was diagnosed with left L5 radiculopathy via EMG in 2004, and he reported symptoms of electrical shock type pains shooting down left leg, with objective findings of absent cool and sharp left lateral lower leg, decreased vibratory at left knee consistent with L5 lumbar radiculopathy. After a careful review of the record, the Board finds that the Veteran's radiculopathy in the left lower extremity does not warrant an evaluation in excess of 20 percent. The Board has based its conclusions on the medical evidence outlined above, which shows symptoms productive of no more than moderate incomplete paralysis of the sciatic nerve in the left lower extremity, which includes findings of chronic severe pain, moderate numbness in the left lower extremity, with tingling down the left leg. On examination in July 2013, March 2014, and April 2016, the examiner noted decreased sensation in the left lower leg/ankle, and toes. The examiner noted involvement of L4/L5/S1/S2/S3 sciatic nerve, moderate on the left. In light of the foregoing, the Board finds that the Veteran's symptoms of a neurological manifestation of the left lower extremity more nearly approximate the criteria for a 20 percent rating under Diagnostic Code 8520, for moderate incomplete paralysis. In the absence of findings which indicate that the neurological manifestation is productive of moderately severe incomplete paralysis, there is no schedular basis for an initial disability rating in excess of 20 percent. See 38 C.F.R. § 4.124a, Diagnostic Code 8520. All things considered, the record as a whole does not show persistent symptoms that equal or more nearly approximate the criteria for an evaluation in excess of 20 percent. In summary, for the reasons and bases expressed above, the Board concludes that an initial disability rating in excess of 20 percent for radiculopathy of the left lower extremity is not warranted. Since the preponderance of the evidence is against the claim, the benefit of the doubt rule does not apply. 38 C.F.R. § 4.3; Alemany v. Brown, 9 Vet. App. 518, 519 (1996). The benefit sought on appeal is accordingly denied. The Board has considered whether referral for an extraschedular rating under 38 C.F.R. § 3.321 (b)(1) is warranted in this case. The Board finds that the Veteran's symptoms of radiculopathy of the left lower extremity are contemplated by the schedular rating criteria. Neither the facts of the case nor the Veteran's allegations raise the issue of extraschedular consideration. Thus, no analysis is required. See Yancy v. McDonald, 27 Vet. App. 484, 494 (2016) (holding that an extraschedular analysis is not warranted where it is not "specifically sought by the claimant nor reasonably raised by the facts found by the Board") (citing Dingess v. Nicholson, 19 Vet. App. 473, 499 (2006), aff'd, 226 Fed. Appx. 1004 (Fed. Cir. 2007). See also Doucette v. Shulkin, 28 Vet. App. 366, 369 (2017) (explaining that the Board had no obligation to analyze whether referral is warranted for extraschedular consideration if an extraschedular rating is not specifically sought by the claimant or reasonably raised by the facts found by the Board). Effective Date Generally, the effective date of an award of a claim is 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. The effective date of an award of disability compensation based on new and material evidence under 38 C.F.R. § 3.156 (other than service department records) received after a final disallowance shall be the date of receipt of the new claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110; 38 C.F.R. § 3.400 (q) (2). Similarly, the effective date of an award of disability compensation based on a reopened claim under the provisions of 38 C.F.R. §§ 3.109, 3.156, 3.157, and 3.160(e) shall be the date of receipt of the claim or the date entitlement arose, whichever is later. 38 C.F.R. § 3.400 (r). During the pendency of this appeal, VA amended it regulations 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, and eliminated the constructive receipt of VA reports of hospitalization or examination and other medical records as informal claims. Prior to this change, a "claim" was 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); Brannon v. West, 12 Vet. App. 32, 34-5 (1998); Servello v. Derwinski, 3 Vet. App. 196, 199 (1992). Any communication or action indicating an intent to apply for one or more benefits under laws administered by VA from a claimant may be considered an informal claim. To determine when a claim was received, the Board must review all communications in the claims file that may be construed as an application or claim. See Quarles v. Derwinski, 3 Vet. App. 129, 134 (1992). 10. Entitlement to an effective date earlier than October 2, 2006 for a grant of service connection for DDD lumbar spine By a rating action in April 2007, the RO granted service connection for DDD of the lumbar spine and GERD, effective October 2, 2006. He was notified of that decision in correspondence issued that same month. He did not appeal the decision. Thus, the decision became final, absent a finding of CUE. In May 2012, the Veteran requested an increased rating for his DDD of the lumbar spine and filed a NOD to a March 2014 rating decision denying an increase of his rating. That NOD included disagreement with the effective date for the grant of service connection for DDD of the lumbar spine. In light of the finality of the April 2007 rating decision, and in the absence of a motion to revise the April 2007 rating decision based on CUE, the Veteran cannot obtain an effective date earlier than October 2, 2006. Legally, there cannot be a free-standing claim for an earlier effective date, and once an effective date has become final, a Veteran's only recourse is to have the final decision revised on the grounds of CUE. Rudd v. Nicholson, 20 Vet. App. 296 (2006). No such motion has been filed, nor have any of the Veteran's written statements contained specific allegations of error in fact or law in the April 2007 rating decision, as required for a CUE motion. 38 C.F.R. § 3.105 (2017); see Fugo v. Brown, 6 Vet. App. 40, 44 (1993) (stating that if a Veteran "wishes to reasonably raise CUE there must be some degree of specificity as to what the alleged error is"). The proper disposition of a free-standing claim for an earlier effective date claim is dismissal. Rudd, 20 Vet. App. at 300. The Board is authorized to dismiss any appeal that fails to allege an error of fact or law. 38 U.S.C. § 7105 (d)(5); 38 C.F.R. § 20.302. Accordingly, this appeal must be dismissed. 11. Entitlement to an effective date earlier than October 2, 2006 for the grant of service connection for GERD By a rating action in April 2007, the RO granted service connection for GERD, effective October 2, 2006. He was notified of that decision in correspondence issued that same month. He did not appeal the decision. Thus, the decision became final, absent a finding of CUE. In June 2014, the Veteran requested an increased rating for his GERD and filed a NOD to an October 2014 rating decision denying an increase of his rating. That NOD included disagreement with the effective date for the grant of service connection for GERD. In light of the finality of the April 2007 rating decision, and in the absence of a motion to revise the April 2007 rating decision based on CUE, the Veteran cannot obtain an effective date earlier than October 2, 2006. Legally, there cannot be a free-standing claim for an earlier effective date, and once an effective date has become final, a Veteran’s only recourse is to have the final decision revised on the grounds of CUE. Rudd v. Nicholson, 20 Vet. App. 296 (2006). No such motion has been filed, nor have any of the Veteran’s written statements contained specific allegations of error in fact or law in the April 2007 rating decision, as required for a CUE motion. 38 C.F.R. § 3.105 (2017); see Fugo v. Brown, 6 Vet. App. 40, 44 (1993) (stating that if a Veteran “wishes to reasonably raise CUE there must be some degree of specificity as to what the alleged error is”). The proper disposition of a free-standing claim for an earlier effective date claim is dismissal. Rudd, 20 Vet. App. at 300. The Board is authorized to dismiss any appeal that fails to allege an error of fact or law. 38 U.S.C. § 7105 (d)(5); 38 C.F.R. § 20.302. Accordingly, this appeal must be dismissed. 12. Entitlement to an effective date earlier than December 31, 2012 for the grant of service connection for right ear hearing loss and radiculopathy of the left lower extremity The Veteran contends that an earlier effective date is warranted for the grant of service connection for right ear hearing loss and radiculopathy of the left lower extremity. The Board notes that the Veteran's current effective date, December 31, 2012, is the date of the Veteran's original claim for service connection for right ear hearing loss and radiculopathy of the left lower extremity. In general, the effective date of an award based on an original claim, or a claim reopened after final adjudication, of entitlement to disability compensation is 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. In a statement in support of claim (VA Form 21-4138), received December 31, 2012, the Veteran indicated that he was submitting a new claim for service connection for hearing loss, tinnitus, neuropathy of the left foot. The Board has reviewed the evidence and determines that the criteria for an effective date prior to December 31, 2012 for the grant of service connection for hearing loss and neuropathy of the left lower extremity have not been met. See 38 C.F.R. § 3.400. The record shows that the Veteran only filed one claim for entitlement to service connection for hearing loss and left lower extremity radiculopathy, on December 31, 2012. The regulations provide that the appropriate effective date is the later of either the date entitlement arose or the date of claim. 38 C.F.R. § 3.400. Therefore, December 31, 2012 is the date of claim and the appropriate effective date for the award of benefits. In addition, there is no evidence that the Veteran clearly expressed intent to file a claim until the December 2012 filing. Contact with VA and treatment at VA medical centers are not themselves the filing of a claim of entitlement to service connection. A preponderance of the evidence shows that VA did not receive his claim of entitlement to disability compensation benefits until December 31, 2012. As there is no evidence that the Veteran filed a claim for hearing loss and neuropathy of the lower extremities earlier than December 31, 2012, the Board finds that the preponderance of the evidence of record is against a grant of an earlier effective date for the grant of the Veteran's service-connected hearing loss and left lower extremity radiculopathy. Thus, an effective date earlier than the current effective date, December 31, 2012, is not warranted. REASONS FOR REMAND After examining the record, the Board concludes that further assistance to the Veteran is required in order to comply with the duty to assist as mandated by 38 U.S.C. § 5103A (2012). The specific bases for remand are set forth below. 1. Entitlement to service connection for an acquired psychiatric disorder, including major depressive disorder The Veteran maintains that he has developed a psychiatric disorder as a result of chronic pains from his multiple physical disabilities. The Veteran was afforded a VA/DBQ examination for evaluation of mental disorders in October 2014. The examiner stated that the Veteran did not report symptoms of sufficient type or severity to meet the criteria for any mental disorder at this time. The examiner opined that it is at least as likely as not that the Veteran does not meet the criteria for any mental disorder as defined by the DSM-V, as a result of his military experiences. Following a mental examination in April 2016, the Veteran was diagnosed with Adjustment Disorder with mixed anxious and depressed mood. At that time of this examination, the Veteran reported that his current problems revolved around his mother’s health and financial stress. The examiner indicated that there are no findings of any chronic or ongoing significant problems from the Veteran’s military service. He also relates negative mood associated with his stepfather’s death in 2003, thus indicating another intervening non-military stressor, which could explain the current mental health symptoms. The examiner concluded that, for those reasons, it is less likely than not that the Veteran’s symptoms are related to military service. He stated that the current concerns appear to have resulted substantially from non-military life stressors. Submitted in support of the Veteran’s claim is a private medical statement from Dr. Heather Henderson-Galligan, dated in May 2015, wherein she stated that the Veteran suffers from a depressive disorder secondary to medical conditions. The examiner opined that the Veteran’s degenerative disc disease of the lumbar spine and tinnitus are more likely than not aggravating his depressive disorder. The Board finds that remand is required for a medical opinion as to whether any current psychiatric disorder is proximately due to or was aggravated by a service-connected disability. See 38 C.F.R. § 3.310 (2017). Moreover, the Board finds that the medical opinions of record are conflicting as to the theory of direct service connection, as discussed below, and a supplemental medical opinion is needed to reconcile these opinions. 2. Entitlement to a rating in excess of 20 percent for degenerative disc disease (DDD) lumbar spine is remanded. The Veteran maintains that his low back disorder is more disabling than the 20 percent rating currently assigned. The Veteran was afforded VA examinations in connection with his claims in March 2014 and April 2016. On both examinations, the Veteran reported flare-ups of the thoracolumbar spine. However, following the examination in March 2014, the examiner stated that he would have to resort to mere speculation to provide an opinion as to whether pain, weakness, fatigability, or incoordination could significantly limit functional ability during flare-ups. On examination in April 2016, the Veteran stated that he has experienced increased back pain since his last examination. The pain is aggravated by any activity; he takes Tramadol 3 times a day. The Veteran indicated that he has a TENS unit which he uses whenever his back flares, and this seems to help. The Veteran indicated that he has flare-ups with any prolonged or repetitive activities; he states that his flares lasts anywhere from a day to 4 days at a time. During flare-ups, he is unable to do any lifting, he can basically do whatever he needs to but has to slow down. The examiner stated that it is not possible without mere speculation to estimate either loss of ROM or describe loss of function during repeated use and/or flare-ups because there is no conceptual or empirical basis for making such a determination without directly observing function under these circumstances. The Board finds that the examiner’s rationale for his inability to provide a medical opinion on the Veteran’s limitations during a flare-up is not sufficient, as discussed below. The Board notes that the Court recently issued an opinion addressing whether a VA examiner is permitted to decline to offer an estimate as to additional functional loss during flare-ups if the veteran is not undergoing a flare-up at the time of the examination. In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that the Board may accept a VA examiner’s assertion that he or she cannot offer such an opinion without resorting to speculation only after it determines that the examiner’s conclusion is not based on the absence of procurable information or on a particular examiner’s shortcomings or general aversion to offering an opinion on issues not directly observed. It must be clear that such an opinion is not procurable based on a lack of knowledge among the “medical community at large” and not merely on a lack of expertise, insufficient information, or unprocured testing on the part of the specific examiner. Accordingly, an examiner must do all that reasonably should be done to become informed before concluding that a requested opinion cannot be provided without resorting to speculation. To be adequate, an examination although acknowledging that the Veteran was not then suffering from a flare of any conditions, must also ascertain adequate information; i.e. frequency, duration, characteristics, severity, or functional loss-regarding flares by alternative means. Furthermore, the examiner must offer an estimate as to additional functional loss during flares regardless of whether the veteran was undergoing a flare-up at the time. Sharp v. Shulkin, 29 Vet. App. 26 (2017); DeLuca v. Brown, 8 Vet. App. 202 (1995). As such, the March 2014 and April 2016 DBQ examination reports’ rationale that an examiner would need to be present to determine the Veteran’s functional ability objectively during a flare-up, does not meet the standards presented by the recent holding in Sharp. Therefore, Veteran should be afforded a new VA examination for his lumbar spine before a decision can be rendered on his claim. The matter is REMANDED for the following actions: 1. Obtain all updated records of VA or adequately identified private treatment the Veteran has received for any psychiatric disability and/or his DDD of the lumbar spine. 2. Then, arrange for the Veteran to be examined by a psychiatrist or psychologist to determine the nature and cause of the Veteran's claimed psychiatric disability. Based on a review of the record, examination of the Veteran, and any tests or studies deemed necessary, the examiner should provide an opinion responding to the following: a. Please identify, by medical diagnosis, all psychiatric disability entities found. The examiner must reconcile all diagnostic findings with any conflicting evidence in the record, to include the May 2015 private diagnosis of depressive disorder. b. For each psychiatric disability diagnosed, the examiner should opine whether it is at least as likely as not (a 50 percent or better probability) that that such disability is either caused by the Veteran's service-connected DDD of the lumbar spine or tinnitus; or is aggravated by the Veteran's service-connected DDD of the lumbar spine or tinnitus (aggravation means the disability increased in severity beyond its natural progression); The examiner must provide a complete rationale for all opinions provided, to include citation to factual evidence and medical literature or principles as appropriate. 3. Then, the Veteran should be scheduled for appropriate VA examination to ascertain the current severity of his service-connected lumbar spine DDD. The claim must be provided to and reviewed by the examiner prior to the any examination. The examiner must obtain a description from the Veteran as to all manifestations of his low back disability. All indicated tests should be accomplished and all clinical findings reported in detail. Tests of range of motion must be performed to determine the extent of limitation of motion due to pain on active motion and passive motion, and with weight-bearing and without weight-bearing. If the examiner is unable to conduct the required testing or concludes that the required testing is not necessary in this case, he or she must clearly explain why that is so. The extent of any incoordination, weakened movement, and excess fatigability on use must be described. To the extent possible, the functional impairment due to incoordination, weakened movement, and excess fatigability must be assessed in terms of additional degrees of limitation of motion. If this is not feasible, the examiner must so state and explain why. The examiner must express an opinion concerning whether there would be additional limits on functional ability on repeated use or during flare-ups, and, if feasible, express this in terms of additional degrees of limitation of motion on repeated use or during flare-ups. The examiner must provide findings as to whether the Veteran's degenerative disc disease of the lumbosacral spine has resulted in any physician prescribed bed rest, and if so, the number of days of such physician prescribed bed rest and must include an explanation as to how the examiner arrived at such findings. The examiner must provide a description of the functional limitations resulting from his low back disability. The examiner must provide a rationale for any opinion rendered. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation stating why this is so. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. (Continued on the next page)   4. The AOJ should ensure that all requested actions have been accomplished in compliance with this remand. If any action is not undertaken, or is taken in a deficient manner, appropriate corrective action should be undertaken. See Stegall v. West, 11 Vet. App. 268 (1998). 5. After the requested development has been completed, re-adjudicate the claim that is the subject of this Remand. If any determination remains unfavorable to the Veteran, both he and his attorney should be furnished a supplemental statement of the case (SSOC) and provided an appropriate opportunity to respond thereto before the case is returned to the Board, if otherwise in order. JAMES G. REINHART Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Department of Veterans Affairs