Citation Nr: 18157121 Decision Date: 12/11/18 Archive Date: 12/11/18 DOCKET NO. 09-49 812 DATE: December 11, 2018 ORDER New and material evidence has not been received and the application to reopen the previously denied claim of entitlement to service connection for arthritis of the bilateral hands is denied. New and material evidence has been received and the claim for entitlement to service connection for arthritis of the bilateral shoulders is reopened. Service connection for arthritis of the bilateral hips is denied. Service connection for a right ulnar condition is denied. An effective date prior to March 15, 2005 for the award of service connection for diabetes is denied. An effective date prior to March 15, 2005 for the award of service connection for erectile dysfunction, secondary to service-connected diabetes, is denied. An effective date prior to March 15, 2005 for the award of special monthly compensation at the K-level is denied. An effective date prior to March 15, 2005 for the award of service connection for right lower extremity peripheral neuropathy, secondary to service-connected diabetes, is denied. An effective date prior to March 15, 2005 for the award of service connection for left lower extremity peripheral neuropathy, secondary to service-connected diabetes, is denied. REMANDED Entitlement to service connection for arthritis of the bilateral shoulders is remanded. Entitlement to service connection for arthritis of the cervical spine is remanded. Service connection for right thigh meralgia paresthetica (previously claimed as nerve pain in the right knee) is remanded. Entitlement to an initial rating in excess of 20 percent for diabetes mellitus type II (diabetes) is remanded. Entitlement to a rating in excess of 50 percent for posttraumatic stress disorder (PTSD) is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. FINDINGS OF FACT 1. A July 1992 rating decision that denied the Veteran’s original service connection claim of arthritis of multiple joints, including the shoulders and hands, is final. 2. A March 1994 rating decision that denied the Veteran’s service connection claim of multiple joint pain of the shoulders and hands is final. 3. A May 1999 rating decision that denied reopening the Veteran’s service connection claim of arthritis of multiple joints, including the shoulders and hands, is final. 4. Evidence received since the last final decision does not raise a reasonable possibility of substantiating the claim of service connection for arthritis of the bilateral hands. 5. Evidence received since the last final decision is both new and material to the claim of service connection for arthritis of the bilateral shoulders. 6. The Veteran does not have a current diagnosis of arthritis of the bilateral hips. 7. The Veteran does not have a current diagnosis of a right ulnar condition. 8. Diabetes was initially diagnosed in February 2003. 9. On March 15, 2005, the Veteran filed an original informal claim for service connection for diabetes, to include the secondary conditions of bilateral lower extremity peripheral neuropathy and erectile dysfunction. 10. Prior to March 15, 2005, there is no evidence of a claim (formal or informal) of service connection for diabetes or any associated disability, to include bilateral lower extremity peripheral neuropathy, erectile dysfunction, and SMC at the K-level. CONCLUSIONS OF LAW 1. The July 1992 rating decision that denied the Veteran’s original service connection claim for arthritis of multiple joints, including the bilateral shoulders and hands, is final. See 38 U.S.C. §§ 7103, 7104 (2012); 38 C.F.R. §§ 3.156, 20.1100 (2018). 2. The March 1994 rating decision that denied the Veteran’s service connection claim for multiple joint pain, including the bilateral shoulders and hands, is final. See 38 U.S.C. §§ 7103, 7104 (2012); 38 C.F.R. §§ 3.156, 20.1100 (2018). 3. The May 1999 rating decision that declined to reopen the previously denied claim of service connection for arthritis of multiple joints, including the bilateral shoulders and hands, is final. See 38 U.S.C. §§ 7103, 7104 (2012); 38 C.F.R. §§ 3.156, 20.1100 (2018). 4. Evidence received since the last final decision is not new and material and the petition to reopen a claim for entitlement to service connection for arthritis of the bilateral hands is denied. 38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156(a) (2018). 5. Evidence received since the last final decision is new and material, and the claim of service connection for arthritis of the bilateral shoulders is reopened. 38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156(a) (2018). 6. The criteria for service connection for arthritis of the bilateral hips have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2018). 7. The criteria for service connection for a right ulnar condition have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2018). 8. The criteria for an effective date prior to March 15, 2005 for the award of service connection for diabetes mellitus have not been met. 38 U.S.C. § 5110 (2012); 38 C.F.R. § 3.400 (2018). 9. The criteria for an effective date prior to March 15, 2005 for the award of service connection for erectile dysfunction, secondary to service-connected diabetes, have not been met. 38 U.S.C. § 5110 (2012); 38 C.F.R. § 3.400 (2018). 10. The criteria for an effective date prior to March 15, 2005 for the award of SMC at the K-level have not been met. 38 U.S.C. § 5110 (2012); 38 C.F.R. § 3.400 (2018). 11. The criteria for an effective date prior to March 15, 2005 for the award of service connection for right lower extremity peripheral neuropathy, secondary to service-connected diabetes, have not been met. 38 U.S.C. § 5110 (2012); 38 C.F.R. § 3.400 (2018). 12. The criteria for an effective date prior to March 15, 2005 for the award of service connection for left lower extremity peripheral neuropathy, secondary to service-connected diabetes, have not been met. 38 U.S.C. § 5110 (2012); 38 C.F.R. § 3.400 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1966 to August 1969. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from multiple rating decisions of Department of Veterans Affairs (VA) Regional Offices (ROs). In a March 2009 rating decision, the RO granted service connection for diabetes (rated 20 percent disabling, effective March 5, 2005); erectile dysfunction (rated 0 percent disabling, effective July 2, 2007); and bilateral lower extremity peripheral neuropathy (rated 10 percent disabling, effective June 11, 2007). The RO also granted SMC at the K level based on loss of use of a created organ, effective July 2, 2007. Finally, the RO denied entitlement to a rating in excess of 50 percent for PTSD and entitlement to a TDIU. In a November 2009 rating decision, during the pendency of the present appeal, the RO granted an effective date of March 15, 2005 for awards of service connection for bilateral lower extremity peripheral neuropathy and erectile dysfunction, as well as for the award of SMC at the K level. Nonetheless, because the Veteran contends that an earlier effective date is still warranted, the claims remain before the Board. See Fenderson v. West, 12 Vet. App. 119, 126 (1999); AB v. Brown, 6 Vet. App. 35 (1993). In an August 2014 rating decision, the RO denied entitlement to service connection for arthritis in the bilateral hands, bilateral shoulders, bilateral hips, and neck. The RO also denied entitlement to service connection for meralgia paresthetica (claimed as nerve pain in right knee from fall in 2011) and a right ulnar condition. Regardless of any RO determination on the application to reopen, the Board has a jurisdictional responsibility to consider whether it is proper for the claim to be reopened. See Jackson v. Principi, 265 F.3d 1366, 1369 (Fed. Cir. 2001 The Veteran was scheduled for a Board videoconference hearing in April 2018. He did not appear for this hearing and did not provide an explanation or ask that it be rescheduled. Therefore, the request for a Board hearing is deemed to have been withdrawn. As detailed below, VA-generated evidence has been added to the claims file since the increased rating and earlier effective date claims were last adjudicated in the April 2015 supplemental statement of the case (SSOC) and the Board is remanding several of the claims on appeal for the Agency of Original Jurisdiction (AOJ) to consider this new evidence in a SSOC. See 38 U.S.C. § 7105(e). To the extent that the Board is adjudicating the earlier effective date issues, the new VA-generated evidence is not relevant to these claims. The Veteran has another appeal before the Board. Because that appeal involves issues dependent on different law and facts, it is the subject of a separate decision. See BVA Memorandum No. 01-18-04; VA Purplebook 01-18-v1.0.0. The Board has limited the discussion below to the relevant evidence required to support its finding of fact and conclusion of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016). New and Material Evidence—Laws and Analysis Rating decisions are final and binding based on evidence on file at the time the claimant is notified of the decision and may not be revised on the same factual basis except by a duly constituted appellate authority. 38 C.F.R. § 3.104(a). The claimant has one year from notification of a RO decision to initiate an appeal or submit new and material evidence before the decision becomes final. 38 U.S.C. § 7103, 7104; 38 C.F.R. §§ 20.1100. An exception to this rule is 38 U.S.C. § 5108, which provides that if new and material evidence is presented or secured with respect to a claim which has been disallowed, VA shall reopen the claim and review the former disposition of the claim. Under applicable regulations, new evidence is defined as existing evidence not previously submitted to agency decision makers. Material evidence means evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence previously of record, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). In determining whether evidence is new and material, the credibility of the evidence is generally presumed. Justus v. Principi, 3 Vet. App. 510, 512-513 (1992). The United States Court of Appeals for the Federal Circuit (Federal Circuit) has held, however, that evidence that is merely cumulative of other evidence in the record cannot be new and material even if that evidence had not been previously presented to the Board. Anglin v. West, 203 F.3d 1343 (2000). In deciding whether new and material evidence has been submitted, the Board looks to the evidence submitted since the last final denial of the claim on any basis. Evans v. Brown, 9 Vet. App. 273, 285 (1996). The threshold for determining whether new and material evidence raises a reasonable possibility of substantiating a claim is “low.” See Shade v. Shinseki, 24 Vet. App. 110, 117 (2010). In order to determine whether new and material evidence has been received, the Board must analyze the law applicable to the underlying service connection claim. Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). 1. Whether new and material evidence has been received to reopen a previously denied claim of entitlement to service connection for arthritis of the bilateral hands. In July 1992, the RO denied the Veteran’s claim for entitlement to service connection for arthritis of multiple joints, including the hands. The Veteran was notified of this denial, but did not appeal the decision as to this issue. Therefore, the decision was final. See 38 U.S.C. §§ 7103, 7104; 38 C.F.R. §§ 3.156, 20.1100. In March 1994, the RO denied the Veteran’s claim for entitlement to service connection for multiple joint pain of the hands. The Veteran was notified of this denial, but did not appeal the decision. Therefore, the decision was final. See 38 U.S.C. §§ 7103, 7104; 38 C.F.R. §§ 3.156, 20.1100. In May 1999, the RO denied reopening the Veteran’s service connection claim of arthritis of multiple joints, including the hands. The Veteran was notified of this denial, but did not appeal the decision. Therefore, the decision was final. See 38 U.S.C. §§ 7103, 7104; 38 C.F.R. §§ 3.156, 20.1100. The May 1999 denial of service connection for arthritis was based on a determination that there was no current disability. The evidence before the RO at that time included the Veteran’s service treatment records, VA treatment records, private treatment records, and lay statements. The evidence received since the May 1999 rating decision includes updated VA and private treatment records, an August 2014 VA examination report, and lay statements. These records provide information on the Veteran’s current reports of pain of the bilateral hands, but do not contain new evidence that would support a finding that the Veteran has been diagnosed with arthritis of the bilateral hands. To the contrary, the August 2014 VA examination report indicated that there were no abnormal findings in hand/finger imagining. The updated medical records do not raise a reasonable possibility of substantiating the claim given the absence of a diagnosis of arthritis of the bilateral hands. For these reasons, the application to reopen must be denied. 2. Whether new and material evidence has been received to reopen a previously denied claim of entitlement to service connection for arthritis of the bilateral shoulders. In July 1992, the RO denied the Veteran’s claim for entitlement to service connection for arthritis of multiple joints, including the shoulders. The Veteran was notified of this denial, but did not appeal the decision as to this issue. Therefore, the decision was final. See 38 U.S.C. §§ 7103, 7104; 38 C.F.R. §§ 3.156, 20.1100. In March 1994, the RO denied the Veteran’s claim for entitlement to service connection for multiple joint pain of the shoulders. The Veteran was notified of this denial, but did not appeal the decision. Therefore, the decision was final. See 38 U.S.C. §§ 7103, 7104; 38 C.F.R. §§ 3.156, 20.1100. In May 1999, the RO denied reopening the Veteran’s service connection claim of arthritis of multiple joints, including the shoulders. The Veteran was notified of this denial, but did not appeal the decision. Therefore, the decision was final. See 38 U.S.C. §§ 7103, 7104; 38 C.F.R. §§ 3.156, 20.1100. The May 1999 denial of service connection for arthritis was based on a determination that there was no current disability. The evidence before the RO at that time included the Veteran’s service treatment records, VA treatment records, private treatment records, and lay statements. The evidence received since the May 1999 rating decision includes updated VA and private treatment records, an August 2014 VA examination report, and lay statements. The August 2014 VA examination report indicates that the Veteran has been diagnosed with arthritis of the bilateral shoulders. Because this evidence speaks to the unestablished element of a current disability and has not been considered by the RO, it is considered both new and material to the claim. As such, the reopening of the claim for service connection for arthritis of the bilateral shoulders is warranted. Service Connection—Laws and Analysis Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. §§ 1110, 1131 (2012); 38 C.F.R. § 3.303 (a) (2017). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease incurred in service. 38 C.F.R. § 3.303 (d) (2017). Establishing service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Congress specifically limited entitlement to service-connected disease or injury to cases where such incidents have resulted in a disability. In absence of proof a present disability there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223 (1992); Rabideau v. Derwinski, 2 Vet. App. 141 (1992). Arthritis (degenerative joint disease) is considered by VA to be a “chronic disease” listed under 38 C.F.R. § 3.309(a); therefore, the presumptive service connection provisions based on “chronic” in-service symptoms and “continuous” post-service symptoms under 38 C.F.R. § 3.303(b) apply. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Where the evidence shows a “chronic disease” in service or “continuity of symptoms” after service, the disease shall be presumed to have been incurred in service. Where there is a chronic disease shown as such in service or within the presumptive period under § 3.307 so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. 38 C.F.R. § 3.303(b). This rule does not mean that any manifestation in service will permit service connection. For the showing of “chronic” disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. If a condition noted during service is not shown to be chronic, then generally, a showing of “continuity of symptoms” after service is required for service connection. 38 C.F.R. § 3.303(b). Service connection may also be established with certain chronic diseases, including arthritis, based upon a legal presumption by showing that the disorder manifested itself to a degree of 10 percent disabling or more within one year from the date of separation from active service. Such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of active service. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309(a). While the disease need not be diagnosed within the presumption 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. As discussed below, the Veteran does not allege that any current arthritis of the cervical spine or bilateral hips manifested within one year from the date of his separation from active service. Therefore, the one-year presumption does not apply. Service connection may also be granted for a disability that is proximately due to or the result of a service-connected disability. See 38 C.F.R. § 3.310(a). When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. See 38 C.F.R. § 3.310(a); Harder v. Brown, 5 Vet. App. 183, 187 (1993). To prevail on the issue of secondary service causation, generally, the record must show (1) medical evidence of a current disability, (2) a service-connected disability, and (3) medical nexus evidence establishing a connection between the current disability and the service-connected disability. Wallin v. West, 11 Vet. App. 509, 512 (1998); Reiber v. Brown, 7 Vet. App. 513, 516-17 (1995). In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). When considering whether lay evidence is competent, the Board must determine, on a case-by-case basis, whether a veteran’s particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). A veteran is competent to report symptoms because this requires only personal knowledge, not medical expertise, as it comes to him through his senses. See Layno, 6 Vet. App. 465, 469. Lay testimony is competent to establish the presence of observable symptomatology, where the determination is not medical in nature and is capable of lay observation. Barr v. Nicholson, 21 Vet. App. 303 (2007). Lay evidence may establish a diagnosis of a simple medical condition, a contemporaneous medical diagnosis, or symptoms that later support a diagnosis by a medical professional. Jandreau, 492 F.3d 1372, 1377. When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with a veteran prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 3. Arthritis of the Bilateral Hips and Right Ulnar Condition The Veteran seeks service connection for arthritis of the bilateral hips. He claims that he has a current diagnosis of arthritis of the bilateral hips that is related to or caused by service. The Veteran also seeks service connection for a right ulnar condition. He claims that he has a current diagnosis of a right ulnar condition that is related to or caused by service or his service-connected disabilities. While the record contains extensive medical evidnece, to include both from VA and private medical providers, there is no evidence of a current diagnosis or current symptoms of arthritis of the bilateral hips or of a right ulnar condition. Furthermore, the August 2014 VA examination report indicated that no arthritis was documented in imaging studies of the hip. Service connection may only be granted for a current disability; when a claimed condition is not shown, there may be no grant of service connection. See 38 U.S.C. § 1110; Rabideau v. Derwinski, 2 Vet. App. 141 (1992) (Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability). “In the absence of proof of a present disability there can be no valid claim.” See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Insomuch as the Veteran has attempted to establish a diagnosis of arthritis of the bilateral hips or of a right ulnar condition through his own lay assertions, the Board finds that while the Veteran is competent to report experiencing pain, he is not competent to diagnose that he has a current diagnosis of arthritis or of an ulnar disability due to the medical complexity of the matter. See Jandreau v. Nicholson, 492 F.3d 1372, 1377, n.4 (Fed. Cir. 2007) (“sometimes the layperson will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer”). Thus, the Veteran is not competent to render such a diagnosis. After a review of all of the evidence of record, both lay and medical, the Board finds that the weight of the competent evidence demonstrates that the Veteran does not have a diagnosis of arthritis of the bilateral hips or of a right ulnar condiiton. The Veteran has asserted that he should be entitled to service connection; however, service connection is only warranted if a claimant has a current disability. Here, the record contains no diagnosis of arthritis of the bilateral hips or of a right ulnar condition. As there is no current diagnosis, service connection must be denied. Effective Date Claims The effective date for an award of disability compensation based on an original claim for direct service connection, if the claim is received within one year after separation from service, shall be the day following separation from active service or the date entitlement arose; otherwise, and for reopened claims, it 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 (2017). The terms claim and application mean 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). Generally, the date of receipt of a claim is the date on which a claim, information, or evidence is received by VA. 38 C.F.R. § 3.1(r). A sympathetic reading as to all potential claims raised by the evidence is required. Szemraj v. Principi, 357 F.3d 1370 (Fed. Cir. 2004). A specific claim in the form prescribed by the Secretary of VA must be filed in order for benefits to be paid to any individual under the laws administered by the VA. 38 U.S.C. § 5101(a). A claim is defined broadly to include a formal or informal communication in writing requesting a determination of entitlement or evidencing a belief in entitlement to a benefit. 38 C.F.R. § 3.1(p); Brannon v. West, 12 Vet. App. 32, 34-5 (1998); Servello v. Derwinski, 3 Vet. App. 196, 199 (1992). Any communication indicating intent to apply for a benefit under the laws administered by the VA may be considered an informal claim provided it identifies, but not necessarily with specificity, the benefit sought. See 38 C.F.R. § 3.155(a). VA is required to identify and act on informal claims for benefits. 38 C.F.R. §§ 3.1(p), 3.155(a). Pursuant to 38 C.F.R. § 3.155, any communication or action indicating intent to apply for one or more VA benefits, including statements from a veteran’s duly authorized representative, may be considered an informal claim. Such an informal claim must identify the benefit sought. In certain circumstances, VA treatment records may constitute an informal claim. 38 C.F.R. § 3.157. 6. Effective date for the award of service connection for diabetes In this case, the RO assigned an effective date of March 15, 2005, for the award of service connection diabetes; this date corresponds with the date the RO received the Veteran’s statement which requested service connection for diabetes. The Board has reviewed all relevant evidence and finds no basis under the law to award an effective date earlier than March 15, 2005, for the grant of service connection for diabetes. There is nothing in the record prior to that date which could be construed as a claim for service connection for diabetes, even under the broadest definition of a claim. While the Veteran was diagnosed with diabetes in February 2003, there is no evidence of such diagnosis prior to March 15, 2005. See March 2005 letter from Veteran. The Board notes that the Veteran contends that he submitted an informal claim in 2003, contemporaneously with his initial diagnosis of diabetes in February 2003. Unfortunately, no informal claim dated prior to March 15, 2005 is present in the claims folder. As such, the RO has already assigned the earliest possible effective date for its grant of the original informal claim, which was determined to be March 15, 2005. Consequently, there is no legal basis upon which to grant an effective date prior to March 15, 2005, for the grant of service connection for diabetes. The Board is bound by the law governing the assignment of effective dates in its determination in this case. See 38 U.S.C. § 7104(c). The claim of entitlement to an effective date earlier than March 15, 2005, for the award of service connection for diabetes must be denied. 7. Effective date for the award of service connection for erectile dysfunction and award of SMC at the K-level. In this case, the RO assigned an effective date of March 15, 2005, for the award of service connection for erectile dysfunction and SMC at the K-level; this date corresponds with the date the RO received the Veteran’s statement which requested service connection for diabetes and residual disabilities, to include erectile dysfunction. The Board has reviewed all relevant evidence and finds no basis under the law to award an effective date earlier than March 15, 2005, for the award of service connection for erectile dysfunction and SMC at the K-level, both as secondary to service-connected diabetes. As detailed above, this corresponds to the date of the Veteran’s original service connection claim for diabetes and residual disabilities, including erectile dysfunction, and is consistent with the effective date of the award of service connection for diabetes. As such, the RO has already assigned the earliest possible effective date for its grant of the original informal claim, which was determined to be March 15, 2005. Consequently, there is no legal basis upon which to grant an effective date prior to March 15, 2005, for the award of service connection for erectile dysfunction and SMC at the K-level, secondary to service-connected diabetes. The Board is bound by the law governing the assignment of effective dates in its determination in this case. See 38 U.S.C. § 7104(c). The claim of entitlement to an effective date earlier than March 15, 2005, for the awards of service connection for erectile dysfunction and SMC at the K-level, secondary to service-connected diabetes, must be denied. 8. Effective date for the award of service connection for bilateral lower extremity peripheral neuropathy In this case, the RO assigned an effective date of March 15, 2005, for the award of service connection for bilateral lower extremity peripheral neuropathy; this date corresponds with the date the RO received the Veteran’s statement which requested service connection for diabetes and residual disabilities, including bilateral lower extremity peripheral neuropathy. The Board has reviewed all relevant evidence and finds no basis under the law to award an effective date earlier than March 15, 2005, for the award of service connection for bilateral lower extremity peripheral neuropathy, secondary to service-connected diabetes. As detailed above, this corresponds to the date of the Veteran’s original service connection claim for diabetes and residual disabilities, including bilateral lower extremity peripheral neuropathy, and is consistent with the effective date assigned for the award of service connection for diabetes. As such, the RO has already assigned the earliest possible effective date for its grant of the original informal claim, which was determined to be March 15, 2005. Consequently, there is no legal basis upon which to grant an effective date prior to March 15, 2005, for the award of service connection for bilateral lower extremity peripheral neuropathy, secondary to service-connected diabetes. The Board is bound by the law governing the assignment of effective dates in its determination in this case. See 38 U.S.C. § 7104(c). The claim of entitlement to an effective date earlier than March 15, 2005, for the awards of service connection for bilateral lower extremity peripheral neuropathy, secondary to service-connected diabetes, must be denied. REASONS FOR REMAND Bilateral Shoulder The Veteran was afforded a VA examination in August 2014. The VA examiner diagnosed the Veteran with arthritis of the bilateral shoulders and opined that this condition was not related to or caused by the Veteran’s service-connected right knee disability. The VA examiner explained that the preponderance of medical evidence did not support disability in one joint causing a disability in an adjacent or contralateral joint in the absence of inflammatory arthritides and/or ankylosis. In addition, osteoarthritis was a frequently slowly progressive joint disease typically seen in middle-aged to elderly people. The VA examiner stated that the radiography finding of mild acromioclavicular joint arthritis of bilateral shoulders was consistent with natural progression of aging, and was not due to or caused by the Veteran’s service-connected right knee disability. However, while the VA examination report indicated that the Veteran’s right shoulder arthritis symptoms began five or six years prior, a September 1991 letter from the Veteran’s treating physician, indicated that he had arthritis of the shoulders that had been slowly worsening over the last five years. In addition, the VA examiner did not consider the Veteran’s September 1991 statement indicating that his shoulder pain first manifested and worsened throughout the 1970’s and early 1980s. For these reasons, the Board finds the August 2014 VA examiner’s nexus opinion inadequate, as it is not based on an accurate medical history and does not address the Veteran’s competent reports of shoulder pain for many years. Therefore, remand is required to obtain an addendum medical opinion that is based on a complete medical treatment history and takes into account the Veteran’s competent reports of pain for many years. Cervical Spine In the May 2015 notice of disagreement, the Veteran reported that he was treated for arthritis of multiple joints at Fort Knox Army Hospital. Such records are not in the claims folder and it does not appear that any such records have been requested. Therefore, remand is required to obtain these records. Right Knee The Veteran seeks service connection for nerve pain in the right knee, to include meralgia paresthetica and lumbar radiculopathy, The Veteran was afforded a VA examination in August 2014. The VA examiner noted diagnoses of meralgia paresthetica and lumbar radiculopathy, and incorrectly stated that the lumbar radiculopathy was already service-connected. The VA examiner opined that the meralgia paresthetica of the right thigh was not related to or caused by the Veteran’s service-connected right knee disability. The VA examiner explained that meralgia paresthetica was numbness or pain in the outer thigh not caused by injury to the thigh, but by injury to a nerve that extends from the thigh to the spinal column. The VA examiner further stated that arthritis of the knee was not recognized by medical research as a causative factor or risk factor for development of either lumbar radiculopathy or meralgia paresthetica. However, the VA examiner did not address the significance, if any, of the Veteran’s reports of frequent falls, and whether those falls are related to or caused by the Veteran’s service-connected disabilities, to include a right knee disability and bilateral lower extremity peripheral neuropathy. See February 2012 VA treatment record. Remand is required to obtain an addendum medical opinion that addresses the significance and etiology of the Veteran’s frequent falls. In addition, in February 2015, subsequent to the last VA examination in August 2014, the Veteran reported having knee pain that radiated from the knee to the ankles and foot, and was exacerbated by walking, sitting, or bending. On remand, the VA examiner should address the significance, if any, of these symptoms. Rating for Diabetes Mellitus, PTSD, and TDIU The record reflects that VA-generated evidence has been added to the claims file since the remaining claims were last adjudicated in the April 2015 SSOC. In this regard, VA treatment records dated in September 2013 to July 2015 were added to the claims file in August 2015, after the SSOC, and a new SSOC was not issued with consideration of the new VA treatment records. While 38 U.S.C. § 7105(e) provides an automatic waiver of initial AOJ review if a veteran submits evidence to the AOJ or the Board with, or after submission of, a Substantive Appeal, this provision is only applicable to cases where the Substantive Appeal was filed on or after February 2, 2013, which is not the case here. 38 U.S.C. § 7105(e). As there is no indication that the Veteran has specifically waived initial AOJ adjudication of the new VA treatment records, a remand is required for the AOJ to consider this evidence in a SSOC. The matters are REMANDED for the following action: 1. Obtain the Veteran’s updated VA treatment records and any identified private treatment records. 2. Request and obtain any hospital records pertaining to treatment received at the Fort Knox Army Hospital in 1968. All reasonable attempts should be made to obtain such records. If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile, which should be documented in the claims file. The Veteran must be notified of the attempts made and why further attempts would be futile, and allowed the opportunity to provide such records, as provided in 38 U.S.C. § 5103A(b)(2) and 38 C.F.R. § 3.159(e). 3. Refer the case to the VA examiner who conducted the August 2014 VA examination (or a suitable substitute) for an addendum opinion as to the etiology of the Veteran’s arthritis of the bilateral shoulders. The claims file, including a copy of this Remand, must be made available to, and be reviewed by, the VA examiner. Another examination is not required; however, if the examiner indicates that he or she cannot respond to the Board’s questions without examination of the Veteran, another examination should be afforded to the Veteran. After a complete review of the record, the examiner is asked to provide an opinion as to whether the diagnosed arthritis of the bilateral shoulders is at least as likely as not (50 percent probability or greater) related to or caused by service. The examiner should note the following evidence: (i) The September 1991 letter from the Veteran’s treating physician indicating that he had arthritis of the shoulders that had been slowly worsening over the last five years. (ii) The Veteran’s September 1991 statement indicating that his shoulder pain first manifested and worsened throughout the 1970’s and early 1980s. A thorough explanation must be provided for the opinion rendered. 4. Refer the case to the VA examiner who conducted the August 2014 VA examination (or a suitable substitute) for an addendum opinion as to the etiology of the Veteran’s nerve pain in the right knee, to include meralgia paresthetica and lumbar radiculopathy. The claims file, including a copy of this Remand, must be made available to, and be reviewed by, the VA examiner. Another examination is not required; however, if the examiner indicates that he or she cannot respond to the Board’s questions without examination of the Veteran, another examination should be afforded to the Veteran. After a complete review of the record, the examiner is asked to provide the following opinions: (i) Whether the Veteran’s nerve pain in the right knee, to include meralgia paresthetica and lumbar radiculopathy, is at least as likely as not (50 percent probability or greater) related to or caused by service. (ii) Whether the Veteran’s nerve pain in the right knee, to include meralgia paresthetica and lumbar radiculopathy, is at least as likely as not (50 percent probability or greater) related to or caused by the Veteran’s service-connected disabilities, including the right knee disability and bilateral lower extremity peripheral neuropathy. The examiner should note the following evidence: (i) The Veteran’s repeated reports in his VA treatment records of frequent falls. (ii) The January 2012 VA treatment record indicating that the Veteran fell after his leg gave out, which it had been doing since Vietnam. (iii) The February 2015 VA treatment record indicating that the Veteran reported having knee pain that radiated from the knee to the ankles and foot, and was exacerbated by walking, sitting, or bending. A thorough explanation must be provided for the opinions rendered. (Continued on the next page)   5. Then, readjudicate the remaining issues on appeal. KELLI A. KORDICH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Thomas, Associate Counsel