Citation Nr: 18156532 Decision Date: 12/10/18 Archive Date: 12/10/18 DOCKET NO. 16-07 820 Date: December 10, 2018 ORDER Entitlement to an earlier effective date than August 27, 2009, for the grant of service connection for left knee patellar femoral syndrome is denied. Entitlement to an earlier effective date than August 27, 2009, for the grant of service connection for left ankle tenosynovitis is denied. Entitlement to an earlier effective date than August 27, 2009, for the grant of service connection for depression, also claimed as posttraumatic stress disorder (PTSD) is denied. Entitlement to an earlier effective date than September 29, 2014, for the grant of service connection for lumbar strain is denied. Entitlement to an earlier effective date than September 29, 2014, for the grant of service connection for tinnitus is denied. Entitlement to service connection for a right heel condition is denied. Entitlement to an initial disability rating in excess of 10 percent for tinnitus is denied. From August 27, 2009, to November 26, 2009, an initial disability rating of 70 percent rating for depression, also claimed as PTSD, is granted. Entitlement to an initial disability rating in excess of 50 percent for depression, also claimed as PTSD, from November 27, 2009, to September 29, 2016, is denied. From September 30, 2016, to January 24, 2017, an initial disability rating of 70 percent rating for depression, also claimed as PTSD, is granted. REMANDED Whether new and material evidence has been received to reopen the claim of entitlement to service connection for a right knee disability is remanded. Whether new and material evidence has been received to reopen the claim of entitlement to service connection for a right ankle disability, claimed with two bones in heel, is remanded. Whether new and material evidence has been received to reopen the claim of entitlement to service connection for a left heel disability is remanded. Entitlement to service connection for headaches is remanded. Entitlement to service connection for primary insomnia is remanded. Entitlement to an initial disability rating in excess 50 percent from January 25, 2017, for depression, also claimed as PTSD, is remanded. Entitlement to an initial disability rating in excess of 20 percent for lumbar strain is remanded. Entitlement to an initial disability rating in excess of 10 percent for left knee patellar femoral syndrome is remanded. Entitlement to an initial disability rating in excess of 10 percent for left ankle tenosynovitis is remanded. Entitlement to a total disability rating due to individual unemployability (TDIU) is remanded. FINDINGS OF FACT 1. A May 2006 rating decision denied service connection for a left knee disability; the Veteran did not file a notice of disagreement with that decision or file new and material evidence within one year of notification of the decision. 2. After the May 2006 rating decision, the Veteran first filed an application to reopen a claim for service connection for a left knee disability on August 27, 2009. 3. A May 2006 rating decision denied service connection for residuals of a left ankle injury; the Veteran did not file a notice of disagreement with that decision or file new and material evidence within one year of notification of the decision. 4. After the May 2006 rating decision, the Veteran first filed an application to reopen a claim for service connection for a left ankle disability on August 27, 2009. 5. The Veteran filed his original claim for service connection for depression on August 27, 2009. 6. The Veteran filed his original claim for service connection for a back condition on September 29, 2014. 7. The Veteran filed his original claim for service connection for a tinnitus on September 29, 2014. 8. A current right heel condition has not been shown during the appeal period. 9. Throughout the rating period, the Veteran has been in receipt of a rating of 10 percent for tinnitus, which is the maximum schedular rating for that disability; and the probative evidence of record does not demonstrate factors warranting an extra-schedular rating. 10. From August 27, 2009, to November 26, 2009, the frequency, duration and severity of the Veteran’s depression, also claimed as PTSD, caused impairment with deficiencies in most areas, but did not cause total occupational and social impairment. 11. From November 27, 2009, to September 29, 2016, the Veteran’s depression, also claimed as PTSD, was not manifested by a lack of hygiene, speech that is illogical or incoherent, abnormal mental trends involving delusions or hallucinations, homicidal ideation, impaired insight, affect that is incongruent to mood, or psychosis that is productive of occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, or other symptoms that meet or approximate deficiencies in most areas. 12. From September 30, 2016, to January 24, 2017, the frequency, duration and severity of the Veteran’s depression, also claimed as PTSD, caused impairment with deficiencies in most areas, but did not cause total occupational and social impairment. CONCLUSIONS OF LAW 1. The criteria for an effective date earlier than August 27, 2009, for the grant of service connection for left knee patellar femoral syndrome have not been met. 38 U.S.C. §§ 5110, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.400 (2018). 2. The criteria for an effective date earlier than August 27, 2009, for the grant of service connection for left ankle tenosynovitis have not been met. 38 U.S.C. §§ 5110, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.400 (2018). 3. The criteria for an effective date earlier than August 27, 2009, for the grant of service connection for depression, also claimed as PTSD, have not been met. 38 U.S.C. §§ 5110, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.400 (2018). 4. The criteria for an effective date earlier than September 29, 2014, for the grant of service connection for lumbar strain have not been met. 38 U.S.C. §§ 5110, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.400 (2018). 5. The criteria for an effective date earlier than September 29, 2014, for the grant of service connection for tinnitus have not been met. 38 U.S.C. §§ 5110, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.400 (2018). 6. The criteria for service connection for a right heel condition have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2018). 7. The criteria for an initial rating in excess of 10 percent for tinnitus have not been met. 38 U.S.C. §§ 1155, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.159, 4.3, 4.7, 4.14, 4.21, 4.87, Diagnostic Code 6260, 4.124a, Diagnostic Code 8045 (2018). 8. From August 27, 2009, to November 26, 2009, the criteria for an initial 70 percent rating, but no higher, for depression, also claimed as PTSD, are met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107(b); 38 C.F.R. §§ 3.102, 3.159, 4.1-4.7, 4.10, 4.126, 4.130, Diagnostic Code 9411 (2018). 9. From November 27, 2009, to September 29, 2016, the criteria for an initial disability rating in excess of 50 percent for depression, also claimed as PTSD, have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. § 4.130, Diagnostic Code 9411 (2018). 10. From September 30, 2016, to January 24, 2017, the criteria for an initial 70 percent rating, but no higher, for depression, also claimed as PTSD, are met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107(b); 38 C.F.R. §§ 3.102, 3.159, 4.1-4.7, 4.10, 4.126, 4.130, Diagnostic Code 9411 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from February 1986 to February 1995. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from rating decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Seattle, Washington. A February 2016 rating decision granted earlier effective dates of August 27, 2009, for the grants of service connection for depression, left knee patellar femoral syndrome, and left ankle tenosynovitis. However, as that action did not represent a total grant of the benefits sought on appeal, the claims of entitlement to earlier effective dates for the grants of service connection for depression, left knee patellar femoral syndrome, and left ankle tenosynovitis remain before the Board. AB v. Brown, 6 Vet. App. 35 (1993). Earlier Effective Dates Generally, the effective date of an award of disability compensation based on an original claim shall be the date of receipt of the claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110(a) (2012); 38 C.F.R. § 3.400 (2018). Unless otherwise provided, the effective date of compensation will be fixed in accordance with the facts found, but will not be earlier than the date of receipt of the claimant’s application. 38 U.S.C. § 5110(a). If a claim is filed within one year after separation from service, service connection will be effective as of the day after separation. 38 C.F.R. § 3.400(b)(2). Where a claim is granted after the submission of new and material evidence, the effective date is the later of the date of receipt of the new claim or the date entitlement arose. 38 C.F.R. § 3.400(q)(2). When there is a prior final decision in the claims file and a later reopened claim results in a grant of the benefit, the general rule for effective dates for reopened claims applies. In such cases the effective date cannot be earlier than the subsequent claim to reopen. 38 C.F.R. §§ 3.400(r), 3.400(q)(2); Leonard v. Principi, 17 Vet. App. 447, 452 (2004); Sears v. Principi, 16 Vet. App. 244, 246-50 (2002), aff’d, 349 F.3d 1326 (Fed. Cir. 2003). Prior to March 24, 2015, a claim was “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). An informal claim is “[a]ny communication or action indicating intent to apply for one or more benefits.” 38 C.F.R. § 3.155(a). VA must look to all communications from a claimant that may be interpreted as applications or claims - formal and informal - for benefits and is required to identify and act on informal claims for benefits. Servello v. Derwinski, 3 Vet. App. 196, 198 (1992). The essential elements for any claim, whether formal or informal, are: (1) an intent to apply for benefits; (2) an identification of the benefits sought; and (3) a communication in writing. Brokowski v. Shinseki, 23 Vet. App. 79, 84 (2009); MacPhee v. Nicholson, 459 F.3d 1323, 1326-27 (Fed. Cir. 2006) (holding that the plain language of the regulations requires a claimant to have intent to file a claim for VA benefits). For claims or appeals filed on or after March 24, 2015, a claim for benefits must be submitted on a standardized form. Standard Claims and Appeals Forms, 79 Fed. Reg. 57,660, 57,686 (Sept. 25, 2014) (eff. Mar. 24, 2015). Claims or appeals pending before VA on that date are to be decided based on the regulations as they existed prior to the amendment. Standard Claims and Appeals Forms, 79 Fed. Reg. 57,660, 57,686. Here, the Veteran’s claims were received prior to March 24, 2015, and so the regulations extant prior to that date are applicable. With regard to the date of entitlement, the term date entitlement arose is the date when the claimant met the requirements for the benefits sought, on facts found basis. 38 U.S.C. § 5110(a); McGrath v. Gober, 14 Vet. App. 28, 35 (2000). These facts found include the date the disability first manifested and the date entitlement to benefits was authorized by law and regulation. See generally 38 C.F.R. § 3.400. For instance, if a claimant filed a claim for benefits for a disability before he actually had the disability, the effective date for benefits can be no earlier than the date the disability first manifested. Ellington v. Peake, 541 F.3d 1364, 1369-70 (Fed. Cir. 2008). However, the date entitlement arose is not the date that the RO receives the evidence, but the date to which that evidence refers. McGrath, 14 Vet. App. at 35. “The statutory framework simply does not allow for the Board to reach back to the date of the original claim as a possible effective date for an award of service-connected benefits that is predicated upon a reopened claim.” Sears v. Principi, 16 Vet. App. 244, 248 (2002). In order for the Veteran to be awarded an effective date based on an earlier claim, he has to show clear and unmistakable error (CUE) in the prior denial of the claim. Flash v. Brown, 8 Vet. App. 332, 340 (1995). The issue of CUE in a specific prior RO decision has not been raised by the Veteran and, therefore, is not before the Board at this time. 1. Entitlement to an earlier effective date than August 27, 2009, for the grant of service connection for depression, also claimed as PTSD, is denied. 2. Entitlement to an earlier effective date than August 27, 2009, for the grant of service connection for left knee patellar femoral syndrome is denied. 3. Entitlement to an earlier effective date than August 27, 2009, for the grant of service connection for left ankle tenosynovitis is denied. The Veteran contends he is entitled to effective dates prior to August 27, 2009, for the grants of service connection for depression, also claimed as PTSD, left knee patellar femoral syndrome, and left ankle tenosynovitis. By way of history, the Veteran submitted an initial claim of entitlement to service connection for a left knee condition and left ankle condition in May 2005. Service connection was denied in a May 2006 rating decision. The Veteran did not appeal this decision nor submit new and material evidence within one year. The May 2006 rating decision was final based on the evidence then of record. See 38 U.S.C. § 7105(c); 38 C.F.R. § 20.1103. The Veteran submitted a request to reopen the claim for entitlement to service connection for a left knee condition and left ankle condition and a claim for service connection for depression on August 27, 2009. On February 1, 2010, the Veteran submitted a claim for PTSD. Subsequently, in February 2010, the RO reopened the Veteran’s claims for entitlement to service connection for a left knee condition and left ankle condition, but denied service connection. The claim for entitlement to service connection for depression was also denied in this rating decision. The Veteran submitted a timely Notice of Disagreement to this rating decision in March 2010. In April 2010, the Veteran’s claim for entitlement to service connection for PTSD was denied. However, in November 2013, a Decision Review Officer Decision reopened and granted service connection for a left knee condition and left ankle condition, assigning each a 10 percent disability rating and an effective date of May 18, 2010, and also granted service connection for depression, claimed as PTSD, assigning a noncompensable rating and an effective date of February 1, 2010. Subsequently, in June 2014, the Veteran’s service-connected depression was increased to a 50 percent disability rating, effective February 1, 2010, and the 10 percent disability ratings for service-connected left knee patellar femoral syndrome and left ankle tenosynovitis were continued. In September 2014, the Veteran submitted a timely Notice of Disagreement. Finally, in a February 2016 Decision Review Officer Decision, the effective dates for the grants of service connection were changed to August 27, 2009, the date of receipt of the Veteran’s application to reopen the claims for a left knee condition and left ankle condition and the initial claim for entitlement to service connection for depression. The Board finds that the date of claim is August 27, 2009. For the issues of service-connected left knee and left ankle conditions, there is no communication of record between the May 2006 rating decision and the August 2009 claims. The Board find that the date of entitlement is August 27, 2009, the date of the claims. VA and private treatment records revealed left knee and left ankle disabilities and symptomatology prior to 2009. Moreover, an effective date prior to the date of the claim to reopen cannot be assigned; the appropriate date is thus already assigned. See 38 C.F.R. §§ 3.400(r), 3.400(q)(2). Regarding the Veteran’s claim for an earlier effective date for the grant of service connection for depression, a review of the claims file indicates that no claim for service connection for depression was filed prior to August 27, 2009. Indeed, the August 27, 2009, claim for service connection is the first and earliest document in the Veteran’s claims file on this matter. No earlier communication or action by the Veteran could be interpreted as a claim for service connection for any psychiatric disorder. See 38 C.F.R. §§ 3.1(p), 3.155(a); Servello, 3 Vet. App. at 198. Furthermore, the VA treatment record dated August 16, 2009, indicated the Veteran was diagnosed with major depressive disorder for the past two years. Therefore, the proper effective date is still August 27, 2009, as it is the later of the date of receipt of the claim and the date entitlement arose. See 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400. Thus, the Veteran’s claim for an earlier effective date for a grant of service connection for depression is denied. There is no reasonable doubt to be resolved as to this matter. See 38 U.S.C. § 5107(b) (2012); 38 C.F.R. § 3.102, 4.3 (2018); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 4. Entitlement to an earlier effective date than September 29, 2014, for the grant of service connection for lumbar strain is denied. 5. Entitlement to an earlier effective date earlier than September 29, 2014, for the grant of service connection for tinnitus is denied. On September 29, 2014, VA received an Application for Disability Compensation and Related Compensation Benefits. The list of conditions from the Veteran that he contended should be service connected included a back condition and tinnitus. A review of the record does not reveal any earlier claim for service connection for these disorders. The Veteran reported at his April 2015 VA audiological examination that his tinnitus began in 1988. It is also noted in the April 2015 VA examination of the back that the onset of his disability was 1992. The Board acknowledges the Veteran’s contention that service connection for the conditions should be granted earlier effective dates. However, the evidence does not reflect that the Veteran filed a claim for service connection for a back condition and tinnitus within a year of his separation from service and the first claim for the conditions that the Board is able to locate within the Veteran’s claims file is from September 29, 2014. No earlier communication or action by the Veteran could be interpreted as a claim for service connection for a back condition or tinnitus. See 38 C.F.R. §§ 3.1(p), 3.155(a); Servello, 3 Vet. App. at 198. Therefore, the Board finds that September 29, 2014, is the proper effective dates for service connection for the disabilities. There is no reasonable doubt to be resolved as to this matter. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131 (2012); 38 C.F.R. § 3.303(a) (2018). 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. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection may be granted for any disease initially 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) (2018). In addition, service connection for certain chronic diseases may be established on a presumptive basis by showing that the condition manifested to a degree of 10 percent or more within one year from the date of separation from service. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137 (2012); 38 C.F.R. §§ 3.307, 3.309(a) (2018); Fountain v. McDonald, 27 Vet. App. 258, 271-72 (2015). Although the disease need not be diagnosed within the presumptive period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309(a). Additionally, for certain chronic diseases with potential onset during service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. If chronicity in service is not established, a showing of continuity of symptoms after discharge may support the claim. 38 C.F.R. §§ 3.303(b), 3.309 (2018); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Entitlement to service connection for a right heel condition is denied. Turning to the evidence of record, service treatment records show that the Veteran did not indicate any specific right heel complaints or symptoms during service, and none are documented. The medical records associated with the claims file do not document a right heel disorder. An April 2015 VA examination report of the ankle noted there was no evidence of any right heel symptoms or pathology on examination. The Veteran had full range of motion with no pain noted upon range of motion testing. Right heel pain causing functional impairment of the Veteran’s earning capacity has not been shown or asserted. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). The Veteran has not been shown to possess the requisite medical training, expertise, or credentials needed to diagnose orthopedic disabilities, nor has he specifically identified any right heel disability. His lay evidence, to the extent that he has provided any, does not constitute competent evidence and lacks probative value. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); Layno v. Brown, 6 Vet. App. 465, 469 1994). The existence of a current disability is the cornerstone of a claim for VA disability compensation. In the absence of proof of a present disability there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The Board has been mindful of the “benefit-of-the-doubt” rule, but, in this case, there is not such an approximate balance of the positive and negative evidence to permit a favorable determination. Increased Disability Ratings Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Schedule), found in 38 C.F.R. Part 4 (2018). The 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 (2018). 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 (2018). When reasonable doubt arises as to the degree of disability, such doubt will be resolved in the veteran’s favor. 38 C.F.R. § 4.3 (2018). In considering the severity of a disability, it is essential to trace the medical history of the veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41 (2018). Consideration of the whole-recorded history is necessary so that a rating may accurately reflect the elements of any disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Although the regulations do not give past medical reports precedence over current findings, the Board is to consider the veteran’s medical history in determining the applicability of a higher rating for the entire period in which the appeal has been pending. Powell v. West, 13 Vet. App. 31, 34 (1999). Where entitlement to compensation has been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Where an appeal is based on an initial rating for a disability, however, evidence contemporaneous with the claim and the initial rating decision are most probative of the degree of disability existing when the initial rating was assigned and should be the evidence “used to decide whether an original rating on appeal was erroneous.” Fenderson v. West, 12 Vet. App. 119, 126 (1999). In either case, if later evidence indicates that the degree of disability increased or decreased following the assignment of the initial rating, staged ratings may be assigned for separate periods of time. Fenderson, 12 Vet. App. at 126; Hart v. Mansfield, 21 Vet. App. 505 (2007) (noting that staged ratings are appropriate whenever the factual findings show distinct time periods in which a disability exhibits symptoms that warrant different ratings). When adjudicating a claim for an increased initial evaluation, the relevant time period is from the date of the claim. Moore v. Nicholson, 21 Vet. App. 211, 215 (2007), rev’d in irrelevant part, Moore v. Shinseki, 555 F.3d 1369 (2009). 1. Entitlement to an initial disability rating in excess of 10 percent for tinnitus is denied. The Veteran seeks an increased rating in excess of 10 percent for his service-connected tinnitus. Disability evaluations are determined by the application of a schedule of ratings, which is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. The percentage ratings in VA’s Schedule for Rating Disabilities (Rating Schedule) represent as far as can practicably be determined the average impairment in earning capacity resulting from such disabilities and their residual conditions in civil occupations. 38 C.F.R. § 4.1. The Veteran seeks an initial increased rating for his service-connected tinnitus, currently rated 10 percent disabling under Diagnostic Code 6260. See Scott v. McDonald, 789 F.3d 1375 (Fed. Cir. 2015). Under Diagnostic Code 6260, a single 10 percent disability rating is warranted for tinnitus, regardless of whether it is unilateral or bilateral, or whether it is constant versus recurrent. Smith v. Nicholson, 451 F.3d 1344 (Fed. Cir. 2006). Accordingly, the Veteran’s appeal for an initial increased rating in excess of 10 percent for his tinnitus is denied. See Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). The Veteran’s symptoms, including difficulty hearing, difficulty with speech discrimination, and ringing in his ears, are contemplated by the diagnostic code and by the also service-connected bilateral hearing loss diagnostic criteria. See 38 C.F.R. § 4.85 (2018); Evaluation of Hearing Loss, 52 Fed. Reg. 17,607 (May 11, 1987); Schedule for Rating Disabilities; Diseases of the Ear and Other Sense Organs, 59 Fed. Reg. 17,295 (April 12, 1994); 64 Fed. Reg. 25,206 (May 11, 1999). Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 369-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). 2. Entitlement to an initial disability rating for depression, also claimed as PTSD, of 70 percent prior to November 27, 2009 is granted; in excess of 50 percent from November 27, 2009, to September 29, 2016 is denied; and of 70 percent from September 30, 2016, to January 24, 2017 is granted. The remaining period of appeal will be addressed in the REMAND portion of this decision. The Veteran’s service-connected depression, also claimed as PTSD, has been evaluated under 38 C.F.R. § 4.130, DC 9411. Under this code, a 50 percent evaluation contemplates occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. A 70 percent rating is warranted when there is occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, and mood, due to such symptoms as: suicidal ideations; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); and the inability to establish and maintain effective relationships. Id. A 100 percent rating is warranted if there is total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation or own name. Id. However, the symptoms recited in the criteria in the rating schedule for evaluating mental disorders are “not intended to constitute an exhaustive list, but rather are to serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating.” Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). “[A] veteran may only qualify for a given disability rating under § 4.130 by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration.” Vazquez-Claudio v. Shinseki, 713 F.3d 112 (Fed. Cir. 2013). The symptoms shall have caused occupational and social impairment in most of the referenced areas. Id. When evaluating a mental disorder, the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the veteran’s capacity for adjustment during periods of remission must be considered. 38 C.F.R. § 4.126. In addition, the evaluation must be based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner’s assessment of the level of disability at the moment of the examination. 38 C.F.R. § 4.126. Psychiatric examinations frequently included assignment of a Global Assessment of Functioning (GAF) score. The Board notes that the GAF scale was removed from the more recent Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) for several reasons, including its conceptual lack of clarity, and questionable psychometrics in routine practice. See DSM-V, Introduction, The Multiaxial System (2013) Upon review of the evidence of record, the Board concludes that staged ratings are warranted as will be discussed. See Hart, 21 Vet. App. at 505. The Veteran was admitted to the VA medical hospital on August 15, 2009, for an attempted suicide. According to a September 2009 VA treatment record of hospitalization, the Veteran was admitted for a suicide attempt by overdose on medication. He stated he needed help with his “problems with alcohol and suicide thoughts.” He stated he attempted suicide due to increased financial problems and marital issues. He was alert and oriented to person, place and time. A suicide risk assessment was low and he agreed not to harm himself while hospitalized. The Veteran reported symptoms of sleep disturbances, anger, and isolation. There were no alterations in thought process such as auditory/visual hallucinations, paranoid ideation, or delusions. There were also no cognitive deficits such as disorientation, mental confusion, or memory impairment. He was not incoherent, combative, or had decreased attention span. According to a September 24, 2009, note from the VA Addiction Treatment Center, the Veteran’s symptoms were more consistent with depression and/or an adjustment disorder. He endorsed mild passive suicidal ideation consistent with his chronic state but claimed awareness of these thoughts and did not believe he would act upon them. He stated he was looking forward to spending time at home with his wife and working on their relationship. The Veteran reported symptoms of depressed mood; diminished interest in activities; change in, appetite; sleep disturbance; psychomotor retardation and loss of energy; feelings of worthlessness and hopelessness; feelings of guilt; diminished concentration; and recurrent thoughts of death during the past 24 days. The Veteran was assessed as having no risk of suicide based on an interview and suicide risk assessment. However, on November 20, 2009, the Veteran stated his suicidal thoughts were back and recently on and off. He stated he is isolating himself from others and easily irritable. He avoided talking to his wife and others and became easily agitated. At this examination, the Veteran was appropriately dressed and groomed, mood was depressed, and affect was restricted. His thought process was logical and goal oriented. He denied auditory and visual hallucinations or delusions. He reported passive suicidal ideation and denied homicidal ideation. He was alert and oriented. There was no evidence of immediate risk to harm self or other at that time. On November 27, 2009, the Veteran stated his suicidal ideation improved and was trying to keep himself busy. He denied plans or intent of suicide. Based on this evidence, the Board finds that a 70 percent rating, but no higher, should be granted prior to November 27, 2009. Notably, the Veteran attempted suicide by overdose in August 2009. Although there was no longer evidence of immediate risk to harm himself or other on November 20, 2009, the Board acknowledges that the Veteran’s suicidal thoughts increased, with impaired impulse control, and he was unable to establish and maintain effective relationships. Therefore, viewing the evidence in light most favorable to the Veteran, the Board finds that a 70 percent rating is warranted prior to November 27, 2009. A 100 percent rating is not warranted during this time period. He did not have total social and occupational impairment due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; and memory loss for names of close relatives, or for the Veteran’s own occupation or name. The evidence of record from this period has consistently described the Veteran as alert and oriented, and there was no suggestion that the Veteran had any issue related to personal hygiene, experienced visual or auditory hallucinations, was disoriented to time or place, or had severe memory loss. While he had mild passive suicidal ideation, he did not believe he would act on these thoughts. On November 20, 2009, he reported his suicidal thoughts were back and it was noted that there was no evidence of imminent risk to harm himself. Even viewing the evidence most favorably to the Veteran, the requirements for a 100 percent rating are not met or approximated. The lay and medical evidence of record does not support the assignment of a 100 percent evaluation. From November 27, 2009, to September 29, 2016, the Board finds that the Veteran’s symptoms do not warrant a rating in excess of 50 percent. As stated above, on November 27, 2009, the Veteran reported his suicidal ideation improved and the VA treatment records since that time does not suggest he was at immediate risk to harm self or others. In February 2010, the Veteran stated he was continuing to feel depressed but this was not as bad as it was in the past. He stated he was finding his medication was helpful. He denied active suicidal ideation. He was appropriately dressed and groomed, speech was within normal limits, his mood was better, and affect was less restricted. His thought process was logical and goal-oriented. He denied auditory and visual hallucinations and delusions. He reported passive suicidal ideation that was less frequent with no intent or plan and he denied homicidal ideation. He was alert and oriented. In March 2010, a VA treatment record noted the Veteran smiled as he discussed the improvements in his marital relationship. He stated he felt “very good” about the support he was receiving from his wife. He also reported making an effort to talk to other family members and getting along better with his step daughter. There were no significant abnormalities in his mental status. The assessment indicated he was stable with no indication of risk. Later that month, the Veteran stated he continued to struggle with sleep disturbances. However, the Veteran was in no apparent distress and he was stable with no indication of risk. In April 2010 he stated he was getting upset easily and arguing with his wife. He denied any hopelessness and suicidal ideation. He stated he wanted to work on his relationship with his wife and found his medications helpful. He denied suicidal ideation for some time and denied homicidal ideation. His mood was described as better and affect was less restricted. In May 2010, the Veteran reported that he and his wife mutually decided to divorce and his mood was better with acceptance of the divorce. There was no evidence of suicidal ideation, psychotic symptoms, excessive agitation, or restlessness. In June 2010, the Veteran stated he started full-time employment at Boeing. He denied suicidal ideation and that his mood was “okay.” In March 2011, the Veteran stated he was working at Boeing full-time and was recently promoted. He stated he was “much happier now.” He was living with his sister and was involved with his family more than ever and enjoyed it. He stated he was happier since separating from his wife. He felt he was stable and drinking less than once a month. He denied feeling depressed. His sleep was variable but over all good. In June 2012, the Veteran had a positive depression screen but denied suicidality. He had some decreased motivation and weight gain but no difficulties with sleep or appetite. There was no psychomotor retardation/agitation. His mood was “ok” and he was functioning at work. Overall, although he has been through some tough times, he was doing quite a bit better than a year previously. He declined treatment or mental health followup. According to a January 2014 VA treatment record, it was noted that the Veteran as last seen by this provider in March 2011 and the Veteran sought treatment as he felt his depression was worsening. He stated he experienced much stress from his divorce. He was laid off from Boeing but was working at another company. He stated he isolated himself from his roommate and broke up with his girlfriend as she could not commit herself to the relationship. He stated he wanted to get back on his medication for his depression and work on his relationships. He was appropriately dressed and groomed; speech was within normal limits; he reported his mood as “down” and affect was mildly restricted; thought process was logical. He denied auditory and visual hallucinations, delusions, and suicidal and homicidal ideation. In February 2014, Veteran reported not doing too well as he went through an episode of severe depression after his cousin who was battling with cancer passed away two weeks prior. He stated he thought of overdosing on a handful of ibuprofen but his ex-girlfriend was able to stop him. He stated he was thinking it would not affect anyone if he was no longer there, but after talking to his mother and other family members, he felt supported. He did not have suicidal thoughts or plans and has not been considering harming himself. He further stated later that month that he had not had a recurrent of suicidal ideation since receiving support from his mother. He expressed interest in building a closer relationship with his children and finding employment. In March 2014, the Veteran continued to express being closer to his children and found exercise helpful. He stated his medication was helpful for his mood and limiting irritability. His self-attitude was intact and although he was discouraged about not finding a job, he maintained his self-worth. He remained future oriented and without suicidal thoughts or plan. He was alert, normal grooming, normal speech, mood was described as “doing ok, maintaining”, and thought process as linear and coherent. There was no evidence of delusions. Recent and remote memory was intact, and insight and judgment were good. A May 2014 VA treatment record indicated that the Veteran experienced a period of lowered mood but received support from friends and family. He stated he was feeling hopeful and future-oriented and self-attitude was improved. He stated an outpouring of support from friends and family moved him greatly. He stated he found more energy and was exercising. He did not have any suicidal thoughts or plans. He enjoyed keeping in touch with people. In August 2014, the Veteran reported experiencing increased depression from chronic pain in his ankles. He had once or twice had some fleeting thoughts of death, but no plan or intent to harm himself and this has improved recently. In September 2014, the Veteran reported stresses in his romantic life but was looking forward to meeting his grandchildren. He also stated he was actively working on moving to Seattle and his mother was helping him in his efforts. He has not had suicidal thoughts or plans recently, and he had future orientation in many areas as well as feeling hopeful. In November 2014, the Veteran reported an increased severity in his depression closely tied to his sleep disturbances. His self-attitude was low but not delusionally so, and he stated he was worried he will not find work again since it was two years since he had a job. He was not anhedonic and enjoyed being around his grandchildren and spending time with his girlfriend. In December 2014, a VA treatment record indicated the Veteran’s mood was fairly stable, but he continued to have low energy and motivation. His sleep disturbances greatly contributed to this. He was alert; cooperative; with good eye contact; normal and appropriate dress/grooming; and not agitated or psychomotor retarded. The tone, rhythm and rate of his speech were all normal. Thought process was linear and without evidence of delusions and suicidal ideation. Following December 2014, the VA treatment records indicate the Veteran was treated for his sleep issues and fitted with a CPAP machine. In May 2015, the Veteran reported he was doing somewhat better overall. There were no sustained depressive periods, and no suicidal thoughts. He was also hopeful and thinking about the future. He stated he moved in with his girlfriend and this situation was going well. He was very upbeat and active. He made plans to travel and have activities most every weekend. His self-attitude seemed somewhat improved and was not abnormally low, and he was not anhedonic. In January 2016, the VA psychiatrist noted the Veteran found he had more depression symptoms, especially irritability and low energy/motivation, since discontinuing his medication, which he had done due to concerns about sexual side effects now that he was in a stable relationship. The Veteran was consistently future-oriented, expressed hope, and did not endorse having suicidal thoughts or plans. In March 2016, the Veteran stated he was experiencing increased symptoms as he noticed he was feeling irritable with other people and isolating himself more at times. He had decreased sleep and appetite. He had less energy and motivation and his self-attitude was lowered, although not delusionally so. He was able to enjoy a few things such as going to the gym regularly, and attend his grandson’s basketball game. He continued to be in touch with his girlfriend and his mother overall, and was not entirely withdrawn. He had some passive thoughts of dying, wondering “what if I was gone” but denied having any active thoughts, plans or intent to harm himself. In April 2016, the Veteran reported having continued low energy, periods of lowered mood, low motivation, feelings of being irritable. He stated the desire to improve so his relationships were better. He remained future oriented and was hopeful and did not have suicidal thoughts, plan or intent. In May 2016, the Veteran stated he was less tense or irritable and a bit more positive. He reported he had strong support from his fiancée and they have been fairly active socially. He stated he did not have suicidal thoughts. He stated he may travel and was hoping to return to the gym. According to a letter from his VA psychiatrist, dated May 2016, the Veteran “has not been able to obtain any form of competitive employment for approximately two years. In my clinical opinion, his inability to participate in any competitive employment is a result of his psychiatric condition. Despite his ongoing and active participation in treatment, he suffers from severely functionally impairing chronic depression symptoms.” Later that month, the Veteran reported distressing “modes” where he was either depressed or angry. He stated he was “withdrawing, cutting off from others, and isolating as a way of protecting himself from having an angry outburst and disrupting his interpersonal relationships.” The Veteran reported that he sometimes spends up to three days alone in his room, without eating, when he is depressed. The last time this occurred was February 2016, which was also the last time that the Veteran experienced suicidal ideation. He displayed anger outbursts then, too, including punching a wall. Veteran reported a distant relationship from his children, and cited hopes for reconciliation and to have a happier life as goals for treatment. In June 2016, the Veteran remained overall future oriented, was hopeful, and did not endorse having suicidal thoughts or plans. He reported he was looking forward to a trip planned with his girlfriend and his energy had been fair. It was noted that the Veteran had been “generally stable with some baseline lowered mood and irritability symptoms consistent with a mild chronic depression or even dysthymia, along with chronic poor sleep that is persistent and may play a large role in the other symptoms he had.” In August 2016, the Veteran reported a period of about a week or two where he felt more tense, irritable and could not sleep well. He stated he was busy socially but had been feeling more anxious due to the many demands on his time. He stated it seemed that social situations were more likely to cause stress. He stated he felt better in the last week, and was not depressed and was hopeful. He did not have any suicidal thoughts or plans. He was looking forward to a trip that month, his self-attitude was intact, and he did not have excess guilt. Finally, according to a VA Suicide Behavior Report, on September 30, 2016, the Veteran attempted suicide. The report indicates the Veteran ceased taking his antidepressant medication in the weeks before the incident and felt increasingly isolated, irritable, withdrawing from friends, family, fiancée. He declined to go to a social event on the day of the incident and began to feel more hopeless. He decided to start drinking and in the context as he described it somewhat impulsively took an unknown amount of unknown medication. Very soon after, he regretted his action and contacted his fiancée who called the police. The Veteran was transported to an outside hospital and received supportive treatment. The Board finds that the aforementioned lay and medical evidence reflects that the Veteran’s symptoms during the period prior to September 30, 2016, do not warrant a rating in excess of 50 percent. From November 27, 2009, to September 29, 2016, the Veteran’s depression, to include PTSD, was characterized by the following signs or symptoms: depressed mood; anxiety; sleep impairment; a negative emotional state; markedly diminished interest or participation in significant activities; and irritable behavior. The Board finds that these symptoms are similar to many of those contemplated by the currently assigned 50 percent rating. However, despite several periods of depressed mood and stress, the record reflects the Veteran was generally hopeful, he was future-oriented and maintained positive relationships with his family and friends, and his self-attitude was intact. While the Veteran’s PTSD did cause some occupational and social impairment, deficiencies in most areas were not shown. With regards to family and social relations, the Board recognizes periods where the Veteran isolated himself and withdrew from people. The Veteran and his wife also divorced during this period of the appeal. However, the totality of the evidence demonstrates that the Veteran was able to maintain effective relationships with his family and friends. He continued to pursue other romantic relationships following his separation and divorce, became engaged, and enjoyed social activities with his partner. He consistently reported the desire to have a good relationship with his children, and relied on the strong support from his family and friends, especially his mother. He looked forward to travelling, working out, and seeing his grandchildren. Therefore, the evidence weighs against a finding of deficiencies in family and social relations equating to a 70 percent or higher rating. Furthermore, the Veteran was employed full-time and sought employment during the periods he was unemployed. The Board acknowledges the Veteran’s statements to VA psychiatrists that he was unable to work due to his symptoms and the May 2016 letter that the Veteran was unable to participate in any competitive employment as a result of his psychiatric condition. Therefore, the Board recognizes the Veteran had difficulty in adapting to stressful circumstances (including work or a worklike setting), and a fleeting instance of suicidal ideation and impaired impulse control in February 2016. As stated, the Board notes that, although he was occasionally noted to report thoughts of death, there was no evidence of consistent suicidal ideation; to the contrary, at his ongoing treatment visits with VA, the Veteran explicitly denied experiencing any suicidal or homicidal ideation. Overall, from November 27, 2009, to September 29, 2016, symptoms indicative of a 70 percent rating such as; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately, and effectively; impaired impulse control; spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances; and the inability to establish and maintain effective relationships have not been shown or approximated. The Board acknowledges that the list of symptoms supporting a 70 percent rating is not exhaustive. See Mauerhan at 442-43. However, even when considering the actual symptoms shown during this appeal, the evidence fails to show occupational and social deficiencies in most areas such as work, school, family relations, judgment, thinking, or mood for the reasons set forth above. Accordingly, and based on the evidence of record, the Board concludes that the totality of the evidence shows that the criteria for a rating in excess of 50 percent for the Veteran’s depression, also claimed as PTSD, from November 27, 2009, to September 29, 2016, have not been met or approximated. As such, the evidence supports a finding that the Veteran’s actual PTSD symptomatology and resulting occupational and social impairment are adequately compensated for by the assigned 50 percent rating, for the period of appeal from November 27, 2009, to September 29, 2016. Turning to the evidence from September 30, 2016, again the Board recognizes that the Veteran attempted suicide by overdosing on medication and alcohol on this date. According to an October 6, 2016, VA treatment record, the Veteran stated approximately a month prior to the incident the he ceased taking his medication and noticed a week prior to the incident feeling more irritable and withdrawn. He stated he wanted to be isolated and was not communicating with his family or fiancée. He stated that on September 30, 2016, he felt more frustrated and was not as clearly fixated on dying. He stated, “I wasn’t in a bad mood, but then it just happened.” He further reported he “shutdown” and “went to a dark place… (thinking) everyone would just be better [off] without me.” He stated he wanted [his fiancée] to find him in the backyard in his anger and: He began to drink large amounts of liquor which is not characteristic of him, and then somewhat impulsively as he describes it, took headache medication (he was not clear on exactly what medication this was), but he started to feel very anxious and regretful, so he contacted his fiancée who called the police. Following hospitalization, he realized it would “hurt his family greatly, and there was in the next few days an outpouring of support from family and friends that greatly improved his outlook and mood.” Furthermore, the VA treatment record noted, “[h]e feels he now understands better how suicide would have a devastating impact on his family, especially his mom and kids. He specifically denies having any suicidal thoughts, plans or intent today.” A mental status examination showed the Veteran was not in acute distress. He was alert, cooperative, maintained good eye contact, had appropriate dress/grooming, and was not psychomotor retarded or agitated. His speech had normal rate, rhythm, and tone. He described his mood as “doing better.” Affect was reserved, serious appropriate to subject, moderately dysphoric but able to brighten somewhat at times, especially when talking about his family. His thought process was linear and goad-directed, and thought content did not have delusions and not responding to internal stimuli. The Veteran did not have suicidal ideation and homicidal ideation. His insight and judgment were both limited but appeared to be improving. Cognition appeared intact for recent and remote memory. The VA psychiatrist noted that the Veteran was at elevated risk because of his recent overdose attempt. The following day, on October 7, 2016, a High Risk for Potential Suicide flag was entered in to the Veteran’s medical record. VA mental health treatment records since this time revealed the Veteran repeatedly denied having suicidal thoughts, plans, or intent and was hopeful. The Veteran reported some occasions of depression and isolation but overall able to manage his symptoms through treatment and group therapy. (In January 2017, the Veteran reported some moments of lower mood, low motivation, lowered self-attitude and energy, but these have not been sustained.) He stated he had his suicide safety plan placed on his refrigerator and felt he understand it and could use it. He had specific future plans such as a cruise vacation in January 2017, enjoyed hobbies such as working out and watching football, and spending time with his grandchildren. His self-attitude seemed improved as he reported a better mood, without excess guilt and no indication of any kind of psychosis. VA psychiatrists continued the high-risk flag protocol in the Veteran’s treatment. Mental status examinations repeatedly showed the Veteran was not in acute distress. He was alert, cooperative, maintained good eye contact, had appropriate dress/grooming, and was not psychomotor retarded or agitated. His speech had normal rate rhythm, and tone. His mood was stable and affect was reserved, serious, appropriate to subject, and moderately dysphoric, but able to brighten at times. His thought process was linear and goal-directed, and thought content did not have delusions and not responding to internal stimuli. The Veteran did not have suicidal ideation and homicidal ideation. His insight and judgment were stable. Cognition appeared intact for recent and remote memory. Finally, on January 25, 2017, the High Risk for Potential Suicide flag was inactivated as it was determined the Veteran no longer met the criteria. When viewing the totality of the evidence most favorably to the Veteran, the Board finds that an increased rating of 70 percent is warranted during this period. Therefore, although the Veteran repeatedly denied suicidal ideation, intent or plan, maintained a positive relationship with his family and friends, looked forward to the future, and managed his symptoms despite periods of depression and isolation, the Board finds that the Veteran was on placed on High Risk for Potential Suicide during this period of the appeal until January 25, 2017. Therefore, giving the Veteran the benefit of the doubt, the Board concludes that a 70 percent rating is appropriate from September 30, 2016 (the date of his suicide attempt), to January 24, 2017 (the date before he was no longer considered as a High Risk for Potential Suicide). From January 25, 2017, the Board finds additional development is warranted A higher schedular rating for the psychiatric disorder is not warranted during this period of the appeal because the impairment is not total and does not meet the level of severity of the features suggested by the rating criteria for a higher rating. The record also does not demonstrate gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation or own name; or other symptoms which approximate such level of disability. Thus, it does not more nearly approximate a 100 percent disability rating under 38 C.F.R. § 4.130 for this period of the appeal. Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 369-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). REASONS FOR REMAND 1. Whether new and material evidence has been received to reopen the claim of entitlement to service connection for a right knee disability is remanded. 2. Whether new and material evidence has been received to reopen the claim of entitlement to service connection for a right ankle disability, claimed with two bones in heel, is remanded. 3. Whether new and material evidence has been received to reopen the claim of entitlement to service connection for a left heel disability is remanded. As to the issues of whether new and material evidence has been received to reopen previously denied claims for service connection for a right knee disability, a right ankle disability and a left heel disability, these claims were denied in June 2015. In September 2015, the Veteran submitted a timely Notice of Disagreement, that expressed disagreement with June 2015 rating decision. By this action, the RO declined to reopen previously denied claims of service connection for a right knee disability, a right ankle disability and a left heel disability. The RO has not issued a Statement of the Case (SOC) addressing the above-cited issues. Therefore, these issues must be remanded for issuance of a SOC. Manlincon v. West, 12 Vet. App. 238 (1999). 4. Entitlement to service connection for headaches is remanded. The Veteran contends that his current headaches stem from his military service. He was afforded a VA examination in April 2015 where upon examination and a review of the records, the VA examiner determined that his recurrent headaches occurred after a motor vehicle accident in 2004 with neck spasms and resolved on follow up. The VA examiner noted there was no other mention of headaches in the Veteran’s records. However, the Board finds this opinion is erroneous and the Veteran’s service treatment records note several instances of complaints for headaches. Specifically, in October 1986 the Veteran stated he experienced headaches since junior high school, typically triggered by hot weather. This evidence was not considered and addressed by the April 2015 VA examiner in the opinion. Therefore, as the evidence reveals the possibility the Veteran’s headache condition preexisted his service and a new opinion is warranted. 5. Entitlement to service connection for primary insomnia is remanded. The Veteran has contended that his primary insomnia is secondary to his service-connected depression, also claimed as PTSD. The Board finds that a comprehensive VA examination and opinion are warranted as to whether the Veteran’s claim of entitlement to service connection for primary insomnia is based on a secondary service connection theory of entitlement. Service connection may be established for disability which is proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310 (a) (2018). Further, a disability which is aggravated by a service-connected disability may be service connected to the degree that the aggravation is shown. 38 C.F.R. § 3.310 (2018); Allen v. Brown, 7 Vet. App. 439 (1995). As such, the Board finds a new VA examination and opinion are warranted. 6. Entitlement to an initial disability rating in excess 50 percent from January 25, 2017, for depression, also claimed as PTSD, is remanded. VA has a duty to assist claimants to obtain evidence needed to substantiate a claim. 38 U.S.C. § 5103A (2012); 38 C.F.R. § 3.159(c) (2018). This includes making as many requests as are necessary to obtain relevant records from a Federal department or agency, including, but not limited to, military records, VA medical records, records from facilities with which the VA has contracted, and records from Federal agencies. 38 C.F.R. § 3.159(c)(2). VA will end its efforts to obtain records only where it concludes that the records sought do not exist or that further efforts to obtain those records would be futile, such as where the Federal department or agency advises VA that the requested records do not exist or the custodian does not have them. 38 C.F.R. § 3.159(c)(2). Here, VA treatment records after January 25, 2017, are not a part of the claims file. Therefore, the Board finds that all reasonable efforts must be made to obtain the Veteran’s complete VA treatment from January 25, 2017. 7. Entitlement to an initial disability rating in excess of 20 percent for lumbar strain is remanded. 8. Entitlement to an initial disability rating in excess of 10 percent for a left knee patellar femoral syndrome is remanded. 9. Entitlement to an initial disability rating in excess of 10 percent for left ankle tenosynovitis is remanded. Turning to the claims of entitlement to increased initial ratings for lumbar strain, left knee patellar femoral syndrome, and left ankle tenosynovitis, new VA examinations are required. VA must provide an examination that is adequate for rating purposes. Barr v. Nicholson, 21 Vet. App. 303 (2007). During the pendency of the appeal and following the most recent VA examination, the United States Court of Appeals for Veterans Claims held that “to be adequate, a VA examination of the joints must, wherever possible, include the results of the range of motion testing described in the final sentence of” 38 C.F.R. § 4.59. See Correia v. McDonald, 28 Vet. App. 158 (2016). 38 C.F.R. § 4.59 states that “[t]he joints involved should be tested for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint.” As such, pursuant to Correia, an adequate VA joints examination must, wherever possible, include range of motion testing on active and passive motion and in weight-bearing and nonweight-bearing conditions. Here, on review, the VA examinations provided to the Veteran were not adequate per Correia. They did not provide the results of range of motion testing for pain on both active and passive motion in weight-bearing and nonweight-bearing. As such, these VA examinations are inadequate in this respect and the Board must remand the claims for new examinations to determine the current severity of the disabilities. 10. Entitlement to TDIU is remanded. The Board finds that additional development is necessary regarding entitlement to TDIU. The record is unclear regarding the Veteran’s employment, and, as such, the evidence of record is insufficient to adjudicate entitlement to TDIU benefits. Specifically, it is unclear whether the Veteran stopped employment in 2013 or 2014. The Veteran should be provided appropriate notice of the elements needed to prove a TDIU claim. 38 U.S.C. § 5103A; Hartman v. Nicholson, 19 Vet. App. 473, 490 (2006). Further, on remand as to entitlement to TDIU, the RO should provide the Veteran with notice regarding the information and evidence necessary to substantiate a TDIU. The Veteran should be asked to complete and return to VA Form 21-8940 (Veteran’s Application for Increased Compensation Based on Unemployability), and allow him an opportunity to identify any outstanding treatment records referable to such claim. Any further development that becomes indicated as part of this remand must be accomplished as well. The matters are REMANDED for the following action: 1. Contact the appropriate VA Medical Center(s) and obtain and associate with the claims file all outstanding records of treatment, especially those dated from January 25, 2017. If any requested records are not available, or the search for any such records otherwise yields negative results, that fact must clearly be documented in the claims file. Efforts to obtain these records must continue until it is determined that they do not exist or that further attempts to obtain them would be futile. The non-existence or unavailability of such records must be verified and this should be documented for the record. Required notice must be provided to the Veteran and his representative. 2. Contact the Veteran and afford him the opportunity to identify by name, address and dates of treatment or examination any relevant medical records. Subsequently, and after securing the proper authorizations where necessary, make arrangements to obtain all the records of treatment or examination from all the sources listed by the Veteran which are not already on file. All information obtained must be made part of the claims file. All attempts to secure this evidence must be documented in the claims file, and if, after making reasonable efforts to obtain named records, they are not able to be secured, provide the required notice and opportunity to respond to the Veteran and his representative. 3. The Veteran must be provided with proper notice regarding information and evidence necessary to establish entitlement to a TDIU determination, and, the following actions are to be taken: (a) Undertake all notice and evidentiary development needed to resolve the issue of entitlement to a TDIU. This should include sending the Veteran a letter advising him of the information and evidence needed to award a TDIU. Any additional development required must be accomplished. (b) Specifically, VA is to request that the Veteran identify any pertinent records that may exist that need to be obtained, if at all possible. The Veteran is to be provided with the appropriate release forms and VA is to obtain said reports for consideration, this requirement is limited to the extent said records are available. If any reports are not available then a statement to that effect must be added to the claims file. (c) The Veteran should be sent and asked to complete in full and return a VA Form 21-8940, Veteran’s Application for Increased Compensation Based on Unemployability. 4. After any additional records are associated with the claims file, provide the Veteran with an appropriate examination to determine the etiology of his headaches. The claims file must be made available to and pertinent documents therein reviewed by the examiner. Any indicated tests and studies must be accomplished and all clinical findings must be reported in detail and correlated to a specific diagnosis. An explanation for all opinions expressed must be provided. After reviewing the record and considering all appropriate symptoms and diagnoses, the examiner should opine as to the following: (a) Is there clear and unmistakable evidence that the Veteran’s headaches, preexisted his entry into active military service? (b) If it is found that the Veteran’s headaches clearly and unmistakably preexisted service, is there also clear and unmistakable evidence that such were not aggravated to a permanent degree in service beyond that which would be due to the natural progression of the disease? (c) If it is found that there is no clear and unmistakable evidence of a preexisting headache disorder that was permanently aggravated beyond the natural progression during service, is it at least as likely as not (50 percent or greater probability) that the Veteran’s headaches began in or are otherwise related to active military service? The examiner is asked to reconcile any opinion with any service personnel records, in-service treatment records (particularly the October 1986 record), the April 2015 VA examination report and opinion, to include the Veteran’s competent lay evidence regarding his pre-service, in-service, and post-service symptomatology. The claims file should be made available to the examiner for review in conjunction with the opinion and/or examination, and the examiner should note such review. A complete rationale should be provided for all opinions given. The opinions should be based on examination findings, historical records, and medical principles. The examiner should fully articulate a sound reasoning for all conclusions made. If the requested opinions cannot be provided without resorting to mere speculation, the examiner should so state but, more importantly, explain why an opinion cannot be provided without resorting to speculation, as merely stating this will not suffice. 5. After any additional records are associated with the claims file, schedule the Veteran for a VA examination to determine the nature and etiology of his claimed primary insomnia. The claims folder must be made available to the examiner and pertinent documents therein should be reviewed by the examiner. All necessary tests and studies should be accomplished, and all clinical findings should be reported in detail. A complete rationale should be provided for all opinions given. The opinions should be based on examination findings, historical records, and medical principles. The examiner should fully articulate a sound reasoning for all conclusions made. If the requested opinions cannot be provided without resorting to mere speculation, the examiner should so state but, more importantly, explain why an opinion cannot be provided without resorting to speculation, as merely stating this will not suffice. (a) The examiner should opine as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s primary insomnia, if diagnosed, is of service onset or otherwise related thereto. (b) The examiner should opine as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s primary insomnia, if diagnosed, is caused by or aggravated by the Veteran’s service-connected depression or medication prescribed therefor or any other service-connected disability. 6. After any additional records are associated with the claims file, schedule the Veteran for a VA examination to determine the severity of his service-connected lumbar strain. The claims file must be made available to the examiner and pertinent documents therein should be reviewed by the examiner. All necessary tests and studies should be accomplished, and all clinical findings should be reported in detail. Weight-bearing, and nonweight-bearing, passive and active range of motion testing must be performed for the Veteran’s lumbar strain. The examiner should be asked to note any additional functional loss, including in terms of additional degrees of limitation of motion (to the extent feasible) due to any weakened movement, excess fatigability, incoordination, or pain on use. If flare-ups are reported, the examiner should likewise note any additional functional limitation resulting from flare-ups, including in terms of any additional degrees of limitation of motion (to the extent feasible). 7. After any additional records are associated with the claims file, schedule the Veteran for a VA examination to determine the severity of his service-connected left knee patellar femoral syndrome. The claims folder must be made available to the examiner and pertinent documents therein should be reviewed by the examiner. All necessary tests and studies should be accomplished, and all clinical findings should be reported in detail. Weight-bearing, and nonweight-bearing, passive and active range of motion testing must be performed for the Veteran’s left knee patellar femoral syndrome. The examiner should be asked to note any additional functional loss, including in terms of additional degrees of limitation of motion (to the extent feasible) due to any weakened movement, excess fatigability, incoordination, or pain on use. If flare-ups are reported, the examiner should likewise note any additional functional limitation resulting from flare-ups, including in terms of any additional degrees of limitation of motion (to the extent feasible). 8. After any additional records are associated with the claims file, schedule the Veteran for a VA examination to determine the severity of his service-connected left ankle tenosynovitis. The claims folder must be made available to the examiner and pertinent documents therein should be reviewed by the examiner. All necessary tests and studies should be accomplished, and all clinical findings should be reported in detail. Weight-bearing, and nonweight-bearing, passive and active range of motion testing must be performed for the Veteran’s left ankle tenosynovitis. The examiner should be asked to note any additional functional loss, including in terms of additional degrees of limitation of motion (to the extent feasible) due to any weakened movement, excess fatigability, incoordination, or pain on use. If flare-ups are reported, the examiner should likewise note any additional functional limitation resulting from flare-ups, including in terms of any additional degrees of limitation of motion (to the extent feasible). 9. Issue the Veteran a SOC as to his appeals for whether new and material evidence has been received to reopen previously denied claims of service connection for a right knee disability, a right ankle disability and a left heel disability. These issues should not be certified or (CONTINUED ON NEXT PAGE) returned to the Board unless the Veteran or his representative submits a timely substantive appeal. BARBARA B. COPELAND Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD H. Yoo, Counsel