Citation Nr: 18157768 Decision Date: 12/13/18 Archive Date: 12/13/18 DOCKET NO. 16-58 026 DATE: December 13, 2018 ORDER New and material evidence having been received, the service connection claim for a nervous condition is reopened. No new and material evidence having been received, the petition to reopen the service connection claim for right shoulder pain and problems is denied. No new and material evidence having been received, the petition to reopen the service connection claim for lower back pain and problems is denied. Service connection for hypertension is denied. Service connection for a left shoulder disability is denied. Service connection for a stomach disability is denied. An initial, compensable disability rating for bilateral hearing loss is denied. REMANDED The issue of entitlement to service connection for an acquired psychiatric disability, to include depression and anxiety, previously claimed as a nervous condition is remanded. The issue of entitlement to service connection for sleep apnea is remanded. The issue of entitlement to service connection for headaches is remanded. The issue of entitlement to service connection for erectile dysfunction is remanded. The issue of entitlement to an effective date prior to December 1, 2014 for the grant of service connection for bilateral hearing loss is remanded. The issue of entitlement to an effective date prior to December 1, 2014 for the award an increased disability rating of 10 percent for a residual scar of the right buttock status post incision for abcess drainage is remanded. The issue of entitlement to an increased disability rating in excess of 10 percent for a residual scar on the right buttock status post incision for abcess drainage is remanded. FINDINGS OF FACT 1. Since the final June 1979 rating decision denying the Veteran’s service connection claim for a nervous condition, new medical and lay evidence have been associated with the claims file bearing on the previously unestablished in service incurrence element, raising a reasonable possibility of substantiating the claim. 2. Although new medical evidence has been associated with the claims file since the final June 2011 rating decision denying the Veteran’s service connection claim for right shoulder pain and problems, it is not material because it does not bear on the previously unestablished in service incurrence element and does not raise a reasonable possibility of substantiating the claim. 3. Although new medical evidence has been associated with the claims file since the final June 2011 rating decision denying the Veteran’s service connection claim for lower back pain and problems, it is not material because it does not bear on the previously unestablished in service incurrence element and does not raise a reasonable possibility of substantiating the claim. 4. The evidence of record does not establish the Veteran’s hypertension onset in service; manifested to a compensable degree within one year of separation from service; or demonstrate chronicity and continuity of symptomatology post-separation. 5. The evidence of record does not establish a current diagnosis of a left shoulder condition. 6. The evidence of record does not establish the Veteran’s current diagnosis of hiatal hernia was incurred in service. 7. At all times, the Veteran’s hearing loss was manifested by hearing impairment no worse than Level II in the right ear and Level I in the left ear. CONCLUSIONS OF LAW 1. The July 1979 rating decision denying the Veteran’s service connection claim for a nervous condition is final. 38 U.S.C. § 7105 (2012); 38 C.F.R. § 20.1103 (2017). 2. Following the July 1979 rating decision, new and material evidence has been received to reopen the service connection claim for a nervous condition. 38 U.S.C. §§ 5108, 7105 (2012); 38 C.F.R. §§ 3.156, 20.1103 (2017). 3. The June 2011 rating decision denying the Veteran’s service connection claim for right shoulder pain and problems is final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. 4. Following the June 2011 rating decision, new and material evidence has not been received to reopen the service connection claim for right shoulder pain and problems. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.156, 20.1103. 5. The June 2011 rating decision denying the Veteran’s service connection claim for lower back pain and problems is final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. 6. Following the June 2011 rating decision, new and material evidence has not been received to reopen the service connection claim for lower back pain and problems. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.156, 20.1103. 7. The criteria for entitlement to service connection for hypertension have not been met. 38 U.S.C. §§ 1131, 1132, 1133, 1137 (2012); 38 U.S.C. §§ 3.303, 3.304, 3.307, 3.309 (2017). 8. The criteria for entitlement to service connection for a left shoulder disability have not been met. 38 U.S.C. §§ 1131, 1132, 1137; 38 U.S.C. §§ 3.303, 3.304. 9. The criteria for entitlement to service connection for a stomach disability have not been met. 38 U.S.C. §§ 1131, 1132, 1137; 38 U.S.C. §§ 3.303, 3.304. 10. The criteria for an initial, compensable disability rating for bilateral hearing loss have not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.6, 4.7, 4.27, 4.85, 4.86, Diagnostic Code (DC) 6100 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from May 1977 to June 1979. Service Connection 1. Whether new and material evidence has been submitted to reopen the service connection claim for a nervous condition. The Veteran first initiated a service connection claim for a “nervous condition” in June 1979. June 1979 Veteran’s Application for Compensation or Pension at Separation from Service. In a June 1979 rating decision, the Regional Office (RO) denied the claim, finding there was insufficient evidence demonstrating a chronic psychiatric condition in service. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). He did not initiate an appeal of this decision and it became final. 38 U.S.C. § 7105(c); 38 C.F.R. § 20.1103. Subsequently, the Veteran submitted a service connection claim for “depression/anxiety” in December 2014. December 2014 Application for Disability Compensation and Related Compensation Benefits. In an April 2015 rating decision, the RO denied the claim. In rendering this decision, the RO did not first adjudicate the issue of whether new and material evidence had been received to reopen the original service connection claim for a nervous condition. Instead, the RO adjudicated the claim on its merits, finding there was insufficient evidence of an in service incurrence. See Shedden, supra. He appealed this decision, and it is now before the Board. Irrespective of the RO’s determination, the Board must independently assess whether new and material evidence has in fact been submitted in order to assume jurisdiction over the merits of this claim. See Barnett v. Brown, 83 F.3d 1380, 1383 (Fed. Cir. 1996); Jackson v. Principi, 265 F.3d 1366, 1369-70 (Fed. Cir. 2001). Generally, “new” evidence is defined as existing evidence not previously submitted to agency decisions makers, while “material” evidence is defined as evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. 38 C.F.R. § 3.156(a). The evidence must not be cumulative or redundant of the evidence previously of record, and must raise a reasonable possibility of substantiating the claim. Id. Since the final June 1979 rating decision, new medical and lay evidence has been received. In pertinent part, a November 2016 Mental Disorders Disability Benefits Questionnaire (DBQ) completed by Dr. R.W. diagnosed the Veteran with depressive disorder and included a nexus opinion that it was more likely than not it began in service and has been aggravated by his service-connected tinnitus as well as his non-service connected lumbar spine disability. In doing so, Dr. R.W. cited his service treatment record (STRs) which were previously associated with the claims file. In particular, STRs from June 1978 and November 1978 in which he reported suffering from sleep disturbances and having difficulty adjusting to military life. Additionally, an October 2016 Buddy Statement from W.L., the Veteran’s brother, has been associated with the claims file. In the Buddy Statement, W.L. described a change in the Veteran’s behavior upon enlistment. Considering the above, the Board finds the new medical and lay evidence, in conjunction with the prior evidence of record, is material because they relate to the previously unestablished in service incurrence element. Therefore, a reasonable possibility of substantiating the claim has been raised. 38 C.F.R. § 3.156(a); see also Shade v. Shinseki, 24 Vet. App. 110 (2010). 2. Whether new and material evidence has been received to reopen the service connection claim for right shoulder pain and problems. The Veteran first initiated a service connection claim for a “right shoulder pain [and] problems” in March 2011. March 2011 Veteran’s Application for Compensation and/or Pension. In a June 2011 rating decision, the RO denied the claim, finding there was insufficient evidence of an in service incurrence. See Shedden, supra. He initiated an appeal of this decision. July 2011 Statement in Support of Claim. Of note, following the June 2011 rating decision, a July 2011 Statement in Support of Claim, July 2011 letter from the Veteran and an July 2011 Buddy Statement from M.L., his wife, were associated with the claims file. In his Statement in Support of Claim, he stated that he injured his right shoulder during boot camp when his shoulder popped during physical training and sought treatment for it in service. In his letter, he relayed that he injured his right shoulder during basic training while doing push-ups and since that time, he has continued to experience pain in his right shoulder. In her Buddy Statement, M.L. recalled he complaint of pain in his shoulder while he was in basic training. This lay evidence was considered by the RO in its June 2013 Statement of the Case (SOC). Even after considering all the relevant evidence of record, the RO once again concluded there was insufficient evidence of an in service incurrence. See Shedden, supra. Unfortunately, the Veteran did not timely perfect the appeal. June 2013 Statement of the Case; November 2013 VA Form 9. Consequently, the decision became final. 38 U.S.C. § 7105(c); 38 C.F.R. § 20.1103. It appears the Veteran subsequently submitted a service connection claim for right shoulder pain. May 2014 Veteran’s Claims Assistance Act of 2000 (VCAA) Letter to the Veteran. In an October 2014 rating decision, the RO properly interpreted the claim as a petition to reopen the previously denied service connection claim for right shoulder pain and problems. The RO denied the petition to reopen finding that while new medical evidence had been received it was not material because it did not relate to the previously unestablished in service incurrence element. 38 C.F.R. § 3.156(a). The Veteran did not appeal the October 2014 rating decision. However, within a month of the decision, he filed a November 2014 Application for Disability Compensation and Related Compensation Benefits. In an April 2015 rating decision, the RO reconsidered its October 2014 denial of the petition to reopen the previously denied service connection claim for right shoulder pain and problems. Nonetheless, the RO denied the petition to reopen, finding that no new or material evidence has been received since the October 2014 rating decision. He appealed this decision and it is now before the Board. Since the final June 2011 rating decision, new medical evidence has been received. In pertinent part, new VA treatment records have been associated with the claims file showing continued right shoulder complaints and diagnoses. However, none of the new VA treatment records relate to the previously unestablished in service incurrence element. Therefore, the new medical evidence is not material because it does not raise a reasonable possibility of substantiating the claim. Cf. 38 C.F.R. § 3.156(a); cf. also Shade, supra. 3. Whether new and material evidence has been received to reopen the service connection claim for lower back pain and problems. The Veteran first initiated a service connection claim for “lower back pain [and] problems” in March 2011. March 2011 Veteran’s Application for Compensation and/or Pension. In a June 2011 rating decision, the RO denied the claim, finding there was insufficient evidence of nexus. See Shedden, supra. He initiated an appeal of this decision. July 2011 Statement in Support of Claim. Notably, following the June 2011 rating decision, new VA treatment records were associated with the claims file in December 2011, which continued to document lumbar spine complaints and diagnoses. Additionally, an July 2011 Statement in Support of Claim, July 2011 letter from the Veteran and an July 2011 Buddy Statement from M.L., his wife, were associated with the claims file. In his Statement in Support of Claim, he stated that he injured his back during basic training and sought treatment for it in service. In his letter, he relayed that he began having back problems in service. He told his commanding officer about it, but was told to “suck it up.” In her Buddy Statement, M.L. recalled he complaint of pain in his back while he was in basic training. The above medical and lay evidence was considered by the RO in its June 2013 Statement of the Case (SOC). Even after considering all the relevant evidence of record, the RO once again concluded there was insufficient evidence of an in service incurrence. See Shedden, supra. Unfortunately, the Veteran did not timely perfect the appeal. June 2013 Statement of the Case; November 2013 VA Form 9. Consequently, the decision became final. 38 U.S.C. § 7105(c); 38 C.F.R. § 20.1103. It appears the Veteran subsequently submitted a service connection claim for a lumbar spine disability. May 2014 VCAA Letter to the Veteran. In an October 2014 rating decision, the RO properly interpreted the claim as a petition to reopen the previously denied service connection claim for lower back pain and problems. The RO denied the petition to reopen, finding that while new medical evidence had been received it was not material because it did not relate to the previously unestablished nexus element. 38 C.F.R. § 3.156(a). The Veteran did not appeal the October 2014 rating decision. However, within a month of the decision, he filed a November 2014 Application for Disability Compensation and Related Compensation Benefits. In an April 2015 rating decision, the RO reconsidered its October 2014 denial of the petition to reopen the previously denied service connection claim for lower back pain and problems. Even so, the RO denied the petition to reopen finding that no new or material evidence has been received since the October 2014 rating decision. He appealed this decision and it is now before the Board. Since the final June 2011 rating decision, new medical evidence has been received. In pertinent part, new VA treatment records have been associated with the claims file showing continued lumbar spine complaints and diagnoses. However, none of the new VA treatment records relate to the previously unestablished nexus element. Therefore, the new medical evidence is not material because it does not raise a reasonable possibility of substantiating the claim. Cf. 38 C.F.R. § 3.156(a); cf. also Shade, supra. 4. The issue of entitlement to service connection for hypertension. The Veteran contends that his diagnosis of hypertension stems from his service. See November 2014 Application for Disability Compensation and Related Compensation Benefits. Generally, service connection may be established if the evidence demonstrates that a current disability resulted from a disease or injury incurred in or aggravated by active duty service. 38 C.F.R. § 3.303. In that regard, service connection may be established for any disease diagnosed after discharge when all the evidence, including that pertinent to the period of service, establishes the disease was incurred during active duty service. 38 C.F.R. § 3.303(d). In order to prove service connection, there must be competent and credible evidence of (1) a current disability; (2) an in service incurrence or aggravation of a disease or injury; and (3) a nexus or link between the current disability and the in service disease or injury. See Shedden, supra. In assessing the evidence of record, the Board acknowledges the Veteran is competent to provide evidence regarding the lay observable symptoms associated with his hypertension. See Barr v. Nicholson, 21 Vet. App. 303, 307-08 (2007), abrogated on other grounds by Walker, 708 F.3d 1331 (Fed. Cir. 2013). However, he is not competent to render a medical diagnosis of hypertension or an opinion on such a complex matter as the etiology thereof. See Barr, supra; Jones v. West, 12 Vet. App. 460, 465 (1999). Therefore, in this regard, the Board relies on the medical evidence of record. Here, a review of the Veteran’s medical records establishes that he has a current diagnosis of hypertension. See April 2016 VA Primary Care Note. Thus, the current disability element has been met. See Shedden, supra. Although the Veteran generally alleges his diagnosis of hypertension is due to his active duty service, he has not submitted any lay statements in support of his contention. Accordingly, the Board turns to his STRs to determine whether the in service incurrence element may be satisfied. A review of the Veteran’s STRs is negative for any complaints related to hypertension. There are no elevated blood pressure readings documented among his STRs. For instance, a March 1978 Chronological Record of Medical Care recorded a blood pressure reading of 138 (systolic)/80 (diastolic) millimeters of mercury (mm Hg) when he sought medical attention related to the lower back. See 38 C.F.R. § 4.104, Diagnostic Code 7101, Note (1) (the VA defines the term “hypertension” as having a diastolic pressure predominantly 90 mm Hg or greater, and the term “isolated systolic hypertension” as having systolic blood pressure predominantly 160 mm Hg or greater with a diastolic blood pressure of less than 90 mm Hg) (2017). Thereafter, an August 1978 Chronological Record of Medical Care recorded a blood pressure reading of 120/70 mm Hg when he sought medical attention for an upper respiratory infection. Significantly, at the time of his separation examination, his blood pressure reading was 120/80 mm Hg and he denied having or having had any issues with high or low blood pressure. April 1979 Report of Medical Examination; April 1979 Report of Medical History. There are no other blood pressure readings among his STRs. Given the above, there is no evidence of record demonstrating the Veteran’s hypertension had its onset in service. Therefore, the in service incurrence element has not been satisfied. See Shedden, supra. Accordingly, the Board finds the preponderance of the evidence does not substantiate his service connection claim for hypertension on a direct basis. Cf. 38 U.S.C. § 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2012); cf. also Fagan v. Shinseki, 573 F.3d 1282, 1287 (2009). Notwithstanding the above, service connection may alternatively be granted on a presumptive basis for certain chronic diseases, such as hypertension. 38 C.F.R. §§ 3.307(a)(3), 3.309(a). A chronic disease may be presumptively service connected if it is shown to have manifested to a compensable degree within one year of separation from service or if the evidence establishes chronicity and continuity of symptomatology post-separation. 38 C.F.R. § 3.303(b); Walker, supra. A review of the claims file shows the earliest diagnosis of hypertension of record comes in June 2010. June 2010 VA Primary Care Note. At the time of the June 2010 appointment, the Veteran reported having been diagnosed with hypertension for the past 10 years; since approximately 2000, more than 20 years post-separation. There are no other relevant medical records prior to June 2010 which document complaints related to or a diagnosis of hypertension. In view of the above, the Board finds the preponderance of the evidence does not demonstrate the Veteran’s hypertension had its onset within one year following his separation from service, much less to a compensable degree, or establish chronicity and continuity of symptomatology post-separation. Cf. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 3.307(a), 3.309(a); cf. also Fagan, supra. Consequently, service connection on a presumptive basis as a chronic disease cannot be justified. The Board acknowledges the Veteran has not been afforded a VA examination with respect to this claim. However, a remand for an examination is not warranted because the McLendon elements necessitating one have not been met. Cf. McLendon v. Nicholson, 20 Vet. App. 79 (2006). Specifically, there is no evidence suggesting that an event, injury or disease occurred in service or during an applicable presumptive period to warrant an examination. 5. The issue of entitlement to service connection for a left shoulder disability. The Veteran contends that he has a left shoulder disability which stems from his service. See November 2014 Application for Disability Compensation and Related Compensation Benefits. Pivotal to any service connection claim is the presence of a current disability Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); see also Shedden, supra. In the absence of proof of a current disability, there can be no valid claim. Once again, although the Veteran generally alleges he has a left shoulder disability due to his active duty service, he has not submitted any lay statements in support of his contention. Further, a review of the medical records discloses no complaints or diagnoses of a left shoulder condition whatsoever. Based on the above, the Board finds the preponderance of the evidence does not support service connection for a left shoulder disability. Cf. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304; cf. also Fagan, supra. The Board acknowledges the Veteran has not been afforded a VA examination with respect to this claim as well. However, a remand for an examination is not warranted because the McLendon elements necessitating one have not been met. Cf. McLendon, supra. Specifically, there is no competent evidence of a current disability or persistent or recurrent symptoms of a disability. 6. The issue of entitlement to service connection for a stomach disability. The Veteran contends that he has been diagnosed with a stomach disability which stems from his service. See November 2014 Application for Disability Compensation and Related Compensation Benefits. Here, a review of the Veteran’s medical records establishes that he was diagnosed with a hiatal hernia in August 2010. See April 2016 VA Primary Care Note. There are no other diagnoses of a stomach condition of record. While there are no current medical records showing that he continues to carry this diagnosis, there are also no medical records suggesting the hiatal hernia has resolved. Therefore, the Board accords him the benefit of the doubt and finds the current disability element has been met. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; see also Shedden, supra. Again, although the Veteran generally alleges his diagnosis of hiatal hernia is due to his active duty service, he has not submitted any lay statements in support of his contention. Accordingly, the Board turns to his STRs to determine whether the in service incurrence element may be satisfied. While a review of the Veteran’s STRs reveals he complained of stomach pains in service on at least one occasion, it was attributed to a viral syndrome, more specifically an upper respiratory infection. August 23, 1978 Chronological Record of Medical Care; August 30, 1978 Chronological Record of Medical Care. His STRs are silent as to a diagnosis of hiatal hernia or any other stomach condition in service. In fact, at the time his separation examination, no abnormal findings were noted and he denied having or having had any stomach, liver or intestinal trouble. April 1979 Report of Medical Examination; April 1979 Report of Medical History. In light of the above, the Board finds there is insufficient evidence of record demonstrating the Veteran suffered from a stomach condition in service. As a result, the in service incurrence element has not been satisfied. See Shedden, supra. For this reason, the Board finds the preponderance of the evidence does not substantiate his service connection claim for a stomach disability. Cf. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304; cf. also Fagan, supra. The Board acknowledges the Veteran has also not been afforded a VA examination with respect to this claim. However, a remand for an examination is not warranted because the McLendon elements necessitating one have not been met. Cf. McLendon, supra. Specifically, there is no evidence indicating the current diagnosis of hiatal hernia may be associated with his in service diagnosis of a viral syndrome. 7. The issue of entitlement to an initial, compensable disability rating for bilateral hearing loss. The Veteran contends that he is entitled to an initial, compensable disability rating for bilateral hearing loss. See June 2015 Notice of Disagreement. As a procedural matter, despite the remand below with respect to the issue of an effective date prior to December 1, 2014 for the grant of service connection for bilateral hearing loss, the Board finds adjudication of this claim is appropriate given the evidence to be considered when an initial disability rating is at issue includes the entire appeal period. See Fenderson v. West, 12 Vet. App. 119 (1999). Preliminarily, the Board notes the applicable DC for hearing impairment is DC 6100. 38 C.F.R. § 4.85. The diagnostic criteria associated with DC 6100 do not list any specific symptoms or functional effects. 38 C.F.R. §§ 4.85, Table VI, Table VIA, Table VII, 4.86; see also Doucette v. Shulkin, 28 Vet. App. 366, 367 (2017). Rather, hearing loss is evaluated through the mechanical application of a veteran’s audiometric test results to the rating tables. Doucette, 28 Vet. App. at 367, citing Lendenmann v. Principi, 3 Vet. App. 345, 349 (1992). The Rating Schedule utilizes three tables to evaluate hearing impairment; Tables VI, VIA, and VII. 38 C.F.R. § 4.85. Table VII is used to determine the percentage evaluation by combining Roman numeral designations for the level of hearing impairment in each ear. 38 C.F.R. § 4.85(e). Roman numeral designations are derived from Table VI or VIA. 38 C.F.R. §§ 4.85(b), (c). Table VI is based on a combination of puretone threshold average and speech discrimination percentage. 38 C.F.R. § 4.85(b). The Roman numerals range from I to XI. A higher Roman numeral is assigned based on a combination of a higher puretone threshold average and a lower speech discrimination percentage. If the use of speech discrimination is not appropriate, then Table VIA is the appropriate source of the Roman numeral designation, which is based solely on puretone threshold average. 38 C.F.R. § 4.85 (c). Puretone threshold average is the average of the puretone thresholds at the 1000, 2000, 3000, and 4000 Hertz (Hz) frequencies. 38 C.F.R. § 4.85(d). Notwithstanding the above, when the puretone threshold at the 1000, 2000, 3000, and 4000 Hz frequencies is 55 decibels (dB) or more; or when the puretone threshold is 30 dB or less at the 1000 Hz frequency and 70 dB or more at the 2000 Hz frequency, whichever table, Table VI or VIA, results in the highest Roman numeral designation will be utilized. 38 C.F.R. § 4.86. As noted above, in assessing the evidence of record, the Board recognizes the Veteran is competent to provide evidence regarding the lay observable symptoms of his hearing impairment. See Barr, supra. However, for VA compensation purposes, audiometric testing conducted by a state-licensed audiologist is required to evaluate the severity of a veteran’s hearing impairment. 38 C.F.R. § 4.85. Since there is no evidence of record establishing the Veteran is a state-licensed audiologist, he is not competent to provide evidence regarding the severity of his hearing loss in terms of puretone thresholds and speech discrimination percentage. See Barr, supra; Jones, supra. As a result, the Board must rely on the medical evidence of record. A review of the claims file produces only one relevant piece of medical evidence; an April 2015 Hearing Loss and Tinnitus VA Examination Report. At the time of the April 2015 examination the Veteran simply relayed that he was having difficulty hearing. Audiometric testing yielded the following results: HERTZ 1000 2000 3000 4000 Average RIGHT 20 dB 45 dB 45 dB 50 dB 40 dB LEFT 30 dB 35 dB 45 dB 55 dB 41 dB The VA examiner determined the use of speech discrimination scores were appropriate. The Board notes not all the puretone threshold levels at the 1000, 2000, 3000 and 4000 Hz frequencies was 55 dB or more for either ear. Further, the puretone threshold is 30 dB or less at the 1000 Hz frequency and 70 dB or more at the 2000 Hz frequency. Based on the foregoing, Table VIA is not applicable. 38 C.F.R. §§ 4.85(c), 4.86. Utilizing Table VI, the combination of the 40 dB puretone threshold average and the 90 percent speech discrimination for the right ear results in the designation of a Roman numeral II. 38 C.F.R. § 4.85. For the left ear, the combination of the 41 dB puretone threshold average and the 96 percent speech discrimination also results in the designation of a Roman numeral I. When the Roman numerals II and I are applied to Table VII, the resulting percentage evaluation is zero percent. As there is no other relevant medical evidence of record, the April 2015 Hearing Loss and Tinnitus VA Examination Report is necessarily the most probative evidence of record. See Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997). For this reason, the Board finds the preponderance of the evidence weighs against an initial, compensable disability rating for bilateral hearing loss. Cf. 38 U.S.C. §§ 1155, 5107 (b); 38 C.F.R. §§ 3.102, 4.3, 4.85, DC 6100; cf. also Fagan, supra; Hart v. Mansfield, 21 Vet. App. 505, 510 (2007). Ordinarily, increased evaluations under other potentially applicable DCs must be considered as well. See Schafrath v. Derwinski, 1 Vet. App. 589 (1991). However, no such assessment is necessary because the evidence of record does not raise any symptoms not addressed by the diagnostic criteria delineated in DC 6100. See Doucette, 28 Vet. App. at 369. REASONS FOR REMAND 1. The issue of entitlement to service connection for an acquired psychiatric disability, to include depression and anxiety, previously claimed as a nervous condition is remanded. Although the November 2016 Mental Disorders DBQ completed by Dr. R.W. provides a positive nexus opinion citing the Veteran’s complaint of sleep disturbances and having difficulty adjusting to military life in a June 1978 and November 1978 Chronological Records of Medical Care, Dr. R.W. did not address the impressions in the November 1978 Chronological Record of Medical Care suggesting the possibility his sleep disturbances was a situational problem, that he had an alcohol problem and also the possibility he suffered from a very atypical seizure. In light of his separation examination during which the examiner found no psychiatric abnormalities and he expressly denied experiencing frequent trouble sleeping, depression or excessive worry and nervous trouble of any sort, Dr. R.W.’s November 2016 Mental Disorders DBQ is inadequate for adjudication purposes. April 1979 Report of Medical Examination; April 1979 Report of Medical History; cf. Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007), citing Ardison v. Brown, 6 Vet. App. 405, 407 (1994). Therefore, a remand is necessary for a VA examination. 2. The issue of entitlement to service connection for sleep apnea is remanded. With regard to this issue, the Board finds it is inextricably intertwined with the above service connection claim for an acquired psychiatric disability given the Veteran contends that it is secondary thereto. See Anglin v. West, 11 Vet. App. 361, 367 (1998); Harris v. Derwinski, 1 Vet. App. 180 (1991); March 2013 Sleep Apnea DBQ from Dr. H.S. As such, it is also remanded for further development, if necessary. 3. The issue of entitlement to service connection for headaches is remanded. In a March 2017 Headaches DBQ from Dr. H.S., Dr. H.S. diagnosed the Veteran with migraines and opined that it was caused by his service-connected tinnitus as well as his non-service connected depressive disorder. In doing so, the Dr. H.S. did not supply any supporting rationale. Cf. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 303-04 (2008). As such, the March 2017 Headaches DBQ from Dr. H.S. is inadequate for adjudication purposes and a remand is necessary for a VA medical opinion. As another matter, the Board finds this issue is also inextricably intertwined with the above service connection claim for an acquired psychiatric disability given the Veteran contends that it is at least in part secondary thereto. See Anglin, supra; Harris, supra; March 2017 Headaches DBQ from Dr. H.S. Therefore, a remand is also appropriate on this basis. 4. The issue of entitlement to service connection for erectile dysfunction is remanded. A review of the Veteran’s VA treatment records shows he was diagnosed with erectile dysfunction in June 2010. June 2010 VA Primary Care Note. Further, a review of his STRs reveals he complained of severe pain in the groin area in July 1978. July 1978 Chronological Record of Medical Care. Upon examination, the treatment provider noted tenderness to his right scrotum and indicated an impression of possible inguinal hernia. To date, he has not been afforded a VA examination in this regard. As the McLendon elements necessitating a VA examination have been met, a remand is necessary to obtain one. McLendon, supra. The issues of entitlement to an effective date prior to December 1, 2014 for the award of service connection for bilateral hearing loss is remanded; and an effective date prior to December 1, 2014 for the award of an increased disability rating of 10 percent for a residual scar of the right buttock status post incision for abcess drainage are remanded. In the Veteran’s June 2015 Notice of Disagreement, he expressed his disagreement with the effective date assigned for the award of service connection for bilateral hearing loss and the effective date assigned for the award of the non-compensable disability rating assigned for the residual scar of the right buttock status post incision for absences drainage. June 2015 Notice of Disagreement; November 2016 Notice of Disagreement. To date, the RO has not issued a SOC with respect to these issues. Therefore, a remand is necessary for the issuance of an SOC. 5. The issue of entitlement to an increased disability rating in excess of 10 percent for a residual scar on the right buttock status post incision for abcess drainage is remanded. With regard to this issue, the Board finds it is inextricably intertwined with the above claim for an effective date prior to December 1, 2014 for the award of an increased disability rating of 10 percent for a residual scar of the right buttock status post incision for abcess drainage given the grant of an earlier effective date may expand the scope of the evidence the Board may consider with respect to this claim. See Anglin v. West, 11 Vet. App. 361, 367 (1998); Harris v. Derwinski, 1 Vet. App. 180 (1991); see also Francisco v. Brown, 7 Vet. App. 55 (1994). As such, the issue of an initial, compensable disability rating for this scar is remanded for further development, if necessary. The matters are REMANDED for the following action: 1. Issue a SOC regarding the issues of entitlement to an effective date prior to December 1, 2014 for the award of service connection for bilateral hearing loss is remanded; and an effective date prior to December 1, 2014 for the award of an increased disability rating of 10 percent for a residual scar of the right buttock status post incision for abcess drainage. 2. Contact the Veteran to determine if there are any relevant, outstanding private treatment records. If so, undertake all appropriate development necessary to obtain a copy of these records from each private treatment provider and/or facility identified by him. 3. Obtain all relevant, outstanding VA treatment records. 4. Once the second and third requests have been completed, to the extent possible, schedule the Veteran for an examination with an appropriate medical professional to determine the nature and etiology of his claimed acquired psychiatric disability. After reviewing the record, the examiner should: (a.) Opine as to whether it is at least as likely as not (50 percent probability or greater) the Veteran’s diagnosis of depressive disorder was caused by or is otherwise related to his active duty service and explain why. (b.) In rendering an opinion, the examiner should consider the June 1978 and November 1978 Chronological Records of Medical Care among the Veteran’s STRs documenting a complaint of sleep disturbances and having difficulty adjusting to military life. (c.) In rendering an opinion, the examiner should consider the November 2016 Mental Disorders DBQ from Dr. R.W. (d.) In rendering an opinion, the examiner should consider the October 2016 Buddy Statement from W.L. describing a change in the Veteran’s behavior upon enlistment. (e.) In rendering an opinion, the examiner should consider and weigh the Veteran’s relevant lay statements of record. 5. Once the second, third and fourth requests have been completed, to the extent possible, obtain a medical opinion from an appropriate medical professional regarding the nature and etiology of the Veteran’s claimed headaches. The need for an in-person examination is left to the discretion of the medical professional proffering the opinion. After reviewing the record, the examiner should: (a.) Opine as to whether it is at least as likely as not (50 percent probability or greater) the Veteran’s diagnosis of migraines is proximately due to or aggravated beyond its natural progression by his service-connected tinnitus and explain why. (b.) If the Veteran’s diagnosis of migraines is not proximately due to or aggravated beyond its natural progression by his service-connected tinnitus and if, and only if, his depressive disorder was caused by or is otherwise related to his service, opine was to whether it is at least as likely as not (50 percent probability or greater) it is proximately due to or aggravated beyond its natural progression by his depressive disorder and explain why. (c.) In rendering an opinion, the examiner should consider the March 2017 Headaches DBQ from Dr. H.S. (d.) In rendering an opinion, the examiner should consider and weigh the Veteran’s relevant lay statements of record. 6. Once the second and third requests have been completed, to the extent possible, schedule the Veteran for an examination with an appropriate medical professional to determine the nature and etiology of his claimed erectile dysfunction. After reviewing the record, the examiner should: (a.) Opine as to whether it is at least as likely as not (50 percent probability or greater) the Veteran’s diagnosis of erectile dysfunction was caused by or is otherwise related to his active duty service and explain why. (b.) In rendering an opinion, the examiner should consider the July 1978 Chronological Record of Medical Care among the Veteran’s STRs documenting a complaint of severe pain in the groin area. (c.) In rendering an opinion, the examiner should consider and weigh the Veteran’s relevant lay statements of record. 7. Once the above requests have been completed, to the extent possible, readjudicate the appeal. L.M. BARNARD Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD G. Suh, Associate Counsel