Citation Nr: 18154255 Decision Date: 11/29/18 Archive Date: 11/29/18 DOCKET NO. 16-13 806 DATE: November 29, 2018 ORDER Service connection for an unspecified depressive disorder, is granted. Service connection for sleep apnea, secondary to service-connected depressive disorder, is granted. A rating greater than 30 percent for chronic obstructive pulmonary disease (COPD) status post bilateral pneumothorax is denied. An initial compensable rating for bilateral hearing loss is denied. An effective date earlier than April 12, 2013 for the award of service connection for bilateral hearing loss is denied. REMANDED The claim for service connection for diverticulitis with irritable bowel syndrome (IBS) and gastroesophageal reflux disease (GERD) is remanded. The claim for service connection for hypertension is remanded. The claim for service connection for chronic kidney disease is remanded. The claim for service connection for a skin disorder is remanded. The claim for service connection for diabetes mellitus, type II, is remanded. The claim for service connection for thyroid cancer is remanded. The claim for service connection for left lower extremity disorder is remanded. The claim for service connection for a right lower extremity disorder is remanded. The claim for entitlement to a total disability rating due to individual unemployability (TDIU) is remanded. The claim for aid and attendance is remanded. The claim for a permanent and total disability rating is remanded. FINDINGS OF FACT 1. The Veteran’s currently diagnosed unspecified depressive disorder, including all psychiatric symptoms, is related to his active service. 2. The Veteran’s currently diagnosed sleep apnea is caused or aggravated by his service-connected unspecified depressive disorder. 3. For the entire period on appeal, the Veteran’s service-connected COPD status post bilateral pneumothorax was not manifested by post-bronchodilator FEV-1 or FEV-1/FVC readings of 55 percent or less of predicted value; or DLCO (SB) less than 55 percent predicted, or; maximum exercise capacity less than 15 ml/kg/min oxygen consumption (with cardiac or respiratory limitation); or pulmonary involvement requiring systemic high dose (therapeutic) corticosteroids for control. 4. On examination in November 2013, the Veteran’s bilateral hearing loss disability was manifested by Level I in each ear. Remaining evidence of record does not show manifestations of hearing loss worse than that noted during the November 2013 VA examination. 5. The earliest effective date for the establishment of service connection for bilateral hearing loss, is April 12, 2013, the date of receipt of the Veteran’s original claim. CONCLUSIONS OF LAW 1. The criteria to establish service connection for an acquired psychiatric disorder, diagnosed as depressive disorder. are met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for sleep apnea, secondary to service-connected depressive disorder, are met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310. 3. The criteria for a rating greater than 30 percent for the service-connected COPD status post bilateral pneumothorax are not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.14, 4.21, 4.96, 4.97, DC 6844, General Rating Formula for Restrictive Lung Disease (2018). 4. The criteria for an initial, compensable rating for bilateral hearing loss are not met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.85, 4.86. 5. The criteria for an effective date earlier than April 12, 2013, for the award of service connection for bilateral hearing loss are not met. 38 U.S.C. §§ 5101(a), 5103A, 5107, 5110(a) (West 2002); 38 C.F.R. §§ 3.1(p), (r), 3.114(a), 3.151(a), 3.159, 3.400(b)(2) (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from July 1983 to April 1987. In November 2016, the Veteran’s attorney submitted additional evidence in support of the claims with a waiver of review by the Agency of Original Jurisdiction (AOJ). Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Direct service connection may not be granted without evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disease or injury. 38 U.S.C. § 1137; 38 C.F.R. § 3.304. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection is also warranted for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury. 38 C.F.R. § 3.310. The determination as to whether the requirements for service connection are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. 38 U.S.C. § 7104 (a); Baldwin v. West, 13 Vet. App. 1 (1999); see 38 C.F.R. § 3.303 (a). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990).   1. Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD). The Veteran asserts that he has a current acquired psychiatric disorder, including PTSD, due to service. He has been diagnosed with dysthymic disorder (see October 2013 VA treatment record), PTSD, rule out bipolar disorder with psychotic features, panic disorder (see March 2016 VA treatment record), and unspecified depressive disorder (see July 2013 VA treatment record and May 2016 private disability benefits questionnaire). He has reported multiple in-service events to which he links his current disorders. I sum, in a June 2014 statement, the Veteran reported two in-service stressful events. He reported that while serving in Korea, in June or July 1985, he feared for his life when an angry group of Korean nationals approached his post, following the death of a Korean cab driver who was killed by a U.S. soldier. He reported that he was scared, that he had a shock baton and that he had to use it several times. Service personnel records confirm that the Veteran was a military police officer in service. The Veteran also reported that on another occasion in the Fall of 1986, in Korea, he was out on night patrol and was called to search for stolen rockets. He was afraid and heard noises that made him feel like he was being watched or followed. An April 1999 VA treatment record noted the Veteran’s report of a sexual assault in service. The Veteran’s friends and family members have submitted statements regarding their observations of a change in the Veteran’s demeanor following an incident in service in which his lung collapsed. R.B. reports that he grew up with the Veteran and served with the Veteran. R.B. reports that he was in service with the Veteran the day that the Veteran’s lungs collapsed while running in formation. He reported that the Veteran was never the same again, became withdrawn, and did not want to go out and do things. The Veteran’s brother reported that the Veteran was friendly and outgoing prior to service and often had friends over, but after service, he had a very different demeanor. He reported that after service, the Veteran was withdrawn and did not want to do anything outside of the house and family. His brother reported that the Veteran seemed anxious about health issues and would complain that no one believed him when he said he had chest pains during physical activity. A VA treatment record dated in 1999 indicates that the Veteran had 10 psychiatric hospital admissions in the 10 years prior to the 1999 psychiatric treatment. Regarding the stressful incidents, the Board observes that the AOJ issued a formal finding of lack of information necessary to corroborate the Veteran’s asserted stressors. See October 2014 Formal Finding. The October 2014 DPRIS response to the AOJ’s attempt to corroborate the stressor regarding the angry group of Korean nationals, indicated that the JSRRC was unable to document any angry mob of local nationals at the gate of Camp Casey in Korea in 1985 following death of cab driver. However, the JSRRC did confirm that a Korean cab driver was killed in 1986, near the installation where the Veteran was stationed, and a U.S. service member was arrested for the crime. See October 2014 DRPIS response. Despite the AOJ’s formal finding, the Board finds the Veteran’s statement regarding the stressor to be credible given the DPRIS response confirming that an American service member had been arrested for the killing a Korean cab driver. Thus, the appeal turns on whether any of the Veteran’s current acquired psychiatric diagnoses is related to the events in service. Resolving all doubt in favor of the Veteran, the Board finds that the Veteran has a current acquired psychiatric disorder related to service. A private psychologist determined that the Veteran’s psychiatric symptoms are best diagnosed as an unspecified depressive disorder and that the disorder began in service. See May 2016 private DBQ noting only one diagnosis for all of the Veteran’s psychiatric symptoms, after reviewing the file which contains multiple psychiatric diagnoses. The private psychologist interviewed the Veteran and reviewed the claims file and all the relevant evidence of record and determined that the Veteran’s unspecified depressive disorder more likely than not began in service. In reaching this conclusion, the psychologist noted the Veteran’s treatment for psychiatric episodes beginning in December 1990. The psychologist also noted medical journal articles that are supportive of a link between service and depression generally. The Board places a high probative value on the May 2016 private opinion. There is no opinion of record contradictory to the private opinion. The Board has no reason to reject the favorable evidence of record. Thus, resolving any doubt in favor of the Veteran, the Board finds that service connection for an unspecified depressive disorder is warranted. The Board finds that the diagnosis of unspecified depressive disorder encompasses all the Veteran’s psychiatric symptoms and prior diagnoses. The Veteran’s attorney does not dispute this conclusion but rather requested that service connection be granted for the unspecified depressive disorder (claimed as an acquired psychiatric disorder to include PTSD). See November 2016 attorney brief. For all of these reasons, service connection for an unspecified depressive disorder is granted. 2. Entitlement to service connection for sleep apnea, secondary to service-connected depressive disorder. The Veteran has a current diagnosis of sleep apnea and asserts that his sleep apnea is due to his now service-connected unspecified depressive disorder. In October 2016, a private physician determined that the Veteran’s service-connected COPD and now service-connected depressive disorder more likely than not aided in the development of the Veteran’s sleep apnea and permanently aggravate his sleep apnea. See October 2016 letter from Dr. H.S. The private physician based the opinion on his interview with the Veteran, review of the claims file, and review of medical literature linking psychiatric disorders and obstructive sleep apnea. The Board has no reason to reject the favorable evidence of record. Thus, resolving any doubt in favor of the Veteran, the Board finds that service connection for sleep apnea, on a secondary basis, is warranted. Increased Rating Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4. The rating schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise the lower rating will be assigned. 38 C.F.R. § 4.7. All benefit of the doubt will be resolved in the Veteran’s favor. 38 C.F.R. § 4.3. A veteran’s entire history is to be considered when making disability evaluations. See generally 38 C.F.R. 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Where the appeal arises from the original assignment of a disability evaluation following an award of service connection, the severity of the disability at issue is to be considered during the entire period from the initial assignment of the disability rating to the present time. See Fenderson v. West, 12 Vet. App. 119 (1999). Where entitlement to compensation has already been established and increase in disability rating is at issue, present level of disability is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Further, the Board must evaluate the medical evidence of record and consider the appropriateness of a “staged rating” (i.e., assignment of different ratings for distinct periods of time, based on the facts). See Hart v. Mansfield, 21 Vet. App. 505 (2007). Disability evaluations are determined by the application of the facts presented to VA’s Schedule for Rating Disabilities (Rating Schedule) at 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and the residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Although all the evidence has been reviewed, only the most relevant and salient evidence is discussed below. See Gonzales v. West, 218 F.3d 1378 (Fed. Cir. 2000) (holding that the Board must review the entire record but does not have to discuss each piece of evidence). 3. Entitlement to a rating greater than 30 percent for chronic pulmonary disease as a residual of bilateral pneumothorax. In this case, the service connection for a lung disability was granted in an October 1989 rating decision and assigned a 10 percent disability rating. The Veteran filed a claim for an increased rating in January 2009, which was denied in October 2009. The Veteran perfected an appeal of the decision but withdrew the appeal when, in an August 2012 rating decision, the AOJ increased the rating to 30 percent, effective in March 2011. See Veteran’s January 2013 statement. Thereafter, he filed a new claim for an increased rating in February 2013. The AOJ denied the request for increase in its October 2014 rating decision. The present appeal arises from disagreement with the October 2014 rating decision. The General Formula provides for ratings from 10 to 100 percent based primarily on the results of pulmonary function tests (PFTs), specifically, Forced Expiratory Volume in one second (FEV-1), Forced Vital Capacity (FVC), and Diffusion Capacity of the Lung for Carbon Monoxide by the Single Breath Method (DLCO (SB)). A 10 percent rating will be assigned where there is FEV-1 of 71- to 80-percent predicted, or FEV-1/FVC of 71 to 80 percent, or DLCO (SB) of 66- to 80-percent predicted. A 30 percent rating is assigned for FEV-1 measured at 56 to 70 percent of predicted value; or FEV-1/FVC of 56 to 70 percent; or, DLCO (SB) measured at 56-65 percent of predicted value. Id. A 60 percent rating is assigned for FEV-1 measured at 40-55 percent of predicted value, or FEV-1/FVC of 40-55 percent; or, DLCO (SB) measured at 40-55 percent of predicted value; or maximum oxygen consumption of 15- 20 ml/kg/min with cardiorespiratory limitation. Id. The maximum 100 percent rating is assigned for FVC measured at less than 40 percent of that predicted; or DLCO (SB) measured at less than 40 percent predicted; or maximum exercise capacity is less than 15 ml/kg/min oxygen consumption with cardiorespiratory limitation; or cor pulmonale or pulmonary hypertension; or requires outpatient oxygen therapy. Id. Notes to the General Rating Formula for Restrictive Lung Disease provide further rating guidance. Note (1) provides that a 100-percent rating shall be assigned for pleurisy with empyema, with or without pleurocutaneous fistula, until resolved. Note (2) provides that, following episodes of total spontaneous pneumothorax, a rating of 100 percent shall be assigned as of the date of hospital admission and shall continue for three months from the first day of the month after hospital discharge. Note (3) provides that gunshot wounds of the pleural cavity with bullet or missile retained in lung, pain or discomfort on exertion, or with scattered rales or some limitation of excursion of diaphragm or of lower chest expansion shall be rated at least 20-percent disabling. Post-bronchodilator studies are required when pulmonary function tests are conducted for disability evaluation purposes except when the results of pre-bronchodilator pulmonary function tests are normal are the examiner provides a reason post-bronchodilator results should not be done. 38 C.F.R. § 4.96 (d)(4). When evaluating based on pulmonary function test results, post-bronchodilator results are to be used in applying the evaluation criteria unless the post- bronchodilator results were poorer than the pre-bronchodilator results. In those cases, pre-bronchodilator results are to be used for evaluation purposes. See 38 C.F.R. § 4.96 (d)(5). The Veteran was provided a VA examination in November 2013 for his lung disability. The examiner confirmed diagnosis of COPD. The Veteran reported increased fatigue and dyspnea. The examiner noted that the Veteran’s COPD did not require any oral or parenteral corticosteroid medications, inhaled medications, oral bronchodilators, antibiotics, or oxygen therapy. Pulmonary function testing at the November 2013 VA examination showed the following prebronchodilator findings: FEV-1/FVC was 80 percent predicted. Postbronchodilator findings were as follows: FEV-1/FVC was 62 percent. The November 2013 VA examiner determined that FEV-1/FVC most accurately reflected the Veteran’s level of disability. Applying the Veteran’s 62 percent postbronchodilator FEV-1/FVC test result to the rating schedule, the currently-assigned 30 percent disability rating is the accurate rating. In this regard, the regulation instructs that a 30 percent rating is warranted for of 56 to 70 percent. The next-higher 60 percent disability rating is not warranted as FEV-1/FVC was not shown to be measured at 40-55 percent. There are no results demonstrating FEV-1 measured at 40-55 percent of predicted value; or, DLCO (SB) measured at 40-55 percent of predicted value; or maximum oxygen consumption of 15- 20 ml/kg/min with cardiorespiratory limitation. VA treatment records and lay statements do not indicate more severe symptoms during the appeal period than those reported during the November 2013 VA examination. The Board acknowledges that the Veteran suffered a pneumothorax in October 2008 following surgery and that he previously pursued a claim for an increased rating based on the incident; however, as discussed above, the Veteran withdrew that appeal. See January 2013 statement. For these reasons, the Board finds that a rating greater than 30 percent is not warranted for the Veteran’s restrictive lung disability. In reaching this conclusion, the Board acknowledges the Veteran’s belief that his lung symptoms are of such severity as to warrant a higher rating. He is not, however, competent to identify a specific level of disability of his lung disability. On the other hand, such competent evidence concerning the nature and extent of the Veteran’s restrictive lung disease has been provided by the medical personnel who have examined him during the current appeal and who have rendered pertinent opinions in conjunction with the evaluations. The medical findings (as provided in the examination reports and VA treatment records) directly address the criteria under which this disability is evaluated. Consideration has been given to assigning a staged rating; however, at no time during the period in question has the restrictive lung disability warranted a higher rating. See Hart, supra. Finally, the Board has considered the applicability of the benefit of the doubt doctrine. However, the preponderance of the evidence is against the Veteran’s claim for an increased rating for his lung disorder. Therefore, the benefit of the doubt doctrine is not applicable in the instant appeal and his rating claim must be denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990). 4. Entitlement to an initial compensable rating for bilateral hearing loss. Ratings for hearing loss range from noncompensable to 100 percent based on organic impairment of hearing acuity as measured by the results of speech discrimination tests combined with the average hearing threshold levels as measured by pure tone audiometry tests in the frequencies 1000, 2000, 3000, and 4000 cycles per second. To rate the degree of disability for service-connected hearing loss, the Rating Schedule has established eleven auditory acuity levels, designated from Level I, for essentially normal acuity, through Level XI, for profound deafness. 38 C.F.R. § 4.85 (h), Table VI. In order to establish entitlement to a compensable rating for hearing loss, it must be shown that certain minimum levels of the combination of the percentage of speech discrimination loss and average pure tone decibel loss are met. The assignment of disability ratings for hearing impairment is derived by a mechanical application of the Rating Schedule to the numeric designations assigned after audiometric evaluations are rendered. See Lendenman v. Principi, 3 Vet. App. 345 (1992). The rating criteria for hearing impairment use controlled speech discrimination tests (Maryland CNC) together with the results of pure tone audiometry tests. These results are then charted on Table VI, or Table VIA in exceptional cases as described in 38 C.F.R. § 4.86, and Table VII, as set out in the Rating Schedule. 38 C.F.R. § 4.85. An exceptional pattern of hearing loss occurs when the pure tone threshold at 1000, 2000, 3000, and 4000 Hertz is 55 decibels or more, or when the pure tone threshold is 30 decibels or less at 1000 Hertz and 70 decibels or more at 2000 Hertz. 38 C.F.R. § 4.86. Specifically, when the pure tone threshold is 30 decibels or less at 1000 Hertz and 70 decibels or more at 2000 Hertz, the Roman numeral designation for hearing impairment is determined from either Table VI or Table VIA, whichever results in the higher numerical. 38 C.F.R. § 4.86 (b). That numeral will then be elevated to the next higher Roman numeral, and then each ear will be evaluated separately. Id. In Martinak v. Nicholson, 21 Vet. App. 447, 455 (2007), the United States Court of Appeals for Veterans Claims (Court) held that relevant to VA audiological examinations, in addition to dictating objective test results, a VA audiologist must fully describe the functional effects caused by a hearing disability in his or her final report. Id. Although all the evidence has been reviewed, only the most relevant and salient evidence is discussed below. See Gonzales v. West, 218 F.3d 1378 (Fed. Cir. 2000) (holding that the Board must review the entire record but does not have to discuss each piece of evidence). Historically, service connection for bilateral hearing loss was established by an October 2014 rating decision, which assigned an initial, noncompensable disability rating pursuant to 38 C.F.R. § 4.86, Diagnostic Code 6100, effective in April 2013, the day the Veteran’s claim for service connection was received. The Veteran was afforded a VA examination in November 2013. At that time, pure tone thresholds, in decibels, were as follows: 500 Hertz 1000 Hertz 2000 Hertz 3000 Hertz 4000 Hertz Right ear 35 35 45 60 70 Left ear 25 25 45 55 70 Adding the sums of the Hertz levels from 1000-4000 and dividing by four, results in an average pure tone threshold of 53 in the right ear and 49 in the left ear. The examiner noted speech recognition ability of 94 percent in both ears. The November 2013 VA examiner also noted the Veteran’s denial of any functional impact. The Veteran reported that his hearing loss did not impact conditions of daily life including his ability to work. Applying the average pure tone thresholds and speech recognition abilities into Table VI reveals the highest numeric designation of hearing impairment is Level I in each ear. 38 C.F.R. § 4.85. Entering the category designation of Level I in each ear results in a zero percent evaluation under Diagnostic Code 6100. 38 C.F.R. § 4.85, Table VII. Based on the VA audiological examination of record, the Board finds that the Veteran is not entitled to an initial compensable rating for his bilateral hearing loss at any time. In this regard, the Board has considered the audiological test results of record and applied the appropriate hearing designation levels, which have resulted in a noncompensable rating. Review of the Veteran’s medical treatment records does not demonstrate that his bilateral hearing was worse, at any time, than as reported during the November 2013 VA examination. To the extent that the Veteran contends that his hearing loss is more severe than reflected by evaluation, the Board observes that, while he is competent to report symptoms such as difficulty hearing or indicate that it takes effort to hear things, he is not competent to report that his hearing acuity is of sufficient severity to warrant a compensable evaluation under VA’s tables for rating hearing loss disabilities because such an opinion requires medical expertise (training in evaluating hearing impairment), which he has not been shown to have. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006); Charles v. Principi, 16 Vet. App. 370 (2002); Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). Based on the evidence of record, the Board finds that the Veteran is not entitled to a compensable rating for his bilateral hearing loss. The November 2013 VA examination report did not reveal audiological evaluations that would warrant a compensable rating. Further, VA treatment records do not contain hearing acuity findings that would warrant a compensable rating. The Board has considered whether staged ratings under Fenderson, supra, are appropriate for the Veteran’s service-connected bilateral hearing loss; however, the Board finds that his hearing acuity has not warranted a compensable rating at any time during the appeal period. Therefore, staged ratings are not warranted. Finally, the Board has considered the applicability of the benefit of the doubt doctrine. However, the preponderance of the evidence is against the Veteran’s claim for an initial compensable rating for bilateral hearing loss. Therefore, the benefit of the doubt doctrine is not applicable in the instant appeal and his initial rating claim must be denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990). Effective Date 5. Entitlement to an effective date earlier than April 12, 2013 for the award of service connection for bilateral hearing loss Generally, if a claim is received within one year after separation from service, the effective date shall be “day following separation from active service.” 38 C.F.R. § 3.400 (b)(2). Otherwise, the effective date shall be date of claim or date entitlement arose, whichever is later. Id. The effective date for a reopened claim, after a final disallowance, shall be the date of receipt of the new claim or date entitlement arose, whichever is later. 38 C.F.R. § 3.400 (q)(2), (r) (2018). 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. 57660 (Sept. 25, 2014). The amendments implement the concept of an intent to file a claim for benefits, which operates similarly to the informal claim process, but requires that the submission establishing a claimant’s effective date of benefits must be received in one of three specified formats. The amendments also eliminate the constructive receipt of VA reports of hospitalization or examination and other medical records as informal claims to reopen under 38 C.F.R. § 3.157. See 79 Fed. Reg. 57,660 (Sept. 25, 2014) (now codified at 38 C.F.R. §§ 3.1 (p), 3.151, 3.155). The amendments apply only to claims filed on or after March 24, 2015. Because the Veteran’s claim to reopen the claim for service connection for hearing loss was submitted prior to that date, the former regulations apply, as provided below. A specific claim in the form prescribed by VA must be filed for benefits to be paid or furnished to any individual under the laws administered by VA. 38 U.S.C. § 5101 (a); 38 C.F.R. § 3.151 (a). The term “claim” or “application” means 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). 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. Such informal claim must identify the benefit 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. 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). Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits. VA shall consider all information and lay and medical evidence of record in a case and when 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 claimant. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). In this case, the Veteran’s claim for service connection for bilateral hearing loss was received at the VA regional office on April 12, 2013. See April 2013 claim. This was more than one year after service separation. Service connection is presently in effect the date that the claim was received. Therefore, no earlier effective date is warranted. REASONS FOR REMAND 1. Entitlement to service connection for diverticulitis with IBS and GERD. The AOJ, by a decision entered in August 2008, denied the Veteran’s claim for service connection for diverticulitis with complications of irritable bowel syndrome and GERD leading to colon resection on grounds that it was not incurred in or caused by service. The Veteran did not appeal the decision; however, new and material evidence was provided within one year of the decision. In June 2009, the Veteran submitted additional evidence in support of his claim including hospital records indicating that he had to have surgery associated with his diverticulitis in October 2008, as well as a statement from his friend, J.B., who reported his observations of the effects of the Veteran’s gastrointestinal disorders. In July 2009, he submitted treatment records from the New York State Office of Temporary and Disability Assistance regarding gastroenteritis and other abdominal problems. These records were not previously reviewed in the August 2008 rating decision and included a July 1998 treatment record containing discussion that the Veteran had a partial colectomy for ruptured diverticular disease that left him with pronounced abdominal hernias. This evidence is new and when combined with the remaining evidence of record, is material to the claim as it bolsters the Veteran’s contentions that he has continued to suffer gastrointestinal symptoms since service. Because the new and material evidence was added to the record within one year of the August 2008 rating decision, that decision did not become final and the claim should be addressed on the merits. 38 C.F.R. § 3.156(b). Having determined that the claim for service connection for diverticulitis with IBS and GERD should be addressed on the merits, the Board observes that there is no adequate VA opinion of record. In this regard, the Veteran was afforded a VA examination in June 2008 however, the examiner did not provide adequate rationale for the negative opinion of record. Specifically, the examiner opined that the Veteran’s current gastrointestinal disorders were not related to service because even though the Veteran had symptoms of gastroenteritis, heart burn, and epigastric pain in service, he was not diagnosed with diverticulitis, IBS, or GERD in service. The examiner did not explain what the in-service symptoms were attributable to or why it was significant that the Veteran would have those symptoms but not an official diagnosis of diverticulitis, IBS, or GERD. Further, the examiner noted that the Veteran’s diverticulitis with surgery in December 1992 was an acute onset of diverticulitis but again, did not explain how the conclusion was reached. Thus, another VA opinion is required. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). 2. The claims for service connection for hypertension, chronic kidney disease, skin disorder, diabetes mellitus, type II, thyroid cancer, and left and right lower extremity disorders, are remanded. The Veteran asserts that these claims are due to exposure to either herbicide agents while serving in Korea, or exposure to toxic chemicals while serving at Fort McClellan. The Veteran has reported that he visited the demilitarized zone (DMZ) multiple times in his role as a military policeman. See June 2014 statement. With respect to the claimed chemical exposure at Fort McClellan, the Veteran reported that he was exposed to smoke pods, fumes, and gas throughout training at Fort McClellan from July 1983 to January 1984. See February 2014 report of general information. He also reported that he remembers walking through areas of Fort McClellan with signs that warned of nuclear and radioactive material but they marched through anyway. See August 2013 statement. The Veteran has reported that the town of Anniston, Alabama (situated near Fort McClellan) won a law suit against the Monsanto company for Monsanto’s role in the establishment of toxic chemicals in the area. See e.g. January 2014 statement. Service personnel records confirm that the Veteran served at Fort McClellan as well as in Korea. Service personnel records also confirm that the Veteran was trained as a military police officer. The Veteran asserts that his diabetes, kidney disease, skin disorder, hypertension, thyroid cancer, and bilateral lower extremity disorders are related to the exposure to herbicide and/or other chemical contaminates while stationed at Fort McClellan or in Korea. VA acknowledges that from 1929 to 1971, an off-post Monsanto chemical plant operated south of Fort McClellan in Anniston, Alabama. VA also acknowledges that potential exposures could have included radioactive compounds, chemical warfare agents, and airborne polychlorinated biphenyls (PCBs). Moreover, VA acknowledges that PCBs from the plant entered into the environment, and the community surrounding the Monsanto plant was exposed. However, there is currently no adverse health condition associated with service at Fort McClellan. See https://www.publichealth.va.gov/exposures/fort-mcclellan/. Even though there is no presumption of an adverse health condition associated with service at Fort McClellan, VA may still consider whether service connection is warranted on a direct basis. The Veteran has yet to undergo a VA examination to determine whether such exposure could reasonably result in the Veteran’s claimed conditions. Under these circumstances, the Board finds that a VA examination is necessary to assist in determining whether service connection is warranted for the claimed disorders. 3. The claim for TDIU is remanded. The Veteran claimed entitlement to TDIU due to service-connected disability as well as disabilities pending adjudication for service connection. Having granted the claim for service connection for an unspecified depressive disorder, the Board notes that the November 2016 private psychologist determined that the Veteran is unable to work due solely to his now service-connected unspecified depressive disorder. The schedular rating criteria for TDIU are not met at this juncture; however, the claim is intertwined with the implementation of the Board’s grant and the assignment of a disability rating. See Parker v. Brown, 7 Vet. App. 116 (1994) and Harris v. Derwinski, 1 Vet. App. 180, 183 (issues are “inextricably intertwined” when a decision on one issue would have a “significant impact” on a veteran’s claim for the second issue). If following implementation of the grant of service connection for the acquired psychiatric disorder and assignment of a disability rating, the Veteran’s combined disability rating does not meet the schedular rating criteria, the AOJ should refer the claim to the Director for Compensation and Pension to determine whether an extraschedular TDIU is warranted. 4. The claims for aid and attendance and permanent and total disability rating, are remanded. As the Veteran has claimed entitlement to these claims based on all of his disabilities, including those not yet service-connected, these claims are intertwined with the remaining pending claims remanded herein. Thus, the Board will not address these issues at this time. See Parker, supra. While on appeal, any outstanding VA treatment records should also be obtained. The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records dated since March 2016. 2. Following completion of item 1, seek another VA opinion regarding the Veteran’s claimed diverticulitis with IBS and GERD. The claims file must be made available to and reviewed by the examiner in conjunction with the opinion. The Board leaves it to the discretion of the examiner as to whether an in-person examination is necessary. If examined, any medically indicated tests should be accomplished, and all pertinent symptomatology and findings must be reported in detail. The examiner is asked to address the following: (a.) Provide diagnoses for all current disabilities associated with the claim for diverticulitis with IBS and GERD. (b.) For each disorder identified, is it at least as likely as not (a fifty percent probability or greater) that the disability is related to the Veteran’s active duty service, to include gastrointestinal symptoms experienced during service, and any exposure to chemicals while serving in Korea and/or at Fort McClellan. (c.) The examiner should consider the lay statements of record. A detailed rationale supporting the examiner’s opinions must be provided. 3. Following completion of item 1, afford the Veteran a VA examination (or examinations, if deemed necessary) to ascertaining the nature of his claimed hypertension, chronic kidney disease, skin disorder, diabetes mellitus, type II, thyroid cancer, and left and right lower extremity disorders. The claims file must be made available to and reviewed by the examiner in conjunction with the examination. Any medically indicated tests should be accomplished, and all pertinent symptomatology and findings must be reported in detail. The examiner is asked to address the following: (a.) Provide diagnoses for all current disabilities associated with the claims for hypertension, chronic kidney disease, skin disorder, diabetes mellitus, type II, thyroid cancer, and left and right lower extremity disorders. (b.) For each disorder identified, is it at least as likely as not (a fifty percent probability or greater) that the disability is related to the Veteran’s active duty service, to specifically include exposure to herbicides while serving in Korea, and/or other contaminates while at Fort McClellan? (c.) The examiner should consider the lay statements of record. A detailed rationale supporting the examiner’s opinions must be provided.   4. After completing the above, and any other development as may be indicated by any response received as a consequence of the actions taken in the preceding paragraphs, readjudicate the Veteran’s service connection claims, as well as claims for TDIU, aid and attendance, and permanent and total disability rating, based on the entirety of the evidence. J.N. MOATS Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Donna D. Ebaugh, Counsel