Citation Nr: 18152519 Decision Date: 11/23/18 Archive Date: 11/23/18 DOCKET NO. 15-42 437 DATE: November 23, 2018 ORDER Entitlement to an initial compensable rating for a tooth disorder is denied. Entitlement to an effective date prior to November 14, 2013, for service connection of a tooth disorder is denied. Entitlement to an effective date prior to November 14, 2013, for service connection of a left knee disorder is denied. Entitlement to an effective date prior to November 14, 2013, for a thoracolumbar spine disorder is denied. Entitlement to service connection for an acquired psychiatric disorder other than posttraumatic stress disorder (PTSD) is granted. Entitlement to service connection for headaches is granted. Entitlement to service connection for tinnitus is granted. Entitlement to service connection for bronchitis is denied. Entitlement to service connection for sinus infections is denied. Entitlement to service connection for residuals of adenovirus is denied. Entitlement to service connection for residuals of H1N1 virus is denied. Entitlement to service connection for anal fissures is denied. Entitlement to service connection for seizures, to include as secondary to a spine disorder, is denied. Entitlement to service connection for residuals of anti-malaria pills is denied. REMANDED Entitlement to an initial compensable rating for a left knee disorder is remanded. Entitlement to an initial rating in excess of 10 percent for a thoracolumbar spine disorder is remanded. Entitlement to service connection for bilateral sensorineural hearing loss is remanded. Entitlement to service connection for a cervical spine disorder, to include muscle spasms, is remanded. Entitlement to service connection for a left shoulder disorder, to include as secondary to a cervical spine disorder, is remanded. Entitlement to service connection for residuals of head trauma is remanded. Entitlement to service connection for a hip disorder is remanded. Entitlement to service connection for PTSD is remanded. FINDINGS OF FACT 1. The Veteran’s tooth has been restored by a suitable prothesis. 2. The Veteran filed an original claim for entitlement to service connection for a tooth disorder and left knee disorder on November 14, 2013. He filed an original claim for a thoracolumbar spine disorder on January 31, 2014 which has been construed as being filed on November 14, 2013. 3. Resolving reasonable doubt in the Veteran’s favor, his headaches are at least as likely as not etiologically related to service. 4. Resolving reasonable doubt in the Veteran’s favor, his diagnosed major depressive disorder is at least as likely as not etiologically related to service. 5. The Veteran’s tinnitus is at least as likely as not related to acoustic trauma in service. 6. The record does not contain any competent evidence of bronchitis currently or during the pendency of this appeal. 7. The record does not contain any competent evidence of chronic sinus infections currently or during the pendency of this appeal. 8. The record does not contain any competent evidence of residuals to exposure to adenovirus and/or H1N1. 9. The record does not contain any lay or medical evidence of anal fissures currently or during the pendency of this appeal. 10. The record does not contain any competent evidence of symptomatic seizures associated with service or service-connected disability. 11. The record does not contain any competent evidence of residuals of anti-malaria pills. CONCLUSIONS OF LAW 1. The criteria for entitlement to an initial compensable rating for a tooth disorder have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1-4.7, 4.10, 4.150, Diagnostic Code (DC) 9913 (2018). 2. The criteria for an effective date prior to November 14, 2013, for a grant of service connection for a tooth disorder have not been met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. §§ 3.102, 3.400. 3. The criteria for an effective date prior to November 14, 2013, for a grant of service connection for a left knee disorder have not been met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. §§ 3.102, 3.400. 4. The criteria for an effective date prior to November 14, 2013, for a grant of service connection for a thoracolumbar spine disorder have not been met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. §§ 3.102, 3.400. 5. The criteria for entitlement to service connection for an acquired psychiatric disorder other than PTSD have been met. 38 U.S.C. §§ 1110, 1111, 5107(b); 38 C.F.R. §§ 3.102, 3.303. 6. The criteria for entitlement to service connection for headaches have been met. 38 U.S.C. §§ 1110, 1111, 5107(b); 38 C.F.R. §§ 3.102, 3.303. 7. With resolution of reasonable doubt in the Veteran’s favor, the criteria for entitlement to service connection for tinnitus have been met. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 8. The criteria for entitlement to service connection for bronchitis have not been met. 38 U.S.C. §§ 1110, 1111, 5107(b); 38 C.F.R. §§ 3.102, 3.303. 9. The criteria for entitlement to service connection for chronic sinus infections have not been met. 38 U.S.C. §§ 1110, 1111, 5107(b); 38 C.F.R. §§ 3.102, 3.303. 10. The criteria for entitlement to service connection for residuals of adenovirus have not been met. 38 U.S.C. §§ 1110, 1111, 5107(b); 38 C.F.R. §§ 3.102, 3.303. 11. The criteria for entitlement to service connection for residuals of H1N1 virus have not been met. 38 U.S.C. §§ 1110, 1111, 5107(b); 38 C.F.R. §§ 3.102, 3.303. 12. The criteria for entitlement to service connection for anal fissures have not been met. 38 U.S.C. §§ 1110, 1111, 5107(b); 38 C.F.R. §§ 3.102, 3.303. 13. The criteria for entitlement to service connection for seizures, to include as secondary to a spine disorder, have not been met. 38 U.S.C. §§ 1110, 1111, 5107(b); 38 C.F.R. §§ 3.102, 3.303. 14. The criteria for entitlement to service connection for residuals of anti-malaria pills have not been met. 38 U.S.C. §§ 1110, 1111, 5107(b); 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from May 2007 to November 2009. The Veteran’s November 2013 claim included a claim of entitlement to service connection for insomnia. The AOJ does not appear to have adjudicated this claim. Therefore, the Board does not have jurisdiction over this matter, and it is referred to the AOJ for appropriate action. Increased Rating Disability evaluations are determined by evaluating the extent to which a Veteran’s service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing his symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Schedule). 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Separate diagnostic codes identify various disabilities and the criteria for specific ratings. Relevant regulations do not require that all cases show all findings specified by the Schedule; however, findings sufficient to identify the disease and the resulting disability and, above all, coordination of the rating with impairment of function will be expected in all cases. 38 C.F.R. §§ 4.7, 4.21. If two disability evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining will be resolved in favor of the veteran. 38 C.F.R. § 4.3. In establishing an appropriate initial assignment of a disability rating, the proper scope of evidence includes all medical evidence submitted in support of the veteran’s claim. Fenderson v. West, 12 Vet. App. 119 (1999). In cases where an assigned disability rating has been challenged or appealed, it is possible for a veteran to receive a staged rating. A staged rating is an award of separate percentage evaluations for separate periods, based on the facts found during the appeal period. Id. at 126-28; see also Hart v. Mansfield, 21 Vet. App. 505 (2007) (in determining the present level of a disability for any increased evaluation claim, the Board must consider staged ratings). If two disability evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining will be resolved in favor of the veteran. 38 C.F.R. § 4.3. 1. Entitlement to an initial compensable rating for a tooth disorder The Veteran’s service-connected traumatic loss of tooth number nine is rated under 38 C.F.R. § 4.150, DC 9999-9913. Under DC 9913, a noncompensable rating is warranted where the loss of masticatory surface can be restored by suitable prothesis. A ten percent rating is warranted where the lost masticatory surface cannot be restored by suitable prothesis for all upper and lower teeth on one side missing; or all lower anterior teeth missing; or all upper anterior teeth missing. In this case, the Veteran lost tooth number nine due to trauma. See July 2014 VA Examination. No other teeth are missing. Additionally, tooth number nine has been prosthodontically replaced with an implant and a crown. As there was sufficient bone to place the implant, the July 2014 VA examiner determined that there was no appreciable loss of bone. Under these circumstances, an initial compensable rating for traumatic loss of tooth number nine is not warranted. The Board notes that the Veteran has not argued the manifestation of loss of bone. Effective Date 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 increased, 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 the application therefor. 38 U.S.C. § 5110(a). The effective date of an award of disability compensation to a veteran is the day following the date of discharge or release if the application therefor is received within one year from such date of discharge or release. 38 U.S.C. § 5110(b)(1). A claim is defined as 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). The Board notes that, effective March 24, 2015, VA amended its regulations to require that all claims governed by VA’s adjudication regulations be filed on a standard form. See 79 Fed. Reg. 57,660 (Sept. 25, 2014), codified as amended at 38 C.F.R. §§ 3.151, 3.155, 3.157. The amended regulations, however, apply only to claims filed on or after March 24, 2015. Because the Veteran’s claim was received by VA prior to that date, the former regulations apply. 2. Entitlement to an effective date prior to November 14, 2013, for service connection of a tooth disorder 3. Entitlement to an effective date prior to November 14, 2013, for service connection of a left knee disorder 4. Entitlement to an effective date prior to November 14, 2013, for service connection of a thoracolumbar spine disorder The Veteran seeks earlier effective dates for the awards of service connection for a tooth disorder, a left knee disorder and a thoracolumbar spine disorder. No specific argument has been raised to support these claims. Section 5110(a), title 38, United States Code, provides that “[u]nless specifically provided otherwise in this chapter, the effective date of an award based on an original claim... of compensation... shall be fixed in accordance with the facts found, but shall not be earlier than the date of receipt of application therefor.” The implementing regulation similarly states that the effective date “will be the date of receipt of the claim or the date entitlement arose, whichever is the later.” 38 C.F.R. § 3.400(b)(2)(i). When an application for disability compensation is received within one year of the date of the veteran’s discharge or release from service, the effective date of such award shall be the day following the veteran’s release. 38 U.S.C. § 5110(b)(1). “Claim” is 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, 34-35 (1998); Servello v. Derwinski, 3 Vet. App. 196, 199 (1992). The Board notes that, effective March 24, 2015, VA amended its adjudication regulations to require that all claims governed by VA’s adjudication regulations be filed on standard forms prescribed by the Secretary (i.e., VA Form 21-526). 38 U.S.C. § 5101 (a); 38 C.F.R. § 3.151(a). This rulemaking also eliminated the constructive receipt of VA reports of hospitalization or examination and other medical records as informal claims for increase and revised 38 C.F.R. § 3.400(o)(2). These amendments, however, are only applicable with respect to claims and appeals filed on or after March 24, 2015, and are not applicable in the present case. See 79 Fed. Reg. 57,660, 57,686 (Sept. 25, 2014). As such, any communication or action in this case, indicating an intent to apply for one or more benefits under laws administered by the VA from a claimant may be considered an informal claim. Such an informal claim must identify the benefits sought. Upon receipt of an informal claim, if a formal claim has not been filed, an application form will be forwarded to the claimant for execution. Upon receipt of an informal claim, if a formal claim has not been filed, an application form must be forwarded to the claimant for execution. If the application form is received within one year from the date it was sent to the claimant, it will be considered filed as of the date of receipt of the informal claim. 38 C.F.R. § 3.155(a). 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). Historically, the record reflects that a claim folder was established in January 2010 with the receipt of service treatment records (STRs) and a VA Form 21-22 (Appointment of Veterans Service Organization as Claimant’s Representative). However, neither the Veteran nor the Veteran’s representative raised any specific service connection claim. On November 14, 2013, the Veteran filed an original claim for entitlement to service connection for several issues, including a tooth disorder, left knee disorder, and a thoracolumbar disorder. See also January 2014 Claims. The AOJ granted entitlement to service connection for a tooth disorder in a June 2014 rating decision, and granted entitlement to service connection for a left knee disorder and thoracolumbar spine disorder in a November 2015 rating decision. All of those are effective November 14, 2013, the day the Veteran filed the original claims at issue in this appeal. The Veteran was discharged from service in November 2009. As these claims were not filed within one year of discharge from service, November 14, 2013, is the earliest effective date allowed by law. 38 U.S.C. § 5110. However, the mere existence of medical records reflecting treatment for a particular disability generally cannot be construed as an informal claim; rather, there must be some intent by the claimant to apply for a benefit. See Criswell v. Nicholson, 20 Vet. App. 501, 504 (2006). Furthermore, the Court has held that, in the absence of a sufficient manifestation of an intent to apply for benefits for a particular disease or injury, a document providing medical information which refers to a disability in and of itself is not an informal claim for VA benefit. Ellington v. Nicholson, 22 Vet. App. 141, 145-46 (2007). In addition, the Court has held that a Veteran’s attempt to obtain treatment does not comprise a claim. Dunson v. Brown, 4 Vet App. 327, 330 (1993). The Board has considered whether 38 C.F.R. §3.157(b), in effect prior to April 2014, is applicable. This provision stated that once a formal claim for pension or compensation has been allowed or a formal claim for compensation disallowed for the reason that the service-connected disability is not compensable in degree, receipt of (1) a report of examination or hospitalization by VA or uniformed services, (2) evidence from a private physician or layman, or (3) reports and records from State and other institutions will be accepted as an informal claim for increased benefits or an informal claim to reopen. However, the Court has held that this regulation only applies to a particular group of claims. See Pacheco v. Gibson, 27 Vet. App. 21 (2014) (en banc) (construing ambiguity contained in §3.157 as applying to a previous disallowance for a service-connected disability not being compensable in degree); see Sears v. Principi, 16 Vet. App. 244, 249 (2002) (finding that §3.157 applies to a defined group of claims, i.e., as to disability compensation, those claims for which a report of a medical examination or hospitalization is accepted as an informal claim for an increase of a service-connected rating where service connection has already been established). Specifically, VA medical records are not accepted as informal claims for disabilities where service connection has not been established, since the mere presence of medical evidence does not establish intent on the part of the Veteran to seek service connection for a condition. See Brannon v. West, 12 Vet. App. 32, 35 (1998); see also Lalonde v. West, 12 Vet. App. 377, 382 (1999). Thus, any reference to symptoms of an acquired psychiatric condition in the VA clinic setting cannot constitute a formal or informal claim under 38 C.F.R. §3.157(b). Pacheco, 27 Vet. App. 21 (2014); Sears, 16 Vet. App. at 249. Thus, based on the evidence presented, the Board finds that the Veteran filed his original service connection claims on November 14, 2013. Service Connection Service connection will be granted if the Veteran has a disability resulting from personal injury or disease incurred in the line of duty, or for aggravation of a preexisting injury or disease incurred in the line of duty during active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. To establish service connection, the evidence must show (1) a present disability, (2) an 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. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). A valid service connection claim requires competent evidence of a current disability. Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). However, the presence of a disability at any time during the claim process – or relatively close thereto – can justify a grant of service connection, even where such disability has become asymptomatic. McClain v. Nicholson, 21 Vet. App. 319 (2007); Romanowsky v. Shinseki, 26 Vet. App. 289 (2013). Service connection for certain chronic disorders may be presumed where demonstrated to a compensable degree within 1 year following separation from qualifying service. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. In Fountain v. McDonald, 27 Vet. App. 258 (2015), the Court determined that tinnitus is an “organic disease of the nervous system” subject to presumptive service connection where there is evidence of acoustic trauma and nerve damage. For an enumerated “chronic disease” shown in service (or within a presumptive period under § 3.307), subsequent manifestations of the same chronic disease at any later date, however remote, are service-connected, unless clearly attributable to intercurrent causes. See Groves v. Peake, 524 F.3d 1306, 1309 (2008). Tinnitus, one of the issues in this case, is a medical term referring to symptoms of noise in the ears, such as ringing, buzzing, roaring or clicking. DORLAND’S ILLUSTRATED MEDICAL DICTIONARY 1714 (28th ed. 1994). In adopting the current rating criteria for tinnitus under Diagnostic Code 6260, VA described tinnitus as follows: Tinnitus is classified either as subjective tinnitus (over 95% of cases) or objective tinnitus. In subjective or “true” tinnitus, the sound is audible only to the patient. In the much rarer objective tinnitus (sometimes called extrinsic tinnitus or “pseudo-tinnitus”), the sound is audible to other people, either simply by listening or with a stethoscope. 67 Fed. Reg. 59033 -01 (Sept. 19, 2002). Thus, tinnitus is a rare type of disability that, in the vast majority of cases, may be established on the basis of lay evidence alone. See Charles v. Principi, 16 Vet. App. 370 (2002). Whenever there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the Veteran. 38 U.S.C. § 5107(b). 5. Entitlement to service connection for an acquired psychiatric disorder November 2009 service treatment records reflect that indicates the Veteran was treated for depressive disorder during service. In the November 2009 separation report of medical history, the Veteran indicated problems with depression and other psychiatric symptoms. Additionally, the doctor examining the Veteran noted a history of depression and suicidal ideation. January 2010 VA treatment records reflect that the Veteran was diagnosed with major depressive disorder, single episode, with mood-incongruent psychotic features. During the course of the appeal, the Veteran received VA treatment for major psychiatric disorders, including PTSD. See, e.g., June 2014 VA Treatment Records. During a January 2015 VA examination, the examiner determined that the Veteran did not have PTSD under DSM-5. Instead, the examiner diagnosed the Veteran with personality disorder and major depressive disorder. The examiner determined that the “vast majority” of the Veteran’s symptoms were related to his personality disorder. Confusingly, the examiner indicated that a claimed condition was at least as likely as not related to service, but then opined that the personality disorder predated service, and the mood disorder was a result of the personality disorder. The Veteran’s representative submitted a January 2017 private psychiatric disability benefits questionnaire. Upon examination, the private examiner diagnosed the Veteran with major depressive disorder, recurrent, with psychotic and anxious distress features. Additionally, the examiner indicated that the Veteran’s major depressive disorder was aggravated by service-connected thoracolumbar, tooth, and left knee disorders. The private examiner included a thorough evaluation, and determined the acquired psychiatric disorder more likely than not began in service. The examiner evaluated the Veteran’s symptoms, medical research, and relevant treatment records in providing the opinion. The claims file contains lay statements that indicate the Veteran exhibited symptoms such as a loss of mental acuity, depression, anger, nightmares, and suicidal ideation after returning home from service. See December 2016 and November 2014 Lay Statements. The Veteran’s mother and aunt are competent to report observing these symptoms. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). The most probative evidence of record is the thorough January 2017 private psychiatric assessment that determined major depressive disorder was etiologically related to service and aggravated by service-connected disorders. Additionally, the lay statements of record are credible and probative, and indicate that the Veteran’s acquired psychiatric disorder symptoms developed during or after service. Resolving reasonable doubt in the Veteran’s favor, the Board finds that service connection for an acquired psychiatric disorder, to include major depressive disorder, is warranted. 6. Entitlement to service connection for headaches Medical evidence reflects that the Veteran sought treatment for headaches and sinus problems or headaches and abdominal problems concurrently on some occasions. See, e.g., October 2009, September 2009, and August 2007 Service Treatment Records. He was diagnosed with viral syndrome on both of those occasions. Additionally, he was treated for headaches and other symptoms in May 2009, and was diagnosed with pharyngitis. See also March 2009 Service Treatment Records. In the November 2009 separation report of medical history, the Veteran indicated problems with frequent and severe headaches, and paralysis. During an April 2014 VA assessment, the Veteran reported experiencing headaches and migraines. During a January 2015 VA examination, the Veteran was diagnosed with migraines, and the examiner noted untreated allergic rhinitis as an additional pertinent diagnosis. The examiner determined headaches were less likely than not related to service, noting no evidence of an objective condition, and noting subjective symptoms only. The Veteran’s representative submitted a March 2017 letter from a private physician regarding the Veteran’s headaches. After reviewing the claims file and interviewing the Veteran, the private physician determined that the medical evidence of record reflects that the Veteran’s headaches began during boot camp in 2007, and have increased in severity since that time. The claims file also contains a December 2016 lay statement from the Veteran’s mother indicating that the Veteran did not have headaches prior to service; reported having headaches to has mother during service; and exhibited symptoms of headaches upon returning from service. The Veteran’s mother is competent to report observing these symptoms. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). The Board finds the Veteran’s mother’s statement to be credible and probative of the issue. The Board notes the conflicting medical opinions in January 2015 and March 2017. The Board also notes the credible lay statement regarding the onset of the Veteran’s headache symptoms. Resolving reasonable doubt in the Veteran’s favor, the Board finds that it is at least as likely as not that the Veteran’s headaches are etiologically related to active duty service. Service connection is warranted. 7. Entitlement to service connection for tinnitus The Veteran served as a gunner’s mate, which has a high probability of noise exposure. See DD 214. During service, the Veteran’s May 2007 entrance examination and November 2009 separation examination both contained audiograms that reflected normal hearing per the standards of 38 C.F.R. § 3.385. See also May 2008 Service Treatment Records Audiogram. May 2014 VA treatment records reflect that the Veteran reported that he had good hearing, but also experienced ringing in his ears because of in-service noise exposure. The Veteran is competent to report experiencing the symptom of ringing in the ears. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). This testimony is consistent with the circumstances of his service, as he served as a gunner’s mate with a high probability of noise exposure. Resolving reasonable doubt in the Veteran’s favor, the Board finds that it is at least as likely as not that tinnitus began during service. As tinnitus is a “chronic” disease under 38 C.F.R. § 3.309(a), the subsequent manifestation of tinnitus warrants a grant of service connection per 38 C.F.R. § 3.309(a). 8. Entitlement to service connection for bronchitis 9. Entitlement to service connection for sinus infections 10. Entitlement to service connection for residuals of adenovirus 11. Entitlement to service connection for residuals of H1N1 virus June 2007 treatment records reflect treatment for strep pharyngitis/fever/bronchitis/bilateral otitis. On his September 2007 entrance report of medical history, the Veteran indicated that he had bronchitis during boot camp, but that it was no longer an issue. October 2009 and September 2009 service treatment records reflect that the Veteran sought treatment for sinus problems and was diagnosed with viral syndrome on both of those occasions. He was also treated for pharyngitis in May 2009. See also March 2009 Service Treatment Records. In the November 2009 separation report of medical history, the Veteran indicated problems with bronchitis and sinusitis, that he had contracted adenovirus during boot camp, and that he had contracted swine flu. In a November 2013 statement, the Veteran indicated that he had been experimented on during boot camp with a type of bacteria that caused virus symptoms, and as a result now has chronic bronchitis and adenovirus. In March 2014, the Veteran underwent a VA pulmonary examination. The VA pulmonologist found no residual impairment from the Veteran’s reported exposure to adenovirus during service. During a January 2015 VA examination, the Veteran was diagnosed with allergic rhinitis. The examiner reviewed the claims file, and the examiner noted exposure to adenovirus during boot camp and in-service treatment for ear, nose, and throat problems. While the examiner noted rhinitis and sinus problems, the examiner determined that the Veteran did not have chronic sinusitis. January 2015 imaging ruled out sinusitis and deviated septum. The examiner determined that the Veteran has moderate-to-severe allergies. Additionally, the January 2015 VA examination for respiratory conditions found that the Veteran’s respiratory system was “normal.” During the examination, the Veteran indicated no respiratory complaints other than rhinitis, and denied any current bronchitis symptoms. After reviewing the claims file and examining the Veteran, the examiner determined respiratory and pulmonary conditions during service were acute only, and any current conditions were less likely than not related to service. The March 2014 VA pulmonary examination and January 2015 VA examination contain the most probative evidence of record regarding the Veteran’s claim of entitlement to service connection for bronchitis, sinus infection, adenovirus, and H1N1 residuals. These examiners determined that the Veteran has no residuals from in-service exposure to adenovirus, and that in-service bronchitis and sinus infections were acute and resolved. Currently, the Veteran has allergic rhinitis that is not related to service. Additionally, there is no competent evidence that the Veteran has residuals from any H1N1 virus exposure. The Veteran is competent to report symptoms, and to relate behind told by a physician that he had been exposed to adenovirus. However, the Veteran is not competent to self-diagnose himself with chronic residuals from any in service viral exposures or treatment for conditions such as pharyngitis, fever, bronchitis, etc. The Board places greater probative weight to the opinion of a VA pulmonologist who evaluated the Veteran for possible residual impairment from adenovirus exposure during service and found none. The Board also places greater probative weight to the opinion of the January 2015 examiner who listened to the Veteran’s description of symptoms in conjunction with physical examination and review of the claims folder, who found that the Veteran CT scans did not shown a chronic sinus disorder and that the Veteran manifested rhinitis which had not been shown to have been incurred in service. For a disability to be service connected, it must be present at the time a claim for VA disability compensation is filed or during or contemporary to the pendency of the claim. McClain v. Nicholson, 21 Vet. App. 319 (2007); Romanowsky v. Shinseki, 26 Vet. App. 289 (2013). Here, the competent evidence establishes that the Veteran has not manifested any current bronchitis, sinus infection, or residuals of adenovirus or H1N1 virus during the appeal period. Congress has specifically limited entitlement to service-connected benefits to cases where there is a current disability. In the absence of proof of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223 (1992). 12. Entitlement to service connection for anal fissures October 2008 and November 2008 service treatment records reflect that the Veteran was treated for anal fissures, and that they resolved. In the November 2009 separation report of medical history, the Veteran indicated problems with rectal bleeding, but indicated no current bleeding. The doctor examining the Veteran at separation also noted a history of anal fissure, with no recent rectal bleeding. There is no other evidence of anal fissures or rectal bleeding in the claims file. Specifically, the Veteran has not alleged a recurrence of anal fissures during the appeal period, and the treatment records do not reflect any anal fissure abnormality during the appeal period. For a disability to be service connected, it must be present at the time a claim for VA disability compensation is filed or during or contemporary to the pendency of the claim. McClain v. Nicholson, 21 Vet. App. 319 (2007); Romanowsky v. Shinseki, 26 Vet. App. 289 (2013). Here, there is no evidence of record showing that the Veteran has any current anal fissures. Congress has specifically limited entitlement to service-connected benefits to cases where there is a current disability. In the absence of proof of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223 (1992). 13. Entitlement to service connection for seizures, to include as secondary to a spine disorder, 14. Entitlement to service connection for residuals of anti-malaria pills In the November 2009 separation report of medical history, the Veteran specifically indicated no seizures, convulsions, epilepsy, or fits during service; and did not indicate any problems with residuals from taking anti-malaria pills. For a disability to be service connected, it must be present at the time a claim for VA disability compensation is filed or during or contemporary to the pendency of the claim. McClain v. Nicholson, 21 Vet. App. 319 (2007); Romanowsky v. Shinseki, 26 Vet. App. 289 (2013). Here, there is no competent evidence of record showing that the Veteran has any current disability of seizures has been persistent since service. There is only a generalized allegation of seizures related to his back disorder, but no evidence other than speculation linking the seizures to a back disability. Similarly, there is no competent evidence of any chronic residuals from taking anti-malarial pills. As such, the criteria for obtaining medical examination or opinion have not been met. Waters v. Shinseki, 601 F.3d 1274 (Fed. Cir. 2010) (holding that a conclusory generalized statement that a service illness caused his present medical problems was insufficient to trigger duty to provide medical examination as this theory would eliminate the carefully drafted statutory standards governing the provision of medical examinations and require the Secretary to provide such examinations as a matter of course in virtually every veteran’s disability case). Congress has specifically limited entitlement to service-connected benefits to cases where there is a current disability. In the absence of proof of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223 (1992). The Board is aware that the Veteran service in the Persian Gulf and, thus, may establish entitlement to service connection for undiagnosed disability. However, such disorder must be manifest to a compensable degree and no symptomatic manifestations are shown for either claimed disorder during the appeal period. 38 C.F.R. § 3.317(a)(i). REASONS FOR REMAND 1. Entitlement to an initial compensable rating for a left knee disorder is remanded. While the record contains a contemporaneous VA examination regarding the Veteran’s left knee disorder, the examination deso not comply with the requirements in Correia v. McDonald, 28 Vet. App. 158, 168 (2016). The examinations do not contain passive range of motion measurements or pain on weight-bearing testing. 2. Entitlement to an initial rating in excess of 10 percent for a thoracolumbar spine disorder is remanded. While the record contains a contemporaneous VA examination regarding the Veteran’s thoracolumbar spine disorder, the examination does not comply with the requirements in Sharp v. Shulkin, 29 Vet. App. 26, 34-36 (2017). The examiner did not attempt to elicit relevant information regarding the description of the Veteran’s flare-ups and any additional functional loss suffered during flare-ups. 3. Entitlement to service connection for bilateral hearing loss is remanded 4. Entitlement to service connection for a cervical spine disorder, to include muscle spasms, is remanded. 5. Entitlement to service connection for a left shoulder disorder, to include as secondary to a cervical spine disorder, is remanded. 6. Entitlement to service connection for residuals of head trauma is remanded. 7. Entitlement to service connection for a hip disorder is remanded. VA is obligated to provide a medical examination when the record contains competent evidence that a claimant has a current disability or symptoms of a current disability, the record indicates that a current disability or symptoms of a current disability may be associated with active service, and the record does not contain sufficient information to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79, 81-83 (2006). See also 38 C.F.R. § 3.159(c)(4). The Veteran has claimed decreased hearing acuity related to service. His military audiograms do not reflect hearing loss per VA standards. In this respect, for the purposes of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz, is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz, are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. Nonetheless, his report of decreased hearing acuity since service reflect report of peristent symptoms of disability since service, which entitles him to VA examination to determine whether he manifests a current hearing loss disability related to service. In the November 2009 separation report of medical history, the Veteran indicated problems with back pain, numbness, impaired use, deformities, broken bones, and other related issues. Notably, January 2009 and February 2009 service treatment records indicate that the Veteran sought treatment for upper back pain and was diagnosed with cervicalgia and cervical muscle spasms. Further, during an April 2014 VA assessment, the Veteran reported experiencing neck pain and muscle spasms. The Veteran also has been diagnosed with left shoulder impingement, possibly related to a cervical spine disorder. See, e.g., May 2014 VA Treatment Records. VA treatment records reflect that the Veteran has a possible fracture of the left hip. See, e.g., May 2010 VA Treatment Records. Finally, the Veteran has reported varying instances of head trauma that he claims he suffered during service. Service treatment records contain a November 2009 psychiatric assessment in which the Veteran reported hit in the side of his head with a steel door during a personal assault. The Board concedes that some head trauma may have occurred during service. On remand, the AOJ must obtain a VA examination of the cervical spine, left shoulder, left hip, and an examination for residuals of head trauma. 8. Entitlement to service connection for PTSD is remanded. The Veteran’s November 2009 claim raised the issue of entitlement to service connection for PTSD, and VA treatment records contain evidence that the Veteran has been diagnosed with PTSD. See, e.g., April 2014 VA Treatment Records. In January 2015, a VA examiner determined that the Veteran did not have a diagnosis of PTSD under DSM-5. An addendum opinion is needed to address these conflicting diagnoses. The matters are REMANDED for the following action: 1. Obtain VA treatment records since June 2014 and associate them with the claims file. 2. Afford the Veteran VA audiology examination to determine whether he manifests right and/or left ear hearing loss and, if so, whether it is at least as likely as not that such hearing loss had its onset in service or is causally related to noise exposure in service. 3. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected left knee and thoracolumbar spine disorders. 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. The examiner must test the Veteran’s active motion, passive motion, and pain with weight-bearing and without weight-bearing. The examiner must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. To the extent possible, the examiner should identify any symptoms and functional impairments due to left knee and thoracolumbar spine disorders alone and discuss the effect of the Veteran’s left knee and thoracolumbar spine disorders on any occupational functioning and activities of daily living. If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, or functional impairment without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). 4. Schedule the Veteran for a VA examination with an appropriate examiner to determine the nature and etiology of any diagnosed cervical spine disorder; left shoulder disorder; and left hip disorder. The examiner should answer the following questions: (a) Is it at least as likely as not (i.e., probability of 50 percent or greater) that any diagnosed cervical spine disorder had its onset in service or is otherwise related to service? In providing this opinion, the examiner must address January 2009 and February 2009 service treatment records indicating diagnoses of cervicalgia and cervical muscle spasms, and the Veteran’s April 2014 VA report of experiencing neck pain and muscle spasms. (b) Is it at least as likely as not (i.e., probability of 50 percent or greater) that any diagnosed left shoulder disorder had its onset in service or is otherwise related to service; or is caused or aggravated by a cervical spine disorder? In providing this opinion, the examiner must address VA treatment records reflecting a possible diagnosis of left shoulder impingement related to a cervical spine disorder. See, e.g., May 2014 VA Treatment Records. The examiner is informed that aggravation is defined for legal purposes as a chronic worsening of the underlying condition versus a temporary flare-up of symptoms, beyond its natural progression. If aggravation is present, the clinician should indicate, to the extent possible, the approximate level of left shoulder disorder (i.e., a baseline) before onset of the aggravation, (c) Is it at least as likely as not (i.e., probability of 50 percent or greater) that any diagnosed hip disorder had its onset in service or is otherwise related to service? In providing this opinion, the examiner must address VA treatment records reflecting a possible left hip fracture. See, e.g., May 2010 VA Treatment Records. A complete rationale must be provided for any opinion offered. 5. Schedule the Veteran for a VA examination with an appropriate examiner to determine the nature and etiology of any residuals from head trauma. The examiner should answer the following question: Is it at least as likely as not (i.e., probability of 50 percent or greater) that the Veteran currently has, or has had during the pendency of this appeal, residuals from an in-service head trauma? In providing this opinion, the examiner should obtain imaging as necessary, and is advised that the Board accepts as true that the Veteran did experience in-service head trauma. See November 2009 Service Treatment Records. A complete rationale must be provided for any opinion offered. 6. Obtain a VA medical opinion from an appropriate examiner concerning the nature and etiology of any diagnosed PTSD. The opinion should address the following questions: (a) Does the Veteran currently have a diagnosis of PTSD, or has the Veteran had a diagnosis of PTSD during the pendency of this appeal? In answering this question, the examiner should address the January 2015 VA examination concluding that the Veteran did not have PTSD, and the VA treatment records reflecting a diagnosis of PTSD. See, e.g., April 2014 VA Treatment Records. (b) If the Veteran does have a diagnosis of PTSD, is that diagnosis etiologically related to active duty service? In answering this question, the examiner should address the Veteran’s May 2014 statement regarding his claimed in-service PTSD stressor. A complete rationale must be provided for these opinions. If an examination is needed to provide a complete opinion, one should be scheduled. If the examiner opines that any question cannot be answered without resorting to speculation, then a detailed medical explanation as to why causation is unknowable must be provided. 7. After completing the actions detailed above, readjudicate the claims remaining on appeal. If any benefit is not granted to Veteran’s satisfaction, a supplemental statement of the case must be provided to the Veteran and his representative. After the Veteran and his representative have had an adequate opportunity to respond, the appeal must be returned to the Board for appellate review. T. MAINELLI Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. Howell, Associate Counsel