Citation Nr: 18158550 Decision Date: 12/17/18 Archive Date: 12/17/18 DOCKET NO. 17-03 528 DATE: December 17, 2018 ORDER Entitlement to service connection for a back disability is denied. Entitlement to service connection for hypertension is denied. Entitlement to service connection for an acquired psychiatric disability is granted. Entitlement to service connection for headaches is granted. Entitlement to an initial rating in excess of 10 percent for tinnitus is denied. An effective date earlier than August 31, 1983 for the award of service connection for fracture of the left humerus, mid-third, is denied. An effective date earlier than August 31, 1983 for the award of service connection for a scar, left anterior humerus associated with fracture, left humerus, mid-third, is denied. An effective date earlier than February 4, 2016 for the award of service connection for tinnitus is denied. REMANDED Entitlement to service connection for a cervical spine disability is remanded. Entitlement to service connection for a left knee disability is remanded. Entitlement to service connection for a right knee disability is remanded. Entitlement to an initial rating in excess of 20 percent for a fracture of the left humerus, mid-third, is remanded. Entitlement to an initial rating in excess of 10 percent for scar of the left anterior humerus associated with a fracture of the left humerus, mid-third, is remanded. Entitlement to an initial rating in excess of 30 percent for a right shoulder dislocation is remanded. Entitlement to a total disability rating based on individual unemployability due to service connected disability (TDIU) is remanded. FINDINGS OF FACT 1. The evidence of record does not establish a nexus between the Veteran’s back disability and service. 2. Hypertension did not manifest in service or within one year of service separation, and is not otherwise etiologically related to service. 3. The Veteran’s acquired psychiatric disability is attributed to service. 4. The Veteran’s chronic tension headaches are attributed to his now service-connected acquired psychiatric disability. 5. The Veteran’s service-connected tinnitus is assigned a 10 percent rating, which is the maximum schedular rating authorized for tinnitus under Diagnostic Code 6260, for either a unilateral or a bilateral condition. 6. The Veteran separated from service on August 30, 1983; he initially filed claims for a fracture of the left humerus, mid-third, and for a scar of the left anterior humerus associated with a fracture of the left humerus, mid-third, on December 23, 1983. 7. As the Veteran’s claim for service connection for his fracture of the left humerus, mid-third, and for the associated scar were filed within one year of his separation from service, the RO awarded him an effective date of August 31, 1983 (the day following separation from service). 8. In a statement received by the RO on February 4, 2016, the Veteran submitted a claim of entitlement to service connection for tinnitus. 9. In an August 2016 rating decision, the RO granted service connection for tinnitus; an effective date of February 4, 2016 was assigned. CONCLUSIONS OF LAW 1. The criteria for service connection for a back disability have not been met. 38 U.S.C. §§ 1131, 1137, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a)-(b), (d), 3.307, 3.309(a). 2. The criteria for service connection for hypertension have not been met. 38 U.S.C. §§ 1131, 1137, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a)-(b), (d), 3.307, 3.309(a). 3. The criteria for service connection for an acquired psychiatric disability are met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a)-(b), (d). 4. The criteria for service connection for headaches are met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a)-(b), (d), 3.310. 5. The criteria for an initial rating in excess of 10 percent for tinnitus have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.87, Diagnostic Code (DC) 6260. 6. The criteria for an effective date earlier than August 31, 1983, for the award of service connection for a fracture of the left humerus, mid-third, have not been met. 38 U.S.C. §§ 5103, 5103A, 5110; 38 C.F.R. § 3.400. 7. The criteria for an effective date earlier than August 31, 1983, for the award of service connection for a scar of the left anterior humerus associated with fracture of the left humerus, mid-third, have not been met. 38 U.S.C. §§ 5103, 5103A, 5110; 38 C.F.R. § 3.400. 8. The criteria for an effective date earlier than February 4, 2016, for the award of service connection for tinnitus have not been met. 38 U.S.C. §§ 5103, 5103A, 5110; 38 C.F.R. § 3.400. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from February 1980 to August 1983. With respect to the Veteran’s claim for a persistent depressive disorder, the Board notes that when a claimant makes a claim, he is seeking service connection for symptoms regardless of how those symptoms are diagnosed or labeled. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). The Board has recharacterized the issue into a claim for an acquired psychiatric disability. See id. Service Connection Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1131 (2012). Generally, the evidence 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. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Under 38 C.F.R. § 3.303(b), an alternative method of establishing the second and third Shedden element is through a demonstration of continuity of symptomatology if the disability claimed qualifies as a chronic disease listed in 38 C.F.R. § 3.309(a). Regulations also provide that service connection may be granted for a disability diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability is due to disease or injury which was incurred in or aggravated by service. 38 C.F.R. § 3.303(d). In addition to the regulations cited above, service connection is warranted for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury. 38 C.F.R. § 3.310 (2018). Any additional impairment of earning capacity resulting from an already service-connected condition, regardless of whether or not the additional impairment is itself a separate disease or injury caused by the service-connected condition, should also be compensated. Allen v. Brown, 7 Vet. App. 439 (1995). When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. Id. Finally, 38 U.S.C. § 1154(a) requires that VA give “due consideration” to “all pertinent medical and lay evidence” in evaluating a claim for disability or death benefits. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). Specifically, “[l]ay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional.” Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); see also Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006). 1. Entitlement to service connection for a back disability. Where a veteran served continuously for ninety days or more during a period of war, or during peacetime service after December 31, 1946, and certain disabilities become manifest to a degree of 10 percent within one year from the date of termination of such service, such disease shall be presumed to have been incurred or aggravated in service, even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C. § 1101 (2012); 38 C.F.R. §§ 3.307, 3.309. However, the Veteran’s treatment records do not reflect a diagnosis of or treatment for a back disability for many years following separation from service. Thus, this presumption is not available to the Veteran. Id. The Board also considers the theory of entitlement to service connection for a back disability on a direct basis. Combee v. Brown, 34 F.3d 1039, 1041-42 (Fed. Cir. 1994). However, the evidence does not show a causal relationship between his back disability and any incident of active service, as will be discussed below. Service treatment records reflect that the Veteran sought treatment in August 1982 for back pain of three days duration, after jumping. He was diagnosed with a muscle spasm. No further treatment for his back was noted in service. Next, and more importantly, post-service evidence does not reflect complaints or treatment associated with his back for many years after service discharge. Such tends to negate a finding for service connection based on direct service incurrence. The Veteran’s reported history of continued symptomatology since active service has also been considered but is not found to be accurate. In making this determination, the Board may consider internal consistency, facial plausibility, and consistency with other evidence submitted on behalf of the claimant. Caluza v. Brown, 7 Vet. App. 498 (1995). The Board is not required to accept an appellant’s uncorroborated account of his active service experiences. Wood v. Derwinski, 1 Vet. App. 190 (1991). Notably, records do not reflect problems related to the Veteran’s back for many years following separation from service. Post service treatment records first reflect treatment for his back around 2014. The mere absence of medical records does not contradict a Veteran’s statements about his symptom history. See Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006). However, if it is determined based upon reliable evidence that there was an extended period of time after service without any manifestations of the claimed conditions, then that tends to weigh against a finding of a connection between the disability and service. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). This long period without problems weighs against the claim. Accordingly, the Board finds the Veteran’s statements asserting continuity of symptomatology of back problems since service lack credibility and are without probative value. See, e.g. Madden v. Gober, 125 F.3d 1477, 1481 (1997) (the Board is entitled to discount the credibility of evidence in light of its own inherent characteristics and its relationship to other items of evidence); Pond v. West, 12 Vet. App. 341 (1999) (although Board must take into consideration a veteran’s statements, it may consider whether self-interest may be a factor in making such statements). Continuity of symptomatology has not here been established, either through the competent evidence or through the statements submitted by the Veteran. Having determined that the Veteran’s alleged clinical history regarding onset and continuity of a back disability is not consistent with the evidence, the Board next considers that service connection may be granted when the evidence establishes a medical nexus between active duty service and current complaints. A March 2015 VA examination and opinion were provided. The VA examiner specifically opined that it is less likely as not that the Veteran’s current spondylosis of the lumbar spine is due to or caused by military service. The VA examiner noted that the Veteran reported he began to have back pain around 1991, which was 8 years following military service, and that it worsened after another car accident in 2001. She considered that the Veteran had sought treatment in August 1982 while in service. After considering all of the Veteran’s records, she stated that the Veteran’s in-service low back strain was a transient and temporary condition that resolved in service without residuals. She then noted that his lumbar spondylosis without myelopathy is a new and separate condition not related to the transient and temporary in-service low back strain. She continued stating that there is no evidence of back pain that occurred chronically in-service or in the presumptive period. She noted that the majority of the evidence suggests that the Veteran had an acute back strain in service, which is a condition of the muscles of the spine, and that the Veteran’s current spondylosis without myelopathy is a condition of the bones and spinal cord, which is not related to the muscles of the spine. Therefore, she concluded that the Veteran’s current spondylosis without myelopathy is not due to or caused by his in-service acute back strain in 1982 that resolved. The Board has closely reviewed the medical and lay evidence in the Veteran’s claims file and finds no evidence that may serve as a medical nexus between the Veteran’s service and his current back disability. Although the Board recognizes that the Veteran is competent to report feelings of back pain, the evidence in this case clearly demonstrates that his current back disability developed many years following separation from service. There is simply nothing in the record to support a finding that his back disability is in any way related to service. In any event, the probative value of the Veteran’s contentions is outweighed by the March 2015 VA opinion. In sum, the competent evidence does not establish that the Veteran’s currently diagnosed back disability is related to his period of active duty in any way. The most probative medical evidence of record has demonstrated that the Veteran’s back disability is less likely than not related to service. Therefore, the evidence in this case is not so evenly balanced so as to allow application of the benefit-of-the-doubt rule as required by law and VA regulations. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. The preponderance of the evidence is against the Veteran’s claim, and as such it must be denied. 2. Entitlement to service connection for hypertension. Where a veteran served continuously for ninety days or more during a period of war, or during peacetime service after December 31, 1946, and certain disabilities become manifest to a degree of 10 percent within one year from the date of termination of such service, such disease shall be presumed to have been incurred or aggravated in service, even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C. § 1101 (2012); 38 C.F.R. §§ 3.307, 3.309. However, the Veteran’s treatment records do not reflect a diagnosis of or treatment for hypertension for many years following separation from service. Thus, this presumption is not available to the Veteran. Id. The Board also considers the theory of entitlement to service connection for hypertension on a direct basis. Combee v. Brown, 34 F.3d 1039, 1041-42 (Fed. Cir. 1994). However, the evidence does not show a causal relationship between the claimed disorder and any other incident of active service, as will be discussed below. Service treatment records do not reflect treatment for hypertension. Next, and more importantly, post-service evidence does not reflect complaints or treatment associated with hypertension for many years after service discharge. Such tends to negate a finding for service connection based on direct service incurrence. The Veteran’s reported history of continued symptomatology since active service has also been considered but is not found to be accurate. In making this determination, the Board may consider internal consistency, facial plausibility, and consistency with other evidence submitted on behalf of the claimant. Caluza v. Brown, 7 Vet. App. 498 (1995). The Board is not required to accept an appellant’s uncorroborated account of his active service experiences. Wood v. Derwinski, 1 Vet. App. 190 (1991). Notably, records do not reflect problems related to the Veteran’s hypertension for many years following separation from service. Post service treatment records first reflect treatment for hypertension around 2010. The mere absence of medical records does not contradict a Veteran’s statements about his symptom history. See Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006). However, if it is determined based upon reliable evidence that there was an extended period of time after service without any manifestations of the claimed conditions, then that tends to weigh against a finding of a connection between the disability and service. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). This long period without problems weighs against the claim. Accordingly, the Board finds that the Veteran’s statements asserting continuity of symptomatology of hypertension since service lack credibility and are without probative value. See, e.g. Madden v. Gober, 125 F.3d 1477, 1481 (1997) (the Board is entitled to discount the credibility of evidence in light of its own inherent characteristics and its relationship to other items of evidence); Pond v. West, 12 Vet. App. 341 (1999) (although Board must take into consideration a veteran’s statements, it may consider whether self-interest may be a factor in making such statements). Continuity of symptomatology has not here been established, either through the competent evidence or through the statements submitted by the Veteran. Having determined that the Veteran’s alleged clinical history regarding onset and continuity of hypertension is not consistent with the evidence, the Board next considers that service connection may be granted when the evidence establishes a medical nexus between active duty service and current complaints. Here, however, the service and post-service evidence provide particularly negative evidence against this claim. The Board has closely reviewed the medical and lay evidence in the Veteran’s claims file and finds no evidence that may serve as a medical nexus between the Veteran’s service and his hypertension. Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), the specific issue in this case, the etiology of hypertension, falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007) (lay persons not competent to diagnose cancer). In light of the above discussion, the Board concludes that the preponderance of the evidence is against the claim for service connection and there is no doubt to be otherwise resolved. As such, the appeal is denied. 3. Entitlement to service connection for an acquired psychiatric disability. Service treatment records reflect that the Veteran was treated by psychiatry for family problems and had an outburst of anger on the job in April 1983. Next, post-service evidence reflects continuing psychiatric problems. The Veteran reports that he has continued to suffer from psychiatric problems since service. He attributes his psychological issues to service. His story has remained consistent throughout the years. Following service, the Veteran has been diagnosed with a persistent depressive disorder with anxious features and a depressive disorder. The record includes an April 2018 private examination and opinion. After reviewing the Veteran’s claims file and interviewing the Veteran, the private examiner opined that the Veteran’s depressive disorder began in service. She noted that this finding is supported by the Veteran’s family statements and corroborated by his service records. She also stated that his service-connected right shoulder, fracture of the left humerus, mid-third, and tinnitus are more likely than not causing his depressive disorder. Clinical citations were provided. There is additionally a VA March 2016 negative opinion. The Board has considered in detail the medical opinions of record. In this regard, the Board finds that no one opinion is any more probative than the other. The opinions are in relative equipoise. See Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990) (held that an appellant need only demonstrate that there is an “approximate balance of positive and negative evidence” in order to prevail.). Therefore, resolving all doubt in favor to the Veteran, the Board finds that the evidence supports a nexus between the Veteran’s current acquired psychiatric disability and service. The nature and extent of the problem related to service is not before the Board. As all elements of service connection have been satisfied, service connection for this disability is granted. See 38 U.S.C. § 1131; 38 C.F.R. § 3.303(d). 4. Entitlement to service connection for headaches. The Veteran alleges that he suffers from a chronic headache disability secondary to his service-connected disabilities. At a July 2018 private examination, the Veteran was diagnosed with tension headaches. He reported that he had begun experiencing headaches in service and they had increased in both frequency and severity over the years. Supporting the Veteran’s claim is a July 2018 private examination report. The treating practitioner stated that it is at least as likely as not that the Veteran’s headaches began in service and are both caused and aggravated by his diagnosed depressive disorder as well as his service-connected tinnitus and chronic pain from his service-connected right shoulder and left humerus fracture. She cited several studies to support her findings. Resolving all doubt in favor to the Veteran, the Board finds that the evidence supports a nexus between the Veteran’s current chronic headaches and his service-connected acquired psychiatric disability, right shoulder, left humerus fracture and/or tinnitus. As all elements of service connection have been satisfied, service connection for headaches is granted. See 38 U.S.C. §§ 1131; 38 C.F.R. § 3.303(d), 3.310. The nature and extent of the disorder is not before the Board at this time. Increased Rating 5. Entitlement to an initial rating in excess of 10 percent for tinnitus. Disability ratings are determined by the application of the VA’s Schedule for Rating Disabilities. Separate diagnostic codes identify the various disabilities, which are based, as far as practically can be determined, on average impairment in earning capacity. 38 U.S.C. § 1155 (2012); 38 C.F.R. Part 4 (2018). When rating a service-connected disability, the entire history must be borne in mind. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). The Board will also consider entitlement to staged ratings to compensate for times since filing the claim when the disability may have been more severe than at other times during the course of the claim on appeal. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability more closely approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (2018). When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability, that reasonable doubt will be resolved in favor of the Veteran. 38 C.F.R. § 4.3 (2018). The evaluation of the same disability under various diagnoses is to be avoided. 38 C.F.R. § 4.14 (2018). However, § 4.14 does not preclude the assignment of separate evaluations for separate and distinct symptomatology where none of the symptomatology justifying an evaluation under one diagnostic code is duplicative of or overlapping with the symptomatology justifying an evaluation under another diagnostic code. Esteban v. Brown, 6 Vet. App. 259, 262 (1994). The Veteran has requested an increased rating for his service-connected tinnitus. The Veteran’s service-connected tinnitus has been assigned a 10 percent rating, which is the maximum schedular rating available for tinnitus. 38 C.F.R. § 4.87, Diagnostic Code 6260. The Veteran’s tinnitus is rated 10 percent under Diagnostic Code 6260. 38 C.F.R. § 4.87 (2018). Under that diagnostic code, a single 10 percent rating is assigned for tinnitus, whether the sound is perceived as being in one ear, both ears, or in the head. The maximum schedular rating available for tinnitus is 10 percent. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.87 (2018); Smith v. Nicholson, 451 F.3d. 1344 (Fed. Cir. 2006). As there is no legal basis upon which to award a higher schedular rating, or separate schedular ratings for each ear, the appeal must be denied. Sabonis v. Brown, 6 Vet. App. 426 (1994). The Board further finds that referral for consideration of an extraschedular rating is not warranted, as the evidence regarding the Veteran’s tinnitus does not show such an exceptional disability picture that would render the available schedular rating inadequate. Thun v. Peake, 22 Vet. App. 111 (2008). The Veteran has not provided any evidence that his tinnitus is of such a degree that the 10 percent schedular disability rating is insufficient. The evidence does not show frequent hospitalization or marked interference with employment as a result of tinnitus. Therefore, the Board finds that the schedular rating of 10 percent for the Veteran’s tinnitus is adequate, and no referral is required for extraschedular consideration. 38 C.F.R. § 3.321(b) (2018). Earlier Effective Dates On December 23, 1983, the RO initially received claims of entitlement to service connection for a fracture of the left humerus, mid-third, and for a scar of the left anterior humerus associated with a fracture of the left humerus, mid-third. The RO received a claim of entitlement for tinnitus on February 4, 2016. In an August 2016 rating decision, the RO granted service connection for tinnitus, effective February 4, 2016 (his date of claim). In a December 2016 rating decision, the RO found clear and unmistakable error in the RO’s previous decision to deny service connection and granted service connection for a fracture of the left humerus, mid-third, effective August 31, 1983 (the day after he was released from active duty service). In the December 2016 rating decision, the RO additionally granted service connection for a scar, left anterior humerus, effective August 31, 1983 (the day after he was released from active duty service). The Veteran appealed, requesting earlier effective dates. Generally, and except as otherwise provided, the effective date of an evaluation and award of pension, compensation or dependency and indemnity compensation based on an original claim, a claim reopened after final disallowance, or a claim for increase will be the date of receipt of the claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400. The effective date of an evaluation and award of compensation on an original claim for compensation will be the day following separation from active duty service or the date entitlement arose if claim is received within 1 year after separation from service; otherwise, date of receipt of claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400(b)(2). The term application, while not defined in the statute, is broadly construed by regulation 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). Where a formal claim has already been allowed, certain submissions will be accepted as an informal claim. Furthermore, any communication or action indicating an intent to apply for VA benefits from a claimant or representative may be considered an informal claim provided that such informal claim identifies the benefit being sought. 38 C.F.R. § 3.155(a). See Brannon v. West, 12 Vet. App. 32, 34 (1998). VA is required to identify and act on informal claims for benefits. 38 U.S.C. § 5110(b)(3); 38 C.F.R. §§ 3.1(p), 3.155(a). See also Servello v. Derwinski, 3 Vet. App. 196, 198-200 (1992). Upon receipt of an informal claim, if a formal claim has not been filed, an application form will be forwarded to the claimant for execution. If received within one year from the date it was sent to the claimant, it will be considered filed as of the date of receipt of the informal claim. 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. The Board notes that the Veteran has already been awarded the earliest effective date possible for his fracture of the left humerus, mid-third, and his scar of the left anterior humerus, the day following separation from service. Although he did not file his claim for service connection until December 23, 1983, the RO granted service connection for these two disabilities back to August 31, 1983, the day following separation from service. 38 C.F.R. § 3.400(b)(2). The Board has considered whether any evidence of record prior to February 4, 2016, could serve as an informal claim in order to entitle the Veteran to an earlier effective date for entitlement to service connection for tinnitus. However, no document submitted prior to February 4, 2016, indicates intent to pursue a claim for tinnitus. The Board acknowledges that treatment records may show treatment for the Veteran’s fracture of the left humerus, mid-third, for a scar of the left anterior humerus associated with a fracture of the left humerus, mid-third, and for tinnitus prior to the effective dates already assigned. However, the Court has explicitly stated that the “mere presence” of a diagnosis of a specific disorder in a VA medical report “does not establish an intent on the part of the veteran” to seek service connection for that disorder. Brannon v. West, 12 Vet. App. 32, 35 (1998); see MacPhee v. Nicholson, 459 F.3d 1323; 38 C.F.R. § 3.155. Accordingly, the mere existence of medical records in a case cannot be construed as an informal claim. Id.; Ellington v. Nicholson, 22 Vet. App. 141, 145-46 (2007), aff’d 541 F.3d 1364 (Fed. Cir. 2008). As previously noted, an effective date is assigned based on the date of the claim or the date entitlement arose, whichever is later. The effective date of an evaluation and award of compensation on an original claim for compensation will be the day following separation from active duty service or the date entitlement arose if claim is received within 1 year after separation from service; otherwise, date of receipt of claim or the date entitlement arose, whichever is later. With respect to the Veteran’s claim for tinnitus, entitlement arose prior to the date of claim. Therefore, the February 4, 2016 date selected by the RO is the earliest possible effective date (his date of claim). With respect to his claims for a fracture of the left humerus, mid-third, and for a scar of the left anterior humerus associated with a fracture of the left humerus, mid-third, the Veteran has been awarded the earliest effective date possible, the day following separation from service. In the instant case, given the governing legal authority, based on these regulations, the effective dates have been appropriately assigned as the date of claim (tinnitus) and the day following separation from service (fracture of the left humerus, mid-third, and his scar of the left anterior humerus). For the reasons outlined above, the Board is precluded by law from assigning effective dates prior to those already assigned for any of these disabilities. Therefore, the Veteran’s claims for earlier effective dates must be denied. REASONS FOR REMAND Further evidentiary development is required prior to reviewing the issues remaining on appeal. 1. Entitlement to service connection for cervical spine, left knee, and right knee disabilities are remanded. Service treatment records reflect treatment visits for the Veteran’s left knee in April 1983 and for unspecified knee problems in July 1983. The Veteran also sought treatment for his neck in April 1983. The Veteran asserts that his current cervical spine, left knee, and right knee disabilities are related to service. It is unclear from the record whether the Veteran is diagnosed with current cervical spine, left knee, and right knee disabilities that are related to service. The Board finds VA examinations and opinions are necessary. 38 U.S.C. § 5103A(d); McLendon v. Nicholson, 20 Vet. App. 79 (2006). 2. Entitlement to increased initial ratings for (a) a fracture of the left humerus, mid-third, (b) a scar of the left anterior humerus associated with a fracture of the left humerus, mid-third, and (c) a right shoulder dislocation are remanded. The Veteran was last afforded VA examinations of his right shoulder, fracture of the left humerus, and scar in March 2016. The evidence of record, specifically VA treatment records, reflect that his disabilities may have worsened since his last VA examinations. The Board finds that he should be afforded new examinations in order to determine the current nature and severity of these service-connected disabilities. See Snuffer v. Gober, 10 Vet. App. 400, 403 (1997). 3. Entitlement to a TDIU is remanded. A review of the evidence reflects that the issue of entitlement to a TDIU has been raised by the record. In Rice v. Shinseki, 22 Vet. App. 447 (2009), the United States Court of Appeals for Veterans Claims (Court) held that a TDIU claim is part of an increased rating claim when such claim is reasonably raised by the record. In light of evidence associated with the Veteran’s claims file during the appeal period, the Board finds that the issue of entitlement to a TDIU is reasonably raised by the record and considered to be part of the Veteran’s appeal for increased ratings. The Veteran’s claim for entitlement to a TDIU is inextricably intertwined with his remanded claims for increased ratings. Therefore, the Board will not issue a decision on this claim at this time. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (issues are ‘inextricably intertwined’ when they are so closely tied together that a final Board decision cannot be rendered unless both are adjudicated). The Board finds that Veterans Claims Assistance Act of 2000 (VCAA) notice should be provided to the Veteran. The matters are REMANDED for the following actions: 1. Provide the Veteran with notice in compliance with the VCAA that notifies him of what evidence he must show to support a claim for a TDIU. 2. Arrange for the Veteran to undergo VA examinations to determine the nature and etiology of his cervical spine, left knee, and right knee disabilities. Any necessary testing should be conducted. The claims file must be reviewed in conjunction with the examination, and the examiner must indicate that such review occurred. The examiner must provide well-reasoned opinions on: (a) Whether it is at least as likely as not (a probability of 50 percent or greater) that any diagnosed cervical spine disability had its clinical onset during the Veteran’s active duty service or is otherwise etiologically related to his period of active service. (b) Whether it is at least as likely as not (a probability of 50 percent or greater) that any diagnosed left knee disability had its clinical onset during the Veteran’s active duty service or is otherwise etiologically related to his period of active service. (c) Whether it is at least as likely as not (a probability of 50 percent or greater) that any diagnosed right knee disability had its clinical onset during the Veteran’s active duty service or is otherwise etiologically related to his period of active service. Any opinions offered should be accompanied by a clear rationale consistent with the evidence of record. If the examiner finds it impossible to provide any part of the requested opinion without resort to pure speculation, he or she should so indicate and provide a rationale as to why such a finding is made. 3. Schedule the Veteran VA examinations to determine the nature and severity of his service-connected (a) fracture of the left humerus, mid-third, (b) scar of the left anterior humerus associated with a fracture of the left humerus, mid-third, and (c) right shoulder dislocation. The Veteran’s claims file should be provided to the examiner. The examiner must obtain a detailed clinical history from the Veteran and must note all pertinent pathology found on examination in the report of the evaluation. Any testing deemed necessary should be performed. The examiner must provide a full description of each disability and report all signs and symptoms necessary for evaluating the Veteran’s fracture of the left humerus mid-third, scar of the left anterior humerus and right shoulder dislocation under the applicable rating criteria. The examiner must comment on the functional effects of each disability evaluated. CAROLINE B. FLEMING Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A.M. Clark, Counsel